STE 17 ANNUAL REPORT OF THE Medical Officer of Health and Public Analyst FOR THE Metropolitan Borough of Stepney. 1917. REPORT OP THE MEDICAL OFFICER OF HEALTH AND PUBLIC ANALYST FOR THE YEAR 1917. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have much pleasure in submitting to you my seventeenth Annual Report, which deals with the Vital and Sanitary Statistics of the Borough of Stepney for the year 1917. Population. The estimated population for the calculation of the death-rate is 232,010, and for the birth-rate 258,626. The former is an estimate of the civilian population; the latter of the total population based on the assumption that the ratio between the total and the civilian population is the same in the Borough, as in England and Wales. Births. The total number of births during the year was 5,625, or 1,496 less than in the previous year. 2,836 were males and 2,789 were females. The birth-rate was 21·7 per 1,000 of the population. The birth-rate, although the lowest on record, is yet above that of London as a whole which was 17·5 per 1,000 in 1917. It may be of interest to give the figures in the Borough of Stepney for the last few years:— In 1912 the births were 8,579 and the birth-rate was 30·9 per 1,000. In 1913 the births were 8,165 and the birth-rate was 29·6 per 1,000. In 1914 the births were 7,983 and the birth-rate was 29·2 per 1,000. In 1915 the births were 7,506 and the birth-rate was 28·2 per 1,000. In 1916 the births were 7,121 and the birth-rate was 25·3 per 1,000. In 1917 the births were 5,625 and the birth-rate was 21·7 per 1,000. A 2 Deaths. After deducting the deaths of non-residents who died in the Borough, and adding those of residents who died in outlying institutions, the total number was 3,908—2,225 males, and 1,683 females, or 113 more than in the previous year. The death-rate was 16·8 per 1,000, while that of London was 15 per 1,000 of the population. Notifiable Diseases. 5,991 notifications were received; this number includes 1,304 notifications of diseases of a tubercular nature. 1,622 were removed to various fever hospitals and infirmaries. In addition to the above, 8 soldiers and 1 naval man were notified to be suffering from Infectious Diseases, viz.:—1 from Scarlet Fever, 1 from Enteric Fever, 6 from Diphtheria, and 1 from Erysipelas. 1,109 notified cases belonged to Limehouse. 1,039 notified cases belonged to St. George's. 2,210 notified cases belonged to Mile End. 1,633 notified cases belonged to Whitechapel. Wrong Diagnosis. 125 cases of Infectious Disease were removed to 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. 44 of the cases were notified by private practitioners, 70 from the London Hospital, and 11 from other Public Institutions. This number referred to 38 cases of Scarlet Fever, 78 of Diphtheria, 7 of Enteric Fever, 1 of Cerebro-spinal Meningitis, and 1 of Continued Fever. Scarlet Fever. 356 cases were notified during the year, or 305 less than in the previous year; 354 were removed to Fever Hospitals. The death-rate was ·02 per 1,000, and that for the whole of London was also ·02 per 1,000. Diphtheria and Membranous Croup. 630 cases were notified, or 220 less than in the previous year; 629 were removed to Fever Hospitals. The death-rate for the whole Borough was ·25 per 1,000, while that of the whole of London was ·14 per 1,000 of the population. 3 Enteric Fever. 38 cases were notified during the year, or 6 more than in the previous year. 11 occurred in the Limehouse District, with 2 deaths; 5 occurred in St. George-in-the-East, with no deaths; 18 occurred in Mile End Old Town, with one death; 4 occurred in the Whitechapel District, with no deaths. The death-rate was ·01 per 1,000; the death-rate for the whole of London was ·02 per 1,000. Puerperal Fever. 16 cases were notified, or 6 more than in the previous year; 7 proved fatal. Erysipelas. 193 cases were notified, or 51 less than in the previous year; 6 died, three deaths being those of children under one year of age. Ophthalmia Neonatorum. 31 cases were notified, or 11 less than in the previous year. 11 occurred in the Limehouse District, 5 in St. George's, 13 in Mile End, and 2 in the Whitechapel District. Poliomyelitis. 4 cases were notified, or 8 less than in the previous year. Cerebro-Spinal Fever. 14 cases were notified, or 20 less than in the previous year. 6 occurred in the Limehouse District, 3 in St. George's, 4 in Mile End, and 1 in the Whitechapel District. Measles. 3,403 cases were notified during the year, or 1,148 more than in the previous year. 2,125 were children under 5 years of age, and 188 of these were under 1 year of age. 593 occurred in the Limehouse District, with 44 deaths. 575 occurred in St. George-in-the-East, with 19 deaths. 1,228 occurred in Mile End Old Town, with 17 deaths. 1,007 occurred in the Whitechapel District, with 23 deaths. The death-rate of the whole Borough was ·44 per 1,000, while that for the whole of London was ·48 per 1,000 of the population. ∆ 2 4 The deaths from Measles are still high, and have been for several years. In 1906 the number was 171. In 1907 the number was 155. In 1908 the number was 264. In 1909 the number was 236. In 1910 the number was 93. In 1911 the number was 291. In 1912 the number was 172. In 1913 the number was 95. In 1914 the number was 174. In 1915 the number was 113. In 1916 the number was 63. In 1917 the number was 103. Whooping Cough. The number of deaths from Whooping Cough was 30, or 39 less than in the previous year. 15 belonged to the Limehouse District; 3 to St. George's; 8 to Mile End; and 4 to the Whitechapel District. The death-rate was ·12 per 1,000, while that for the whole of London was ·13 per 1,000. Summer Diarrhœa. The number of deaths was 167, or 7 less than in the previous year. 118 were those of children under one year of age; 55 belonged to the Limehouse District; 46 to St. George's; 49 to Mile End; and 17 to the Whitechapel District. The death-rate for the whole Borough was ·68 per 1,000 of the population. Zymotic Diseases. The total deaths from diseases of a Zymotic character numbered 376, or 36 more than in the previous year. It includes deaths from Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, Puerperal Fever and Diarrhoea. 137 belonged to the Limehouse District; 79 to St. George's; 103 to Mile End Old Town; and 57 to the Whitechapel District. The number of deaths from these diseases is greater in the Limehouse District than in any other part of the Borough, and it is accounted for partly by the fact that Whooping Cough was more prevalent, and that Measles was apparently more fatal 5 than in the rest of the Districts. For instance, the number notified in St. George's was nearly the same, but the deaths from Measles were more then twice the number in the Limehouse District than in St. George's. In Mile End the number of children notified to be suffering from Measles was more than twice that in Limehouse, but the number of deaths was nearly three times as much in the latter district than in Mile End. The same remark applies to Diphtheria, although not to the same extent, the fatality of the disease was greater in the Limehouse District than in the rest of the Borough. Phthisis. 1,069 new cases were notified, or 108 more than in the previous year:— Notifications. Deaths. Limehouse 199 108 St. George's 206 82 Mile End Old Town 406 162 Whitechapel 258 155 Number of deaths from Consumption from 1901 to 1917:— Limehouse District. St. George's. Mile End. Whitechapel. Whole Borough. 1901 123 186 107 208 626 1902 130 105 168 173 576 1903 123 122 189 193 627 1904 143 119 229 198 689 1905 98 117 171 187 573 1906 116 94 178 138 526 1907 98 90 141 153 482 1908 98 79 154 103 494 1909 93 102 146 180 521 1910 74 80 146 110 410 1911 109 69 177 126 481 1912 74 77 149 133 433 1913 98 55 137 140 430 1914 90 53 162 149 454 1915 118 74 176 131 499 1916 95 69 146 165 475 1917 108 82 162 154 507 Other Forms of Tuberculosis. 235 new cases were notified, or 25 less than in the previous year:— Notifications. Deaths. Limehouse 67 23 St. George's 56 26 Mile End Old Town 73 39 Whitechapel 39 25 6 Deaths from Diseases of a Tubercular nature, other than Phthisis, from 1901 to 1917:— 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 1916 21 21 28 19 89 1917 23 26 39 25 113 Diseases of the Respiratory Organs. There were 872 deaths due to diseases of the respiratory organs or 76 more than in the previous year; 186 belonged to the Limehouse District, 155 to St. George's, 298 to Mile End and 233 to the Whitechapel District. Infantile Mortality. 580 infants died under one year of age or 76 less than in the previous year. 149 belonged to the Limehouse District, or at the rate of 118 per 1,000 births. 139 belonged to the St. George's District, or at the rate of 139 per 1,000 births. 200 belonged to the Mile End Old Town, or at the rate of 85 per 1 ,000 births. 92 belonged to the Whitechapel District, or at the rate of 90 per 1,000 births. The infantile mortality for the whole Borough was 103 per 1,000 births, while that for the whole of London was 103 per 1,000 births. This is the lowest infantle mortality for the Borough of Stepney, and it is the first time that is has been as low as that for London as the whole. 7 During the year 1917, considerable progress has been made with regard to the work done in connection with Infant Welfare. This is due to the appointment of two additional Municipal Health Visitors in the early part of the year, and also to the increased activities of the various Infant Welfare Agencies working in the Borough. Except where it is obviously unnecessary, all births are visited on the tenth day, or as soon after as possible, and the mother is advised to attend a Welfare Centre. Birth Cards for these infants are then sent to six of the nine Societies for the purpose of subsequent visiting. If mothers fail to attend the Infant Welfare Centres, the birth cards are returned for supervision and subsequent visiting by the Municipal Health Visitor. Monthly, weekly or even daily visits are paid where urgently necessary. Uniformity of method in the distribution of cards is maintained and records are kept. A notable step forward is the interest taken by various Societies in Antenatal Welfare Work; classes and clinics for this purpose have been opened at most of the Centres. It is interesting to note that in spite of trying conditions and increased strain, etc., during the past year, breast feeding has been fairly well maintained, and though supplementary feeding with Nestle's Milk and other artificial foods has been resorted to, often at an early date, natural feeding has fortunately, not been entirely given up. Visits for 1917 by Health Visitors. Limehouse— Births 821 Revisits 2,127 Total 2,948 Mile End— Births 2,022 Revisits 771 Total 2,793 8 Whitechapel— Births 1,040 Revisits 875 Total 1,915 (9 months) St. George's— Births 1,241 Revisits 579 Total 1,820 (8 months) Total Births 5,124 Total Revisits 4,352 Total 9,476 Unsound Food Destroyed during the Year. The following foodstuffs were condemned under the Unsound Food Series and the Public Health (Foreign Meat) Regulations, 1908, as unfit for human consumption, but were utilised for trade purposes. I.—At the Wharves. Tons. cwts. qrs. lbs. Meat 3,650 Bales of Bacon 365 0 0 0 Preserved Meats 55,673 Tins of Beef 49 3 0 3 2,588 „ Mutton 6 18 3 8 9,616 „ Rabbits 8 10 2 12 380 „ Ox Tongues - 11 2 9 Preserved Fish 22,971 Tins of Crayfish 9 5 2 16 426 „ Herrings — 1 3 17 33,023 „ Salmon 16 18 3 17 100 „ Sardines — - - 25 Fresh Fruit and Vegetables 6,490 Crates of Bananas 188 7 0 0 16 Cases of Onions 1 0 0 0 Potatoes 361 10 1 0 58 Bundles of Tomatoes 2 9 0 0 Preserved Fruits and Vegetables 1,770 Tins of Assorted Fruits 1 19 2 24 5,192 „ Fruit Pulp 19 3 2 0 74,526 „ Pineapples 56 19 0 20 5,054 „ Tomatoes 12 1 3 2 Dried Fruits 1,948 Bags of Figs 46 5 0 0 Carried forward 1,146 6 0 13 9 Unsound Pood Destroyed during the Year— continued. I.—At the Wharves. Tons. cwts. qrs. lbs. Brought forward 1,146 6 0 13 Sundries 9,870 Tins of Assorted Canned Goods 8 16 1 26 1,029 Cheeses 5 6 3 2 21 Bags of Cocoa (in bean) 1 8 0 12 770 „ „ Powder 48 1 3 0 25 Boxes of Dessicated Cocoanut 1 9 0 2 176 Tins of Chicken — 3 0 16 136 Bags of Quaker Oats 6 5 3 0 41 Tins of Soup — — 1 13 39 Bags of Rice 3 18 0 0 Total 1,221 15 2 0 II.—Diseased Meat and Offal destroyed, from the Slaughter-houses and Offal Dealers:— Tons. cwts. qrs. lbs. 66 Sheep's Carcases and Organs 1 6 1 17 37 Calves „ „ 1 7 1 8 5 Forequarters of Mutton - - 2 18 2 „ Veal - - — 26 2 „ Beef - 2 1 18 1 Hindquarter of Veal - - 1 2 31 Bullocks' Heads - 7 2 6 22 Cows' Udders - 2 1 19 309 Sets of Sheep's Lungs - 6 1 11 161 „ Bullocks' „ - 13 3 24 12 „ Calves' „ - - 1 17 296 Sheep's Livers - 6 2 9 18 Bullocks' „ - 2 3 5 15 Calves' „ - - 1 20 Total 4 17 3 4 General Sanitary Work. 36,036 houses were inspected, 2,758 being the result of house to house inspections. 8,076 intimation notices were served for the abatement of various nuisances as well as 4,221 statutory notices. It was necessary to take police court proceedings against the owners or persons causing the nuisance in 19 cases. 39,169 revisits were made by the Inspectors to supervise the abatement of the nuisances complained of. 4,218 drains were tested with smoke or water, and 209 were re-tested; 1,321 drains were either constructed or re-constructed, cleansed or repaired, and 293 were trapped. 10 100 new soil pipes were fixed and ventilated; 505 new closet pans and traps were fixed; 1,419 closets were either cleansed or repaired or provided with additional light and ventilation; 1,241 water-closets were provided with proper flushing apparatus. 987 yards, forecourts and areas were paved or repaired. Notices were served to provide 782 sanitary dust receptacles, and 12 manure receptacles; 589 offensive accumulations were removed from the rear of dwelling houses. 74 houses were ventilated under the lower floor. 17 underground rooms, which were illegally occupied, were discontinued from being used as such. 23 notices were served for the abatement of smoke nuisances. 329 visits were made to bakehouses. 2,858 notices were served to have houses cleansed; water supply was reinstated to 110 houses. 156 sink, bath or rain-water pipes, which were communicating directly with the drain, were disconnected. 5,735 miscellaneous repairs to roofs, floors, gutters, &c., were made as the result of notices served. 59 rooms were provided with additional light and ventilation, and the damp walls of 512 rooms were remedied. There are 741 houses registered as houses let in lodgings, and 972 visits were made under the bye-laws. Overcrozcding.—12,159 inspections were made for the purpose of detecting overcrowding. 188 rooms were found to be overcrowded. Police Court proceedings were taken in one instance. The number of registered milkshops at the end of 1917 was 456, and 1,973 visits were made to inspect the condition of the premises, milk receptacles, &c. Ice cream was manufactured at 96 premises and 212 visits were made to them. 163 verminous persons were cleansed and their clothing disinfected, and 1,280 verminous premises were dealt with during the year. Disinfection.—27,758 articles were disinfected at the Disinfecting Station during the year. 2,082 rooms were fumigated and the bedding, etc., removed to be disinfected by steam; 1,414 rooms were disinfected because of infectious diseases, 615 as a result of pulmonary tuberculosis, and 53 rooms were verminous. In addition to these, scabies occurred in 789 families and their bedding was taken away and disinfected with steam. SANITARY INSPECTORS' REPORT. WRACK. COOK. MILLS. SHEPHERD. WHITE. FLINT. STILES. TWAITS. PAVITT. CROOK. SIMPSON. JOHNSON. QUAINTRELL. WATERMAN. TOTALS. Number of InspectionsHouse to house 288 152 96 1ll 126 369 336 322 303 108 144 82 102 219 2758 Miscellaneous 1462 2556 1719 1922 1368 1941 1671 1764 1645 910 1822 1717 1149 1607 23253 Complaints 309 393 288 128 102 186 180 205 423 289 194 81 122 82 2982 Infectious diseases 250 532 570 195 312 249 293 622 393 471 371 419 226 310 5213 Visits to Oases of Consumption 86 162 98 40 184 216 210 146 102 159 108 114 89 116 1830 Intimations served 355 468 494 516 495 530 901 458 780 510 961 761 400 447 8076 Statutory notices served 127 253 462 170 267 203 388 442 558 345 678 104 49 75 4221 Houses re-visited 2487 2708 2455 2511 2378 2514 3199 3046 3193 2467 4162 3716 1370 2963 39169 Summonses taken out under the Public Health (London) Act, 1891 ... ... 4 ... 1 2 2 2 6 ... ... ... ... 2 19 Samples taken under the Food & Drugs Acts 70 73 85 66 75 82 86 100 100 99 100 72 38 77 1123 Summonses „ „ „ „ ... 3 3 5 1 4 3 2 13 8 2 4 1 7 56 Houses or parts of houses cleansed 111 241 145 220 184 225 251 175 149 105 344 268 213 227 2858 Water supply to houses re-instated 3 3 2 5 6 1 2 31 5 9 7 2 8 26 110 Drains constructed and reconstructed 16 17 5 6 4 12 4 62 14 8 7 13 21 14 203 „ cleansed and repaired 66 58 31 70 58 56 97 50 147 60 127 154 89 56 1119 „ trapped 30 58 29 5 26 16 8 75 14 6 11 5 5 5 293 New soil pipes fixed and ventilated 10 23 5 2 2 3 1 4 4 15 5 13 2 11 100 New oloset pans and traps fixed 27 52 23 20 40 21 12 80 28 40 48 64 30 20 505 Closets provided with a water supply and flushing apparatus 44 104 117 78 30 80 122 91 66 45 154 151 63 96 1241 Closets provided with light and ventilation 2 3 7 3 2 ... ... 10 4 10 ... 37 1 12 91 „ cleansed and repaired 100 107 134 50 32 70 165 41 43 100 177 133 90 86 1328 Yards cleansed, repaved, or paving repaired 35 73 36 43 38 81 41 100 82 58 97 59 82 25 850 Wash-houses, forecourts, areas, &c., paved 16 11 3 ... 25 3 ... 19 4 3 6 36 8 3 137 Sanitary dust receptacles provided 7 27 23 30 15 36 39 84 134 27 138 102 60 60 782 Sink, bath, and lavatory pipes and rain-water pipes disconnected 17 15 8 ... 2 2 ... 32 2 11 12 24 7 24 156 Houses ventilated under lower floor ... 4 ... ... 8 12 ... 36 4 1 3 ... 5 1 74 Miscellaneous repairs, viz.: roofs, floors, gutters, &c. 191 373 352 2 280 386 965 348 455 205 551 787 400 440 5735 Overcrowding in dwellings abated 4 25 12 20 22 10 51 3 4 12 11 2 8 ... 184 Illegal occupation of underground rooms discontinued ... 2 4 ... ... 3 ... 4 1 3 ... ... ... ... 17 Manure receptacles provided or reconstructed ... 3 ... 1 ... ... ... 2 1 ... 2 3 ... ... 12 Offensive accumulations removed 132 54 120 140 7 10 17 7 7 7 14 13 50 11 589 Bakehouses inspected 22 22 30 20 12 26 30 ... 10 28 24 60 ... 45 329 „ cleansed 22 22 30 20 12 26 30 ... 10 16 24 11 ... 12 235 Smoke nuisances abated 1 2 ... ... 7 2 4 3 1 ... 3 ... ... ... 23 Animals kept so as to constitute a nuisance, removed 1 17 9 8 2 3 10 2 6 4 5 ... ... 2 69 Damp walls remedied 13 15 55 6 25 16 72 49 49 33 14 81 35 49 512 Cisterns cleansed and covered 1 3 3 4 4 2 ... 1 ... 8 1 3 4 34 Urinals fixed ... 2 1 ... ... ... ... 2 ... ... 1 ... ... ... 6 Open fires in yards abolished ... 4 ... 8 ... 2 ... ... ... ... ... ... ... ... 9 Canal Boats inspected ... ... ... ... ... ... ... ... ... ... ... 43 ... ... 43 Areas and stables paved and drained ... 7 ... ... ... ... ... 2 ... ... ... 2 2 ... 13 Occupation of shed as dwelling discontinued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Light and ventilation provided to rooms ... ... ... 2 ... 2 ... 4 3 3 ... ... 6 39 59 Face page 10) 11 The Mortuary. The number of bodies deposited in the Mortuary during the year was 500, 444 being removed by the Coroner for the purpose of holding inquests. 50 post mortem examinations were made; 52 bodies were deposited in the Jewish part of the Mortuary, but 17 only were officially " watched." Factories and Workshops. The total number of workshops on the Register was 3,192; but this does not include factories, workplaces and out-workers' premises. 4,692 inspections were made to factories, workshops and workplaces, and revealed defects, which necessitated the service of 756 written notices. 46 of the notices, referred to factories, 689 to workshops including workshop laundries, and 21 to workplaces other than out-workers' premises. Cleanliness.—315 notices were served to cleanse workshops. Ventilation.—The ventilation of 16 workshops was improved. Overcrowding.—Overcrowding was abated in 15 workshops. Sanitary Accommodation.—The sanitary accommodation was improved in 152 workshops by providing additional and suitable water-closets. 65 other nuisances were remedied in workshops. Table showing the number of milk premises, ice cream premises, etc., together with the number of inspections made to them. PREMISES. NUMBER OF PLACES. Numbei of inspections. Numbei of notices Number ot prosecutions. No. on register at end of 1916. No. added in 1917. No. removed in 1917. No. on register at end of 1917. Milk premises 477 8 29 456 1,793 67 ... Cowsheds 28 ... ... 28 65 2 ... Slaughter houses 4 ... ... 4 13 ... ... Other offensive trade premises 6 ... ... 6 24 2 ... Ice cream premises 144 ... 48 96 212 19 ... Registered houses let in lodgings 761 20 741 972 (a) 60 (a)... (6)423 (b)... (a) For overcrowding. (b) For other conditions. 12 Total number of Intimations served for all purposes 8,076 Overcrowding— Number of Inspections 12,159 Number of dwelling rooms overcrowded 188 Number of Notices served (Intimations) 190 (Statutory Notices) 72 Number remedied 188 Number of Prosecutions 1 Underground Rooms— Illegal occupation dealt with during the year 16 Number of rooms closed 8 Insanitary Houses— Number closed under the Public Health (London) Act, 1891 — Number closed under the Housing and Town Planning Act — London County Council (General Powers) Act, 1903—Part 8.— Number of Prosecutions for breach of bye-laws as to conveyance of dead horses through the street — London County Council (General Powers) Act, 1904.— Number of verminous rooms cleansed (Section 20) 1,280 Number of filthy articles purified (Section 19) 67 Number of sanitary conveniences altered (Section 22) — Number of sanitary conveniences removed (Section 22) — Number of fixed ashpits removed (Section 23) 2 London County Council (General Powers) Act, 1907.— Number of tenement houses dealt with as regards water supply (Section 73) — Shelters provided under Section 60 (4) of the Public Health (London) Act, 1891 — Number of persons accommodated during the year — Places where food is prepared for sale— Number on Register 429 Number of Inspections 1,477 Number of Notices served (Intimations) 89 (Statutory Notices) 22 Revenue Acts— Number of houses for which applications were received during the year 1 Number of tenements comprised therein 9 Number of tenements for which, certificates were granted 9 13 Number of Prosecutions under Bye-laws under Public Health (London) Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. - (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc - (c) For the prevention of keeping animals in such a manner as to be injurious to health - (d) As to paving of yards, etc., of dwelling houses - (e) In connection with the removal of offensive matter, etc 3 (f) 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. - (i) With respect to sufficiency of water supply to water closets - (j) With respcct to drainage, etc. (Metropolis Management Act, Section 202) - (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendments (Bye-laws) Act, 1899 - House to House— Inspections 2,858 Defects 1,952 Intimations 930 Statutory Notices 733 Mortuaries— Total number of bodies removed 500 Total number of infectious bodies removed - TOTAL FINES AND COSTS. Fines. Costs. £ s. d. £ s. d. Under the Public Health (London) Act for various nuisances 25 6 0 20 11 0 Margarine Act 91 19 0 9 11 0 For Obstruction 20 0 0 — London County Council (General Powers) Act, 1904 2 0 0 1 1 0 London County Council (General Powers) Act, 1908 1 0 0 1 0 0 Food and Drugs Act 185 2 0 32 15 0 Total 325 7 0 64 18 0 14 FACTORIES, WORKSHOPS, LAUNDRIES AND WORKPLACES. 1.—INSPECTIONS. Premises. Inspections. Number of Written Notices. Prosecutions. (1) (2) (3) (4) Factories 1,050 46 .. (Including Factory Laundries) Workshops 3,678 689 .. (Including Workshop Laundries) Workplaces (Other than Outworkers' premises) 1.10 .21 •• Totals 4,692 756 •• 2.-DEFECTS FOUND. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuitances under the Public Health Acts:—* Want of cleanliness 315 315 .. .. Want of ventilation 16 16 .. .. Overcrowding 15 15 .. .. Want of drainage of floors .. .. .. .. Other nuisances 50 50 .. .. Sanitary Accommodation insufficient 112 112 .. .. unsuitable or defective 143 143 .. .. not separate for sexes 12 12 .. .. Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (S. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 42 42 .. • • Other offences 63 63 .. .. (Excluding offences relating to outwork which are included in Part 3 of this report.) Totals 768 768 •• * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Art, 1001, as, remediable under the Public Health Acts. 3.—HOME WORK. NATURE OF WORK. Outworkers' Lists. Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists Received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the Year. Once in the Year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) Making. &c. 94 230 1,058 29 7 66 .. .. .. 237 237 .. 73 .. .. (2) Cleaning and Washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Household linen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Curtains and furniture hangings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery 1 .. 2 .. .. .. .. .. .. 1 1 .. .. .. .. Electro plate .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. File making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur pulling (furriers) 1 .. 1 .. .. .. .. .. .. .. .. .. 2 .. .. Cables and chains .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Artificial flowers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. Sacks .. .. .. .. .. .. .. .. .. .. .. .. .. .. Racquet and tennis balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper, etc., boxes, paper bags 8 .. .. 1 .. 17 .. .. .. 6 6 .. 2 .. .. Brush making .. .. .. 1 .. 1 .. .. .. 1 1 .. 1 .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Stuffed toys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chocolates and sweetmeats .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cosaques, Christmas crackers, .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Christmas stockings, &c. Textile weaving .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 105 230 1,123 31 7 84 .. .. .. 245 245 •• 78 .. .. 15 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 151) at the end of the year 1917. Number. (1) (2) Bakehouses 168 Boot, Shoe and Slipper Making 152 Cabinet Making 95 Furriers 124 Hat and Cap Manufacturers 89 Miscellaneous 460 Laundries 14 Rag Sorting, etc. 73 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) 2,017 Total 3,192 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:- Failure to affix Abstract of the Factory and Workshop Acts (S. 133, 1901) 8 Underground Bakehouses (S. 101):— Certificates granted during the year In use at the end of the year 56 Public Analyst's Annual Report. During the year 1,123 samples were submitted by the Inspectors of the Department for examination under the Sale of Food and Drugs Acts, consisting of:— 739 Milks, 1 Skimmed Milk, 188 Butters, 1 Milk-blended Butter, 20 Margarines 4 Cheeses, 3 Lards, 18 Cocoas, 1 Cocoa Essence, 31 Coffees, 1 Chicory, 12 Mustards, 41 Peppers, 12 Vinegars, 1 Ground Ginger, 3 Baking Powders, 7 Flours, 1 Oatmeal, 28 Jams, 1 Saffron, 2 Aspirin Tablets, 1 Camphorated Oil, 3 Seidlitz Powders, 4 Soda Mints. 120 Samples or 10-6 per cent, were found to be adulterated. These consist of :— 92 Milks, 14 Butters, 2 Coffees, 1 Mustard, 6 Vinegars, 2 Aspirin Tablets, 2 Seidlitz, Powders, 1 Soda Mint. 16 Proceedings were taken in 46 cases. Total fines secured on the prosecutions £185 2s. Total costs allowed £32 15s. The average fine on the prosecutions was £4 0s. 6d. There were in addition 9 prosecutions for infringements of the Margarine Acts, resulting in £91 19s. fines, and £9 l1s. costs. Sunday Samples. 106 Samples were taken on 17 Sundays, 98 Milks and 8 Butters. Of these 15 Milks and 3 Butters, or 17.0 per cent. were adulterated, and 7 prosecutions resulted. Unofficial Samples. 242 Samples purchased informally by the Inspectors were examined, consisting of:—17 Milks, 202 Butters, 1 Margarine, 1 Pepper, 6 Breads, 3 Flours, 1 Tea, 7 Soda Mints, 4 Seidlitz Powders. Of these 74 Samples, or 30.6 per cent., were adulterated, consisting of:—6 Milks, 61 Butters, 4 Soda Mints, 3 Seidlitz Powders. 5 Samples of Butter were examined for the general Public and found genuine. Preservatives. All Samples of Milk and Butter were tested for Preservatives. 1 Sample of Milk contained Formalin and 18 Samples of Butter contained small quantities of Boron preservative. 1 Milk was artificially coloured. Food Orders. The following Samples were submitted under the various Food Orders:1 Bun, 3 Scones, 15 Cakes, 2 Biscuits, 1 Pastry, 2 Teas. There were 13 contraventions. In addition to the samples already enumerated, 37 miscellaneous Samples were examined for the Public Health Department. The amount of adulteration of official Samples in the various District was as follows :— District. Samples Examined. Per cent.of Adulteration. Whitechapel 294 11.2 St. George's 243 7.0 Limehouse 187 13.4 Mile End 399 11.3 17 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, obstruction, &c., and offences under the Margarine Acts. No of Cases. Fines. Costs. £ s. d. £ s. d. £ s. d. £ s. d. J.W. Johnson 72 5 4 5 1 0 2 2 0 ... ... ... H. Ouaintrell 38 6 1 ... ... ... ... R. H. Waterman 77 14 7 3 0 0 5 9 0 ... ... ... J. Twaits 100 5 1 ... ... 1 ... 1 3 0 G. O. Pavitt 100 18 10 115 1 0 5 5 0 3 43 0 0 1 1 0 E. T. Crook 99 15 8 15 0 0 7 7 0 ... • • • • • • R. Simpson 100 8 2 2 0 0 1 1 0 ... ... ... A. W. Stiles 86 7 3 ... 1 1 0 ... ... ... J.White 75 4 1 20 0 0 1 1 0 ... ... ... E. W. Flint 82 6 3 6 0 0 2 2 0 1 1 0 0 1 1 0 T. P. Wrack 70 2 0 ... ... ... • • • ... H.Mills 85 8 1 5 0 0 1 1 0 2 55 0 0 2 2 0 A. Cook 73 12 2 7 0 0 3 3 0 1 5 0 0 2 2 0 W. Shepherd 66 10 3 7 0 0 3 3 0 2 7 19 0 2 2 0 Total 1,123 120 46 185 2 0 32 15 0 10 111 19 0 9 11 0 18 Infant Mortality. 1917. 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 116 21 22 17 176 97 124 91 92 580 Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 2 4 14 Scarlet Fever .. .. .. .. .. .. .. 1 .. 1 Whooping Cough .. .. .. .. .. 1 2 .. 3 9 Diptheria and Croup .. .. .. .. .. .. 3 1 5 9 Erysipelas .. .. .. 1 1 1 1 .. .. 3 Tuberculous Meningitis .. .. .. .. .. .. 2 4 4 10 Abdominal Tuberculosis .. .. .. .. .. .. .. .. 1 1 Other Tuberculous Diseases 1 .. .. .. 1 .. 3 .. 5 9 Meningitis (not Tuberculous ) .. .. .. .. .. .. 1 2 1 4 Convulsions 6 3 .. .. .. 9 9 5 3 37 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 3 .. 4 15 7 1 1 28 Pneumonia (all forms) 2 1 .. .. 3 2 12 24 23 64 Diarrhoea 1 1 3 1 6 21 35 33 23 118 Enteritis .. .. .. .. .. .. .. .. .. .. Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. 2 1 3 6 5 .. .. 14 Rickets .. .. .. .. .. .. 2 .. .. 2 Suffocation, overlying 2 1 .. .. 5 6 3 1 1 16 Injury at Birth 14 .. .. .. 14 .. .. .. .. 14 Atelectasis 15 1 2 1 19 1 .. .. .. 20 Congenital Malformations 7 .. 1 .. 8 4 1 .. .. 13 Premature Birth 60 7 5 5 77 .. .. .. .. 77 Atrophy, Debility and Marasmus 6 3 6 2 17 29 29 11 5 91 Other causes 2 3 .. 2 7 2 5 1 9 24 Ant. Poliomyelitis .. .. .. .. .. .. 1 .. .. 1 Cerebro Spinal Meningitis .. .. .. .. .. .. 1 .. .. 1 Totals 116 21 22 17 176 97 124 91 92 580 19 Cases of Infectious Disease notified during the Year 1917. Metropolitan Borough of Stepney. Notifiable Disease. Number of Cases notified. Total Cases notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. 1. 2. 3. 4. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Limehouse. St. George's. Mile End. Whitechapel. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. •• Diphtheria (including Membranous Croup) 630 42 279 259 37 12 1 .. 120 103 241 166 629 Erysipelas 193 12 22 26 11 45 58 .. 41 30 65 57 32 Scarlet Fever 356 7 133 202 11 3 •• .. 54 54 152 96 354 Typhus Fever 1 .. •• •• •• •• 1 .. •• 1 •• •• 1 Enteric Fever 38 .. 4 17 2 13 2 .. 11 5 18 4 35 Relapsing Fever .. .. .. •• •• •• .. .. •• •• .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 16 .. •• 1 4 11 .. .. 5 1 8 2 15 Cerebro-spinal Meningitis 14 3 4 3 2 2 .. .. 6 3 4 1 13 Poliomyelitis 4 1 1 2 •• .. .. .. 2 .. 1 1 4 Ophthalmia Neonatorum 31 31 .. •• •• •• .. .. 11 5 13 2 2 Pulmonary Tuberculosis 1069 3 14 126 242 514 152 18 199 206 406 258 376 Other forms of Tuberculosis 235 7 51 128 31 13 4 1 67 56 73 39 63 M easles and German Measles 3403 188 1937 1208 54 14 2 •• 593 575 1228 1007 97 Anthrax 1 •• •• .. •• •• 1 •• •• •• 1 •• 1 Totals 5991 294 2445 1972 394 627 221 38 1109 1039 2210 1633 1622 20 Causes of, and Ages at Death during the year 1917. Metropolitan Borough of Stepney. Causes or Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without 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 3,908 580 238 189 130 171 582 992 1,026 Ucertified .. .. .. .. .. .. .. .. .. Enteric Fever 3 .. .. .. .. .. 1 2 Small-pox .. .. .. .. .. .. .. .. .. Measles 103 14 45 43 1 .. .. .. .. Scarlet Fever 6 1 1 4 .. .. .. .. .. Whooping Cough 30 9 12 8 1 .. .. .. .. Diphtheria and Croup 60 9 12 27 12 .. .. .. .. Influenza 31 .. .. .. 1 .. 6 9 15 Erysipelas 6 3 .. .. .. .. .. 2 1 Phthisis (pulmonary tuberculosis) 507 1 1 1 17 78 223 154 32 Tuberculous Meningitis 66 10 15 17 16 3 5 Other Tuberculous Diseases 47 9 2 6 12 9 2 2 5 Cancer, malignant disease 235 .. .. .. 2 2 32 141 58 Rheumatic Fever 3 .. .. .. .. .. 2 1 .. Meningitis 5 2 1 .. .. 2 .. .. .. Organic Heart Disease 424 .. .. .. 9 13 60 136 206 Bronchitis 406 28 14 2 1 1 18 126 216 Pneumonia (all forms) 428 64 72 38 15 10 53 113 63 Other diseases of respiratory organs 38 5 .. .. .. 5 11 5 12 Diarrhoea and Enteritis 167 118 31 6 1 .. 3 3 5 Appendicitis and Typhlitis 15 .. .. 1 4 2 4 3 1 Cirrhosis of Liver 16 .. .. 1 .. .. 1 8 6 Alcoholism .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 119 .. 2 6 .. 3 16 66 26 Puerperal Fever 7 .. .. .. .. 1 6 .. .. Other accidents and diseases of Pregnancy and Parturition 20 14 .. .. .. 3 3 .. .. Congenital Debility and Malformation, including Premature Birth 241 241 .. .. .. .. .. .. Violent Deaths, excluding Suicide 192 24 9 12 22 12 25 44 44 Suicide 7 .. .. .. .. .. 4 2 1 Other Defined Diseases 677 20 12 13 15 18 102 166 331 Diseases ill-defined or unknown 49 8 9 4 1 9 5 9 4 Totals 3,908 580 238 189 130 171 582 992 1,026 Sub-entries included in above figures Cerebro-spinal gitis 5 2 1 .. .. 2 .. .. .. 21 I have again to express my indebtedness to the Sanitary Inspectors and Clerical Staff—including the temporary clerical staff—for the manner in which they have assisted me in carrying out the duties of their office. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, D. L. THOMAS. Medical Officer ef Health and Public Analyst. Public Health Offices, 43, White Horse Street, Commercial Road, E. 1. July, 1918. 22 INDEX. A PAGE Analyst's Report 15, 16 & 17 B Births 1 C Cerebro-Spinal Fever 3 Cowhouses 11 D Deaths 2 Diarrhoea 4 Diphtheria and Membraneous Croup 2 Disinfection of Articles10 E Enteric Fever 3 Erysipelas 3 F Factory and Workshops Acts 11, 14 & 15 Food and Drugs 15,16 & 17 G General Sanitary Work 9, 10 & 11 H Houses let in Lodgings 11 23 I page Infantile Mortality 6, 7, 8 & 18 Inquests 11 Ice Cream Premises 11 M Measles 3 Milkshops 11 Mortuary and Coroner's Court 11 N Notifiable Diseases 2 O Ophthalmia Neonatorum 3 Overcrowding 10&12 Offensive Trades 11 P Phthisis, number of notifications and deaths 5 Poliomyelitis 3 Population 1 Puerperal Fever 3 R Respiratory Diseases 6 S Scarlet Fever 2 Slaughter-Houses 11 Statistics:— Table. „ Cases of Infectious Diseases notified during the year 1916 19 „ Causes of, and ages at death, during the year 1916 20 „ Infantile Mortality during the year 1916 18 Summer Diarrhoea 4 Smoke Nuisances 10 Sale of Food 12 24 T PAGE Tuberculosis 5 & 6 U Underground Rooms 12 Unsound Food destroyed 8 & 9 W Whooping Cough 4 Wrong Diagnosis 2 Water Supply 10 Z Zymotic Diseases 4