STE 16 ANNUAL REPORT of the Medical Officer of Health and Public Analyst for the Metropolitan Borough of Stepney. 1915. REPORT OF THE MEDICAL OFFICER OF HEALTH AND PUBLIC ANALYST FOR THE YEAR 1916. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have much pleasure in submitting to you my fifteenth Annual Report, which deals with the Vital and Sanitary Statistics of the Borough of Stepney for the year 1915. Population. The resident population of the Borough of Stepney estimated to the middle of the year was 265,731, distributed as follows:— Limehouse District 50,740 St. George-in-the-East 45,173 Mile End Old Town 107,935 Whitechapel District 61,883 265,731 This estimated population is less than that of the previous year, and is not so approximately correct as in previous years. As stated by the Registrar-General, "men of military age have been largely drafted to military training centres or sent abroad with the Army, and the remainder of the male adult population, as well as, to a less extent, the female population, has migrated on an unprecedented scale into areas other than those in which it was enumerated at the last census. Under these circumstances estimates of local population based on the census returns were clearly inadmissible, and it became necessary to search for a substitute. Fortunately this was ready to hand in the shape of the National Register, which referred to a date only six weeks removed from that for which estimates were required, viz.:—the middle of the year 1915. No doubt this does not form a perfect record, as it is known that a number of persons escaped registration. From investigations, however, which have been made in another 2 connection, it appears that the dcfects in the Register, taken as a whole, are not on such a scale as to affect seriously the estimates of population based upon it. By the method described below it was possible to derive from these returns estimates of the civil population only of each administrative area on August 15th. No attempt has been made to increase these by allowance for members of the fighting forces, because apart altogether from the difficulty of ascertaining the average military population of each district during the year, experience has shown that under present circumstances only civilian deaths can be tabulated for local areas. If military deaths were to be included they would have either to be debited to the area in which they occurred, a course which would render the death-rates of districts containing large military hospitals meaningless, or to the area of residence. An attempt made to pursue the latter course has had to be abandoned owing to military authorities having been unable to furnish to the Registrars the necessary information. It has been found necessary, therefore, to limit the tabulation of deaths by local areas to deaths of civilians, and under these circumstances the civilian population is obviously the proper one to use for the calculation of death-rates. An additional advantage in the use of National Register populations is that these consist of habitual residents in each locality and not merely of the persons who happened to be present therein on a certain date. The deaths tabulated from the year 1911 onwards are also those of habitual residents only, and therefore the use hitherto of populations which in certain cases included very large institutional elements, chiefly composed of non-residents, introduced in these cases serious errors into the rates calculated from them, as pointed out in the Registrar-General's Annual Reports. This source of error now, of course, disappears for the time being, and in such districts an unavoidable break in the continuity of the previously misleading rates will result. In any case, however, the maintenance of continuity is under present circumstances obviously impossible, and it is felt that the present estimates will furnish death-rates calculated to indicate as nearly as may be the health conditions of the civil population. The method by which the estimates of civil population have been derived from the National Register returns may now be described. The ratio of the total population, less the males aged 15-65 years, to the number of females aged 15 to 65 years at the date of the census, was calculated for each administrative area, and this ratio was applied to the number of females on the National Register; the resulting product plus the number of males aged 15 to 65 years on the National Register, was taken to be the number of the civil population of the district. A small adjustment was necessary in order to make the sum of the estimates for the several districts equal to the estimate for the country as a whole made on the same basis. Further, the population in institutions was not registered, and this (taken to be the same in the aggregate for England and Wales as at census date), together with a number of persons of no fixed abode, were distributed evenly over the whole country. These two adjustments raised the original estimates by about one per cent. 3 The question of the population to be used for the calculation of birth rates has also required consideration. The births registered are not only those of the children of civilians, and the estimates of civil population, therefore, form an unsuitable basis for the calculation of birth-rates. It is impossible to frame any estimate that would give reliable birth-rates, and it is suggested, therefore, that the birth-rates for 1915 be. based on the existing estimates of total population for 1914. These will sometimes be seriously in error owing to extensive migration having occurred. Although in such cases the Registrar-General does not possess the local information necessary for applying any correction, it is not suggested that this fact need preclude medical officers of health from making use of their opportunities in this direction. Difficulties, which will probably prove insoluble, remain as to estimation of population in sex and age groups and the standardising factors dependent upon them. Moreover, the present method of estimation will obviously not apply to 1916 or subsequent years, unless the National Register is effectively kept up-to-date or further enumeration made. Nothing can at present be decided as to these matters." One must not forget, however, that trade was brisk and unemployment was conspicuous by its absence in 1915 in the Borough of Stepney. On account of these facts, very few houses were unoccupied during the year, and to this extent there was a tendency to an increase in the population. Although a large number of men worked in munition factories, they did not migrate for that purpose. They came home every night. Births. The total number of births registered during the year was 7,506, or 477 less than in the previous year. They consisted of 3,868 males and 3,638 females. 1,667 belonged to the Limehouse District, or at the rate of 32.8 per 1,000 of the population. 1,314 belonged to St. George-in-the-East, or at the rate of 29.7 per 1,000 of the population. 3,052 belonged to Mile End Old Town, or at the rate of 28.2 per 1,000 of the population. 1,443 belonged to the Whitechapel District, or at the rate of 23.3 per 1,000 of the population. The birth-rate throughout the whole Borough was 28.2 per 1,000 of the population, while that for the whole of London was 22.6 per 1,000. 526 births occurred in the Mothers' Lying-in Home, Commercial Road:— 101 belonged to Mile End Old Town. 135 belonged to the Limehouse District. 75 belonged to St. George-in-the-East. 27 belonged to the Whitechapel District. 188 belonged to outlying districts. A 2 4 328 births occurred in the London Hospital:— 72 belonged to Mile End Old Town. 31 belonged to St. George-in-the-East. 20 belonged to the Limehouse District. 50 belonged to the Whitechapel District. 155 belonged to outlying districts. 25 births occurred in the St. George's Infirmary:— 23 belonged to St. George's and 2 to Mile End. 24 births occurred in the Mile End Infirmary:— 23 belonged to Mile End Old Town. 1 belonged to the Whitechapel District. 72 births occurred in the Whitechapel Infirmary:— 37 belonged to the Whitechapel District. 2 belonged to Mile End Old Town. 2 belonged to St. George-in-the-East. 2 belonging to the Limehouse district. 29 belonged to outlying districts. 212 births occurred at 24, Underwood Street:— 38 belonged to Mile End Old Town. 45 belonged to the Whitechapel District. 23 belonged to St. George-in-the-East. 106 belonged to outlying districts. 8 births belonging to this Borough occurred in the Poplar and Stepney Sick Asylum, 7 belonging to Limehouse and 1 to' Mile End. 5 occurred in the Bromley House Institution, all belonging to the Limehouse District. 28 births belonging to the Borough of Stepney occurred in the City of London Lying-in Hospital; 6 in Queen Charlotte's Hospital; 1 in the General Lying-in Hospital; 1 in St. Bartholomew's Hospital; 1 in the Middlesex Hospital; 5 in Poplar Workhouse; 2 in the Holborn Workhouse; 1 each in Lambeth, St. Thomas's Hospital, University College Hospital, St. George's Hospital, Bristol Infirmary and Cardiff Workhouse, and 6 in private houses outside the district. There were 71 births among refugees, most of which occurred at 24, Underwood Street. 55 of the mothers came from Antwerp, 10 from Paris, 2 from Ostend, 1 from Brussels, 1 from Rouen, 1 from Warsaw, and 1 from Berlin. 5 Illegitimate Births. 26 illegitimate births were registered in the Limehouse District, or at the rate of 9.5 per 1,000 births. 22 illegitimate births were registered in St. George-in-the-East, or at the rate of 16 3 per 1,000 births. 46 illegitimate births were registered in Mile End Old Town, or at the rate of 15 0 per 1,000 births. 68 illegitimate births were registered in the Whitechapel District, or at the rate of 47 1 per 1,000 births. The illegitimate births were less than in the previous year in all the districts, with the exception of the Whitechapel District. Marriages. The marriages during the year numbered 3,570, or 1,036 more than in the previous year. The proportion of persons married was 26.8 per 1,000 of the population, while that for the whole of London was 25.7 per 1,000. 618 marriages occurred in the Limehouse District, or at the rate of 24 3 per 1,000 of the population. 364 marriages occurred in St. George-in-the-East, or at the rate of 161 per 1,000 of the population. 1,905 marriages occurred in Mile End Old Town, or at the rate of 35 3 per 1,000 of the population. 683 marriages occurrcd in the Whitechapel District, or at the rate of 22.0 per 1,000 of the population. Deaths. The total number of deaths occurring in the Borough was 5,065 Deduct deaths occurring within the Borough among persons not belonging thereto 1,319 3,746 Add deaths of residents that occurred outside the Borough 781 The deaths consisted of 2,434 males and 2,093 females. 4,527 6 The death-rate throughout the whole Borough was 17.0 per 1,000 of the population, while that for the whole of London was 16.0 per 1,000. 1,089 of the deaths belonged to the Limehouse District, or at the rate of 21.4 per 1,000. 793 of the deaths belonged to St. George-in-the-East, or at the rate of 17.5 per 1,000. 1,626 of the deaths belonged to Mile End Old Town, or at the rate of 15 0 per 1,000. 1,019 of the deaths belonged to the Whitechapel District, or at the rate of 16.3 per 1,000. Homeless. During the year there occurred in lunatic asylums the deaths of 229 persons, said to have been removed from addresses in this Borough to those institutions, but with regard to 84 of the deaths, no definite addresses could be given when the deaths were reported to the Registrars. 18 were stated to have been removed from the Limehouse District, 14 from St. George-in-the-East, 23 from Mile End, and 29 from the Whitechapel District. 9 had been removed from registered common lodging houses. 93 deaths, or 40 per cent. of the total were those of persons above 65 years of age. Nine bodies of unknown persons were found on the foreshore of the Thames in the Limehouse District and were included in the Limehouse death returns. One was that of a private in Kitchener's Army, but all inquiries failed to discover his identity. Nine unknown persons were killed in the streets, four being in the Whitechapel District and one in the Limehouse District. In the St. George's returns is included the death of an unknown person who fell into the water at St. George's baths and died from a fractured skull. There were 42 deaths of unknown persons in public institutions in the Borough, of which 5 died from consumption of the lungs. 32 occurred in the Whitechapel Infirmary and Workhouse, 6 in the London Hospital, 3 in the Mile End Infirmary, and 1 in St. George's Infirmary. In addition to these, there were 8 deaths in the Poplar and Stepney Sick Asylum and Bromley Institution, of persons stated to have been removed from the Limehouse District, and were therefore included in the Limehouse returns. Common Lodging Houses.—There were 255 deaths in public institutions of persons admitted from common lodging houses in the Borough. 63, or nearly a quarter, died from Phthisis. 7 217 had been residents in common lodging houses in the Whitechapel District 23 in the Limehouse District, 12 in St. George's and 3 in Mile End. Refugees.—Two Belgian refugees died in the district during the year. Soldiers.—29 soldiers died from wounds at the London Hospital, but none of them belonged to this Borough. Spies.—Nine spies were shot at the Tower during the year, making 1C altogether up to December 31st, 1915. On June 23rd, a spy was shot whose status was unknown and who appeared to be about 50 years of age. On July 30th, two sailors were shot, one was 29 years of age and the other was 32. On September 10th, a ship broker, aged 49, was shot, and on September 17tl a farmer, aged 34. On October 19th, a commercial traveller, aged 25, who, until recently, was a native of Brazil, and on October 26th, another ship broker, aged 31, were shot On the following day a commercial traveller, aged 55, was shot, and a commercia traveller, aged 22, on December 2nd. The following table shows the death-rate throughout the whole Borough and in the various districts since 1890:— I imehouse. St. George's. Mile End. Whitechapel. The whole Borough. 1890 26.8 350 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 21.9 1893 27.7 310 22.8 25.0 25.5 1894 24.2 26.5 211 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 27.1 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 20.0 19.1 16.5 160 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 14.8 151 1914 19.6 17.7 15.1 16.0 16.6 1915 21.4 17.5 15.0 16.3 17.0 8 Compared with 1911, the causes of death were .— Disease. 1914. 1915. Increase. Decrease. Small Pox — — — - Scarlet Fever 25 27 2 - Enteric Fever 8 4 — 4 Measles 174 113 — 61 Diphtheria and Croup 71 66 — 5 Whooping Cough 71 50 — 21 Erysipelas 9 7 — 2 Diarrhoea and Enteritis 297 260 — 37 Rheumatic Fever 9 6 — 3 Phthisis 454 499 45 — Other Tubercular Diseases 152 118 — 34 Bronchitis, Pneumonia, and other Respiratory Diseases 929 1,056 127 Heart Disease 385 441 56 Appendicitis 19 13 — 6 Influenza 22 27 5 — Nephritis 143 117 — 26 Puerperal Fever 13 6 — 7 Injuries 222 252 30 — Suicides 29 20 — 9 Convulsive and Wasting Diseases 182 200 18 Premature Births 143 118 — 25 Old Age 218 237 19 — Cancer Alcoholism and Cirrhosis of 242 255 13 — Liver 36 30 — 6 All other causes 697 605 — 92 4,550 4,527 315 338 Inquests.—647 inquests were held on residents during the year, or one less than in the previous year. 171 were those of children under 5 years of age. 212 were due to accidents of various kinds, and 37 were due to being run over by vehicles. 12 were killed by motor-omnibuses, 5 by electric trams, and 6 by motor cars and taxis. 22 residents committed suicide. There were 11 deaths from hostile airship raids, 5 being due to direct violence and 6 to shock. The first deaths were caused by bombs on May 31st, when two persons were killed, viz. :—A boy, aged 8, son of a tailor, living at 15, Montefiore House, Cannon 9 Street Road, and a tailoress, aged 16, of 13, Ficklin Buildings. Both were killed by a bomb which dropped in Christian Street. Four bombs were dropped on the return journey of the Zeppelin on October 13th, when damage was done to buildings and injuries to several persons. These injuries, however, did not prove fatal. Fatal injuries were caused to three residents, who were at the time in other parts of London— (1) A City constable, aged 35, who lived at 7, Lower Chapman Street. Died at St. Bartholomew's Hospital. (2) A motor lorry driver, aged 23, of 15, Cleveland Street, Mile End. Died on the way to Charing Cross Hospital. (3) The wife of a ladies' tailor, aged 38, of 28, Bancroft Road. Died at St. Bartholomew's Hospital. There were also five deaths due to heart failure as a result of shock from the explosion of bombs from aircraft. (1) A tailor, aged 49, living at 22, Cephas Street. (2) A cigar maker, aged 69, of 192, Rothchild's Buildings. (3) A master cooper, aged 65, of 42, Nicholas Street. (4) The wife of a sign writer, aged 72, of 34, Farrance Street. (5) The wife of a labourer working at Woolwich Arsenal, aged 42, of 4, Sampson's Gardens, St. George's. (6) An inquest was held on the baby child, aged 8 hours, of a private in the Army Service Corps. The verdict of the jury was, that the death was due to "Convulsions, accelerated by the mother receiving shock from Zeppelin raid." The following number of deaths of residents occurred in Public Institutions in the Borough — East London Hospital for Children 192 London Hospital 467 Mile End Infirmary 210 Mothers' Lying-in Home, Commercial Road 4 St. George's Infirmary 348 Spanish and Portuguese Hospital 1 Whitechapel Infirmary 327 Whitechapel Workhouse, South Grove 54 1,633 10 There were 1,319 deaths of non-residents in Public Institutions in the District, and 781 deaths of residents in Public Institutions outside the district. Notifiable Diseases. 3,336 notifications of infectious disease were received, or 80 less than in the previous year. Deducting the notifications of Chicken-Pox—which was not a notifiable disease in 1914—the decrease was 498. This corresponds to a rate of 12.5 per 1,000 of the population. In addition to the above, 16 soldiers were notified to be suffering from infectious diseases, viz., 5 from Diphtheria, 5 from Scarlet Fever, 2 from Enteric Fever, 3 from Cerebro-Spinal Meningitis, and 1 from Chicken-Pox. 2,571 were removed to various Hospitals and Infirmaries. 483 belonged to the Limehouse District, or at the rate of 9.5 per 1,000. 597 belonged to St. George-in-the-East, or at the rate of 13.2 per 1,000. 1,214 belonged to Mile End Old Town, or at the rate of 11.2 per 1,000. 1,042 belonged to the Whitechapel District, or at the rate of 16.8 per 1,000. There were received in addition, 2,670 notification certificates referring to Tuberculosis, 1,335 being notified for the first time. Excluding Tuberculosis, the greatest number of notifiable diseases occurred during the second week in June, when 104 were notified. The greatest number of notifications of Scarlet Fever was received during the first week in September when 58 were notified, and of Diphtheria during the last week in July and third weeks of September and October, when 38 cases were notified in each week. Four cases of Enteric Fever were notified during the first week in April ; in no other week did the number exceed two. The maximum number of cases occurred during the second week in June in the Limehouse District, the last week in June and July and second week in August in St. George's, the second week in September in Mile End, and second week in June in the Whitechapel District. Wrong Diagnosis 95 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 disease. 52 of the cases were notified by private practitioners, 38 from the London Hospital, and 5 from other public institutions. This number referred to 50 cases of Scarlet Fever, 13 of Diphtheria, and 2 of Enteric Fever. 11 Bacteriological Examinations. 839 specimens were bacteriologically examined, with the following results :— No. Positive. No. Negative. Total. Consumption 184 391 575 Diphtheria 79 163 242 Enteric Fever 5 17 22 268 571 839 Small Pox. One case of Small Pox was notified during the year. A sailor was taken ill with Small Pox on board the S.S. "Wendenjels," which arrived in London from Alexandria. He was taken ill on April 26th, and after landing, he was removed to a Small Pox Hospital on May 9th. The destination of several of the crew was in this district, and they were kept under observation. One of the sailors stayed at a Seamen's lodging house, and he had Small Pox on May 16th, and was immediately removed to the Small Pox Hospital. Scarlet Fever. 1,458 cases were notified during the year, or 551 less than in the previous year . 1,441 were removed to Fever Hospitals. 138 belonged to the Limehouse District, with 6 deaths; 267 belonged to St. George-in-the-East, with 3 deaths; 543 belonged to Mile End Old Town, with 10 deaths; 510 belonged to the Whitechapel District, with 8 deaths; The death rate for the whole Borough was TO per 1,000 of the population, while that for the whole of London was .07 per 1,000. Diphtheria and Membranous Croup. 1,030 cases were notified during the year, or 82 more than in the previous year. 170 belonged to the Limehouse District, with 15 deaths, or at the rate of .29 per 1,000 of the population. 180 be'onged to St. George-in-the-East, with 6 deaths, or at the rate of .13 per 1,000 of the population. 399 belonged to Mile End Old Town, with 32 deaths, or at he rate of .29 per 1,000 of the population. 281 belonged to (he Whitechapel District, with 13 deaths, or at the rate of .21 per 1,000 of the population. 12 The death rate throughout the whole Borough was .24 per 1,000 of the population, while that for the whole of London was .15 per 1,000. Some people are criminally careless in exposing their children when in an infected condition, and thus cause danger to others. The following is a flagrant case, and the Public Health Committee decided to take proceedings against the mother, as an example to others. On January 20th, Mrs. J., of Jamaica Street, was summoned for wilfully exposing her daughter Hilda in a public place while she was suffering from diphtheria. A doctor at the London Hospital notified the case on November 15th, and the certificate was received on November 16th. On the latter date, the Sanitary Inspector visited the premises and found that the child was at school. She was immediately sent for. He handed the "Instructions on the Spread of Diphtheria," as well as the removal certificate to Mrs. J. As there were four children in the family, and there were no means of isolation at home, arrangements were made to have the patient removed to the Fever Hospital on the same day. When the ambulance called, the mother refused to allow the child to be removed, and the Inspector called on the following day to enquire the reason. Mrs. J. informed him that the child was quite well and she was not going to allow her to be removed to the Fever Hospital, and that she was about to take her to see a doctor. The Inspector cautioned her against taking the child into the street, and told her of her liability for exposing her while in an infected condition. He then left, and communicated with me through the telephone. I arranged to call at the premises a few minutes afterwards, and the Inspector on returning to meet me, saw Mrs. J. and the patient walking in the street. When Mrs. J. saw the Inspector, she said, " I am going to take Hilda to Dr. F. or Dr. P." The Inspector again told hen that she was doing wrong in bringing the child into the street. I met the Inspector as arranged, and we called at Dr. F.'s surgery, as well as Dr. P.'s. It was now after 12 noon, and these surgeries were closed. We then went to the London Hospital, and there found Mrs. J. and her daughter sitting in the waiting room with about 20 to 30 other people. Arrangements were made to have the child removed to the Fever Hospital, and the premises were disinfected. On January 20th the summons was heard at the Thames Police Court, when Mrs. J. was fined £5. Typhus Fever. Four cases of Typhus Fever were notified during the year; all occurred in St. George-in-the-East. Typhus Fever is a contagious disease, which is usually associated with conditions of filth ar.d overcrowding. F. C., aged 19, of Cornwall Street, St. George-in-the-East, was notified on March 20th to be suffering from Enteric Fever, and was removed on the same day 13 to the South Eastern Fever Hospital. On March 22nd the Medical Superintendent of the Fever Hospital informed me that the patient was suffering from Typhus Fever and not Enteric. On March 22nd, E. C. (mother of F. C.) was removed to the South-Eastern Fever Hospital from Spencer Street, St. George's, where she had gone to live while the house in Cornwall Street was being thoroughly disinfected. The Medical Superintendent notified her also to be suffering from Typhus Fever. She had been ill since March 19th. On making enquiries, I found that F. C. was engaged as a rag sorter, but the rags were clean rags. That is, they were tailor's cuttings, and as such, had never been used and were quite new. E. C. was engaged in selling crockeryware on a stall in Watney Street, where she also sold second-hand clothes. The house in Cornwall Street is a four-roomed house, the two rooms on the ground floor were occupied by the mother and daughter, and the two rooms on the first floor were occupied by a man and wife and a newly-born baby. The premises were fairly clean and were in no way overcrowded. On making enquiries, I found that a son of E. C. went to see a doctor on March 1st. His name, was J. C., and was 39 years of age. The doctor recommended his removal to the Infirmary, where he was admitted on the same date, and was supposed to be suffering from "catarrh and influenza." On admission to the Infirmary his temperature was 102° at 6 p.m. on that day (March 1st). His pulse was 126, and his respirations were 48. Pneumonia of both bases was diagnosed, but it was thought that the pneumonia of the right base was more recent than that on the left. On the following day he was delirious, his urine was acid, sp. gr. 1020, and contained cloudy albumen. He got worse, delirium became continuous, he had twitching of the hands, and pneumo¬coccal meningitis. He had rusty sputum, and his expectoration was exceedingly foul and offensive. On the fourth day he became comatose and died on March 5th. J. C. had no permanent address and generally lived when in London in Seamen's lodging houses or common lodging houses. He was a stevedore and worked latterly on the S.S. "St. Servan." This boat left London on January 29th for St. Nazaire, and started her return journey on February 18th, arriving in London on February 20th. She left London on February 27th for Morocco, and as far as I can ascertain there had been no other suspicious illness on board. On February 20th (the day of his arrival in London), J. C. heard that his wife was ill in St. George's Infirmary, and he went there to see her. He was evidently under the influence of drink, and his wife hardly spoke to him. This was the only occasion that his wife saw him for a period of five months before his death. He slept in a common 14 lodging house in Upper East Smithfield on February 20th, 21st and 22nd, but although I enquired in other common lodging houses and seamen's lodging houses, I was not able to ascertain where he slept on February 23rd and 24th. On February 25th, 26th, 27th and 28th he slept at Cornwall Street. On what date he fell ill, it is impossible to find out, but he was ill probably for two or three days at this house, and he was certainly nursed by his mother and sister previous to his removal to St. George's Infirmary. He did not go to his wife's premises, as this tenement had been locked up by her son, and the key returned to the owner. J. C. was a married man, but had not lived with his wife for a considerable time. He was a heavy drinker. His wife was a widow when he married her, and went under the name of her former husband. She was therefore known as Mrs. L. and lived at Crellin Street, St. George's. She was also a rag sorter, but was only engaged in sorting clean rags or tailors' cuttings. She was taken ill on February 1st and was seen by the District Medical Officer, and was, according to him, suffering from "Pains about the body" with a high temperature. The doctor diagnosed rheumatism and sent her into the Infirmary under the name of Mrs. L. When she entered the Infirmary, according to the Medical Officer's notes, she had been ill one week, and had a temperature of 101°, and a pulse of 126. On examination, she was found to have lobar pneumonia of both bases. She was almost pulseless, that is, the pulse was so weak that it could hardly be counted. She was a heavy drinker, and "the pneumonia developed into a low type met with in alcoholics." Expectoration was also exceedingly foul smelling. She gradually improved, and left on March 5th to bury her husband, J. C. The fact that E. C. and her daughter F. C., who nursed J. C. previous to his admission to the Infirmary on March 1st, were taken ill about the same time is very suggestive. The two women were taken ill about March 18th. The incubation period of typhus fever is from 8 to 12 days, rarely 14 days. The probability is, therefore, that J. C. had typhus fever as well. Where did J. C. contract it ? Did his wife have typhus fever and did she give it to him when he visited her on February 20th, or did he contract it at St. Nazaire? It is true that their symptoms were very much alike; but, on the other hand, it is hardly credible that it should be so infectious at that stage. As far as I can ascertain, E. C. had no rash or flea bites. J. C., on the other hand, had a profuse petechial eruption, which the nurse, who saw him on admission, attributed to flea bites. The premises were thoroughly disinfected and the contacts were kept under daily supervision. On Thursday, April 8th, the Medical Superintendent of St. George's Infirmary asked me to see a patient named M. S., aged 56, who he thought had Typhus Fever, and who had been in the Infirmary since April 6th. I agreed with him that the case was Typhus, and the patient was removed to the Fever Hospital on the same day. 15 M. S. lived at Chigwell Hill, and was taken ill on Friday, March 26th, with pains in the head and body. She was seen by a doctor on March 28th, and was advised to go into the Infirmary, but she refused. She became worse, and on Saturday April 3rd, she was seen by another doctor who gave her an order for her admission into the Infirmary. She still refused to be removed into the Infirmary, but on Tuesday, April 6th, she was so ill that the doctor insisted on her removal to the Infirmary. On admission to the Infirmary, on April 6th, she had a temperature of 103°, a pulse of 116, and respirations 26. The patient was stated to be dirty on admission, but the attendant who bathed her reported that no lice or fleas were noticed. There was no rash on the chest or forearms, but a few flea bites were observed. In the evening the temperature was 103.8°, and the pulse was 115. On April 7th the temperature in the morning was 101.8°, and 103.2° in the evening. There was no rash on the body. On April 8th the patient complained of severe headache, she was slightly delirious during the night. The temperature in the morning was 101.4°, and 102.6° in the evening. Her body was covered with a blotchy mulberry-like rash, but the face was quite free. The rash was on the front of the chest and abdomen, but more marked towards the sides, and especially marked on the back of the body. It was also apparent on the upper arms and shoulders, thighs and legs, and back of feet. The rash was definitely petechial in character. There was no crepitations to be heard in the lungs. The urine was acid, sp. gr. 1010, and a trace of albumen was found. M. S. was an old friend of E. C. and lived in the same street for some years. She called to see E. C. when J. C.'s dead body had been taken home from the Infirmary, and probably called to see E. C. when she was ill. M. S.'s husband slept with the patient up to, and including April 5th. There were also in the same house a son and daughter-in-law, two grandchildren and three other lodgers. These were kept under observation and the premises were disinfected. M. S.'s husband, J. S., was taken ill and was removed to St. George's Infirmary on May 1st. His temperature was 103°, his pulse 100, and respirations were 24. There were no signs of Pneumonia or Bronchitis. His clothes were clean and apparently were free from vermin. His body was dirty, and it was only after bathing that a "dusky measley" rash was found about the shoulders, forearms and thighs— especially on the inner sides—and slightly about the trunk. It was not the rash of Measles. The legs and feet were quite free from spots. The rash was similar to that on his late wife. It was stated he had been ill three days before he was admitted to the Infirmary. On May 2nd, he became worse, his pulse was 120, and respirations were 34. There was muttering delirium. The rash was more marked and now appeared on the legs, but not on the feet. 16 He died early on May 3rd. A post-mortem examination was made, and the diagnosis of Typhus Fever confirmed. How is it the disease did not spread in the Infirmary? The theory is that Typhus Fever is generally spread by lice. On admission, both these patients received a warm bath and were put in clean clothes, their own clothes being disinfected. There was, therefore, not much chance for the disease to spread through these agencies. The disease can be spread by exhalations from lungs and skin, but it rarely spreads in a well-ventilated ward, unless there are two or more patients suffering from Typhus in the same ward. This suggests that the poison must be present in a large quantity before it spreads the disease, but is rapidly destroyed by dilution with fresh air. Enteric Fever. 32 cases of Enteric Fever were notified during the year, or 12 less than in the previous year. 8 occurred in the Limehouse District, with 1 death; 7 occurred in St. George-in-the-East, with no deaths; 10 occurred in Mile End Old Town, with 1 death; 7 occurred in the Whitechapel District, with 2 deaths. The death rate throughout the whole Borough was .01 per 1,000 of the population, while that for the whole of London was .02 per 1,000. The decline in the incidence of Enteric Fever has been most marked during the last 15 years. In 1901 the number of cases notified 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 1914 „ „ „ 44 1915 „ „ „ 32 17 Erysipelas. 289 cases were notified, or 112 less than in 1914. 58 belonged to the Limehouse District, with 2 deaths; 61 belonged to St. George-in-the-East, with 1 death: 87 belonged to Mile End Old Town, with 2 deaths; 83 belonged to the Whitechapel District, with 2 deaths. Puerperal Fever. 13 cases of Puerperal Fever were notified, or 20 less than in the previous year. 1 belonged to the Limehouse District; 1 belonged to St. George-in-the-East, which proved fatal; 9 belonged to Mile End Old Town, with 3 deaths; 2 belonged to the Whitechapel District, both proved fatal. 7 were attended by private practitioners, 4 by midwives and 2 at public institutions. Ophthalmia Neonatorum. 65 cases were notified during the year, or 13 more than in the previous year. 33 belonged to the Limehouse District, 4 to St. George-in-the-East, 20 to Mile End Old Town, and 8 to the Whitechapel District. 53 were notified by private practitioners, 8 by midwives, and 4 from public institutions. Poliomyelitis. 5 cases of Poliomyelitis were notified during the year, or 20 less than in the previous year. 2 belonged to Limehouse, 1 to St. George's, 1 to Mile End, and 1 to Whitechapel. Cerebro-Spinal Meningitis or Spotted Fever. 20 cases were notified during the year, or 16 more than in the previous year. No case occurred in Limehouse, 2 occurred in St. George's (one proved fatal), 12 in Mile End (8 proved fatal), 6 occurred in the Whitechapel District, with 5 deaths. 18 Chicken Pox. Chicken-Pox was made a notifiable disease from March 17th to June 30th, 1915, and during this period 418 cases were notified. 73 occurred in the Limehouse District, 70 in St. George-in-the-East, 132 in Mile End Old Town, and 143 in the Whitechapel District. None proved fatal. Zymotic Diseases. The total deaths from diseases of a Zymotic character numbered 526. It includes deaths from Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, Puerperal Fever and Diarrhoea. This number is 134 less than in the previous year. 143 belonged to the Limehouse District, or at the rate of 2 81 per 1,000 of the population. 110 belonged to St. George-in-the-East, or at the rate of 2 43 per 1,000 of the population. 199 belonged to Mile End Old Town, or at the rate of 184 per 1,000 of the population. 74 belonged to the Whitechapel District, or at the rate of 119 per 1.000 of the population. Measles. The number of deaths from Measles was 113, or 61 less than in the previous year. 29 belonged to the Limehouse District, or at the rate of 57 per 1,000 of the population. 32 belonged to St. George-in-the-East. or at the rate of 70 per 1,000 of the population. 42 belonged to Mile End Old Town, or at the rate of 38 per 1,000 of the population. 10 belonged to the Whitechapel District, or at the rate of 15 per 1,000 of the population. The death rate for the whole Borough was 42 per 1,000 of the population. The death-rate for the whole of London was .50 per 1,000. With the exception of 2, all the deaths were those of children under 5 years of age, and 80 (or 70 per cent.) were under 2 years of age. 19 In the last 26 years 4,952 deaths have been caused by Measles, or an annual average of 190. In the same period Scarlet Fever, Diphtheria and Typhoid Fever have been responsible for 4,761 deaths, or an annual average of 183 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 1914 174 1915 113 Whooping Cough. The number of deaths from Whooping Cough was 50, or 21 less than in the previous year. This corresponds to a death rate of .19 per 1,000 of the population, while that for the whole of London was 25 per 1,000. 11 belonged to the Limehouse District, or at the rate of .27 per 1,000 of the population. 12 belonged to St. George-in-the-East, or at the rate of .26 per 1,000 of the population. 18 belonged to Mile End Old Town, or at the rate of .16 per 1,000 of the population. 6 belonged to the Whitechapel District, or at the rate of .09 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 260, or 37 less than in the previous year. 79 belonged to the Limehouse District, or at the rate of 1.55 per 1,000 of the population. b 2 20 56 belonged to St. George-in-the-East, or at the rate of 1.23 per 1,000 of the population. 93 belonged to Mile End Old Town, or at the rate of .86 per 1,000 of the population. 33 belonged to the Whitechapel District, or at the rate of .53 per 1,000 of the population. The death-rate for the whole Borough was .97 per 1,000 of the population. In June and early July, 7,440 leaflets were sent to premises where births occurred during the previous 12 months. These leaflets gave instructions as to the precautions which were to be taken to prevent deaths from Summer Diarrhoea. A special film on the Fly Danger was bought by the Council, which was shown at Cinemas in the various parts of the Borough. No fee was charged for showing the film. Special visits and re-visits were made by the Health Visitors during the season to premises, in which there were infants from 3 to 12 months old, and in which breast feeding was known to have ceased. Special stress was laid on the methods to be adopted for storing milk and other food. The mothers were urged to have milk vessels thoroughly cleansed and scalded, and afterwards kept cool in water, or wrapped in a damp cloth. The mothers were also advised to have all flies destroyed by fly-traps, fly-catching papers, etc. Diseases of the Respiratory Organs. There were 1,056 deaths due to diseases of the Respiratory Organs, which corresponds to a death rate of 3.97 per 1,000 of the population. This number is 126 more then in the previous year. 267 belonged to the Limehouse District, or at the rate of 5.26 per 1,000 of the population. 184 belonged to St. George-in-the-East, or at the rate of 4.07 per 1,000 of the population. 354 belonged to Mile End Old Town, or at the rate of 3.28 per 1,000 of the population. 251 belonged to the Whitechapel District, or at the rate of 4.05 per 1,000 of the population. 21 Phthisis. 499 deaths occurred during the year from Phthisis, or 45 more than in the previous year. This corresponds to a death-rate of 187 per 1,000 of the population, while that for the whole of London was 1.50 per 1,000. 118 belonged to the Limehouse District, or at the rate of 2.32 per 1,000 of the population. 74 belonged to St. George-in-the-East, or at the rate of 1.62 per 1,000 of the population. 176 belonged to Mile End Old Town, or at the rate of 163 per 1,000 of the population. 131 belonged to the Whitechapel District, or at the rate of 2.11 per 1,000 of the population. Number of deaths from Consumption from 1901 tc 1915:— Limehoute 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 1914 90 53 162 149 454 1915 118 74 176 131 499 Other Forms of Tuberculosis. There were 118 deaths from diseases of a Tubercular nature other than Phthisis or 34 less than in the previous year. 30 occurred in the Limehouse District, or at the rate of .59 per 1,000 of the population. 24 occurred in St. George-in-the-East, or at the rate of .53 per 1,000 of the population. 11 43 occurred in Mile End Old Town, or at the rate of .39 per 1,000 of the population. 21 occurred in the Whitechapel District, or at the rate of .33 per 1,000 of the population. The death-rate for the whole Borough was at the rate of .14 per 1,000 of the population. Deaths from Diseases of a Tubercular nature, other than Phthisis, from 1901 to 1915:— 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 1914 52 24 50 26 152 1915 30 24 43 21 118 In 1915, 1,335 new cases were notified, of which 1,051 referred to Pulmonary Tuberculosis or Consumption of the Lungs. For these cases we received 2,670 notifications. There were, therefore 1,335 duplicate certificates, or an average of 2 certificates for each case. The new cases of Pulmonary Tuberculosis were distributed as follows, together with the deaths in each district:— Notifications. Deaths. Percentage. Limehouse District 246 118 47.9 St. George's District 178 74 41.5 Mile End Old Town 412 176 42.7 Whitechapel District 215 131 60.9 The number of notifications and deaths per 1,000 of the population was as follows:— Notifications. Deaths. Limehouse District 4.84 2.32 St. George's District 3.94 1.60 Mile End Old Town 3.81 1.63 Whitechapel District 3.47 2.11 Whole of the Borough 3.95 1.87 23 All the cases were not notified. 252 deaths occurred in 1915, the certificates of death stating that they had died of Consumption, although they had never been notified to be suffering from the disease during their life time. The number of insured persons that received sanatorium treatment by the London Insurance Committee was 135, and were referred to the following institutions for treatment:— Sanatoria 117 City of London Chest Hospital 9 Brompton Hospital 3 University College Hospital 2 Royal National Hospital 2 Metropolitan Hospital 1 Royal Sea Bathing Hospital 1 38 non-insured persons were admitted to Sanatoria through the London_County Council. Infantile Mortality. 861 infants died under one year of age or 139 less than in the previous year. 215 belonged to the Limehouse District, or at the rate of 128 per 1,000 births; 183 belonged to St. George-in-the-East, or at the rate of 136 per 1,000 births; 327 belonged to Mile End Old Town, or at the rate of 107 per 1,000 births. 136 belonged to the Whitechapel District, or at the rate of 94 per 1,000 births. The infant mortality for the whole Borough was 114 per 1,000 births, while that for the whole of London was 111 per 1,000 births. Maternity and Infant Welfare. With the object of encouraging the extension of already existing activities, and the adoption of new measures, annual grants are distributed by the Local Government Board under the Notification of Births (Extension) Act, 1915, one-half of the cost of a scheme for maternity and child welfare, approved by the Board. Grants in aid are made in respect of Clinics, or other institutions concerned with the provision of medical and surgical advice and treatment, as well as in respect of the salaries of Health Visitors and other officers engaged for this work. It has been realised more and more in recent years that a high infant death-rate does not merely indicate a destruction of the unfit, but also a weakening of those 24 who are left. Dr. Newsholme, in his report to the Local Government Board, states: "A heavy infant mortality implies a heavier death-rate up to five years of age; and right up to adult life the districts suffering from a heavy child mortality have higher death-rates than the districts whose infant mortality is low. It is strictly correct, therefore, to say that a high infant mortality implies a high prevalence of the conditions which determine national inferiority." Two Health Visitors are employed by the Borough Council, but there arc numerous Voluntary Organisations doing good work in the Borough. The work at the Voluntary Centres can only be satisfactory when it is kept in touch with a system of organised health visiting at home. By means of the Notification of Births Act, early visits can be made to a household where a birth has occurred, and where a visit is considered desirable. At these visits suitable advice is given by the Health Visitor, and the mother is recommended to bring the child to the Centre. The Health Visitor attached to the Centre hears the advice given by the doctor to the mothers, and subsequently revisits the houses, thus ensuring that the medical instructions are being carried out in the house. The homes of the mothers that attend at the Centres are therefore not visited by the Council's Health Visitors, and they devote their energies to those mothers who cannot, or will not, so attend. The Council's Health Visitors attend the consultations at a certain number of the Centres and thus keep in touch with the Voluntary Agencies. The list of births is supplied to the Voluntary Agencies by the Public Health Department together with literature on infant feeding, etc. Cards for filling in particulars are also supplied to their Health Visitors, and these (or copies of them), when properly filled up, are returned to me.at the end of the year. The Voluntary Agencies receive a moiety of the amount of their expenditure from the Local Government Board provided the Medical Officer of Health gives a certificate that he is satisfied with their work, and that they work in co-operation with the Public Health Department. In order to further co-ordinate the work, a Council formed of the Superintendent and one other representative of each Voluntary Agency meets regularly at the Public Health Offices. It will be seen therefore that the Public Health Department co-operates with the Voluntary Agencies. Details of areas and Voluntary Agencies dealing with maternity and infant welfare in the Borough:— No. 1 area.—Limehouse, Ratcliff and Shadwell. In this area are situated the Mothers' Welcome, Commercial Road, and the Institute, Three Colt Street. About 1,400 births occur in this area every year. Miss Virtue, the Council's Health Visitor, visits the births in Limehouse and Ratcliff, and gives advice, etc. As many mothers as possible are advised to attend the Welcomes with their babies. She regularly visits those who will not, or are unable to attend. In this way the Health Visitor visits about 1,000 births every year, the first visit being on the tenth day. She then decides how often a case is to be 25 visited; some are only visited three times a year, others are visited for a certain period every week, every month or every two months. A paid Health Visitor, attached to the Mothers' Welcome, systematically visits all the births in Shadwell. She calls at the Public Health Office, and the list of addresses where births have occurred, are supplied to her. Two doctors attend the consultations at the Mothers' Welcome, Commercial Road, together with the Lady Superintendent and nurses. The Visitor from the Mothers' Welcome visits about 350 to 400 premises where births occur in Shadwell. A Centre has been newly opened at the Institute, Three Colt Street, which is open one afternoon a week, when a doctor and Miss Virtue are in attendance. No. 2 area.—St. George-in-the-East and Wapping. The eight Centres are:— 22, Raines Mansions. St. George's Congregational Church. Our Ladys Hall, Johnson Street. The Institute, 136, St. George Street. The Institute, Planet Street. Wesleyan Chapel, Cable Street. St. Mary's Mission Hall, Johnson Street. Infant School Room, Scandrett Street. The Jewish Sick Room Helps Society employ a Health Visitor to visit Jewish babies in this area. A doctor and nurse attend at each of these eight Centres once a fortnight, but arrangements are made so that babies can be seen by the doctor once a week if necessary. Miss Lough, the Council's Health Visitor, visits all the non-Jewish cases and systematically visits those non-Jewish babies who do not attend at the Centres, about 600 in number. The homes of those who attend the Centres are visited by the voluntary workers attached to them. About 1,600 births occur in this area every year. No. 3 area.—District West of Sidney Street and Cambridge Road. There are two Centres for Jewish babies, one at Camperdown House and another at 53,Vallance Road, which is connected with the Sick Room Helps Society. The Jewish babies are visited by the Health Visitors from these two organisations. There are two other Centres in this area which deal with non-Jewish cases. (a) The Minories branch of Mothers' Dining Rooms, Women's League of Service, 49, Church Street, whose district extends from Back Church Lane to the Minories and to the South of Whitechapel High Street. The homes are visited by the Secretary, who is a paid and qualified Health Visitor. 26 (b) The Whitechapel School for Mothers at St. Olaves Hall, Buxton Street. This Centre deals with some of the non-Jewish cases in Whitechapel, and is under the control of a whole time superintendent who visits the homes. This Centre was opened in August, 1915, and during the last five months of the year, 43 new cases were brought to the Centre. No. 4 area.—East of Sidney Street and Cambridge Road. There is no Voluntary Organisation which deals with Jewish cases and only one which deals with non-Jewish cases. This Centre is situated in Emmott Street at the corner of Harford Street. It is affiliated to the Mothers' Welcome, Commercial Road, and works in co-operation with the Public Health Department. All the visits are made by Voluntary Health Visitors. It has only been recently started. The numbers of babies visited at their homes are as follows :— Limehouse— Visited by the Municipal Visitor 1,097 „ Stepney Mothers' Welcome Health Visitor 356 St. George-in-the-East— Non-Jewish cases. Visited by Municipal Visitor 601 Jewish cases. Visited by Jewish Health Visitor 521 Mile End— Jewish cases. Jewish Voluntary Society Visitor 201 Whitechapel— Jewish cases. Jewish Voluntary Society Visitor 310 Non-Jewish cases. (Whitechapel School for Mothers) 68 Number of babies seen at the Infant Consultation Centres :— Number of Consultations held. Number of New Cases Registered. Total attendanc in 1915. St . George's Centres 191 234 2,157 Camperdown House 12 50 309 Whitechapel School for Mothers (August to December) 11 43 239 Minories Dining Centre 46 152 437 Sick Room Helps Society, 24, Underwood Street 86 637 2,597 Mothers' Welcome, Commercial Road 51 243 1,391 These results compare favourably on the whole with those of the previous year 27 It will be seen that 1,359 out of 3,157 babies visited, were taken to Welcomes during the year. This large proportion gives a fair idea of the extent to which Infant Welfare Centres are appreciated by the mothers. Figures, however, give but a crude idea of the actual results attained. It is only by means of a personal knowledge of the individual cases benefitted that one is able to realise the possibilities of Infant Consultations. Opportunities have been given to the women to attend classes organised for them by the Voluntary Societies. The subjects taught at these classes are Infant Care ; Sewing and Knitting, including the cutting out and making up of suitable clothes for babies and young children ; Home Nursing ; Personal and Domestic Hygiene ; Domestic Economy and Cooking. In many cases simple talks on the above subjects are given at the Welcomes. It is usually found more satisfactory to hold special meetings for the classes. At the Stepney Mothers' Welcome, classes are held on three days in each week, the subjects being Cooking ; Infant Care and Home Nursing ; Needle-work and Cutting Out. 377 mothers attended these classes during the year. The St. George-in-the-East and Wapping Infant Welfare Association holds a weekly class in Sewing and Cutting Out. During the year four special courses of lectures on other subjects were organised. At all of these classes the total number of attendances was about 900. Sewing classes were also held in connection with Camperdown House and Sick Room Helps Society. Cookery classes were held at the Minories Dining Centre at which there were 155 attendances at two series of 12 lectures. 6,299 dinners were provided during the year to expectant mothers and to those mothers who had been recently confined. The dinners are supplied at the nominal cost of a halfpenny to twopence each, but 1,704 were provided free. Deaths of Illegitimate Children. There were 28 deaths of illegitimate children under one year of age, or at the rate of 172 per 1,000 illegitimate births. 2 belonged to the Limehouse District, or at the rate of 76 per 1,000 illegitimate births ; 4 belonged to St. George-in-the-East, or at the rate of 130 per 1,000 illegitimate births ; 11 belonged to Mile End Old Town, or at the rate of 239 per 1,000 illegitimate births; 11 belonged to the Whitechapel District, or at the rate of 161 per 1,000 illegitimate births. 28 Old Age. 237 deaths were attributable to Old Age. This corresponds to a death rate of .89 per 1,000 of the population. 69 belonged to the Limehouse District, or at the rate of 1.35 per 1,000 of the population. 38 belonged to St. George-in-the-East, or at the rate of .84 per 1,000 of the population. 92 belonged to Mile End Old Town, or at the rate of .85 per 1,000 of the population. 38 belonged to the Whitechapel District, or at the rate of .81 per 1,000 of the population. Table showing the ages of persons who died over 65 years of age and the localities:— I.imehouse St. Georges. Mile End. Whitechapel. Total. Between 65 and 70 years of age 61 30 104 74 269 70 „ 75 69 43 113 92 317 „ 75 80 56 37 73 46 212 80 „ 85 28 17 44 30 119 85 „ 90 17 8 24 19 68 Over 90 years of age 5 — 15 2 22 236 135 373 263 1,007 One was a hundred, and another 102 years of age. Both were residents of Mile End, and died at their own homes. 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 100 29 107 236 St. George-in-the East 57 9 69 135 Mile End Old Town 189 39 145 373 Whitechapel District 99 16 148 263 445 93 469 1,007 Alcoholism. The number of deaths due to Alcoholism and Cirrhosis of the Liver was 30, or 6 less than in the preceeding year. 12 belonged to the Limehouse District, or at the rate of .23 per 1,000 of the population. 1 belonged to St. George-in-the-East, or at the rate of .02 per 1,000 of the population. 11 belonged to Mile End Old Town, or at the rate of .11 per 1,000 of the population. 0 belonged to the Whitechapel District, or at the rate of .09 per 1,000 of the population. 29 Cancer. The deaths due to Cancer were 255, or 12 more than in the previous year. This corresponds to a death rate of .95 per 1,000 of the population. 44 belonged to the Limehouse District, or at the rate of 86 per 1,000 of the population. 35 belonged to St. George-in-the-East, or at the rate of .77 per 1,000 of the population. 110 belonged to Mile End Old Town, or at the rate of 1.01 per 1,000 of the population. 66 belonged to the Whitechapel District, or at the rate of 1.06 per 1,000 of the population. Inhabited House Duty. Twelve applications were received for certificates under the Inland Revenue Act, 1903. for the purpose of securing exemption from Inhabited House Duty. The certificates granted related to 85 tenements. One application was refused. Verminous Persons. 583 men and 5 women were cleansed during the year and their clothing disinfected. Disinfection. Rooms disinfected for infectious diseases 3,387 „ „ pulmonary tuberculosis 747 „ „ vermin 750 4,884 Workshops disinfected—" Military tailoring " 57 Scabies. Number of cases notified by the London Hospital 454 The clothing, etc., were disinfected in 411 cases, but 43 addresses could not be verified. Articles destroyed at request of Owners. Beds 29 Jackets 8 Pillows 27 Vests 6 Mattresses 21 Quilts 5 Palliasses 16 Blankets 4 Bolsters 7 Sheets 3 Cushions 5 Carpets 3 Trousers 7 Sacks, Waste paper 60 Coats 13 Sundries 281 30 ARTICLES DISINFECTED. January. February. March. April. May. June. July. August. September October. November. December. Totals. Beds 241 254 279 227 282 297 323 313 240 355 307 282 3,440 Mattresses 48 31 46 36 27 28 58 102 79 54 47 37 593 Palliasses 94 80 65 71 43 65 90 93 140 109 93 79 1,022 Bolsters 81 67 86 62 64 54 87 79 101 91 83 87 942 Pillows 549 461 486 458 386 500 554 611 686 623 543 438 6,295 Sheets 225 196 243 195 180 314 264 257 284 296 278 242 2,974 Quilts 163 155 175 162 176 158 150 166 235 196 192 148 2,076 Blankets 208 195 346 468 329 710 290 224 322 542 350 253 4,237 Vests 29 23 22 49 39 31 38 32 27 34 54 37 415 Trousers 38 66 35 47 36 24 21 31 33 43 60 38 472 Cushions 60 74 102 206 74 64 69 50 51 87 95 58 990 Coats 29 36 39 26 36 61 45 25 38 47 79 40 501 Sundries 535 314 881 1,489 786 685 560 595 670 767 778 605 8,665 TOTALS 2,300 1,952 2,805 3,496 2,458 2,991 2,549 2,578 2,906 3,244 2,959 2,344 32,582 Articles of Clothing in a Verminous Condition 5,860 Total 38,442 31 Mortuary Returns The number of bodies deposited in the Mortuary during the year was 710. Of these 640 were removed by the Coroner, 63 by the Police, 1 by Relieving Officer, 4 at the request of friends, and 2 on my instructions. 77 bodies were placed in Jewish Mortuary, 33 being "watched." 703 inquests were held in the Coroner's Court and 93 post-mortems were made. Unsound Food Destroyed during the Year. I.—At the Wharves. Tons. cwts. qrs. lbs. Preserved Meats 308 Bullocks' Livers 1 13 0 15 59,196 Tins of Beef 41 16 0 9 480 Mutton 1 6 0 8 4,568 „ Rabbits 4 2 1 4 275 Tongues — 4 3 18 Fresh Fruit and 14,211 Crates of Bananas 365 19 3 0 Vegetables 117 Barrels of Grapes 2 1 3 3 8 Boxes of Melons — 8 0 0 639 Onions 27 16 3 0 645 Oranges 34 8 1 0 1,441 Bags of Potatoes 65 2 0 0 321 Boxes of Tomatoes 3 12 1 0 Preserved Fruits and 6,529 Tins of Assorted Fruits 8 16 2 5 Vegetables. 4,632 Pears 3 7 1 0 68,786 Pineapples 40 17 0 10 620 „ Fruit Pulp 2 15 1 12 3,728 Tomatoes 4 8 3 10 Preserved Fish 27,331 „ Crayfish 7 0 3 23 2,016 Fish Puddings — 19 1 20 40,735 Salmon 23 1 2 12 Dried Fruits 61 Bags of Figs 3 8 0 0 448 Plums 5 0 2 0 Sundries 5 Cocoa Beans — 7 3 22 60 Cases of Eggs 1 15 1 0 69 Tins of Soup — — 2 13 Total 650 10 2 16 82 II.—Unsound Meat and Offal destroyed, from Slaughter-houses and Offal shops:— Tons. cwts. qrs lbs. 51 Sheeps' Carcases and Organs — 19 1 5 26 Calves' „ 1 6 1 13 1 Cow's Carcase „ — 4 1 6 1 Goat's „ — — — 14 1 Pig's ,, — — 3 20 25 Forequarters of Mutton — 2 3 23 2 Breasts and Ribs of Mutton — — — 13 4 Forequarters of Veal — 1 1 9 2 Pieces of Brisket — — — 15 2 Fowls — — — 6 149 Sets of Bullocks' Lungs — 12 1 21 235 „ Sheeps' „ — 4 0 15 28 „ Calves' „ — — 3 5 8 Bullocks' Livers — 1 1 1 193 Sheeps' „ — 3 3 4 18 Calves' „ — — 2 8 19 Bullocks' Heads — 4 2 7 5 Calves' Spleens — — — 10 2 Ox Tongues — — — 7 2 „ Tails — — — 3 5 Cows' Udders — — 1 24 Total 4 3 3 5 III.—Unsound Food seized or surrendered in other parts of the Borough:— Tons. cwts. qrs. lbs. Apples 1 3 0 0 Bacon — — — 21 Bananas — 11 3 19 Beef — 3 2 16 Black Currants — 3 2 18 Celery — 4 1 0 Chestnuts — 1 0 14 Chocolates — — — 7 Dutch Herrings — — 3 0 Eggs 13 5 0 0 Fish — 16 2 18 Fruit Pulp — 9 0 0 Meat — 13 4 0 Carried forward 17 13 1 1 33  Tons. cwts. qrs. lbs. Brought forward 17 13 1 1 Mixed Foodstuff — 11 3 0 Olives — 4 1 0 Onions — — 2 0 Oranges 12 10 0 0 Pears — 1 2 18 Peas — 13 1 0 Plums 3 2 0 19 Potatoes 14 5 3 0 Rabbits — — 1 0 Strawberries — 1 2 26 Tomatoes 1 4 0 0 Total 50 8 2 8 General Sanitary Work. 38,700 houses were inspected, 4,128 being the result of house to house visitation. 12,381 intimation notices were served for the abatement of various nuisances as well as 6,428 statutory notices. It was necessary to take proceedings against the owners or persons causing or suffering the nuisance in 24 cases. 59,835 visits were made by the Inspectors to supervise the abatement of the nuisances complained of. 7,037 drains were tested with smoke or water, and 324 were re-tested. 1,808 drains were either constructed or re-constructed, cleansed or repaired, and 599 were trapped. 229 new soil pipes were fixed and ventilated ; 1,132 new closet pans and traps were fixed; 2,127 closets were either cleansed and repaired or provided with additional light and ventilation; 1,435 water-closets were provided with proper flushing apparatus. 2,034 yards, forecourts and areas were paved or repaired. Notices were served to provide 1,192 sanitary dust receptacles, 20 manure receptacles ; 681 offensive accumulations were removed from the rear of dwelling houses. 220 houses were ventilated underneath the lower floor. 27 underground rooms, which were illegally occupied, were discontinued from being used as such. c 34 45 notices were served for the abatement of smoke nuisances. 381 visits were made to bakehouses, and each bakehouse was cleansed twice during the year. 4,224 notices were served to have houses cleansed, and one owner was summoned. The magistrate made an order to abate with £1 6s. costs. Water supply was reinstated to 91 houses. 366 sink, bath or rain-water pipes, which were communicating directly with the drain, were disconnected. One owner was fined £1 and 23s. costs for improperly fixing a sink waste pipe. 6,656 miscellaneous repairs to roofs, floors, gutters, &c., were made as the result of notices served. Police-court proceedings were taken against the owners of six premises for failing to remedy the defective condition of the roofs. Orders were made to remedy the defects in seven days, with costs amounting to £11 9s. 135 rooms were provided with additional light and ventilation and the damp walls of 603 rooms were remedied. Police Court proceedings were taken against two owners. The magistrate made an order to abate, with £1 6s. costs in each case. The nuisance due to the keeping of too many animals in back yards was abated on 87 premises. Proceedings were taken against 10 persons for conveying offensive matter through the streets during prohibited hours or in improper receptacles. Convictions were obtained in every case, the total fines and costs obtained amounting to £16 13s. 15,201 inspections were specially made for the purpose of detecling overcrowding ; 322 living rooms were found to be overcrowded. Intimation notices were served in every instance, followed by 110 statutory notices where the nuisance was not abated as a result of serving the intimation notice. Police Court proceedings were necessary in one case only. The defendant had removed before the day of hearing and the summons was withdrawn. Overcrowding. 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 484 224 497 130 392 97 89 79 327 265 419 182 519 243 181 .. .. 4128 Miscellaneous 1521 1749 1291 2086 1532 655 1571 1619 1712 1292 1441 1694 1580 1311 2168 1132 1155 26509 Complaints 209 109 425 365 316 281 369 115 101 135 278 134 215 179 72 156 63 3513 Infectious diseases 292 157 221 289 272 385 342 158 136 97 257 221 172 115 178 .. .. 3292 Visits to Cases of Consumption 151 119 114 219 128 271 191 80 114 96 117 234 158 92 174 .. .. 2258 Intimations served 675 872 677 654 983 523 884 560 511 694 977 637 1356 600 655 514 600 12381 Statutory notices served 453 551 252 356 655 3J7 576 349 306 302 714 70 600 392 90 334 91 6428 Houses re-visited 4112 4635 3751 3604 4261 2980 2916 2737 3232 2353 4919 2589 4343 2776 4715 2639 3273 59835 Summonses taken out under the Public Health (London) Act, 1891 .. 3 .. 1 6 2 4 .. .. 1 .. 1 .. 1 4 1 .. 24 Samples taken under the Food & Drugs Acts 100 72 92 78 100 100 97 72 72 72 101 71 72 42 72 .. .. 1213 Summonses „ ,, „ ,, .. .. 3 2 6 17 3 4 3 4 2 .. 9 1 2 .. .. 60 Houses or parts of houses cleansed 185 402 79 264 217 205 272 172 228 378 335 163 196 236 322 337 233 4224 Water supply to houses re-instated 4 2 8 3 5 4 .. 4 8 2 5 4 16 8 17 .. 1 91 Drains constructed and reconstructed 130 17 37 57 43 52 11 35 14 30 53 27 18 7 39 14 .. 584 ,, cleansed and repaired 75 138 60 61 174 95 65 23 87 21 118 95 100 27 92 .. 13 1224 ,, trapped 152 38 64 72 .. 65 62 33 29 6 27 3 15 11 17 5 .. 599 New soil pipes fixed and ventilated 10 25 31 16 2 40 14 2 10 8 20 .. 6 13 32 .. .. 229 New closet pans and traps fixed 163 86 85 58 81 40 72 60 43 26 122 62 24 31 179 .. .. 1132 Closets provided with a water supply and flushing apparatus 66 138 112 118 29 24 155 93 33 35 134 25 133 91 222 24 3 1435 Closets provided with light and ventilation 11 52 10 5 9 9 9 .. 5 2 1 1 1 5 23 .. .. 143 ,, cleansed and repaired 66 113 147 136 127 86 195 100 49 76 84 58 202 116 122 183 124 1984 Yards cleansed, repaved, or paving repaired 230 104 39 117 246 109 100 40 88 58 101 123 102 94 90 75 57 1773 Wash-houses, forecourts, areas, &c., paved 61 58 21 5 3 6 14 28 6 15 11 5 20 6 2 261 Sanitary dust receptacles provided 90 108 29 29 127 38 134 42 25 43 113 72 101 66 60 79 36 1192 Sink, bath, and lavatory pipes and rain-water pipes disconnected 138 28 42 17 3 5 11 1 8 2 22 6 1 32 50 .. .. 366 Houses ventilated under lower floor 86 3 .. 11 6 3 11 3 13 17 4 5 23 5 30 .. .. 220 Miscellaneous repairs, viz.: roofs, floors, gutters, &c. 250 810 177 306 425 207 470 279 330 484 508 405 803 246 420 305 231 6666 Overcrowding in dwellings abated 6 3 6 26 13 17 33 7 29 12 15 8 50 17 9 28 43 322 Illegal occupation of underground rooms discontinued .. .. .. 2 .. 3 2 1 .. 11 .. .. 5 2 1 .. .. 27 Manure receptacles provided or reconstructed 4 4 .. 5 1 .. .. .. 1 .. 2 .. .. 3 .. .. .. 20 Offensive accumulations removed 15 21 80 68 8 15 230 26 17 32 10 45 28 27 16 17 26 681 Bakehouses inspected 33 30 24 22 20 45 32 24 10 22 24 26 30 7 32 .. .. 381 ,, cleansed 28 15 24 22 20 35 32 24 10 22 24 26 30 6 13 .. .. 331 Smoke nuisances abated 1 2 13 2 .. .. .. 1 4 4 3 2 5 8 .. .. .. 45 Animals kept so as to constitute a nuisance, removed 1 1 1 4 23 4 18 3 1 8 2 1 9 4 1 1 5 87 Damp walls remedied 23 70 11 5 39 2 46 13 30 35 13 14 102 66 82 21 31 603 Cisterns cleansed and covered 3 2 2 .. .. 6 4 4 2 .. 3 .. 2 21 .. 1 50 Urinals fixed 2 7 4 3 .. 1 .. .. .. 2 .. .. 3 .. .. .. 22 Open fires in yards abolished .. .. .. 2 1 6 2 .. 2 4 .. .. .. .. .. .. .. 17 Canal Boats inspected .. 62 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 62 Areas and stables paved and drained 3 .. 1 16 .. .. .. .. .. 4 .. .. .. 6 8 .. .. 38 Occupation of shed as dwelling discontinued .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Light and ventilation provided to rooms .. .. .. .. 6 3 3 3 6 14 2 2 2 12 35 41 9 135 Face page 34) 35 Factories and Workshops. The total number of workshops on the Register was 3,431; but this does not include factories, workplaces and out-workers' premises. 5,326 inspections to factories, workshops and workplaces revealed defects, which necessitated the service of 1,197 written notices. Of the notices, 54 referred to factories, 1,039 referred to workshops including workshop laundries, and 104 to workplaces other than out-workers' premises. Cleanliness.— 476 notices were served to properly cleanse workshops. Ventilation.—The ventilation of 68 workshops was improved. Overcrowding.—Overcrowding was abated in 27 workshops. Sanitary Accommodation.—The sanitary accommodation was improved in 217 workshops by providing additional and suitable water-closets. Drainage of Floors.—The drainage of the floor was found defective in two workshops. 524 other nuisances were remedied in workshops. Out-workers' Premises.—4,065 inspections were made to out-workers' premises during the year ; 490 premises were found to be insanitary, and notifiable diseases occurred in 197. 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. o 2 36 FACTORIES, WORKSHOPS. LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—INSPECTIONS. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 701 51 .. Workshops (Including Workshop Laundries) 4,522 1,039 .. Workplaces (Other than Outworkers' premises) 103 104 .. Total 5,326 1,197 .. 2.-DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuitancet under the Public Health Acts :—* .. Want of cleanliness 476 476 .. .. Want of ventilation 68 68 .. .. Overcrowding 27 27 .. .. Want of drainage of floors 2 2 .. .. Other nuisances 524 524 .. .. Sanitary Accommodation infjiiffii-ient 19 19 .. .. unsuitable or defective 176 176 .. .. not separate for sexes 22 22 .. .. Offences under the Factory and TForkuhop Acts:— Illegal occupation of underground bakehouse (S. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 42 « 42 .. .. Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) 4 4 .. .. Total 1,360 1,360 .. * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as, remediable under the Public Health Acts. 37 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). Proiecutions (Sections 109, 110). Twice in the Year. Once in the Year. Failing to 1 keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors Workmen. Wearing Apparel— (1) Making. &c. 228 774 2,435 55 274 447 .. .. .. 474 474 .. 188 .. .. (2) Cleaning and Washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Household linen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. Curtains and furniture hangings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. Electro plate .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. File making.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur pulling (Furriers) 4 .. 45 .. .. .. .. .. .. .. .. .. .. .. Cables and chains .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Artificial flowers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sacks 4 .. 8 .. .. .. .. .. .. .. .. .. .. .. .. Racquet and tennis balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper, etc.. boxes, paper bags .. 6 .. 60 .. .. .. .. .. .. ..10.. ..io.. .. .. Brush making 4 .. 19 .. .. .. .. .. .. 4.. 4 .. .. .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carding, of., of button, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Stuffed toys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chocolates and sweetmeats .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cosaques, Christmas crackers, Christmas stockings, &.c .. .. .. .. .. .. .. .. .. .. .. .. .. Textile weaving .. .. .. .. .. .. .. .. •• •• .. • • •• .. Total .. 248 774 2,529 61 278 550 .. .. •• 490 490 .. 197 •• ••1 38 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. (1) (2) Bakehouses 168 Boot, Shoe and Slipper Making 172 Cabinet Making 108 Furriers 135 Hat and Cap Manufacturers 108 Miscellaneous 426 Laundries 18 Rag Sorting, etc. 88 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) 2,208 Total 3,431 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to II.XI. Inspector of Factories : — Failure to affix Abstract of the Factory and Workshop Acts (S. 133, 1901) 36 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 390 Reports (of action taken) 257 sent to H.M. Inspector. Other — Underground Bakehouses (S. 101): — In use at the end of the year 52 39 Table showing the number of milk premises, slaughter houses, ice-cream premises, etc., together with the number of inspections made to them. PREMISES NUMBER OF PLACES. Number of inspections, 1915. Number of notices, 1915. Number of prosecutions. 1916. No. on register at end of 1914. No. added in 1916. No. removed in 1915. No. on register at end of 1915. (1) (2) (3) (4) (5) (6) (7) Milk premises 589 18 32 575 1953 108 ... Cowsheds 31 1 30 63 5 ... Slaughter-houses 4 ... ... 4 11 ... ... Other offensive trade premises 7 ... ... 7 27 1 ... Ice cream premises 228 9 44 193 402 50 ... Registered houses let in lodgings 2546 1 ... 2547 3870 (a) 137 (a) ... (b) 14G0 (b) 13 (a) For overcrowding. (6) For other conditions. Total number of Intimations served for all purposes 12,381 Overcrowd ing— Number of Inspections 15,201 Number of dwelling rooms overcrowded 322 Number of Notices served Intimations 322 Statutory Notices 110 Number remedied 322 Number of Prosecutions — Underground, rooms— Illegal occupation dealt with during the year 27 Number of rooms closed 19 Insanitary Houses— Number closed under the Public Health (London) Act, 1891 — Number closed under the Housing and Town Planning Act 23 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 — 40 L.C.C. (General Powers) Act, 1904— Number of verminous rooms cleansed (Sec. 20) 1,815 Number of filthy articles purified (Sec. 19) 95 Number of sanitary conveniences altered (Sec. 22) — Number of sanitary conveniences removed (Sec. 22) 4 Number of fixed ashpits removed (Sec. 23) 1 L.C.C. (General Powers) Act, 1907. Number of tenement houses dealt with as regards water supply (Sec. 78) 5 Shelters provided under Sec. 60 (1) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 81 Places where Food is prepared for sale — 434 Number of Inspections 1201 Number of Notices served Intimations 124 Statutory Notices 34 House to House Inspections— 4,128 Number of defects 2,106 Number of Notices served Intimations 1,957 Statutory Notices 742 Revenue Acts— Number of houses for which applications were revived during the year 8 Number of tenements comprised therein 87 Number of tenements for which certificates were (a) granted 85, (b) refused 2, (c) deferred — 87 Number of Prosecutions under Bye-laws under the Public Health (London) Act, 1891— (a) For prevention of nuisance arising f.om 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 — (i) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc 10 (/) 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 — (t) With respect to sufficiency of water supply to water closets — 41 (j) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) — (k) With respect to deposit of plans as to drainage, etc., (Metropolis Management Acts Amendments (By-laws) Act, 1899) — Mortuary. Total number of bodies removed 710 Total number of infectious bodies removed — Public Analyst's Annual Report. During the year 1,213 samples were submitted by the Inspectors for examination under the Sale of Food and Drugs Acts, consisting of:—868 Milks, 2 Separated Milks, 2 Skimmed Milks, 212 Butters, 2 Milk-blended Butters, 1 Canned Cream, 2 Fresh Creams, 3 Preserved Creams, 8 Margarines, 3 Lards, 13 Cocoas, 18 Coffees, 16 Mustards, 32 Peppers, 5 Pearl Barleys, 5 Flours, 2 Oatmeals, 6 Rices, 4 Jams, 1 Almond Oil, 3 Camphorated Oils, 2 Cod Liver Oils, 2 Olive Oils, 1 Liquorice Powder. 15-4 Samples, or 12-7 per cent, were found to be adulterated. These consisted of:—130 Milks, 2 Separated Milks, 20 Butters, 1 Milk-blended Butter, 1 Cocoa. Proceedings were taken in 51 cases. The total fines secured on the prosecutions were £202 7s. Od. Total costs allowed, £54 0s. Od. The average fine on the prosecutions was £3 19s. 4d. There were 14 prosecutions for infringements of the Margarine Acts, resulting in £19 lis. Od. fines and £7 10s. Od. costs. Three milk vendors were prosecuted for refusing to serve the Inspector, resulting in £9 0s. Od. fines and £1 Is. Od. costs. One milk vendor was fined £1 for failing to put his name on his barrow, and one milk vendor was prosecuted for obstruction ; case withdrawn. Sunday Samples. 66 Samples were taken on 11 Sundays:—60 Milks and 6 Butters. 11 Milks, or 16-7 per cent, of the whole, were adulterated, and 3 prosecutions resulted. Unofficial Samples. 86 Samples purchased informally by the Inspectors were examined. These consisted of:—17 Milks, 65 Butters, 2 Margarines, 1 Cocoa, 1 Saffron. Of these, 44 Samples, or 51-2 per cent., were adulterated, consisting of:—12 Milks, 32 Butters. 76 Samples were examined for the General Public, consisting of:—39 Milks, 1 Separated Milk, 2 Margarines, ] Mustard, 1 Pepper, 1 Desiccated Cocoanut, 1 Wine, 42 4 Vegetable Oils. Of these, 31 samples, or 41.1 per cent., were adulterated, consisting of:—11 Milks, 19 Butters, 1 Mustard. Preservatives. All samples of Milk, Butter, and Cream were examined for preservatives. One sample of Milk contained Formalin, 34 samples of Butter contained small quantities of Boron preservatives. The 3 samples of preserved Cream contained Boron preservatives, but not in excess of the amount stated on the label. 16 Samples of Milk were artificially coloured. In addition to the samples already enumerated, 14 miscellaneous samples were examined:— 12 for the Public Health Department. 2 for the Works Department. Comparison of Adulteration with that of the previous 10 years. YEAR. Number of Samples Examined. Number Adulterated. Number of Prosecutions. Percentage of Adulteration. Percentage of Prosecutions. Amount secured in Fines. Average Fine. £ s. d. £ s. d. 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 1913 1263 146 79 11.6 6.3 529 13 0 6 14 1 1914 1237 139 65 11.2 5.3 135 9 0 2 1 8 Average for 10 years 1217 172 80 14.2 6.6 262 12 0 3 5 8 1915 1213 154 51 12.7 4.2 202 7 0 3 19 4 43 STATISTICS OF ADULTERATION FOR THE YEAR. Nature or Sample. Number Examined. Number Adulterated. Number of Prosecutions. Percentage of Adulterations. Percentage of Prosecutions. Milk 868 130 40 15.0 4.6 Milk (separated) 2 2 ... 100.0 ... Milk (skimmed) 2 ... ... ... ... Butter 212 20 11 9.4 5 2 Butter (milk blended) 2 1 ... 50.0 ... Cream (canned) 1 ... ... ... ... Cream (fresh) 2 ... ... ... ... Cream (preserved) 3 ... ... ... ... Margarine 8 ... ... ... ... Lard 3 ... ... ... ... Cocoa 13 1 ... 7.6 ... Coffee 18 ... ... ... ... Mustard 16 ... ... ... ... Pepper 32 ... ... ... ... Barley (pearl) 5 ... ... ... ... Flour 5 ... ... ... ... Oatmeal 2 ... ... ... ... Rice 6 ... ... ... ... Jam 4 ... ... ... ... Almond Oil 1 ... ... ... ... Camphorated Oil 3 ... ... ... ... Cod Liver Oil 2 ... ... ... ... Olive Oil 2 ... ... ... ... Liquorice Powder 1 ... ... ... ... Total 1,213 154 51 32.7 4.2 District. Whitechapel 339 27 10 8.0 2.9 St. George's 258 37 16 14.0 6.0 Limehouse 215 23 4 10.7 1..9 Mile End 401 67 21 16.7 5.2 Total 1,213 154 51 12.7 4.2 44 SAMPLES TAKEN BY INSPECTORS DURING THE YEAR. Nature of Sample. Inspector— J. W. Johnson. H. Quaintrell. R. H. Waterman. J. Twaits. G. O. 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 ... 37 49 30 73 83 80 86 49 57 37 31 87 63 62 48 872 Butter ... 17 12 8 17 5 14 3 21 15 31 9 4 34 11 13 214 Cream ... ... ... 1 3 ... 1 ... ... ... ... ... 1 ... ... ... 6 Margarine ... ... 1 2 ... ... 2 ... 2 ... 1 ... ... ... ... ... 8 Lard ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 Cocoa ... 3 1 3 1 2 ... 2 ... ... ... ... ... ... 1 ... 13 Coffee ... 5 2 1 ... 2 ... 4 ... ... ... ... ... ... ... 4 18 Mustard ... 3 1 4 2 ... ... 4 ... ... ... ... ... ... ... 2 16 Pepper ... 4 4 10 ... ... 3 2 ... ... 3 2 ... ... 2 2 32 Barley ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 Flour ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 5 Oatmeal ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Rice ... ... ... 6 ... ... ... ... ... ... ... ... ... ... ... ... 6 Jam ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... 4 Dru ... ... ... ] 4 4 ... ... ... ... ... ... ... ... ... ... 9 Total ... 72 71 72 100 100 100 101 72 72 72 42 92 97 78 72 1213 45 RESULT OF INSPECTORS' WORK UNDER THE SALE OF FOOD AND DRUGS ACTS, MARGARINE ACTS, &c., DURING THE YEAR. INSPECTOR. Samples taken. Number Adulterated. Number of Prosecutions. Fines Secured. Costs Allowed. Cases of refusing to sell, obstr action, &c., and offences under the Margarine Acts. No of Cases. Fines. Costs. £ s. d. £ s. d. £ s. d. £ s. d. J. W. Johnson 72 7 ... ... ... ... H. Quaintrell 71 12 2 5 0 0 2 2 0 2 2 2 0 2 2 0 R. H. Waterman 72 4 2 2 0 0 1 1 0 ... ... ... J. Twaits 100 14 4 16 0 0 3 3 0 1 ... ... G. O. Pavitt 100 17 3 5 0 0 1 1 0 3 5 0 0 1 1 0 E. T. Crook 100 28 12 65 0 0 9 13 0 4 10 0 0 2 3 0 R. Simpson 101 8 2 ... 1 3 0 1 5 0 0 ... A. W. Stiles 72 15 9 82 5 0 4 9 0 4 4 0 0 ... J. White 72 12 3 5 0 0 2 6 0 ... ... ... E. W. Flint 72 7 3 5 5 0 1 1 0 1 0 19 0 1 1 0 T. W. Dee 42 3 1 1 0 0 1 1 0 ... ... T. P. Wrack 92 6 3 4 7 0 2 14 6 ... ... ... H. Mills 97 9 2 ... 20 1 6 1 1 0 0 1 1 0 A. Cook 78 6 2 10 0 0 3 3 0 ... ... ... W. Shepherd 72 6 3 0 10 0 1 1 0 2 1 10 0 1 3 0 Total 1,213 154 51 202 7 0 54 0 0 19 29 11 0 8 11 0 46 ARTICLES ADULTERATED. Number. Article. Adulteration. Result. 2.L. Milk 10 per cent, added water £117s. fineand 23s. costs. 4.L. Milk 6 „ deficient in fat Caution. 3.N. Milk 21 „ added water Dismissed. Warranty. Previous convictions & cautions. £1 1s. costs. 1.H. Separated Milk 3 „ ,, Caution. 7.H. Milk 16 „ deficient in fat £2 fine and 23s. costs. 4.B. Milk 3 „ added water Caution. 12.N. Milk 3 „ „ Caution. 12.M. Milk 7 ,, ,, Caution. 13.M. Milk 10 „ „ Caution. 14.M. Milk 8 „ added water, 5 per cent. deficient in fat Caution. 17.L. Milk 4 „ added water Caution. 8.S. Milk 13 „ deficient in fat Dismissed. Warranty. Previous conviction and caution. 7.E. Milk 16 „ „ „ £5 fine and 21s. costs. 9.E. Milk 7 „ added water Caution. 11.E. Milk 3 „ ,, Caution. 17.S. Milk 4 ,, ,, Caution. 24.N. Milk 16 „ deficient in fat £10 fine and 42s. costs. Several previous convictions and cautions. 3.F. Milk 7 „ added water Dismissed Warranty. Previous prosecution and caution. 5.F. Milk 10 „ deficient in fat Dismissed. Warranty. Several previous convictions and cautions. 8.F. Milk 7 „ added water 42s. costs. 10.F. Milk 21 „ ,, £50 fine and 42s. costs. Several previous convictions and cautions. 13. J. Butter ... Margarine (sold in wrapper) No action. 13.F. Milk 3 per cent. added water Caution. 13.D. Milk 5 „ deficient in fat Caution. 20.L. Milk 8 „ added water £2 fine and 21s. costs. 17.G. Milk 9 „ ,, Dismissed. Warranty. Previous convictions and several cautions. 7.A. Milk 6 „ deficient in fat Caution. 6.C. Milk 10 „ „ „ Dismissed. Warranty Previous caution. 25.N. Milk 4 „ added water Caution. 16.D. Milk 3 „ ,, Caution. 18.D. Milk 3 „ „ Caution. 19.D. Milk 4 „ deficient in fat Caution. 47 Articles Adulterated—continued. Number. Article. Adulteration. Result. 21. F. Milk 4 per cent. added water Caution. 24. F. Milk 2 „ „ Caution. 22.E. Milk 7 „ „ Dismissed. Warranty. 26.E. Milk 5 „ deficient in fat Caution. 24.N. Milk 3 „ added water Caution. 16.J. Milk 3 „ „ Caution. 29.D. Milk 4 „ added water, 5 per cent. deficient in fat Dismissed. Sold as received. 24.G. Milk 5 „ deficient in fat Caution. 13.B. Milk 3 „ „ Caution. 14.B. Milk 3 „ added water Caution. 20.K. Milk 3 „ „ Caution. 34.N. Milk 5 „ deficient in fat Caution. 27.E. Milk 3 „ added water Caution. 31.E. Milk 3 „ „ Caution. 21.J. Milk 16 „ deficient in fat £2 fine and 23s. costs. 19.A. Milk 3 „ added water Caution. 26.A. Cocoa 2 „ added alkali Caution. 34.G. Milk 5 „ deficient in fat Caution. 28.K. Milk 10 „ „ 25s. fine. 31.K. Butter Margarine £2 fine. 36.E. Milk 3 per cent. deficient in fat Caution. 38.E. Milk 3 „ added water Caution. 35.G. Milk 3 „ deficient in fat Caution. 29.H. Milk 8 „ added water £1 fine and 20s. costs. 30.H. Separated Milk 3 „ „ Caution. 19.B. Butter Margarine £4 fine and 21s. costs. 38.N. Milk 4 per cent. deficient in fat Caution. 35.L. Milk 13 10s. fine and 10s. 6d. costs. 27.J. Milk 3 „ added water Caution. 28.J. Milk 10 „ deficient in fat 23s. costs. 31.J. Milk 3 „ „ „ Caution. 17.T. Milk 3 „ „ „ Caution. 20.T. Milk 5 „ „ „ Caution. 20.B. Milk 3 „ „ „ Caution. 40.E. Milk 3 „ added water Caution. 38.D. Milk 4 „ „ Caution. 40.D. Milk 3 „ „ Caution. 27.F. Milk 10 „ deficient in fat Dismissed. Warranty. 28.F. Milk 10 „ „ „ Dismissed. Warranty. 30.F. Milk 6 „ „ „ Caution. 41.G. Milk 3 „ added water Caution. 44.G. Milk 4 „ „ Caution. 49.M. Milk 4 „ „ Caution. 50.M. Milk 6 „ deficient in fat 23s. costs. 38.F. Milk 4 „ added water Caution. 41.F. Milk 3 „ deficient in fat Caution. 48 Articles Adulterated—continued. Number. Article. Adulteration. Result. 45.E. Milk 3 per cent. added water Caution. 50.E. Milk 5 „ deficient in fat Caution. 34.K. Milk 3 „ „ „ Caution. 35.K. Milk 8 „ „ „ £2 fine and 21s. costs. 33.A. Milk 2 „ added water Caution. 35.A. Milk 3 „ „ „ Caution. 36.A. Milk 4 „ „ „ Caution. 31.H. Butter Margarine £2 fine. 32.H. Butter „ £3 fine and 23s. costs. 36.H. Butter „ £20 fine and 23s. costs. 38.H. Butter 80 per cent. foreign fat £2 fine. 39.H. Milk 11 „ added water 5s. fine. 69.M. Milk 5 „ „ 3 months, reduced to 6 weeks on appeal. Costs. £18 18s. 6d. Previous conviction and caution. 38.J. Milk 3 „ „ Caution. 39.J. Milk 10 „ deficient in fat Caution. 36.S. Milk 20 „ „ „ 10s. fine and 21s. costs. 40.C. Milk 8 „ added water, 5 per cent deficient in fat £2 fine and 21s. costs. 41.K. Milk 3 „ added water Caution. 41.H. Milk 17 „ „ £50 fine. Several previous convictions and cautions. 47.F. Milk 6 „ deficient in fat Dismissed. Warranty. Previous caution. £2 4s. costs. 50.F. Milk 3 „ added water Caution. 38.B. Milk 3 „ „ Caution. 52.F. Milk 4 „ deficient in fat Caution. 53.F. Milk 6 „ „ „ Dismissed. Warranty. 41.S. Milk 13 „ „ „ Dismissed. Warranty. 2 previous convictions. 48.L. Milk 4 „ added water Caution. 44.J. Milk 3 „ „ Caution. 45.J. Milk 3 „ „ Caution. 59.G. Milk 3 „ „ Caution. 60.F. Milk 3 „ „ Caution. 63.F. Butter 75 „ foreign fat £5 fine. 65.F. Butter Margarine No action. 66.F. Butter „ No action. 67.F. Butter 75 per cent. foreign fat No action. 55.D. Milk 3 „ added water Caution. 56.D. Milk 3 „ „ Caution. 46.B. Milk Contained Formalin Caution. 46.S. Milk 6 per cent. deficient in fat Caution. 71.E. Milk 3 „ added water Caution. 49 Articles Adulterated—continued. Number. Article. Adulteration. Result. 72.E. Milk 12 per cent. added water Vendor absconded. Adjourned. 4 previous summons. 47.H. Milk- blended Butter 5 „ foreign fat Caution. 53.H. Butter 5 „ „ Caution. 73.F. Butter 5 „ „ Caution. 51.J. Milk 5 „ added water Caution. 54.J. Butter 65 „ foreign fat, 2.4 per cent. excess of water £3 fine. 68.D. Milk 4 „ added water Caution. 54.S. Butter Margarine Summons withdrawn. 52.B. Milk 3 per cent. added water Caution. 80.D. Milk 4 „ „ Caution. 31.T. Milk 23 „ „ £1 fine and 21s. costs. 87.E. Milk 4 „ „ Caution. 85.M. Milk 3 „ deficient in fat Caution. 90.M. Butter Margarine No action. 58.A. Milk 3 per cent. added water Caution. 87.D. Butter 80 „ foreign fat £10 fine and 21s. costs. 58.B. Milk 3 „ added water Caution. 59.B. Milk 4 „ „ Caution. 65.K. Butter 74 „ foreign fat No action. 90.D. Milk 10 „ deficient in fat £2 fine and 21s. costs. 85.G. Milk 10 „ added water Withdrawn. 23s. costs. 94.M. Milk 3 ,, ,, Caution. 69.H. Milk 16 ,, „ £2 fine. 70.H. Butter 2.5 „ excess of water Caution. 86.F. Milk 33 „ deficient in fat £3 fine and 23s. costs. 87.F. Milk 16 „ „ 97.E. Milk 3 „ added water Caution. 99.E. Milk 5,, ,, Caution. 63.B. Butter 78 „ foreign fat 21s. fine and 21s. costs. 68.C. Milk 3 „ added water Caution. 71.C. Milk 5 „ „ Caution. 93.F. Milk 26 „ deficient in fat Caution. 94.F. Milk 5 „ added water Caution. 99.F. Milk 4 „ ,, £6 fine and 21s. costs. 100.F. Milk 7 ,, ,, £2 fine and 21s. costs. Previous caution' 69.B. Milk 3 ,, ,, Caution. 99.D. Milk 8 „ deficient in fat £4 fine and 21s. costs. D 60 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, 1916. 51 TABLES OF STATISTICS OF THE BOROUGH DURING 1915 AND PREVIOUS YEARS. Area of Borough in aores (land and inland water).. 1,765.6 Total population of all ages 279,804 No. of inhabited houses 36,217 Average number of persons per house 7.7 Total families or separate occupiers 56,949 At Census of 1911. D 2 TABLE 1.—Vital Statistics of Whole District during 1915 and Previous Years. Metropolitan Borough of Stepney. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. * Rate. Number. * Kate per 1,000 Nett Births. Number. * Rate. Number. Rate. 1 2 3 4 6 6 7 8 9 10 11 12 13 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 1914 273265 8396 7983 29.2 4844 17.7 1093 799 1000 125 4550 16.6 1915 265731 7919 7506 28.2 5065 19.0 1319 781 861 114 4527 17.0 *In Column 6 arc included the whole of the deaths registered during the calendar year as having actually occurred within the district, but excluding the deaths of Soldiers and Sailors that have occurred in hospitals and institutions in 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 in 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 51) TABLE II.—Cases of Infectious Disease notified during the Year 1915. Metropolitan Borough of Stepney. Notifiable Disease. At all Ages. Number of Cases notified. Total Cases notified in each Locality. Total cases removed to Hospital. At Ages—Years. 1. 2. 3. 4. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Limehouse. St. George's Mile End. Whitechapel. Small-pox 1 •• •• •• •• 1 •• •• •• •• •• 1 1 Cholera •• •• •• •• •• •• •• •• •• •• •• •• •• Plague •• •• •• •• •• •• •• •• •• •• •• •• •• Diphtheria (including Membranous Croup) 1030 28 451 490 44 12 5 •• 170 180 399 281 1015 Erysipelas 289 17 9 24 46 81 88 24 58 61 87 83 39 Scarlet Fever 1458 29 536 809 60 24 •• •• 138 267 543 510 1441 Typhus Fever 4 •• •• •• 1 •• 3 •• •• 4 •• •• 4 Enteric Fever 32 •• 2 9 8 11 2 •• 8 7 10 7 26 Relapsing Fever •• •• •• •• •• •• •• •• •• •• •• •• •• Continued Fever 1 •• •• •• 1 •• •• •• •• •• 1 1 Puerperal Fever 13 •• •• •• 4 9 •• •• 1 1 9 2 11 Cerebro-spinal Meningitis 20 8 1 9 2 •• •• •• •• 2 12 6 18 Poliomyelitis 5 •• 3 1 •• 1 •• •• 2 1 1 1 2 Ophthalmia Neonatorum 65 65 •• •• •• •• •• •• 33 4 20 8 •• Pulmonary Tuberculosis 1051 2 41 233 160 410 180 25 246 178 412 215 381 Other forms of Tuberculosis 284 6 50 155 36 22 10 5 81 49 86 68 57 Chicken Pox 418 41 205 165 2 5 •• •• 73 70 132 143 13 Totals 4671 196 1298 1895 364 576 288 54 810 824 1712 1325 3009 TABLE III.—Causes of, and Ages at Death during the year 1915. Metropolitan Borough, of Stepney. Causes or Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or "nonResidents" 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 4527 861 310 246 180 200 631 1092 1007 2759 Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever 4 .. .. .. .. 1 2 1 .. 4 Small-pox .. .. .. .. .. .. .. .. .. .. Measles 113 25 55 31 2 .. .. .. .. 56 Scarlet Fever 27 4 7 9 7 .. .. .. .. .. Whooping Cough 50 21 20 9 .. .. .. .. .. 23 Diphtheria and Croup 66 8 13 28 17 .. .. .. .. 28 Influenza 27 .. .. .. .. 1 4 11 11 6 Erysipelas 7 4 1 .. .. .. .. 1 1 5 Phthisis (pulmonary tuberculosis) 499 .. 4 7 11 72 213 154 38 237 Tuberculous Meningitis 57 8 11 20 14 3 1 .. .. 91 Other Tuberculous Diseases 61 15 11 10 6 4 10 1 4 66 Cancer, malignant disease 255 .. .. .. 2 4 42 143 64 229 Rheumatic Fever 6 .. .. .. 3 1 .. 2 .. 2 Meningitis 14 7 2 1 4 .. .. .. .. 41 Organic Heart Disease 441 1 .. 1 15 23 77 179 145 185 Bronchitis 452 49 18 11 1 2 25 158 188 133 Pneumonia (all forms) 571 113 84 67 23 19 81 107 77 330 Other diseases of respiratory organs 33 .. 3 1 .. 2 6 11 10 18 Diarrhoea and Enteritis 260 192 43 9 3 .. 3 4 6 213 Appendicitis and Typhlitis 131 .. .. 3 3 3 1 2 1 47 Cirrhosis of Liver 22 .. .. ..... .. .. 5 13 4 15 Alcoholism 8 .. .. .. .. .. 6 2 .. 2 Nephritis and Bright's Disease 117 .. 1 .. 3 5 24 55 28 64 Puerperal Fever 6 .. .. .. .. 3 3 .. .. 16 Other accidents and diseases of Pregnancy and Parturition 24 15 .. .. .. 2 7 .. .. 10 Congenital Debility and Malformation, including Premature Birth 318 318 .. .. .. .. .. .. .. 145 Violent Deaths, excluding Suicide 228 22 5 19 30 14 47 54 37 199 Suicide 20 .. .. .. .. 1 10 6 3 8 Other Defined Diseases 757 46 15 13 29 36 60 178 380 545 Diseases ill-defined or unknown 71 13 17 6 7 4 4 10 10 14 Totals .. 4,527 861 310 246 180 200 631 1092 1007 2759 Sub-entries included in above figures Cerebro-spinal meningitis 14 7 2 1 4 .. .. .. .. 25 Poliomyelitis .. .. .. .. .. .. .. .. .. 1 Typhus Fever 2 ..... .. .. .. .. .. 2 .. 1 53 TABLE IV.—Infant Mortality. 1915. LIMEHOUSE DIVISION. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause or 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 40 5 4 2 51 38 44 41 41 215 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 2 4 7 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. 1 2 3 Diphtheria and Croup .. .. .. .. .. .. .. 1 1 2 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. 1 1 1 4 Abdominal Tuberculosis .. .. .. .. .. .. 1 1 1 3 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. 1 2 .. .. 3 Convulsions 3 2 .. .. 5 5 4 2 .. 16 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 1 2 4 6 3 6 21 Pneumonia (all forms) 1 .. .. .. 1 1 5 5 11 23 Diarrhoea .. .. .. .. .. 8 16 21 12 57 Enteritis .. .. .. .. .. .. 1 .. .. 1 Gastritis .. .. .. .. .. .. .. 1 .. 1 Syphilis .. .. .. .. .. 2 .. .. .. 2 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. 1 1 .. .. 2 Injury at Birth 4 .. .. .. 4 .. .. .. .. 4 Atelectasis 4 .. .. .. 4 .. .. .. .. 4 Congenital Malformations 2 .. .. .. 2 2 .. .. .. 4 Premature Birth 22 2 2 1 27 3 .. .. .. 30 Atrophy, Debility and Marasmus 4 1 1 .. 6 9 5 2 2 24 Other causes .. .. .. .. .. 1 1 1 1 4 Cerehro Spinal Meningitis .. .. .. .. .. .. .. .. .. Totals 40 5 4 2 51 38 44 41 41 215 Nett Births in the year legitimate, 1,641 illegitimate, 26 Nett Deaths in the year of legitimate infants, 213 illegitimate infante, 2 (4) 54 TABLE IV.—Infant Mortality. 1915. 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 23 7 8 5 43 27 48 30 35 183 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. 1 .. 3 3 7 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 .. 3 2 6 Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Erysipelas .. .. .. .. .. .. 1 .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. 1 1 .. 2 Abdominal Tuberculosis .. .. .. .. .. .. 1 1 1 3 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. 1 1 .. .. 2 Convulsions .. .. .. .. .. 2 2 2 .. 6 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. .. 1 2 .. 4 .. 3 9 Pneumonia (all forms) .. 2 1 .. 3 2 3 2 10 20 Diarrhœa .. 1 1 .. 2 4 12 8 10 36 Enteritis .. .. .. .. .. 3 1 1 .. 5 Gastritis .. .. .. .. .. 1 .. .. .. 1 Syphilis .. .. .. .. .. .. 4 .. .. 4 Rickets .. .. .. .. .. .. .. .. 1 1 Suffocation, overlying .. .. .. 1 1 1 .. .. .. 2 Injury at Birth 3 .. .. .. 3 .. .. .. .. 3 Atelectasis 3 .. 1 1 5 .. .. .. .. 5 Congenital Malformations 2 1 .. .. 3 1 .. 1 .. 5 Premature Birth 14 1 4 1 20 l .. .. .. 21 Atrophy, Debility and Marasmus .. 1 1 1 3 7 17 8 3 38 Other causes .. 1 .. .. 1 2 1 .. 1 5 Cerebro Spinal Meningitis .. .. .. .. .. .. .. .. .. .. Totals 23 7 8 5 43 27 48 30 35 183 Nett Births in the year legitimate, 1,322 illegitimate, 22 Nett Deaths in the year of legitimate infants, 179 illegitimate infants, 4 (5) 55 TABLE IV.—Infant Mortality. 1915. MILE END DIVISION. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause or 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 58 16 14 12 100 56 68 50 53 327 Uncertified Small-pox • • • • • • • • • • • • • • • • • • • • Chicken-pox • • • • • • • • • • • • • • • • • • • • Measles • • • • • • • • • • • • 1 4 4 9 Scarlet Fever • • • • • • • • • • • • • • • • 2 2 Whooping Cough • • • • • • • • • • 2 1 2 4 9 Diphtheria and Croup • • • • • • • • • • 1 • • 1 2 4 Erysipelas • • • • • • • • • • • • • • • • 1 1 Tuberculous Meningitis • • • • • • • • • • • • 2 • • • • 2 Abdominal Tuberculosis • • • • • • • • • • 1 2 2 • • 5 Other Tuberculous Diseases • • • • • • • • • • • • 1 • • • • 1 Meningitis (not Tubertulous) • • 1 • • • • 1 • • • • 1 • • 2 Convulsions 4 1 • • 1 6 6 2 7 1 22 Laryngitis • • • • • • • • • • • • • • • • • • • • Bronchitis • • • • 2 l 3 3 2 5 2 15 Pneumonia (all forms) • • • • 1 • • 1 3 14 10 15 43 Diarrhoea • • • • 2 1 3 11 29 11 13 67 Enteritis • • • • 1 • • 1 • • 1 • • • • 2 Gastritis • • • • • • • • • • • • 1 • • • • 1 Syphilis • • 1 • • 1 2 3 • • • • • • 6 Rickets • • • • • • • • • • • • • • • • • • • • Suffocation, overlying 1 1 • • • • 2 6 • • • • • • 8 Injury at Birth 7 • • • • • • 7 • • • • • • • • 7 Atelectasis 7 1 • • • • 11 • • • • • • • • 11 Congenital Malformations • • 1 • • l 2 2 2 • • 1 7 Premature Birth 31 5 3 • • 41 3 • • • • • • 44 Atrophy, Debility and Marasmus 7 4 5 l 17 11 9 • • 3 44 Other causes 1 1 • • l 3 2 • • • • 3 10 Cerebro Spinal Meningitis • • • • • • • • • • 2 1 • • 2 5 Totals 58 16 14 12 100 56 68 50 53 327 Nett Births in the year legitimate, 3,006 illegitimate, 46 Nett Deaths in the year of legitimate infants, 316 illegitimate infants, 11 (6) 56 TABLE IV.—Infant Mortality. 1915. WHITECHAPEL DIVISION. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause or Death. Under 1 Week. 1-2 Weeks. / 2-3 Weeks. 8-4 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 31 4 2 6 43 23 26 24 20 136 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 1 2 Scarlet Fever .. .. .. .. .. 1 .. 1 .. 2 Whooping Cough. . .. .. .. .. .. 1 1 .. 1 3 Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. .. .. .. .. 2 .. 2 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. 1 1 .. .. 2 Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. 1 2 3 Convulsions 3 1 .. .. 4 2 3 ..2 11 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 .. 1 1 1 .. 1 4 Pneumonia (all forms) .. .. .. .. .. 3 8 9 7 27 Diarrhœa .. .... .. 1 1 8 4 4 .. 21 Enteritis .. .. .. .. .. .. .. .. .. .. Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. 1 2 3 .. .. .. .. .. Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 4 1 .. .. 5 .. .. .. .. 5 Congenital Malformations .. 1 .. .. 1 .. .. .. .. 2 Premature Birth 21 .. .. 2 23 .. .. .. .. 23 Atrophy, Debility and Marasmus 2 1 .. 1 4 .. 5 .. 2 19 Other causes .. .. .. .. .. 2 .. .. 9 Cerebro Spinal Meningitis .. .. .. .. .. .. 1 .. 1 2 Totals 31 4 2 6 43 23 26 24 20 136 Nett Births in the year legitimate, 1,375 illegitimate, 08 Nett Deaths in the year of legitimate infants, 125 illegitimate infants, 11 (7) 57 TABLE IV.—Infant Mortality. 1915. 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 152 32 28 25 237 144 186 145 149 861 Uncertified Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. 1 2 10 12 25 Scarlet Fever .. .. .. .. .. 1 .. 1 2 4 Whooping Cough .. .. .. .. .. 4 2 6 9 21 Diphtheria and Croup .. .. .. .. .. 1 .. 3 4 8 Erysipelas .. .. .. .. .. .. 1 2 1 4 Tuberculous Meningitis .. .. .. .. .. 1 4 2 1 8 Abdominal Tuberculosis .. .. .. .. .. 2 5 4 2 13 Other Tuberculous Diseases .. .. .. .. .. .. 1 .. 1 2 Meningitis (not Tuberculous ) .. 1 .. .. 1 2 3 2 2 10 Convulsions 10 4 .. 1 15 15 11 13 1 55 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. 4 3 8 8 13 8 12 49 Pneumonia (all forms) 1 2 2 .. 5 9 30 26 43 113 Diarrhœa .. 1 3 2 6 31 61 44 39 181 Enteritis .. .. 1 .. 1 3 3 1 .. 8 Gastritis .. .. .. .... .. 1 1 1 .. 3 Syphilis .. .. .. .. 2 5 4 1 .. 12 Rickets .. .. .. .. .. .. .. .. 1 1 Suffocation, overlying 1 .. .. 6 8 1 .. . ... 15 Injury at Birth ..15 .. .. .. 15 .. .. .. .. 15 Atelectasis 18 2 .. .. 25 .. .. .. .. 25 Congenital Malformations 4 3 .. 1 8 6 2 1 .. 18 Premature Birth 88 8 .. .. 111 7 .. .. .. 118 Atrophy, Debility and Marasmus 13 7 .. .. 30 32 36 17 10 125 Other causes 1 2 .. 1 4 5 4 3 5 21 Cerebro Spinal Meningitis .. .. .. .. .. 2 2 .. 3 7 Totals 152 32 28 25 237 144 186 145 149 861 Nett Births in the year legitimate, 7,344 illegitimate, 162 Nett Deaths in the year of legitimate infants, 833 illegitimate infants, 28 (8) 59 INDEX. A PAGE Alcoholism 28 Analyst's Report 41 Articles of Bedding disinfected or destroyed 29 & 30 B Bacteriological Examinations 11 Births 3, 4 & 5 C Cancer 29 Cerebro-Spinal Fever 17 Chicken Pox 18 Consumption 21 Cowhouses, Inspection of 39 D Dairies and Milkshop, Inspection of 39 Deaths 5 to 8 Diarrhoea 19 & 20 Diphtheria and Membraneous Croup 11 Disinfection of rooms 29 E Enteric Fever 16 Erysipelas 17 F Factory and Workshops Acts 35 Food, Preparation of 40 G General Sanitary Work 33 & 34 60 H PAGE Health Visitors, Report on the work of 23 to 27 Houses-let-in-Lodgings 39 House to House inspections 40 Housing and Town Planning Act, 1909 39 I Ice Cream Premises 39 Illegitimate Children, death of 27 Infantile Mortality 23 to 27 Inhabited House Duty 29 Inquests, number and cause of death 8&9 M Marriages 5 Maternity and Infant Welfare 23 to 27 Measles 18 & 19 Military clothing disinfected 29 Mortuary and Coroner's Court 31 N Notifiable Diseases 10 Offensive Trades 39 Old Age 28 Ophthalmia Neonatorum 17 Outworkers 37 Overcrowding 34 & 39 P Phthisis, number of notifications and deaths 20 to 23 Poliomyelitis 17 Population 1 to 3 Public Analyst's Report 41 Puerperal Fever 17 R Respiratory Diseases 20 61 s PAGE Sanitary Inspector's Report * between 34 & 35 Scabies 29 Scarlet Fever 11 Slaughter-Houses, Inspection of 39 Small Pox 11 Statistics of the Borough during 1915 51 to 57 Summer Diarrhoea 19 & 20 T Tuberculosis 20 to 22 Typhus Fever 12 to 16 U Underground Rooms 39 Unsound Food destroyed 31 to 33 Y Verminous Persons, Cleansing of 29 Vital Statistics of the whole Borough during 1915 and previous years 51 W Whooping Cough 19 Wrong Diagnosis10 Z Zymotic Diseases 18