THE METROPOLITAN Borough of Stepnen. REPORT OF THE MEDICAL OFFICER OF HEALTH AND PUBLIC ANALYST FOR THE YEAR 1913, BY D. L.THOMAS, M.R.C.S., L.R.C.P., D.P.H., BARRISTER-AT-LAW -'Kan St)-akfk & Sons, Ltd., Bisho^gale Avenue Lontf&h. E.C ex libris Wellcome Bureau of Scientific Research london STE 14 ANNUAL REPORT OF THE Medical Officer of Health and Public Analyst FOR THE Metropolitan Borough of Stepney. 1913. REPORT OF THE MEDICAL OFFICER OF HEALTH AND PUBLIC ANALYST. FOR THE YEAR 1913. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have much pleasure in submitting to you my thirteenth Annual Report, which deals with the Vital and Sanitary Statistics of the Borough of Stepney during the 53 weeks ended January 3rd, 1914. I have called attention in previous reports to the question of overcrowding and want of house accommodation. This was at its worst in 1901, when there were hardly any empty houses in the district. A reaction set in, more houses became vacant and it became easier to deal with overcrowding. There was quite a slump in house property which reached its height in 1908, as is seen by the following figures which the Borough Treasurer has supplied me with :— In the quarter ended March 31st, 1904, the number of empty houses was 1,073. In the quarter ended March 31st, 1906, the number of empty houses was 1,670. In the quarter ended March 31st, 1907, the number of empty houses was 2,865. In the quarter ended March 31st, 1908, the number of empty houses was 2,944. In the quarter ended March 31st, 1909, the number of empty houses was 2,729. Population. The resident population of the Borough of Stepney estimated to the middle of the year was 275,300; distributed as follows:— Limehouse District 52,687 St. George-in-the-East 46,580 Mile End Old Town 110,727 Whitechapel District 65,306 275,300 2 In the quarter ended March 31st, 1910, the number of empty houses was 2,529. In the quarter ended March 31st, 1911, the number of empty houses was 2,408. In the quarter ended March 31st, 1912, the number of empty houses was 1,847. In the quarter ended March 31st, 1913, the number of empty houses was 1,770. It is therefore apparent that there has been a distinct improvement in this direction during the last few years. The number of empties continued to decrease towards the end of the year. Indeed in some parts of the Borough there were hardly any empty houses. This is not due to the immigration of aliens. The migration of aliens was less last year than in previous years in nearly all parts of the Borough, and there was no increase in any part. Some of the old inhabitants returned to the district, but more especially to that part of the Borough near the river. The reasons which are generally given are:— (1) That men desire to be near their work when they have to start work in the early morning. (2) The rents in the suburbs have risen, and the cost of transit brings up the total to a figure beyond the means of a large number of people. (3) The inconvenience of travelling in the overcrowded carriages which occur night and morning discount the advantages of living in outlying districts. I believe a larger number would be attracted if the existing houses were modernised. Births. The total number of births registered during the year was 8,165, or 402 more than in the previous year. They consisted of 4,115 males and 4,050 females. 1,804 belonged to the Limehouse District, or at the rate of 34.2 per 1,000 of the population. 1,454 belonged to St. George-in-the-East, or at the rate of 31.2 per 1,000 of the population. 3,327 belonged to Mile End Old Town, or at the rate of 30.0 per 1,000 of the population. 1,580 belonged to the Whitechapel District, or at the rate of 24.2 per 1,000 of the population. The birth-rate throughout the whole Borough was 29.6 per 1,000 of the populatinn, while that for the whole of London was 24.5 per 1,000. 3 433 births occurred in the Mothers' Lying-in Home, Commercial Road:— 77 belonged to Mile End Old Town. 106 belonged to the Limehouse District. 48 belonged to St. George-in-the-East. 22 belonged to the Whitechapel District. 180 belonged to outlying districts. 307 births occurred in the London Hospital, exactly the same number as in the previous year:— 61 belonged to Mile End Old Town. 36 belonged to St. George-in-the-East. 17 belonged to the Limehouse District. 46 belonged to the Whitechapel District. 147 belonged to outlying districts. 31 births occurred in the St. George's Infirmary:— 29 belonged to St. George-in-the-East. 1 belonged to the Whitechapel District. 1 belonged to the Limehouse District. 36 births occurred in the Mile End Infirmary:— All belonged to Mile End Old Town. 54 births occurred in the Whitechapel Infirmary:— 36 belonged to the Whitechapel District. 3 belonged to Mile End Old Town. 1 belonged to the Limehouse District. 2 belonged to St. George-in-the-East. 12 belonged to outlying districts. 99 births occurred at 24, Underwood Street:— 24 belonged to Mile End Old Town. 44 belonged to the Whitechapel District. 1 belonged to the Limehouse District. 10 belonged to St. George-in-the-East. 20 belonged to outlying districts. 16 births belonging to this Borough occurred in Poplar, 12 having occurred in the Stepney Workhouse, all belonged to the Limehouse District, and 4 in the Poplar and Stepney Sick Asylum, 3 belonging to Limehouse and 1 to Mile End. A '2 4 11 births belonging to the Borough of Stepney occurred in the City of London Lying-in Hospital; 10 in Queen Charlotte's Hospital; 2 in the General Lying-in Hospital; 2 in St. Bartholomew's Hospital; 2 in the Middlesex Hospital; 1 in the Salvation Army Maternity Home, Hackney; 3 in the West Ham Workhouse; 1 each in the Shoreditch Workhouse, Islington Workhouse, Holborn Workhouse, Newington Workhouse, Eastern Hospital, and 1 birth occurred in a private house in another Borough. Illegitimate Births. 30 illegitimate births were registered in the Limehouse District, or at the rate of 16.6 per 1,000 births. 32 illegitimate births were registered in St. George-in-the-East, or at the rate of 22 per 1,000 births. 56 illegitimate births were registered in Mile End Old Town, or at the rate of 16.8 per 1,000 births. 36 illegitimate births were registered in the Whitechapel District, or at the rate of 22.7 per 1,000 births. Marriages. The marriages during the year numbered 2,500, or 69 less than in the previous year. The proportion of persons married was 18T per 1,000 of the population while that for the whole of London was 18.3 per 1,000. 422 marriages occurred in the Limehouse District, or at the rate of 16 per 1,000 of the population. 277 marriages occurred in St. George-in-the-East, or at the rate of 11.8 per 1,000 of the population. 1,322 marriages occurred in Mile End Old Town, or at the rate of 23.8 per 1,000 of the population. 479 marriages occurred in the Whitechapel District, or at the rate of 14.6 per 1,000 of the population. 5 Deaths. The total number of deaths occurring in the Borough was 4,467 Deduct deaths occurring within the Borough among persons not belonging thereto 1,081 3 386 Add deaths of residents that occurred outside the Borough 775 4,161 The deaths consisted of 2,229 males and 1,932 females. The death.rate throughout the whole Borough was 15.1 per 1,000 of the popula. tion, while that for the whole of London was 14.2 per 1,000. 979 of the deaths belonged to the Limehouse District, or at the rate of 18.5 per 1,000. 683 of the deaths belonged to St. George.in.the.East, or at the rate of 14.6 per 1 000. 1,532 of the deaths belonged to Mile End Old Town, or at the rate of 13.8 per 1,000. 967 of the deaths belonged to the Whitechapel District, or at the rate of 14.8 per 1,000. The following table shows the death.rate throughout the whole Borough and in the various districts since 1890:— Limehouse. St. George's. Mile End. Whitechapel. The whole Borough. 1890 26.8 35.0 20.0 24.0 25.2 1891 26.0 29.1 21.2 24.7 24.4 1892 25.5 27.8 23.0 25.2 24.9 1893 27.7 31.0 22.8 25.0 25.5 1894 24.2 26.5 21.1 20.3 22.3 1895 27.3 29.5 22.5 22.8 24.0 1896 23.7 24.4 19.9 20.1 21.7 1897 25.1 26.4 18.7 19.7 21.4 1898 23.7 24.8 23.4 19.7 22.7 1899 25.5 271 20.3 19.3 22.0 1900 25.9 24.4 19.3 18.1 21.0 1901 24.6 23.0 18.5 19.3 20.8 1902 23.6 22.1 19.0 19.2 20.5 1903 19.7 20.3 16.3 17.5 17.9 1904 23.2 21.4 18.2 17.4 19.5 1905 20.3 20.4 16.9 15.4 17.7 1906 21.0 19.1 16.5 16.0 17.6 1907 17.3 17.6 14.5 15.4 15.8 1908 20.1 17.2 15.7 14.9 16.6 1909 17.5 17.0 13.9 14.1 15.2 1910 15.6 14.9 12.8 12.3 13.5 1911 22.1 18.1 16.0 15.0 17.3 1912 18.5 15.9 13.5 15.2 15.3 1913 18.5 14.6 13.8 14.8 15.1 6 Compared with 1912, the causes of death were:— Disease. 1912. 1913. Increase. Decrease. Small Pox — — — — Scarlet Fever 14 7 — 7 Enteric Fever 9 10 1 — Measles 172 95 — 77 Diphtheria and Croup 25 21 — 4 Whooping Cough 90 26 — 64 Erysipelas 4 11 7 — Diarrhoea and Enteritis 178 305 127 — Rheumatic Fever 10 16 6 — Phthisis 433 447 14 — Other Tubercular Diseases 105 125 20 — Bronchitis, Pneumonia, and other Respiratory Diseases 975 889 - 86 Heart Disease 323 363 40 — Appendicitis 11 23 12 — Influenza 31 24 — 7 Nephritis 124 132 8 — Puerperal Fever 13 7 — 6 Injuries 223 221 — 2 Suicides 23 21 — 2 Convulsive and Wasting Diseases 175 159 - 16 Premature Births 184 121 — 63 Old Age 181 172 — 9 Cancer 232 236 4 — Alcoholism and Cirrhosis of Live 34 30 - 4 All other causes 675 700 25 — 4,244 4,161 264 347 There were 696 inquests held on residents during the year. The causes of death were as follows :— Accidents 141 Alcoholism 8 Aneurism of Aorta 4 Apoplexy 40 Bright's Disease 14 Burns (adults) 10 Cancer 5 Diseases of the Lungs :— Bronchitis 24 Pneumonia 49 Phthisis 22 Other Respiratory Diseases 1 7 Diseases accelerated by self-neglect and want of proper nursing 1 Diseases of Liver 1 Drowning 24 Epilepsy 5 Gastric Ulcer 4 General Paralysis of the Insane 1 Haemorrhage 1 Heart Disease 84 Intestinal Obstruction 1 Meningitis 2 Murder 3 Osteo-myelitis 1 Post Partum Hæmorrhage 1 Ptomaine Poisoning 1 Rupture of extra-uterine gestation 1 Rupture of varicose vein in leg 1 Senility 1 Septicaemia 2 Shock while undergoing a necessary operation under the influence of an anaesthetic 8 Strangulated Hernia 1 Suicide 30 Syphilis 3 Affecting Children (under five years of age) :— Accidents 13 Accidents and Inattention at Birth 6 Atelectasis 6 Bronchitis 2 Burns and Scalds 13 Circumcision 1 Congenital deformity 1 Convulsions 40 Diarrhœa 20 Gastro-Enteritis 1 Heart Disease 5 Inanition 1 Marasmus 4 Measles 1 Murder 1 Overlying and suffocation in bed with the parents 27 Pneumonia 35 8 Premature births 18 Respiratory obstruction 1 Status Lymphaticus 3 Tuberculosis 1 Whooping Cough 1 There were 14 deaths due to accidents caused by motor omnibuses, 1 by taxicab and 3 by electric trams—a decrease of 1 death over that in the preceding year. The following is a list of the Outlying Institutions and the number of residents who died in them during the year:— Bath Hospital 1 Bermondsey Infirmary 1 Bethnal Green Infirmary 10 Brompton Hospital 6 Cambridge Lodge, Hackney 2 Cancer Hospital 1 Central London Sick Asylum 6 Children's Hospital, Great Ormond Street 8 Charing Cross Hospital 1 City of London Chest Hospital 8 Convalescent Home for Children, Grosvenor Place 2 Daneswood Sanatorium 1 Downs Sanatorium 2 East Cliff House 2 Fever Hospitals :— Brook Fever Hospital 2 Eastern Fever Hospital 26 North-Eastern Fever Hospital 3 North-Western Fever Hospital 1 Park Fever Hospital 37 South-Eastern Fever Hospital 17 Friedenheim Hospital 6 French Hospital 1 German Hospital 27 Great Northern Hospital 2 Guy's Hospital 2 Hackney Infirmary 1 H.M. Prison, Pentonville 2 H.M. Prison, Wormwood Scrubbs 2 Home for Incurable Children, Hampstead 1 Home for Jewish Incurables 13 9 Homeopathic Hospital 1 Hostel of God 2 Infant's Hospital 1 Jubilee Hospital, Woodford 1 Kingston Infirmary 1 Lambeth Infirmary 2 Lunatic Asylums:— Banstead 7 Belmont 1 Bethnal House 2 Cane Hill 3 Canterbury 1 Caterham 6 Claybury 26 Colney Hatch 52 Dartford 8 East Sussex 1 Essex County, Fisherton 1 Fountain (Temporary) 4 Hanwell 2 Horton 6 Leavesden 39 Long Grove 7 Manor 5 Middlesex County 1 Tooting Bec 29 Metropolitan Hospital 1 Middlesex Hospital 7 Mildmay Mission Hospital 3 Mount Vernon Hospital 1 National Hospital, Queen's Square 1 National Hospital, St. Lawrence 1 New Hospital for Women 1 Phillips Memorial Hospital 1 Poplar Hospital 7 Poplar and Stepney Sick Asylum 216 Queen's Hospital 6 Queen Mary's Hospital, Carshalton 18 Royal Free Hospital 1 Royal Chest Hospital, City Road 2 Royal Naval Hospital 1 Royal Sea-Bathing Hospital 1 10 Royal Waterloo Hospital 1 St. Bartholomew's Hospital 12 St. Catherine's Hospital, Ramsgate 2 St. Joseph's Hospice 1 St. Luke's Hospital 1 St. Luke's House, Kensington 3 St. Mary's Hospital 1 St. Thomas's Hospital 2 Seamen's Hospital 6 Shoreditch Infirmary 2 Sick Room Help Society, Underwood Street 1 Stepney Workhouse 68 University College Hospital 2 Westminster Infirmary 1 West Ham Infirmary 1 775 The following number of deaths of residents occurred in Public Institutions in the Borough:— East London Hospital for Children 201 London Hospital 428 Mile End Infirmary 383 Mothers' Lying-in Home, Commercial Road 8 St. George's Infirmary 182 Whitechapel Infirmary 262 Whitechapel Workhouse, South Grove 44 1,508 There were 1,081 deaths of non-residents in Public Institutions in the District. Notifiable Diseases. 1,717 notifications of Infectious Disease were received, or 16 less than in the previous year. This corresponds to a rate of 6.23 per 1,000 of the population. 1,369 were removed to various Hospitals and Infirmaries. 334 belonged to the Limehouse District, or at the rate of 6.33 per 1,000. 245 belonged to St. George-in-the-East, or at the rate of 5'25 per 1,000. 714 belonged to Mile End Old Town, or at the rate of 6 .44 per 1,000. 424 belonged to the Whitechapel District, or at the rate of 6.49 per 1,000. There were in addition, 3,931 notification certificates received referring to Tuberculosis, 2,542 of whom were notified for the first time. Chart showing the number of cases notified week by weeks the Borough, of Scarlet Fever, Typhoid Fever and Diphtheria, during 1913. 10-11(1) SCARLET FEVER TYPHOID DIPHTHERIA Chart showing the total number of cases of Infectious Diseases (excluding Tuberculosis) notified week by week in Limehouse, St. George's, Mile End and Whitechapel, during 1913. LIMEHOUSE ST. GEORGE'S MILE END WHITECHAPEL 10-11 (2) Chart showing the total number of cases of Infectious Diseases (excluding Tuberculosis) notified week by week in the Borough during 1913. 10-11 (3) 26 11 Excluding Tuberculosis the greatest number of notifiable diseases occurred during the first week in October, when 60 were notified. During this week the greatest number of notifications of Scarlet Fever was received, viz., 37. The largest number of notifications of Diphtheria was received during the fourth week in March when 16 notifications were received. The maximum number of notifications of Enteric Fever was received in the second week in June when 7 notifications were received, in no other week did the number exceed 5. The largest number of notifiable diseases occurred during the third week of October in the Limehouse District, the last week of November in St. George's, the first week of October in Mile End Old Town, and the last week of July, and the third week of September in the Whitechapel District. Wrong Diagnosis. 47 cases of Infectious Disease were removed to the Hospitals of the Metropolitan Asylums Board, which were subsequently returned home in consequence of the patients being found not to be suffering from the diseases stated on the certificates, or any other notifiable diseases. 22 of the cases were notified by private practitioners, 20 from the London Hospital, and 5 from other public institutions. This number referred to 13 cases of Scarlet Fever, 33 of Diphtheria, and 1 of Enteric Fever. Bacteriological Examinations. 852 specimens were bacteriologically examined, with the following results :— No. Positive. No. Negative. Total. Consumption . 123 485 608 Diphtheria 82 134 216 Enteric Fever 15 12 27 Cerebro-Spinal Meningitis – 1 1 220 632 852 Small Pox. No case of Small Pox was notified during the year. 12 Scarlet Fever. 784 cases of Scarlet Fever were notified during the year, or 109 less than in the previous year. 758 were removed to Fever Hospitals. 135 belonged to the Limehouse District, with 3 deaths ; 92 belonged to St. George-in-the-East, with no deaths ; 380 belonged to Mile End Old Town, with 4 deaths ; 177 belonged to the Whitechapel District, with no deaths. The death rate for the whole Borough was .025 per 1,000 of the population, while that for the whole of London was .04 per 1,000. Diphtheria and Membranous Croup. 423 cases were notified during the year, or 83 more than in the previous year, and 409 were removed to Fever Hospitals. 96 belonged to the Limehouse District, with 5 deaths, or at the rate of .094 per 1,000 of the population. 76 belonged to St. George-in-the-East, with 4 deaths, or at the rate of .085 per 1,000 of the population. 151 belonged to Mile End Old Town, with 7 deaths, or at the rate of .063 per 1,000 of the population. 100 belonged to the Whitechapel District, with 5 deaths, or at the rate of .076 per 1,000 of the population. The death rate throughout the whole Borough was .076 per 1,000 of the population. The death rate for the whole of London was .09 per 1,000. Typhus Fever. 2 cases were notified, both occurring in Mile End Old Town. On May 19th I received notification certificates from Dr. Manning, of the South Eastern Hospital, that M. L. B., aged 17, (who was admitted to the Fever Hospital on May 14th), and F. B., aged 7, (who had been at the Fever Hospital since May 7th), were suffering from Typhus Fever. On making enquiries at 75, Ocean Street, where they were removed from, I found that the following persons had been ill:—J. F. W., aged 30, a street vendor of Vinegar, was taken ill on March 11th, and taken to the Mile End Infirmary on March 25th. He had lived at 75, Ocean Street for a year. He was taken ill about 13 mid-day on Sunday, March 11th. He was all right until dinner time, but was taken ill soon afterwards. He went up-stairs to lay down on the bed, and slept until teatime. When he woke he was very ill. He was attended at home, but on the 25th March, he was admitted to the Infirmary, when his temperature was 102.5°, and rales and rhonchi were heard in both lungs. There seems to have been no signs of disease in the abdomen. His bowels were quite regular and there was no diarrhoea. On March 27th, the right-lower lobe was solid. On April 3rd, his chest was quite clear. He was discharged on April 15th. The diagnosis was Pneumonia. On April 5th, A. M. W., aged 21, wife of J. F. W., was taken ill, and took to her bed on April 8th. On April 9th, she was admitted to the Mile End Infirmary. On admission, her temperature was 102.6°. She had a rash on her right arm, with scattered spots elsewhere. There were no signs of disease in her lungs, heart, or abdomen. Her tongue was furred, and her urine was albuminous. On April 12th, she was dull mentally, her legs were drawn up, and she vomited. After April 12th, her condition improved. She was at the Infirmary on May 19th, but was about to be discharged. Her temperature chart was very suggestive of Enteric Fever. In the Assistant Medical Officer's opinion she suffered from Enteric Fever, but the case was not notified as the diagnosis was doubtful. On April 11th, J. B., aged 47, the father of A. W., was taken ill, and was admitted to the Mile End Infirmary on April 16th. He is a painter by trade. On admission his temperature was 103°, and he complained of pains all over his stomach, but there was no vomiting. He had flea bites on his legs. His blood was examined on April 17th, and gave a negative widal's reaction, but was positive on April 24th. There was no tenderness or rigidity over the abdomen, and the spleen was not palpably enlarged. He became gradually worse, and, on April 27th, the pulse was very weak, and the patient was delirious. He died on April 29th, and on the same day the case was notified to be suffering from Enteric Fever by the Medical Superintendent of the Infirmary. The temperature chart was not available, at the time I made my inquiries. F. M. B., aged 7, was taken ill on May 4th, and notified to be suffering from Enteric Fever on May 7th. She was removed to the South Eastern Fever Hospital on the same day. She was notified by Dr. Manning of that Hospital to be suffering from Typhus Fever on May 19th. M. B., aged 17, was notified on May 16th (the certificate being dated May 15th) to be suffering from Typhoid Fever. She had been removed to the Fever Hospital late the previous evening (May 14th). She had been ill since May 11th. On May 17th Dr. Manning reported that she was suffering from Typhus Fever and not Enteric Fever. Oh May 27th Dr. Bryett, the Medical Officer of Health for Shoreditch, telephoned to me that K. B. (daughter-in-law of J. B.) was in the Metropolitan 14 Hospital suffering from Typhoid Fever. She had visited 75, Ocean Street. I informed Dr. Bryett that two cases from that house had been definitely notified as Typhus Fever. As a result he called at the Hospital, and K. B. was removed to the Eastern Fever Hospital on the same day (May 27th). Dr. Goodall, the Medical Superintendent, certified that she was suffering from Typhus Fever. She had been ill since May 11th, and was admitted to the Metropolitan Hospital on May 19th. 75, Ocean Street is a four-roomed house, consisting of three bedrooms and a kitchen, and was occupied by Mr. and Mrs. B., who were both aged 47, their daughter and son-in-law, Alfred, aged 15, and the two daughters already mentioned. Of the seven people in the house the mother and Alfred were the only two who escaped. The milk supply was condensed milk, and the water was constant from the main. The premises were clean. The drains were tested but gave no results, and the water closet was in good condition. The premises were thoroughly cleansed. No further cases occurred at these premises, and no suspicious cases were notified from the Mile End Infirmary. Enteric Fever. 70 cases of Enteric Fever were notified during the year, or 19 more than in the previous year. 23 occurred in the Limehouse District, with 4 deaths ; 11 occurred in St. George-in-the-East, with 1 death ; 26 occurred in Mile End Old Town, with 4 deaths ; 10 occurred in the Whitechapel District, with 1 death. The death rate throughout the whole Borough was .03 per 1,000 of the popu lation. The death rate for the whole of London was .02 per 1,000. The diminution in the incidence of Enteric Fever has been most marked during the last thirteen years, although there was a slight increase in 1913, as is seen by the following figures :— In 1901 the number of cases was 245 1902 „ „ 273 1903 „ „ 179 1904 „ „ 183 1905 „ „ 117 1906 „ „ 119 1907 „ „ 107 1908 „ „ 83 1909 „ „ 63 1910 „ „ 111 1911 „ „ 79 1912 „ „ 51 1913 „ „ 70 15 Erysipelas. 356 cases were notified, or 10 more than in the previous year. 60 occurred in the Limehouse District, with 2 deaths ; 53 occurred in St. George-in-the-East, with 2 deaths ; 124 occurred in Mile End Old Town, with 4 deaths ; 119 occurred in the Whitechapel District, with 3 deaths. Puerperal Fever. 33 cases of Puerperal Fever were notified, or 1 more than in the previous year. 5 occurred in the Limehouse District, with 1 death; 11 occurred in St. George-in-the-East, with 2 deaths ; 10 occurred in Mile End Old Town, with 2 deaths ; 7 occurred in the Whitechapel District, with 2 deaths. Cerebro-Spinal Fever. 9 cases were notified during the year, 4 having occurred in the Limehouse District, 1 in St. George-in-the-East, 2 in Mile End Old Town, and 2 in the Whitechapel District; 4 proved fatal. Ophthalmia Neonatorum. 22 cases were notified during the year : 8 belonged to the Limehouse District, 1 to St. George in the East, 7 to Mile End Old Town, and 6 to the Whitechapel District. Poliomyelitis. Poliomyelitis has, under the name of infantile paralysis, been well known in general medical and surgical practice. Though ordinarily regarded as of sporadic occurrence, it has gradually become known that poliomyelitis may occur in small outbreaks or localised groups of cases. It is mainly a disease of early childhood, and is most prevalent in the dry and dusty seasons of the year. The virus of the disease has not been identified, but it passes through the finest filter. It has been transmitted from one ape to another by inoculation from the nasal mucous membranes of apes already suffering from the disease. From this fact it has been conjectured that the disease is transmitted by dust, and enters the body by the respiratory tract. Over half the patients who survive an attack of poliomyelitis are crippled for life. 16 The disease was made a notifiable one in London on September 1st, 1911. 15 cases were notified during the year : 3 belonged to the Limehouse District, 10 belonged to Mile End Old Town, and 2 to the Whitechapel District. The schools were communicated with in the usual way, but the other children were not prevented from attending school, and the premises were disinfected. In all the cases the patients were notified by hospital physicians, and most of them became in-patients of those institutions. I have personally visited all the premises, and examined all the patients who were at their own homes and not at the Hospitals. 8 were notified in September, 3 in October, 1 in November, 1 in August and 1 in May ; 1 child only attended school, 13 out of the 15 children notified being under 3 years of age. W. S., aged 2, of Jupps Road, was in the London Hospital for a fortnight. His left leg is weak and he is lame. There are 6 children in this house, 4 going to school. One of the children had Diphtheria some time ago, the tracheotomy tube still being in position. J. B., aged 6, of King John Street, was 9 weeks in the hospital, and 6 weeks in a convalescent home. There are 5 children in this family, but 2 only are old enough to go to school. Both arms and legs are affected. The speech is slow. F. A., aged 2, of Eric Street, was an out-patient at the Hospital. One leg is affected and the child is not able to walk. The rest of the children were not kept away from School. The parents informed me that they have no friends in London that they visit. E. M., aged 2½, of Jupps Road. This family has moved and left no address. I am unable to trace them. F. S., aged 1½, of West India Dock Road, was in the hospital for a few days only. Right leg is still very weak, but the child is progressing. A. C., aged 9 months, of Peabody Buildings, Glasshouse Street, was living with his grandparents at the above address, but has since gone to Hendon. This was the only child in the family. The brother of the grandfather of the patient suffered from infantile paralysis. T. S., aged 1, of Brunswick Buildings, Goulston Street, was 4 months in the Hospital. The right leg and right arm are affected. One child attends school. 17 I. H., aged 2, of Smith Street. There are no children going to school in this family, and only one child ever visited the patient. The patient was 5 weeks in the hospital. The left leg is still bad, but the patient is able to walk a little. F. B., aged 2f, of Mercers Terrace, Salmon Lane, was at the London Hospital at the time of my visit. There were no children in the family going to school. The right arm is affected. G. D., aged 2, of Canal Road, was an out-patient at the Hospital. She is the only child. One leg only is affected. V. G., aged 1¾, of Skidmore Street, was an in-patient at the Hospital for 5 weeks. The left leg is affected and is now put up in plaster of Paris. Two of the children go to school. This patient is one of twins, the other twin being dead. It appears her illness started soon after a severe attack of summer diarrhoea. D. L., aged 4, of Bloomfield Road. This case was notified first as Cerebrospinal Meningitis, and was admitted to the Homerton Fever Hospital where the Medical Superintendent afterwards certified her to be suffering from Poliomyelitis. The child was in the Fever Hospital for 5 weeks. One child only attends school. A. H., aged 2½, of St. Thomas' Road (now removed to 3, St. Dunstan's Road). This patient was in the Hospital at the time of my first visit and when I visited the premises a second time, I found that the people had left, and I was not able to trace them. One child attended school. B. J., aged 1½, of Bermuda Street attends at the Great Ormond Street Children's Hospital once a month. The left arm is affected. There does not seem to be much improvement. E. O., aged 1, of Diggon Street, attends at the London Hospital twice a week where the arm is massaged. The right arm is affected, but it seems to be getting stronger and the muscles appear to be developing. Anthrax. Two cases were notified, both belonging to Mile End Old Town. Zymotic Diseases. The total deaths from diseases of a Zymotic character numbered 471. It includes deaths from Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, Puerperal Fever and Diarrhoea. This number is 30 less than in the previous year. 130 belonged to the Limehouse District, or at the rate of 2.46 per 1,000 of the population. B 18 86 belonged to St. George in the East, or at the rate of 1.84 per 1,000 of the population. 178 belonged to Mile End Old Town, or at the rate of 1.60 per 1,000 of the population. 77 belonged to the Whitechapel District, or at the rate of 1.17 per 1,000 of the population. Measles. The number of deaths from Measles was 95, or 77 less than in the previous year. 31 belonged to the Limehouse District, or at the rate of .58 per 1,000 of the population. 20 belonged to St. George in-the-East. or at the rate of .42 per 1,000 of the population. 30 belonged to Mile End Old Town, or at the rate of .27 per 1,000 of the population. 14 belonged to the Whitechapel District, or at the rate of .21 per 1,000 of the population. The death rate for the whole Borough was .34 per 1,000 of the population, whilst that for the whole of London was .34 per 1,000. With the exception of 5, all the deaths were those of children under 5 years of age, and 64 (or 67 per cent.) were under 2 years of age. The deaths from Measles were less in number than in the previous years. In the last 24 years 4,665 deaths have been caused by Measles, or an annual average of 191. In the same period Scarlet Fever, Diphtheria and Typhoid Fever combined have been the cause of 4,559 deaths, or an annual average of nearly 189 deaths. The number of deaths from Measles in the Borough since 1901 is as follows :— 1901 155 1902 158 1903 162 1904 176 1905 151 1906 171 1907 155 1908 264 1909 236 1910 93 1911 291 1912 172 1913 95 The following chart shows the number of Deaths from Measles per 100,000 inhabitants since 1890. Face page 18 19 List of Schools where unprotected children were excluded owing to the presence of Measles for the dates mentioned during 1913 :— School. Room. Period. Villareal All unprotected children in Grade 1. 2nd Jan. to 17th Jan. Senrab Street All unprotected children in Rooms A and C. 8th Jan. to 22nd Jan. Bucks Row All unprotected children in Rooms C and C1. 15th Jan. to 20th Jan. Baker Street All unprotected children in Room A. 16th Jan. to 22nd Jan. Good Shepherd All unprotected children in Room A. 16th Jan. to 22nd Jan. Commercial Street All unprotected children in Rooms E and F. 20th Jan. to 7th Feb. Gill Street All unprotected children in Room C. 23rd Jan. to 30th Jan. Commercial Street All unprotected children in Room D. 23rd Jan. to 31st Jan. Broad Street All unprotected children in Rooms R and H. 23rd Jan. to 31st Jan. Hamlet of Ratcliffe All unprotected children in Rooms A and B. 27th Jan. to 7th Feb. St. Mark's All unprotected children in Room B. 27th Jan. to 31st Jan. St. Paul's, Wellclose Square. All unprotected children in Room I. 28th Jan. to 7th Feb. Gill Street All unprotected children in Room C. Previous exclusion extended to 7th Feb. Broad Street All unprotected children in Room G. 31st Jan. to 7th Feb. Single Street All unprotected children in Room C. 31st Jan. to 7th Feb. Senrab Street All unprotected children in Room B. 3rd Feb. to 7th Feb. Christian Street All unprotected children in Room E. 3rd Feb. to 10th Feb. Red Coat All unprotected children in Room IIb. 3rd Feb. to 7th Feb. Dempsey Street All unprotected children under 5 years of age. 3rd Feb. to 14th Feb. Single Street All unprotected children in Room D. 4th Feb. to 12th Feb. B 2 20 School. Room. Period. Ben Jonson Road All unprotected children in Room G. 7th Feb. to 14th Feb Redman's Road All unprotected children in Room E. 10th Feb. to 21st Feb. St. Mark's All unprotected children in Room B. 10th Feb. to 21st Feb. Dalgleish Street All unprotected children in Room A. 10th Feb. to 21st Feb Commercial Street All unprotected children in Room D. 13th Feb. to 28th Feb, St. Paul's Road All unprotected children in Room F. 14th Feb. to 28th Feb. Broad Street All unprotected children in Room F. 20th Feb. to 7th Mar. Old Castle Street All unprotected children in Room D. 21st Feb. to 28th Feb. Old Castle Street All unprotected children in Room E. 21st Feb. to 7th Mar Fieldgate Street All unprotected children in Room B. 21st Feb. to 7th Mar. St. Peter's, Cephas Street. All unprotected children in Room C. 21st Feb. to 14th Mar. Chicksand Street All unprotected children in Rooms A and B. 24th Feb. to 7th Mar. Single Street All unprotected children in Room A. 24th Feb. to 7th Mar. Redman's Road All unprotected children in Room A. 24th Feb. to 7th Mar. Christian Street All unprotected children in Room E. 26th Feb. to 7th Mar. St. Paul's Road All unprotected children in Room A. 26th Feb. to 7th Mar. St. Paul's Road All unprotected children in Room F. Extended to 7th Mar. St. Paul's Road All unprotected children in Room G. 3rd Mar. to 19th Mar. Christian Street All unprotected children in Room D. 3rd Mar. to 19th Mar. Chicksand Street All unprotected children in Room C. 6th Mar. to 14th Mar. Redman's Road All unprotected children in Rooms B, D and E. 10th Mar. to 19th Mar. 21 School. Room. Period. Dalgleish Street All unprotected children in Room C. 10th Mar. to 19th Mar. Hamlet of Ratcliffe All unprotected children in Room B. 10th Mar. to 19th Mar. Chicksand Street All unprotected children in Rooms A and D. 12th Mar. to 19th Mar. Settles Street All unprotected children in Room E. 12th Mar. to 19th Mar. Christ Church All unprotected children in Grade 2. 13th Mar. to 19th Mar. St. Paul's Road All unprotected children in Room E. 17th March to 4th April. Red Coat All unprotected children in Rooms B and C. 17th March to 4th April. Hamlet of Ratcliffe All unprotected children in Room A. 17th March to 19th March Jewish, Commercial Street. All unprotected children under 5 years of age. 28th March to 11th April. Old Castle Street All unprotected children in Room F. 28th March to 18th April. *Baker Street All unprotected children in Rooms A1 and A2. 31st March to 11th April. *Buck's Row All unprotected children in Rooms C and C1. 31st March to 11th April. *Northey Street All unprotected children in Room D. 3rd April to 18th April. Old Castle Street All unprotected children in Room F. 3rd April to 18th April. Commercial Street Jews All unprotected children in Rooms 8, 11 and 11a. 4th April to 18th April. Buxton Street All unprotected children in Room A. 7th April to 18th April. Betts Street All unprotected children in Rooms Al, A2 and C. 7th April to 18th April. Commercial Street Jews All unprotected children in Room 4. 11th April to 25th April. Baker Street All unprotected children in Room D. 14th April to 25th April. Buxton Street All unprotected children in Room C. 16th April to 25th April. Old Castle Street All unprotected children in Room G. 16th April to 2nd May. 22 School. Room. Period. Commercial Street Jews All unprotected children in Room 10. 18th April to 2nd May. Red Coat All unprotected children in Room A. 18th April to 2nd May. Ratcliffe C.E All unprotected children in Room C. 21st April to 9th May. St. Ann's, Dixon Street All unprotected children in Room D. 21st April to 9th May. Red Coat C.E. All unprotected children in Room B. 1st May to 16th May. Deal Street All unprotected children under 5 years. 8th May to 30th May Commercial Street All unprotected children in Room D. 16th May to 30th May Deal Street All unprotected children in Room D. 19th May to 30th May Myrdle Street All unprotected children in Room A. 22nd May to 6th June Christian Street All unprotected children in Room D. 22nd May to 6th June Essex Street All unprotected children in Rooms Al, A2 and D. 22nd May to 6th June Old Castle Street All unprotected children in Rooms G and D. 23rd May to 13th June Fairclough Street All unprotected children in Room C. 29th May to 13th June. Berner Street All unprotected children in Room B. 2nd June to 13th June. Dalgleish Street All unprotected children in Room C. 2nd June to 20th June. Dalgleish Street All unprotected children in Room B. 5th June to 20th June. Old Castle Street All unprotected children in Room H. 6th June to 20th June. Rutland Street All unprotected children in Room F. 9th June to 20th June. Heckford Street All unprotected children in Room D. 9th June to 20th June. All Saints, Buxton Street All unprotected children in Room A. 10th June to 24th June. Christian Street All unprotected children in Room F. 16th June to 27th June. 23 School. Room. Period. Red Coat All unprotected children in Rooms B and D. 16th June to 4th July. Heckford Street All unprotected children in Room B. 23rd June to 11th July. All Saints, Stepney All unprotected children in Room D. 4th July to 11th July. Holy Trinity All unprotected children in Room F. 9th July to 23rd July. Berner Street All unprotected children in Rooms D and F. 16th July to 23rd July. Chicksand Street All unprotected children in Room C. 17th July to 23rd July. Myrdle Street All unprotected children in Room F. 18th July to 23rd July. Fieldgate Street All unprotected children in Room A. 21st July to 23rd July. Old Castle Street All unprotected children in Room G. 15th Sept. to 30th Sept. St. Thomas Colet All unprotected children in Room D. 22nd Sept. to 10th Oct. Chicksand Street All unprotected children in Room G. 22nd Sept. to 10th Oct. Buckle Street Jews All unprotected children in Room X. 29th Sept. to 10th Oct. Buckle Street Jews All unprotected children in Room IX. 30th Sept. to 17th Oct. Buckle Street Jews All unprotected children in Room XI. 1st Oct. to 17th Oct. Christian Street All unprotected children in Rooms D and E. 24th Nov. to 12th Dec. Dempsey Street All unprotected children in Rooms H, I and J. 9th Dec. to 19th Dec. Christian Street All unprotected children in Rooms B, D, E and F. 9th Dec. to 19th Dec. Old Montague Street All unprotected children in Room B. 10th Dec. to 19th Dec. Broad Street All unprotected children in Room C. 11th Dec. to 19th Dec. Broad Street All unprotected children in Room F. 18th Dec. to 19th Dec. * These children were in class-room before the holidays. 24 Whooping Cough. The number of deaths from Whooping Cough was 23, or 67 less than in the previous year. This corresponds to a death rate of .083 per 1,000 of the population, while that for the whole of London was .17 per 1,000. 4 belonged to the Limehouse District, or at the rate of .075 per 1,000 of the population. 6 belonged to St. George-in-the-East, or at the rate of .12 per 1,000 of the population. 5 belonged to Mile End Old Town, or at the rate of .045 per 1,000 of the population. 8 belonged to the Whitechapel District, or at the rate of .12 per 1,000 of the population. Summer Diarrhoea. The number of deaths from Diarrhoea (which includes Epidemic and Zymotic Enteritis, Dysentery and Dysenteric Diarrhoea) was 305, or 129 more than in the previous year. 246 were under 1 year of age. 81 belonged to the Limehouse District, or at the rate of 1.53 per 1,000 of the population. 52 belonged to St. George-in-the-East, or at the rate of 1.11 per 1,000 of the population. 125 belonged to Mile End Old Town, or at the rate of 1.12 per 1,000 of the population. 47 belonged to the Whitechapel District, or at the rate of .73 per 1,000 of the population. The death rate for the whole Borough was 1.10 per 1,000 of the population. As stated in previous Annual Reports, Summer Diarrhoea is now generally believed to be an infectious disease, capable of spreading from the sick to the healthy. Direct infection may be conveyed by the milk, or other food, as well as by other means such as the use of comforters, placing the infants on dirty floors, &c. The disease is believed to be due to many different species of micro-organisms, and that they reside in the superficial layers of the earth, which contain suitable food for them, that is, soil polluted with decomposing organic matter. The development and multiplication of the micro-organism depend on a high temperature not of the air itself, but of the superficial layers of the soil, 25 The rise in the Diarrhoea death rate does not begin until the average weekly temperature of the earth thermometer (suspended in an iron tube 4 feet deep) has attained 56 degs. Fahrenheit, or thereabouts. This takes place about a week later than in the atmosphere. Allowing that death occurs in a week to a fortnight after the onset of the disease, this relationship is observed in the following table, which gives the deaths from diarrhoea for the last three years. The years 1911, 1912 and 1913 differed materially in the matter of rainfall, heat and sunshine. In 1911, the mean reading of the thermometer was above the week's average in the 65 years ended 1905, during the 18 weeks from the beginning of July to the end of the first week in November, with the exception of three weeks, one being equal to the week's average. In 1912 it was below the average, with the exception of 5 weeks, these being the last three weeks in July, third week in October, and the first week in November. It was below the average in every week during the corresponding period in 1913, with the exception of 7 weeks. It was above the average during the last week in August and from the last week in September onwards it remained above the average. The summer and autumn of 1911 were dry and hot, and the death rate from diarrhoea was very high. The summer and autumn of 1912 were wet and cold, and the deaths from diarrhoea were about two-thirds less than in the previous year. At the end of the third week of August there had been 180 deaths from diarrhoea of children under two years of age in 1911, 30 in 1912, and 44 in 1913. During the first three weeks in August the mean temperature was higher in 1912 than in 1913, but from the beginning of the fourth week until the last week in September it was higher in 1913. The rainfall in September was greater in 1913 than in the corresponding month of the previous year. In September, 1913, there were 79 deaths of children under 2 years of age from diarrhoea, as compared with 29 in 1912. During the months of October and November the mean temperature was higher in 1913 than in 1912, and, with the exception of two weeks, the temperature was even higher than in 1911. The rainfall, however, was greater in 1911 than in 1913, and least of all in 1912. During the months of October and November there were 69 deaths of children under 2 years of age in 1913, 19 in 1912, and 30 in 1911. It appears, therefore, that rainfall, apart from high temperature, has no influence on the mortality from diarrhoea, and that the increased mortality is due to the heat rather than to the deficiency of rainfall. 26 DEATHS FROM DIARRHOEA IN THE CORRESPONDING WEEKS IN 1911, 1912 & 1913, WITH THE METEOROLOGICAL CONDITIONS. Week ending Saturday Mean Reading of Barometer. Mean Reading of the Thermometer. Rainfall. Deaths of Infants from Diarrhoea. 1911. 1912. 1913. 1911. 1912. 1913. 1911. 1912. 1913. 1911. 1912. 1913. Under 1. Between 1 & 2* Under 1 Between 1 &2. Under 1. Between 1 & 2.  June 28th 29.79 29.74 29.96 57.5° F. (4° below avg.) 60.2° F. (1.2° below avg.) 59.2° F. (2.0° below avg.) .50 of an in. .30 of an in. .06 of an in. 3 1 Nil. Nil. 6 1 July 5th 30.09 29.80 29.99 65.6° F. (3.5° above avg.) 58.7° F. (3.2° below avg.) 59.9° F. (1.9° below avg.) Nil. .36 of an in. .21 of an in. 4 Nil. 2 Nil. 3 Nil. „ 12th 30.23 29.82 29.75 65.2° F. (2.3° above avg.) 67° F. (4.4° above avg.) 57.2° F. (5.4° below avg.) Nil. .20 of an in. 1.33 of inches. 4 Nil. 4 Nil. 6 1 „ 19th 29.88 29.81 29.81 69.5° F. (6.2° above avg.) 65.8° F. (2.5° above avg.) 60.° F. (3.3° below avg.) Nil. .04 of an in. .52 of an in. 9 3 3 2 2 Nil. „ 26th 29.82 29.70 29.94 71° F. (8.4° above avg.) 64.8° F. (1.9° above avg) 57.7° F. (5.2° below avg.) .26 of an in. .16 of an in. .05 of an in. 14 6 2 Nil. 3 4 Aug. 2nd 29.84 29.52 29.98 68° F. (5.9° above avg.) 57.8° F. (4.4° below avg.) 59.5° F. (2.8° below avg.) .06 of an in. .54 of an in. Nil. 31 8 3 1 2 2 ,, 9 th 29.91 29.49 29.82 72.5° F. (10.1° above avg.) 57.6° F. (4.C below avg.) 57.1° F. (5.1° below avg.) Nil. 1.26 inches .09 of an in. 47 6 7 1 6 Nil. ,, 16 th 29.90 29.71 29.87 69.4° F. (7.2° above avg.) 56.2° F. (6.2° below avg.) 60.7° F. (11.7° below avg.) .58 of an in. .23 of an in. .14 of an in. 36 8 5 Nil. 6 2 „ 23rd 29.63 29.59 29.91 63.9° F. (2.9° above avg.) 57.2° F. (4.1° below avg.) 60.9° F. (.6° below avg.) .29 of an in. 1.27 inches .36 of an in. 42 10 10 1 9 1 „ 30th 29.92 20.51 29.85 65.3° F. (5.2° above avg.) 56.9° F. (3.4° below avg.) 62.8° F. (2.3° above avg.) .41 of an in. 1.33 inches .51 of an in. 36 7 8 4 16 5 Sept. 6th 29.79 29.84 29.88 66.9° F. (7.7° above avg.) 54.8° F. (4.7° below avg.) 59.1° F. (.5° below avg.) .01 of an in. .21 of an in. 1.43 of inches 37 n 6 1 19 2 „ 13th 29.91 30.03 29.87 60.3° F. (2.4° above avg.) 52.4° F. (5.8° below avg.) 58° F. (.4° below avg.) .41 of an in. .02 of an in. .06 of an in. 20 5 6 1 18 4 „ 20th 29.72 30.16 29.52 54.3° F. (1.9 below avg.) 53.6° F. (3.2° below avg.) 54.9° F. (2.2° below avg.) .48 of an in. Nil. .60 of an in. 21 1 5 1 17 5 „ 27th 29.90 30.03 29.84 55° F. (being equal to week's average) 51.5° F. (3.8°below avg.) 60.2° F. (4.8 above avg.) .44 of an in. .02 of an in. .13 of an in. 18 6 9 Nil. 11 3 Oct. 4th 29.82 29.76 29.71 48.2° F. (4.9° below avg.) 48.8° F. (4.9° below avg.) 58.5° F. (4.5c above avg.) .27 of an in. 2.30 inches .22 of an in. 6 1 2 Nil. 11 2 ,, 11th 30.03 30.09 29.54 51.9° F. (.9° above avg.) 46° F. (5.6° below avg.) 52.9°F. (l° above avg.) .29 of an in. Nil. 1.28 inches. 7 2 3 2 11 4 „ 18th 29.80 30.01 30.08 54.5° F. (5.2° above avg.) 49.8° F. (.1° above avg.) 52.8° F. (2.8° above avg.) .37 of an in. .13 of an in. .12 of an in. 2 2 4 Nil. 11 1 „ 25th 29.20 29.31 29.73 48.5° F. (.8° above avg.) 45.4° F. (2.8° below avg.) 49.3° F. (1° above avg.) 1.98 inches .88 of an in. .69 of an in. 1 Nil. Nil. Nil. 10 Nil. Nov. 1st 29.83 29.62 29.40 48.4° F. (1.5° above avg.) 49.1° F. (1.9° above avg.) 54.1° F. (6.8° above avg.) .63 of an in. .55 of an in. 1.27 inches. 2 1 2 1 8 Nil. ,, 8th 29.51 30.05 29.55 44.5° F. (1.6° below avg.) 47.2° F. (1.5° above avg.) 48.3° F. (2.3° above avg.) 1.16 inches .18 of an in. .40 of an in. 2 Nil. Nil. 1 4 Nil. „ 15th 29.38 29.61 29.31 49° F. (5.9° above avg.) 43.3° F. (.3° below avg.) 49° F. (5.2° above avg.) 1.7 inches .17 of an in. 1.50 inches. 2 Nil. 1 Nil. 4 1 „ 22nd 29.39 30.01 29.93 39.3° F. (2.8 below avg.) 46.2° F. (3.9° above avg.) 48.9° F. (6.6° above avg.) .25 of an in. .31 of an in. .63 of an in. 2 Nil. 3 Nil. 2 Nil. 27 Diseases of the Respiratory Organs. There were 889 deaths due to diseases of the Respiratory Organs, which corresponds to a death rate of 3.22 per 1,000 of the population. 194 belonged to the Limehouse District, or at the rate of 3.68 per 1,000 of the population. 157 belonged to St. George-in-the-East, or at the rate of 3.37 per 1,000 of the population. 319 belonged to Mile End Old Town, or at the rate of 2.88 per 1,000 of the population. 219 belonged to the Whitechapel District, or at the rate of 3.34 per 1,000 of the population. Tuberculosis. Under the Public Health (London) Act, 1891, the Local Government Board are empowered to make Regulations with a view to the treatment of persons affected with any epidemic or infectious disease and for preventing the spread of the disease; and to provide for the enforcement and execution of the Regulations. Whereas Tuberculosis is an endemic and an infectious disease, the Board made Regulations called the Public Health (Tuberculosis) Regulations, which have the same force as an Act of Parliament. The first Tuberculosis Regulations came into force on January 1st, 1909. At that time it was only compulsory to notify cases of Consumption amongst the inmates of Poor Law Institutions and amongst persons under the care of Poor Law Medical Officers. This Order was extended on May 1st, 1911, to persons attending Hospitals, as in-patients or out-patients. So that after May 1st, 1911, the pauper class and the Hospital class who were suffering from Consumption were notified to the Medical Officer of Health. The Local Government Board were evidently feeling their way cautiously to see how much it would interfere with the freedom of the patient, and how much friction would ensue. On January 1st, 1912, all cases of Pulmonary Tuberculosis, or Consumption of the Lungs, were to be made notifiable to the Medical Officer of Health within 48 hours. On February 1st, 1913, all forms of Tuberculous diseases were made notifiable and in the Regulations which came into force on this date, certain duties were 28 placed on the Borough Councils as the local sanitary authorities. Under these Regulations, all forms of Tuberculous diseases are to be notified to the Medical Officer of Health of the district. Until this time persons suffering from Consumption of the Lungs or Pulmonary Tuberculosis only were to be notified. There are four different forms on which a case may be notified, Forms A. B. C. and D. Notifications to be made by medical practitioners may be divided into two classes which are described for convenience as " Primary" and " Supplemental Notifications." "Primary Notification" is required of every case of Tuberculosis unless the practitioner has reasonable grounds for believing that the case has already been previously recognised and notified as such to the Medical Officer of Health of the appropriate district. A " Supplemental Notification " is an additional notification of a case which has been previously notified. Except in the case of notifications by School Medical Inspectors all Primary Notitications are to be made on Form A. School Medical Inspectors notify on Form B. Supplemental Notifications are to be made on Form C. and D. by Medical Officers of Poor Law Institutions and Sanatoria. The majority of the patients at these Institutions will have been notified before their admission, and Supplemental Notification is to be made on Form C., to be completed after the end of each week of all cases admitted during the week and believed by the Medical Officer to have been previously notified. Supplemental Notification is also required to be made after the end of each week on Form D. of all cases discharged from the Institution during the week. Upon the receipt of a notification the Medical Officer of Health or an officer of the Local Authority acting under the instructions of the Medical Officer of Health, shall make such inquiries and take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection and for removing conditions favourable to infection. The circular of the Local Government Board, dated December 20th, 1912, on the same subject stated that it is contemplated that, for the purpose of carrying out these requirements, a visit to the home of the patient will generally be necessary, and inquiries should be made to ascertain the state of health of all other members of the household (this refers, of course, to the examination of contacts). A record should be kept of the inquiries or investigations made in each case, into the cause and antecedents of the disease and of the conclusions reached by the Medical Officer of Health as to the factors which combine to produce it. These inquiries are set out on forms which I have had printed, a copy of which is given as Appendix B. The results of the inquiries are entered on these forms by the Assistant Medical Officer of Health and Sanitary Inspectors in all cases where they visit as a result of receiving notifications under these Regulations. This information is again copied on case sheets and indexed. 29 These Regulations repealed the three previous series of Regulations and were meant to simplify the system of notification as well as to extend it to all forms of Tuberculosis. The working of the Regulations has meant a great increase in the clerical work of the Public Health Department, but a greater increase was inevitable in the work of supervision (visiting, &c.) of patients, unless the Regulations were allowed to degenerate into a mere machinery for collecting statistical data. In 1913,2,542 new cases were notified, of which 2,038 referred to Pulmonary Tuberculosis or Consumption of the Lungs. For these cases we received 3,931 notifications, so that 1,389 were duplicate certificates. The Pulmonary Tuberculosis cases were distributed as follows, together with the deaths in each district:— Notifications. Deaths. Percentage. Limehouse District 387 106 273 St. George's District 252 56 222 Mile End Old Town 852 139 163 Whitechapel District 547 146 266 The number of notifications and deaths per 1,000 of the population was as follows:— Notifications. Deaths. Limehouse District 7.34 2.01 St. George's District 5.41 1.20 Mile End Old Town 7.69 1.25 Whitechapel District 8.37 2.23 Whole of the Borough 7.40 1.62 The death-rate for the whole of London during the same period was 1.30 per 1,000 of the population. The namber notified by the three voluntary tuberculosis dispensaries was 572, of which 561 referred to Pulmonary Tuberculosis. The number of new cases notified during the year by the three dispensaries is a little less than 28 per cent. of the total number of Pulmonary Tuberculosis, and less than 23 per cent. of new cases of Tuberculosis of all kinds notified during the year. It has been stated that this number is materially increased by the number of cases sent by general practitioners to be treated at the dispensaries which have already been notified by the doctors who sent them. This is not the case, as will be seen later on when the actual number of cases treated at the dispensaries since their inception are considered. 30 New cases of Tuberculosis notified in 1913 :— Pulmonary. All Others. Whitechapel Tuberculosis Dispensary 229 6 Stepney 231 4 St. George's ,, „ 101 1 General Practitioners 814 68 Poor Law 303 59 Hospitals, Sanatoria 354 302 Schools 6 64 2,038 504 Of the Pulmonary Tuberculosis cases 905 were Jews and 1,133 were Christians. The deaths from Pulmonary Tuberculosis numbered 447, but 284 only of these were notified for the first time during the year 1913. That is to say, of the new cases notified nearly 14 per cent, died before the end of the year. The premises of 663 consumptives, consisting of 857 rooms, were disinfected during the year. Of the 2,038 fresh cases of Pulmonary Tuberculosis notified during the year 701 were insured and 1,337 were not insured. That is 34 per cent of all the cases. were insured. If you deduct the 390 cases under 16 years of age, which are, of course, all uninsured, the percentage of insured cases is as 42 to 58 non-insured cases. 490 patients had moved before the end of the year. Most of the new addresses could not be traced. 373 received treatment during the year at various hospitals, 320 in infirmaries, 37 at Carshalton, 196 at sanatoria, and 81 in other institutions. In Whitechapel the number of deaths from Tuberculosis is greater per 1,000 of the population than in the rest of the Borough. This may be due to several causes. In the first place there is a greater proportion of Jews living in this part of the Borough than in any other part, and Consumption is probably more prevalent among Jews. It is undoubtedly on the increase among them. There is another factor which refers to the number of persons occupying a room. In the premises where cases of Consumption occurred the average number of persons occupying the room with the Consumptive was 21 in Whitechapel, whereas it was only 1.5 in Mile End, l.6 in Limehouse and 1.7 in St. George's. 31 The following table contains the number of persons notified and the number of deaths from Tuberculosis per 1,000 of the population during 1913 in certain model dwellings in different parts of the Borough, which are occupied by Jews and Non-Jews. Building. Population. Jews or Non-Jews. Notification rate, per 1,000. Death rate, per 1,000. Nathaniel Buildings, Whitechapel 779 Jews 25,6 1,20 Rothschild Buildings, Whitechapel 1,046 Jews 11.1 3.82 Brunswick Buildings, Whitechapel 1,008 Jews 16.8 3.96 Lolesworth Buildings, Whitechapel 705 Mixed population of Jews and Non-Jews 11.1 2.83 Peabody's Buildings, Glasshouse Street, Whitechapel 1,047 Non-Jews 2.8 1.91 Langdale Mansions, St. George's 1,484 Jews 7.7 .67 Peabody's Buildings, Shadwell 665 Non-Jews 10.5 1.50 Juniper Street Buildings, Shadwell 2,001 Non-Jews 3.9 1.00 Bekesbourne Buildings, Ratcliffe 1,230 Non-Jews 2.4 .81 Brightlingsea Buildings, Limehouse 1,905 Non-Jews 2.6 Nil. Stepney Green Buildings, Mile End 887 Jews 29.3 2.25 Cressy and Dunstan Houses, Mile End 585 Jews 15.3 3.41 Less value is attached to statistics and deductions to be drawn from small numbers, than from large figures, on account of the greater liability to error. Leaving Lolesworth Buildings out of the calculation, as the number of Jews and Non-Jews, is fairly equally divided, the remaining Buildings, which are of a similar type, are occupied by 5,789 Jews and 6,848 Non-Jews. In the former 16.4 per 1,000 of the occupiers were notified to be suffering from Pulmonary Tuberculosis, and 2'41 per 1,000 died. In the Buildings which contained no Jews, 38 per 1,000 were notified to be suffering from the disease, and .87 per 1,000 died. That is, in the Buildings entirely occupied by Jews, 95 notifications were received, and there were 14 deaths or 14 7 per cent. of the persons attacked. In the Buildings where there were no Jews, 26 notifications were received, and there were 6 deaths, which is equal to a percentage of 23 of those attacked. From the above it will be seen that a greater percentage of Jews contract the disease than Non-Jews (16'4 and 3 8), but a smaller percentage die of those attacked (14.7 to 23). The above figures tend to confirm the opinion which I have frequently expressed, that Pulmonary Tuberculosis is more common among Jews than others 32 and that it appears to be of a more chronic nature. Its chronic character may be the cause of it its greater prevalence among Jews. Some of these chronic cases live for many years. They cough and expectorate quantities of sputum laden with Tubercle Bacilli, and are the centrc of infection for many years. The danger of this in crowded rooms or in workshops where many work in close proximity to others, is obvious. Other Tuberculous Diseases. 125 deaths occurred from Tuberculous Diseases other than Phthisis, or 20 more than in the previous year. This corresponds to a death-rate of .45 per 1,000 of the population. 33 belonged to the Limehouse District, or at the rate of '62 per 1,000 of the population. 32 belonged to St. George-in-the-East, or at the rate of '68 per 1,000 of the population. 39 belonged to Mile End Old Town, or at the rate of .35 per 1,000 of the population. 21 belonged to the Whitechapel District, or at the rate of .32 per 1,000 of the population. Deaths from Diseases of a Tubercular nature, other than Phthisis, from 1901 to 1913 .— Limehouse District. St. George's. Mile End. Whitechapel. Whole Borough. 1901 60 73 54 52 239 1902 43 49 89 52 233 1903 52 37 61 45 195 1904 44 35 61 34 174 1905 42 29 53 35 159 1906 57 47 53 57 214 1907 51 50 59 42 202 1908 38 40 64 25 167 1909 37 41 40 26 144 1910 33 26 43 35 137 1911 40 40 59 27 166 1912 29 15 39 22 105 1913 33 32 39 21 125 33 Table showing the occupation of the Consumptives notified during 1913:— Jews. Christians. Total Dressmakers and Blouse Makers 3 11 14 Tailors (including Pressers, Machinists and Waistcoat Hands) 227 58 285 Furriers 8 — 8 Boot and Shoemakers (including Boot Finishers, Boot Trimmers and Slipper Makers) 34 19 53 Barge and Lightermen — 8 8 Bookfolders 1 6 7 Brushmakers — 8 8 Cabinet Maker and Upholsters 16 7 23 Cap Makers 10 — 10 Caretakers — 1 1 Carmen 1 48 49 Cellermen and Barmen 1 18 19 Charwomen and Office Cleaners 4 36 40 Cigarette Makers 25 3 28 Clerks 4 24 28 Coal Porters — 10 10 Confectionery 3 2 5 Cork Cutters — 2 2 Crane Drivers — 3 3 Fancy Box Makers — 5 5 General Servants:— Male — I 1 Female 3 25 28 Hairdressers 4 4 8 Harness Makers — 1 1 Hawkers 29 35 64 Housewives 229 176 405 Insurance Agents 1 — 1 Labourers 13 204 217 Mattress Makers — 6 6 Messengers and Errand Boys — 10 10 Milliners 1 11 12 Nursing 2 1 3 Packers — 25 25 Painters 4 10 14 Pawnbrokers Assistants — — — Pianists 1 4 5 Postmen — 2 2 Post Office Sorters — — 34 Jews. Christians. Total. Printers — 11 11 Railway Porters 1 4 5 Ropemakers — 2 2 Sawyers — 1 1 Shirt Makers — — — Shop Assistants 9 8 17 Shop Keepers 12 42 54 Stick Makers 1 — 1 Stokers — 8 8 Tank Makers — 4 4 Teachers 3 1 4 Tin Box Workers 1 12 13 Typists — — — Underclothing Manufacture — — — Waiters 2 5 7 Warehousemen 2 13 15 Watchmen — 2 2 Wine Packers — — — Miscellaneous 20 37 57 Not Ascertained 64 69 133 No Occupation 68 164 232 School Children 235 333 568 1,042 1,500 2,542 Number of houses in which there were (or had been):— 2 cases of Tuberculosis 384 accounting for 768 cases. 3 ,, ,, 65 ,, 195 ,, 4 ,, ,, 10 ,, 40 ,, 5 and over „ 9 ,, 45 ,, 468 1,048 Number of cases occurring in tenements of:— 1 room. 2 rooms 3 rooms. 4 and more. Total. Limehouse 78 131 119 166 494 St. George's 69 114 89 89 361 Mile End Old Town 129 248 245 323 945 Whitechapel 88 236 94 58 476 364 729 547 636 2276 35 Lodging-Houses 163 Infirmaries 12 Asylums 27 Shelters 7 Sailors' Home 7 Unknown 28 Dr. Barnardo's Home 22 266 Total number of persons occupying the rooms with Consumptive persons, the number of rooms so occupied, and the average number of persons living per room:— Number of patients and contacts. Number of rooms. Average No. per room. Limehouse 2,358 1,451 16 St. George's 2,011 1,140 17 Mile End 4,172 2,663 1.5 Whitechapel 2,242 1,075 21 10,783 6,329 1.7 The condition of the houses has a great deal to do with the cause and spread of Consumption. Better houses, general sanitary leiorms, and improved conditions of living have been important factors in diminishing the number of deaths. The number of deaths from Consumption decreased from 1901 (when the Borough Council came into existence,) to 1910 by 35 per cent. Since that date there has been a slight increase in the number of deaths. Number of deaths from Consumption from 1901 to 1913 :— Limehouse District. St. George's. Mile End. Whitechapel. Whole Borough 1901 123 186 107 208 626 1902 130 105 168 173 576 1903 123 122 189 193 627 1904 143 119 229 198 689 1905 98 117 171 187 573 1906 116 94 178 138 526 1907 98 90 141 153 482 1908 98 79 154 103 494 1909 93 102 146 180 521 1910 74 80 146 110 410 1911 109 69 177 126 481 1912 74 77 149 133 433 1913 98 55 137 140 430 c 36 Where the homes are visited by the Sanitary Inspectors, the houses are inspected and defects are ordered to be remedied. In this way, the conditions in which the people live and sleep are remedied as far as possible. Overcrowding of a room where a Consumptive lives, which, to my mind, is a serious cause of the spread of the disease, is at once abated. The number of cases notified in the three Dispensaries during 1912 and 1913 (the St. George's and Whitechapel Dispensaries were only in existence during the latter half of 1912), were as follows :— Stepney Green Dispensary Whitechapel Dispensary St. George's Dispensary 499 635 220 In the Whitechapel Dispensary, 635 cases were notified, but only 567 were included in the list of those receiving treatment, and who were supposed to be actually suffering from Pulmonary Tuberculosis. The remaining number includes those who had died or had left the district. In addition to these, there were other cases said to be actually suffering from Pulmonary Tuberculosis, but had not been notified to us. In the Stepney Green Dispensary 499 cases were notified and 517 received treatment, the remaining 18 having probably been previously notified by general practitioners. The same thing occurred in St. George's, 236 patients actually suffering from Consumption of the Lungs received treatment at the dispensary, although only 220 cases had been notified. Of the 561 new cases notified from the three Tuberculosis Dispensaries in 1913, 124 had moved before the end of the year, leaving no address, and 40 had died. With regard to the treatment of patients at the three dispensaries, the system differs slightly. At the Stepney Green Dispensary 517 cases were notified in 1913, but 859 patients were treated; 23 of these belonged to other boroughs. The attendance at the dispensary varied, but lor the first few months the patient usually attended once a week and then once a fortnight, according to symptoms. At the Whitechapel Dispensary 815 received treatment, but 567 only were notified; 36 lived in outlying boroughs. Of the persons notified:— 126 attended regularly; 84 attended weekly; 8 attended twice a week ; 38 attended fortnightly; 3 attended monthly; 115 attended once only ; 193 attended irregularly. 37 Of the 236 notified cases treated in the St. George's Dispensary :— 26 received treatment twice a week ; 168 received treatment once a week ; 4 received treatment every fortnight; 1 received treatment every three weeks ; 24 received treatment irregularly ; 13 received treatment once only. To prevent overlapping I made arrangements with the Medical Officers of the Tuberculosis Dispensaries to supply me with the necessary particulars on the forms previously mentioned and which I supplied. Unfortunately these arrangements proved unsatisfactory, as after a time these forms were not regularly supplied. In February, 1914, I applied for 164 forms, which referred to patients notified during 1913 and which I had not received. 100 of these belonged to the Stepney Green Dispensary, 52 to the Whitechapel Dispensary, and 12 to the St George's Dispensary. I regret to say that I have had to fall back on my original plan and arrange for the Assistant Medical Officer of Health and the Inspectors to call and obtain the particulars in all cases. I have already indicated the small percentage of cases of patients attended by the three dispensaries, and therefore the small percentage of contacts examined throughout the borough. What of the contacts of the patients treated at the dispensaries ? At the Stepney Green Dispensary I was informed that in some cases the nurses were unable to gain admission into the houses of patients and in others the contacts refused to be examined. There are no records kept of the examination of some of the contacts examined, but the examination of the contacts of 180 patients was made as follows :— All the contacts were examined in 46 instances ; Three-fourths of the contacts were examined in 39 instances; Two-thirds of the contacts were examined in 17 instances ; One-half of the contacts were examined in 38 instances ; One-third of the contacts were examined in 18 instances ; One-fourth of the contacts were examined in 22 instances. So that in 337 instances either no contacts were examined or no records kept. At the Whitechapel Dispensary :— All the contacts were examined in None of the contacts were examined in Three-fourths of the contacts were examined in Two-thirds of the contacts were examined in One-half of the contacts were examined in One-third of the contacts were examined in One-fourth of the contacts were examined in 197 instances. 94 instances. 96 instances. 69 instances. 77 instances. 21 instances. 13 instances. c 2 38 In 162 cases no contacts were examined or no record kept. At the St. George's Dispensary:— All the contacts were examined in None of tho contacts were examined in Three-fourths of the contacts were examined in Two-thirds of the contacts were examined in One-half of the contacts were examined in One-third of the contacts were examined in One-fourth of the contacts were examined in Refused to be examined 109 instances. 41 instances. 29 instances. 10 instances. 14 instances. 6 instances. 3 instances. 6 In 65 instances either no contacts were examined or no records kept. As a result of the examination of contacts in the Whitechapel and St. George's Dispensaries one Consumptive was discovered in 193 families, two in 48 families three in 13 families, and 4 in 1 family; besides 154 cases which were looked upon as being in a suspicious condition. It is thus seen that the examination of contacts is an important part of the administrative control of Tuberculosis. Many patients are discovered in the curable or merely suspicious stage who might otherwise progress to the incurable stage before a diagnosis of Pulmonary Tuberculosis is established, or even before the patient realised that anything serious is the matter. It is only by a systematic examination of all contacts that we can hope to make a successful fight against the malady. We must not wait until the infected members of the family present themselves for treatment. It is then often too late. In the course of an examination of the contacts advanced cases are occasionally discovered which had probably been the original source of infection, but advice had never been sought, with the result that ignorance caused the onset of the disease in other members of the family. It is admitted that an attempt is made to examine the contacts of patients attending the Tuberculosis Dispensaries, although in my opinion the results are not satisfactory. As I have already pointed out, over 70 per cent, of the Consumptives are not treated at these dispensaries, and no attempt is made to examine the contacts of these patients. I have no intention of casting any reflection on the work of the dispensaries in this particular, but I am anxious to emphasise that fact. No scheme can be considered a satistactory one unless a large proportion of the whole of the contacts throughout the Borough are examined. 3!) Comprehensive Scheme for the Treatment of Tuberculosis. A complete scheme for the treatment of Tuberculosis embraces a number of conditions, and to make it satisfactory there should be a co-ordination and cooperation of all authorities which deal with patients suffering from Tuberculosis, their relatives and contacts. (1) In the first place, the Public Health Department should be the centre of the organisation which should link up the other agencies, as it is to the Medical Officer of Health of the district all cases are officially notified. Medical men are compelled to notify all cases unless they have reason to believe that the cases have already been notified. (2) Upon the receipt of a notification, the Medical Officer of Health or Officer of the Local Authority acting under the instructions of the Medical Officer of Health, shall visit the premises and take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing the cause of infection if possible. (3) Visit by Nurse.—The preliminary visit may well be done by a Nurse or Health Visitor, who will fill up a form containing full particulars of home conditions. At this visit, the Nurse may discover that the patient or doctor desires one of the dispensaries to undertake the treatment, when necessary arrangements can be made. In every case the Nurse gives advice on the preventive aspect, supplies a sputum flask and disenfectants, and fills up her form of particulars. This form is returned to the Medical Officer of Health and the Tuberculosis Officer, and if the patient is dealt with at a dispensary, a copy is supplied to the Medical Officer of the dispensary. (4) Contacts.—The home of every notified case is to be visited at least once a month, whether the patient is in a sanatorium, is attended by a private doctor, or at a dispensary. The contacts are seen by the Nurse who urges and makes arrangements for them to be examined:— (a) By Private Practitioners.—If the Consumptive is a patient of a general practitioner, the latter will be informed of the names of the contacts, and if it is the doctor's intention to examine the contacts, endeavours will be made to obtain a confidential report of such examination. If he is in doubt as to the condition of any of them, the services of the Tuberculosis Officer are at his disposal. If it is not his intention to examine contacts, this can be done by one of the Medical Officers of the dispensaries or Tuberculosis Officer. 40 (b) School Cases.—A list of the contacts who attend school will be sent to the Divisional Medical Officer Who will arrange for their examination by the School Medical Officers. Arrangements will be made to examine doubtful cases at one of the dispensaries. In this way the Divisional Medical Officer can arrange for the periodical weighing of the contacts, and the results sent to the Public Health Offices to be entered on the Records. The Divisional Medical Officer can also arrange for the better or more suitable feeding, of such children if they are poor, as well as for their attendance at open-air schools if possible, and when necessary. (c) Dispensary Contacts.—The contacts of the patients attending at the dispensaries would generally be examined at such dispensaries, as well as those of Poor-Law patients, Hospital patients and those not attended by general practitioners. (5) Bacteriological Examination of Sputum.—The bacteriological examination of sputum of persons suspected to be suffering from Consumption is now, and can be continued, to be examined free of charge at the Borough Council's Laboratory. (6) Satisfactory arrangements should be made with the present three Voluntary Dispensaries if possible, as well as with the London Hospital Dispensary:— (a) For curative treatment. (b) For examination of contacts. The London Hospital will provide a Tuberculosis Dispensary as well as act as a Consultative Institution where doubtful cases of Tuberculosis of all kinds can be referred to experts of both branches— Medical and Surgical. The most modern methods of diagnosis, e.g., X-rays, can be utilised at this Institution. Institutional treatment of Surgical Tuberculosis can be obtained at the Hospital in the future as it has been in the past. (7) Disinfection.—Premises are disinfected by the staff of the Public Health Department, after the removal or death of persons who have suffered from Pulmonary Tuberculosis. (8) Advanced Cases.—Arrangements can be made for the nursing of advanced cases at the patients' own homes by the East London Nursing Society. (9) Shelters with beds and bedding in connection therewith for the open- air treatment of patients at their own homes, where they may have a suitable open space, can be supplied by the Borough Council. There are, unfortunately not many spaces in connection with the homes of the patients in this borough that can be utilised in this respect, and therefore few shelters will be required. 41 (10) The conditions under which the patient lives will be considered and housing accommodation should be continually improved. The education of the general public by means of lectures on the prevention of consumption should be encouraged, and the issue of printed general instructions as to the prevention of the spread of the disease, See., by Health Visitors should be continued. Institutional treatment is a matter for the London County Council, and will include:— (a) Observation beds in connection with one of the dispensaries for the diagnosis of doubtful cases. (b) Beds at sanatoria for the treatment of suitable cases. (c) Beds for advanced cases. The patients who are in too advanced a stage to be sent to sanatoria are a danger to the health of other people and should be segregated as far as possible. The advantage of the above suggested scheme is that the Public Health Department will co-operate with general practitioners, School Medical Officers, Poor Law Medical Officers, General Hospitals, as well as with the Voluntary Tuberculosis Dispensaries. The expenditure of the Borough Council on their Dispensary scheme, after deducting the payment by the Insurance Committee in respect of the treatment of insured persons and any other contribution will be met as follows :— (a) 50 per cent, by the Local Government Board; (b) 25 per cent, by the London County Council; (•c) 25 per cent, out of the rates of the Borough. I. The cost of such a scheme would be approximately as follows:— (1) London Hospital. Dispensary and consultative treatment, examination of contacts and diagnosis of doubtful cases, both medical and surgical £300 a year. (2) For the treatment of patients and examination of contacts at each of the present three dispensaries—£100 a year £300 a year. (3) Appointment of one of the Medical Officers of the above four dispensaries as Tuberculosis Officer of the Borough and Assistant Medical Officer of Health and the payment of one-half his salary £250 a year. (4) Appointment of four Nurses or Health Visitors at £100, rising by £10 a year to £130, say £500 a year. £1,350 42 The amount that would have to be raised from the local rates will be about £300 a year, after deducting the sum received from the Insurance Committee for the treatment of insured persons. The Tuberculosis Officer would call at the Public Health Offices every morning and ascertain the names of the persons notified, &c. He will superintend the duties of the Nurses and examine those contacts who are unable to come to the dispensary. The Nurses, in addition to visiting the homes and supplying the Medical Officers of the dispensaries with all particulars as to the home conditions, &c., will attend at the dispensaries when necessary and be at the service of the Voluntary dispensaries. The present dispensaries only deal with a third of the notified cases in the borough. As it will be necessary in future to deal with all cases of Tuberculosis, the nursing staff of the dispensaries would naturally have to be increased, but this would be obviated by the assistance of the four Nurses suggested to be appointed by the Borough Council. In this way the dispensaries will be brought in close touch with the Public Health Department. • The salaries of three nurses, as well as one-half of the salary of one of their Medical Officers if he were appointed Chief Tuberculosis Officer of the Borough, would be saved to the Voluntary Dispensaries. This would raise the subsidy to the three Voluntary Dispensaries from £850 to £940 a year. There should, however, be representation on the Committees of the Voluntary Dispensaries. Arrangements will have also to be made for the payment to special hospitals outside the borough for the treatment of patients residing in the Borough who have applied at such hospitals for treatment. This will not be done indiscriminately, and payment will not be made unless the patient has a card from the Public Health Department authorising him to apply for such treatment. These cards will act as vouchers. We should require the following from the four dispensaries:— (a) To examine and give medical treatment to persons residing in the borough found to be suffering from definite Tuberculosis and to examine the " contacts." (b) To supply all information and reports that are reasonably required. (c) To give free access to the records of the dispensary. (id) To undertake the after-care of sanatoria cases when requested, and to examine patients who may be sent to the dispensary by private medical practitioners. ^3 (e) In connection with the London Hospital, the serivce of the Consultative Staff of the Hospital will be given in connection with the diagnosis and treatment of such difficult cases as may be sent. The weaknesses of this scheme are two-fold:— (1) All the four Dispensaries are situated in the Western half of the Borough. (2) We shall be dependent entirely on Voluntary Institutions over which we shall have very little, if any, control. We cannot prevent them treating cases other than Tuberculosis, and if they do, the time given to Tuberculosis cases will be restricted or the staff will have to be increased. In the latter event, it is only natural to expect the Voluntary Committee to apply for an increase of the subsidy. II.—It would add materially to the usefulness of the scheme if the Voluntary Tuberculosis Committee would transfer their Whitechapel Dispensary to a suitable area east of White Horse Street, White Horse Lane and Globe Road. Failing this, I would suggest a Municipal Dispensary in this part, and not to approve the Whitechapel Dispensary, as the area now served by that Dispensary will be better served by the London Hospital Dispensary. After deducting a sum of £300 a year from the Insurance Committee the amount to be raised from the local rates would be approximately from £460 to £515 a year. III.—In the event of the Borough Council not being able to come to an arangement with the Committee of the Voluntary Dispensaries. I would suggest the establishment of a Municipal Dispensary, with a larger staff than in the second scheme, to deal with all cases in the Eastern part of the Borough, with the London Hospital Dispensary in the Western part. The cost of this scheme would be as follows:— Rent, Rates and Taxes £100 a year Drugs and Tuberculin £100 a year Coal and Gas £ 10 a year Tuberculosis Officer £500 a year Assistant Tuberculosis Oflicer £300 — £400 a year Four Nurses £400 — £520 a year Dispenser, Clerical Assistance, Stationery, &c. £230 a j-ear Subsidy to the London Hospital £300 a year Subsidy to two Voluntary Dispensaries £200 a year £2,140 —£2,360 a year 44 I estimate the expense of such a scheme as follows:— Rent, Rates and Taxes £100 a year Drugs and Tuberculin £150 a year Coal and Gas £ 10 a year Tuberculosis Officer £5C0 a year Two Assistant Medical Officers £600 — £800 a year Seven Nurses £700 — £910 a year Dispenser, Clerical Assistance, Stationery, &c. £230 a year Subsidy to the London Hospital £300 a year £2,590 — £3,000 a year The amount to be paid from the local rates under this scheme would be from £572 to £675 a year. It will be remembered that until the beginning of 1913, the cost of retaining 10 beds at sanatoria for the use of residents suffering from Pulmonary Tuberculosis was £650. In future the duty of providing Sanatoria beds for non-insured, as well as for insured persons, will devolve on the London Council Council. A great deal of the time of the Sanitary Inspectors is now taken up in visiting the homes of the Consumptives. In this scheme they will be relieved of these duties as they will be done by the Nurses or Health Visitors which are suggested to be appointed. In submitting these three alternative schemes, I have endeavoured to suggest the establishment of a closer relationship between the municipal and voluntary division of the work. The final result will be a scheme of closely co-ordinated activity in which each clement plays its distinct role, and the several elements harmoniously linked together for the common good. APPENDIX A. Municipal Dispensaries have already been established by six Borough Councils, viz., Deptford, Greenwich, Hampstead, Lambeth, Southwark and Wandsworth. Lewisham Borough Council have prepared a scheme for the establishment of a Municipal Dispensary, and they are in communication with the Local Government Boarel and the London County Council thereon. In Deptford the estimated annual cost is £774 per annum, the estimated number of persons treated is 600. 45 In Greenwich the estimated annual cost is £800 per annum. In Hampstead the estimated annual cost is £750 per annum, the estimated number of persons treated is 165. In Lambeth the estimated annual cost is £1,327 per annum, the number of persons treated in five months was 3,880. In Southwark the estimated annual cost is £1,152 per annum, the estimated number of persons treated is 3,500. In Wandsworth the estimated annual cost is £1,120 per annum, the number of persons treated in 10 months was 936. Poplar have a Voluntary Dispensary, but it is not in connection with the Central Fund. The Council do not make any contribution, but are negotiating with a view to an agreement. The Council elect two representatives out of six, and the Medical Officer of Health is ex-officio on the Committee. There are no Voluntary Dispensaries in Bethnal Green, Camberwe'l, Chelsea, Finsbury, Hackney, Hammersmith, Holborn, Shoreditch, Stoke Newington, Westminster, City of London. The question is still under consideration in all these, except Shoreditch, where the Council have made arrangements with the City Road Hospital, and agreed to contribute a sum not exceeding £800 per annum, subject to deduction trom the Local Government Board and the London County Council. The Committee of Management of the dispensary in connection with the hospital consists of 12 members, six of whom are appointed by the borough. Chelsea Council propose to establish a dispensary in connection with Brompton Hospital. Finsbury have submitted a scheme for a Municipal Dispensary to the Local Government Board. Hackney Council propose to establish 2 dispensaries in connection with 2 hospitals. 46 Hammersmith is now in communication with the West London Hospital for the establishment of a dispensary. In Stoke Newington the question of the provision of a Municipal Dispensary is under consideration. In Westminster a scheme foi the establishment of dispensaries in connection with 2 of the general hospitals is at piesent under consideration. There are Voluntary Dispensaries in—Battersea, Bermondsey, Fulham, Islington, Kensington. Paddington, St. Marylebone, St. Pancras, Stepney, Woolwich. The question is still under consideration in Battersea and Bermondsey. In Fulham the Council contribute £300 per annum and the estimated number of persons treated is 1,926. The Council elect three members on the Committee or one-sixth. In Islington a special committee is considering the question of providing dispensaries in co-operation with local hospitals. In Kensington the Council propose to pay 100 pounds a year to the Dispensary Committee for treatment of cases in North Kensington, and Is. 6d per head to the Brompton Hospital for each patient's attendance for persons resident in South Kensington. In Paddington the dispensary has offered to undertake the treatment of uninsured persons for £500 per annum. It is proposed to make arrangements for special treatment at St. Mary's Hospital and at the Children's Hospital, Paddington Green. In St. Marylebone there are two Voluntary Dispensaries, one being in connection with the Central Fund and it is proposed to pay £100 per annum to each dispensary. In St. Pancras the Council do not at present contribute, but the question is now under consideration. The Council elect six out of a total of 18 members on the Committee of the dispensary which is not in connection with the Central Fund. 47 In Woolwich, the Council contributed £400 in 1913. The Local Committee invited the Borough Council to take the dispensary over, but the Central Fund refused to assist them in paying their debt if this course was taken. Apparently, it will be necessary for a time to go on under the Central Fund. APPENDIX B. Form of inquiries of particulars required under the Regulations. Public Health (Tuberculosis) Regulations, 1911. Record No. Form No. 4. TUBERCULOSIS Medical Record of case of Pulmonary Tuberculosis notified to the Medical Officer of Health under the Public Health (Tuberculosis) Regulations, 1912. Serial No. in Notification Register Date of Receipt of Notification 19 1. Particulars of Patient. Name Age Sex Whether Poor Law (P), Hospital (H), Medical Practitioners' (M), or School (S) case Address; (i) If in a Poor Law Institution, Hospital, Private Residence or otherwise. Address of Patient Any other Address to be visited (ii) Changes of Address, where to If to another Medical Officer of Health's District, name thereof, and date when particulars sent to that M.O.H. Including particulars of Medical History 2. Personal and Family History. Number in family, adults, lodgers, children : Ages: Previous History of Patient and Family History : 3. Diagnosis. Symptoms: Verification of the Notification : Method Bateriological Examination of sputum or other method of diagnosis : Dates Results Probable predisposing causes of infectivity : Probable sources of infection, Nutrition: Occupation: Other particulars of diagnosis and personal particulars: 48 4. Environment. i. At Home: Accommodation ? Cleanliness ? General surroundings ? Adequacy ? Sleeping accommodation ? Other details ? ii. At Work ? 5. Visits following notification. By whom visited, with Dates Instructions given to Patients and Ralatives ? Card of "Instruction" left ? Inquiries made ? Give references to inquiry, paper, &c., containing records Does notifying Piactitioner continue to act ? Consulation with Medical Piactioner ? Dates, details Any other Tuberculosis cases discovered ? Reference to record. If patient in an Institution any visits paid to usual residence ? Action taken ? Reference to records Any other details of visits ? 6. Personal Hygiene of patient and precautionary measures i. At House: Disinfection of rooms and bedrooms ? Removal of overcrowding ? Separate Sleeping Accommodation provided for Patient ? Cleansing of Premises ? Disposal of infective Articles or Materials ? Removal of any other conditions favouring infection or re-infection ? Spit-bottles or other appliances provided ? Any Out-Relief granted by the Poor Law Guardians ? ii. At Work: Occupation continued or changed ? Any preventive measures ? iii. Institutional: It sent to Poor Law Institution, Sanatorium, or other Isolation treatment, where, and whether in or out-patient ? Dates Reference to records iv. Any other Measures taken : v. If Residence changed : Disinfection of old Residence ? Dates Details References to records 7. Results. As to recovery ? Occupation resumed ? or changed ? Reference to later records Date. 8, General treatment, &c. 49 Treatment of patients at the Council's beds in Sanatoria, and the after-history of such patients. All the patients belonged to the wage-earning classes, and their admission to the Sanatorium beds provided by the Council depended upon their inability to pay the fees of private institutions, and upon their being certified as medically suitable. Poor-law cases were not accepted as the Guardians made suitable arrangements for them. At first, the Council provided 6 beds for male patients at Fairlight Sanatorium, Hastings, and 4 beds for females at Maitland Sanatorium, Reading. Strangely enough, applications for treatment were comparatively few, and oftener than not, there was a vacant bed. This caused the Public Health Committee to reduce the number of beds to 4,—2 for males and 2 for females. The difficulty was due to the want of any system for providing for the support of the sick worker's family during his residence in the Sanatorium. He was thus prevented from entering the Sanatorium at the earliest stage, while he yet felt himself capable of working, and perhaps earning full wages. It is, however, at this stage of the disease that the best results can be looked forward to. The necessities of his family rather than his own progress towards recovery, might often induce him to return to his work too soon. For this reason, the Sanatorium benefits of the National Insurance Act influenced a larger number to enter the Sanatorium, and will undoubtedly occupy a prominent place in the anti-tuberculosis campaign of the future. The number of persons treated in the Council's Sanatorium beds from July, 1911, to the end of 1913, was 48. The average length of stay for each patient in the Council's beds was a little over 4 months, while the average stay of insured persons in Sanatoria provided by the London Insurance Committee was just under 2J months. A large number after their return expressed their regret that they had not made a longer stay at the Sanatorium. The number of non-insured persons treated in the Council's Sanatoria beds in 1913 was 13. The number of insured persons resident in the Borough of Stepney that received Sanatorium treatment by the London Insurance Committee during the same period was 283, and were referred to the following institutions for treatment :— Sanatoria ... 211 Mount Vernon Hospital ... 27 City of London Chest Hospital 13 City Road Chest Hospital ... 1 Brompton Hospital 22 Eversfield Chest Hospital ... 1 University College Hospital ... 3 Royal National Hospital ... 1 Metropolitan Hospital ... 3 The Mount ... ... ... 1 50 The results of the Sanatorium treatment are more encouraging and promising if the disease is in the earliest stages. Attention is therefore concentrated on the early diagnosis of the disease. The early consumptive does not discover himself, but must be actively sought out. 25 of the patients admitted to the Council's beds moved from the premises where they lived previous to their going to the Sanatorium, but we have been able to trace the addresses of 17 out of the 25. Some have left the district and their addresses cannot be ascertained. It is our intention to keep as many under observation as possible and to report on their condition from year to year. As far as I can ascertain they live under similar conditions whether they return to their previous addresses or not, and they have nearly all returned to their former occupations. It is a pity that some form of occupation could not be provided for them, which does not necessitate long confinement indoors, but such an arrangement is extremely difficult. After their return from the Sanatorium, the Sanatorium principles were observed as far as possible. The windows were kept open day and night, winter and summer. In every instance the " cured " patient informed me that he or she " was unable to breathe properly if the windows were shut." They stated that they felt as if they were choking. The other members of the family complained at first that they were having more air than they desired or required. They got used to it, however, and afterwards appreciated its advantage. Of the twelve that have been discharged from the Sanatorium for two years and longer, one is dead, one is very ill, three are in a fair condition, and seven appear to be quite well and have continued regularly at their usual occupation. Of the ten that have been discharged for one-and-a-half years and under two years, eight are doing well, one is not doing so well, and one is in an unsatisfactory condition. Mrs. W., aged 24, of Lower Chapman Street, was admitted to Maitland Sanatorium on July 17th, 1911, where she remained for 4 months. She gained 9 lbs. in weight, and on her discharge, her temperature was normal. She could walk one or two miles and do housework without difficulty. The breath sounds weie weak at the apices of both lungs, but no crepitations could be heard. Her general health was much improved. 6| months after her discharge, it was found that her pulmonary condition was about the same. There has been some return of the symptoms. She has been undergoing treatment with Tuberculin, at the Tuberculosis Dispensary. Her temperature kept normal. She attended the Stepney Green Dispensary until July, 1912, but since that date she has been attending St. George's Dispensary. 51 2½ years after her discharge from the Sanatorium, there were no signs of active disease, and she was able to do housework. She had no cough or expectoration, although she had lost flesh. M. W., aged 25, of Raymond Street (she has removed to Old Tower Buildings), was admitted to Maitland Sanatorium on July 17th, 1911, and remained there for 4 months. She gained nearly 7 lbs. in weight, and on her discharge her temperature was quite normal. She could walk two or three miles, and do housework without difficulty. Fine crepitations could be heard at the apices of both lungs. Her " general health was excellent, and the condition of lungs in statu quo." 6½ months after her discharge, it was found that there had been a return' of symptoms. On examination, it was found that there was extension of the disease. She was not doing well. She got married in 1912, and had a baby in October, 1913. She attended the St. George's Dispensary regularly since July, 1912. Since the baby was bom she has got rapidly worse, and her condition is now very unsatisfactory. H. G., aged 24, of Anthony Street (now of Jane Street), was admitted to Fairlight Sanatorium on August 28th, 1911, and after remaining there for three months left against the advice of the Medical Superintendent, although there was little or no activity of the disease at that time. The doctor thought it would have been wiser to wait for a few weeks longer in order that he might have been tested with the hardest grade of work. 6 months afterwards, there was no return of the symptoms. The pulmonary condition showed no return of activity, and he was doing well. 2 \ years afterwards he appeared to be very fit. He gained 15 lbs. at the Sanatorium, and since his discharge he had gained another 26 lbs. in weight. He did not return to the tailoring trade on leaving the Sanatorium, but joined his father as a poulterer. He had no cough or expectoration, and did not receive medical treatment of any kind. E. B., aged 38, of Charles Street (now of Spring Garden Place), was admitted to Fairlight Sanatorium, on September 4th, 1911. At the end of 4 months, the Medical Superintendent reported that the patient was not very robust, but that there was not much, if any, active disease. His general physique was poor, and he doubted his capacity of performing hard work. For the last month his temperature had not risen above 99 degrees, in spite of the fact that he had been doing moderately hard work, e.g., digging broken ground, scrubbing and garden sweeping. He had gained 14 lbs. in weight. 2 months after leaving the Sanatorium he had no return of symptoms. The chest conditions had apparently healed. p 52 2¼ years afterwards he had lost some weight. He received the Tuberculin treatment, until the middle of 1913. The cough had been rather troublesome especially night and morning, but not much expectoration. He had suffered from irregularity of temperature, which had caused him to lose several days work. Unfortunately, he had to return to his former occupation—that of cooper—where there is much dust and smoke. A. H. V., aged 19, of William's Buildings, Ann Street, was admitted to Fairlight Sanatorium, on October 2nd, 1911, where he remained for 8 months, when he decided to emigrate to Canada, where a position was found for him on a dairy farm, and all arrangements were made by the Sanatorium Authorities. The Medical Superintendent considered this gave him thebest chance. He had done very well at the Sanatorium, and for months he was doing the hardest form of manual work without difficulty, or rise of temperature. The Medical Superintendent was of opinion that the disease, therefore, was perfectly arrested. 18 months afterwards, he was doing well in Canada, and had no return of his symptoms. F. C. H., aged 30, of Oxford Street (now of Wellesley Street), was admitted to Maitland Sanatorium on October 12th, 1911, where she remained for 4 months. She gained 18½ lbs. and her temperature on discharge was normal. She could walk two or three miles, and do light housework without difficulty. The percussion note was dull at the apices of both lungs and the expiration was prolonged. There was marked improvement in her general condition, and no Tubercle Bacilli could be found in the sputum. After her return home, she was confined and her symptoms returned. She attended at the Tuberculosis Dispensary, where she received the Tuberculin treatment. 2½ years afterwards, she was able to do housework, and appeared to be keeping in good health, although she had not been able to return to her trade—tailoring. She had not lost weight since she was discharged. J. H. aged 20, a brass finisher of Settles Street, was admitted to Fairlight Sanatorium on October 16,1911, where he remained for 5 months. He got on very well at the Sanatorium. On his discharge, there was no sign of active disease, and no Tubercle Bacilli could be found in the sputum. For 5 weeks, he was doing grade IV. work without discomfort, and his average daily temperature was 97 to 98 2 degrees. He gained 16 lbs. in weight, and the Medical Superintendent considered that the disease had been arrested. Three months after his discharge he had no return of activity or symptoms, although he had lost 6 lbs. in weight. He received the Tuberculin treatment at the Stepney Green Dispensary. He attended at the Dispensary until June, 1912. He was then 9 lbs. heavier than when he went to the Sanatorium, and had only a slight cough and expectoration. His present address cannot be ascertained. 53 E. K., aged 35, a plumber of Watt's Street Buildings, was admitted to the Fairlight Sanatorium on October 23rd, 1911. I informed the Public Health Committee that I did not consider the patient a suitable case for Sanatorium treatment, and that the report of the Council's Medical Referee was unsatisfactory. It was, however, decided to send him to the Medical Referee of the Sanatorium who accepted him, and he was sent to the Sanatorium. The Medical Superintendent of the latter institution wrote on November 14th that he did not think any good purpose would be served by keeping the patient there much longer. He had advanced Pulmonary Tuberculosis, and in addition, his general health was feeble. Since his admission he had made no real progress. His temperature had been constantly up to, and over 101 degrees, and was not affected by rest in bed to any extent. He was of opinion that he was not a suitable case for a Sanatorium. E. K. died on November 30th. W. E., aged 39, of Johnson Street (now moved to Coburg Buildings), was admitted to Fairlight Sanatorium on November 27th, 1911, where he remained for 10 weeks. The Medical Superintendent reported that considering the comparatively short time he was at the Institution he had got on very well. He had extensive lung disease and early Tuberculous Laryngitis. There was, however, distinct diminution in the activity of the disease in both localities. He had gained 21 lbs. in weight, and for a considerable time he had no abnormal rise of temperature. He was able to do such work as light digging, carrying earth, &c., for 4 hours a day. 3 months after his discharge he had lost 6 lbs. in weight. The pulmonary condition showed some activity, and he was undergoing the Tuberculin treatment at the Dispensary until April, 1913. 2 years afterwards he was in a fair condition, and had not lost a day's work as a crane driver on account of illness during this period, and had no cough or expectoration. His wife, R. E., aged 36, was admitted to the Maitland Sanatorium on April 14th, 1913, and remained there for 2 months. She gained 9 lbs. in weight, and her temperature became normal. Her walking capacity was 4 miles, and she was doing various grades of housework. During the first month at the Sanatorium, her physical signs increased, but cleared up later. The Medical Superintendent was of opinion that Dispensary care was necessary after her discharge. She attended at the Dispensary for some time, but gave it up, as she strongly objected to the Tuberculin treatment. In the meantime she had become pregnant. She had no cough or expectoration, and was able to do housework comfortably. A. H., aged 27, of Gun Street (now of Sandringham Road, Dalston), was admitted to Maitland Sanatorium on December 11th, 1911, where she remained for nearly 3 months, when she gained 1 stone in weight. Her temperature on discharge was quite normal, and she could walk well and do hard work without difficulty. Her d 2 54 breathing was good, and she was free from cough. She made excellent progress while at the Sanatorium. 3 months afterwards, there had been no return of symptoms nor any sign of a return of activity. 6 months after her discharge, she had lost about 5 lbs., but her physical signs were practically normal. There was no cough or temperature. 2 years afterwards she appeared quite well, and has had no illness since her return home. She had no cough or expectoration, but attended the Whitechapel Dispensary periodically. L. G., aged 8, of Selby Street, was admitted on November 13th, 1911, and discharged on October 11th, 1912, having gained a stone in weight; her temperature was normal, and walking capacity 3 miles. The Medical Superintendent reported that the patient was much better in general health, the physical signs in the chest being much less, but there was a considerable area of disease. This appears to have become of a chronic nature, but is not interfering with the child's ordinary life. Her temperature was steady, and she had very little cough. She kept well for about a year after her discharge. Since then she has lost weight, and her condition is not so good, but she has no cough. She attends school regularly. She has not been attending any dispensary or institution for medical treatment, and apparently has had no cause to receive medical treatment. H. S., aged 37, a tailor's cutter, of Selby Street, was admitted to the Fairlight Sanatorium on November 1st, 1911. The Committee considered the report as to his condition on September 26th, but on account of the recent dock strike and other domestic circumstances, he was allowed to remain at the sanatorium until the end of 1912, when he was taken on as a porter at the Sanatorium. He has since been employed as sculleryman at the Sanatorium, and at the end of 1913 was in good health. He has not been off duty on account of ill-health since he became a member of the staff. L. C., aged 18, a tailor, of Terrace Place (now of Brook Street), was admitted to Fairlight Sanatorium on December 7th, 1911, and left on April 13th, 1912. On his discharge he was enjoying excellent health, and was fit to return to work. He gained 20 lbs. in weight, and the Medical Superintendent considered that the disease was arrested. 15 months afterwards he was the same weight as when he went to the Sanatorium, and attended the Stepney Green Dispensary. 2 years after he left the Sanatorium he felt quite fit and well. He had no cough, expectoration or night sweats. M. T., aged 39, of the Philpot Street Synagogue (now of Dunstan's Buildings, Brook Street), was admitted to Maitland Sanatorium on January 29th and left on April 22nd. During her stay of 3 months she gained 17| lbs. in weight, weighing 11 st. 1£ lbs. on leaving the Sanatorium. She could walk well and do 55 housework. Dry crepitations were still heard at the apex. The Medical Superintendent was of opinion that she made excellent improvement in general health, but needed further care. She continued to attend at the Stepney Green Dispensary and received the Tuberculin treatment until September of the same year. Two years after her discharge from the Sanatorium she was in a fair condition and was still attending at the dispensary. She complained of a slight cough and had lost weight. H. B., aged 35, of Jamaica Street, was admitted to Maitland Sanatorium on February 26th, 1912, and left on April 22nd. During her stay of 2 months she gained 10¼ lbs. in weight, weighing 9st 3¼ lbs. on leaving the Sanatorium; she could walk 4 miles comfortably and do housework well. The upper third of the right lung was involved. The Medical Superintendent considered she had made excellent improvement in general health, but that she still needed further care. 2 years afterwards, she was able to do housework and had only lost 3 lbs. in weight since her discharge. H. H., aged 27, of Fieldgate Mansions, was admitted to Fairlight Sanatorium on February 27th, 1912, and left on June 8th. During his stay of 3| months he gained 22 lbs. in weight, weighing 9 st. 13½ lbs. on leaving the Sanatorium. The Medical Superintendent was of opinion that the disease was arrested. Nearly 2 years afterwards he was in fairly good condition. He was in constant work as a cigarette-maker. He had not lost a day's work since he left the Sanatorium, although his cough troubled him occasionally. V. E., aged 12, of Copperfield Road, was admitted to Maitland Sanatorium on March 5th, 1912, and left on October 11th, 1912, having gained 2 st. in weight. Her temperature on discharge was normal and her walking capacity was 3 miles. Practically no abnormal physical signs were present in the lungs when she was discharged. Her progress at the Sanatorium was excellent. This patient has gone to Edmonton and her present address cannot be found. J. K., aged 29, a tailor's machinist, of Little Turner Street, was admitted to the Fairlight Sanatorium on March 27th, 1912, and left on June 17th, 1912. During his stay of 3 months he gained 15 lbs. in weight, weighing 10 st. 2½ lbs. when he left, and had improved very much in health. He left the Sanatorium because the only other patient who could speak Yiddish was also leaving. The Medical Superintendent did not recommend it as the disease was not yet arrested, and a further stay would have been advisable. This patient has left the district and his present address cannot be traced. E. S., aged 32, a waistc oat hand, of Senrab Street, was admitted to Maitland Sanatorium on April 22nd, 1912, and discharged on July 15th, 1912. Herweignt on admission was 6 st. 8¾ lbs. and on discharge 7 st. 8¼ lbs. Her temperature on 56 admission was 99 degrees, and on discharge normal. She was able to walk several miles, and her working capacity was good. No abnormal physical signs could be detected in the lungs on her discharge. The Medical Superintendent reported that her progress at the Sanatoiium was excellent. She attended the Stepney Green Dispensary until May, 1913, when she was keeping well. She has left Senrab Street and her present address cannot be ascertained. M. A., aged 43, of Devonshire Street, was admitted to Maitland Sanatorium on April 24th, 1912, and left on July 17th, 1912. Her weight on admission was 8st. 4 lbs., and on discharge 9¾ st. Her temperature remained normal. She was able to walk 3 miles, and do full work as well as gardening. There were still slight physical signs in the lower lobe of the left lung. The Medical Superintendent reported that her progress at the Sanatorium was excellent. 2 years afterwards, she had lost a great deal of the weight gained at the Sanatorium. The cough and expectoration had returned, but she had not been medically attended by a doctor or at an institution since she left Maitland. She was able to do housework comfortably. J. S., aged 30, of Duckett Street (now of Knott Street), was admitted to Fairlight Sanatorium, on May 30th, 1912, and discharged on August 31st, 1912, when he showed no sign of active disease. He was doing the hardest grade of manual work for the last fortnight of his stay in the Sanatorium without any rise of temperature. During his stay he gained 34 lbs. in weight, and the Medical Superintendent was of opinion that the disease had been arrested. Soon afterwards he suffered from Duodenal ulcer, and was taken to the London Hospital. If years after his discharge from the Sanatorium, he was in good health and was following his occupation as a wood-sawyer. He had no cough or expectoration. V. M., aged 37, a carman, of Albion Street, was admitted to the Sanatorium on June 17th, 1912, and left on September 23rd, 1912, having gained 21 lbs. in weight, and was doing the hardest grade of manual work on discharge, without discomfort or rise of temperature. The Medical Superintendent recommended a course of Tuberculin treatment, and arrangements were made with the Stepney Dispensary for this purpose. He attended at the dispensary for some time, and continued to do well. He has left the above address, and his present address is not known. F. C., aged 33, of Fair Street, was admitted to Fairlight Sanatorium, on July 6th, 1912, and discharged on October 5th. The right side did not expand as well as the left. There were no signs of active disease, and no Tubercle Bacilli in the sputum. He gained one stone in weight, and left fit for work. 57 11 years afterwards, he continued to feel fit, and had not lost a day's work on account of illness since he had left the Sanatorium. He is employed as a clerk. He occasionally goes to the Stepney Green Dispensary, but he has no cough. S. W., aged 31, of White Horse Lane, was admitted to Maitland Sanatorium, on July 17th, 1912, and discharged on September 11th. Her weight on admission was 8 st. 7 lbs. and on discharge 9 st. 31 lbs. The temperature on discharge was normal, and her walking capacity 5 miles. She was able to do a full day's work. The condition of lungs was very indefinite, occasional moist sounds being heard over the left apex. The report on the progress at the Sanatorium was very good. 6 months after returning home, she lost weight, and she became an inmate of Mile End Infirmary for three weeks. 1J years after her discharge her condition had not improved. She was thin, coughed a great deal, and stated that she occasionally expectorated blood-stained sputum. She continues to attend at the Stepney Green Dispensary. M. P., aged 21, cork cutter, of Love Lane (now of Brook Street), was admitted to Maitland Sanatorium on July 17th, 1912, and left on October 8th, having gained 1 st. in weight. Her temperature on discharge was normal. Her walking capacity was 5 to 6 miles, and she was able to do full C. work. The apex of her right lung was involved (early). Her progress at the Sanatorium was excellent. 1| years afterwards, she had not lost a day's work on account of illness. She had lost a little weight, but not much. She had no cough or expectoration. A. N., aged 14, draper's assistant of Albert Square, was admitted to Fairlight Sanatorium on July 26th, 1912, where he remained for 11 months. He gained 22 lbs. in weight and there were no signs of active disease when he left. He did the highest grade of manual work without the slightest discomfort or rise of temperature, During the 10 months since he left the Sanatorium, he had not lost a day's work on account of illness; he had no cough, and had gained weight. R. A., aged 11, of Langdale Mansions, was admitted to Maitland Sanatorium on October 12th, 1912, and discharged on April 4th, 1913. She gained 10J lbs. in weight and her temperature was normal. She had made excellent progress, her cough and sputum being much less. On her arrival at the Sanatorium her sputum was crowded with Tubercle Bacilli, but was quite tree prior to her discharge. Her condition a year afterwards was not so good. She coughed a great deal. She had not been to school since her discharge and spent most of the time in the open air. E. B., aged 31, a hawker, of Rutland Street (now living at Turner Street), was admitted to Maitland Sanatorium, on October 12th, 1912, and discharged on January 3rd, 1913. She gained 12¼ lbs. in weight. Her temperature was normal, 58 and her walking and working capacity were normal. The physical signs in both lungs had quite cleared up. She made very good progress. She remained well for five months, when she commenced to lose weight. Since then she has been attending the Brompton Hospital. 15 months after her discharge from the Sanatorium, she was in a poor physical condition, and was only able to follow her occupation intermittently. Her cough was troublesome during the winter months. R. D., aged 16, an errand girl, of St. Ann's Road, was admitted to Maitland Sanatorium, on October 12, 1912, and discharged on January 3rd, 1913. She gained 13 lbs. in weight, and her temperature was normal. Her walking capacity was good, and her working capacity was fair. There was some stickiness of breath sounds over the second and third intercostal spaces, where formerly there were definite crepitations. Her general condition was much improved, and her lungs showed distinct improvement. She did not attend any dispensary for after-treatment. She resumed her duties, but was not able to continue for long periods. 15 months after her discharge, she was much thinner, and complained of a bad cough. She worked intermittently. G. H., aged 47, a hawker, of Maidman Street, was admitted to Fairlight Sanatorium, on October 21st, 1912, and was discharged on December 6th. He left at his own request, and against the advice of the Medical Superintendent. He was doing Grade III. work with only an occasional rise of temperature to 99°. His weight was quite maintained. He only attended once at the dispensary after his discharge, in July, 1913, when his symptoms had returned. Moist sounds could be heard in the chest. 18 months afterwards, his condition was worse; the cough and expectoration had returned. He was not able to follow his employment as a hawker regularly. W. C., aged 42, of Maplin Street, was admitted to Fairlight Sanatorium, on July 31st, 1912, and discharged on September 7th. The apex of the right lung was affected. He made very satisfactory progress during his stay at the Sanatorium, gaining over 18 lbs. in weight. He was able to do Grade III. work, and for the last week or two, his temperature was normal except on two occasions when it touched 99°. The Medical Superintendent did not consider that he was fit to leave when he did, and told him so. 20 months after his discharge he kept well, and worked regularly as a shoemaker He was free from cough and expectoration. He did not receive any after treatment at a dispensary. E. H., aged 21, a tie cutter, of Peabody Buildings, Commercial Street, was admitted to Fairlight Sanatorium on September 13th, 1912, and was discharged on 59 April 5th, 1913. He had advanced disease affecting both lungs. When he left he was doing Grade IV. work without rise of temperature. There was still Tubercle Bacilli in the sputum, and crepitations could be heard; but the Medical Superintendent considered that the disease was not active, and that he was fit for work. He gained one stone in weight. He attended at Margaret Street Hospital as an out-patient, but died a year after his discharge from the Sanatorium. L. J., aged 23, a carpenter, of Mile End Road (now of Leyton), was admitted to Fairlight Sanatorium on September 13th, 1912, and was advised to leave on November 16th, as he was suffering from fits. The fits appeared to be increasing in frequency and severity. There was no sign of active disease in the lungs, the sputum being free from Tubercle Bacilli. His temperature was generally below 99 degrees, but was distinctly influenced (for about two days) by the occurrence of a lit. His general health was very fair and he gained 12 lbs. in weight. 16 months afterwards he had not lost weight, and had been feeling well. He had not had a fit for 3 months, and the cough had entirely disappeared. He has now moved out of the district, bat comes up to see me periodically. He has lost about 8 days, on account of illness, since leaving Fairlight. E. P., aged 20, a box maker, of Albion Street, was admitted to Maitland Sanatorium on September 23rd, 1912. The temperature on her discharge was about 101 degrees. Both lungs were extensively and acutely involved. She made no progress. The Medical Superintendent was of opinion that it was a very acute case and unsuitable for Sanatorium ; he advised her discharge, which was done on October 18th. Soon after her discharge, she became an in-patient at the Mile End Infirmary for 5 months. Afterwards she attended at the Stepney Green Dispensary, and has since become pregnant. Her cough is better, and altogether she feels very much improved. E. F., aged 29, of Harford Street, was admitted to Maitland Sanatorium on October 23rd, 1912, and discharged on January 13th, 1913. She gained 11¼ lbs. in weight. Her walking capacity was 3 to 4 miles. There was slightly prolonged expiration and plus vocal resonance over the right upper lobes as well as crepitations in the second space near the sternum. There was nothing abnormal in the left lung. She made very great improvement in the Sanatorium. She left the above address soon afterwards, and her present address cannot be traced. E. R., aged 15, of Skidmore Street (now of Single Street), was admitted to Maitland Sanatorium on January 11th, 1913, where she remained for 3 months. She gained 13½ lbs. in weight, and her walking capacity was good. Her temperature was normal, and she made excellent progress. She lost her cough and had no expectoration. A year afterwards she had lost most of the weight gained at the Sanatorium, but has worked regularly as a fancy soap labeller since her 60 discharge. She has not attended any dispensary or received medical attention since leaving the Sanatorium. She appears to be keeping well, and works regularly in a druggist warehouse. F. E. A., aged 11, of Parnham Street, was admitted to Maitland Sanatorium on January 28th, 1913, where she remained for 2 months, and gained 8 lbs. in weight. Her breath sounds were weaker on the right side, but no adventitious sounds could be heard. Her progress at the Sanatorium was quite good, especially during the second month. Exercise and drill have much improved her breathing. The improvement was well maintained during the 12 months that have elapsed since she left Maitland. She had no cough and her nutrition was good. She attended at the Victoria Park Hospital on two occasions during this period. Mrs. B., aged 25, of Whites Row, was admitted to Maitland Sanatorium on February 24th, 1913, but only remained 1 month, when she left at her own wish. She gained 6 lbs. in weight. She had harsh expiration and a slight cough, but no adventitious sounds could be heard. She had a slight attack of haematemesis. She continued fairly well after her return, but a year afterwards, she was admitted to St. Bartholomew's Hospital, suffering from perforated gastric ulcer, where she was operated on. She was an in-patient of the Hospital for nearly 4 months. M. S., aged 26, of Exmouth Street, was admitted to Maitland Sanatorium on April 7th, 1913, and remained there for 4 months. She gained 6 lbs. in weight, and her temperature on discharge was quite normal. Her walking capacity was 5 miles, and her working capacity was fair. She had no cough or expectoration when she was discharged. She made good progress at the Sanatorium, her physical signs clearing up; the Medical Superintendent was of opinion that she should receive dispensary care, but she has not availed herself of this opportunity. She kept in fair condition until Christmas, 1913, when she seemed to lose ground, and two months afterwards, she had Haemoptysis. Since then she has been attending at the Victoria Park Hospital, and has lost one stone in weight. S.S., aged 38, of Cressy Houses, was admitted to Fairlight Sanatorium on April 28th, 1913, where he remained for 3 months, and made fair progress. On his discharge the Medical Superintendent was of opinion that the disease was still active and the patient had considerable amount of cough, due to his throat condition, as well as to his chest trouble. He was informed that he ought not to work in London, and might have fair health if he were in good surroundings On his discharge he attended the Stepney Green Dispensary. His throat symptoms have not improved. He has lost all the weight he put on at the Sanatorium. He continued at his work as a traveller for 5 months but had not been able to work regularly since. The family, which consists of man, wife, and two children, occupies two rooms only, the kitchen being also used as a sleeping apartment. 61 S. S., aged 28, of Jewell Street, was admitted to Maitland Sanatorium on June 9th, 1913, and remained for 5 months. She gained 11½ lbs. in weight, but became easily tired. On her discharge she had very little cough, and no expectoration. Her general condition improved, but she had very little stamina. She left the above address just before Christmas, 1913, and her present home is unknown. N. L., aged 33, of Green Dragon Yard, was admitted to Fairlight Sanatorium on July 15th, 1913, where he remained for 6 months. He had very little resisting power and his lung condition did not improve during the latter part of his stay at the Sanatorium. His general health improved, that is, he gained 15 lbs. in weight, but his temperature continued to rise to nearly 100 degrees and his cough was very troublesome. He did not attend any dispensary or other institution after leaving the Sanatorium. S. C., aged 29, of Fulbourne Street, was admitted to the Maitland Sanatorium on August 26th, 1913, and remained there for 3 months. She gained 7 lbs. in weight and her temperature was normal. Her cough and expectoration disappeared. She was very despondent and was advised to have dispensary treatment. Since her discharge she has been attending the Whitechapel Dispensary, M. S., aged 50, a plumber of Eric Street, was admitted to Fairlight Sanatorium on September 9th, 1913, and discharged on November 8th. He gained a stone in weight and his temperature became normal. The Medical Superintendent reported that his sputum was free from Tubercle Bacilli, and as regards his chest, he saw no reason why he should not remain well. In a day or two, however, he was admitted to the Victoria Park Chest Hospital, where he died on November 16th from Pulmonary Tuberculosis and Tuberculous Enteritis. S. S., aged 28, of Bromhead Street, was admitted to Maitland Sanatorium on October 27th, where she remained for 3 months and gained 6 lbs. in weight. Her walking and working capacity were good. She had not much cough, but she expectorated a great deal in the mornings. No Tubercle Bacilli were found in the sputum when she was discharged. Since her discharge she attended at the Stepney Green Dispensary. Her cough at times was troublesome, but she was able to do housework and was steadily gaining weight. I. W., aged 44, a bootmaker of Graces Alley, was admitted to the Fairlight Sanatorium on November 10th, 1913, and remained there for 4 months, where he gained 27 lbs. in weight. His temperature was quite normal when he was discharged. The Medical Superintendent considered him to be in good condition and should keep well. 62 G. G., aged 36, of Fieldgate Mansions, was admitted to Maitland Sanatorium on November 27th, 1913, where she remained for 11 weeks. She gained 10 lbs. in weight and her temperature was normal on her discharge. Her walking and working capacity were good. Dry crepitations were heard over the left apex. The cough was very slight and no Tubercle Bacilli were found in the sputum. She made excellent progress at the Sanatorium but dispensary care was advised. Infantile Mortality. 917 infants died under one year of age, which corresponds to a death rate of 112 per 1,000 births. This number is 29 less than in the previous year. 236 belonged to the Limehouse District, or at the rate of 130 per 1,000 births; 171 belonged to St. George-in-the-East, or at the rate of 117 per 1,000 births ; 348 belonged to Mile End Old Town, or at the rate of 104 per 1,000 births; 162 belonged to the Whitechapel District, or at the rate of 102 per 1,000 births. The infantile mortality for the whole Borough was 112 per 1,000 births, while that for the whole of London was 105 per 1,000 births. Deaths of Illegitimate Children. There were 57 deaths of illegitimate children under one year of age during the year, or at the rate of 370 per 1,000 illegitimate births. 11 belonged to the Limehouse District, or at the rate of 366 per 1,000 illegitimate births; 6 belonged to St. George-in-the-East, or at the rate of 187 per 1,000 illegitimate births; 26 belonged to Mile End Old Town, or at the rate of 464 per 1,000 illegitimate births; 14 belonged to the Whitechapel District, or at the rate of 388 per 1,000 illegitimate births. Copy of Report submitted to the General Purposes and Staff Committee on Infantile Mortality, with special reference to the appointment of a Female Health Visitor for the District of St. George-in-the-East. Acting on the instructions of the above Committee I reported on the infantile mortality in the Borough and the appointment of a Female Health Visitor for the district of St. George-in-the-East. 63 By infantile mortality is meant the deaths of infants before they are twelve months old The infantile mortality in towns is higher than in rural districts, although at birth, according to the Registrar General, the town infant is almost as healthy as the rural; and during the first month of life, during which over one-third of the total infant mortality occurs, the town or urban excess is usually only about 8 per cent. During the first three months of life, the town or urban excess is only 11.6 per cent, higher than the rural death-rate, while in the next three months it is 43 per cent., and in the second half of infancy 67 per cent, higher in the urban than in the rural districts. This greater excess in the later months is due to the greater prevalence of diarrhoeal diseases in town than in country districts. Among the influences affecting infant mortality, according to Dr. Newsholme of the Local Government Board, are the following:— (1) The proportion of male to female births. Male infants always suffer from a higher death rate than female infants, and this excessive mortality persists throughout the rest of life except at the ages of 5 to 15, when boys and girls are equal in their freedom from the causes of death. In 1911 and 1912, there were over 6 per cent, more male births than female in the Borough of Stepney, but in 1910 there was an excess of female births, which is the only exception during the last 11 years. (2) The proportion of legitimate to illegitimate births. The death-rate among illegitimate children is twice that of children born in wedlock. (3) The size of the family. It is stated that moderately small families conduce to low infant mortality, although it is well-known that the deathrate is higher among the first-born than among subsequent infants, and large families, should therefore on an average have a slightly lower inlant death-rate. Large families are, however, most common among the poorest, who live under conditions unfavourable to child life. (4) The number of still births. (5) The quality of the help given at birth. Want of skilled care at birth may bear an important part in the number of deaths from accidents of child-birth. (6) The age of the mother. Excessive infant mortality is often ascribable in part to too early motherhood, with its associated inexperience and possible carelessness. (7) Poverty and social condition. Infant mortality is higher among the poor and lowest among the well-to-do. 64 (8) The non-domestic employment of married women. The infantile mortality is greatest in districts having the highest proportion of married women industrially employed. Such employment must necessarily involve some neglect of the home, and especially of any young children. (9) Poverty is a direct cause of infant mortality where it induces malnutrition of mother or infant, or where it implies that the mother cannot give adequate care to the infant. (10) Poverty is also an important indirect cause of infant mortality. Its influence is exercised in the following among other ways:— (a) Poverty is not infrequently associated with ignorance and carelessness. (b) With these are commonly associated overcrowding and uncleanliness. (c) Alcoholic habits frequently result from living under conditions of poverty, the converse also being true. What are the principal sanitary defects that can be abated or minimised by action taken under the Public Health Acts ? (a) Overcrowding and lack of cleanliness are undoubtedly most important. This usually means for the infant exposure to a stuffy, dusty atmosphere, very variable in temperature. It implies for the bottle-fed infant insufficient or unsatisfactory arrangements for storing food, and the consumption of food which may be partially decomposed, and probably is uncleanly. The fact that in tenement dwellings, refuse is often stored within the living room, and in other forms of houses close to the kitchen, adds to the possibilities of mischief. (b) The yard may be unpaved or imperfectly paved, dirt then being trodden into the house. (c) The sanitary conveniences may be in an unsatisfactory condition, and give off noxious effluvia. (d) Household refuse may have to be taken through the house, or even through the living room. Infective material may thus be brought into the house, or blown in or carried in by flies bred in accumulations of refuse. The first condition of safe rearing of infants is breast feeding. Ignorant mothers are, however, fond of giving occasional "tastes" of their own food to the babies when still breast-fed. The substitution of artificial for natural feeding is one of the chief evils associated with the industrial employment of women. 65 Many mothers are persuaded by neighbours that the baby is " not satisfied," and that mother's milk needs supplementing by artificial food One of the chief uses of health visitors is to counteract mischievous advice of this type. When partial or entire artificial feeding cannot be avoided the artificial food is often prepared under uncleanly conditions, gastric disturbances and diarrhoea being produced. Artificial feeding also carries with it the fact that the majority of infants thus fed are being slowly starved in respect of the essential fat in their food. The majority of mothers are ignorant of the relative nutritive value and digestibility of different foods, and health visitors are needed to explain such points in detail. Ignorance of the mother is commonly associated with carelessness and indifference, the true explanation of which is a lack of appreciation of the extent to which infant health depends on the steady adoption of simple hygienic precautions. It may be of interest to give the history of the movement for the appointment of a Female Health Visitor on the staff of the Public Health Department in this Borough before considering the advisability of making another appointment. In 1899, before the formation of the Borough Council, the late Limehouse District Board of Works resolved to appoint a Health Visitor to instruct mothers in the proper care of infants, and thus endeavour to reduce the high infantile mortality in the district, provided the Local Government Board paid half her salary. The Local Government Board, while sympathising with the objects of the District Board, could not sanction the payment of a portion of her salary. The project therefore fell through. In October, 1902, a Sub-Committee of the Public Health Committee presented a report which was adopted by the full Committee, and submitted to the Council on November 12th, 1902. The Public Health Committee recommended that two Female Health Visitors be appointed for a period of two years at a salary of £100 per annum. Their duties were to include visiting the homes of the poor, and give advice upon matters of home hygiene, viz., the proper feeding and clothing of infants. The Health Visitors were to visit houses in districts where Diarrhoea, Measles, Whooping Cough, etc., were prevalent, and give instructions as to the necessary and proper care of the sick, and to act generally under the Medical Officer of Health. The recommendation of the Public Health Committee was rejected by the Council by 29 votes to 17. The matter was taken up by a society outside the Council, and a lady was appointed for five years, her services being paid for by a private individual. This Health Visitor worked for three years in that part of the Borough known as 66 "Limehouse Fields," where the infantile mortality is, and has been for many years, abnormally high. Unfortunately, when she had become well known in the area, and her services were appreciated, she was transferred to another part of the Borough. On October 24th, 1906, a letter was received from the Secretary of the Legal Committee of the Women's Industrial Council, asking for the appointment of a Female Sanitary Inspector. The communication was referred to the Public Health Committee, which deferred its consideration for twelve months. On March 13th, 1907, a deputation from the Stepney Visitors' Association came before the Council, urging the appointment of a Female Sanitary Inspector. The subject was referred to the Public Health Committee. I was instructed to obtain information from other Metropolitan Borough Councils on the matter, and the replies were submitted to a Sub-Committee. After carefully considering the experience of other Borough Councils, the Sub Committee arrived at the conclusion that a Woman Sanitary Inspector and Health Visitor should be appointed for a period of twelve months. The report of the Sub-Committee was rejected by the full Committee, and it was resolved to recommend the Council to take no action in the matter. On April 24th, an amendment was moved at the Council meeting that the matter be adjourned, and the full report of the Sub-Committee be circulated to the members of the Council. This amendment was defeated by 23 votes to 16. The recommendation of the Committee was adopted. On March 25th, 1908, a deputation from the Stepney Council of Public Welfare, including the Bishop of Stepney, addressed the Council on the same subject. The matter was referred to the Public Health Committee. The Committee recommended that no action be taken, and this was approved by the Council by 19 votes to 9 on April 8th. In 1909, the question was again considered and a Health Visitor was appointed She commenced her duties on February 1st, 1910, in a part of the Borough where the infantile mortality was abnormally high; in 1910 it was 198 per 1,000 births. The fact that the infantile mortality was higher in this part of the Limehouse district can be readily understood when it is remembered that there is a larger number of females working in factories residing here than in any other part of the Borough. In June, 1912, the area was extended to include the Parish of Limehouse and the Hamlet of Ratcliffe, and she works in association with a voluntary Health Visitor appointed by the Stepney School for Mothers, Commercial Road, who devotes her attention to Shadwell. The Health Visitor and the School for Mothers have the same object, namely, to teach mothers the art of rearing healthy babies, and so to lessen the high mortality among infants and improve the health of those who survive. The activities of the School, centre round the infant consultations, which are held every Tuesday afternoon throughout the year. Two medical men are in regular 67 attendance at these consultations, each mother has a personal interview with the doctor, and each infant is weighed. In special cases, when ordered by the Medical Officer, dinners are given to expectant and nursing mothers. During the summer months special instruction is given, both orally and by leaflets, on Summer Diarrhoea and how to prevent it. Dinners are also provided by the Stepney Invalid Kitchen, on the recommendation of the Health Visitor. The area comprised in the Limehouse district, viz., the Parishes of Limehouse and Shadwell and the Hamlet of Ratcliffe is thus served by two Health Visitors (one being voluntary), the Mother's Welcome and the Stepney Invalid Kitchen. The duties of the Health Visitor may be classified as follows:— (1) To advise expectant mothers on the management of their health and as to the influence of ante-natal conditions on their infants. (2) To follow up the notification of births, and to visit the homes when doctor and midwife have ceased to attend. (3) To note the conditions of ignorant and improper feeding and to take steps to correct these evils. (4) To give advice on the proper feeding of infants ; to warn mothers against premature weaning; to inculcate in particular, the importance of breast feeding until the teeth appear, and, above all, of the avoidance of the use of foul feeding bottles. (5) To promote and encourage the practice of weighing infants regularly and to instruct in, or remind mothers of the simple rules of hygiene in relation to the home and its inmates, and otherwise to assist in preventing the spread of such diseases as Measles, Whooping Cough, &c. (6) To promote a knowledge of the value of fresh air and of keeping windows open day and night. (7) To note any sanitary or foul conditions in any of the homes visited where infants have recently been born, and to report such matters to the Medical Officer of Health. (8) To visit and report on all cases in the Borough communicated by the Almoners of the London Hospital. (9) To keep a systematic record of cases. A little over one-third of the total deaths occur in the first month of life. It is generally acknowledged that three-fourths of the infants bom throughout the E 68 country are healthy at birth. Among the causes of this high mortality in children during the first year of life are:— (a) Want of breast milk. (b) Want of a pure supply of milk in cases in which artificial feeding must be resorted to. (c) Breathing foul air. (d) Insufficient warmth. (e) Want of cleanliness and sleep. Among the contributory factors are:— Improper housing conditions. Poverty. Condition of work. Drink. Ante-natal conditions. There has been a marked decrease in the infantile mortality during the last 20 years or so in each district in the Borough, but nowhere so marked, perhaps as in the Limehouse district, where it was above 200 per 1,000 births in the two quinquennial periods, 1895-1899 and 1900-1904. Average infantile mortality for five year periods from 1890-1909:— Limehouse. St. George's. Mile End. Whitechapel. Whole Borough. 1890-1894 186 197 175 163 178 1895-1899 204 187 166 147 168 1900-1904 201 162 148 135 157 1905-1909 153 142 120 112 129 1910 137 120 100 110 113 1911 189 170 138 106 149 1912 126 128 100 96 110 1913 130 117 104 102 112 For a few years previous to 1911, the marked decrease in infantile mortality was probably due to such favourable conditions as cool and wet summers which we experienced. These conditions, however, cannot be held responsible for the gradual decline during the last 22 years. It must be due to improved sanitary conditions and an awakening to the fact that innumerable and unnecessary deaths were occurring from year to year. In a part of the Limehouse district where the Health Visitor first commenced, as already stated, there is a larger number of females working in factories than in any other part of the. Borough. The mothers, soon after confinement, return to work, and leave the baby in the custody of one of their other children, which renders hand-feeding inevitable. Human milk is the best food, and no other milk can be made into a perfect food for infants. In infant feeding nature is superior to art, and the artificial food should approximate as closely as possible to this ideal. 69 Premature weaning and the want of proper attention in the care of the infants seem to be the main factor in producing the high infantile mortality in the Limehouse district. Contrast this with the comparatively low infantile mortality in the Whitechapel district, where the Jewish population is greater relatively than in any other part of the Borough. The Jewish mother suckles her baby, and if she assists her husband at all in his employment, it is done by means of home work. The disease which one would expect to be more directly caused by the improper feeding of infants than by any other disease is Summer Diarrhoea. Diarrhoea is less fatal in breast-fed children than in hand-fed children. The death-rate of infants under one year of age from diarrhoea was three times higher in the Limehouse district than in the Whitechapel district in the last three years. Measles is another disease which owes its fatality mainly to neglect. Very few deaths are due to measles per se. The deaths generally are caused by complications, such as broncho-pneumonia, due to catching cold while suffering from Measles. The death-rate from Measles was much higher in the Limehouse district than in the Whitechapel district during the last three years. The same remark holds good to a much greater extent with regard to Whooping Cough. These facts are worthy of consideration, especially when the number of cases of notifiable diseases was almost as high in the Whitechapel district as in the Limehouse district. Nine infant consultation centres have recently been started in St. George's and Wapping under the auspices of the St. George-in-the-East and Wapping Infant Care Committee. One voluntary and two paid doctors attend at these places to give advice. A large number of infants are brought by the mothers to see the doctors. It is felt, however, that unless the homes are visited the better dressed babies only are brought to the consultation rooms. A Health Visitor would be of great help in visiting the homes, and in addition to giving advice to the mothers, induce those who really need it to seek medical advice. In connection with this matter, it may be of interest to quote the following paragraph from the circular letter of the Local Government Board of July 25th, 1913, on infantile mortality. It reminds the Council " of the importance of taking all practicable measures for the prevention of Epidemic Diarrhoea and other diseases of infants, and of promoting hygienic conditions in the feeding of infants. In many districts much useful voluntary work is done in relation to the welfare of mothers, infants and young children by such institutions, as infant consultations, classes for mothers, health societies, guilds of help, dinners for pregnant and nursing women, funds for supplying milk, fresh or dried, for infants and nursing mothers, either gratuitously or at cost price and by county and district nursing associations. Such work loses much of its value if it is not properly co-ordinated with the work of the local sanitary authority, and the Board suggest that the Medical Officer of Health should endeavour to secure this co-ordination in carrying out his duties." E 2 70 APPOINTMENT OF FEMALE HEALTH VISITORS. Name of District. Population. Number of Health Visitors. When first Appointed. Any subsequent increase in the number of Health Visitors and dates thereof. In addition to duties in connection with Infantile Mortality has she any duties in connection with— (a) Tuberculosis; (b) Workshops, &c. Whether the ap. pointment of a Health Visitor is a success. Battersea 167,793 3 1907 April, 1909 (a) Yes (b) No Mainly in connection with Infantile Mortality Yes Bermondsey 125,200 2 January, 1909 January, 1912 (a) Yes (b) No Yes Bethnal Green 127,824 1 1906 No (a) No (b) No Entirely in connection with Infantile Mortality Yes Camberwell 263,636 No One Female Sanitary Inspector 1901 (a) No (b) Yes Chelsea 65,397 1 1904 No (a) Yes (b) Yes Yes City of London 17,916 3 1902 1904 & 1909 (a) No (b) Yes Partially in connection with Infantile Mortality Yes Deptford Finsbury 109,496 86,000 3 2 January, 1910 1909 July. 1912 January, 1913 Temporary Assistants from time to time (a) Yes (b) No Not entirely in connection with Infantile Mortality (a) No (b) No Yes Yes Fulham 155,000 1 1903 — (a) Yes (b) Yes Yes Greenwich 96,015 No Only Female Sanitary Inspector 1910 Under consideration now (a) No (b) Yes Depends upon the tactfulness of the person appointed 71 APPOINTMENT OF FEMALE HEALTH VISITORS-(contnued). Name of District. Population. Number of Health Visitors. When first Appointed. Any subsequent increase in the number of Health Visitors and dates thereof. In addition to duties in connection with Infantile Mortality has she any duties in connection with:— (a) Tuberculosis; (ft) Workshops, &c. Whether the appointment of a Health Visitor is a success. Hackney 223,022 1 October, 1910 — (a) No (b) No Yes Hammersmith 123.745 1 1906 — (a) No (b) No No Hampstead 86,346 2 1902 1908 (a) Yes (b) Yes Yes Holborn 49,357 1 1903 (a) Yes (b) Yes Yes Islington 325,585 No Two Female Sanitary Inspectors 1895 1906 (a) No (b) Yes Kensington 171,700 2 1905 1907 (a) Yes (b) No Yes Lewisham 168,822 3 1904 1905 & 1913 (a) Yes (b) No Depends on the individual Paddington 144,000 2 1902 — (a) Yes (b) Not now Yes Poplar 56,035 2 1908 1911 (a) No (b) No Yes St. Marylebone 114,532 3 1900 1907 & 1910 (a) Yes (b) Yes Yes St. Pancras 214,330 3 1896 1904 & 1912 (a) Yes (b) Yes Yes Shoreditch 111,390 2 1909 1912 (a) Yes (b) No Yes Southwark 188,487 1 13 years — (a) No (b) No Yes Stoke Newington 50,581 1 4 years ago — (a) Yes (b) Yes Yes Wandsworth 327,386 1 and two Female Sanitary Inspectors 1902 1905 & 1913 (a) Yes (b) No Yes Westminster 154,810 2 and two female Inspectors 1903 1907 & 1912 (a) Yes (b) Yes Yes Woolwich 123,311 2 1904 1906 (a) Yes (b) Yes Yes 72 In Great Britain there are 470 salaried Health Visitors actually at work in 195 different localities ; of these 350 are paid entirely out of the rates, 38 partly out of the rates, while 82 others draw a salary from some philanthropic organisation co-operating with the local authority. I append a table showing the number of health visitors employed in the other metropolitan districts, some of the suburban districts and the principal provincial towns. Table taken from the report of the Medical Officer of the Local Government Board on Infantile Mortality, showing variations of Infant Mortality, 1907-10, in the different Metropolitan Boroughs. 73 Report on the work of the Health Visitor. During the year 1913 the number of births visited by the Council's Health Visitor was 1,430. Of this number 37 died, and the parents of 4 removed before the first visit was made. In 13 instances an incorrect address had been given. 304 cases were attended by doctors ; the remainder were attended bymidwives. The majority of the infants were breast-fed entirely at the time of the first visit of the Health Visitor, but it was found at subsequent visits that artificial feeding, either partly or entirely, was resorted to after the first month or so. At the first visit 1,210 infants were breast-fed, 62 were artificially fed, and 77 were partly breast and partly bottle-fed. Nestle's milk was more generally used than cow's milk. Boiled bread, teabiscuits, and oatmeal were occasionally given to supplement breast-feeding in spite of advice to the contrary. 272 were first-born children; the mothers were more anxious to learn and appreciated the advice given than the mothers who had several children. Instruction as to the necessity for cleanliness, fresh air, suitable clothing and regularity of feeding was given. Where feeding-bottles were used the boat-shape bottle was recommended as being easier to cleanse than one with a long tube. 176 infants died before they were a year old, which is equivalent to an infantile mortality of 123 per 1,000 births. If the 37 deaths of infants who died immediately after birth and before the first visit was made were excluded, the infantile mortality for the area would be 97 per 1,000 births. Infantile mortality in the area where the Health Visitor works, together with that for the Limehouse District and for the whole Borough:— Health Visitor's Area. Limehouse District. Whole Borough. 1904 212 208 158 1905 145 163 142 1906 178 168 136 1907 142 131 119 1908 190 171 130 1909 114 133 118 1910 198 137 113 1911 165 189 129 1912 126 110 1913 123 130 112 Premature Births, Pneumonia, Diarrhoea and Convulsions were responsible for most of the deaths. 74 221 mothers were employed in factories, &c., and 145 were engaged as outworkers. In the above cases where the mothers worked away from home, eighteen only worked to within four weeks of the birth, work being resumed in four to eight weeks after. When the mother resumes work at the factory the child is looked after by a woman in the same house, or taken to a neighbour to be nursed. These women keep the babies clean and give them the bottle during the day. They unfortunately give " bits of everything going " to even quite young infants. Where the mothers are employed at their own homes they frequently work to within a few hours of confinement, and resume work fourteen days later. 105 premises in various parts of the Borough were visited at the request of the Almoners of the London Hospital, and a report sent on the home conditions. 41 insanitary premises were referred to the Sanitary Inspectors. 4 cases of neglect of children were reported to the National Society for the Prevention of Cruelty to Children. 55 newly-confined mothers were recommended for extra nourishment to the Stepney Invalid Kitchen, and granted in every case. 1,670 re-visits were made. The infants were found to be fairly well cared for. In the instances where neglect takes place it is usually owing to the necessity of the mother having to earn the money for the next meal. The mothers do their best to carry out the instructions given, and some improvement is shown. EMPLOYED AT FACTORIES, &c. 221 mothers were employed away from home at the following trades:— Rope-making 42 Tent and Bag-making 33 Rag Sorting 21 Paper Sorting 12 Tin-plate Machining 21 Confectionery and Jam 42 Fish Curing 9 Bottle Washing 6 Laundries 9 Cigar Making 5 Office Cleaning 10 Hawking 8 Waitresses 3 75 Time of ceasing to work before confinement:— Three months and over 102 Two months 55 One month 46 Under one month 18 145 mothers employed at home at the following:— Tailoring 82 Laundry-work 18 Needlework 8 Card-box Making 5 Brush Making 6 Shopkeeping 26 17 worked to three months before confinement. 29 worked to two months before confinement. 37 worked to one month before confinement. 28 worked to two weeks before confinement. 34 worked to one week and under before confinement. TABLE SHOWING THE FEEDING OF INFANTS AT DIFFERENT PERIODS DURING THE FIRST YEAR OF INFANCY. Nature of Food. Weeks. Months. 1 2 3 4 2 3 4 5 6 7 8 9 10 11 12 Breast only 700 698 661 616 581 516 472 399 337 176 106 39 — - — Breast and Artificial Food. — 2 34 36 70 76 90 143 149 270 317 306 305 260 248 Artificial Food only — — 5 46 46 94 113 126 168 198 208 276 302 342 349 Dead at — — — 2 1 2 3 2 1 2 - 1 1 1 2 Removed at — — — — — 9 8 5 13 8 13 9 13 4 3 Dead and Removed Carried forward.) — — — — 2 3 14 25 32 46 56 69 79 93 98 Total 700 700 700 700 700 700 700 700 700 700 700 700 700 700 700 77 Old Age. 172 deaths were attributable to Old Age. This corresponds to a death rate of 62 per 1,000 of the population. 61 belonged to the Limehouse District, or at the rate of 1.15 per 1,000. 27 belonged to St. George-in-the-East, or at the rate of .58 per 1,000. 61 belonged to Mile End Old Town, or at the rate of -54 per 1,000. 23 belonged to the Whitechapel District, or at the rate of .35 per 1,000. Table showing the ages of persons who died over 65 years of age and the localities:— Limehouse St. Georges Mile End. Whitechapel Total Between 65 and 70 years of age . 53 39 120 70 282 ,, 70 ,, 75 ,, 61 35 115 60 271 ,, 75 „ 80 ,, 46 29 88 41 204 „ 80 „ 85 „ 23 15 44 15 97 ,, 85 „ 90 ,, 13 5 18 11 47 Over 90 years of age 3 — 10 1 14 199 123 395 198 915 The deaths of persons over 65 years of age occurred as follows:- At their own homes. In Lunatic Asylums. In other Institutions. Total. Limehouse District 88 20 91 199 St. George-in-the East 53 9 61 123 Mile End Old Town 212 29 154 395 Whitechapel District 71 18 109 198 424 76 415 915 Alcoholism. The number of deaths due to Alcoholism and Cirrhosis of the Liver was 30, or 4 less than in the previous year. 7 belonged to the Limehouse District, or at the rate of .13 per 1,000 of the population. 6 belonged to St. George-in-the-East, or at the rate of 12 per 1,000 of the population. 9 belonged to Mile End Old Town, or at the .rate of '08 per 1,000 of the population. 8 belonged to the Whitechapel District, or at the rate of .12 per 1,000 of the population. The death rate throughout the whole Borough was .10 per 1,000 of the population. 78 Cancer. The deaths due to Cancer were 236, or 4 more than in the previous year. This corresponds to a death rate of .85 per 1,000 of the population. 45 belonged to the Limehouse District, or at the rate of '85 per 1,000 of the population. 39 belonged to St. George-in-the-East, or at the rate of .83 per 1,000 of the population. 91 belonged to Mile End Old Town, or at the rate of .82 per 1,000 of the population. 61 belonged to the Whitechapel District, or at the rate of .93 per 1,000 of the population. Glanders. Under the London (Notification of Glanders) Order, 1907, the Veterinary Inspector of the London County Council reported in accordance with the provisions of that Order, the existence of Glanders in 14 stables in the borough in which 32 horses were affected. Inhabited House Duty. 8 applications were received for certificates under the Inland Revenue Act, 1903, for the purpose of securing exemption from Inhabited House Duty. Certificates were granted for 56 tenements, and refused for 14 tenements. 5 certificates were also granted with regard to lodging houses in accordance with the provisions of the Housing, Town Planning, &c., Act, 1909. Verminous Persons. 1,784 verminous persons were cleansed during the year and their clothing disinfected, 1,769 men, 11 women, 1 boy and 3 girls. Articles Destroyed on account of their condition and at the request of the Owners. Mattresses 53 Sheets 4 Beds 29 Quilts 3 Pillows 18 Coats 2 Pillow cases 5 Sack of tailors' cuttings 1 Palliasses 20 290 Bolsters 6 Sundries 147 Cushions 2 Rooms Disinfected. 4,421 rooms were disinfected during the year, 2,322 having been occupied by persons suffering from notifiable diseases, and 857 by consumptives. 1,242 rooms which were in a verminous condition, were fumigated with sulphur, and the papers stripped from the walls. Scabies. A large number of patients attend at the London Hospital suffering from Scabies, and for whom sulphur baths are provided. The bed and bedding of 419 patients were disinfected during the year in order to obviate as far as possible re-infection after treatment. FOR THE YEAR 1913. ARTICLES DISINFECTED. January. February. March. April. May. June. July. August. September October. November December. Totals. Beds 161 163 151 148 174 192 159 171 208 231 184 156 2,098 Mattresses 65 55 64 40 61 87 57 56 44 79 39 68 716 Palliasses 73 81 65 57 63 73 60 53 73 92 58 74 822 Bolsters 81 112 87 95 74 68 69 73 89 91 79 68 986 Pillows 367 363 269 357 392 385 298 480 454 498 444 395 4,702 Sheets 183 174 132 187 194 178 192 189 193 258 190 158 2,228 Quilts 103 166 84 77 131 127 108 111 149 179 102 126 1,463 Blankets 259 105 111 149 176 183 144 157 197 195 193 136 2,008 Vests 53 40 29 41 32 46 26 24 32 27 30 35 415 Trousers 36 28 39 32 26 30 36 37 48 44 55 31 442 Cushions 60' 39 48 49 58 56 47 38 44 55 47 51 592 Coats 291 54 45 51 37 39 51 33 31 37 39 35 743 Sundries 1,380 1,818 1,661 1,690 2,021 1,088 991 666 658 895 1,051 1,054 14,973 TOTALS 3,112 3,199 2,785 2,973 3,439 2,555 2,238 2,088 2,220 2,681 2,511 2,387 32,188 Articles of Clothing in a Verminous Condition 14,286 Total 46,474 79 80 Mortuary and Coroner's Court. The number of bodies deposited in the mortuary during the year was 572. Of these 513 were removed by the Coroner, 49 by the police, 2 by relieving officers, 4 at the request of friends of the deceased and 4 on my instructions. Two of the bodies were those of persons who had died from infectious disease and were placed in the infectious mortuary. 90 bodies were placed in the Jewish mortuary, and 30 were " watched " in accordance with the Jewish custom. 562 inquests were held in the Coroner's Court and 97 post-mortem examinations were made. Canal Boats Acts 1877 and 1884. Pursuant to the Third Section of the Canal Boats Act, 1884, I have to report, with regard to the execution of such Acts and of the Regulations made thereunder and as to the steps taken during the year 1913, to give effect to the provisions of the said Acts and Regulations, viz.:— (1) Canal boats coming within the district are inspected by a Sanitary Inspector, who receives a sum of £10 per annum for the performance of this duty. His inspection is irrespective of the examination of boats made by the Examining Officer prior to their registration. (2) The number of Boats inspected in 1913 was 68, and the condition of the Boats and their occupants, as regards the matters dealt with in the Acts and Regulations, was very good. (3) Infringements of Acts and Regulations were discovered as follows:— (a) Registration—Nil. (b) Notification of change of Master—Nil. (c) Certificates—Nil. (d) Marking—Nil. (e) Overcrowding—Nil. (/) Separation of Sexes—Nil. (g) Cleanliness—Nil. (h) Ventilation—Nil. (t) Painting—Nil. (j) Provision of Water Cask—Nil. (k) Removal of Bilge Water—Nil. (I) Notification of Infectious Diseases—Nil. (m) Admittance of Inspector—Nil. (4) No legal proceedings were taken. (5) No infringements were found. (6) No cases of Infectious Disease occurred. 81 (7) No Boats were detained for Cleansing and Disinfection. (8) The total number of Boats on the Register on the 31st December, 1913:— (a) Number of Boats believed to be in use or available was 13 (b) Number of Boats that cannot be traced Nil. (9) No Boats were Registered during 1913. Unsound Food Destroyed During the Year 1913. The following -foodstuffs were destroyed during the year under the Unsound Food Series and the Public Health (Foreign Meat) Regulations, 1908:— At the Wharves. Tons. Cwts Ors. Lbs. Fresh Meat 3 Pigs Carcases — 1 0 5 113 Rabbits — 2 3 13 Preserved Meat 40,104 Tins of Beef 86 7 0 13 2,866 „ „ Rabbits 2 11 0 24 461 „ „ Ox Tongues — 13 2 25 Fresh Fruit and Vegetables 3,861 Crates of Bananas 100 9 1 0 21 Cases of Melons — 18 3 0 50 Bags of Onions 2 10 0 0 3 Cases of Oranges — 4 2 0 430 Crates of Plums 3 8 2 0 5 Boxes of Tomatoes — — 2 14 Dried Fruits 220 Bags of Peaches 14 0 0 0 92 Boxes of Dried Plums 1 3 1 0 Preserved Fruit and Vegetables 877 Tins of Apples 2 5 1 6 ]2 „ „ Apricots — — 1 2 456 „ „ Cherries — 4 0 8 7,698 „ „ Assorted Fruits 8 4 2 23 87 „ ,, Peaches — 2 1 9 241 „ „ Pears — 5 1 15 725 „ „ Peas — 6 1 25 54,510 „ „ Pineapple 50 5 1 10 1,832 „ „ Fruit Pulp 8 10 0 27 777 „ „ Tomatoes — 14 0 13 Preserved Fish 10,785 ,, „ Crayfish 2 18 1 13 1,328 „ „ Lobster — 6 3 27 11,576 „ „ Salmon 5 5 0 21 318 „ „ Sardines — — 3 23 Sundries 2,830 „ „ Soups 1 17 1 23 Total 294 18 0 3 82 Diseased Meat and Offal destroyed, from the Slaughter-houses and Offalshops. under the supervision of Mr. H. Abson, the Food Inspector:— Tons. Cwts Qrs Lbs. 14 Sheeps Carcases — 7 0 16 11 Calves Carcases — 10 2 21 201 Sets of Bullocks Lungs — 16 3 22 456 Sets of Sheeps Lungs — 6 1 10 11 Sets of Calves Lungs — — 1 0 1 Set of Goats Lungs — — — 1 245 Sheeps Livers — 4 2 14 13 Bullocks Livers — 1 3 2 9 Calves Livers — — 1 10 20 Bullocks Heads — 5 0 27 10 Udders (Cows) — 1 0 17 2 Forequarters of Mutton — — 1 14 1 Hindquarter of Mutton — — — 27 12 Breasts of Mutton — — 1 12 2 Breasts of Veal — — 1 10 2 Shoulders of Veal — — — 16 4 Ox Cheeks — — — 22 4 Sheeps Kidneys — — — 1 2 Sheeps Spleens Total 2 16 0 1 19 Unsound Food seized or surrendered to the District Sanitary Inspectors Tons. Cwts Ors Lbs. Apples, 42 Packages 1 6 2 4 Bananas — — — 20 Celery — — — 20 Eggs, 10,492 — 7 0 7 Eggs, liquid — — — 11 Fish, 6 boxes — 4 2 8 Fruits (Canned) 1 0 0 0 Kippers, 12 boxes — — 2 16 Milk (Condensed), 1,042 tins — 8 2 24 Mutton — 4 2 10 Oranges, 3 cases — 4 0 0 Pears, 60 Packages 1 3 2 23 Pineapple, 48 tins — — 1 22 Plums, 369 Packages 3 12 2 0 Potatoes, 375 bags 17 3 0 14 Strawberries, 13 packages — 1 1 12 Tomato Puree, 12 cases — 18 0 0 Tomatoes, 38 Packages 1 5 0 18 Total 28 0 3 13 83 Police Court Proceeding's for selling Unsound Food. On January 21st, 1913, Mr. Abraham Baronsky, of 56, Hessel Street, was summoned at the Thames Police Court for having exposed for sale 35 eggs, which were unsound and unfit for human food. He elected to be tried by a jury and the case was remanded to the Sessions. The Jury found him guilty on February 6th, but the Judge, instead of imposing a fine, bound him over to come up for judgment if called upon, and placed him under the supervision of an officer of the Court. On October 13th, 1913, proceedings were taken against the Alexandra Trust for selling to the London County Council for the breakfasts of necessitous children, bread and dripping which were unsound, unwholesome and unfit for human consumption. On Thursday morning, July 17th, after receiving a communication from the chairman of the Infant Care Committee, I, together with Sanitary Inspector Johnson, visited the Salvation Army Hall, 765, Commercial Road, which is used for the feeding of necessitous school children. I saw 90 slices of bread and dripping, weighing about 11¼ lbs., which had been delivered that morning. On examining them I found that 88 were unfit for food, the bread being sour and the dripping mouldy. They were seized and taken before the Magistrate at the Thames Police Court, who made an order that they should be destroyed. I had previously communicated with the Manager of the Trust. The Manager was present at the Court when the food was examined by the Magistrate and he made no objection to their being destroyed. He admitted they were quite unfit for human food. At the hearing of the summons, Counsel for the defence pleaded guilty, and no witnesses were therefore heard. It was stated that the Trust had to cut some 20,000 slices a day, and with that exception the food had always been sent out in good condition. Owing to the weather the gravy mixed with the dripping got bad quickly, but steps had been taken effectually to prevent a recurrence of such a tiling. The Magistrate said that he agreed with the Counsel for the defence that the unsoundness arose in a very short time. He considered he would be doing justice by ordering the defendant to pay 44s. costs. On October 14th, 1913, Mr. Solomon Hyman, of 12, Maplin Street, was summoned for exposing and depositing for the purpose of sale 809 eggs, which were unsound and unfit for food. He was fined £25 with £2 6s. costs, or 1 month in default. On October 23rd, 1913, Mr. Joseph Goodman, of 12, Montague Place, Whitechapel, was summoned for exposing for sale a quantity of unsound plums and pears. He was fined £5 with 23s. costs. On November 27th, 1913, Mr. Nathan Reich, of 12, Bedford Street, was summoned for selling 580 eggs which were unsound and unfit for the food of man. He was fined £25, with 63s. costs. F 84 On November 27th, 1913, Mr. Alec. Benjamin, of 77, Plumbers Row, was summoned for having in his possession 77 eggs and about 5 quarts of liquid eggs in preparation for sale for the food of man. He was fined £10 with 23s. costs. General Sanitary Work. In the Sanitary Inspectors' Report table will be found the record of the work carried out by each Inspector during the year, together with its nature. 45,665 houses were inspected, 5,678 being the result of house to house visitation. 15,536 intimation notices were served for the abatement of various nuisances, as well as 7,871 statutory notices. 65,110 were made to supervise the abatement of the nuisances complained of. Police Court proceedings were taken in 36 instances where statutory notices were not complied with. This number does not include proceedings under the Food and Drugs Acts. 8,200 drains were tested with smoke or water, and 840 were re-tested. 2,231 drains were either constructed or re-constructed, cleansed or repaired, and 860 were trapped. 320 new soil pipes were fixed and ventilated ; 1,218 new closet pans and traps were fixed, 2,780 closets were either cleansed and repaired or provided with additional light and ventilation; 1,781 water-closets were provided with proper flushing apparatus. 3,040 yards, forecourts and areas were paved or repaired. Notices were served to provide 2,941 sanitary dust receptacles, 20 manure receptacles were provided; 744 offensive accumulations were removed from the rear of dwelling houses. 237 houses were ventilated underneath the lower floor. 47 underground rooms, which were illegally occupied, were discontinued from being used as such. 59 notices were served for the abatement of smoke nuisances. 359 visits to bakehouses were made, and every bakehouse was cleansed twice during the year. SANITARY INSPECTORS' REPORT. TWAITS. JOHNSON. WRACK. COOK. PAVITT. CROOK. MILLS. SHEPHERD. WHITE. FLINT. SIMPSON. QUAINTRELL. STILES. DEE. WATERMAN. HARRIS. BOTTOMLEY. TOTALS. Number of Inspections— House to house 389 218 458 298 357 235 245 285 453 709 532 174 456 477 392 .. .. 5678 Miscellaneous 2485 1751 1312 2221 1947 1440 2166 2030 1878 1648 1608 1606 1637 1300 1905 1806 1794 30534 Complaints 221 214 421 399 289 314 327 238 205 257 284 297 479 123 144 252 78 4542 Infectious diseases 202 120 163 203 158 171 148 53 70 55 158 141 83 42 90 .. .. 1857 Visits to Cases of Consumption 126 91 153 456 480 112 220 183 355 204 109 96 210 174 85 .. .. 3054 Intimations served 1172 961 763 861 985 696 1224 909 729 684 1080 622 1404 791 725 955 995 15536 Statutory notices served 864 638 412 495 694 453 752 150 403 301 772 494 557 542 106 96 142 7871 Houses re-visited 4246 5061 3730 3506 4434 3192 2926 3857 3720 2748 4383 2804 4624 3406 4576 3724 4173 65110 Summonses taken out under the Public Health (London) Act, 1891 2 1 2 15 2 15 1 1 2 3 1 5 3 3 56 Samples taken under the Food & Drugs Acts .. 101 72 110 93 100 100 102 75 72 72 110 72 72 42 72 .. .. 1265 Summonses ,, ,, ,, 8 4 2 6 12 15 4 8 1 3 6 4 5 3 4 .. .. 85 Houses or parts of houses cleansed 204 326 150 352 83 227 378 228 300 240 350 185 256 386 341 426 422 4854 Water supply to houses re-instated 3 17 4 7 3 2 1 2 5 2 10 6 8 3 22 5 .. 100 Drains constructed and reconstructed 150 42 74 48 100 60 28 23 24 37 52 49 23 23 52 .. .. 785 „ cleansed and repaired 68 124 141 147 158 100 77 46 72 23 102 93 88 49 102 45 11 1446 „ trapped 185 87 137 61 3 79 156 47 23 7 15 11 19 6 24 .. .. 860 New soil pipes fixed and ventilated 10 60 37 15 8 70 25 2 2 6 21 3 13 15 33 .. .. 320 New closet pans and traps fixed 188 109 146 71 67 10 102 75 45 5 116 78 30 57 106 13 .. 1218 Closets provided with a water supply and flushing apparatus 64 150 179 142 46 75 205 58 52 9 150 43 162 139 197 95 15 1781 Closets provided with light and ventilation 22 42 8 6 2 6 •• 3 3 1 •• 2 18 25 .. .. 138 ,, cleansed and repaired 50 135 189 161 35 136 247 238 55 92 111 95 160 266 171 371 130 2642 Yards cleansed, repaved, or paving repaired 270 124 95 133 163 115 186 92 130 106 155 132 179 257 147 252 105 2641 "Wash-houses, forecourts, areas, &c., paved 52 66 40 21 20 12 19 •• 31 6 9 34 21 21 32 4 11 399 Sanitary dust receptacles provided 436 309 127 47 304 84 172 291 42 26 307 183 88 104 155 76 130 2941 Sink, bath, and lavatory pipes and rain-water pipes disconnected 119 37 13 31 8 3 27 7 6 •• 52 4 1 33 34 •• •• 375 Houses ventilated under lower floor 129 7 •• 13 23 .. 5 3 12 .. 5 6 6 9 11 •• •• 237 Miscellaneous repairs, viz. : roofs, floors, gutters, &c. 214 587 224 358 253 206 159 218 397 316 289 304 706 273 326 450 369 5649 Overcrowding in dwellings abated 10 5 8 37 13 8 51 23 29 30 31 5 62 10 14 60 91 487 Illegal occupation of underground rooms discontinued 10 •• 1 3 •• 6 7 •• •• 7 •• •• 4 2 1 5 1 47 Manure receptacles provided or reconstructed 3 2 •• 2 3 •• 1 •• •• 1 2 2 1 20 Offensive accumulations removed 13 5 165 71 10 6 199 32 10 12 17 56 35 35 18 14 20 744 Bakehouses inspected 32 31 24 22 22 36 30 24 10 22 24 28 32 8 14 359 ,, cleansed 32 31 24 22 22 36 30 24 10 22 24 28 32 8 14 359 Smoke nuisances abated 1 3 15 3 2 1 1 7 14 2 2 1 4 3 59 Animals kept so as to constitute a nuisance, removed 3 6 2 17 9 13 7 2 8 7 2 6 3 10 4 6 105 Damp walls remedied 24 78 8 21 44 19 59 19 30 21 11 28 76 J05 70 23 27 663 Cisterns cleansed and covered 3 1 2 1 12 1 25 8 2 4 2 •• •• 5 22 18 16 122 Urinals fixed •• 14 3 •• 1 .. 1 •• •• 2 3 •• 5 •• •• •• •• 29 Open fires in yards abolished •• •• •• 5 1 10 14 6 •• 3 •• •• 6 •• •• •• •• 45 Canal Boats inspected •• 68 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 68 Areas and stables paved and drained 56 •• •• 4 •• 2 2 •• •• 3 4 6 •• 4 •• •• •• 81 Occupation of shed as dwelling discontinued •• •• •• •• 1 •• •• •• •• •• •• •• •• •• •• •• •• 1 Light and ventilation provided to rooms 1 •• •• •• 2 22 5 1 2 10 •• 7 l 5 35 29 5 125 (Face page 84) 85 4,854 notices were served to have houses cleansed, and water supply was reinstated to 100 houses. 375 sink, bath or rain-water pipes, which were communicating directly with the drain, were disconnected. 5,649 miscellaneous repairs to roofs, floors, gutters, etc., were made as the result of notices served. 663 damp walls were remedied and 125 rooms were provided with additional light and ventilation. The nuisance due to the keeping of too many animals in back yards was abated on 105 premises. Overcrowding. 19,131 inspections were specially made for the purpose of detecting overcrowding, 487 living rooms were found to be overcrowded, and 521 intimation notices were served for its abatement, as well as 125 statutory notices. Policecourt proceedings were necessary in five instances. Police Court Proceedings for the abatement of overcrowding. On February 15th, 1913, Mr. Jeremiah Santree was summoned for causing overcrowding at 13, John's Hill. The case was adjourned to February 24th, to enable him to abate the nuisance, but as there was no alteration on that date he was fined 40s., in default 20 days. On August 1st, 1913, Mr. Jacob Acabodka and Mr. Solomon Acabodka, of 114, Oxford Street, were summoned for permitting overcrowding in a wooden shed at the rear of their house. They were fined 10s. with 7s. costs each. On December 11th, 1913, Miss Elsie Vernon, of 5, Anns Place, Wentworth Street, was summoned for causing overcrowding of the premises. At the hearing of the summons she pleaded poverty of circumstances, and the Magistrate adjourned the case, referring her to the Court Missionary. At the resumed hearing on December 18th, the Magistrate dismissed the case putting her on probation. On December 12th, 1913, Mrs. Rachael Wyman, of 2, Ely Place, Finch Street, was summoned for permitting the first floor back room to be overcrowded. An order was made to abate the nuisance within 14 days. 86 Police Court Proceedings under the Public Health (London) Act, 1891. On January 14th, 1913, Mr. J. Webber, of 182 and 183, St. George Street, was summoned for carrying on the business of rubber stripping so as to be a nuisance. He was fined 10s., with 65s. costs. On February 25th, 1913, Mr. B. Paterson, the owner of 114, Oxford Street, was summoned for failing to comply with the Council's notice to abate a nuisance arising from the damp condition of the wall. The work was done at the hearing of the case, and he was fined 1s., with 23s. costs. On March 14th, 1913, Mr. A. Gowler, the owner of 49, Joseph Street, was summoned for failing to provide a proper dust receptacle. He was fined 40s., with 23s. costs. On March 19th, 1913, Mr. R. Button, the owner of 97, Shandy Street, was summoned for not complying with the Council's notice to abate a nuisance due to the foul and offensive condition of the drain. An order to abate the nuisance was made, with 25s. costs On March 28th, 1913, the owner of 122, Oxford Street, was summoned for failing to comply with a notice to abate a nuisance arising from dampness in walls and from defective floor of basement front room. An order was made to abate the nuisance within 28 days, and he was fined £2, with 46s. costs. On May 13th, 1913, James Pealing, the owner and occupier of 31a, Smith Street was summoned for failing to comply with the Council's notice to provide a proper and sufficient supply of water. A closing order was granted, with 27s. costs. On July 19th, 1913, Mr. Rosenthal, of 14, Hanbury Street, was summoned for failing to abate a nuisance arising from the dirty condition of the water closet. As the necessary work was completed before the hearing, the summons was withdrawn on payment of £2 4s. costs. On July 19th, 1913, the owner of Newman's Buildings, Leyden Street, was summoned for non-compliance with notice to abate a nuisance due to the water closet being without a supply of water for flashing purposes. The work was completed before the hearing, and the summons was withdrawn on payment of £2 4s. costs. On August 20th, 1913, Mr. Jacob Rubinstein, of 21, Liverpool Street, E.C., was summoned for not complying with the Council's notice to remedy a defective drain at 1, Solander Street. An order was made to do the work in 14 days, with 27s. costs. 87 On August 20th, 1913, Mr. Jacob Rubinstein, of 21, Liverpool Street, E.C., was summoned for not complying with the Council's notice to remedy a defective drain at 2, Solander Street. An order was made to do the work in 14 days, with 6s. costs. On August 20th, 1913, Mr. Jacob Rubinstein, of 21, Liverpool Street, E.C., was summoned for not complying with the Council's notice to remedy a defective drain at 3, Solander Street. An order was made to do the work in 14 days, with 6s. costs. On August 21st, 1913, Messrs. Martineau, Ltd., of King Edward Street, were summoned for allowing black smoke to issue from their chimney on the 29th July. They were fined £2, with 23s. costs. On August 21st, 1913, Messrs. Martineau, Ltd., of King Edward Street, were summoned for allowing black smoke to issue from their chimney on July 31st. They were order to pay 2s. costs. On September 24th, 1913, Mr. Lazarus Mahler, of 51, Brick Lane, was summoned for causing a nuisance from the foul and offensive condition of the fish barrows at his premises. An order was made to abate the nuisance in three days and to prohibit the recurrence of the nuisance, with 27s. costs. On October 9th, 1913, Mr. J. Rubinstein, of 21, Liverpool Street, E.C., was summoned for permitting a nuisance to continue due to one of the water closets being choked at 61, Wilkes Street. The work was done before the hearing of the summons, but he was fined 20s., with 23s. costs. On October 9th, 1913, Mr. J. Rubinstein, of 21, Liverpool Street, E.C., was summoned for failing to provide a sufficient ash-pit at 61, Wilkes Street. The ashpit was provided before the hearing of the summons, but he was fined 20s., with 23s. costs. On October 22nd, 1913, Mrs. R. Specterman, of 320, Commercial Road, was summoned for causing a nuisance caused by the yard paving being defective, and the walls of the front and back basement rooms being damp at 29, Old Montague Street. The yard paving was remedied before the hearing of the summons. With regard to the damp walls, an order was made to abate the nuisance in 14 days, with £3 3s. costs. On October 24th, 1913, Mr. W. F. Laing, was summoned for failing to comply with the Council's notice to abate various nuisances at 12, Trafalgar Square. The work having been done before the hearing of the case, the summons was withdrawn on payment of £2 4s. costs. 88 On November 11th, 1913, Mr. Rutkowski, of Unity Works, Bethnal Green Road, the owner of 11, Mary Ann Street, was summoned for failing to comply with the Council's notice to remedy the defective condition of the roof. The work having been done before the hearing of the case, the summons was withdrawn on payment of £2 4s. costs. On November 11th, 1913, Mr. Rutkowski, of Unity Works, Bethnal Green Road, the owner of 22, Stutfield Street, was summoned for failing to comply with the Council's notice to remedy the defective condition of the roof. The work having been done before the hearing of the case, the summons was withdrawn on payment of £2 4s. costs. On November 13th, 1913, Mr. Lazarus Mahler, of 51, Brick Lane, was summoned for failing to comply with the prohibition order made on September 24th, 1913, with regard to the foul and offensive condition of the fish-barrows. He was fined £5, with 23s. costs. On November 20th, 1913, Mrs. Rose Specterman, of 320, Commercial Road, was summoned for failing to abate a nuisance arising from the damp walls at 19, Kinder Street. An order was made to abate the nuisance within 14 days, with 27s. costs. On December 12th, 1913, Mr. Hyman Pobersky, of 30, Finch Street, was summoned for keeping fowls in the yard so as to be a nuisance. An order was made to abate the nuisance within 21 days and a prohibition order was made, with 21s. costs. On December 12th, 1913, Mr. Hyman Pobersky, of 30, Finch Street, was summoned for keeping fowls at 4, Hope Street, so as to be a nuisance. An order was made to abate the nuisance within 21 days and to prohibit the recurrence of the nuisance, with 21s. costs. On December 17th, 1913, Mrs. Rose Specterman, of 320, Commercial Road, was summoned for disobeying the Magistrate's order made on the 22nd October, 1913, to remedy the damp walls of the front and back basement room at 29, Old Montague Street. She was fined £7, with 44s. costs. Police Court Proceeding's under the London County Council Bye-Laws made under sec. 16 of the Public Health (London) Act, 1891. On July 31st, 1913, Mr. Alfred Martan, of 47, Goding Street, Vauxhall, S.E., was summoned for carrying offensive matter in improper receptacles through the streets. He was fined 40s., with 23s. costs. 89 On September 10th, 1913, Messrs. John Knight, Ltd., of Silvertown, were summoned for carrying offensive matter in improper receptacles through the streets. They were fined £5, with 23s. costs. On September 10th, 1913, Mr. Samuel Hellicar, of 12, Evelyn Road, Silvertown, was summoned for carrying offensive matter during prohibited hours. He was fined 5s., with 23s. costs. On October 3rd, 1913, Messrs. Cockman Bros., Ltd., of Marsh Gate Lane, Stratford, were summoned for conveying offensive matter in improper receptacles through the streets. They were fined £5, with £2 4s. costs. On October 3rd, 1913, Mr. Ernest Norris, of 9, Preston Road, Stratford, was summoned for conveying offensive matter during prohibited hours. He was fined 10s. with 2s. costs. On October 3rd, 1913, Messrs. Cockman Bros., Ltd., of Marsh Gate Lane, Stratford, were summoned for conveying offensive matter in improper receptacles. They were fined £5. On October 3rd, 1913, Mr. John Price, of 762, Old Ford Road, was summoned for conveying offensive matter through the streets during prohibited hours. The defendant having met with a serious accident and was lying dangerously ill, the case was withdrawn. On October 22nd, 1913, The Sheppy Glue & Chemical Works, Ltd., 34, Mark Lane, E.C., were summoned for carrying offensive matter through the streets in improper receptacles. They were fined 40s., with 23s. costs. On October 22nd, 1913, Mr. Herbert William Perfect, of 27, Wallis Road, Hackney Wick, was summoned for conveying offensive matter through the streets during prohibited hours. He was fined 5s., with 2s. costs. On October 24th, 1913, The Sheppy Glue & Chemical Works, Ltd., 34, Mark Lane, E.C., were summoned for carrying offensive matter through the streets in improper receptacles. They were fined 40s., with 23s. costs. On October 24th, 1913, Mr. R. H. Luff, was summoned for conveying offensive matter during prohibited hours. He was ordered to pay 2s. costs. Police Court Proceeding's under the London County Council (General Powers) Act, 1904. On April 18th, 1913, Mr. Davis, of 234, Bishopsgate, E.C., was summoned for failing to comply with the Council's notice to cleanse walls and ceiling of the back bedroom at 7, Montefiore Houses. He was fined 10s. with £2 4s. costs. 90 Proceeding's under the Metropolis Local Management Act, 1862, sec. 61. On February 6th, 1913, Mr. Edward Bell, of Aldgate East Chambers, was summoned for failing to give written notice of his intention to construct a drain at 26, Old Montague Street. He was fined £10 with £10 10s. costs. Police Court Proceedings under the Dairies, Cowsheds and Milkshops Orders. On April 10th, 1913, Mr. Rose, of 63, Commercial Road, was summoned for selling milk without being registered. He was fined 20s. with 23s. costs. On April 10th, 1913, Mr. Weintroub, of 64, Varden Street, was summoned for aiding and abetting Mr. Rose to sell milk when he was not registered. He was fined 20s. with 23s. costs. On June 2nd, 1913, Mrs. Dora Saunders, of 27, Nottingham Place, was summoned for not having her milk utensils in a cleanly condition. She was fined 20s. with 23s. costs. On July 10th, 1913, Mr. Joseph Cohen, of 94a, Christian Street, was summoned for selling milk without being registered. Defendant having absconded, the summons was not served. On July 28th, 1913, Mr. Aaron Rees, of 43, Redman's Road, was summoned for selling milk without being registered. He was fined 40s. with 23s. costs. On September 10th, 1913, Mr. Abraham Wimborne, of 17, South Grove Buildings, was summoned for selling milk without being registered. He was fined 1s. with 23s. costs. On October 23rd, 1913, Mr. Simon Rees, of 65, Brick Lane, was summoned for having a dirty half-pint milk measure in use. He was fined 5s. with 5s. costs Police Court Proceedings under the London County Council (General Powers) Act, 1908. On March 26th, 1913, Mr. Charles Stern, of 61, Wellesley Street, was summoned for not observing due cleanliness in his shop where food is exposed for sale. He was fined 20s. with 23s. costs. 91 On March 26th, 1913, Mr. Benjamin Harbour, of 116, Redman's Road, was summoned for not observing due cleanliness in his shop where food is exposed for sale. He was fined 20s. with 23s. costs. On March 26th, 1913, Mr. Mark Strubel, of 64, Wellesley Street, was summoned for not observing due cleanliness in his shop where food is exposed for sale. He was fined 20s. with 23s. costs. On March 26th, 1913, Mr. Morris Rosenthal, of 283, Oxford Street, was summoned for not observing due cleanliness in his shop where food is exposed for sale. He was fined 20s. with 23s. costs. On March 31st, 1913, Mr. Simon Oberbuch, of 103, Charles Street, was summoned for not observing due cleanliness in his shop where food is exposed for sale. He was fined 20s. with 44s. costs. On April 29th, 1913, Mr. Morris Cohen, of 100, Stepney Green, was summoned for not keeping his shop in a cleanly condition. He was fined 20s. with 23s. costs. On April 30th, 1913, Mr. Abraham Milberg, of 2, Clark Street, was summoned for not observing due cleanliness in his shop where milk is sold. He was fined 20s. with 23s. costs. On April 30th, 1913, Mrs. Fanny Tepperofsky, of 66, Oxford Street, was summoned for not observing due cleanliness on premises where milk is sold. She was fined 20s. with 23s. costs. On July 10th, 1913, Mr. Barnett Weinstock, of 85, Wilkes Street, was summoned for failing to observe due cleanliness of premises where milk is sold. He was fined 20s. with 12s. 6d. costs. On July 10th, 1913, Mrs. Dinna Goldberg, of 14, Spelman Street, was summoned for failing to observe due cleanliness of milkshop premises. She was fined 20s. with 12s. 6d. costs. On July 15th, 1913, Mr. Joseph Lipovitch, of 386, Mile End Road, was summoned for keeping milk and milk utensils on his premises in a dirty condition. The summons was withdrawn on payment of £2 4s. costs, and on defendant giving a written undertaking to discontinue the sale of milk on the premises. On December 4th, 1913, Mr. Cecil Goldberg, of 23, Vallance Road, was summoned for not observing due cleanliness in the bakehouse. He was fined £1 with 23s. costs. 92 Public Analyst's Annual Report, 1913. During the year 1,263 samples were submitted by the Inspectors of the Department for examination under the Sale of Food and Drugs Acts, consisting of :— 906 Milks, 9 Separated Milks, 2 Skimmed Milks, 187 Butters, 3 Milk-blended Butters, 4 Canned Creams, 7 Fresh Creams, 12 Preserved Creams, 4 Lards, 8 Margarines, 12 Cocoas, 11 Coffees, 14 Mustards, 35 Peppers. 13 Pearl Barleys, 5 Flours, 1 Rice, 3 Jams, 1 Wine, 2 Blaud's Pills, 1 Glycerine, 1 Lime Water, 1 Liquorice Extract, 6 Liquorice Powders, 2 Olive Oils, 10 Saffrons, 3 Milk of Sulphurs. 146 samples, or 116 per cent., were found to be adulterated. These consisted of:—101 Milks, 1 Skimmed Milk, 27 Butters, 5 Cocoas, 1 Pearl Barley, 1 Blaud's Pills, 1 Glycerine, 1 Lime Water, 6 Saffrons, 2 Milk of Sulphurs. Proceedings were taken in 79 cases. The total fines secured on the prosecutions was £529 13s. and £83 10s. 6d. was allowed in costs. The average fine secured on the prosecutions was £6 14s. 1d. There were also 2 prosecutions for obstructing the Inspector, resulting in £40 fines and 25s. costs, and 2 prosecutions for infringement of the Margarine Acts, resulting in £1 10s. fines and £2 6s. costs. Sunday Samples. 111 Samples were obtained on 21 Sundays, 110 Milks and 1 Butter; 16 Milks were adulterated, and 8 prosecutions followed. The adulteration of Sunday samples was at the rate of 144 per cent. Unofficial Samples. 281 Samples purchased informally by the Inspectors were examined. These consisted of:—25 Milks, 240 Butters, 1 Cream, 2 Margarines, 2 Cheeses, 3 Cocoas, 1 Flour, 1 Tapioca, 1 Pepper, 5 Drugs. Of these, 89 Samples, or 31'6 per cent. were adulterated—9 Milks, 76 Butters, 2 Cocoas, 2 Drugs. 71 Samples were examined for the General Public, consisting of: — 59 Milks, 3 Milk Powders, 6 Butters, 1 Cream, 1 Cheese 1 Lemonade. Of these, 11 Samples, or 15'5 per cent., were adulterated, 11 Milks. All Samples of Milk, Butter, and Cream were tested lor Preservatives. 1 Milk contained Formalin, 29 Butters contained small quantities of Boron Preservative. 93 2 Samples of Butter, informally purchased, contained Boron Preservative in excess of the legal standard. The 12 Preserved Creams all contained Boron Preservative, but not in excess of the amount declared on the label. Compared with the previous 10 years, the adulteration, &c., was as follows— YEAR. Nvmber of Samples Examined. Number Adulterated. Number of Prosecutions. Percentage ol Adulteration. Percentage of Prosecutions. Amount secured in Fines. Average Fines. £ s. d. £ s. d. 1903 1171 214 88 18.3 7.5 175 18 0 1 19 11 1904 1191 190 58 15.9 4.9 131 11 0 2 5 4 1905 1176 187 76 15.9 6.5 137 11 1 1 16 2 1906 1147 241 122 21.0 10.6 252 3 0 2 1 4 1907 1208 219 77 18.1 6.4 129 9 0 1 13 6 1908 1210 190 84 15.7 7.0 301 4 0 3 11 8 1909 1203 140 75 11.6 6.2 342 7 0 4 11 3 1910 1222 155 75 12.7 6.1 298 16 0 3 19 8 1911 1257 139 73 11.1 5.8 315 4 0 4 6 4 1912 1249 162 79 13.0 6.3 184 4 0 2 6 7 Average for 10 years 1203 184 81 15.3 6.7 226 16 8 2 17 2 1913 1263 146 79 11.6 6.3 529 13 — 6 14 1 94 STATISTICS OF ADULTERATIONS FOR THE YEAR 1913. Nature of Sample. Number Examined. Number Adulterated. Number of Prosecutions. Percentage of Adulterations. Percentage of Prosecutions. Milk 906 101 56 11.1 6.2 Milk (separated) 9 ... ... ... ... Milk (skimmed) 2 1 1 50.0 50.0 Butter 187 21 13 14.4 7.0 Butter (milk blended) 3 ... ... ... ... Cream (canned) 4 ... ... ... ... Cream (fresh) 7 ... ... ... ... Cream (preserved) 12 ... ... ... ... Lard 4 ... ... ... ... Margarine 8 ... ... ... ... Cocoa 12 5 ... 41.7 ... Coffee 11 ... ... ... ... Mustard 14 ... ... ... ... Pepper 35 ... ... ... ... Barley (pearl) 13 l ... 7.7 ... Flour 5 ... ... ... ... Rice 1 ... ... ... ... Jam 3 ... ... ... ... Wine 1 ... ... ... ... Blaud's Pills 2 1 1 50.0 50.0 Glycerine 1 1 1 100.0 100.0 Lime Water 1 1 1 100.0 100.0 Liquorice Extract 1 ... ... ... ... Liquorice Powder 6 ... ... ... ... Olive Oil 2 ... ... ... ... Saffron 10 6 6 60.0 60.0 Milk of Sulphur 3 2 ... 66.7 ... Total 1,263 146 79 11.6 6.3 District. Whitechapel 379 39 17 10.3 4.5 St. George's 258 24 14 9.3 5.4 Limehouse 216 18 11 8.3 5.1 Mile End 410 65 37 15.9 9.0 Total 1,263 146 79 11.6 6.3 Warranty, &c.—The warranty clause has been so much abused, especially in the case of the sale of milk, that the Public Health Committee has on several occasions passed resolutions in favour of rescinding it. Proceedings under the Food and Drugs Acts may be taken against persons who sell adulterated milk, as follows :— (1) If an Inspector purchases milk from the milkseller and the milk proves to be adulterated, the milkseller is liable to prosecution, and the information must be laid before the Magistrate of the district in which the purchase was made. On the hearing of the information, if the milkseller proves that he purchased the milk with a warranty of purity, and that no adulteration has taken place while the milk has been in his possession, he is entitled to be discharged. (2) Proceedings can then be taken against the giver of the warranty, but these proceedings are not for selling adulterated milk, but for the offence of giving a false warranty. Such proceedings may be taken before the same Magistrate who heard the original charge against the milkseller, even though the warranty was not given within the district in which the Magistrate ordinarily has jurisdiction. A warranty from the farmer who supplied him, together with evidence that there was no reason to believe that the statements contained in the warranty given to the retailer were untrue, will, in all probability, ensure the acquittal of the wholesale dealer of knowingly giving a false warranty. (3) You may take proceedings against the farmer for giving a false warranty to the wholesale dealer, but in that case, proceedings can only be taken before the Justices of the district in which the warranty was given. Thus our Council would, if we desired to proceed against the farmer for giving a false warranty, have to lay an information before the Justices of Essex, Derbyshire, Hampshire, or even possibly Somersetshire. We would have to take all the witnesses there, including the milkseller and representatives of the wholesale firm, and prove not only the fact that the milk when purchased by the Inspector was adulterated, but that it was adulterated by the farmer and not by the wholesale dealer who purchased from the farmer, or by the milkseller who purchased from the wholesale dealer. In addition to the expense of trying to prove such a case, it would be almost impossible to obtain a conviction. The warranty clause of the Food and Drugs Act, 1899, states that the warranty shall not be available as a defence unless the defendant has, within seven days after service of the summons, sent to the purchaser a copy of such warranty 96 with a written notice stating that he intends to rely on the warranty, and specifying the name and address of the person from whom he received it. The Public Health Committee resolved some years ago, that in every case where proceedings were to be taken, the Sanitary Inspector should call and inform the dairyman of the fact, and if he had a warranty, he must give notice within the specified time. It has happened on more than one occasion that a dairyman has informed the Inspector that he has no warranty, but a day or two before the summons was to be heard, he called at the Public Health Offices and produced a warranty. On two occasions they were so obviously ante-dated, that I cautioned the dairyman, reminding him of the statements he had made to the Sanitary Inspector, and of his liability to proceedings for producing a false warranty. As a result of this caution, the warranty was not produced at the Court on the day of the trial. Warranties have been produced in Court when the milk has contained as much as 30 per cent. of added water. On one occasion, in June, 1913, one of the Inspectors actually saw a milkman adding water to the milk, but when a sample was taken on delivery for the purpose of analysis, an attempt was made to obstruct the Inspector, and the assistance of the police had to be invoked. The milk contained 22 per cent. of added water. Proceedings were taken against the dairyman for obstruction, as well as for the adulteration, and he was heavily fined. He had previously been summoned on several occasions for refusing to serve, and for the adulteration of milk. He had a warranty from the wholesale company, and had the Inspector not actually seen him add water to the milk, the milk would have been sold to him in the ordinary way, and the warranty would have been used as a defence. The same milkman has since been summoned for selling adulterated milk, and he pleaded the warranty. We denied that he had complied with the requirements of the warranty clause, inasmuch as he had not given notice of his intention to the wholesale firm that he intended to rely on the warranty. The Magistrate convicted, but the milkseller has appealed. Since then he was actually seen adding water to milk, and when the Inspector demanded milk from a certain can on his barrow he refused to serve him, saying, that the particular can contained milk and water. He was, however, prepared to serve him from another can, but the Inspector refused to accept it. He had also on the barrow a can of water. He was fined £10 for refusing to serve. It is only the unscrupulous dairyman that carries water on his barrow in a separate hand can. He carries as a rule, three hand cans and a churn. One can of pure milk, is carried to serve the Inspector, should he appear on the scene. One contains milk and added water, and the other contains water. The water is added to the milk on the round. It is usually done by first pouring water into the small cans which hang from the barrow, and then adding milk shortly before the cans are delivered to the customers. It may be claimed that the water is carried for the purpose of cleansing the small cans, which are delivered and returned 97 from the customers. This cannot be so, because cold water will not cleanse greasy utensils. Moreover, the regulations state that all utensils must be washed in hot water, and before a person is registered, provision must be made for the boiling of water for the purpose of cleansing. During the last five years in this Borough, proceedings have been instituted on 33 occasions unsuccessfully as a result of the production of a warranty, but this does not give an adequate idea of the extent of adulteration carried on under the cloak of the warranty. A dairyman proves his warranty, and the case is dismissed. If the same dairyman is found on a subsequent occasion to sell adulterated milk, the fact that he had previously won on a warranty is reported to the Public Health Committee, and on some occasions, the Committee has decided not to take proceedings. Many of the dairymen in this district keep cows and buy milk from wholesale firms as well. If the sample purchased is found to be adulterated, a warranty is produced, although the milk may have been given by their cows, and afterwards adulterated. A cowkeeper, if he buys one churn a day, is thus protected, even if he keeps a hundred or more cows. For instance, a cowkeeper in this Borough, who keeps between 70 and 80 cows, was summoned on two occasions. He pleaded a warranty and both cases were dismissed, the last occasion being in July, 1912. In December, 1912, another sample of milk was taken for analysis, and although it contained 5 per cent. of added water, the Public Health Committee decided to take no action under the circumstances. Another instance was that of a dairyman, who is licensed to keep nineteen cows. On three different occasions he was prosecuted for selling adulterated milk, but in each instance the summons was dismissed on production of a warranty. In 1913, six summonses for selling adulterated milk were dismissed on proving the warranty, and four were withdrawn for a similar reason. In two of the dismissed cases, one contained 10 per cent. of added water, and the other was 13 per cent. deficient in fat. The wholesale firms may believe that they are selling the milk as they receive it, but they do not cause sufficient supervision to be observed over their carmen. My attention was called recently to a flagrant offence of this kind. I was told that three carmen, working for two wholesale firms, drove up to the side entrance of a milk-shop premises in our district, twice a day, and that water was brought from these premises to adulterate the milk. I kept observation on several occasions, and saw the adulteration taking place. On one occasion a full churn of water was lifted on to the van, and the contents divided between nine churns of milk, which were not quite full. The milk then reached to the top of these nine churns. It was then stirred, and milk from each churn was added to a tenth churn, which was empty. 98 While the caiman was in the act of adulterating the milk, in fact, he was holding up the gallon measure which was full of water and was about to pour it into the milk, one of our Sanitary Inspectors passed by within a foot of the van. The carman looked at him and said jocularly in Welsh to the proprietor of the milk premises "one of them." Both laughed. I must admit that the humour of the situation struck me as well, as I heard and understood the remark. The adulteration of the milk was continued immediately the Inspector had passed. When the churn was practically empty, it was handed back to the proprietor of the premises who was standing on the pavement the whole time. He tilted it over, so that the remainder of the water in the churn was poured into the gutter. The van containing milk thus adulterated with 10 per cent. of added water was then driven off, and the milk delivered to various retail shops in the district. I communicated with the wholesale firm, and two days afterwards, the Managing Director kept observation with me, when a similar precedure was followed by the carman and the proprietor of the premises. A summons was applied for by the Company against the carman for wilfully damaging their milk, and against the proprietor of the premises for aiding and abetting him. On the evening of the date of the application the carman absconded. The carman who was employed by the other wholesale Company and who had been seen doing a similar thing at the same address also absconded the same night. Curiously enough, the carman of a third Company who had been seen adding water from a horse trough to milk, also disappeared after a summons had been applied for. Although a warrant was applied for the absconding carman, he was not found, but the owner of the premises was fined £5 for aiding and abetting. The latter maintained at the trial that he did not know why the carman called nor did he know what the churn contained. It is not surprising that the defence was not believed when the above facts are considered. The wholesale firms take a large number of samples from churns delivered at railway stations from farmers, and great care is observed that no milk is delivered to them, unless it is well above the standard. Comparatively few samples for analysis, if any at all, are taken from their carmen, while they are delivering the milk. It seems to me that the wholesale firms prefer to rely on the warranty they receive from the farmers and on the warranty they give to the customers, rather than to exercise greater care to deliver the milk to their retail customers as they receive it. It is during this journey between the wholesale trader and retailer that milk may be tampered with, and the general public defrauded. Although the retail dairyman is not convicted, because he pleads the warranty, yet he has the stigma attached to his name of being prosecuted when he is often quite innocent. The protection afforded by the warranty clause to wholesale and retail dairymen is so often abused that unless it is deleted, or very much modified, the adulteration of milk will be continued and the public defrauded. If it is retained, the wholesale firm and the retail dairyman should be summoned on each occasion 99 when the warranty is put forward as a defence. The Magistrate could then decide whether the milk had been adulterated by the retailer, or when under the control of the wholesale firm. The wholesale firm would take greater pains in ascertaining whether their carmen were adulterating the milk, and on the other hand they would not be so eager to give a warranty to tradesmen that they know are dishonest. If the milk received at the stations is genuine, and is dispatched from the wholesale firm's dep6ts in the same condition, and is then found to be adulterated when a sample is taken by the Sanitary Inspector from the retailer, it is obvious that it could only have been adulterated by one of two persons, viz.: the carman or the retail tradesman. The same care should be taken by the wholesale firms to deliver the milk to the retailers as they receive it. This can only be done by taking samples more frequently from the carmen during the course of delivery. The warranty clause should not be made use of to evade the law by one party or the other. The law should be amended in other directions. For instance, if the Inspector personally tries to buy milk in the street, or in the shop, the vendor knows who he is, and he knows that the milk is intended for analysis. The milkman immediately declares that the article is milk and water, and he is not liable to any penalty, even if the milk contains 50 per cent, of added water. In cases of this kind the man is often watched to ascertain the houses where he delivers the milk, and a sample is taken from the can that he has just delivered. In order to obtain a conviction, it is necessary for the purchaser to give evidence, that he thought and believed that genuine milk was being delivered to him. Statements to this effect are often made to us, and signed by the purchaser; but when his evidence is taken in the Court, he invariably swears that he knew that the milk was not genuine, and that it contained added water. The Magistrate has no alternative but to dismiss the summons, under the circumstances. If a section was introduced into the Act, making it illegal to sell milk and water, this difficulty would be got over. At other times, if the milkman has been convicted on several occasions, he refuses to sell to the Inspector. The maximum penalty which the Magistrate can inflict is £10 for refusing to sell, and £20 for obstruction, whereas the previous fine for adulteration may have been £50. He prefers, therefore, to refuse to sell, or to pour the milk into the road, than run the risk of having a big fine inflicted for selling adulterated milk. Another defence which seems to be on the increase is the " appeal to the cow." One dairyman in our district keeps twenty-six cows. The Inspector bought a sample from his employee in the street. After the milk had been divided into three parts and sealed, the Inspector demanded a sample from a second can, which he had O 100 on the barrow. One sample contained 10 per cent, of added water, and the other 4 per cent, of added water with deficiency in fat to the extent of 8 per cent. Evidence was brought at the trial that milk taken direct from his cows was deficient in cream. The summons was dismissed. The milk first taken from the cow, or " foremilk," is very inferior milk, but the last milk, or " strippings," may contain 10 per cent, of fat. It is obvious, therefore, that if the cow is not milked dry, the milk will be of inferior quality. No one is able to say with any certainty whether the cowman has obtained all the milk by simply watching the process of milking. Two hundred and eighty-one informal samples were taken during the year. Tradesmen generally know their customers by sight, if not by name. If a stranger goes into a shop and asks for butter, the dishonest trader looks upon him as a possible agent of the Sanitary Inspector, and he is served in this instance with the genuine article. He is probably similarly served on the second or even third occasion. Later, however, he is served with an adulterated article. Advantage is taken of this, where we suspect that a tradesman is dishonest or we have received complaints. A woman is engaged, and she buys the article in question on several occasions before the official sample is taken. In the meantime the agent has become known as a regular customer, and an official sample is then taken. 240 butters were thus bought, and 76 were found to be adulterated. 101 SAMPLES TAKEN BY INSPECTORS DURING THE YEAR 1913. Nature of Sample. Inspector— J. W. Johnson. H. Quaintrell. R. H. Waterman. | J. Twaits. G. 0. Pavitt. E. T. Crook. R. Simpson. A. W. Stiles. J. White. E. W. Flint. T. W. Dee. T. P. Wrack. H. Mills. A. Cook. W. Shepherd. TOTAL. Milk ... 38 44 40 75 76 91 101 55 60 31 34 95 62 72 43 917 Butter ... 14 15 10 9 7 ... 4 16 8 31 8 12 34 6 16 190 Cream ... 2 1 3 3 ... 2 1 1 1 ... 3 ... 4 2 23 Margarine ... ... 3 2 1 ... ... ... 1 ... ... ... ... ... 1 ... 8 Lard ... 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 4 Cocoa ... 2 ... ... 4 5 ... ... ... ... 1 ... ... ... ... ... 12 Coffee ... 2 1 1 1 2 ... ... ... ... ... ... ... ... ... 4 11 Mustard ... 3 1 2 1 1 ... 1 ... ... 1 ... ... ... 1 3 14 Pepper ... 4 5 7 1 1 3 1 ... 2 6 ... ... ... 2 3 35 Flour ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... 2 5 Barley ... ... 1 2 ... 3 3 2 ... 1 ... ... ... ... 1 ... 13 Rice ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Jam ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 3 Wine ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Drugs ... 5 2 5 2 1 ... ... ... 1 ... ... 4 4 2 26 Total ... 72 72 72 100 100 100 110 72 72 72 42 110 102 92 75 1263 g 2 102 RESULT OF INSPECTORS' WORK UNDER THE SALE OF FOOD AND DRUGS ACTS DURING THE YEAR 1913. INSPECTOR. Samples taken. Number Adulterated. Number of Prosecutions. Fines Secured. Costs Allowed. Fines and Costs for refusing to serve, obstruction, and for offences under the Margarine Acts. Fines. Costs. £ s. d. £ s. d. £ s. d. £ S. d. J. W. Johnson 72 6 4 14 10 0 3 11 0 ... ... H. Ouaintrell 72 7 4 7 10 0 3 9 0 ... ... R. H. Waterman 72 5 3 35 0 0 2 6 0 ... ... J. Twaits 100 18 6 28 8 0 5 11 0 20 0 0 1 3 0 G. O. Pavitt 100 18 11 152 0 0 13 10 0 20 0 0 0 2 0 E. T. Crook 100 19 14 170 10 0 14 7 0 ... ... R. Simpson 110 10 6 21 0 0 3 9 0 ... ... A. W. Stiles 72 6 5 13 5 0 4 12 0 ... ... J. White 72 6 1 5 0 0 1 3 0 ... ... E.W.Flint 72 9 3 18 0 0 5 9 0 ... ... T. W. Dee 42 3 3 20 0 0 2 6 0 1 0 0 1 3 0 T. P. Wrack 110 8 2 10 0 0 3 7 0 H. Mills 102 13 4 15 10 0 5 0 6 A. Cook 92 7 5 7 0 0 5 15 0 0 10 0 1 3 0 W. Shepherd 75 11 8 12 0 0 9 15 0 ... Total 1,263 146 79 529 13 0 83 10 6 41 10 0 3 11 0 In addition to the samples already enumerated, 40 miscellaeonus samples were examined. 18 for the Public Health Department, 6 „ Electrical Department, 8 ,, Public, 3 „ Police, 3 „ Guardians, and 2 samples of Rag Flock from the Manufacturers. 103 ARTICLES ADULTERATED. Number. Article. Adulteration. Result. 2.D. Blaud's Pills 45 per cent, deficient in iron carbonate Dismissed on warranty. 4.D. Milk 3 „ added water Caution. 4.T. Milk 10 „ deficient in fat £10 fine and 23s. costs. (Previous summons.) 9.E. Butter Margarine No action (sold with label). 10.E. Butter Margarine £2 fine and 23s. costs. 11.E. Milk 20 per cent, added water £15 fine and 23s. costs. (Previous summons.) M.S. Milk 5 „ deficient in fat Caution. 10.M. Milk 4 „ added water Caution. 5.A. Saffron 25 „ Foreign mineral matter 10s. fine and 2s. costs. ll.D. Butter 4 „ excess of water No actjon. (Fined for obstruction.) 12.D. Butter Margarine £15 fine and 23s. costs. (Previous summons.) l.F. Milk 3 per cent. deficient in fat Caution. 4.F. Milk 10 ,, ,, ,, 30s. fine and costs. 5.F. Milk 10 ,, ,, ,, 6.F. Milk 13 ,, ,, ,, £3 fine and 23s. costs. (Previous summons.) 8.J. Milk 4 „ added water Caution. 16.F. Milk 7 ,, ,, £5 fine and 23s. costs. (Previous summons.) 15.D. Milk 14 „ deficient in fat £4 fine and 23s. costs. (Previous summons.) 16.D. Milk 3 ,, ,, ,, Caution. 23.E. Milk 15 „ added water £8 fine and 23s. costs. (Previous summons.) 18.E. Butter ... Margarine £30 fine and 23s. costs. (Previous summons.) 26.E. Milk 22 per cent. added water £20 fine and 44s. costs. (Previous summons.) 15.G. Milk 16 „ deficient in fat Dismissed. Sample sold as received. (Previous summons.) 17.G. Milk 23 ,, ,, ,, £5 fine and 23s. costs. (Previous summons.) 19.G. Milk 10 ,, ,, ,, £1 fine and 23s. costs. 9.C. Milk 6 ,, ,, ,, Caution. 15.C. Milk 5 ,, ,, ,, Caution. 20.D. Milk 10 ,, ,, ,, £1 fine and 23s. costs. 20.M. Milk 7 „ added water £15 fine and 42s. costs. (Previous summons.) 21.M. Milk 7 „ „ 5.H. Milk 13 „ deficient in fat £1 fine and 23s. costs. 23.M. Milk 5 ,, ,, ,, Caution. 8.B. Milk 33 ,, ,, ,, 10s. fine and 23s. costs. 14.A. Milk 3 ,, ,, ,, Caution. 104 Articles Adulterated—continued. Number. Article. Adulteration. Result. 23.N. Butter Margarine £3 fine and 23s. costs. (Previous summons.) 23.F. Milk 34 per cent, added water £50 fine and 23s. costs. (Previous summons.) 27.L. Milk 5 „ deficient in fat Caution. 30.D. Milk 3 „ added water Caution. 16.S. Milk 6 „ deficient in fat Caution. 17.S. Milk 10 „ added water £2 fine and 40s. costs. 17.B. Milk 3 „ deficient in fat Caution. 30.G. Milk 3 „ added water Caution. 34.D. Cocoa 2 „ added alkali No action. 35.D. Cocoa 2 „ „ No action. 28.E. Glycerine 29 „ sugar £10 fine and 44s. costs. 38.L. Milk 3 ,, added water Caution. 39.D. Milk 5 „ „ Caution. 34.G. Milk 3 ,, ,, Caution. 36.F. Milk 7 ,, „ £10 fine and 23s. costs. (Previous summons.) 24.K. Butter 2 „ excess of water No action. 45.D. Milk 5 „ deficient in fat Caution. 43.G. Butter 65 „ foreign fat £15 fine and 23s. costs. (Previous summons.) 22.H. Milk 5 „ deficient in fat Caution. 31.K. Butter Margarine £5 fine and 23s. costs. 30.S. Milk 6 per cent, deficient in fat £1 fine and 23s. costs. (Previous summons.) 31.S. Milk 10 ,, „ „ £6 fine and 42s. costs. (Previous caution.) 37.N. Milk 13 ,, „ „ 10s. fine and 23s. costs. (Previous caution.) 38.N. Milk 10 „ „ „ 51.D. Butter 10 „ foreign fat Caution. 38.E. Milk 20 ,, added water £7 fine and 23s. costs. (Previous summons.) 39.E. Milk 20 „ „ 18.B. Milk 6 „ deficient in fat Dismissed. Warranty. 20.B. Milk 10 ,, „ „ £2 fine and 23s. costs. 40.F. Milk 10 ,, „ „ £1 fine and 23s. costs. 28.H. Milk 10 ,, „ „ 25s. fine and 23s. costs. 55.D. Milk 6 ,, „ „ Withdrawn. Warranty. 58.E. Milk 10 „ added water £30 fine and 44s. costs. 47. L. Milk 37 „ „ £10 fine and 44s. costs. 34.J. Milk 3 ,, „ Caution. 37. J. Milk 3 ,, „ Caution. 31.H. Milk 10 „ „ £3 fine aad 23s. costs. (Previous summons.) 27.B. Butter 75 „ foreign fat No action. Sold in stamped wrapper. 54.M. Milk 10 „ deficient in fat 10s. fine and 23s. costs. 36.A. Butter 65 „ foreign fat £2 fine and 23s. costs. 43.F. Milk 13 „ deficient in fat £30 fine and 42s. costs. (Previous summons.) 105 Articles Adulterated—continued. Number. Article. Adulteration. Result. 51.F. Milk 13 per cent, deficient in fat Dismissed. Warranty. 52.F. Milk 6 ,, „ „ Dismissed. Warranty. 52.L. Milk 3 ,, „ „ Caution. 55.L. Milk 13 ,, „ „ 23s. costs. 56.L. Milk 3 ,, „ „ Caution. 61.M. Milk Contained formalin Caution. 32.K. Milk 3 per cent, deficient in fat Caution. 36.K. Butter 4 „ excess of water Caution. 62.E. Milk 10 „ deficient in fat Dismissed. Warranty. (2 previous convictions.) 37.A. Milk 4 ,, „ „ Caution. 23.T. Butter 80 „ foreign fat Withdrawn. Convicted under Margarine Act. 52.G. Milk 13 „ deficient in fat Dismissed. Warranty. 41.S. Milk 12 „ added water Dismissed on appeal. 40. J. Milk 4 ,, „ Caution. 47.K. Butter Margarine £3 fine with £2 4s. costs. 48.K. Butter Margarine No action. Labelled. 48.J. Butter 80 per cent, foreign fat £5 fine with 23s. costs. 44.C. Butter 74 „ „ £20 fine with 23s. costs. 54.G. Milk 8 „ added water Dismissed. Warranty. (Previous conviction.) 55.G. Milk 8 „ „ 60.F. Milk 5 „ „ £20 fine with £2 4s. costs. (Two previous convictions.) 61.F. Milk 5 „ „ £50 fine with £3 3s. costs. 38.B. Milk 10 „ „ £5 fine with 23s. costs. 67.F. Milk 5 „ „ Withdrawn by order of Committee. 70.F. Milk 3 ,, „ Caution. 67.E. Milk 3 ,, „ Caution. 69.E. Milk 5 ,, „ Adjourned sine die. (Three previous convictions.) 74.M. Butter Margarine Caution. Labelled. 75.M. Butter Margarine Caution. Labelled. 76.M. Butter Margarine Caution. Labelled. 77.M. Butter 5 per cent, excess of water Caution. 73.E. Cocoa 3 „ added alkali No action. 74.E. Cocoa 3 ,, „ No action. 75.E. Cocoa 3 ,, „ No action. 51.J. Milk 5 „ added water Caution. 52.C. Milk 11 ,, „ £15 fine with 23s. costs. (Previous conviction and four cautions.) 53.C. Milk 5 „ „ Case withdrawn. 50.K. Milk 3 „ deficient in fat Caution. 51.K. Milk 3 ,, „ „ Caution. 106 Articles Adulterated—continued. Number. Article. Adulteration. Result. 49.A. Milk 5 „ added water £5 fine with 23s. costs. 16 „ deficient in fat. 53.A. Butter 75 „ foreign fat £7 fine with 23s. costs. 45.B. Butter Margarine Caution. 83.E. Milk 17 per cent, added water £30 fine and 23s. costs. (Three previous convictions.) 53.S. Milk 11 „ „ £1 fine and 23s. costs. 75.G. Milk 3 „ „ Caution. 86.M. Milk of Sulphur Sublimed sulphur No action. 87.M. Lime water 25 per cent, deficient in lime 23s. costs. 66.L. Milk 5 „ added water Caution. 62.N. Milk 13 „ deficient in fat 30s. fine and 23s. costs. (Two previous cautions.) 88.M. Skimmed milk Separated milk 12s. 6d. costs. 72.L. Milk 17 per cent, added water Caution. 76.N. Milk of sulphur Milk sugar No action. 63.S. Butter 75 per cent, foreign fat Caution. 66.S. Saffron 33 „ foreign mineral matter 23s. costs. Wholesale dealer convicted, 75.S. 61.H. Milk 10 ,, added water Dismissed. Warranty (Previous conviction.) 91.D. Milk 14 „ „ Station samples. £8 8s. fine and £2 2s. costs. 92.D. Milk 24 „ „ 93.D. Milk 23 „ „ 70.S. Milk 8 „ „ Adjourned sine die. (Two previous cautions.) 65.K. Butter Margarine £10 fine and 42s. costs. 86.F. Milk 12 per cent, added water Dismissed. (Two previous convictions.) 87.F. Milk 4 ,, „ and 8 per cent, deficient in fat. 95.D. Milk 15 per cent, added water No action. Declaration. 86.N. Saffron 30 „ foreign mineral matter £1 fine and 23s. costs. 92.N. Saffron 30 „ „ ,, £1 fine and 23s. costs. 38.T. Milk 8 „ added water £10 fine and 23s. costs. (One previous conviction and one caution). 75.S. Saffron 37 „ foreign mineral matter £2 fine and 44s. costs. 72.H. Milk 14 „ added water £8 fine and 23s. costs. (Two previous convictions and one caution.) 98.F. Saffron 32 „ foreign mineral matter Withdrawn. Wholesale dealer convicted. 99.F. Pearl barley. 0.7 „ mineral facing No action. 89.E. Butter Margarine No action. Declaration. 107 Proceedings under the Margarine Act. On March 6th, 1913, Mr. Abraham Stappley, of 20, Vallance Road, was summoned for selling margarine in a plain wrapper. He was fined 10s., with 23s. costs. On April 7th, 1913, Mr. Nathan Kerstein, of 62, Redman's Road, was summoned for selling margarine in an unlabelled wrapper. The summons was withdrawn, as he was fined £30 and costs for selling margarine as butter under the Food and Drugs Acts on the same day. On August 29th, 1913, Mrs. Louisa Hutchings, of 10, Old Gravel Lane, was summoned for selling margarine in an unlabelled wrapper. She was fined 20s., with 23s. costs. Proceeding's for refusingto sell under the Food and Drugs Acts. On March 18th, 1913, Mrs. Rose Cherry of 60, Burdett Road, was summoned for obstructing the Sanitary Inspector in the execution of his duty. She attempted to regain possession of the sample after it had been purchased, with the result that it was partly destroyed. The remaining portion was found to contain an excess of water. She was fined £20, with 23s. costs. On April 2nd, 1913, Mr. Lewis Marcus, of 2, Leslie Street, was summoned for obstructing the Inspector when the latter was taking a sample for analysis. He was fined £20, with 2s. costs. On June 12th, 1913, Mr. Henry Cohen, of 54, Sutton Street, was summoned for refusing to serve a sample for analysis. The defendant had given a false address, and the case was adjourned, a fresh summons or a warrant to be granted if he should be found. 108 Total Fines and Costs. Fines. Costs. Under the Public Health (London) Act for various nuisances £ s. d. £ s. d. 44 11 0 47 0 0 For selling unsound food 65 0 0 9 19 0 By-laws for Houses let in Lodgings 1 0 0 0 14 0 General Powers Acts 11 10 0 17 1 0 Metropolis Management Act 10 0 0 10 10 0 Food and Drugs Acts 529 13 0 83 10 6 Refusing to serve samples for Analysis 40 0 0 1 5 0 Margarine Act, 1887 1 10 0 2 6 0 Dairies, Cowsheds and Milkshops Orders 5 6 0 6 0 0 Total 708 10 0 178 5 6 Table showing the number of milk premises, slaughter houses, ice-cream premises, &c., together with the number of inspections made to them. PREMISES NUMBER OF PLACES— Number of inspections, 1913. Number of notices, 1913. Number of prosecutions, 1913. No. on register at end of 1912. No. added in 1913. No. removed in 1913. No. on register at end of 1913. (1) (2) (3) (4) (6) (6) (7) Milk premises 1051 38 488 601 1954 170 9 Cowsheds 32 ... 1 31 53 ... ... Slaughter-houses 6 ... 2 4 17 1 ... Other offensive trade premises 7 ... ... 7 28 1 ... Ice cream premises 201 38 8 231 429 64 ... Registered houses let in lodgings 2911 2509 2911* 2509 5310 (a) 269 (a) 3 (b) 2550 (b) 5 * Automatically removed by new Bye-laws. (a) For overcrowding. (b) For other conditions. 109 Total number of Intimations served for all purposes 15,556 Overcrowding— Number of Inspections 19,131 N umber of dwelling rooms overcrowded 487 Number of Notices served Intimations 521 125 Statutory Notices Number remedied 487 Number of Prosecutions 5 Underground rooms— Illegal occupation dealt with during the year 47 Number of rooms closed 25 Insanitary Houses— Number closed under the Public Health (London) Act, 1891 1 Number closed under the Housing and Town Planning Act 8 L.C.C. (General Powers) Act, 1903. Part VIII. Number of prosecutions for breach of Bye-laws as to conveyance of dead horses through the street — L.C.C. (General Powers) Act, 1904— Number of verminous rooms cleansed (Sec. 20) 2,420 Number of filthy articles purified (Sec. 19) 153 Number of sanitary conveniences altered (Sec. 22) 2 Number of sanitary conveniences removed (Sec. 22) — Number of fixed ashpits removed (Sec. 23) 32 L.C.C. (General Powers) Act, 1907. Number of tenement houses dealt with as regards water supply (Sec. 78) 6 Shelters provided under Sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 5 Places where Food is prepared for sale— Number on Register 418 Number of Inspections 828 Number of Notices served 126 House to House Inspections— Number of Inspections 5,678 Number of defects 2,897 Number of Notices served Intimations 2,897 Statutory Notices 1,013 110 Revenue Acts— Number of houses for which applications were received during the year 8 Number of tenements comprised therein 70 Number of tenements for which certificates were (a) granted 56 (6' refused 14 (c) deferred — Number of prosecutions under Bye-laws under the Public Health (London) Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. ... — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. (c) For the prevention of keeping of animals in such a manner as to be injurious to health _ (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc 11 (/) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc — (h) With respect to water closets, earth closets, etc. 1 (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc. (Metropolis Local Management Act, 1855, Sec. 202) 1 (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) — Mortuaries— Total number of bodies removed 572 Total number of infectious bodies removed 2 lit Factories and Workshops. The total number of workshops on the Register was 3,396 ; but this does not include factories, workplaces and out-workers' premises. 5,015 inspections to factories, workshops and workplaces revealed defects, which necessitated the service of 1,453 written notices. Of the notices, 50 referred to factories, 1,385 referred to workshops including workshop laundries, and 18 to workplaces other than out-workers' premises. Cleanliness.—753 notices were served to properly cleanse workshops. Ventilation.—The ventilation of 94 workshops was improved. Overcrowding.—Overcrowding was abated in 42 workshops. Sanitary Accommodation.—The sanitary accommodation was improved in 209 workshops by providing additional and suitable water-closets. Drainage of Floors.—The drainage of the floor was found defective in seven workshops. 293 other nuisances were remedied in workshops. Out-workers' Premises.—5,484 inspections were made to out-workers' premises during the year ; 452 premises were found to be insanitary, and notifiable diseases occurred in 100. A large percentage of out-workers' addresses were found to be incorrect, and on being visited by the Inspectors it was found that they had either left the premises some considerable time previously or had never lived there at all. The actual number of out-workers' premises varied from time to time, but at the end of the year it was 4,609. 112 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK 1.—INSPECTIONS. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories .. .. .. .. ,, (Including Factory Laundries) 215 50 •• Workshops (Including Workshop Laundries) 4,741 1,385 •• Workplaces (Other than Outworkers' premises) 59 18 •• Total 5,015 1,453 •• 2.-DEFECTS FOUND. Particulars. (1) Number of Defects Number Found. (2) Remedied. (3) Kef erred to H.M. Inspector. (4) of Prosecutions. (5) Nuisances under the Public Health Acts :—* Want of cleanliness 753 753 .. .. Want of ventilation 94 94 .. .. Overcrowding 42 42 .. .. Want of drainage of floors 7 7 .. .. Other nuisances 293 293 .. .. Sanitary Accommodation insufficient 24 24 .. .. unsuitable or defective 166 166 .. .. not separate for sexes 19 19 .. .. Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (S. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 76 76 .. .. Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) .. .. .. .. Total 1,474 1,474 .. .. * Including tho3a specified in S3ction3 2, 3, 7 and 8, of the Factory and Workshop Aci, 1901, a. remediable under the Public Health Acts. 113 3.—HOME WORK. NATURE OF WORK. Outworkers' Lists. Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists Received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the Year. Once in the Year. Failing to i keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors Workmen. Wearing Apparel— (1) Making. &c. 288 737 3,313 25 12 122 .. .. .. 436 436 .. 95 .. .. (2) Cleaning and Washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Household linen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Curtains and furniture hangings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery 2 .. 2 .. .. .. .. .. .. 1 1 .. .. .. .. Electro plate .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. File making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur pulling (Furriers) 2 .. 6 .. .. .. .. .. 1 1 .. 2 .. .. Cables and chains .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c. .. .. .. .. .. .. .. .. .. 2 2 .. .. .. .. Artificial flowers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sacks 4 .. 6 1 .. 2 .. .. .. 2 2 .. .. .. .. Raiquet and tennis balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper bags and boxes 10 .. 105 1 .. 14 .. .. .. 5 5 .. 1 .. .. Brush making 2 .. 2 1 .. 1 .. .. .. 5 5 .. 2 .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. StufTed toys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chocolates and sweetmeats .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cosaques, Christmas crackers, Christmas stockings, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Textile weaving .. .. ..•• .. .. .. •• .. •• .. .. .. •• .. .. Total 308 737 3,434 28 12 139 •• 452 452 .. 100 .. .. 114 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. (1) (2) Bakehouses 175 Boot, Shoe and Slipper Making 203 Cabinet Making 116 Furriers 139 Hat and Cap Manufacturers 88 Miscellaneous 470 Laundries 22 Rag Sorting, etc. 76 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) 2,107 Total 3,396 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories : — Failure to affix Abstract of the Factory and Workshop Acts (S. 133, 1901) 26 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (S. 5, 1901) Notified by H.M. Inspector 360 Reports (of action taken) sent to H.M. Inspector. 287 Other 73 Underground Bakehouses (S. 101): — Certificates granted during the year .. In use at the end of the year 61 115 BAKEHOUSES. 49, Anthony Street 104, Anthony Street 22, Batty Street 20, Bedford Street 51, Bedford Street 38, Bell Lane 60, Bell Lane 43, Ben Jonson Road 81, Ben Jonson Road 70, Berner Street 150, Bow Common Lane 224, Bow Common Lane 26, Brick Lane 48, Brick Lane 70, Brick Lane 122, Brick Lane 21, Brady Street 7, Braintree Street 96, Braintree Street 3, Bridge Street 92, Bridge Street 91, Brook Street 58, Burdett Road 91, Burdett Road 173, Burdett Road 54, Buxton Street 20, Cable Street 36, Cable Street 86, Cable Street 111, Cable Street 186, Cable Street 278, Cable Street 293, Cable Street 415, Cable Street 367, Cable Street 43, Cadiz Street 108, Cannon Street Road 49, Charles Street 127, Charles Street 167, Charles Street 9a, Chicksand Street 14, Chicksand Street 32, Church Lane 36, Christian Street 135, Christian Street 137, Christian Street 141, Christian Street 122, Clark Street 62, Cleveland Street 59, Commercial Road 81, Commercial Road 136, Commercial Road 192, Commercial Road 508, Commercial Road 265, Commercial Road 336 & 338, Commercial Road 337, Commercial Road 411, Commercial Road 631, Commercial Road 821, Commercial Road 72, Commercial Street 18, Copley Street 9, Coke Street 81, Coutts Road 1, Crellin Street 13, Devonport Street 3, Dock Street 12, Duckett Street 73, Duckett Street 137, Eastfield Street 31, Fieldgate Street 48, Fieldgate Street 38, Globe Road 142, Globe Road 32, Great Hermitage Street 48, Great Garden Street 65, Greenfield Street 13, Grove Street 4, Hanbury Street 102, Hanbury Street B 116 BAKEHOUSES—continued. 156, Hanbury Street 27, Hardinge Street 68, Harford Street 19, Hawkins Street 34, Heath Street 7, Hessel Street 71, Hessel Street 3, High Street, Shoreditch 28, Hunt Street 2, Jubilee Street 115, Jubilee Street 135, Jubilee Street 201, Jubilee Street 5, King David Lane 32, King Edward Street 1, Lamb Street 117, Leman Street I, Leydon Street 7, Limehouse Causeway 40, Limehouse Causeway 84, Locksley Street 67, Lower Chapman Street 76a, Maplin Street 68 & 70, Middlesex Street II, Mile End Road 132, Mile End Road 205, Mile End Road 397, Mile End Road 640, Mile End Read 4, Morris Street 34, New Road 107, Old Gravel Lane 6, Old Castle Street 67, Old Montague Street 87, Old Montague Street 75, Oxford Street 249. Oxford Street 256, Oxford Street 275, Oxford Street 35, Pelham Street 42, Philpot Street 41, Portland Street 1, Providence Street 77, Plumber's Row 99, Redman's Road 90, Red Lion Street 3, Repton Street 31, Repton Street 35, Rhodeswell Road 56, Rhodeswell Road 132, Rhodeswell Road 71, Salmon Lane 131, Salmon Lane 181, Salmon Lane 209, Salmon Lane 53, Settles Street 40, Sheridan Street 89, Sidney Street 16, Spelman Street 4, Stepney Green 36 & 37, Steward Street (Factory) 43, Stainsby Road 64, St. Ann's Road 31, St. George Street 31, St. Paul's Road 117, St. Paul's Road 6, St. Peter's Road 10, St. Mark Street 3, Tenter Street 18a, Thrawl Street 36, Three Colt Street 51, Three Colt Street 77, Three Colt Street 93, Three Colt Street 45, Thomas Street, Limehouse 22, Umberston Street 57 & 59, Umberston Street 76, Umberston Street 23, Vallance Road 38, Vallance Road 117 BAKEHOUSES—continued. 79, Vallance Road 17, Waley Street 49, Watney Street 1, Wentworth Street 41, Wentworth Street 75, Wentworth Street 91, Wentworth Street 54, Whitechapel High Street 56, Whitechapel High Street 185, Whitechapel Road 42, White Horse Street 105, White Horse Street 146, White Horse Street 147, White Horse Street 84, White Horse Lane 87, Wilkes Street 1, Wilson Street LIST OF COWHOUSES. Number of Cows kept in October Number of Cows licensed to be kept. Batson Street — 50 21a, Black Lion Yard 44 56 63, Brook Street 19 19 136, Charles Street 11 14 77, Commercial Road 26 26 155, 156 & 157, Railway Arches, Drewton Street 35 41 18, Fairclough Street 54 56 1, Hannibal Road 25 25 37, Hanbury Street 16 18 12, Hilton Street 8 8 42, Jubilee Street 44 44 15, Maroon Street 11 12 5, Meeting House Alley 11 12 28, Mile End Place 4 8 25a, Norfolk Street 46 56 46, Old Church Road 148 148 37, Old Montague Street 12 16 64, Pelham Street 15 16 56, Princes Square 32 32 5, Russell Street 7 7 33, St. Ann's Road 19 19 Saw Yard 8 8 Ship Street 10 12 1, Sidney Street 20 21 150, Sidney Street 20 20 15, Tilley Street 14 14 Tredegar Dairy, Upper Montague Street 59 75 H 2 118 LIST OF COWHOUSES—continued. Number of Cows kept in October. Number of Cows licensed to be kept 9 & 11, Umberston Street 14 14 1, Upper Chapman Street 8 19 37, White Horse Street 20 29 64, White Horse Lane 11 14 LIST OF SLAUGHTERHOUSES. 2, High Street, Whitechapel 3, High Street, Whitechapel 199, Mile End Road 26, Three Colt Street I have again to express my indebtedness to the Sanitary Inspectors and Clerical Staff for the manner in which they have assisted me in carrying out the duties of my office. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, D. L. THOMAS. Medical Officer of Health and Public Analyst. Public Health Offices, 43, White Horse Street, Commercial Road, E. May, 1914. 119 VITAL STATISTICS OF THE WHOLE BOROUGH DURING 1913 AND PREVIOUS YEARS. Required by Local Government Board. Area of Borough in acres (land and inland water) 1,765.6 Total population of all ages 279,804 At Census of 1911. No. of inhabited houses 36,217 Average number of persons per house 7.7, TABLE I.—Vital Statistics of Whole District during 1913 and Previous Years. Metropolitan Borough of Stepney. Yeah. 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. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate.* Number. Rate per 1,000 Nett Births. Number. Rate.* Number. Rate.* 1 2 3 4 6 6 7 8 9 10 11 12 13 1908 285020 10404 10124 35.5 5456 19.1 1062 782 1320 130 5176 18.1 1909 283190 9819 9502 33.4 5225 18.4 1142 676 1130 118 4759 16.8 1910 281360 9512 9164 32.5 4792 17.0 1128 635 1041 113 4299 15.2 1911 279560 8798 8464 30.2 5179 18.5 1196 871 1261 148 4854 17.3 1912 277315 8990 8579 30.9 4566 16.4 1044 722 946 110 4244 15.3 1913 275300 8419 8165 29.6 4467 16.2 1081 775 917 112 4161 15.1 * Rates in Columns 5, 7, and 13 calculated per 1,000 of estimated population. In Column 6 are included the whole of tho deaths registered during the year as having actually occurred within the district. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number m Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. Follows page 119) TABLE II.—Cases of Infectious Disease notified during the Year 1913 Metropolitan Borough of Stepney. Notifiable Disease. Number of Cases notified. • Total Cases notified in* each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. 1. 2. 3. 4. Under 1. 1 to 5. 0 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Limehouse. St. George's. Mile End. Whitechapel. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 423 19 192 169 27 14 2 .. 96 76 151 100 409 Erysipelas 356 20 12 35 38 118 109 24 60 53 124 119 72 Scarlet Fever ,, 784 10 272 439 39 23 1 .. 135 92 380 177 758 Typhus Fever 2 .. •• 1 1 •• .. .. .. 2 .. 2 Enteric Fever .. .. .. 70 .. 3 25 15 19 8 .. 23 11 26 10 67 Relapsing Fever .. .. .. .. •• •• •• •• .. .. .. .. .. .. Continued Fever 1 .. •• 1 •• •• .. .. .. .. 1 1 Puerperal Fever 33 .. •• •• 8 24 1 .. 5 11 10 7 30 Cerebro-spinal Meningitis 9 6 1 2 .. .. .. .. 4 1 2 2 9 Poliomyelitis 15 1 13 1 .. .. .. .. 3 a a 10 2 15 Pulmonary Tuberculosis 2038 8 54 328 331 819 446 52 387 252 852 547 512 Other forms of Tuberculosis .. 504 14 109 263 59 44 14 1 120 87 185 112 179 Ophthalmia Neonatorum 22 22 •• .. •• .. .. .. 8 1 7 6 4 Anthrax 2 •• • • •• 1 •• 1 .. •• .. 2 •• 2 Totals 4259 100 656 1263 520 1061 582 77 841 584 1751 1083 2060 119 (2) TABLE III.—Causes of, and Ages at Death during the year 1913. Metropolitan Borough of Stepney. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total Deaths whether of " Residents " or unonresidents " in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. All causes Certified Uncertified 4161 917 227 159 141 178 589 1035 915 2751 Enteric Fever 10 .. .. .. 2 1 5 2 .. 8 Small-pox .. .. .. .. .. .. .. .. .. Measles 95 23 41 26 4 1 .. .. 31 Scarlet Fever 7 .. .. 4 3 .. .. .. .. Whooping Cough 26 7 9 10 .. .. .. .. 15 Diphtheria and Croup 21 7 10 3 .. 1 .. .. 18 Influenza 24 .. .. .. .. 1 8 10 5 6 Eiysipelas 11 5 .. .. .. .. 2 2 2 10 Phthisis (pulmonary tuberculosis) 447 1 3 2 9 61 180 160 31 169 Tuberculous Meningitis 45 7 9 13 12 1 3 .. .. 74 Other Tuberculous Diseases 80 16 12 15 9 10 6 10 2 91 Cancer, malignant disease 236 .. 1 .. 1 3 30 130 71 194 Rheumatic Fever 16 • • .. .. 4 5 4 1 2 13 Meningitis 10 10 .. .. .. .. .. .. 50 Organic Heart Disease 363 4 2 2 22 21 57 127 128 157 Bronchitis 376 46 4 4 1 1 20 124 176 146 Pneumonia (all forms) 495 120 69 35 12 16 64 109 70 319 Other diseases of respiratory organs 18 .. 1 .. 1 2 3 10 1 14 Diarrhoea and Enteritis 305 250 38 4 2 1 4 3 3 323 Appendicitis and Typhlitis 23 .. .. 2 10 4 1 5 1 64 Cirrhosis of Liver 23 .. .. .. .. .. 7 15 1 19 Alcoholism 7 .. .. .. .. .. 4 3 .. 5 Nephritis and Blight's Disease 132 .. .. .. 3 1 27 63 38 123 Puerperal Fever 7 .. .. .. .. 2 5 .. .. 15 Other accidents and diseases of Pregnancy and Parturition 27 16 .. ... .. 1 10 .. .. 9 Congenital Debility and Malformation, including Premature Birth 280 270 2 4 1 1 2 .. .. 111 Violent Deaths, excluding Suicide 221 48 5 13 17 15 (JO 4 47 43 139 Suicide 21 .. 1 .. .. 4 1 1 0 11 1 9 Other Defined Diseases 630 65 12 20 28 25 1 lv 196 174 591 Diseases ill-defined or unknown 33 22 8 2 .. .. • • 1 .. 6 Old Age 172 .. .. • • .. .. 6 166 22 Totals 4,161 917 227 159 141 178 589 1,035 915 2,751 119 (3) 121 TABLE IV.—Infant Mortality. 1913. LIMEHOUSE DIVISION. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. G-9 Months. 9-12 Months. Total Deaths under One Year. A11 Causes. Certified 38 9 4 6 57 42 49 47 41 236 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. (Jhicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. 1 2 3 6 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. 1 .. 1 Diphtheria and Croup .. .. .. .. .. .. .. l 1 3 Erysipelas .. .. .. .. .. 1 .. .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. 1 .. 1 Abdominal Tuberculosis .. .. .. .. .. .. 1 2 3 6 Other Tuberculous Diseases .. .. .. .. .. .. 1 2 .. 3 Meningitis (not Tuberculous) .. .. 1 .. 1 1 .. 3 .. 5 Convulsions 1 1 .. 1 3 2 4 2 1 12 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 .. 1 3 3 .. 5 12 Pneumonia (all forms) 1 3 .. 1 5 6 5 6 9 31 Diarrhoea 1 .. .. .. 1 2 7 15 8 33 Enteritis .. 1 .. .. 1 4 9 7 8 29 Gastritis .. .. .. .. .. 1 .. .. .. 1 Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. 3 3 5 2 1 .. 11 Injury at Birth 4 .. .. .. 4 .. .. .. .. 4 Atelectasis 2 1 .. .. 3 .. .. .. .. 3 Congenital Malformations .. .. .. 1 1 .. .. .. .. 1 Premature Biith 23 2 2 .. 27 2 .. .. .. 29 Atrophy, Debility and Marasmus 6 1 .. .. 7 12 15 4 2 40 Other causes .. .. .. .. .. 3 .. .. 1 4 38 9 4 6 57 42 49 47 41 236 Nett Births in the year legitimate, 1,774 Nett Deaths in the year of legitimate infants, 225 illegitimate, 30 illegitimate infants, 11 I*) 122 TABLE IV.—Infant Mortality. 1913. ST. GEORGES DIVISION. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause of Death. Under 1 week. 1 -2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certified 30 4 7 6 47 30 40 32 22 171 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 4 .. 4 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. 1 1 Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Erysipelas .. .. .. .. .. 1 .. 1 .. 2 Tuberculous Meningitis .. .. .. .. .. .. .. 2 .. 2 Abdominal Tuberculosis .. .. .. .. .. .. .. .. 1 1 Other Tuberculous Diseases .. .. .. .. .. .. .. 2 .. 2 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. 2 2 Convulsions 1 1 .. .. 2 4 1 2 1 10 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. 1 .. 2 3 3 2 1 11 Pneumonia (all forms) .. .. .. 1 1 3 6 5 5 20 Diarrhoea .. .. 2 .. 2 1 9 5 3 20 Enteritis .. .. .. .. .. 4 11 2 4 21 Gastritis .. .. 1 .. .. .. 1 .. .. 1 Syphilis .. .. .. .. 1 2 1 .. .. 4 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 4 .. .. 1 5 2 2 .. .. 9 Injury at Birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis .. .. .. .. 1 .. .. .. 1 1 .. .. .. 2 Congenital Malformations 1 .. .. .. 1 .. 1 .. .. 2 Premature Birth 19 2 2 2 25 1 .. .. 26 Atrophy, Debility and Marasmus 1 .. 1 1 3 8 3 5 3 22 Other causes .. .. .. 1 .. 1 2 .. 2 2 .. 6 30 4 7 6 47 30 40 32 22 171 Nett Births in the year legitimate, 1,422 Nett Deaths in the year of legitimate infants, 165 illegitimate, 3 2 (illegitimate infants, 6 (5) 123 TABLE IV.—Infant Mortality. 1913. MILE END DIVISION. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 0-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certified 71 17 21 15 124 65 57 48 54 348 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 2 8 10 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 .. 1 .. 2 Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. .. .. 1 .. .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. 1 2 3 Abdominal Tuberculosis .. .. .. .. .. .. .. .. 1 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 1 1 3 Convulsions 6 .. 6 1 13 5 3 4 1 26 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. 1 2 4 2 1 3 .. 10 Pneumonia (all forms) .. .. 2 2 4 4 11 8 13 40 Diarrhoea .. .. .. 1 1 12 26 18 17 74 Enteritis 2 .. 1 2 5 8 8 5 5 31 Gastritis .. 1 .. .. .. 1 .. .. .. 1 Syphilis .. .. .. 1 2 4 .. .. .. 6 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 2 1 .. .. 3 3 2 .. .. 10 Injury at Birth 8 1 .. .. 9 .. .. .. .. 9 Atelectasis 7 1 .. 2 10 .. .. .. .. 10 Congenital Malformations 1 2 1 .. 4 1 1 .. .. 6 Premature Birth 35 5 4 2 46 1 .. .. .. 47 Atrophy, Debility and Marasmus 7 5 5 1 18 14 4 2 .. 39 Other causes 2 1 1 1 5 8 .. .. 4 17 71 17 21 15 124 65 57 48 54 348 Nett Births in the year legitimate, 3,271 Nett Deaths in the year of legitimate infants, 322 illegitimate, 56 illegitimate infants, 26 (6) 124 TABLE IV.—Infant Mortality. 1913. WHITECHAPEL DIVISION. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certified 22 11 6 6 .45 25 45 30 17 162 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 2 3 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 1 1 .. 3 Diphtheria and Croup .. .. .. .. .. .. .. 1 1 2 Erysipelas .. .. .. .. .. .. 1 .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. 1 .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. 1 .. .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. 1 1 2 Meningitis (not Tuberculous) .. .. .. .. .. .. .. 2 .. 2 Convulsions 2 3 .. .. 5 1 1 1 8 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 .. 2 3 3 3 2 13 Pneumonia (all forms) .. 3 1 .. 4 3 8 9 5 29 Diarrhoea .. .. .. .. 1 3 8 5 .. 20 Enteritis .. .. .. .. .. 6 8 3 1 18 Gastritis .. .. .. .. .. .. 1 .. .. 1 Syphilis .. .. .. .. .. 3 1 .. .. 4 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 2 .. .. .. 3 2 1 .. 1 7 Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 4 1 1 .. 6 .. .. .. .. 6 Congenital .Malformations .. l .. .. 1 .. .. .. .. 1 Premature Birth 13 2 2 2 19 .. .. .. .. 19 Atrophy, Debility and Marasmus .. .. .. .. .. 3 7 .. .. 10 Other causes .. 1 1 1 3 1 3 3 .. 10 22 11 6 6 45 25 45 30 17 162 Nett Births in the year legitimate, 1,544 Nett Deaths in the year of legitimate infants, 148 illegitimate, 36 illegitimate infants, 14 (7) 125 TABLE IV.—Infant Mortality. 1913. BOROUGH OF STEPNEY. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year All Causes. Certified 161 41 38 33 273 162 191 157 134 917 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 9 13 23 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 2 1 3 1 7 Diphtheria and Croup .. .. .. .. .. .. 1 3 3 7 Erysipelas .. .. .. .. .. 3 1 1 .. 5 Tuberculous Meningitis .. .. .. .. .. .. 1 4 2 7 Abdominal Tuberculosis .. .. .. .. .. .. 2 2 5 9 Other Tuberculous Diseases .. .. .. .. .. .. 1 5 2 8 Meningitis fnot Tuberculous.) .. .. 1 .. 1 1 6 3 12 Convulsions .. 6 .. 23 11 9 9 4 56 Laryngitis . . . . ., . . .. .. .. .. .. .. .. .. .. Bronchitis 2 .. 4 3 9 11 10 8 8 46 Pneumonia (all forms) 1 6 3 4 14 16 30 28 32 120 Diarrhoea 1 .. .. 2 5 18 50 43 31 147 Enteritis 2 1. 1 2 6 22 36 17 18 99 Gastritis .. .. .. 2 2 .. .. 4 Syphilis .. 1 .. 1 3 9 2 .. .. 14 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 8 .. .. 5 14 12 7 3 1 37 Injury at Birth 15 .. .. .. 16 .. .. .. .. 16 Atelectasis 14 3 .. 2 20 1 .. .. .. 21 Congenital Malformations 2 3 .. 1 7 1 2 .. .. 10 Premature Birth 90 11 10 6 117 4 .. .. .. 121 Atrophy, Debility and Marasmus 14 6 6 2 28 37 29 11 6 111 Other causes 2 3 2 3 10 12 5 5 5 37 161 41 38 33 273 162 191 157 134 917 Nett Births in the year legitimate, 8,011 illegitimate, 154 Nett Deaths in the year of legitimate infants, 860 illegitimate infants, 57 (8) 126 LIST OF STREETS in the Borough of Stepney, their situation and the number of Infectious Diseases that occurred in them during the year. Streets. A Districts. Small Pox. Scarlet Fever. Typhoid Fever. Diphtheria. MembraDous Croup. Erysipelas. Total. Abel's Buildings Whitechapel .. .. .. .. .. .. .. Acland Street Limehouse .. .. .. 2 .. .. 2 Adelina Grove Mile End .. 1 .. 1 . . .. 2 Adler Street Whitechapel and Mile End .. .. .. .. .. .. .. Agatlia Street St. George's .. .. .. .. .. .. .. Agnes Street Limehouse .. .. .. .. .. .. .. Agra Place St. George's .. .. .. .. .. .. .. Albany Street Eatcliff and Mile End .. .. .. .. .. .. .. Albert Buildings, Cartwright Street Aldgate .. .. .. .. .. .. .. Albert Square Eatcliff .. 4 .. .. .. .. 4 Albert Street Mile End New Town .. .. .. .. .. .. .. Albert Workshop, Great Pearl Street Spitalfields .. .. .. .. .. .. .. Albion Cottages Shadwell .. .. .. .. .. .. .. Albion Street Mile End .. 1 .. .. .. .. 1 Alderney Place Mile End .. .. .. .. .. .. .. Alderney Eoad Mile End .. 1 .. .. .. .. 1 Alexandra Buildings, Commercial Street Spitalfields .. 1 .. .. .. .. 1 Alfred Buildings, Cartwright Street Aldgate .. .. .. .. .. .. .. Alma Eoad Mile End .. 1 .. .. .. .. 1 Amazon Street St. George's .. .. .. .. .. .. .. Amber Place St. George's .. .. .. .. .. .. .. Amoy Place Limehouse .. .. .. 1 .. .. 1 Anchor Street Limehouse .. 1 .. .. .. .. 1 Angel Alley Whitechapel .. .. .. .. .. .. .. Ann's Place, Went worth Street Spitalfields .. .. .. .. .. .. .. Antcliff Street Mile End .. .. .. 1 .. .. 1 Anthony Street St. George's .. .. .. 1 .. 1 2 Antili Eoad Mile End .. 4 .. 1 .. .. 5 Antill Terrace Mile End .. 1 .. .. .. .. 1 Apsley Street Mile End .. .. .. .. .. .. .. Arbour Square Mile End .. 2 .. .. .. .. 2 Argyle Eoad Mile End .. .. .. .. .. 1 1 Arno Place Limehouse .. .. .. .. .. .. .. Artichoke Hill St. George's.. .. .. .. .. .. .. .. Artillery Lane Old Artillery Ground .. .. .. 1 .. 1 2 Artillery Passage Old Artillery Ground .. .. .. .. .. .. .. Ashcroft Eoad Mile End .. .. .. .. .. .. .. 127 Returns of Infectious Diseases.—continued. Streets. Districts, Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. Ashford House, Puma Court Spitalfields .. .. .. .. .. .. .. Assam Street Whitechapel .. .. .. .. .. .. .. Assembly Mews Mile End .. .. .. .. .. .. .. Assembly Passage .. Mile End .. .. .. .. .. .. .. Aston Street Limehouse .. 5 4 .. .. 2 11 Augustine House.. Mile End New Town .. .. .. .. .. .. .. B .. .. .. .. .. .. .. Back Church Lane Whitechapel and St. George's .. .. .. .. .. 1 2 Baggally Street Mile End .. 1 .. .. .. .. 2 Baker Court Mile End .. .. .. .. .. .. .. Baker Street Mile End .. 1 .. .. .. .. 2 Bale Street Mile End .. 1 .. .. .. .. 2 Bancroft Road Mile End .. 12 .. 1 .. .. 13 Barnardo Street Ratcliff .. .. .. .. .. .. .. Barnes Street Ratcliff .. 4 .. .. .. .. 12 Barnett Street St. George's .. .. .. .. .. .. .. Batson Street Limehouse .. .. .. .. .. .. .. Batty Street St. George's .. .. .. 1 .. .. 1 Baythorne Street Mile End .. 3 .. 1 .. 1 5 Beaclicroft Buildings, Brook Street Ratcliff .. 1 .. .. .. .. 1 Beagle Street Whitechapel .. .. .. .. .. .. .. Beard's Place Limehouse .. .. .. .. .. .. .. Beatrice House, Phillip Street St. George's .. .. .. .. .. .. .. Beaumont Square Mile End .. .. .. .. .. .. 4 Beaumont Street Mile End .. .. .. 1 .. .. 1 Beccles Street Limehouse .. .. .. .. .. .. .. Becksbourne Buildings Ratcliff .. .. .. .. .. .. .. Bedford Street Mile End and Wliitechapel .. .. .. 1 .. 2 6 Belgrave Street Ratcliff .. .. .. .. .. 1 1 Bell Court Spitalfields .. .. .. .. .. .. .. Bell Lane Spitalfields .. .. .. .. .. 1 1 Belle Vue Place, Cleveland Street Mile End .. .. .... .. .. .. .. Ben Jonson Eoad Mile End and Limehouse .. .. .. .. .. .. .. Bennett's Place Spitalfields .. .. .. .. .. ; .. .. Bermuda Street Mile End .. .. .. .. .. .. .. Berner Street St. George's .. .. .. 1 .. .. 3 Berney Buildings St. George's .. .. .. .. .. .. .. Betts Street St. George's .. .. .. .. .. .. .. 128 Returns of Infectious Diseases.— continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. Bewley Buildings Shadwell .. .. .. .. .. .. .. Birchfield Street Limehouse .. .. .. .. .. .. .. Black Eagle Street Spitalfields .. .. .. .. .. .. .. Black Lion Yard Whitechapel .. .. .. .. .. .. .. Blackwall Buildings, Fulbourne Street "Whitechapel .. 1 .. 2 .. .. 3 Blakesley Street St. George's .. 4 .. 1 .. .. 6 Bloomfield Road Mile End .. 3 .. 1 .. .. 4 Blossom Court Norton Folgate .. .. .. .. .. .. .. Blossom Street Norton Folgate .. .. .. 1 .. 1 Blount Street Limehouse .. 4 .. .. .. .. 6 Boarded Entry St. George's .. .. .. .. .. .. .. Boar's Head Yard Whitechapel .. .. .. .. .. Bolin Street Mile End 1 .. 3 .. .. 4 Booth Street Mile End New Town and Spitalfields .. 1 .. .. .. .. 1 Booth Street Building Spitalfields .. .. 1 .. .. .. 1 Bostock Street St. George's .... .. .. .. .. .. .. Boulcott Street Ratcliff .. .. 1 .. .. 1 Boundary Court Spitalfields and Mile End New Town .... .. .. .. .. .. .. Bow Common Lane Mile End and Limehouse .. 2 .. 2 .. .. 4 Bower Street Ratcliff .. .. .. .. .. .. Bowyer's Buildings St. George's .. .. .. .. .. .. .. Boyd Street St. George's .. 4 .. 3 .. .. 1 Bradwell Street Mile End .. .. .. 3 .. .. 3 Brady Street Whitechapel .. 1 .. .. .. 1 2 Brady Street Buildings Whitechapel .. 4 .. 3 .. 2 9 Brady Street Mansions Whitechapel .. 4 .. 5 .. .. 9 Brain tree Street Mile End .. 4 .. .. .. .. 7 Breezer's Hill St. George's .. .. .. .. .. .. .. Brenton Street Limehouse .. 1 .. 1 .. .. 3 Brewer's Court Shadwell .. .. .. .. .. .. Brewhouse Lane Wapping .. .. .. .. .. .. .. Brick Lane Spitalfields and Whitechapel .. 8 1 1 .. 3 13 Bridge Street Mile End .. 4 .. 1 .. 1 6 Bridge Terrace Limehouse .. .. .. .. .. .. .. Brighdingsea Buildings Limehouse .. .. .. .. .. .. .. Briuhtlingsea Place Limehouse .. .. .. .. .. .. .. Brilliant Street Mile End .. .. .. .. .. .. .. Britten's Court St. George's .. .. .. .. .. .. .. Broad Street Ratcliff .. .. .. .. .. .. Bromhead Boad Mile End .. 1 .. .. .. .. 1 Bromhead Street Mile End .. 8 .. 2 .. .. 13 Bromley Street Ratcliff .. 4 .. 2 .. 1 7 129 Returns of Infectious Diseases.— continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. Brook Street Ratcliff .. 2 .. .. .. 2 Brownings Court St. George's .. .. .. .. .. .. Brownson's Court Whitecliapel .. .. .. .. .. .. Brunswick Buildings Whitechapel .. .. .. 3 .. 4 10 Brunswick Street St. George's .. .. .. .. .... 2 2 Brunton's Cottages Ratcliff .. 1 .. .. .. 1 Brunton's Place Ratcliff .. .. .. .. .. .. Brushfield Street Spitalfields and Old Artillery Ground .. .. .. .. .. .. Buckeridge Street Mile End .. .. .. 1 3 Buckle Street Whitechapel .. .. .. .. .. .. Buckle Street Buildings . Whitecliapel .. .. .. .. .. 2 Bull Stake Court Whitechapel .. .. .. .. .. .. Bulwer House, Pelham Street Mile Knd New Town .. .. .. .. .. .. Bungay Street Limehouse .. .. .. .. .. .. Burdett Road Limehouse and Mile End .. 4 1 4 .. 9 Burgess Street Limehouse .. 4 .. .. .. 2 6 Buross Street St. George's .. 1 .. .. .. 1 2 Burr Street Aldgate .. .. .. .. .. .. Burslem Street St. George's .. 1 .. .. .. 1 Burton's Entry Ratcliff .. .. .. .. .. .. Bushel Street St. George's .. .. .. .. .. .. Butcher Row Ratcliff .. .. .. .. .. Butler Street Spitalfields .. .. .. 1 .. 1 Buttress Gardens Mile End New Town .. .. .. .. .. .. Buttress Street Mile End New Town .. .. .. .. .. .. Buxton Street Mile End New Town .. 5 .. 2 3 10 c Cable Street St. George's, Shadwell .. and Whitechapel .. 3 2 5 .. 7 17 Cadiz Street Mile End .. 1 1 .. .. 2 4 Calcutta Street Limehouse .. .. .. .. .. .. Calverley Street Mile End .. .. .. .. .. .. Cambridge Mansions Mile End .. 1 .. .. .. .. 1 Cambridge Road Mile End .. 4 .. 1 .. 1 6 Cameron Place Mile End .. 1 .. .. .. .. 1 Canal Road Mile End .. 8 .. 1 .. .. 9 Cannon Place Mile End and Whitechapel .. .. .. .. .. .. .. Cannon Street Road St. George's .. .. .. 1 .. 4 5 Carlton Road Mile End .. 2 .. .. .. 3 Carlton Square Mile End .. 2 .. .. .. 1 3 Carr Place Limehouse .. .. .. .. .. .. .. 130 Returns of Infectious Diseases.—continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. M em brau ous Croup. Erysipelas. Total. Caroline Place, Globe Road Mile End .. .. .. .. .. .. .. Caroline Street RatclifE .. .. .. .. .. .. .. Carr Street Limehouse .. .. .. .. .. 2 2 Carter Street Mile End .. .. 3 1 .. .. 4 Carter Street Spitalfields .. .. .. .. .. .. .. Cartwright Street Aldgate .. .. .. .. .. .. .. Casson Place Whitechapel .. .. .. .. .. .. .. Casson Street Whitechapel .. 1 1 .. .. .. 2 Castle Alley Whitechapel. .. .. .. .. .. .. .. Castle Court Whitechapel .. .. .. .. .. .. .. Catherine Terrace Spitalfields .. .. .. .. .. .. .. Causeway Court RatclifE .. .. .. .. .. .. .. Cayley Street Limehouse .. .. .. 2 .. 1 3 Cecil Street Mile End .. .. .. .. .. .. .. Cephas Street Mile End .. .. .. .. .. .. .. Challis Court St. George's .. .. .. .. .. .. .. Chamber Street Whitechapel .. .. .. 1 .. 1 2 Chancery Buildings Shadwell .. .. .. .. .. .. .. Chancery Place Shadwell .. .. .. .. .. .. .. Chandler Street St. George's .. .. .. .. .. .. .. Chapel Street Spitalfields .. .. .. .. .. .. .. Chapman Place St. George's .. .. .. .. .. .. .. Charles Place Shadwell .. .. .. .. .. .. .. Charles Street Mile End .. 4 .. .. .. .. 4 Charlotte Court, Hunton Street Mile End New Town .. .. .. .. .. .. .. Chaseley Street RatclifE .. .. .. .. .. .. .. Chicksand Place Mile End New Town .. .. .. .. .. .. .. Chicksand Street Mile End New Town .. 2 .. 1 .. 1 4 Chigwell Hill St. George's .. .. .. .. .. .. .. Chiver's Court Limehouse .. .. .. .. .. .. .. Cholsey Buildings, Booth Street Spitalfields .. .. .. .. .. 1 1 Choppin's Court St. George's .. .. .. .. .. .. Christian Street St. George's .. 5 .. 5 .. 1 11 Christopher Court Whitechapel .. .. .. .. .. 1 1 Church Court Wapping .. .. .. .. .. .. .. Church Lane Whitechapel .. .. .. .. 1 1 2 Church Passage Spitalfields .. .. .. .. .. .. .. Church Row Limehouse .. 2 .. .. .. 1 3 Church Street Holy Trinity, Minories .. .. .. .. .. .. .. Chusan Place Limehouse .. .. .. .. .. .. .. Claremont Place Mile End .. .. .. .. .. .. .. Clark Street Mile End .. 5 .. 1 .. 1 7 Clayden's Buildings Limehouse .. .. .. .. .. .. .. 131 Returns of Infectious Diseases.— continutd. Streets. District!. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total Clegg Street St. George's .. .. .. .. .. 2 2 Clemeuce Street Limehouse .. 4 .. .. .. .. 4 Cleveland Buildings Mile End .. .. .. .. .. .. .. Cleveland Grove Mile End .. 1 .. .. .. .. 1 Cleveland Street Mile End .. 2 .. 2 .. 2 6 Clifford House, AVellclose Square St. George's .. 1 .. .. .. .. 1 Clinton House, Pelham Street Mile End New Town .. .. .. .. .. .. .. Clinton Road Mile End .. 2 .. 1 .. 1 4 Clive Street Mile End .. .. .. .. .. .. Cobbs Street Spitalfields .. .. .. 1 .. .. 1 Coborn Road Mile End .. .. .. .. l .. .. 1 Coburg Buildings St. George's .. .. .. .. .. .. .. .. Coburg Court Spitalfields .. .. .. .. .. .. .. Coburg Place Mile End .. .. .. .. .. .. .. Colien's Court Mile End .. .. .. .. .. .. .. Coke Street Mile End .. .. .., .. .. 2 2 Colchester Street Whitechapel .. .. .. .. .. .. Coleman Street Shadwell .. .. .. .. .. 1 1 College Buildings, Went worth Street Whitechapel .. .. .. .. .. .. .. College Street Mile End .. .. .. 1 .. .. 1 Collliurst Villas, Devonshire Street Mile End .. .. .. .. .. .. .. Colrnar Street Mile End .. 2 .. .. .. .. 2 Commercial Mansions Mile End .. .. .. .. .. .. Commercial Road Whitechapel, St. George's, Mile End and Limehouse .. 13 .. 10 .. 8 31 Commercial Street Whitechapel and Spitalfields .. 1 .. 2 .. .. 3 Commodore Street Mile End .. .. .. .. 1 1 Conder Street Limehouse .. 3 .. 2 .. .. 8 Copenhagen Place Limehouse .. .. .. 1 .. 2 3 Copley Street Mile End .. 2 .. 1 .. 1 4 Copperfield Road Mile End .. .. .. 1 .. 1 2 Corbett's Court Spitalfields .. .. .. .. .. .. .. Cordelia Street Mile End .. .. .. .. .. .. .. Cornwall Place Mile End .. .. .. .. .. .. .. Cornwall Road Mile End .. .. .. .. .. .. .. Cornwall Square Mile End .. .. .. .. .. .. .. Cornwall Street St. George's .. 1 .. 1 .. 1 3 Cosh's Buildings, School House Lane Ratcliff .. .. .. .. .. .. .. Cosh's Buildings, Brook Street Ratcliff .. .. .. .. .. .. .... I 132 Returns of Infectious Diseases.—continued. Streets. Districts, Small Pox. Scarlet Fever. Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. Total. Cottage Court Mile End .. 1 .. .. .. .. 1 Cottage Grove Mile End .. .. .. .. .. .. .. Court Street Whitechapel .. .. .. .. .. .. .. Coutts Road Mile End .. 1 3 .. .. 5 Cowley Street St. George's .. 5 .. 2 .. .. 7 Cranford Cottage Ratcliff .. .. .. .. .. .. .. Cranford Street Ratcliff .. .. .. .. .. .. .. Crawshaw Place Whitechapel .. .. .. .. .. .. .. Crellin Street St. George's .. .. .. .. .. .. .. Cressy Houses Mile End .. .. .. .. .. 1 .. Cressy Place Mile End .. .. .. .. .. 1 1 Crispin Street Spitfjfields .. .. .. .. .. 1 2 Cross Court St. George's .. .. .. .. .. .. .. Cuttle Place St. George's .. .. .. .. .. .. .. D . Dakin Street Limehouse .. 1 .. .. .. .. 1 Dalgleish Place Limehouse .. .. .. 1 .. .. 1 Dalgleish Street Limehouse .. .. .. .. .. 1 1 Darby Street Whitechapel .. .. .. .. .. .. .. Davis Avenue, Hunton Street Mile End New Town .. .. .. 2 .. .. 2 Davis Mansions, New Goulston Street Whitechapel .. 1 .. 1 .. .. 2 Davis Terrace, Hunton Street Mile End New Town .. .. .. .. .. .. .. Day Place St. George's .. .. .. .. .. .. .. Deal Street Mile End New Town .. .. .. .. .. Dean Street St. George's .. 1 .. 1 .. .. 2 Dellow Street Shadwell .. .. .. .. .. .. .. Dellow Street Buildings . Shadwell .. .. .. .. .. Dempsey Street Mile End .. 3 .. 2 .. .. 5 Denmark Street St. George's .. 1 .. 1 .. 2 Devonport Street Ratcliff .. .. .. 1 .. .. 1 Devonshire Place Limehouse .. .. .. .. .. .. .. Devonshire Street Mile End .. 4 .. 5 .. 1 10 Diggon Street Mile End .. 6 .. .. .. 4 10 Dixon Street Limehouse .. 4 .. 1 .. .. 5 Dock Street Whitechapel and Wapping .. .. .. .. .. 1 1 Dod Street Limehouse .. .. .. .. .. .. .. Dora Street Limehouse .. .. .. .. .. .. .. Dongola Street Mile End .. .. .. 1 .. .. 1 133 Returns of Infectious Diseases.— continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever | Diphtheria. Membranous Croup. Erysipelas. Total. Doris House, Philip Street St. George's .. .. .. .. .. .. .. Dorset Street Rate! iff .. .. .. 1 .. 1 2 Doveton Street Mile End .. .. .. .. .. .. .. Drant Street Spitalfields .. .. .. .. .. .. .. Drew's Buildings, Elbow Lano Shadwell .. .. .. .. .. .. .. Drew's Buildings, High Street Shadwell .. .. .. .. .. .. .. Drew's Buildings, Juniper Street Shadwell .. .. .. .. .. .. .. Drewton Street Ratcliff .. .. .. .. .. .. .. Driver's Buildings Mile End .. 2 .. .. .. .. 2 Drum Yard Whitechapel .. .. .. .. .. .. .. Duckett Street Mile End .. 3 3 1 .. 1 8 Dudloy Terrace Mile End .. .. .. .. .. .. .. Duke Street Old Artillery Ground .. .. .. .. .. .. Duncan Street Whitechapel .. 1 .. .. .. .. 1 Dunch Street St. George's .. .. .. .. .. .. .. Dundee Street Wapping .. .. .. 1 .. .. 1 Dunk Street Mile End New Town .. 1 .. 2 1 4 Dunstan's Houses Mile Knd .. 2 .. .. .. 1 3 Dunstan's Place Ratcliff .. .. .. .. .. .. Dupont Street Limehouse .. .. .. .. .. .. .. Durer Place St. George's .. .. .. .. .. .. .. Durham Row Ratcliff .. 2 .. 2 .. .. 4 Durward Street Whitechapel .. 1 .. .. 1 .. 2 Duval Street Spitalfields .. .. .. .. .. 3 3 E East Arbour Street Mile End 1 .. .. .. 1 2 Eagle Place Mile End .. .. .. .. .. .. .. Eagle Place Mile End New Town .. .. .. .. .. .. .. Easington Buildings Whitechapel .. .. .. .. .. .. .. Eastbury Terrace Mile End .. .. .. .. .. .. .. Eastfield Street Limehouse .. 4 2 4 1 2 13 East India Dock Eoad Limehouse .. 4 .. 1 .. .. 5 Eastman's Court Spitalfields .. .. .. .. .. .. East Mount Street Whitechapel .. 1 .. .. 1 1 3 East Pier Wapping .. .. .. .. .... .. .. East Street Spitalfields .. .. .. .. .. .. .. Eaton Place Wapping .. .. .. .. .. .. .. Ebenezer Place Limehouse .. .. .. .. .. .. .. Edinburgh Eoad Mile End .. .. .. .. .. .. .. Edward Mann Buildings Ratcliff .. .. 1 .. .. 1 Edward's Eoad Mile End .. 3 .. .. .. 1 .. 3 12 134 Returns of Infectious Diseases.— continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. Edward Street Mile End .. 2 .. .. .. .. 2 Eele Street, King Edwar Street Mile End New Town .. .. .. 1 .. .. 1 Eileen Mansions, Christia Street St. George's .. 1 .. .. .... .. 1 Elbow Lane - Shadwell .. .. .. .. .. .. .. Elbow Lane Buildings Shadwell .. .. .. .. .. .. .. Elder Court Norton Folgate .. .. .. .. .. .. .. Elder Street Norton Folgate .. .. .. .. .. .. .. Ellen Place St. George's .. 2 .. .. .. .. 2 Ellen Street St. George's .. 1 .. .. .. .. 2 Elm Bow Shadwell .. .. .. .. .. .. .. Elsa Street Limehouse .. .. .. .. .. .. 1 Elsie House, Philip Stree St. George's .. .. .. .. .. .. .. Elthaui Placo Mile End .. .. .. .. .. .. .. 1 Ely Place, Cliiclf sand Stree Whitecbapel .. .. .. .. .. .. 1 Ely Terrace M ile End .. .. .. .. .. .. .. Emery Place Butler Stree Spit.alfields .. .. .. .. .. .. .. Emmott Street Mile End .. 3 .. .. .. .. 4 Endive Place Limehouse .. .. .. .. .. .. .. Endive Street Limehouse .. 1 .. .. .. .. 1 Entick Street Mile End .. .. .. .. .. .. 2 Eric Street. Mile End .. 7 .. .. .. .. 10 Ernest Street Mile End .. 5 .. .. .. 2 9 Essex Street Essian Street Mile End Mile End .. 1 1 .. .. .. 1 2 1 Everard Street St. George's .. .. .. 1 .. .. 1 Ewing Street M ile End .. 1 .. .. .. 1 2 Exmouth Street Mile End .. .. .. 1 .. l 2 F Fair Street Mile End .. .. .. .. .. .. .. Fairclough Street St. George's. .. .. .. .. .. .. .. Faith Street Mile End .. 1 .. .. .. .. 1 Farmer's Bow Limehouse .. .. .. .. .. .. .. Farrance Street Limehouse .. .. .. 1 .. .. 1 Fashion Street Spitalfields .. 1 .. .. .. .. 1 Felix Houses, Splidts Stree St. George's .. .. 1 .. .. 3 4 Fenton Street St. George's .. 1 .. .. .. 1 2 Ferrier's Court Mile End .. .. .. .. .. .. .. Ficklin Buildings St. George's .. .. .. .. .. 1 1 Fieldgate Mansions, Myrdle, Bomford and Fieldgate Streets Mile End .. .. .. 5 .. 1 6 135 Returns of Infectious Diseases.—continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. Fieldgate Street Whitecliapel .. 2 .. 1 .. 2 5 Finch Street Whitechapel and Mile End New Town .. 2 .. 1 .. .. 3 Flam borough Street Limehouse .. .. .. .. .. .. .. Fleur-de-lis Buildings Norton Folgate .. .. .. .. .. .. 1 Fleur-de-lis Street Norton Folgate .. .. .. .. .. .. .. Floreston Street Mile End .. .. .. .. .. .. .. Flower and Dean Street Spitaltields .. .. .. .. .. 4 Ford Square Mile End .. .. .. .. .. .. .. Fordham Street Mile End .. .. .. .. .. .. 1 Forrester Street Mile End .. .. .. .. .. Fort Street Old Artillery Ground .. .. .. .. .. .. 3 Fournier Street Spitaltields .. .. .. .. .. .. .. Frederick Place Mile End .. .. .. .. .. 3 Freemaii Street Spitaltields .. .. .. .. .. .. 2 Freeman's Cottages Mile End .. .. .. .. .. .. .. French Court St George's .. .. .. .. .. .. .. Friav's Hill St. George's .. .. .. .. .. .. .. Frimley Street Mile End .. .. .. .. .. .. Frostic Mansions "Whitechapel .. .. .. .. .. .. 3 Frostic Place Whitechapel .. .. .. .. .. .. .. Frying Pan Alley Spitaltields .. .. .. .. .. .. .. Fulbourne Street. Whitechapel .. .. .. .. .. .. .. Fulcher'.s Buildings, Fore ham Street Mile End .. 1 .. .. .. .. 1 G Gainsborough Road Mile End .. .. .. .. .. .. .. Gait Street Limehouse .. 1 .. .. .. 1 2 Garden Cottages Limehouse .. .. .. .. .. .. Garden Place Mile End New Town .. .. .. .. .. .. .. Garden Street Mile End .. .. .. .. .. .. Gardom Street Mile End .. 1 .. .. .. .. 1 Garrick's Buildings Limehouse .. .. .. .. .. .. Garth Street Shadwell .. .. .. .. .. .. Gates Head Place Mile End .. .. .. .. .. .. .. Georgina Place Mile End .. .. .. .. .. .. .. Gertrude House St. George's .. .. .. .. .. .. Giles Place Batcliff .. .. .. .. .. .. .. Gill Place Limehouse .. .. .. .. .. .. .. Gill Street Limehouse .. .. .. .. .. .. .. Glamis Road Shadwell .. 5 .. 4 .. .. 9 Glasshouse Fields Ratcliff .. .. .. .. .. .. .. Glasshouse Street Whitechapel .. .. .. .. .. .. .. Globe Alley Limehouse .. .. .. .. .. .. .. Globe Buildings Mile End .. .. .. .. .. .. .. 136 Returns of Infectious Diseases.—continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. Globe Court St. George's .. .. .. .. .. .. .. Globe Road Mile End .. 3 .. .. .. 2 7 Globe Street St. George's .. .. .. Godfrey House, Thrawi .. .. .. Street Spitalfields .. 1 .. .. .. .. 1 Gold Street Mile End .. 2 .. 1 .. .. 3 Golding Terrace, .. .. mercial Road St. George's .. .. .. .. .. .. .. Goodhart Place St. George's .. .. .. .. .. .. .. .. .. Goodman's Yard Whitechapel .. .. .. .. .. .. .. Gould's Hill Shadwell .. .. .. .. .. .. .. Goulston Street Whitechapel .. .. .. .. .. .. .. Govey's Place Mile End .. .. .. .. .. .. .. Gower's Walk Whitechapel .. .. .. .. .. .. Grace's Alley VVhitechapel .. 1 .. .. .. .. 1 Grafton Street Mile End .. 1 .. 5 .. 1 7 Gray Street Mile End .. .. .. .. .. .. .. Grebe Court Mile End .. .. .. .. .. .. .. Green Bank Wapping and St. George's .. 1 .. .. .. .. 1 Green Street Whitechapel .. , , .. .. .. .. .. Green Dragon Yard Whitechapel .. . , .. .. .. .. .. Greenfield Street Mile End .. 1 .. .. .. 1 2 Greenwood Street Mile End .. .. .. 1 .. .. 1 Grenade Street Limehouse .. 1 .. 1 .. 1 3 Grey Eagle Street Spitalfields .. 1 .. 1 .. 1 3 Grigg's Court Whitechapel .. 1 .. .. .. .. 1 Grosvenor Street Mile End .. .. .. .. 1 1 Grove Buildings, South .. .. Grove Mile End .. 1 .. .. .. .. 1 Grove Road Mile End .. .. .. 1 .. 1 2 Grove Street St. George's .. .. .. 1 .. 2 3 Great Alie Street Whitechapel .. .. .. .. .. .. .. Great Eastern Buildings, .. .. .. Fieldgate Street Whitechapel .. .. .. .. .. .. .. Great Eastern Buildings, .. .. Quaker Street Spitalfields .. 3 .. .. .. 1 4 Great Garden Street Whitechapel .. 3 .. 1 .. .. 4 Great Hermitage Street St. George's .. 1 .. 3 .. .. 4 Great Pearl Street Spitalfields .. .. .. .. .. 2 2 Great Prescot Street Whitechapel .. 2 2 1 .. .. 5 Gun Street Old Artillery Ground .. .. .. .. .. .. .. Gunthorpe Street Whitechapel .. .. .. .. .. .. .. 137 Returns of Infectious Diseases.—continued. Streets. H District. Small Pox. Scarlet Fever. Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. |Total. Hadleigh Street Mile End .. .. .. .. .. 1 1 Half Moon Passage Wliitecliapel .. .. .. .. .. .. .. Hall Street Mile End .. .. .. .. .. .. .. Halley Street Limehouse .. .. .. 2 .. .. 2 Hampshire Court Whitechapel .. .. .. .. .. .. .. Hanbury Fields Spitalfields .. .. .. .. .. .. .. Hanbury Street Spitaltields and Mile End New Town .. 6 .. 6 5 17 Hannibal Mews Mile End . .. .. .. .. .. .. .. Hannibal Road Mile End .. 2 .. .. .. .. 2 Hardinge Street Ratcliff and St. George's .. .. .. 1 .. 1 2 Hardy's Place Mile End .. .. .. .. .. .. Hare Street Mile End .. .. .. .. .. .. .. Harford Street Mile End .. 4 6 1 .. 3 14 Harlow Place Mile End .. .. .. 1 .. .. 1 Harad's Place Whitechapel .. .. .. .. .. .. .. Harris Terrace St. George's .. .. .. .. .. .. .. Harrison's Court Spitalfields .. .. .. 1 .. .. 1 Havering Street Ratcliff .. 2 .. 2 .. 2 6 Hawkins Street Mile End ... . .. 1 .. .. 3 5 Haydon Street Holy Trinity, Minories .. .. .. .. .. .. .. Hayfield Passage Mile End .. .. .. .. .. .. .. Hayfield Place Mile End .. .. .. .. .. .. .. Hayfield Yard Mile End .. .. .. .. .. .. .. Heath Street Mile End .. .. .. 2 .. .. 2 Heckford Street Ratcliff .. .. .. 1 .. .. 1 Helena House, Loleswort Street Spitalfields .. 4 .. 1 .. .. 5 Helena Terrace, Chicksand Street Spitaltields and Whitechapel .. 1 .. .. .. .. 1 Hellings Street St. George's .. .. .. .. .. .. .. Heneage Street Whitechapel and Mile End New Town .. .. .. .. .. 2 2 Heury Street Limehouse .. .. .. .. .. .. .. Hessel Street St. George's .. 2 .. .. .. 1 3 Hessel Street Buildings St. George's .. 1 .. .. .. 1 2 Hewitt's Court Mile End .. .. .. .. .. .. .. High Street Shadwell .. 2 .. 2 .. 2 6 High Street Stepney .. 1 .. 1 .. .. 2 High Street Wapping .. .. .. .. .. .. .. Hilliard's Court St. George's .. .. .. 1 .. .. 1 Hilton Street Ratcliff .. .. .. 1 .. .. I Hobson's Cottages,Pelham Street Mile End New Town .. .. .. .. .. .. .. 138 Returns of Infectious Diseases.—continued. Streets. Districts Small Pox. | Scarlet Fever. Typhoid Fever Diphtheria. embranous Croup. Erysipelas. Total.  Hobson's Place ,. Mile End New Town .. .. .. .. .. .. .. Hogarth Houses, Batty St St. George's .. 1 .. 1 .. 1 3 nolt'ord Street Mile End .. .. .. 1 .. .. 1 Holker Place Limehouse .. .. .. .. .. .. .. Hollowav Street Mile End .. .. .. .. .. .. .. Hooper Street Whitechapel .. .. .. .. .. .. .. Hope Place Limehouse .. .. .. .. .. .. .. Hope Street Whitechapel .. .. .. .. .. .. .. Horndon Place Rrttcliff .. .. .. .. .. .. .. Horseferry B ranch Road. Ratcliff .. .. .. .. .. .. .. Horseferrv Road . Ratcliff .. .. .. .. .. .. .. Horsley Buildings Mile End .. .. .. .. .. .. .. Howard's Buildings Mile End New Town .. .. .. .. .. .. ... . Huddart Street Mile End .. 3 .. 1 .. .. 4 Hungerford Street St. George's .. 1 .. .. .. 1 2 Hunton Court Mile End New Town .. 1 .. .. .. 1 2 Hunton Place Mile End New Town .. 1 .. .. .. .. 1 Hunton Street Mile End New Town .. .. .. .. .. .. .. Hunts Mews Shadwell .. .. .. .. .. .. .. I Imperial Buildings Irene House, Flower am Dean Street St. George's Spitalfields .. 4 .. .. .. 1 1 4 Irish Court Whitechapel .. .. .. .. .. .. .. Island Row Limehouse .. .. .. .. .. .. J Jamaica Street Mile End .. 3 .. .. .. .. 3 James' Place Ratcliff .. .. 1 2 .. .. 3 James' Street Mile End .. .. .. .. .. .. .. Jane Court St. George's .. .. .. .. .. .. .. Jane Street St. George's .. .. .. .. .. .. .. Jenkins Court Limehouse .. .. .. .. .. .. .. Jewell Street Mile End .. .. .. .. .. .. .. John's Court St. George's .. .. .. .. .. .. .. Joint's Gardens Limehouse .. .. .. .. .. .. .. John's Hill St. George's .. .. .. .. .. .. .. John's Place Mile End .. .. .. .. .. .. .. Johnson's Buildings Wapping .. .. .. .. .. .. .. Johnson Street Mile End New Town .. .. .. .. .. .. .. Johnson Street St. George's .. .. .. .. .. 1 1 Joseph Street Mile End .. 1 .. .. .. 2 3 139 Returns of Infectious Diseases.—continued. Streets. Districts. Small Pox | Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. Joseplh Street St. George's .. .. .. .. .. 1 1 Josephine House, Thrawl Street Spitalfields .. 3 .. .. .. 1 4 Jubilee Street Mile End .. 7 .. 1 .. .. 8 Juniper Court St. George's .. .. .. .. .. .. Juniper Street Skadwell .. 5 .. 1 .. .. 6 Jupp's Road Mile End .. 9 1 1 .. 1 12 K Katharine Buildings, Cartwright Street Aldgate .. .. .. .. .. .. .. Kent and Essex Yard Whitechapel .. .. .. .. .. .. .. Key Street Mile End .. 2 .. .. .. 2 4 Kinder Street St. George's .. .. .. .. .. 1 1 King Uavid Lane Shadwell .. .. .. .. .. .. .. King Edward Street Mile End New Town .. 1 .. .. .. .. 1 King Jolin Street Mile End .. 2 .. 1 .. .. 3 King Street Aldgate .. 1 .. .. .. .. 1 King's Arms Court Whitechapel .. .. .. .. .. .. Kirk's Place Limehouse .. .. .. .. 1 .. 1 Knott Street Mile End .. .. .. .. .. .. L Lady Mica's Almshouses Ratcliff .. .. .. .. .. .. .. Lake Street Ratcliff .. .. .. .. .. .. .. Lamb Court Spitalfields .. .. .. .. .. .. Lamb Street Spitalfields .. .. .. .. .. 1 Lambeth Street Whitechapel .. .. .. .. .. .. .. Lancaster Place Holy Trinity, Minories .. .. .. .. .. .. .. Lance Street Limehouse .. .. .. .. .. .. .. Langdale Mansions St. George's .. 5 .. 2 .. 1 8 Langdale Street St. George's .. .. .. .. .. .. .. Latimer Street Mile End .. .. .. .. .. .. .. Lavender Place St. George's .. .. .. .. .. 2 2 Lawn House Yard Mile End .. .. .. .. .. .. .. Lawrence Buildings St. George's .. .. .. .. .. .. .. Lawton Road Mile End .. .. .. .. .. .. .. Leatherdale Street Mile End .. 2 .. 2 .. .. 4 Lee Street Limehouse .. 3 .. .. .. 1 4 Leman Passage Whitechapel .. .. .. .. .. 1 1 Leman Street Whitechapel .. 2 .. 1 .1 .. 4 Leopold Street Mile End .. .. .. .. .. .. .. Leslie Street Mile End .. .. .. .. .. .. .. 140 Returns of Infectious Diseases—continued Streets. Districts. Small Fox. Scarlet Fever. Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. Total. Lewin's Building's Mile End .. .. .. .. .. .. .. Leyden Street Spitalfields .. .. .. .. .. .. Lichfield Road Mile End .. 1 .. .. .. 1 2 Lilian House, Philip Stree St George's .. .. .. .. .. .. .. Limehouse Causeway Limehouse .. 1 .. .. .. 1 Lincoln Street Mile End 2 .. .. .. 2 4 Lindley Street Mile End .. 2 .. .. .. .. 2 Little Alie Street Whitechapel .. .. .. .. .. .. .. Little Ann Street St George's .. .. .. .. .. .. .. Little Bridge Street Mile End .. .. .. .. .. .. .. Little Halifax Street Whitechapel .. .. .. .. .. .. .. Little Hermitage Street St George's .. .. .. .. .. .. .. Little Holloway Street Mile End .. .. .. .. .. 1 1 Little Pearl Street Spitalfields .. .. .. .. .. I 1 Little Tongue Yard Whitechapel .. .. .. .. .. .. .. Little Turner Street St George's .. .. 3 1 .. .. 4 Loat's Buildings Aid gate .. .. .. .. .. .. .. Lockhart Street Mile End .. .. .. .. .. .. .. Lockside Limehouse .. 1 .. .. .. .. 1 Locksley Street Limehouse .. 2 1 1 .. .. 4 Lolesworth Buildings, Thrawl Street Spitalfields .. 1 .. 1 .. 3 5 Lolesworth Street Spitalfields .. .. .. .. .. .. .. Lomas Buildings Mile End .. .. .. .. .. 1 1 Lombard Street Mile End New Town .. 3 .. .. .. .. 3 London Street Ratcliff .. .. .. .. .. .. .. London Teirace, Commer cial Road St George's .. .. .. .. .. 1 1 Longfellow Road Mile End .. .. 1 .. .. 2 3 Longnor Road Mile End .. 4 .. .. .. .. 4 Lotus Court Spitalfields .. .. .. .. .. .. .. Louisa Gardens Mile End .. 1 .. .. .. .. 1 Louisa Street Mile End .. .. .. .. .. .. • • Louvaine Street Mile End .. .. .. .. .. .. .. Love Court Ratcliff .. .. .. .. .. .. .. Love Lane Shadwell , .. 1 .. 1 .. .. 2 Lowder Street St George's .. .. .. 1 .. .. 1 Lowell Street Limehouse .. .. 2 .. .. .. 2 Lower Chapman Street St George's .. .. .. 3 .. .. 3 Lower Fenton Street St George's .. .. .. .. .. .. .. Lower Shadwell Shadwell .. .. .. .. .. .. .. Lowood Buildings Shadwell .. .. .. .. .. .. .. Lucas Street St George's .. 3 .. 2 .. 2 7 Ludens Place St George's .. 1 .. .. .. .. 1 Lufton Place Limehouse .. .. .. .. .. 1 1 Luntley Place Whitechapel .. .. .. .. .. .. .. 141 Returns oJ Infectious Diseases—continued Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. Total. Lyall Road Mile End .. 2 .. 1 .. .. 3 Lydbrook Street Limehouse .. .. .. .. .. .. .. Lydia Street Mile End .. .. .. .. .. .. .. Lytton House Pelham Street Mile End New Town .. 2 .. .. .. .. 2 M Magdalen Passage Whitechapel .. .. .. .. .. .. .. Maidman Street Mile End .. .. .. .. .. .. .. Malay Street St George's .. .. .. 1 .. .. 1 Manning Street Limehouse .. .. .. .. .. 1 1 Manor Court Ratcliff .. .. .. .. .. .. .. Mansell Passage Whitechapel .. .. .. .. .. .. .. Mansell Street Whitechapel .. .. .. .. .. .. .. Maplin Street Mile End .. 8 1 4 .. 2 15 Maria Terrace Mile End .. .. .. .. .. .. .. Maritime Street Mile End .. 1 .. .. .. .. 1 Market Buildings Shadwell .. .. .. .. .. .. .. Market Hill Shadwell .. .. .. .. .. .. .. Market Street Ratcliff .. .. .. .. .. .. .. Marmaduke Place St George's .. .. .. .. .. .. .. Maroon Street Limehouse .. 2 .. .. .. 1 3 Martha Street St George's .. .. .. 1 .. .. 1 Mary Ann Street St George's .. 1 .. .. .. .. 1 Mary Place St George's .. .. .. .. .. .. .. Mary Street St George's .. .. .. .. .. .. .. Mason's Court Mile End Now Town .. .. .. .. .. .. .. Master's Street Mile End .. .. .. .. .. .. Matlock Street Limehouse .. 1 1 .. .. .. 2 Matilda Place St George's .. .. .. .. .. .. .. Matilda Street ; St George's .. .. .. .. .. .. .. May's Buildings Mile End .. I .. .. .. 1 2 May'8 Cottages Limehouse .. .. .. .. .. .. .. Mayfields Buildings St George's .. .. .. 1 .. .. 1 Medland Street Ratcliff .. 1 .. .. .. .. 1 Medway Road Mile End .. 1 .. .. .. .. 1 Meeting House Alley St George's .. .. .. .. .. .. .. Mercer Street Shadwell .. 2 .. .. .. .. .. Meredith Buildings St George's .. .. .. .. .. .. .. Metropolitan Buildings Mile End New Town .. 1 .. .. .. .. 1 Middle Shadwell Shadwell .. .. .. .. .. .. .. Middlesex Street Whitechapel and Spitalfields .. .. .. .. .. .. .. Mile End Buildings Mile End .. .. .. .. .. .. .. Mile End Place Mile End .. 1 .. 1 .. .. 2 142 Returns of Infectious Diseases—continued Streets DiltricU Small Pox | Scarlet Fever Typhoid Fever Diphtheria Membranous Croup Erysipelas Torn, Mile End Road Mile End .. 20 .. 3 1 24 Milk Yard Shadwell .. .. .. .. Miller's Court Spitalfields .. .. .. .. Mill Place Limehouse .. .. .. .. Mill Yard Whitechapel .. .. .. 1 1 Milward Street Mile End .. 1 .. .. 1 Minories (part of) Holy Trinity, Minories .. .. .. .. Mitre, The Limehouse .. .. .. .. Monmouth Street Shadwell .. .. .. .. Montague House, Old Montague Street Whitechapel .. .. .. .. • • Montague Place Whitechapel .. .. .. 1 Monteagle Street Mile End .. .. .. 1 Montefiore Houses St George's .. 1 .. .. 1 Monza Street Shadwell .. .. .. .. • • Moody Street Mile End .. 2 .. 1 4 Morgan Street Mile End .. 6 .. .. I 7 Morgan Terrace, Coborn Road Mile End .. .. .. .. Morrison's Buildings, North, Mile End ' .. .. .. .. , Morrison's Buildings, South Whitechapel .. .. .. .. 1 1 Morris Street St George's .. .. .. .. , Moss Buildings, St Mary Street Whitechapel .. 1 .. 1 1 Mossford Street Mile End .. .. .. .. Mount Street Whitechapel .. .. .. .. 1 1 Mountford Street Whitechapel .. 1 .. 1 .. Monsey Street Mile End .. 1 .. .. 1 Mulberry Street Mile End .. .. .. .. 1 Mundy's Place Whitechapel .. 1 .. .. 1 Murdock Cottages Milo End .. .. .. .. .. Muriel House, Philip Street St George's .. .. .. .. .. Myrdle Street Mile End .. 1 .. 2 3 N Nag's Head Yard Whitechapel .. .. .. .. Narrow Street Limehouse and Ratcliff .. .. 1 1 Nathaniel Buildings Spitalfields .. 3 .. 5 6 13 Neat's Cottages Mile End .. .. .. .. .. .. .. Nelson Court Whitechapel .. .. .. .. .. .. .. Nelson Street Mile End .. 5 .. 1 2 8 Neptune Street Wapping .. .. .. 1 .. .... 1 New Alley Limehouse .. .. .. .. .. .. .. New Alley Square Limehouse .. .. .. .. .. .. .. 143 Returns of Infectious Diseases—continued Streets Districts Small Pox Scarlet Fever [Typhoid Fever Diphtheria ^Membranous Croup Erysipelas Total Newark Street Mile End .. 8 .. .. .. .. 8 Newbold Street New Buildings, Tenter Mile End .. 2 .. .. .. .. 2 Street Whitechapel .. .. .. 1 .. .. 1 Newcastle Place Whitechapel .. .. .. .. .. 1 1 Newcastle Street Whitechapel .. .. .. .. .. 1 1 New Church Street Mile End New Town .. .. .. .. .. .. .. New Goulston Street Whitechapel .. .. .. .. .. .. .. New Gravel Lane Shadwell .. .. 1 1 .. .. 2 Newman's Buildings, Leyden Street Spitalfields .. .. .. 1 .. .. 1 Newman's Buildings, Pelham Street Spitalfields .. 1 .. .. .. .. 1 New Martin Street Whitechapel .. .. .. .. .. .. .. Newnham Street Whitechapel .. .. .. .. .. .. .. Newton's Rents Shadwell .. .. .. 1 .. .. 1 New Road Whitechapel and Mile End .. 1 .. 1 .. l 3 New Tower Buildings Wapping .. 1 .. .. .. .. 1 Nicholas Street Mile End .. 1 .. 1 .. .. Nightingale Lane Aldgate .. 1 .. .. .. .. 1 Norfolk Buildings St George's .. .. .. .. .. .. .. Norfolk Street Mile End .. .. .. .. .. .. 2 Norman's Buildings St George's .. 1 .. .. .. .. 1 North Place Mile End New Town .. 1 .. .. .. .. 1 North Street Spitalfields .. .. .. .. .. .. .. North-East Passage St George's .. .. .. .. .. .. .. Northey Street Limehouse .. .. .. 2 .. .. 2 Norton Folgate Norton Folgate .. .. .. .. .. .. .. Norway Place Limehouse .. .. .. .. .. .. .. Norway Yard limehouse .. .. .. .. .. .. .. Norwich Court Whitechapel .. .. .. .. .. .. .. Notgrove Court Limehouse .. .. .. .. .. .. Notgrove Street Limehouse .. .. .. .. .. .. Nottingham Place Mile End .. .. .. 1 .. .. 1 0 Oak Lane Limehouse .. .. .. .. .. .. .. Oak Place Mile End .. .. .. .. .. .. .. Ocean Street Mile End .. .. 3 .. .. .. 3 Old Castle Street Whitechapel .. .. .. .. .. .. Old Church Road Mile End .. 1 .. 2 .. 3 6 Old Gravel Lane St George's .. 4 .. .. .. 1 5 Old Montague Street Whitechapel .. 14 .. 2 .. 2 18 Old Tower Buildings Wapping .. .. .. .. .. 1 1 144 Returns of Infectious Diseases— continued Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. Total. Oley Place Mile End .. 1 .. .. .. .. 1 Orange Mews, Hunton Street Mile End New Tonn .. .. .. .. .. .. .. Orchard Gardens Mile End .. .. .. .. .. .. .. Orchard, The Ratcliff .. .. .. .. .. .. .. Orson Place Mile End .. .. .. .. .. .. .. Osborn House, Pelham Street Mile End New Town .. .. .. .. .. .. .. Osborn Place Whitechapel .. .. .. .. .. 1 1 Osborn Street Whitechapel .. .. .. .. .. .. .. Oxford Street Mile End and Whitechapel .. 10 .. 5 .. 2 17 P Padstow Place Limehouse .. 1 .. .. .. .. 1 Palmer Street Spitalfields .. .. .. .. .. 1 1 Paragon Mansions Mile End .. .. .. .. .. .. .. Parfett Street Mile End .. 3 .. .. .. .. 3 Park Road Mile End .. .. .. .. .. .. .. Park Street Limehouse .. .. .. .. .. .. .. Park hurst Buildings, Samuel Street Limehouse .. .. .. .. .. .. .. Parliament Court Old Artillery Ground .. .. .. .. .. .. .. Parnham Street Limehouse .. .. .. .. .. .. .. Pasteur Street Whitechapel .. .. .. .. .. .. .. Paternoster Row Spitalfields .. .. .. .. .. .. .. Pattison Street Mile End .. 1 .. 1 .. .. Pavilion Yard Whitechapel .. .. .. .. .. .. .. Peabody Buildings Shadwell .. 1 .. 3 .. 2 6 Peabody Buildings Spitalfields .. .. .. .. .. .. .. Peabody Buildings Whitechapel .. 4 .. .. .. 6 10 Pear Tree Court Shadwell .. .. .. .. .. .. .. Pearl Place Mile End .. .. .. 1 .. .. 1 Pearl Street St George's .. 1 .. .. .. .. 1 Peck's Yard, Haubury Street Spitalfields .. .. .. .. .. .. .. Peel's Alley Shad well .. .. .. .. .. .. .. Pelham House Mile End Now Town .. .. .. .. .. .. .. Pelham House, Spital Square Spitalfields .. 1 .. .. .. .. 1 Pelham Street Spitalfields .. 2 .. 2 .. 2 6 Pelham Street Buildings Mile End New Town .. .. .. .. .. .. .. Pelican Passage Mile End .. .. .. .. .. .. .. Pell Place St George's .. .. .. .. .. 1 1 Pell Street St George's .. 2 .. .. .. .. 2 Pelling Street Limehouse .. .. .. 3 .. .. 3 145 Returns of Infectious Diseases— continued Streets. Districts. Small Pox. Scarlet Fever Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. Total. Penang Street St George's .. .. .. .. .. .. .. Pennington Place St George's .. .. .. .. .. .. .. Pennington Street St George's .. .. .. .. .. .. Pennington Street Buildings St George's .. 1 .. .. .. .. 1 People's Arcade, Backchurch Lane "Whitechapel .. .. .. .. .. .. .. Periwinkle Street Ratcliff .. .. .. .. .. .. .. Perry's Avenue, Booth Street Spitalfields .. 6 1 .. .. 1 8 Perth Street Mile End .. .. .. .. .. 1 1 Phillip Buildings, Crellin Street St George's .. .. .. 5 .. .. 5 Phillip Street St George's .. 1 .. .. .. .. 1 Philpot Street Mile End .. 1 .. 1 .. 1 3 Phoe be Street Limehouse ,, .. .. .. .. .. 1 1 Phoenix Court St George's .. .. .. .. .. .. .. Pier Head St George's .. .. .. .. .. .. .. Pigott Street Limehouse 2 .. .. .. 1 3 Pinchin Street St George's .... .. .. .. .. .. .. Pinchin Street Buildings St George's .. .. .. .. .. .. .. Pitsea Place Ratcliff .. .. .. .. .. .. .. Pixley Street Limehouse .. .. .. .. .. .. .. Planet Street St George's .. .. .. .. .. .. .. Plough Alley St George's .. .. .. .. .. .. .. Plough Street Whitechapel .. 1 .. 1 .. .. 2 Plough Street Buildings Whitechapel .. .. .. .. .. .. .. Plumber's Row Whitechapel and Mile End 4 .. .. .. .. 4 Pole Street Mile End .... .. .. .. .. 3 3 Pool's Square Spitalfields .. .. .. .. .. .. Poouah Street St George's .... .. .. .. .. .. .. Pope's Head Court Spitalfields .. .. .. .. .. .. .. Pope's Hill Shadwell .. 1 1 .. .. .. 2 Portland Street Ratcliff and Mile End 2 .. .. .. 1 3 Portman Place Mile End .. .. .. .. .. .. .. Potter's Buildings Limehouse .. 1 .. .. .. .. 1 Priestley's Buildings St George's .. .. .. .. .. .. .. Princes Place Whitechapel .. .. .. .. .. .. .. Princes Square St George's .. .. .. 1 .. .. 1 Princelet Street Spitalfields .. 1 .. .. .. .. 1 Prince of Orange Court St George's .. .. .. .. .. .. .. Prittlewell Place Ratcliff .. .. .. .. .. .. .. Prospect Place St George's .. .. .. .. .. .. .. Prospect Place Limehouse .. .. .. .. .. .. .. Prosperous Place Limehouse .. .. .. .. .. .. .. Providence Street St George's .. .. 1 .. .. 1 Prusom Street St George's .. 1 .. .. .. .. 1 Prusom Street Buildings, St George's .. .. .. .. .. .. .. Puma Court , Spitalfielda .. .. .. .. .. .. .. 146 Returns of Infectious Diseases—continued Streets Districts Small Pox Scarlet Fever Typhoid Fever Diphtheria ^Membranous Croup i Erysipelas i Total Q Quaker Square Spitalfields .. .. .. .. .. .. .. Quaker Street Spitalfields .. 3 1 .. .. .. 4 Queen's Head Alley W apping .. .. .. .. .. .. .. Queen's Place St George s .. .. .. .. .. .. .. Queen Street Mile End New Town .. 2 .. .. .. .. 2 R Eaby Street Ratcliff .. .. .. .. .. .. .. Railway Place Limehouse .. .. .. .. .. .. .. Railway Place Mile End .. .. .. .. .. .. .. Raine's Mansions, St George's .. 1 .. .. .. .. 1 Raine's Street St George's .. .. .. 2 .. .. 2 Ramar Place Mile End New Town .. .. .. .. .. .. .. Ratcliff Square Ratcliff .. .. .. .. .. .. .. Ratcliff Street St George's .. .. .. .. .. .. .. Raven Row Whitechapel and Mile End .. 1 .. .. .. .. 1 Raymond Street St George's .. .. .. .. .. .. .. Rectory Buildings Shadwell .. .. .. .. .. .. .. Rectory Square Mile End .. .. .. .. .. .. .. Red Lion and Spread Eagle Yard Whitechapel .. .. .. .. .. .. .. Red Lion Court Wapping .. .. .. .. .. .. .. Red Lion Street St George's and Wapping .. 1 .. .. .. .. 1 Redman'8 Cottages Mile End .. .. .. .. .. .. .. Redman's Road Mile End .. 5 .. .. .. .. 5 Redmead Lane St George's .. .. .. .. .. .. .. Reform Place Limehouse .. 1 .. .. .. .. 1 Regal Place Mile End New Town .. .. .. .. .. .. .. Regent's Cottages Limehouse .. .. .. .. .. .. .. Regent's Court Limehouse .. .. .. .. .. .. .. Regent's Place Limehouse .. .. .. .. .. .. .. Regent's Place, Blossom Street Norton Folgate .. .. .. .. .. .. .. Regent's Place, Maplin Street Mile End .. .. .. .. .. .. .. Repton Street Limehouse .. .. 1 1 .. 2 4 Rhodeswell Road ' Limehouse and Mile End .. 5 .. 1 .. 1 7 Rich Street Limehouse .. 1 .. .. .. .. 1 Richard Court St George's .. .. .. .. .. .. .. Richard Street St George's .. .. .. 2 .. 1 3 147 Returns of Infectious Diseases—continued Streets Districts Small Pox Scarlet Fever Typhoid Fever Diphtheria Membranous Croup Erysipelas Total Robert Street Limehouse .. .. .. 1 .. .. 1 Robeson Street Mile End .. 2 .. .. .. .. 2 Roger's Court St George's .. .. .. .. .. .. .. Romford Street Mile End .. 1 .. .. .. .. 1 Ronald Street Ratcliff .. .. .. .. .. .. .. Ropemakers' Fields , Limehouse .. .. .. .. .. .. .. Ropery Street Mile End .. .. .. .. .. 2 2 Ropner Place Limehouse .. .. .. .. .. .. .. Rose Place Mile End .. .. .. .. .. .. .. Rose Lane Ratcliff .. 1 .. .. .. .. 1 Rose Lane Limehouse .. .. .. .. .. .. .. Rosetta Place Spitalfields .. .. .. .. .. .. .. Rothschild's Buildings, Thrawl Street Spitalfields .. 3 .. 6 .. 1 10 Howsell Street Mile End .. 2 .. 1 .. 1 4 Royal Jubilee Buildings Shadwell .. 1 .. 1 .. 3 5 Royal Mint .. .. .. .. .. .. Royal Mint Square Aldgate .. .. .. .. .. 2 2 Royal Mint Street Aldgate and Whitechapel .. .. .. 1 .. .. 1 Rugg Street Limehouse .. .. .. 1 .. .. 1 Rupert Street Whitechapel .. .. .. .. .. .. Russell Court St George's .. .. .. 1 .. .. 1 Russell Street Mile End .. 1 .. .. .. .. 1 Ruth House, Flower and Dean Street Spitalfields .. .. .. .. .. .. Rutland House St George's .. .. .. .. .. .. Rutland Street Mile End .. 3 .. .. .. 3 6 Rycroft Court St George's .. .. .. .. .. .. Rygate Street St George's .. .. .. 1 .. .. 1 s .. St Ann's Road Mile End .. 1 .. 3 .. 2 6 St Anne's Row .. .. .. .. .. .. St Anne Street Limehouse .. .. 1 .. .. .. 1 St Dunstan's Road Mile End .. 1 .. 3 .. 1 5 St George's Buildings St George's .. .. .. .. .. .. •• St George's House, Gunthorpe Street Whitechapel .. .. .. .. .. .. St George's Street St George's and Wapping .. 2 .. 1 .. 2 5 St Katharine's Way Aldgate and St Katharine .. .. .. 1 .. .. 1 St Mark Street .. .. .. .. .. .. 148 Returns of Infectious Diseases—continued Streets Districts Small Pox Scarlet Fever Typhoid Fever Diphtheria Membranous Croup Erysipelas Total St Mary Street Whitechapel St Paul's Road Mile End and Limehouse .. 1 .. 1 2 St Peter's Road Mile End .. 4 .. 2 7 St Thomas' Road Mile End .. .. 1 1 Sage Street Shadwell .. 1 .. .. 1 Salisbury Street Mile End .. .. .. .. Salmen Street Mile End .. .. .. .. Salmon Lane Limehouse .. .. .. .. 6 Salter Street Limehouse .. .. .. .. Sampson's Gardens St George's .. .. .. .. Samuel Court Mile End New Town .. .. .. Samuel Street Limehouse .. .. .. .. Sander Street St George's .. .. .. .. Sander Street Buildings St George's .. .. .. .. Sandy's Row Spital fields .. .. .. .. Sarah's Place Mile End New Town .. .. .. .. Sarah Street Shadwell .. .. .. .. Saw Yard Spitalfields .. .. .. .. Scandret Street Wapping .. .. .. .. Scarborough Street Whitechapel .. .. .. .. Sceptre Street Mile End .. .. .. Sclioolhouse Lane Ratcliff .. .. .. .. Selby Street (South Side) Mile End New Town .. .. .. .. Selsey Street Limehouse .. 2 .. .. 5 Selwyn Road Mile End .. 1 .. .. 1 Senrab Street Mile End .. 1 .. .. 2 Settles Court Mile End .. .. .. Settles Street Mile End .. 1 .. .. 3 Seven Star Alley St George's .. .. .. .. Severne Street St George's .. .. .. .. 2 Shadwell Fish Market Shadwell .. .. .. .. Shadwell Green Shadwell .. .. .. .. Shadwell Place St George's .. .. .. .. Shandy Street Mile End .. .. .. .2 2 Sheha Street Spitalfields .. .. .. 1 4 Shepherd Street Spitalfields .. .. .. 1 2 Shepherd Street Buildings Spitalfields .. .. .. .. 1 Shepherd's Place Spitalfields .. .. .. .. Sheppy Yard Holy Trinity, Minories .. .. .. .. Sheridan Street St George's .. .. .. 1 Ship Alley St George's .. .. .. .. Ship Street St George's .. .. .. .. Shoreditch High Streets (part of) Norton Folgate .. .. .. .. Shorter Street St George's and Whitechapel .. .. .. .. 149 Returns of Infectious Diseases—continued Streets Districts | Small Pox Scarlet Fever Typhoid Fever Diphtheria Membranous Croup Erysipelas Total Shorter's Rents, Lamb Street Spitalfields .. .. .. .. Slioulder of Mutton Alley Limehouse .. .. .. Silas Street Mile End .. 3 .. .. 3 Single Gardens Mile End .. .. .. Single Place Mile End .. .. .. Single Street Mile End .. 3 .. .. 3 Sidney Square Mile End .. .. 1 .. 1 2 Sidney Street Mile End .. 2 .. 2 1 2 7 Silver Street Mile End .. 1 .. .. 1 2 Size Yard Whitechapel .. .. .. Skidmore Street Mile End .. 9 .. .. 4 16 Sly Street St George's .. .. .. 1 Smith Place Mile End .. 1 .. .. 1 Smith Street Mile End .. 3 .. 3 Solander Street Shadwell .. 1 .. .. 1 South Grove Mile End .. 2 .. .. 3 South Grove Buildings Mile End .. 1 .. .. 1 South Street Spitalfields .. .. .. Speck's Fields Mile End New Town .. .. .. .. Spectacle Alley Whitechapel .. 1 .. 1 .. 2 Spelman Court Spitalfields and Mile .. .. .. .. End New Town .. .. .. .. Spelman Street Whitechapel, .. .. .. .. fields, and Mile End New Town .. 2 .. .. 2 4 Spencer House, Lolesworth Street Whitechapel .. 1 .. .. 1 Spencer Street St George's .. .. .. 2 .. 1 Spenlow Street Limehouse .. .. .. 1 .. 1 Spital Court Mile End New Town .. .. .. .. Spital Square Norton Folgate .. 2 .. .. Spital Street Mile End New Town .. 1 .. .. 1 Spital Yard .. .. .. Spitalfields Market Spitalfields .. .. .. .. Splidts Street St George's .. .. .. .. Spring Gardens, King Edward Street Mile End New Town .. .. .. 1 .. 1 Spring Gardens Shadwell .. .. .. .. Spring Garden Place Mile End and Ratcliff .. 2 .. .. Stainsby Road Limehouse 1 .. 1 .. Stanfield Road Mile End .. .. .. .. Star and Garter Yard .. .. .. Star Place St George's .. .. .. .. Starch Yard St George's .. .. .. .. Station Place St George's .. .. 1 .. 1 k 2 150 Returns of Infectious Diseases.—continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. Total. Stayner's Road Mile End .. .. .. 3 .. 1 4 Steel's Lane Mile End and Ratcliff .. 1 .. .. .. .. 1 Stephen's Cottages, Conder Street Limehouse .. .. .. .. .. .. .. Stepney Causeway Ratcliff .. .. .. 5 .. 3 8 Stepney Green Mile End .. 5 .. .. .. .. 5 Stepney Industrial Dwellings Mile End .. 3 .. 1 .. .. 4 Stepney Square Mile End .. .. .. .. .. .. .. Steward Street Old Artillery Ground .. .. .. .. .. 1 1 Stocks Place Limehouse .. .. .. .. .. .. .. Storer's Buildings Mile End .. .. .. .. .. 1 1 Strafford House, Wentworth Street Spitalfields .. 2 .. .. .. .. 2 Strahan Road Mile End .. .. .. 2 .. .. 2 Streatfield Street Limehouse .. .. .. .. .. .. .. Stutfield Street St. George's .. .. .. 1 .. .. 1 Sugar Loaf Court Whitechapel .. .. .. .. .. .. .. Sun Tavern Place Wapping .. .. .. .. .. .. .. Sutton Street St. George's .. 3 .. 2 .. .. 5 Swan Street Whitechapel .. .. .. .. .. .. .. Swedenborg Street St. George's .. .. .. .. .. .. .. Synagogue Place Mile End • • 2 .. 1 .. .. 3 T Tait Street St. George's .. .. .. .. .. .. .. Tarling Street St. George's .. .. 1 2 .. .. 3 Tasburg Buildings St. George's .. .. .. .. .. .. .. Taylor's Place Limehouse .. 2 .. 1 .. .. 3 Taylor's Rents St. George's .. .. .. .. .. .. .. Tenbury Place Limehouse .. .. .. .. .. .. .. Tench Street St. George's .. 1 .. .. .. 1 2 Tenter Buildings, St. Mark's Street Whitechapel .. .. .. .. .. .. .. Tenter Street Spitalfields .. .. .. .. .. .. .. Tenter Street East Whitechapel .. .. .. .. .. .. .. Tenter Street North Whitechapel .. .. .. .. .. .. .. Tenter Street South Whitechapel .. 2 .. .. .. .. 2 Tenter Street "West Whitechapel .. .. .. .. .. .. .. Terrace Place Mile End .. .. .. .. .. .. .. Tewkesbury Buildings Whitechapel .. .. .. .. .. .. 1 The Cottages Limehouse .. .. .. .. .. .. .. Thirza Street Ratcliff .. .. .. .. .. 1 1 Thomas Street Limehouse .. 3 .. .. .. 1 4 151 Returns of Infectious Diseases.—continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. Thrawl Street Whitechapel .. 1 .. .. .. .. 1 Three Colt Court Limehouse .. .. .. .. .. .. .. Three Colt Street Limehouse .. .. .. .. .. 1 1 Three Compass Court Ratcliff .. .. .. .. .. .. .. Tile Yard Limehouse .. .. .. .. .. .. .. Tilley Street Spitalfields .. .. .. 1 .. .. 1 Tillman Street St. George's .. 1 .. 1 .. .. 2 Tillotson Street Mile End .. .. .. .. .. .. .. Toilet Street Mile End .. 1 1 2 .. .. 4 Tomlin's Terrace Limehouse .. .. .. 1 .. .. 1 Tower Hill Aldgate and Tower .. .. .. .. .. .. .. Tower of London Tower .. 1 .. .. .. .. 1 Trafalgar Square Mile End .. .. .. .. .. .. .. Trahorn Street Whitchapel .. .. .. .. .. .. .. Tredegar Square Mile End .. 1 .. 1 .. 1 3 Tredegar Terrace Mile End .. .. .. 1 .. .. 1 Trinidad Street Limehouse .. .. .. 1 .. .. 1 Trinity Almshouses Mile End .. .. .. .. .. .. .. Trinity Square Aldgate .. .. .. .. .. .. .. Troon Street Eatcliff .. .. .. .. .. .. .. Turner's Buildings St. George's .. .. .. .. .. .. .. Turner's Place Limehouse .. .. .. .. .. .. .. Turner's Road Limehouse and Mile End .. 5 .. 1 .. 3 9 Turner's Street Mile End .. 2 .. 1 .. .. 3 Twenty - nine - and - half Court Wapping .. .. .. .. .. .. .. Twine Court Shadwell .. .. .. 2 .. .. 2 U Umberstone Street St. George's .. .. .. .. .. 1 1 Underwood Street Mile End New Town .. 2 .. .. .. 1 3 Union Buildings Mile End .. .. .. .. .. .. .. Union Place Limehouse .. .. .. .. .. .. .. Union Terrace Limehouse .. .. .. .. .. .. .. Upper Chapman Street St. George's .. .. .. .. .. .. .. Upper East Smithfield Aldgate and Wapping .. .. .. .. .. 3 3 V Vallance Road Whitechapel and Mile End New Town .. 1 .. 2 .. 4 7 Varden Street Mile End .. 5 .. .. .. 2 7 Yenour Eoad Mile End .. .. .. .. .. .. .. 152 Returns of Infectious Diseases.—continued. Streets. District*. Small Pox. Scarlet Fever. Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. Total. Victoria Buildings, Cartwright Street Aldgate .. .. .. 1 .. .. 1 Victoria Buildings, Emmott Street Mile End .. 4 .. .. .. 1 5 Victoria Cottages, Albert Street Mile End New Town .. .. .. .. .. .. .. Victoria Cottages, Church Row Limehouse .. .. .. .. .. .. .. Vine Court Whitechapel .. .. .. .. .. .. .. Vine Yard Spitalfields .. .. .. 1 .. .. 1 Vintner's Almhouses Mile End .. .. .. .. .. .. .. Virginia Place St. George's .. .. .. .. .. .. .. w Wade's Place Mila End .. .. 1 .. .. .. 1 Wainwright Place St. George's .. .. .. .. .. .. .. Wakeling Street Retcliff .. .. .. .. .. .. .. Walburgh Place St. George's .. .. .. .. .. .. .. Walburgh Street St. George's .. 1 .. 1 .. .. 2 Walden Street Mile End .. 1 .. .. .. 1 2 Waley Street Mile End .. .. .. .. .. 1 1 Walker Street Limehouse .. 1 .. 2 .. 1 4 Wallwood Street Limehouse .. 3 .. .. .. .. 3 Walter Street Ratcliff .. 1 .. .. .. .. 1 Wapping Wall Shadwell .. .. .. .. .. 1 1 Waterloo Court St. George's .. .. .. .. .. 1 1 Waterloo Street Limehouse .. .. .. .. .. .. .. Watney Passage St. George's .. .. .. .. .. .. .. Watney Street St. George's .. 3 .. .. .. .. 3 Watts Street St. George's .. .. .. .. .. .. .. Watts Street Buildings St. George's .. .. .. .. .. .. .. Weaver Street Mile End New Town .. .. .. .. .. 1 1 Webb's Place Whitechapel .. .. .. .. .. .. .. Well Street Whitechapel .. 2 .. 2 .. 1 5 Wellclose Square St. George's, Whitechapel and Wapping .. 1 .. 1 .. 1 3 Wellesley Street Mile End .. 1 .. .. .. 1 2 Wellington Buildings St. George's .. .. .. .. .. .. .. Wentworth Buildings Whitechapel .. .. .. 2 .. 1 3 Wentworth Court East Spitalfields .. .. .. .. .. .. .. Wentworth Court West Spitalfields .. .. .. .. .. .. .. Wentworth Street Whitechapel and Spitalfields .. .. .. .. .. 2 2 West Gardens Shadwell .. .. .. .. .. .. .. West Gardens Buildings Shadwell .. .. .. .. .. .. .. 153 Returns of Infectious Diseases.—continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever Diphtheria. Membranous Croup. Erysipelas. Total. West Pier Wapping .. .. .. .. .. .. .. West Arbour Street Mile End .. 1 .. .. .. 1 2 West India Dock Road Limehouse .. 2 .. .. .. .. 2 West's Folly St. George's .. .. .. .. .. .. .. West Street Spitalfields .. .. .. .. .. .. .. Western Passage St. George's .. .. .. .. .. .. .. Warton Place Batcliff .. .. .. .. .. .. .. Wheeler Street Spitalfields .. .. .. .. .. .. .. Whitechapel High Street Whitechapel .. 1 .. .. .. 2 3 Whitechapel Road Whitechapel and Mile End .. 12 1 5 .. 3 21 White's Gardens St. George's .. .. .. .. .. .. .. White's Rents Limehouse .. .. .. .. .. .. .. White's Row Spitalfields .. .. .. .. .. .. .. White Hart Court Mile End .. .. .. 1 .. .. 1 White Horse Lane Mile End .. .. .. 2 .. .. 2 White Horse Street Batcliff .. 3 1 .. .. .. 4 White Lion Street Spitalfields and Norton Folgate .. .. .. .. .. .. .. Whitehall Court Limehouse .. .. .. .. .. .. .. Whitehead Street Mile End .. .. .. 1 .. .. 1 Whitethorne Court St. George's .. .. .. .. .. .. .. Whitethorne Place St. George's .. 1 .. .. .. 1 2 Whitman Road Mile End .. 1 .. 1 .. .. 2 Wicker Street St. George's .. .. 1 .. .. .. 1 Wickford Street Mile End .. 3 .. .. .. .. 4 Wilkes Street Spitalfields .. 1 .. 1 .. .. 2 Williams' Buildings Mile End .. .. .. .. .. .. .. Williams' Place Limehouse .. .. .. 1 .. .. 1 William Street St. George's .. .. .. .. .. .. .. Willow Row Limehouse .. .. .. .. .. .. .. Willow Street Mile End .. 2 .. .. .. .. 2 Wilson's Place Limehouse .. .. .. .. .. .. .. Wilson Street Mile End .. 4 .. 1 .. 2 7 Winifred House, Thrawl Street Spitalfields .. .. .. .. .. .. .. Winterton Buildings St. George's .. .. .. .. .. .. .. Winterton Street St. George's .. .. .. .. .. .. .. Winter's Buildings Mile End .. .. .. .. .. .. .. Winthrop Street Whitechapel .. .. .. .. .. 2 2 Winwood Street Mile End .. .. .. .. .. .. .. Wodeham Street Whitechapel .. .. .. .. .. 2 2 Wolsey Street Mile End .. 1 .. 4 .. .. 5 Woodisan Street Whitechapel .. .. .. .. .. .. .. Woodside Mansions St. George's .. .. .. .. .. .. .. Worcester Court St. George's .. .. .. .. .. .. .. 154 Returns of Infectious Diseases.—continued. Streets. Districts. Small Pox. Scarlet Fever. Typhoid Fever. Diphtheria. Membranous Croup. Erysipelas. Total. Worcester Street St. George's .. .. .. .. .. .. .. Wright's Buildings, Salmon Lane Limehouse .. .. .. .. .. .. .. Wright's Bow St. George's .. .. .. .. .. .. .. X XX Place Mile End .. 1 .. .. .. .. 1 Y Yalford Street Mile End .. .. .. .. .. 1 1 Yeoman's Yard Whitechapel .. .. .. .. .. .. .. York Buildings Limehouse .. .. .. .. .. .. .. York Place Limehouse .. 1 .. .. .. .. 1 York Road Ratcliff .. .. .. .. .. .. .. York Square Batcliff .. .. .. 1 .. .. 1 Yule Court St. George's .. .. .. .. .. .. .. 155 Returns of Infectious Diseases - continued. Streets. Districts. Anthrax. St. Dunstan's Road Mile End 1 Murdoch Cottages, Grove Road Mile End 1 Cerebrospinal Fever Dalgleish Street Limehouse 1 Devonshire Street Mile End 1 Eastfield Street Limehouse 1 Eric Street Mile End 1 Farrance Street Limehouse 1 Fleur-de-lis Buildings Spitalfields 1 Lee Street Limehouse 1 Lucas Street St. George's 1 Quaker Street Spitalfields 1 Continued Fever. Durward Street Whitechapel 1 Ophthalmia Neonatorum Bow Common Lane Mile End 1 Brady Street Mansions Whitechapel 1 Bromley Street Eatcliff 1 Burgess Street Limehouse 1 Butler Street Spitalfields 1 Charlotte Court, Hunton Street Mile End New Town 1 Dempsey Street Mile End 1 East India Dock Road Limehouse 1 Edinburgh Road Mile End 1 Floreston Street Mile End 1 Flower and Dean Street Spitalfields 1 Hardinge Street Eatcliff 1 Lamb Street Spitalfields 1 Lee Street Limehouse 1 Mile End Road Mile End 1 Myrdle Street Mile End 1 Neat's Cottages, Charles Street Mile End 1 Eich Street Limehouse 1 Eopery Street Mile End 1 Scarborough Street Whitechapel 1 Stepney Causeway Limehouse 1 Trinidad Street Limehouse 1 Poliomyelitis. Bermuda Street Mile End 1 Bloomfield Road Mile End 1 Brunswick Buildings, Goulston St. Whitechapel 1 Canal Road Mile End 1 156 Returns of Infectious Diseases—continued. Streets. Districts. Poliomyelitis— continued Diggon Street Mile End 1 Eric Street Mile End 1 Jupps Road Mile End 2 King John Street Mile End 1 Mercer's Terrace, Salmon Lane Limehouse 1 Peabody Buildings, Glasshouse St. Whitechapel 1 St. Thomas Road Mile End 1 Skidmore Street Mile End 1 Smith Street Mile End 1 "West India Dock Road Limehouse 1 Puerperal Fever. Anthony Street St. George's 1 Barnardo Street Ratcliff 1 Birchfield Street Limehouse 1 Booth Street Spitalfields 2 Bow Common Lane Mile End 1 Braintree Street Mile End 1 Cambridge Road Mile End 1 Christian Street St. George's 1 Commercial Road Mile End 1 Commercial Street Spitalfields 1 Dundee Street St. George's 1 Fieldgate Mansions, Myrdle St. Mile End 1 Grafton Street Mile End 1 Grove Street St. George's 1 Havering Street Ratcliff 1 Hawkins Street Mile End 1 Katherine Bldgs., Cartwright St. Aldgate 1 Lee Street Limehouse 1 Lower Chapman Street St. George's 1 Lower Fenton Street St. George's 1 Mary Ann Street St. George's 1 Old Montague Street Whitechapel 1 Plumbers Row Whitechapel 1 Queen's Head Place St. George's 1 Richard Street St. George's 1 St. George Street St. George's 1 Stepney Green Buildings Mile End 1 Tewkesbury Buildings, High St. Whitechapel 1 Turner Street Mile End 1 Varden Street Mile End 1 Wellclose Square St. George's 1 William Street St. George's 1 Typhus Fever. Ocean Street Mile End 2 157 INDEX. A PAGE Alcoholism 77 Analyst's Report 92 Articles adulterated 103 to 106 Articles adulterated in various Districts 94 Inspectors' work under the Food and Drugs Acts 102 Proceedings (number of cases) 93 Proceedings for Obstruction, &c. 107 Samples purchased by the Inspectors 101 Statistics of adulterations, 1913 94 Sunday samples 92 Unofficial samples 92 Warranty, &c. 95 to 100 Anthrax 17 Articles of Bedding, &c., destroyed 78 Articles of Bedding, &c., disinfected 79 B Bacteriological Examinations 11 Bakehouses in the Borough, List of 115 to 117 Births 2, 3 & 4 C Canal Boats, Inspection of 80 & 81 Cancer 78 Cerebro-Spinal Fever 15 Charts (Infectious Disease) between 10 & 11 Consumption 33 to 38 Table showing the occupation of Consumptives 33 & 34 Cowhouses in the Borough, List of 117 & 118 158 D PAGE Dairies and Milkshops in the Borough 108 Deaths 5 Causes of death compared with 1912 6 Death-rate in various districts in the Borough 5 Deaths of residents in outlying institutions 8, 9 & 10 Deaths of residents in public institutions in the Borough 10 Total number of deaths in the Borough 5 Total number of non-residents 5 Total number of residents outside the Borough 5 Diarrhœa 26 Diphtheria and Membranous Croup 12 Disinfection of rooms 78 E Enteric Fever 14 Erysipelas 15 F Factory and Workshops Acts Ill Administration of (tables for Home Office) ... ... ... 112, 113 & 114 Fines and Costs (total) 108 G General Sanitary Work 84 & 85 Glanders ... , 78 H Health Visitor, Report on the work of 73 to 76 Report submitted to Staff Committee on Infantile Mortality 62 to 72 Housing and Town Planning Act, 1909 109 159 I PAGE Illegitimate Children (Deaths of) 62 Infantile Mortality 62 Infants, Table showing the feeding of, at different periods 76 Infectious Diseases and the Streets in which they occurred during 1913 125 to 155 Inhabited House Duty 78 Inquests, number and cause of death 6, 7 & 8 M Marriages 4 Measles 18 to 23 Chart showing the number of Deaths per 100,000 inhahitants between 18 & 19 Mortuary and Coroner's Court 80 N Notifiable Diseases 10 & 11 O Old Age 77 Ophthalmia Neonatorum 15 Other Tuberculous Diseases 32 Deaths from Diseases of a Tubercular Nature in various Districts in the Borough, 1901-1913 32 Outworkers 113 Overcrowding 85 P Phthisis:— Deaths in various Districts in the Borough, 1901-1913 32 Total number of Deaths in the Borough 32 Polio-myelitis 15, 16 & 17 Population 1&2 Proceedings:— For the abatement of Overcrowding 85 160 PAGE Under Bye-laws (Section 16) Public Health (London) Act, 1891 88 & 89 Under the Dairies, Cowsheds and Milkshops Orders 90 Under the Dairies, Cowsheds and Milkshops Orders and London County Council (General Powers) Act, 1908 90 & 91 Under the Food and Drugs Acts 103 to 106 Under the London County Council (General Powers) Act, 1904, Sections 20 and 22 89 Under the Margarine Act, 1887 107 Under the Metropolis Local Management Act, 1855 90 Under the Public Health (London) Act, 1891 86, 87 & 88 Puerperal Fever 15 R Respiratory Diseases 27 Rooms Disinfected 78 S Sanatorium Treatment of Consumption 49 to 62 Sanitary Inspectors' Report between 84 & 85 Scabies 78 Scarlet Fever 12 Slaughter-Houses in the Borough, List of 118 Small Pox 11 Statistics:— Table 1. Of whole district during 1913 and previous years between 119 & 124 ,, 2. Cases of Infectious Diseases notified during the year 1913 119 & 124 „ 3. Causes of, and ages at death, during the year 1913 119 & 124 ,, 4. Infantile Mortality during the year 1913 119 & 124 Streets, List of, and the number of Infectious Diseases occurring during 1913 125 to 155 Summer Diarrhœa 24, 25, & 26 161 T PAGE Tables as suggested by the Medical Officer of Health for the London County Council 108 to 110 Tables of Milk Premises, Cowsheds, Slaughter-houses, other Offensive Trades, Ice Cream Premises, and Registered Houses Let in Lodgings 108 House to House Inspection 109 Insanitary houses 109 Number of Intimations served for all purposes 109 Number of Places where Food is prepared for Sale 109 Overcrowding 109 Underground rooms 109 Treatment of Consumption 49 Tuberculosis 27 to 32 Comprehensive scheme for the treatment of 39 to 48 Typhus Fever 12, 13 & 14 U Underground Rooms 109 Unsound Food:— Destroyed 81 & 82 Proceedings 83 Y Verminous Persons, Cleansing of 78 Vital Statistics of the whole Borough during 1913, and previous years 119 to 124 W Whooping Cough 24 Wrong Diagnosis 11 Z Zymotic Diseases 17 & 18