STE 19 Metropolitan Borough of Stepney. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH of the Borough of Stepney During the Year 1921 by D. L. THOMAS, M.R.C.S., L.R.C.P., D.P.H., BARRISTER-AT-LAW, Medical Officer of Health and Administrative Tuberculosis Officer. together with the REPORT OF THE PUBLIC ANALYST. VAIL & Co., 170, Farringdon Road, E.C.I. PUBLIC HEALTH COMMITTEE. His Worship. The Mayor, Alderman O. Tobin, J.P., Chairman. Councillor J. Alberts, Vice-Chairman. Alderman G. R. Boustred. Alderman Mrs. J. Collins. Councillor A Barber. Councillor H. Beber. „ E. J. Bigden. „ F. R. Ellis. ,, P. Hartigan. „ Miss M. Hughes. „ D. Hume. „ A. Kershaw. „ Miss M. Moses, J.P. „ Mrs. F. W. Reidy. „ J. J. Reidy, J.P., M.D. „ T. S. Selwood. „ E Sexton. „ I. Sharp. „ T. Williams. „ J. Sullivan. THE MATERNITY AND CHILD WELFARE COMMITTEE. The Members of the Public Health Committee, together with following Members; — Miss H. L. Cartwright. Mrs. E. C. Grenfell. Mrs. C. J. Matthew. Mrs. A. Model. Miss Page. Mrs. A. Walsh. His Worship The Mayor, Alderman O. Tobin, J.P., Chairman. Councillor A. Barber, Vice-Chairman. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE METROPOLITAN BOROUGH OF STEPNEY FOR THE YEAR 1921. Public Health Department, 43, White Horse Street May 1922. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to submit herewith my twenty-first Annual Report upon the vital statistics and sanitary condition of the Borough for the year 1921. Before proceeding to a detailed description, it may be interesting to compare a short statistical summary of the population, births, deaths, infantile mortality and infectious diseases, with the figures tor the year 1901, when the Borough of Stepney first came into existence. (1). Population. The population has declined by 48,862 in 20 years. This decline is due to the erection of factories and business premises, the conversion of living rooms in the upper part of dwellings into domestic workshops, the conversion of the ground floor rooms in private houses into small grocery and provisions shops, fruiterers and vegetable shops, etc. A number of slum properties has been demolished, more especially courts and alleys with entrances only through covered archways. The greatest reduction has been in that part of the Borough bordering on the City. 4 (2). Births. Taking the Borough as a whole there has been a gradual decline in the birth-rate, which is equally true of the whole country. The birth-rate has been fairly stationary at 32 to 34 per 1,000 in the Limehouse District (Limehouse, Ratcliff, Shadwell and Wapping) for the last 30 years. It has never been below 32 nor above 34 per 1,000 during this period. In Mile End Old Town for 16 years previous to 1906, the annual birthrate—with one exception—ranged from 36 to 38 per 1,000, but since 1909 it has been below 30 per 1,000. In St. George's during the first-mentioned period the birth-rate was always above 40 per 1,000,—on three occasions being 44 per 1,000, and on five occasions being 43.- During the last 7 years it has been under 30 in each year. The greatest reduction has been in the Whitechapel District, (Whitechapel, Mile End New Town, Spitalfields, &c.) Pievious to 189?, the birth-rate was always above 40 per 1,000. From 1897 to 1912 it fluctuated from 30 to 40 per 1,000. Sincc the latter year, however, it has gradually declined until it lias reached a figure below 20 per 1,000 during the last 6 years. (3). Death-rate. Taking the total deaths for the four districts which now form the Borough of Stepney, the combined death-rate for the 10 years previous to 1901 had not been below 21 per 1,000. It has never been as high as 21 per 1,000 since the Council has been in existence. The improved conditions have been more marked in the Limehouse and St. George's districts than in the other parts of the Borough. Previous to 1901 the annual death-rates in these two districts were from 25 to 29 per 1,000, whereas since 1908 the death-rates have been—with one exception,—below 20 per 1,000, and during the last three years they have been below 15 per 1,000. These figures are calculated on the revised estimate of the population of the census of 1921. (4). Infantile Mortality. Satisfactory as the reduction in the general death-rate must be considered to be, the lowering of the rate of infantile mortality is still more satisfactory. In 1901, the infantile mortality for the whole of the Borough was 165 per 1,000 births. This was due to the fact that infantile mortality in the Limehouse district was 211 per 1,000 births and 184 in St. George's. In fact the average infantile mortality for 10 years previous to 1902 had been above 200 per 1,000 births in the Limehouse district, and the latter had, in those years, the highest infantile mortality in London, and one of the highest throughout the whole country. Twentythree years ago, I strongly recommended the late Limehouse District Board of Works to appoint a Health Visitor to instruct mothers in the proper care 5 of infants, and thus endeavour to reduce this high infantile mortality. My recommendation was adopted, and it was decided to appoint a Health Visitor provided the Local Government Board paid one-half the salary. The Local Government Board, while sympathising with the objects of the District Board, could not sanction the payment of a portion of her salary. The project therefore fell through. I was very disappointed, for, had the appointment been made, the District Board would have been the first Local Authority to appoint a Health Visitor in London, and one of the first in the whole country, and I have no doubt a large number of infants' lives would have been saved. I brought the matter before the Public Health Committee in 1902 after the formation of the Borough Council, and although the Committee adopted the recommendation, it was rejected by the Council. The matter was taken up by a Voluntary Society and a lady health visitor was appointed for five years, her salary being paid by a private individual. In 1907 when the services of the Health Visitor terminated, the question of appointing a Municipal Health Visitor was again considered, but the recommendation of the Public Health Committee was rejected by the Council. It was also rejected in the following year, but in 1909 a Municipal Health Visitor was appointed, followed by that of a second one in 1916. At present we have an Assistant Medical Officer of Health and eleven Health Visitors, all engaged in maternity and infant welfare work. There are also 5 municipal Centres, and nine Voluntary Centres, working in conjunction with the Public Health Department, and all working with one object, viz., the saving of infants' lives. What is the result? During the last three years, the infantile mortality has been less than 100 per 1,000 births in each year, not only in the Borough as a whole, but in each of the four districts comprising the Borough. The year 1921 was one of the hottest and driest on record, and therefore the worst as far as infantile mortality is concerned, and yet even in the Limehouse District in 1921 the infantile mortality was below 100 per 1,000. This result is very satisfactory, especially as a large number ofinfants underl year of age died from Scarlet Fever and Diphtheria— diseases which were very prevalent in the district during the year.— 1911 was the nearest approach to 1921 with regard to the intense heat, and in that year the infantile mortality in Limehouse and St. George's was 189 and 170 respectively. In the former year there was no epidemic of Scarlet Fever or Diphtheria as in 1921. (5). Milk Supply. The milk supplied during the year cost nearly £12,000, which included £144 for dried milk. This is £8,000 less than in the previous year, due partly to a more efficient check on those who were not 6 entitled to a free supply of milk, and to a decrease cost in the price of milk. Unemployment was very prevalent during the year, and the Health Visitors informed me that the only food in the house on some occasions was the municipal milk. If it had not been for this provision, many babies would have had a very poor chance of surviving. When the mother has not sufficient nourishing food, it stands to reason, that the breast milk must be deficient in quantity and quality. The babies, as well as the children under three years of age, who attend the Centres, are remarkable for their health and strength, compared with those who were visited by the Health Visitors a few years ago. Their physique is undoubtedly better, due to the milk supplied by the Borough Council. (6). Infectious Disease. There has been no decline in the number of children suffering from Scarlet Fever and Diphtheria during the last 21 years, but there has been a great reduction in the mortality from these two diseases. Whether this is due to the fact that practically all the cases are removed to the Hospital, and 'the patients have a better chance of recovery than they would at their own homes, or because there has been a change in the type of these diseases, I do not know — probably both. Although Whooping Cough and Measles are not removed to Fever Hospitals, there has been a vast improvement in the number of deaths. This may also partly be due to change of type, but it is also due to the teaching received at the Infant Welfare Centres. The mothers are beginning to realise that they are not simple diseases which may be ignored. Enteric or Typhoid Fever used to be prevalent, but it may be said now that it has nearly disappeared. In 1901, we had 245 cases notified, and in 1902, 273. In the former year, 47 died and 33 in the latter. In 1920 we had 15 cases with 3 deaths, and in 1921, 20 cases with 2 deaths. This satisfactory result is due partly to improved water supply, partly to better supervision of food, and partly to better sanitation generally. During the 8 years that Ophthalmia Neonatorum has been a notifiable disease, 313 cases have been notified to us, but no blindness has resulted thereby, and in only three cases has vision been slightly affected. (7). Tuberculosis. The three voluntary Tuberculosis Dispensaries and the staff were transferred to the Borough Council during the year. It is intended to utilise the Dispensaries and the staff in future, more for preventative, than for curative treatment. To enable us to do this, 7 it is essential that all cases should be notified as early as possible, so that means can be taken for the treatment of the patients themselves, as well as for the examination of members of their families, who have been exposed to infection. One-half of the deaths registered from Phthisis last year had never been notified, or only at the time of death. The Tuberculosis Regulations, 1912, require medical men to notify every case of Tuberculosis within 48 hours of the same coming to their knowledge. The only penalty under these regulations is for wilful violation, but it would be difficult to prove that failure to notify amounts to wilful violation of the regulations. (8). House to House Inspection. Every house in the Borough was inspected and the drains tested between 1901 and 1914. The systematic inspection was suspended during the war, but it was resumed in 1919 and five temporary inspectors were appointed to supplement the work of the permanent inspectors, and to serve notices more especially under the Housing and Town Planning Act. It took three years to inspect every house and every room in such house, but the drains were not inspected, except where the inspection took place as a result of a complaint or a case of infectious disease had occurred there. In conclusion, I have to thank the Maternity and Infant Welfare Committee, the Public Health Committee and Council for their kind support, and the members of my staff for the manner in which their duties have been performed. I am, Ladies and Gentlemen, Yours respectfully, D. L. THOMAS. 8 Population. The resident population of the Borough of Stepney at the Census in June, 1921, was 249,738, or a decrease of 30,066 from that of the Census in 1911. At the Census of 1891, the population was 285,116 1901 ,, „ 298,600 1911 „ „ 279,804 1921 „ „ 249,738 It will be seen therefore that the largest number was in 1901 when the Census was taken, and that there was a considerable drop in the population when the 1911 Census was taken, but not nearly to the same extent as it was found to be ten years afterwards. In 1901, overcrowding was prevalent, and it was most difficult to abate it on account of the demand for houses. It was impossible for anyone to obtain a house without paying a premium, which was called " key-money." The demand gradually became less, and in 1904 there were 1,073 empty houses at the end of the first quarter of the year. The number became greater each year following, until, at the end of the first quarter of 1908, 2,944 houses were empty in the Borough of Stepney. This number gradually decreased afterwards, so that in 1911 it was 2,408, but even in 1914 it was 1,700, whereas on March 31st, 1921, the number was only 388. Yet the population was 30,000 less in 1921 than in 1911. What is the cause of it ? There were more houses in 1921 which contained more than two families. In fact, it was quite common to find extra families living in houses because they could not obtain separate accommodation elsewhere. It cannot be said that a very large number of houses was demolished in the meantime, although some had undoubtedly been pulled down, and business premises erected instead. It is also true that the upper parts of many houses had been converted into domestic workshops, and ground floor rooms have been converted into shops. The diminution in the population occurred in every part of the Borough, but not to the same extent. For instance, there was a decrease of 7.3 per cent. from 1901 to 1911 in the Limehouse District, but in 1921 it was only 2.6 per cent. lower than in 1911. In St. George's in 1911 it was 4 per cent. less than in the previous census, but in 1921 it was 14.1 per cent. lower. In Mile End Old Town the decrease was 1.3 per cent. in 1911 and 7.3 per cent; in 1921. 9 In the Whitechapel district there was a decrease of nearly 25,000 in 20 years, a percentage decrease of 13.7 in 1911, and of 20.6 in 1921, so that in 20 years the population in the Whitechapel district was reduced by more than 30 per cent. Taking into consideration the decrease in the population in 1921 as compared with the Census of 1911, it is obvious that the estimated population for the intercensal years was too high, with the result that the birth-rates given in the annual reports were too low and the death-rates were too high. As stated above, the decrease in the population has been less in some parts of the Borough than in others, and this difference has caused a greater discrepancy in the estimated population of those districts where the decrease has been greater, with a greater error in the birth and death-rates. The population was estimated for each of the intercensal years following 1911, as if the population had continued to decrease in the same ratio as it did between 1901 and 1911. The population estimated on the number of food cards issued was a great deal below the actual population of the Census. Another method of estimating the population is based upon the extent of the excess of the number of births over the number of deaths in any particular year. The excess of births over deaths is known as the " natural increase" in the population, but the accuracy of this method rests upon the absence of any marked difference between the immigration and emigration associated with the district concerned. In the Borough of Stepney there is a great deal of emigration and immigration which varies considerably in different years, and any estimate based upon the natural increase of the population would be almost worthless. In any case, after a certain period since the Census was taken, all methods of estimating the population are liable to error. The population was distributed as follows:— Limehouse District 52,265 40,450 103,121 53,902 St. George-in-the-East Mile End Old Town Whitechapel District 10 Births. The total number of births during the year was 6,169,—3,159 males and 3,010 females—or 1,178 less than in the previous year. The birth-rate was 24.7 per 1,000 of the population, while that for the whole of London was 22.3 per 1,000. 1,678 of the births belonged to the Limehouse District, or at the rate of 32.1 per 1,000. 956 of the births belonged to St. George-in-the-East, or at the rate of 23.6 per 1,000. 2,575 of the births belonged to Mile End Old Town, or at the rate of 24.0 per 1,000. 960 of the births belonged to the Whitechapel District, or at the rate of 17.8 per 1,000. There was a decrease in the number of births in each of the four districts. The number of illegitimate births was 78, and 16 died before they were a year old. This corresponds to an infantile mortality of 205 per 1,000. Marriages. The total number of marriages was 2,389. The proportion of persons married was 19.1 per 1,000 of the population. 405 of the marriages were registered in the Limehouse District. 313 ,, ,, ,, St. George-in-the-East. 1,224 ,, ,, ,, Mile End Old Town. 447 ,, ,, ,, the Whitechapel District. Deaths. After deducting the deaths of non-residents who died in the Borough, and adding those of non-residents who died in Outlying Institutions, the total number was 3,244—1,748 males and 1,496 females—or 235 less than in the previous year. 774 of the deaths belonged to the Limehouse District, or at the rate of 14.8 per 1,000 of the population. 522 of the deaths belonged to St. George-in-the-East, or at the rate of 12.9 per 1,000 of the population. 1,221 of the deaths belonged to Mile End Old Town, or at the rate of 12.0 per 1,000 of the population. 727 of the deaths belonged to the Whitechapel District, or at the rate of 13.4 per 1,000 of the population. The death-rate was 12.9 per 1,000 of the population, while that for the whole of London was 124 per 1,000. 11 Notifiable Diseases. 3,905 notifications were received, or 109 less than in the previous year, and 3,462 were removed to fever hospitals and infirmaries. 081 belonged to the Limehouse District, or at the rate of 13.2 per 1,000 of the population. 690 belonged to St. George-in-the-East, or at the rate of 17.0 per 1,000 of the population. 1,623 belonged to Mile End Old Town, or at the rate of 15.7 per 1,000 of the population. 911 belonged to the Whitechapel District, or at the rate of 16.9 per 1,000 of the population. Wrong: Diagnosis. 195 cases of Infectious Diseases were removed to the Metropolitan Asylums Board Hospitals, which were subsequently returned home in consequence of the patients found not to be suffering from the diseases stated on the certificates, or any other notifiable disease. 137 of the cases were notified by private practitioners, 26 from the London Hospital, and 32 from other Public Institutions. This number referred to 69 cases of Scarlet Fever, 125 of Diphtheria, and 1 of Enteric Fever. Small-Pox. The district was entirely free from Small-Pox during the year. Scarlet Fever. 1,996 cases were notified during the year, or 415 less than in the previous year; 1,970 were removed to fever hospitals. 299 belonged to the Limehouse District, with 9 deaths. 390 ,, St. George-in-the-East, with 3 deaths. 768 ,, Mile End Old Town, with 9 deaths. 539 ,, the Whitechapel District, with 2 deaths. The death-rate for the whole Borough was at the annual rate of .09 per 1,000 of the population, while that for the whole of London was .06 per 1,000. 12 Diphtheria, and Membranous Croup. 956 cases were notified during the year, or 305 more than in the previous year, 951 were removed to fever hospitals. 197 belonged to the Limehouse District, with 29 deaths. 146 ,, St. George-in-the-East, with 8 deaths. 452 ,, Mile End Old Town, with 40 deaths. 161 ,, the Whitechapel District, with 10 deaths. The death-rate for the whole Borough was at the annual rate of .34 per 1,000 of the populaton, while that for the whole of London was .25 per 1,000 Enteric Fever. 20 cases were notified, or 5 more than, in the previous year; 19 were removed to hospitals. 3 belonged to the Limehouse District, with no deaths. 5 ,, St. George-in-the-East, with no deaths. 10 ,, Mile End Old Town, with 1 death. 2 ,, the Whitechapel District, with 1 death. The death-rate was .008 per 1,000 of the population, and that for the whole of London was .01 per 1,000. Puerperal Fever. 21 cases were notified, or 1 less than in the previous year. 3 belonged to the Limehouse District, 2 to St. George-in-the-East, 8 to Mile End Old Town, and 8 to the Whitechapel District. Of these, 8 died; 3 of them belonging to the Limehouse District, 2 to Mile End Old Town, and 3 to the Whitechapel District. Erysipelas. 132 cases were notified, or 22 less than in the previous year; 32 were removed to hospitals and infirmaries. 14 belonged to the Limehouse District, with 2 deaths. 17 ,, St. George-in-the-East, with no deaths. 58 ,, Mile End Old Town, with no deaths. 43 ,, the Whitechapel District, with 2 deaths. . Encephalitis Lethargica. 17 cases were notified, or the same number as in the previous year. 2 belonged to the Limehouse District, 3 to St. George-in-the-East, 8 to Mile End Old Town, and 4 to the Whitechapel District. Of these, 5 died; 1 belonging to Limehouse, 1 to St. George-in-the-East, 1 to Whitechapel, and 2 to Mile End Old Town. 13 Cerebro-Spinal Fever or " Spotted " Fever. 6 cases were notified, or 8 less than in the previous year. 4 belonged to the Limehouse District, of which 1 died; 2 belonged to the Whitechapel District, and both recovered. Polio-Myelitis and Polio-Encephalitis. 1 case of Poliomyelitis and 1 of Polio-encephalitis occurred during the year. The former belonged to the Whitechapel District, and the latter to Mile End Old Town. Both died. Ophthalmia Neonatorum. Ophthalmia Neonatorum is a purulent discharge from the eyes of newlyborn children, and is a notifiable disease if it occurs within 21 days of the date of birth. Notification has been in force since 1st of April, 1914. There is a statutory obligation on the part of medical men and certified midwives to notify every case of Ophthalmia Neonatorum to the Medical Officer of Health of the district. The midwife is not obliged to notify if the case has been already notified by a medical practitioner. The rules of the Central Midwives Board compel all midwives to obtain the assistance of a medical practitioner when there is any inflammation of, or discharge from, the eyes, however slight, and to send notice to the Local Supervising Authority (the London County Council) that medical help has been sought. When a doctor has been called to see the baby, the midwife presumes that the notification will be done by him, but I do not think this releases her from her liability unless she satisfies herself that the doctor has actually notified the case. However, this is probably the reason why we receive so few notifications from midwives. If the midwife always carried out this rule, no very great harm need arise. It happens, however, occasionally that babies are brought to our Infant Welfare Centres with purulent discharge from the eyes concerning which we have received no notification. On making enquiries the Health Visitors are informed that the discharge started within the stipulated time mentioned in the Act, and they are also informed that no doctor was asked to see the babies' eyes. On some occasions, the gist of the conversation is reported to the midwife, who, knowing that we have no locus standi under the Midwives Act, is not complimentary in her remarks with respect to the Health Visitors and the Infant Welfare Centres. The last thing we desire, is to provoke the antipathy and resentment of the midwives in our district. When a case is notified by a general practitioner (and the certificate is often brought by hand to the Public Health Offices to save delay), the Health 14 Visitor usually visits on the same day. If she finds that the baby requires local applications to the eyes oftener than the doctor is able to give, and the patient is treated at home, the East London Nursing Society is immediately communicated with by telephone, and requested to send a nurse. It is left to the discretion of the nurse to visit and apply treatment as often as she considers necessary, or as often as the doctor in attendance requests her to do so. The Borough Council pays for this nursing attendance per visit, and not per case, so that there is no reason why the baby's eyes should not receive proper care and prompt attention. On the other hand, if the patient is attended by a midwife, she reports it to the London County Council by post, and the Inspector of Midwives visits. If the latter considers that the case requires treatment by a nurse, she telephones to this office and arrangements are made to send a nurse as soon as possible. At the best, a longer time must elapse before the nurse appears on the scene, than if the midwife reported direct to the Public Health Office. All Authorities are agreed that speed is the most important point in the treatment of Ophthalmia Neonatorum. Every hour lost means that the disease is obtaining a deeper hold. In addition, there is the danger of the other inhabitants of the house contracting gonorrhoeal disease from the infected baby. If all cases of even slight inflammation of the eyes were notified direct to the Public Health Authority by the midwife, as in the case of the doctor, then immediate treatment could be secured. Another advantage would be that the child could be seen at the Infant Welfare Centre after the third week and the treatment continued if necessary. The midwife is generally engaged for a confinement some time in advance, and knows probably whether there is any suspicion of the expectant mother to be suffering from Gonorrhoea. The immediate necessity is of course that treatment be given to the mother, and to the baby when it arrives. But in order to prevent the disease of Ophthalmia Neonatorum occurring in the woman's next child, treatment should be given after her confinement, either by a private practitioner, or at a Venereal Disease Centre. It would be advisable to have a swab taken from every case of discharging eyes in the newly-born. If on bacteriological examination the gonococcus (the active cause of Gonorrhoea) is proved to be present, the midwife should procure suitable treatment for the mother as well as for the baby The infection is either contracted during birth or by subsequent infection from the mother, as Gonorrhoea is spread by contact. 15 The routine method of applying silver nitrate solution to the eyes of all newly-born babies is scarcely to be recommended. Where it is not properly applied, it may cause a feeling of false security, so that early signs of inflammation may be overlooked. Besides, the baby may contract the disease other than at birth. In 1921, out of the 42 cases notified, 13 only were under a week old at the time of birth, and 25 were over a week old and under a fortnight. The remainder were over a fortnight old. Harm may be done by unskilled persons using strong solutions, or through handling the eye roughly. Ordinary boric acid solution frequently applied, is a safe and reliable method in the hands of a parent or nurse. Whether the case is treated at home or at the hospital, the Health Visitor keeps the patient under observation during the whole course of the disease, and is able to report finally whether the baby's eyes have Teceived permanent damage or not. All cases of inflammation or discharge from the eyes of babies under three weeks old which have been notified to the Public Health Office from all sources, are visited and treatment given as if the disease was genuine Ophthalmia Neonatorum. A genuine Ophthalmia Neonatorum requires more drastic treatment than mere inflammation of the eyes. The source of the infection is different, and in genuine Ophthalmia Neonatorum the actual cause of the disease is nearly always Gonorrhoea. Genuine cases of Ophthalmia Neonatorum are rare in this district, and there has not been any blindness as a result thereof for nearly eight years, and in only three cases was vision slightly injured. Of the 42 cases notified during 1921, five were notified by private doctors. Of these, three were removed to St. Margaret's Hospital (M.A.B.). Eight were notified by Hospital doctors and six from Infirmaries. Several duplicates were received. One case was notified by a medical man and afterwards a notification was received from the midwife. One was notified by a midwife and afterwards by the Inspector of Midwives of the London County Council. In one case only was a notification received from a midwife, and from no other source. 15 notifications were received from the Inspector of Midwives of the London County Council. These were the only notifications received. In addition, nine others were received, which were duplicate certificates. The notifications were received when the babies were two days' old, in one case, four days in another, two babies were five days old, three were six days old, one was seven days, four were eight days, one was nine days, seven were ten days, two were eleven days, seven were twelve days, and the remainder between twelve days and three weeks. 16 The Health Visitors visited the same day in 24 instances, and as a result thereof the East London Nursing Society's nurse started the treatment on the same day with eight of the patients, and the day after the Health Visitor's visit in two cases. Where the notifications were received from the various Infirmaries and Hospitals, the Health Visitors did not visit the houses until the day after the date of the receipt of the notification. Five of the babies were treated at home, and as the disease was slight, no trained nursing was required. The eyes of seven of the babies received daily treatment in the outpatient departments of either the London Hospital or Moorfields Eye Hospital, supplemented by more frequent applications to the eyes by nurses arranged by the Public Health Department from the East London Nursing Society. Three received treatment from the nurses only. Total cases notified to us in:— 1914 52 1915 65 1916 42 1917 31 1918 20 1919 30 1920 31 1921 42 Summer Diarrhoea. The number of deaths was 180, or 91 more than in the previous year. 60 belonged to the Limehouse District, or at the rate of 1.14 per 1,000. 26 belonged to St. George-in-the-East, or at the rate of .64 per 1,000. 70 belonged to Mile End Old Town, or at the rate of .67 per 1,000. 24 belonged to the Whitechapel District, or at the rate of .44 per 1,000. The death-rate for the whole Borough was .72 per 1,000; nearly 80 per cent. of the deaths from Diarrhoea were those of infants under one year of age. Measles. Measles is not now a notifiable disease. The number of deaths was very low compared with previous years, and was 7 less than in the previous year. 17 The death-rate for the whole Borough was at the rate of .16 per 1,000 while that for the whole of London was .05 per 1,000 of the population. 12 of the deaths belonged to the Limehouse District, or at the rate of .22 per 1,000. 13 of the deaths belonged to the St. George-in-the-East, or at the rate of .32 per 1,000. 15 of the deaths belonged to the Mile End Old Town, or at the rate of .14 per 1,000. 1 of the deaths belonged to the Whitechapel District, or at the rate of .01 per 1,000. The annual number of deaths from Measles 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 1916 63 1917 103 1918 145 1919 14 1920 48 1921 41 Whooping: Cough. The number of deaths from Whooping Cough was 24, or 50 less than in the previous year. 10 belonged to the Limehouse District, or at the rate of .18 per 1,000. 4 belonged to St. George-in-the-East, or at the rate of .09 per 1,000. 8 belonged to Mile End Old Town, or at the rate of .01 per 1,000. 2 belonged to the Whitechapel District, or at the rate of .03 per 1,000. The death-rate for the Borough was .09 per 1,000 of the population, while that for the whole of London was .12 per 1,000. 18 Zymotic Diseases. The total deaths from diseases of a Zymotic character was 357, or 90 more than in the preceding year. They include all deaths from Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever, and Diarrhoea. 120 belonged to the Limehouse District, or at the rate of 2.29 per 1,000. 54 belonged to St. George-in-the-East, or at the rate of 1.33 per 1,000. 143 belonged to Mile End Old Town, or at the rate of 1.38 per 1,000. 40 belonged to the Whitechapel District, or at the rate of .74 per 1,000. The death-rate for the whole Borough was 1.42 per 1,000. Phthisis. 573 new cases were notified, or 5 less than in the previous year. Notifications. Deaths.  Limehouse 110 64 St. George's 98 49 Mile End Old Town 244 87 Whitechapel 121 99 Number of deaths from Consumption from 1901 to 1921:— Limehouse District. St. George's. Mile End. Whitechapel. Whole Borough.  1901 123 186 107 208 624 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 79 154 103 434 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 82 162 154 506 1918 102 92 184 164 542 1919 81 51 123 112 367 1920 60 48 94 81 283 1921 64 49 87 99 299 19 Other Forms of Tuberculosis. 140 new cases were notified, or 23 more than in the previous year:— Notifications. Deaths.  Limehouse 38 9 St. George's 23 13 Mile End Old Town 55 14 Whitechapel 24 11 Deaths from diseases of a Tubercular nature, other than Phthisis, from 1901 to 1921:— 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 1918 20 22 32 12 86 1919 16 6 12 16 50 1920 11 7 18 14 50 1921 9 13 14 11 47 Of the 299 deaths certified to be due to Phthisis, 130, or nearly onehalf, had not been notified during life-time. Of the 169 notified during life-time, 17 were notified at the same time that the deaths were certified, 21 died within a month of their being notified, 25 died within 1 and 3 months of their being notified, and 17 between 3 and 6 months. This result is even worse than in the previous year, when 123 out of 283 deaths had not been notified during life-time. The Dispensaries were taken over by the Borough Council on April 1st, 1921, and re-organised. Their usefulness is severely handicapped through 20 the remissness on the part of medical men in not notifying persons suffering from Phthisis immediately they have made up their minds as to the diagnosis. It may be supposed that the cases which are not notified are residents of Mental Hospitals and other places where notification and subsequent action by the Health Department would not result in any benefit. Of the 29 deaths from Phthisis that occurred at these Institutions during the year, 16 were not notified at all, and 13 were notified. 167 died in Institutions other than Lunatic Asylums or Mental Hospitals, e.g., Infirmaries, Hospitals, etc. Of these, 93 were notified during life-time and 74 were not notified. 103 died at their own homes, and of these, 41 had never been notified, the only intimation being the weekly returns of the local Registrar of Births and Deaths. 3 were notified at the time of death only, 3 within one month of death, and 5 between 1 and 3 months of death. The local infirmaries were the worst offenders in notifying the cases at death only, 14 notifications being so received. The same remarks apply to diseases of a Tubercular nature other than Phthisis. Of the 47 deaths, 29 had not been notified during life-time, 18 had been notified, but of these, 13 had been notified at the time of death only, and two about a month before they died. ' 13 of the deaths from Phthisis occurred nearly 4 years after they had been notified, 7 nearly 5 years after, 1 nearly 6 years, 5 nearly 7 years, 2 nearly 8 years, and 2 nearly 9 years after notification. In one house in 1921, the husband and wife died from Phthisis, and a child, aged two, died from Tubercular Meningitis. No age is altogether exempt from the disease, though it is generally considered to be rare at the two extremes of life. In our district in 1921, 55 per cent. of the deaths were persons above 40 years of age, 26 per cent. were above 50, 9.3 per Cent. were above 60, and 3 per cent. were above 70 years of age. Tuberculosis Dispensaries. The subjoined tables of figures show the number of patients dealt with by the three Tuberculosis Dispensaries during the year, together with an analysis of the diagnosis, etc., of the new patients. Attention has been directed towards eliminating work in the Dispensaries which interferes with the more important preventive measures, and which is of little praotical value. 21 Treatment of patients had increased considerably during the years of the War, and a large attendance of query cases was seriously clogging the machinery. This has now been reduced to a large extent, and only those patients requiring treatment are retained. Patients are not now treated merely as a means of keeping them under observation, but arrangements are made for periodic re-examinations when necessary. New Patients. The number of patients examined for the first time at the Dispensaries remains almost the same as in previous years, and there is little variation in the relative diagnosis. As each year passes, the number of advanced cases attending for the first time becomes less, and it is now very seldom that such a type of case is seen, which has not been previously diagnosed. TABLE I. New Cases. Stepney and Mile End 546 St. George-in-the-East 534 Whitechapel 415 Analysis. Definite. Doubtful. No evidence of Tuberculosis.  Stepney and Mile End 149 187 210 St. George-in-the-East 66 80 388* Whitechapel 69 140 206 *These figures are exclusive of "Contacts" except in the case of St. George-in-the-East. The figure for this Dispensary includes certain " Contacts " " Contacts." The subjoined table of figures includes " contacts " under two heads, viz. (1) the " contacts" of cases officially notified as suffering from Tuberculosis, and (2) "contacts" of patients who have attended a Dispensary for the first time. The latter are not necessarily definite cases of Tuberculosis, some being query cases. " Contacts " of these are, however, examined because it sometimes occurs that a " contact " of a query case, is found to be the original source of infection. Since the Dispensaries were taken over by the Borough Council in April, 1921, the examination of " contacts " has become more efficient owing to the fact that the Tuberculosis Officers now have access to the notifications of Tuberculosis. The patients' homes are visited and appointments made for the examination of the " contacts." Any " contact" found to be tuberculous or to show any suspicion of the disease, is placed under treatment or observation as is considered appropriate, and the notifying doctor is informed. 22 TABLE II. Analysis of " Contacts." Borough Council " Contacts." Definite. Doubtful. No evidence of Tuberculosis. Unable to attend for examination.  Stepney and Mile End 15 54 421 179 St. George-in-the-East 6 7 354 42 Whitechapel 7 13 256 22 Other " Contacts." Stepney and Mile End 19 116 296 — St. George-in-the-East 7 15 196 — Whitechapel 6 18 212 — Table III. shows the number of War pensioners dealt with at the Dispensaries during the year. The Tuberculosis Officers act as referees for the Ministry of Pensions as far as tuberculosis is concerned. TABLE III. War Pension Cases. New cases examined during the year. Cases in attendance during the year.  Stepney and Mile End 34 118 St. George-in-the-East 15 46 Whitechapel 13 38 After-Care. There is at the present time urgent need for the after-care of patients, who have undergone a course of treatment. Many of these cases benefit considerably from Sanatorium treatment, but on discharge they have to return to, perhaps, unsuitable occupations, and poor home conditions, with the result that the disease again becomes active and nearly all the benefit obtained whilst under treatment, is lost. These cases would often profit from suitable work of a comparatively light nature, and in some cases the disease would eventually become arrested entirely. Many are fit for such light work, but they are not fit to compete with healthy men and women in the open market. There is not yet any adequate organisation for dealing with the after-care problem. Tables IV. and V. show a general analysis of the patients attending the Dispensaries during the year. Table IV. 1. (a) Number of persons examined for first time at or in connection with the Dispensary. (b) Number included under 1 (a) found to be suffering from Pulmonary Tuberculosis. (c) Number included under 1 (a) found to be suffering from NonPulmonary Tuberculosis. (d) Number included under 1 (a) found to be Non-Tuberculous. (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful. Insured. Uninsured. Insured. Uninsured. Insured. Uninsured. Insured. Uninsured. Insured. Uninsured. Male. Female. Under 16. Male. Female. Male. Female. Under 16. Male. Female. Male. Female. Under 16 Male. Female. Male. Female. Under 16. Male. Female. Male. Female Under 16. Male. Female.  Stepney and Mile End 275 114 636 58 139 76 23 24 15 23 — 1 21 — 1 90 54 399 24 86 109 36 192 19 29 St. George-in-the-East 102 40 390 31 180 40 7 5 9 18 — 1 14 — 3 50 27 333 20 135 12 5 38 2 24 Whitechapel 73 49 378 69 202 22 16 — 15 17 1 - 6 — — 35 26 296 45 154 15 7 76 9 31 Total 450 203 1404 158 521 138 46 29 39 58 1 2 41 — 4 175 107 1028 89 375 136 48 306 30 84 23 24 Table V. II. (a) Total attendances at the Dispensary of persons included under I. (a). (ib) Number of attendances at which systematic physical examinations and records were made. III. Number of visits to patients at their own homes by the Dispensary Medical Officer in connection with the supervision of home conditions. IV. Number of visits to patients at their own homes by the Dispensary Nurses in connection with supervision of home conditions and " following up." V. Number of persons suffering from or suspected to be suffering from Tuberculosis referred to the Hospital to which Dispensary is affiliated. VI. (a) Number of consultations with the consulting physician at the Hospital to which Dispensary is affiliated. (6) Number of consultation1; with the practitioners at the homes of the patients. VII. («) Number of written reports concerning individual patients made to Public Authorities. (b) Number of written reports concerning individual patients made to Practitioners. ] VIII. Number of specimens of sputum examined. Insured. Uninsured. • Insured. Uninsured Insured. Uninsured Insured. Uninsured. Insured. Uninsured. Insured. Uninsured. Insured. Uninsured. Insured. Uninsured. Insured. Uninsured. Insured. Uninsured. Stepney and Mile End 1,320 6,106 512 1,302 150 93 329 1,962 — — — — 1 i 424 308 196 291 81 136 St. George-in-the-East 743 2,129 506 1.340 67 197 203 1,090 ii 7 — — 4 2 230 186 51 23 141 187 Whitechapal 724 2,765 213 935 51 232 210 1,608 6 10 — — — — 201 177 53 11 84 152 Total 2,787 11,000 1.231 3,577 268 522 742 4,660 17 17 — — 5 3 855 671 300 325 306 475 25 Diseases of the Respiratory Organs. 748 deaths were due to diseases of the Respiratory Organs, or 174 less than in the previous year. 194 belonged to the Limehouse District, or at the rate of 3.3 per 1,000. 147 belonged to St. George-in-the-East, or at the rate of 3.6 per 1,000. 240 belonged to Mile End Old Town, or at the rate of 2.3 per 1,000. 167 belonged to the Whitechapel District, or at the rate of 3.0 per 1,000. The death-rate was 2.9 per 1,000 of the population. Influenza. 42 deaths were due to Influenza, or 74 less than in the previous year. Most of the deaths were those of persons above 45 years of age; no child under Ave years, died from the disease. 4 belonged to the Limehouse District, 15 belonged to St. George's. 15 to Mile End, and 8 to the Whitechapel District. The death-rate for the whole Borough was .16 per 1,000; the death-rate for London was -23 per 1,000 of the population. Cancer. 263 deaths were due to Cancer, or 19 more than in the previous year. 47 belonged to the Limehouse District, or at the rate of .89 per 1,000. 39 belonged to St. George-in-the-East, or at the rate of .85 per 1,000. 123 belonged to Mile End Old Town, or at the rate of 1.19 per 1,000. 54 belonged to the Whitechapel District, or at the rate of 1.01 per 1,000. The death-rate for the whole Borough was at the annual rate of 1.05 per 1,000 of the population. The number of people who die from Cancer is on the increase year after year in this Borough. This may be due, partly, to more correct diagnosis, and partly to the fact that Cancer is generally a disease of advanced life. On account of the lowering of the death-rate, more people live to an age susceptible to Cancer. Pneumonia, Malaria, Dysentery and Trench Fever Regulations. 338 cases were notified under these Regulations. Of these 329 were Pneumonia, 8 Malaria, and 1 Dysentery. The cases occurred in the districts as follows:— Limehouse St. George's Mile End Whitechapel Total Pneumonia 130 16 155 28 329 Malaria — — 3 5 8 Dysentery — — — 1 1 26 Infantile Mortality. 550 infants died under 1 year of age, or 113 less than in the previous year. 165 belonged to the Limehouse District, or at the rate of 98 per 1,000 births. 74 belonged to St. George^in-the-East, or at the rate of 77 per 1,000 births. 231 belonged to Mile End Old Town, or at the rate of 89 per 1,000 births. 80 belonged to the Whitechapel District, or at the rate of 83 per 1,000 births. The infantile mortality for the whole of the Borough was 89 per 1,000 births, while that for London was 80 per 1,000. Of the 78 illegitimate births, 16 died before they were a twelvemonth old, or at the rate of 205 per 1,000. This is a very high infantile mortality when compared with that of 76 per 1,000 among the legitimate births in the Borough. The average infantile mortality for five-year periods from 1890-1919, and for the year 1921:— Limehiuse. Si. George's. Mile End. Whitechapel. Whole Borough. 1890-1894 186 197 175 163 178 1895-1899 204 187 166 147 168 1900-1904 201 162 148 135 157 1905-1909 153 142 120 112 129 1910-1914 143 137 112 103 122 1915-1919 107 123 90 93 100 1920 86 98 84 98 90 1921 98 77 89 83 89 There were 67 sets of twins born during the year. Return of births notified under the Notification of Births Act during the year:— Number notified by medical practitioners 1,190 Number notified by midwives 3,137 Number notified by miscellaneous Institutions 695 Number notified by the London Hospital 164 Number notified by the East End Mothers' Home (396, Commercial Road) 608 Number notified by parents 51 Total 5,845 In addition 159 Stillbirths were notified. 27 VISITS BY THE HEALTH VISITORS:— Addis Chabot Clements Cordwell Davis Gibbs Goodfellow Mitchell Phillips Virtue Whitty (2 months) Cooke (3 months) Power (9 months) Total Primary 324 808 457 797 628 559 250 693 664 301 162 83 126 5,852 Revisits 868 1,115 986 847 1,490 1,238 526 1,017 1,837 1,688 189 200 731 12,732 Ante-natal 31 10 129 76 4 43 107 68 11 — 9 3 65 556 Miscellaneous 383 433 105 776 276 426 502 178 51 127 84 80 246 3,667 Total 1,606 2,366 1,677 2,496 2,398 2,266 1,385 1,956 2,563 2,116 444 366 1,168 22,807 Centres attended.. 124 124 66 98 135 126 121 142 120 164 21 23 83 1,347 28 The three ante-natal clinics in the Borough, send us cards asking that expectant mothers should be visited. The Health Visitor reports on the home conditions, and advises the mother on the preparation of confinement. Any sanitary defects in the home are noted, and in these cases where home conditions are obviously unsuitable for a confinement, arrangements are made for the woman's admission to a Lying-in Hospital. A bed is reserved in the East End Mothers Lying-in Home for necessitous cases recommended by the Council. The mother and baby are visited for the first time ten days after a confinement. The mother is urged to attend the nearest Infant Welfare Centre with her baby. The Municipal Health Visitors undertake the primary visiting throughout the whole of the Borough, except for those Jewish babies who are born in 24, Underwood Street, and who live in the area worked by that clinic. The babies are afterwards visited from the centres which they attend. All children are visited at regular intervals until they reach five years of age or are attending school. During the past year every case of stillbirth was visited, and also all cases of Ophthalmia Neonatorum occurring in the Borough. In addition to consultation days when the doctor attends, lectures are given by the Health Visitors at the Centre at least once a week, on hygiene and health. A sewing class is held once weekly at each of the Municipal Centres. The mothers are taught how to cut out and make simple garments, and to remodel old ones. It was not an easy matter to attract the poorer women to these classes, as very many of them are unable to sew. However, after persistent efforts the attendance at each sewing class is now satisfactory, particularly so, in that it is mainly composed of those mothers who need the instruction most. As a result of this there is an obvious improvement in the general cleanliness and tidiness of the mothers and babies who attend the Centre. All the sewing classes arc now in the charge of a Municipal Health Visitor, each of whom is experienced and well qualified for the work. Owing to the large attendance at the Whitechapel Centre, it was found necessary to hold a consultation day twice a week. A cot is reserved at the Stepney Nursing Home for babies attending the Borough Centres who are delicate, and require skilled nursing. The Matron of the Home submits a monthly report of the progress of each case. It has been found that wasting babies do extremely well under the treatment at the Home. Cases in urgent need of treatment are sent to hospital, mainly to the London Hospital and the East London Hospital. 29 The East London Nursing Society undertake the nursing of all cases of Measles and Ophthalmia Neonatorum for the Stepney Borough Council. In addition, any minor ailment which calls for skilled home nursing is referred to them. The Lady Forster Guest House at Sydenham, where so many Stepney mothers and babies had a happy holiday, has had to close down for lack of funds. Arrangements are now being made for the provision of beds at a Convalescent Home for mothers and babies. The toddlers from two to five years are sent to the Marjorie Lumley Home at Maidenhead. All the children sent to this Home during the past year returned looking very healthy and happy. Feeding of Infants: Breast fed 5,349 Artificially fed 225 Mixed feeding 278 5,852 Dead before first visit 152 List of Infant Welfare Centres, Clinics and Creches in the Borough:— 1.—Municipal Centres. Limehouse Town Hall, Commercial Road. Monday Afternoon 2-4 (Consultation). Thursday Morning 10-11.30. Thursday Afternoon 2-4 (Sewing Class). 52, Red Lion Street, Wapping. Monday Afternoon 2-4 (Sewing Class). Wednesday Alternate (Consultation). Thursday Afternoon 2-4 „ Friday Morning 10-11.30. Town Hall, Cable Street, St. George's. Tuesday Afternoon 2-4 (Consultation). Wednesday Morning 10-11.30. Wednesday Afternoon 2-4 (Sewing Class). F riday Morning 10-11.30. Bedford Institute, Quaker Street, Spitalfields. Tuesday Afternoon 2-4 (Consultation). Wednesday Afternoon 2-4 (Sewing Class). St. Phillip's Institute, Newark Street, Whitechapel. Monday Morning 10-11.30. Monday Afternoon 2-4 (Consultation). Tuesday Afternoon 2-4 (Sewing Class). Thursday Afternoon 2-4 (Consultation). 30 II.—Voluntary Centres. Stepney Infant Welfare Centre, 587, Commercial Road. St. Paul's Schoolhouse, High Street, Shadwell. Jewish Centre, 220, Cable Street. Cotton Estate, St. Paul's Road. Congregational Buildings, Burdett Road. Dame Colet House, 3, St. Helen's Terrace, Mile End. Jewish Centre, 24, Underwood Street. 49, Church Street, Minories. Jewish Centre, 14, Great Alie Street. III.—Ante-natal Clinics. East End Mothers' Lying-in-Home, Commercial Road. London Hospital. Cotton Estate, St. Paul's Road. 24, Underwood Street. IV.—Creches. Jewish Day Nursery, New Road. Port of London Day Nursery, Pier Head. Million Penny Fund Creche, Great Garden Street. George Yard Mission, Day Nursery, Angel Alley. Marie Hilton Creche, Stepney Causeway. St. Paul's Day Nursery, Wellclose Square Martha Street Creche. Nursery School, Rectory Square. Municipal Centres. Limehouse. St. George's. Spitalfields. Wapping. Whitechapel No. of sessions held 48 50 44 78 85 No. of attendances of infants 1,625 1,823 323 2,263 2,032 No. of attendances of children 1-5 years of age 632 568 205 503 537 No. of doctors' consultations 48 50 44 78 85 Sewing Classes:— Limehouse. St. George's. Spitalfields. Wapping. Whitechapel. No. of classes held 52 41 37 43 43 No. of attendances 300 234 336 405 364 31 Supply of Milk to Expectant and Nursing Mothers and to Children. Approximate quantity of milk distributed, together with the cost, etc., during the year. Month. Galls, per day. Persons. Cost per month. £ January 290 1,781 1,485 February 310 1,886 1,547 March 303 1,941 1,907 April 296 1,902 1,421 May 254 1,642 920 June 180 1,171 655 July 186 1,486 696 August 168 1,349 694 September ... 147 1,186 614 October 160 1,266 661 November ... 150 1,214 620 December 131 1,056 536 Total cost for year £11,756 Unsound Food destroyed during the Year. The following foodstuffs were destroyed during the year under the Unsound Food Series and the Public Health (Foreign Meat) Regulations, 1908, at the wharves:— Tons. cwts. qrs. lbs. Meat 21 Sides of Bacon — 12 0 6 Preserved Meats .. 228,227 Tins of Beef 154 14 0 13 36 „ Chicken — — — 18 404 „ Tongues — 11 3 7 Preserved Fish 11,006 Tins of Pilchards 6 9 2 0 19,330 „ Salmon 9 10 1 9 Fresh Fruit and Vegetables. 566 Crates of Bananas 11 11 0 0 201 Packages of Grapes 31 17 3 12 1 Box of Oranges — — 3 0 762 Bags of Potatoes 33 13 0 0 176 Boxes of Tomatoes 1 7 0 1 Carried forward 250 7 2 10 32 Tons cwts. qrs. lbs. Brought forward 250 7 2 10 Preserved Fruit anc Vegetables. 7,301 Tins of Apricots 9 13 1 4 5,397 „ Assorted Fruits 5 13 2 26 33,758 „ Pineapples 23 2 0 13 410 ,, Fruit Pulp 1 14 3 15 2,040 „ Plums 2 1 2 0 38,616 „ Tomatoes 34 6 3 2 Sundries 215,795 Tins of Condensed Milk 96 8 1 13 43 Cases of Chocolate 1 17 0 17 33,630 Tins of Assorted Canned Goods 32 10 2 26 Dried Fruits 3 3 0 0 Total 460 19 0 14 Diseased Meat and Offal destroyed from the Slaughter-houses and Offal Dealers:— Tons. cwts. qrs. lbs. 6 Calves Carcases and Organs — 3 2 10 3 Forequarters of Veal — — 1 16 23 Bullocks' Livers — 2 0 24 110 Sheeps' Livers — 2 1 21 5 Calves' Livers — — — 16 57 Sets of Sheeps' Lungs — 1 0 •21 4 Sets of Calves' Lungs — — — 17 4 Bullocks' Heads — 1 0 8 1 Bullocks' Tongue — — — 4 39 Bullocks' Spleens — — 2 20 Total — 11 3 17 33 Unsound Food seized by, or surrendered to the Inspectors: — Tons. cwts. qrs. lbs. Apple Rings 2 5 0 0 Apples 7 17 3 7 Apricot Pulp 11 1 2 0 Assorted Canned Goods 11 3 1 0 Bacon 1 12 0 0 Bananas — 2 3 0 Black Currants — 4 3 4 Cheese — — 1 18 Cherries — 2 3 4 Chestnuts 1 10 0 0 Christmas Puddings — 15 0 0 Crab (Tinned) — — 2 16 Dutch Herrings 4 2 2 0 Eels — — 1 5 Eggs — 2 0 0 Fish (Salt Water) 1 5 1 26 Fish (Fresh Water) 1 5 3 0 Geese 11 10 0 0 Gooseberries — 2 2 3 Grapes — 2 0 0 Jam — 13 3 25 Milk (Condensed) 35 14 2 8 Mussels — 1 2 0 Oranges 9 5 0 24 Pears 1 8 3 20 Plums — — 1 0 Pork — 1 3 0 Potatoes — 3 0 0 Prunes 1 a a 0 0 Raisin Waste 2 0 0 0 Raspberries — l 1 3 Sweets (Mixed) 1 7 0 0 Tomatoes — 1 3 0 Tomatoe Puree 5 18 2 0 Total 113 6 0 23 34 The Mortuary. The number of bodies deposited in the Mortuary during the year was 300. Of these: 260 were removed by the Coroner's order, 24 by the Police, 5 at the request of deceased's friends, and 11 on my instructions. 11 bodies were placed in the Infectious Mortuary. 35 bodies were placed in the Jewish part of the Mortuary, but only 4 were officially " watched." 284 inquests were held in the Coroner's Court, and 53 post morten examinations were made. 296 Inquests were held on residents of the Borough during the year, 106 being due to accidents. 18 of these were held on persons run over in the streets. 28 had committed suicide. Verminous Persons. 767 persons were cleansed during the year, and their clothing disinfected. Of these, 465 were adults—435 males, and 30 females, and 302 were children. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. The number of applications for Certificates during the year under Sec. 2 (2) of the Act was 115. Of these, 104 were granted, 8 were refused, and 3 were withdrawn by the applicants. Rats and Mice Destruction Act, 1919. Complaints received 230 Number of drains tested 230 Number of drains defective 40 Number referred to the Borough Engineer 190 Number of notices served 40 Canal Boats Acts, 1877 and 1884. Pursuant to the Third Section of the Canal Boats Acts, 1884, the Metropolitan Borough of Stepney, being the Registration Authority under the above Acts, has to report as follows with regard to the execution of such Acts and of the Regulations made thereunder, and as to the steps taken by them as such authority during the year, to give effect to the provisions of the said Acts and Regulations, viz.:— (1) Canal boats coming within the district are inspected by a Sanitary Inspector, who receives a sum of £10 per annum for the performance of this duty. His inspection is irrespective of the examination of boats made by the Examining Officer prior to their registration. 35 (2) The number of boats inspected was 55, and the condition of the boats and their occupants, as regards the matters dealt with in the Acts and Regulations was very good. (3) Infringements of Acts and Regulations were discovered as follows: (a) Registration Nil. (b) Notification of change of Master Nil. (c) Certificates Nil. (d) Marking Nil. (e) Overcrowding Nil. (f) Separation of sexes Nil. (g) Cleanliness Nil. (h) Ventilation Nil. (i) Painting 3 (j) Provision of Water Cask Nil. (k) Removal of Bilge Water 1 (l) Notification of Infectious Disease Nil. (m) Admittance of Inspector Nil. (4) No legal proceedings were taken. (5) Four infringements were found and received attention. (6) No cases of Infectious Disease occurred, (7) No boats were detained for cleansing and disinfection. (8) The total number of boats on the register on the 31st December, 1921: (a) Number of boats believed to be in use or available was 4 Boats propelled by Motor Nil (£) Number of boats that cannot be traced Nil (9) One boat was registered during the year. House to House Inspection. Section 28, Housing, Town Planning, etc., Act, 1919. A certain number of streets is systematically inspected every year by each of the 15 district Inspectors in addition to the number inspected as a result of complaints, infectious diseases, etc. Previous to 1914, every house in the Borough had been inspected at least once since the formation of the Borough Council, as a result of a systematic house-to-house inspection, which took many years before it was completed. Every room in those houses was inspected as well as the yards and water closets, and the drains were tested by the smoke machine. Where defects were 36 found, notices were served on the owners to have them remedied. During the War, house-to-house inspection was, to a considerable extent, in abeyance. In 1919, it was re-commenced and it was decided to have every house in the Borough re-inspected, and to have the houses brought into a reasonably fit state for human habitation. Considerable progress was made, but the Public Health Committee decided in 1920 to have the work done more expeditiously, and for this purpose, five temporary Sanitary Inspectors were appointed in connection with Section 28 of the Housing and Town Planning Act, 1919. They commenced their duties in August, 1920. The district Inspectors worked in co-operation with them under the Public Health (London) Act, 1891. The house-to-house inspection was commenced in 20 parts of the Borough simultaneously, the great progress was made. Unfortunately, two of the Inspectors in March, and a third in September obtained permanent employment elsewhere. It was arranged for the Inspectors for Houses-let-inlodgings to assist in the house-to-house inspection, and one of the Clerks, Mr. McGrath, who was a duly qualified Sanitary Inspector, was appointed to assist in the work. The inspection of the whole Borough was completed with the exception of the southern portion of Burdett Road. Statutory notices were served, but the final batch of Statutory notices will not be complied with, until the second quarter of 1922. During the year 1921, Statutory notices were served to remedy defects in 12,124 houses and were complied with before the end of the 1st quarter in 1922, in all, with the exception of 168 houses, and the work was in hand in nearly all of these. This does not mean that this is the total number of houses inspected, as in some, no sanitary defects were discovered, and in others, the necessary work was done as the result of the serving of Intimation notices only. These were not reported to the Public Health Committee, and no Statutory notices were served. At present the district Inspectors are employed together with the two Inspectors diverted from the administration of the by-laws for houses-let-in lodgings. The work of supervising the houses-let-in-lodgings is carried out by one of the Clerks, Mr. Trimming, who has the status of a Sanitary Inspector, and by Mr. Twynham, who is the Foreman Disinfector. It was decided to continue the inspection, and the systematic house-tohouse inspection was re-commenced, not necessarily with the streets inspected in 1919. but with those streets where the houses are so old and worn, that it is necessary to supervise their condition often. These probably want inspecting once in two years, while others are in such a fair condition that systematic inspection is not necessary oftener than once in five years or more. I.—DISTRICT INSPECTORS. Jan. Feb. Mar. Apl. May June July Aug. Oct. Nov. Dec. Number of houses in which the work had not been completed early in March, 1922. Cook 45 26 18 46 31 19 8 11 50 66 43 1 Crook 79 58 72 52 70 48 — — 130 74 104 3 Dee 41 39 49 29 35 35 11 — 48 35 31 1 Flint 60 37 31 53 42 39 38 3 80 34 32 2 Johnson 51 29 29 34 49 39 31 14 77 31 62 9 Mills 88 80 43 59 74 89 36 — 109 57 84 — Pavitt 93 73 66 50 75 84 56 — 150 76 101 11 (a) Quaintrell 69 47 24 36 52 28 49 30 92 40 38 36 (b) Shepherd 38 22 21 66 37 36 61 1 76 26 26 — Simpson 64 77 70 114 89 54 66 — 140 96 87 13 (c) Stiles 85 58 51 100 73 67 58 — 95 45 55 — Twaits 65 107 109 83 115 70 64 5 164 81 88 3 Waterman 65 28 35 33 26 30 50 8 67 14 35 6 White 65 38 44 41 28 35 30 7 68 47 45 1 Wrack 39 8 18 8 30 19 17 16 64 43 37 5 Total 947 727 680 804 826 692 575 95 1,410 765 868 91 (a) 10 refer to houses in Cephas Street which have been surrendered by the leaseholder and the work is now being done by the freeholder. (b) Mr. Quaintrell has been ill. 23 of the houses were included in a housing scheme in Dupont Street but the portion including these houses is not being proceeded with. (c) 5 of the houses are in Knott Street. They have been abandoned by the owner and no rent is collected. 37 Numbers of Notices authorised by the Public Health Committee at their meetings in 1921 : — 38 II.—SPECIAL INSPECTORS AND INSPECTORS FOR HOUSES-LET-IN-LODGINGS. Jan. Feb. Mar. Apl. May June July Aug. Get. Nov. Dec. Number not completed Bottomley 91 52 55 29 24 28 71 — 59 90 42 3 Forbes 115 90 3 — — — — — — — — — Galvin 78 60 71 75 72 78 78 3 27 — — — Harris 79 70 67 101 21 30 95 — 139 108 63 41 McGrath — — — — — — — — — 112 113 1 Toll 91 88 — — — — — — — — — — Trimming 81 70 42 77 68 41 55 2 94 67 81 17 Twynham 90 11 43 39 68 52 38 — 106 57 90 15 Total 625 441 281 321 253 229 337 5 425 434 389 77 SANITARY INSPECTORS' REPORT. COOK. CROOK. DEE. FLINT. JOHNSON. MILLS. PAVITT. QUA INTRELL. SHEPHERD. SIMPSON. STILES. TW AITS. WATERMAN. WHITE. WRACK. BOTTOMLEY. HARKIS. TRIMMING. TWYNHAM. GALVIN (8 months) McGRATH (4 months) TOTAL. Number of luspectious— House to house 514 501 530 582 244 466 761 117 759 789 923 1117 805 604 823 1199 1069 144 209 675 339 13170 Micellaneous 2630 667 1280 1386 1401 1660 702 1047 911 812 1483 677 1212 1213 881 398 507 1149 1426 244 188 21874 Complaints 337 509 228 192 201 256 528 156 108 279 180 506 115 178 473 15 99 244 64 28 7 4703 Infectious diseases 283 393 76 154 209 225 335 198 122 368 203 322 217 173 244 ... ... ... ... ... ... 3522 Re-visits—Number of 2033 2545 2251 2262 4254 3295 4488 1277 3511 5712 3079 3860 2909 2366 1974 6078 4006 4726 3787 2206 1540 68159 Intimations served 622 1062 686 592 1082 926 1142 638 788 1376 1365 1277 857 741 539 713 741 1055 1161 508 431 18802 Statutory notices served 389 787 394 441 595 492 916 456 231 1033 648 1225 431 409 299 79 123 541 201 217 42 9949 Summonses taken out under the Public Health (London) Act, 1891 2 1 2 4 4 3 13 4 ... 7 44 8 24 ... 7 ... ... 10 2 ... ... 130 Food and Drugs Acts, etc.—No. of samples taken 94 90 91 90 91 95 96 101 97 92 90 90 100 92 93 ... ... ... ... ... ... 1402 „ ,, No. of summonses taken ... 2 4 7 4 5 14 5 2 4 5 12 2 2 1 ... ... ... ... ... ... 69 Animals kept so as to constitute a nuisance, removed 8 6 2 ... ... 8 ... 1 3 2 3 ... 1 4 1 1 2 5 5 3 ... 50 Areas and stables paved and drained 1 ... ... 2 ... 1 ... ... 1 ... ... 9 ... ... ... ... ... ... ... ... ... 14 Bakehouses—No. of inspections to 22 30 8 20 22 30 22 22 16 24 30 28 14 10 20 ... ... ... ... ... ... 318 „ No. cleansed 22 30 8 20 22 30 22 22 16 24 30 28 14 10 20 ... ... ... ... ... ... 818 Cisterns cleansed and covered 3 ... ... 2 1 7 8 2 4 ... ... 11 52 4 3 ... 8 5 ... ... 2 107 Damp walls remedied 29 58 68 40 58 36 50 32 18 21 83 118 54 57 22 39 94 103 52 89 62 1183 Drains—Cleansed or repaired 54 138 38 33 112 68 103 99 20 148 163 113 116 29 46 16 33 37 30 5 4 1405 Constructed or reconstructed 17 72 8 10 29 14 28 13 6 19 16 39 27 8 13 ... ... ... ... ... ... 319 Soil pipes fixed and ventilated 7 26 3 4 33 13 ... 8 2 4 11 6 20 2 9 ... ... ... ... ... ... 143 Trapped 25 15 4 8 32 78 12 ... 6 11 19 47 5 3 27 ... ... ... ... ... ... 292 Dust receptacles provided 31 165 102 128 249 64 333 116 57 237 128 235 158 57 28 122 180 143 210 81 57 2881 Houses or parts of houses cleansed 887 623 271 445 397 267 640 361 450 754 254 818 490 254 251 541 581 613 555 275 268 9495 ,, ventilated beneath the lower floor ... 8 2 11 3 1 6 ... ... 7 22 22 14 ... ... 3 16 39 2 3 8 167 Light and ventilation provided to rooms ... 4 5 8 ... ... 1 2 2 ... 9 15 3 5 ... 1 219 1 ... ... ... 270 Manure receptacles provided or reconst ructed 4 ... ... 2 1 ... ... 2 ... 1 ... ... 1 ... ... ... ... ... ... ... ... 11 Offensive accumulations removed 73 13 16 7 9 143 6 23 40 9 21 16 7 18 65 5 8 21 19 3 3 525 Open fires in yards abolished 2 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 3 ... ... ... 7 Overcrowding in dwellings abated 4 9 2 10 3 1 2 4 1 5 5 1 ... 4 ... ... ... ... 5 ... ... 56 Sheds occupied as dwellings discontinued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sink, bath, lavatory pipes and rainwater pipes disconnected 16 9 15 ... 23 11 2 2 ... 13 ... 115 25 ... 24 ... ... ... ... ... ... 255 Smoke nuisances abated 2 ... 8 2 1 ... ... ... ... 4 9 2 ... 10 ... ... ... ... ... ... 38 Underground rooms—Illegal occupation discontinued 1 2 ... 6 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 11 Urinals fixed 2 2 ... ... ... 3 ... ... 1 3 ... 6 4 ... 2 ... ... ... ... ... ... 28 Verminous rooms cleansed 83 347 43 110 120 113 161 124 80 306 211 191 105 46 68 88 297 368 102 50 19 3032 Wash-houses, forecourts, &c., paved ... 5 4 7 111 9 10 18 12 9 10 65 13 7 9 13 ... 61 43 11 ... 417 Waterclosets—Cleansed or repaired 119 223 118 168 209 366 119 144 167 191 265 306 176 58 117 247 165 490 472 105 25 4250 „ Light and ventilation provided 2 7 4 2 25 35 1 2 8 ... 1 9 23 3 3 ... 1 ... ... ... ... 126 „ Pans and traps fixed 39 98 35 8 93 57 64 21 13 67 21 83 59 17 41 2 6 12 15 18 7 776 „ Water supply or flushing apparatus provided 69 95 91 62 144 146 48 50 33 157 151 85 180 55 71 6 68 101 152 ... 22 1787 Water supply to houses reinstated 9 1 4 1 2 7 18 30 32 19 10 2 27 17 13 ... 10 2 ... ... ... 174 Yards cleansed, paved, or paving repaired 31 240 42 112 115 66 145 102 19 172 148 285 116 117 37 167 92 159 179 203 75 2572 Miscellaneous repairs to roofs, gutters, floors, sashes, fireplaces, coppers, etc. 521 1648 517 948 1548 784 1025 1105 970 1663 1391 2220 627 607 509 1258 1504 1775 1424 1323 558 23920 Face page 38. 39 Overcrowding. 10,031 inspections were made for the purpose of detecting overcrowding, but only 5G dwellings were found to be overcrowded. No Police Court proceedings were taken for the abatement of overcrowding. Water Supply. Water supply cut off. In accordance with the requirements of the Public Health (London) Act, 1891, the Metropolitan Water Board reported that the water had been cut off in 174 premises. The reason for discontinuing the water supply was the non-payment of the rate. The water supplies have been reinstated. Cisterns. In most of the houses water for drinking purposes is drawn from the main, but there are many houses in which the supplies are obtained from cisterns. Their situation and accessibility are often far from being satisfactory, and the majority of them are not cleansed as often as they should be. Notices were served during the year in regard to defects and the necessity for cleansing 107 cisterns. Houses let in Lodgings. Included under this heading are houses occupied by members of more than one family, which have been registered by a resolution of the Council, irrespective of the rents at which the houses are let. No addition to the list of registered houses has been made during the year. The number at the end of 1921 was 2,512. All the houses were kept under supervision, irregular and systematic inspections were made to them. The number of inspections made was 4,028. The number of notices served was 2,816. General Sanitary Work. 43,269 inspections were made to houses. 68,159 re-visits were made by the Inspectors to supervise the abatement of the nuisances found in 18,302 houses. 9,949 statutory notices were served. 130 summonses were taken under the Public Health (London) Act, 1891. 4,434 drains were tested with smoke, and 145 were re-tested; 1,724 drains were either constructed or re-constructed, cleansed or repaired; 292 were trapped. 143 new soil pipes were fixed and ventilated; 776 new closet pans and traps were fixed; 4,376 closets were either cleansed or repaired, or provided 40 with additional light and ventilation; 1,787 water closets were provided with a proper flushing apparatus. 2,572 yards were cleansed, paved or repaired; 14 areas and stables were paved and drained; and 417 washhouses and forecourts were paved. There were 50 nuisances under the Public Health (London) Act, 1891, with respect to the keeping of animals, and these were all abated. 7 nuisances with respect to open fires in yards were remedied. Notices were served to provide 2,881 sanitary dust receptacles, and 11 manure receptacles were provided or re-constructed; 525 offensive accumulations were removed from the rear of dwelling houses. 167 houses were ventilated under the lower floor. 11 underground rooms, which were illegally occupied, were discontinued from being used as such. 23 urinals have been fixed. 38 notices were served for the abatement of smoke nuisances. 318 visits were made to bakehouses, and 318 cleansings were carried out. 9,495 notices were served to have houses cleansed. 255 sink, bath, lavatory or rain-water pipes, which were communicating directly with the drain, were disconnected. 23,920 miscellaneous repairs to roofs, floors, gutters, etc., were carried out as the result of notices served. 270 rooms were provided with additional light and ventilation, and the damp walls of 1,183 rooms were remedied. The number of registered milkshops at the end of the year was 419, and 1,442 visits were made to inspect the condition of the premises, milk receptacles, etc. Ice cream was manufactured at 137 premises, and 260 inspections were made to them. 3,032 verminous premises were cleansed during the year. Disinfection. 159,068 articles were disinfected at the Disinfecting Station during the year. 3,494 rooms were fumigated, and the bedding, etc., removed and disinfected by steam. Of these, 3,195 rooms were disinfected because of Infectious Disease, 244 as a result of Pulmonary Tuberculosis, and 55 rooms because they were verminous. In addition to these, scabies occurred in 218 families, and their bedding was taken away and disinfected with steam. In addition 3,032 verminous rooms were cleansed by the owners as a result of notices served by the Inspectors. 41 POLICE COURT PROCEEDINGS. (1) UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. On 4th January, Messrs. Pinhorn & Pinhorn, were summoned for failing to abate a nuisance, arising from defective roof at 1, Little Turner Street. An order was made to do the work within 14 days with £2 2s. costs. On 11th January, Mr. J. Donn was summoned for failing to remedy a nuisance arising from a defective roof at 12, Spital Street. An order was made to do the work within 7 days with £2 8s. costs. On 11th January, Mr. J. Donn was summoned for failing to remedy a nuisance arising from a defective roof at 19, Spring Gardens. An order was made for the work to be done within 7 days with £2 8s. costs. On 11th January, Messrs. Pinhorn & Pinhorn were summoned for failing to abate nuisance arising from defective roof at 4, Little Turner Street. The summons was dismissed with £2 2s. costs. On 13th January, Messrs. Abraham & Philip Wiggins, of 81, Clark Street, were summoned for having in their possession and exposing for sale, 891 tins of Condensed Milk which were found unsound and unfit for the food of man. The summons against Mr. Abraham Wiggins was dismissed. Mr. Philip Wiggins was fined £15 with £5 5s. costs. On 13th January, Mr. Philip Wiggins, of 81, Clark Street, was summoned for selling a quantity of unsound condensed milk "Starling Brand" to Mr. Isaac Lewis, of 20, Newark Street. He was fined £2 with £2 2s. costs. On 13th January, Mr. Isaac Lewis, of 20, Newark Street was summoned for exposing for sale on a stall in Salmon Lane, 53 tins of unsound condensed milk "Starling Brand." He was fined £2 with £1 1s. costs. On 17th January, Mr. J. Hodges, was summoned for failing to remedy the defective condition of the roof and to cleanse the walls and ceilings of 92, Stepney Green. He was fined 10s. with £3 3s. costs. On 18th January, Messrs. C. C. & T. Moore, were summoned for failing to provide a proper ashpit at 3, Clark Street. The summons was dismissed with £3 3s. costs. On 18th January, Mr. H. J. Leinehantz, was summoned for failing to remedy defective yard paving of 15, Heneage Street. He was fined £1 with £2 2s. costs. 42 On 18th January, Mr. D. Galinski, was summoned for failing to remove an accumulation of filth in the yard of 5, Chicksand Place. He was fined £5 with £2 8s. costs, and an order was made to abate the nuisance within 3 days. On 18th January, Mr. D. Galinski, was summoned for failing, to remedy the defective rain-water pipe at 7, Chicksand Place. An order was made to abate the nuisance within 7 days with £2 8s. costs. On 20th January, Mr. J. Donn, was summoned for failing to remedy the dirty and defective condition of the walls and ceilings at 32, Grove Street. An order was made to do the work within 7 days with £2 8s. costs. On 20th January, Mr. Rosen, was summoned for failing to repair the roof gutter, and to cleanse the walls and ceilings of at 60, Wicker 'Street. An order was made to do the work within 7 days with £2 8s. costs. On 20th January, Mr. Rymer, was summoned for failing to repair the floors and to cleanse the walls and ceilings of 102, Grove Street. An order was made to do the work within 7 days with £2 8s. costs. On 25th January, Mr. Lyons, was summoned for failing to comply with the Magistrate's order to cleanse the walls and ceilings, and repair the roof, floors and gutters of 17, Grove Street. He was fined £2 with £4 4s. costs. On 1st February, Mr. D. Galinski, was summoned for failing to supply a dust receptacle to 18, Scarborough Street. He was fined 10s. with £2 2s. costs. On 1st February, Mr. D. Galinsky, was summoned for failing to repair the defective roof, etc., at 18, Scarborough Street. He was fined 10s. with £2 2s. costs. On 2nd February, Mr. D. Galinski, was summoned for failing to abate a nuisance at 131, Jubilee Street. An order had been previously made by the Magistrate to do the work. He was fined 10s. with £2 2s. costs. On 3rd February, Mr. C. Edmunds, was summoned for failing to comply with the Magistrate's order to carry out sanitary work at 27, St. Thomas' Road. He was fined £3 with £2 4s. costs. On 10th February, Mr. W. Garten, was summoned for failing to remedy the defective roof, etc., at 4, Matilda Place. He was ordered to pay £2 8s. costs. On 10th February, Mr. W. Garten, was summoned for failing to provide a dust receptacle at 4, Matilda Place. He was fined £2 with £2 2s. costs. 43 On 15th February, Mr. J. Donn, was summoned for failing to comply with the Council's notice to cleanse and do the necessary repairs at 38, Buxton Street. The work having ibeen completed (before the hearing, the summons was withdrawn on payment of £2 4s. costs. On 15th February, Mr. J. Donn, was summoned for failing to comply with the Council's notice to cleanse and do the necessary repairs at 121, Hanbury Street. The work having been completed before the hearing, the summons was withdrawn on payment of £2 4s. costs. On 22nd February, Mrs. Rose Cohen, was summoned for failing to abate a nuisance arising from a defective roof at 50, Weaver Street. She was ordered to pay £1 8s. costs. On 22nd February, Mrs. Rose Cohen, was summoned for failing to abate a nuisance arising from a defective roof at 60, Weaver Street. She was ordered to pay £1 8s. costs. On 24th February, Mr. D. Galinski, was summoned for failing to repair yard paving and eaves gutters at 20, Scarborough Street. He was fined £1 with £2 2s. costs. On 24th February, Mr. D. Galinski, was summoned for failing to repair the roofs of house and scullery, and the kitchen stove at 22, Scarborough Street. An order was made to do the work within 14 days with £2 8s. costs. On 24th February, Mr. D. Galinski, was summoned for failing to repair the roof of scullery, and for not cleansing the ground floor rooms at 24, Scarborough Street. The work having been done at the time of hearing, the summons was withdrawn. On 24th February, Mr. D. Galinski, was summoned for failing to repair the roof of house and scullery, and kitchen stove at 26, Scarborough Street. An order was made to do the work within 14 days with £2 8s. costs. On 8th March, Mr. Dubowski, was summoned for failing to repair the roof gutters of 13, Christian Street. An order was nade to do the work within 7 days with £3 3s. costs. On 8th March, Mr. Bonner, was summoned for failing to reinstate the brickwork, and repair the floor, and window sashes of 98, Christian Street. An order was made to do the work within 30 days with £1 1s. costs. On 11th March, Messrs. Franks & Simons, were summoned for failing to repair and cleanse 74, Ben Jonson Road. The work having been completed before the hearing, the summons was withdrawn on payment of £4 8s. costs. 44 On 18th March, Mr. Isowitsky, was summoned for failing to repair roof, walls, and floor at 3 & 4, Durer Place. An order was made to do the work in 7 days with £2 8s. costs. On 18th March, Mr. W. Rutkowski, was summoned for failing to repair W.C. flushing apparatus, and cleanse the walls and ceilings of 8, Stutfield Street. An order was made to do the work within 14 days with £2 8s. costs. On 18th March, Mr. W. Rutkowski, was summoned for failing to repair the defective sashes, and cleanse the walls of 4, Mary Ann Street. An order was made to do the work within 14 days. On 18th March, Mrs. B. Gales, was summoned for failing to repair w.c. flushing apparatus, and cleanse the walls and ceilings of 59, Cable Street. An order was made to do the work within 14 days with £2 8s. costs. On 18th March, Mr. J. Donn, was summoned for failing to provide proper w.c. accommodation at 5, Durer Place. An order was made to do the work within 7 days with £2 8s. costs. On 18th March, Mr. J. Donn, was summoned for failing to repair the roof, defective floor and gutters of 22, Christian Street. The work having been completed before the hearing of the summons, he was fined 5s. with £2 2s. costs. On 18th March, Mr. Cook, was summoned for failing to repair yard paving, floor and roof, and cleanse walls and ceilings of 19, Mary Ann Street. The work having been completed before the hearing, the summons was withdrawn on payment of £2 4s. costs. On 22nd March, Mr. L. Seigenberg, occupier of the first floor front room, 93, Cleveland Street, was summoned for failing to cleanse the flooring, bed and bedding of the said room. An order was made to abate the nuisance within 7 days, with £2 8s. costs. On 24th March, Mr. I. Solomons, was summoned for failing to remedy defective condition of the roof of 23, Paragon Mansions. An order was made to do the work within 7 days with £2 8s. costs. On 24th March, Mr. I. Solomons, was summoned for failing to cleanse the walls and ceiling of the front room of 29, Paragon Mansions. He was fined £2 with £2 2s. costs. On 24th March, Messrs. Franks & Simons, were summoned for not complying with the Council's notice to repair the defective roof of w.c., cleanse dirty walls and ceilings, repair paving of yard, flooring, and flushing apparatus at 55, Church Row. An order was made to do the work within 14 days with £2 8s, costs. 45 On 30th March, Mr. J. Posner, occupier of the first floor room at 44, Langdale Street, was summoned for failing to abate nuisance by keeping four cats in the room. Defendant, having reduced the number of cats by two, was ordered to pay £1 1s. costs. On 30th March, Mr. W. Ravchick, was summoned for failing to repair yard paving, floors and window sashes, and cleanse walls and ceilings of 44, Langdale Street. An order was made to do the work within 14 days with £2 8s. costs. On 20th April, Mr. J. Bonner, was summoned for failing to remedy damp walls and repair roof, stairs, and floor of 94, Christian Street. An order was made to do the work within 28 days with 6s. costs. On 20th April, Mr. Bonner, was summoned for failing to repair yard paving and W.C. of 96, Christian Street. An order was made to do the work within 28 days with 6s. costs. On 25th April, Mr. W. Rutkowski, was summoned for failing to abate nuisances arising from the dilapidated condition of 118, Cable Street. An order was made to do the work within 21 days with £2 8s. costs. On 25th April, Mr. Silverstone, was summoned for not complying with the Council's notice to reinstate the water supply of 16, Taylors Place. The work having been done at the hearing, the summons was withdrawn on payment of £2 4s. costs. On 2nd May, Mr. C. De Winton, was summoned for failing to provide a proper sanitary dust receptacle at 2, Dorset Street. He was fined 10s. with £2 2s. costs. On 2nd May, Mr. C. De Winton, was summoned for failing to provide a proper sanitary dust receptacle at 4, Dorset Street. He was fined 10s. with £2 2s. costs. On 2nd May, Mr. C. De Winton, was summoned for failing to repair the yard paving in accordance with the Council's notices at 4, Dorset Street. He was ordered to do the work within 14 days with £1 7s. costs. On 2nd May, Mr. C. De Winton, was summoned for failing to provide a proper sanitary dust receptacle at 8, Dorset Street. He was fined 10s. with £2 2s. costs. On 2nd May, Mr. C. De Winton, was summoned for failing to cleanse and repair 8, Dorset Street. He was ordered to do the work within 14 days with £1 7s. costs. On 2nd May, the Owner of 417, Cable Street, (Mr. J. Hodges), was summoned for failing to cleanse and repair the house in accordance with the Council's notice. He was ordered to do the work within 14 days with £2 8s. costs. 46 On 3rd May, Mr. I. Green, was summoned for failing to provide a proper sanitary dust receptacle at 101, Cephas Street. He was fined £2 with £2 2s. costs. On 17th May, Mr. Margolinsky, was summoned for failing to repair W.C. and cleanse walls and ceilings of 57, Cable Street. An order was made to do the work within 14 days with £2 8s. costs. On 17th May, Mr. J. Donn, was summoned for failing to repair flooring, sashes, and ceilings of 5, Stutfield Street. The work having been done at the hearing of the summons he was fined 10s. with £3 3s. costs. On 24th May, Mr. L. Ratzker, was summoned for failing to provide a proper sanitary dust receptacle to tenement "A", 50, Vallance Road. He was fined £3 including costs. On 24th May, Mr. L. Ratzker, was summoned for failing to remedy defective roof, skylight, water closet, and dirty and dilapidated condition of middle room of tenement "C", 48, Vallance Road. He was fined £2 including costs. On 24th May, Mr. L. Ratzker, was summoned for failing to remedy defective water closets of tenements "A" and "B", 50, Vallance Road. He was fined £2 including costs. On 26th May, Mr. E. Rayner, was summoned for failing to provide a sanitary dust receptacle at 33, Gold Street. The receptacle having been provided before the hearing of the summons he was ordered to pay £1 3s. costs. On 27th May, Mr. J. Donn, was summoned for failing to abate nuisances arising from the defective condition of the roof, etc., at 82, Cable Street. An order was made to abate the nuisances within 21 days with £2 8s. costs. On 1st June, the Owner of 9, Matlock Street, (Agent, Mr. A. Benabo), was summoned for failing to comply with the Council's notice to cleanse walls and ceilings. The work being in hand at the time of hearing of the summons, an order was made to complete the work within 14 days with £2 8s. costs. On 10th June, Mr. C. De Winton, was summoned for not obeying Magistrate's order of the 2nd May, 1921, to repair the yard paving, in 14 days, at 4, Dorset Street. He was fined 10s. with £2 4s. costs. 47 On 10th June, Mr. C. De Winton, was summoned for failing to comply with the Magistrate's order to repair floors, walls, and roof at 8, Dorset Street. He was fined 10s. with £2 4s. costs. On 13th June, Mr. Bonner, owner of 98, Christian Street, was summoned for failing to comply with the Magistrates order to repair floor, walls, roof, etc. The Magistrate inspected the premises on the 6th June. At the hearing, the defendant in the box, pleaded that he was without means and unable, to carry out the work. The Magistrate dismissed the summons. On 14th June, Mr. H. Warman, was summoned for failing to repair roof, yard paving, and w.c. of 61, Cable Street. The work having been done at the hearing of the summons, he was ordered to pay £2 2s. costs. On 14th June, Mr. H. Warman, was summoned for failing to repair roof, w.c. and cleanse walls and ceilings of 63, Cable Street. The work having been done at the hearing of the summons he was ordered to pay £1 1s. costs. On 14th June, Mr. H. Warman, was summoned for failing to repair roof, w.c. and cleanse walls and ceilings of 69, Cable Street. The work having been done at the hearing of the summons he was ordered to pay £1 1s. costs. On 14th June, Mr. H. Warman, was summoned for failing to repair roof, w.c. and cleanse walls and ceilings of 73, Cable Street. The work having been done at the hearing of the summons he was ordered to pay £1 Is. costs. On 14th June, Mr. H. Warman, was summoned for failing to provide a proper sanitary dust receptacle at 73, Cable Street. Having provided it before the hearing of the summons he was ordered to pay £1 1s. costs. On 16th June, Mr. H. L. Hutchings, was summoned for failing to provide proper and sufficient supply of water for sanitary and domestic purposes at 55, Ocean Street. An order was made to re-instate same within 7 days with £2 8s. costs. On 16th June, Mr. H. L. Hutchings, was summoned for failing to provide proper and sufficient supply of water for sanitary and domestic purposes at 57, Ocean Street. An order was made to re-instate same within 7 days with £2 8s. costs. 48 On 30th June, Mr. D. Reily, was summoned for failing to abate the nuisances arising from the dilapidated condition of 80, White Horse Lane. An order was made to abate the nuisances within 21 days with £2 8s. costs. On 1st July, Mr. M. Abrahams, was summoned for failing to repair and cleanse 5, Dakin Street. The work having been in hand at the time of the hearing, he was ordered to complete it within 14 days with £2 8s. costs. On 7th July, the Owner of 9, Clinton Road, (Agent, C. P. Kitchen), was summoned for failing to abate a nuisance arising from a defective drain. An order was made to abate the nuisance within 21 days with £2 8s costs. On 7th July, the Owner of 11, Clinton Road, (Agent, C. P. Kitchen), was summoned for failing to abate a nuisance arising from a defective drain. An order was made to abate the nuisance within 21 days with £2 8s. costs. On loth July, Mr. Wolmark, was summoned for failing to cleanse walls and ceilings, and to repair floor and stairs of 33, Crellin Street. An order was made to do the work within 14 days with £2 8s. costs. On 15th July, Mr. Levy, was summoned for failing to repair water and waste pipes at 6, Sander Street Buildings. The work having been done at the time of hearing of the summons, he was fined 10s. with £2 4s. costs. On 15th July, Mr. Roonick, was summoned for failing to comply with Magistrate's order to cleanse walls and ceilings of first floor rooms of 14, Langdale Street. He was fined £1 with £2 4s. costs. On 29th July, the Owner of 26, Knott Street, (Agent, Mr. A. Benabo), was summoned for failing to repair defective roof, and to cleanse premises. An order was made to do the work within 21 days with £2 8s. costs. On 29th July, Mr. A. Benabo, was summoned for failing to provide a proper sanitary dust receptacle at 26, Knott Street. He was fined £1 with £2 2s. costs. On 2nd August, Mr. H. Woolf, was summoned for not providing water closet for men employed in workplace at 41, Leman Street, within the time specified in the notice. He was fined 1s. with £2 4s. costs. On 10th August, Mr. C. De Winton, was again summoned for failing to provide a proper sanitary dust receptacle at 2, Dorset Street. He was fined £2 with £2 4s. costs, 49 On 10th August, Mr. C. De Winton, was again summoned for failing to provide a proper sanitary dust receptacle at 4, Dorset Street. He was fined £2 with £2 4s. costs. On 10th August, Mr. C. De Winton, was again summoned for failing to provide a proper sanitary dust receptacle at 8, Dorset Street. He was fined £2 with £2 4s. costs. On 10th August, Mr. C. De Winton, was again summoned for failing to comply with the Magistrate's order to repair the yard paving at 4, Dorset Street. He was fined £2 with £2 4s. costs. On 10th August, Mr. C. De Winton, was again summoned for failing to comply with the Magistrate's order to repair and cleanse the walls and ceilings of 8, Dorset Street. He was fined £2 with £2 4s. costs. On 7th September, Mr. D. J. Josyfon, was summoned for failing to abate a nuisance caused by the defective flushing apparatus, roof and water closet of 155, Ernest Street. An order was made to do the work within 14 days with £2 8s. costs. On 3rd October, Mr. W. Rutkowski, was summoned for failing to remedy defective yard paving, etc., at 9, Mary Ann Street. An order was made to do the work within 14 days with £2 8s. costs. On 3rd October, Mr. W. Rutkowski, was summoned for failing to remedy defective roof and sashes, and cleanse the walls and ceilings at 19, Pinchin Street. An order was made to do the work within 28 days with £2 8s. costs. On 19th October, Mr. L. Wolmark, was summoned for failing to comply with the Magistrate's order to repair floor and stairs of 33, Crellin Street. He was fined £5 with £3 3s. costs. On 19th October, Mr. Goldstine, was summoned for failing to cleanse verminous rooms at 86, Grove Street. The work having been done at the time of hearing of the summons he was fined 10s. with £3 3s. costs. On 19th October, Mr. W. Rutkowski, was summoned for failing to cleanse the walls and ceilings and repair the stairs and w.c. of 14, Mary Ann Street. An order was made to do the work within 14 days with £2 8s. costs. On 19th October, Mr. Wicks, was summoned for failing to repair gutters at Doris Houses. An order was made to do the work within 7 days with £2 8s. costs. 50 On 21st October, Mr. A. Pinhorn, was summoned for failing to repair yard paving, flooring, stoves, sashes, plaster of walls, and to cleanse walls and ceilings of rooms at 53a, Three Colt Street. The case was adjourned sine die to enable him to do the work. On 21st October, Mr. A. Pinhorn, was summoned for failing to cleanse walls and ceilings and to repair skylight and sashes of 55, Three Colt Street. The case was adjourned sine die to enable him to do the work. On 21st October, the Owner of 81, Thomas Street, was summoned for failing to cleanse the walls and ceilings and to repair sashes. An order was made to do the work within 14 days with £2 8s. costs. On 28th October, Mr. T. W. Thwaits, was summoned for failing to repair a defective drain at 7, James Place. An order was made to do the work within 28 days with £2 8s. costs. On 28th October, Mr. T. W. Thwaits, was summoned for failing to repair a defective drain at 49, James Place. An order was made to do the work within 28 days with £2 8s. costs. On 28th October, Mr. T. W. Thwaits, was summoned for failing to repair a defective drain at 50, James Place. An order was made to do the work within 28 days with £1 7s. costs. On 31st October, Mrs. Riches, of 3, Fair Street, was summoned for assaulting Inspector Quaintrell, on 6th October, while in the execution of his duties. She was fined £2 or 21 days' hard labour. On 1st November, Mr. T. C. King, was summoned for failing to remedy the damp, dirty and defective condition of walls and ceilings of first and second floor rooms at 30, Vallance Road. An order was made to do the work within 14 days. On 1st November, Mr. R. Bridges, was summoned for failing to remedy the defective roof of 48, Braintree Street. An order was made to do the work within 7 days with £2 7s. costs. On 1st November, Messrs. Kyffin & Kyffin, were summoned for failing to remedy the defective flushing apparatus of 42, Essex Street. They were fined 10s. with £2 2s. costs. On 1st November, Messrs. Franks & Simons, were summoned for failing to remedy defective yard paving at 11, Eagle Place. The work having been done at the time of hearing of the summons, they wr.re ordered to pay £2 2s. costs. 51 On 7th November, Mr. W. Rutkowski, was summoned for failing to remedy the defective flooring, and to cleanse walls and ceilings at 6, Severne Street. An order was made to do the work within 14 days with £2 8s. costs. On 7th November, Mr. W. Rutkowski, was summoned for failing to cleanse the walls and ceilings at 5, Ellen Place. An order was made to do the work within 14 days with £2 8s. costs. On 7th November, Mr. W. Rutkowski, was summoned for failing to cleanse the walls and ceilings, and to remedy the defective roof, sashes, and yard paving of 27, Pinchin Street. An order was made to do the work within 14 days with £1 7s. costs. On 11th November, Messrs. C. C. & T. Moore, were summoned for failing to provide a proper supply of water to 142, Globe Road. The summons was dismissed. The Magistrate held that, under the terms of the lease of the premises, which was produced, the occupier was responsible for all water and other charges. On 24th November, Messrs. Wilks & Co., were summoned for failing to remedy the defective w.c., yard paving, and main roof, and to cleanse the dirty walls and ceilings at 62, Red Lion Court, Wapping. An order was made to do the work within 14 days with £2 8s. costs. On 24th November, Messrs. Wilks & Co., were summoned for failing to remedy the defective w.c., and damp, dilapidated and dirty walls and ceilings of 7, Red Lion Court. An order was made to do the work within .14 days with £2 8s. costs. On 29th November, Mr. G. A. McDowall, was summoned for failing to provide a proper sanitary dust receptacle at 21, Ronald Street. He was fined 1s. with £2 2s. costs. On 29th November, Mr. G. A. McDowall, was summoned for failing to cleanse and do the necessary repairs at 21, Ronald Street. He was ordered to do the work within 14 days, with £1 7s. costs. On 29th November, Mr. G. A. McDowall, was summoned for failing to supply a proper sanitary dust receptacle at 23, Ronald Street. He was fined 1s. with £2 2s. costs. On 29th November, Mr. G. A. McDowall, was summoned for failing to cleanse and repair the defects at 23, Ronald Street. An order was made to do the work within 14 days with £1 7s. costs. On 29th November, Mr. G. A. McDowall, was summoned for failing to cleanse and repair the defects at 25, Ronald street. An order was made to do the work within 14 days with £1 7s. costs. 52 On 29th November, Mr. G. A. McDowall, was summoned for failing to provide a proper sanitary dust receptacle at 25, Ronald Street. He was fined 1s. with £1 1s. costs. On 29th November, Mr. G. A. McDowall, was summoned for failing to provide a proper sanitary dust receptacle at 27, Ronald Street. He was fined 1s. with £1 1s. costs. On 29th November, Mr. G. A. McDowall, was summoned for failing to cleanse and repair the defects at 27, Ronald Street. An order was made to do the work within 14 days with £1 7s. costs. On 1st December, Mrs. A. Jacobs, was summoned for failing to remedy the defective roof, and to cleanse the dirty and verminous rooms at 55, Cephas Street. An order was made to do the work within 14 days with £1 6s. costs. On 1st December, Mrs. A. Jacobs, was summoned for failing to provide a proper sanitary dust receptacle at 55, Cephas Street. The receptacle having been supplied before the time of hearing of the summons, she was ordered to pay £1 6s. costs. On 1st December, Mrs. A. Jacobs, was summoned for failing to remedy the defective roof, and to cleanse the dirty and verminous rooms at 57, Cephas Street. An order was made to do the work within 14 days with £1 6s. costs. On 6th December, Messrs. A. & A. Field, were summoned for failing to remedy the defective roof and stove at a workshop situated in 40, Crellin Street. An order was made to do the work within 14 days with £2 8s. costs. On 6th December, Messrs. A. & A. Field, were summoned for failing to remedy the defective roof and floor at 42, Crellin Street. An order was made to do the work within 14 days with £2 8s. costs. On 6th December, Mr. W. Rutkowski, was summoned for failing to remedy the defective roof, sashes, and drain of 8, Severne Street. The work having been done at the time of hearing of the summons, he was ordered to pay £2 4s. costs. On 20th December, Mr. J. H. L. Bishop, was summoned for failing to remedy the defective walls, windows, and threshold of water closet of 5, Great Pearl Street. The work having been done at the time of hearing of the summons, it was withdrawn on payment of £2 4s. costs. 53 On 20th December, Mr. J. H. L. Bishop, was summoned for failing to remedy the defective yard paving at 7, Great Pearl Street. The work having been done at the time of hearing of the summons, it was withdrawn on payment of £2 4s. costs. II. UNDER THE BY-LAWS FOR HOUSES LET-IN-LODGINGS. On 8th November, Mr. M. Lamp, lodger, of 32, Heneage Street (two rooms on ground floor), was summoned under Bye-law 12, Houses let-inlodgings for failing to cleanse the floors, woodwork, furniture, etc. He was fined 20s. with 20s. costs. III. UNDER THE LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1904. On 7th March, Mr. D. Galinski, was summoned for failing tocleansethe verminous rooms at 22, Scarborough Street. He was fined £2 with £3 3s. costs. On 22nd August, Mr. W. Rosenberg, was summoned for failing to failing to cleanse the verminous rooms at 7, Milward Street. The case was adjourned for 21 days for the work to be completed. At the resumed hearing on the 12th September, nothing having been done, he was fined £3 3s. with £2 2s. costs. On 22nd August, Mr. W. Rosenberg, was summoned for failing to cleanse the verminous rooms at 8, Milward Street, The case was adjourned for 21 days for the work to be completed. At the resumed hearing on the 12th September, nothing having been done, he was fined £3 3s. with £2 2s. costs. On 2nd December, Mr. I. White, of 10, King John Street, was summoned for failing to cleanse the verminous beds, bedding, walls and ceilings of first floor back room. He was fined 10s. with £2 2s. costs. IV. UNDER THE DAIRIES, COWSHEDS, AND MILKSHOPS ORDER, 1885. On 13th January, Mr. Herbert Davis, of 75, Laburnham Street, Shoredltch, was summoned for selling milk without being registered. He was fined 40s. On 13th January, Mrs. Nellie Rhodes, of 231, Kingsland Road, was summoned for aiding and abetting Herbert Davis in selling milk without being registered. The summons was dismissed. 54 On 13th June, Mr. Jack Firmin, of 3, Raven Row, was summoned for selling milk from a receptacle not having his name and address inscribed thereon. He was fined £2 with £3 3s. costs. Housing Conditions Statistics,—1921. Ministry of Health Table. 1.—General. (1) Estimated population 249,738 (2) General death-rate 12.9 per 1,000 (3) Death-rate from tuberculosis 1.38 per 1,000 (4) Infantile mortality 89 per 1,000 (5) Number of dwelling-houses of all classes 38,914 (6) Number of working-class dwelling-houses 38,914 (7) Number of new working-class houses erected 17 2—Unfit Dwelling Houses. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 43,269 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 13,170 (3) Number of dwelling-houses found to be in a state dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 18,302 II.—Remedy of Defects without service of formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 8,3.53 III.—Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, &c„ Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 261 (2) Number of dwelling houses which were rendered fit:— (а) By owners 228 (b) By Local Authority in default of owners 31 (3) N umber of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close 2 56 (6) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 18,302 (2) Number of dwelling-houses in which defects were remedied :— (a) By owners 18,302 (b) By Local Authority in default of owners — (c) Proceeding under Section 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made . with a view to the making of Closing Orders — (2) Number of dwelling-houses in respect of which Closing Orders were made — (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — (4) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — 3.—Unhealthy Areas. Areas represented to the Local Authorities with a view to Improvement Schemes under (a), Part I, or (b), Part II., of the Act of 1890:— (1) Name of area Nil (2) Acreage — (3) Number of working-class houses in area — (4) Number of working-class persons to be displaced — 4.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 — 5.—Staff engaged on Housing work with briefly, the duties of each Officer 4* *4 special Sanitary Inspectors (2 being temporary) are engaged in the administration of the Housing Acts, more especially with respect to Section 28 of the Housing, Town Planning, &c., Act, 1919. 56 London County Council Table. Premises, No. on register at end of 1921. Number of inspections. Number of prosecutions. Cowsheds 25 109 — Milkshops 419 1,442 — Houses let in lodgings 2,512 4,028 — Ice cream premises 137 260 — Slaughterhouses 3 9 — Offensive trades 7 26 — Smoke Nuisances. No. of observations 318 No. of notices 38 Housing of the Working Classes. No. of houses inspected — No. of representations by householders — No. of representations by Medical Officer — No. of houses included in such representations — No. of houses remedied without Closing Orders — No. of demolition orders — Obstructive Buildings. No. of representations under Section 38 of the Housing Act, 1890 No. of representations still under consideration No. of Orders for repairs issued under Section 28 of the Housing Act, 1919 - 261 No. of nuisances and complaints 79 No. of summonses — No. of houses dealt with under Section 15 of the Housing, Town Planning, &c., Act., 1909 — No. of Closing Orders — No. of houses included in such Closing Orders — No. of Closing Orders determined — No. of houses demolished :— (а) in pursuance of orders — (б) voluntarily 2 No. of buildings demolished — No. of houses repaired by Local Authorities 31 No. of houses closed on notice by owner that they could not be made fit 2 57 Obstructive Buildings—continued. Total number of houses in the borough 38,914 No. of houses for the workingclasses :— (а) erected during year 17 (b) in course of erection 15 Underground Rooms. No. illegally occupied 11 Overcrowding. No. of rooms overcrowded 56 Prosecutions — Cleansing. No. of adults cleansed 465 No. of children cleansed 302 Water Supply to Tenement Houses. Premises supplied 2 Sale of Food. No. of premises used other than ice cream premises, milk shops and cowsheds 461 Disinfection Shelter. Persons accommodated 66 No. of houses occupied by the working-classes 38,914 No. closed or illegal occupation discontinued 11 No. remedied 56 No. of rooms or premises cleansed 3,032 Prosecutions — No. of inspections 12,663 Ophthalmia Neonatorum Regulations. No. of notifications received during the year from certified midwives 1 Sanitary Officers. No. of Sanitary Inspectors (Whole time)—Male, 20*. Female, Nil. ,, ,, (Part time)—Male, Nil. Female, Nil. No. of Health Visitors—Whole time, 11. Part time, Nil. *2 temporary. House to House. Number of Inspections 13,170 Number of Houses where defects have been found to exist 8,117 Number of houses where Intimation Notices have been served 8,117 Number of houses where Statutory Notices have been served 3,792 58 TOTAL FINES AND COSTS. Fines. Costs. £ S. d. £ S. d. Under the Public Health (London) Act, for various nuisances 51 1 0 241 17 0 Margarine Acts 21 2 6 26 5 6 London County Council (General Powers) Act, 1904 8 16 0 9 9 0 Food and Drugs Acts 88 0 0 83 14 0 Unsound Food 19 0 0 8 8 0 Dairies, Cowsheds and Milkshops Orders 4 0 0 3 3 0 Bye-laws Houses-Let-in-Lodgings 1 0 0 1 0 0 Total £192 19 6 £373 16 6 Factories and Workshops. The total number of workshops on the Register was 3,033; but this does not include factories, workplaces and out-workers' premises. 3,587 inspections to factories, workshops and workplaces revealed defects, which necessitated the service of 1,236 written notices. 55 of the notices referred to factories, 1,130 to workshops including workshop laundries, and 51 to workplaces other than out-workers' premises. Cleanliness. —533 notices were served to cleanse workshops. Ventilation—The ventilation of 79 workshops was improved. Overcrowding.— Overcrowding was abated in 10 workshops. Sanitary Accommodation.— The sanitary accommodation was improved in 282 workshops by providing additional and suitable water-closets. 296 other nuisances were remedied in workshops. Out-workers' Premises.- 1,180 inspections were made to out-workers' premises during the year; 119 premises were found to be insanitary, and 500 cases of notifiable infectious diseases occurred therein. 59 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—INSPECTIONS. Premises. Number. Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 538 55 ... Workshops (Including Workshop Laundries) 2,864 1,130 ... Workplaces (Other than Outworkers premises) 185 51 ... Total 3,587 1,236 ... 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 533 533 ... ... Want of ventilation 79 79 ... ... Overcrowding 10 10 ... ... Want of drainage of floors ... ... ... ... Other nuisances 296 296 ... ... Sanitary Accommodation insufficient 30 30 ... ... unsuitable or defective 218 218 ... ... not separate for sexes* 34 34 ... ... 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) 33 33 ... ... Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) 3 3 ... ... Total 1,236 1,236 ... ... *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 60 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 222 402 966 37 27 84 .. .. .. 114 114 474 13 .. (2) Cleaning and Washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Household linen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Curtains and furniture hangings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. Electro plate .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. File making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur pulling (Furriers) 2 .. 3 .. .. .. .. .. .. 5 5 .. 8 .. .. Cables and chains .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c. .. .. .. .. .. .. .. .. .. .. .. .. 7 .. .. Artificial flowers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. Sacks 2 .. 4 1 .. 1 .. .. .. .. .. .. .. .. .. Racquet and tennis balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper, &c., boxes, paper bags 16 .. 71 1 .. .. .. .. .. .. .. .. 5 .. .. Brush making 4 .. 6 .. .. .. .. .. .. .. .. .. 2 .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Stuffed toys 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chocolates and sweetmeats .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cosaques, Christmas crackers, Christmas stockings, &c. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Textile weaving .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 250 402 1,052 40 27 85 .. .. .. | 119 119 .. 500 13 .. 61 4—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year 1921. Number. (1) (2) Bakehouses 159 Boot, Shoe and Slipper Making 145 Cabinet Making 122 Furriers 150 Hat and Cap Manufacturers 88 Miscellaneous 411 Laundries 11 Rag Sorting, etc. 71 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) - 1,876 Total . 3,033 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) - — Action taken in matters referred/ Notified by H.M. by H.M. Inspectoras remediable Inspector under the Public Health Acts, Reports (of action but not under ihe Factory and taken) sent to H.M. Workshop Acts (s. 5, 1901) Inspector 447 424 Other 23 Underground Bakehouses (s. 101) :— Certificates granted during the year — In use at the end of the year - 57 62 List of Cowsheds. No of Cows kept in October. No. of Cows licensed to be kept 21a, Black Lion Yard 46 56 63, Brook Street 19 19 134, Charles Street 6 14 77,Commercial Road 25 26 185, 186, Railway Arches, Drewton Street 41 41 18, Fairclough Street 56 56 37, Hanbury Street 18 18 12, Hilton Street 10 10 42, Jubilee Street 42 44 15, Maroon Street 11 12 25, Norfolk Street 34 56 46, Old Church Road 96 148 64, Pelham Street 16 16 56, Princes Square 36 36 5, Russell Street — 8 33, St. Anns Road 19 19 Saw Yard 8 8 1, Sidney Street 18 21 150, Sidney Street 20 20 15, Tilley Street 14 14 9 and 11, Umberston Street 12 14 1, Upper Chapman Street 12 12 64, White Horse Lane 16 14 37, White Horse Street 12 29 587 719 List of Slaughter Houses. 2, High Street, Whitechapel. 3, High Street, Whitechapel. 199, Mile End Road. List of Knackers' Yards. 19, Winthrop Street. 63 Causes of, and Ages at Death during the Year. Metropolitan Borough of Stepney. Causes of Death 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 Ages. Enteric Fever ... ... ... ... ... 1 1 ... 2 Small Pox ... ... ... ... ... ... ... ... ... Measles 11 18 6 5 1 ... ... ... 41 Scarlet Fever 2 4 14 2 ... 1 ... ... 23 Whooping Cough 8 12 4 ... ... ... ... ... 24 Diphtheria and all deaths from Croup (except "spasmodic" "False" " stridulous " and " catarrhal") 6 16 31 32 1 1 ... ... 87 Influenza ... ... ... 4 3 5 11 19 42 Erysipelas 1 ... ... ... ... ... 3 ... 4 Cerebro- Spinal Fever ... 1 ... ... ... ... ... ... 1 Typhus Fever ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... 1 1 2 4 Glanders ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... Lead Poisoning ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) ... ... ... 3 53 123 105 15 299 Tuberculous Meningitis (Acute Hydrocephalus) 6 8 6 9 2 ... ... ... 31 Other Tuberculous Diseases 1 1 2 1 1 3 3 4 16 Rheumatic Fever ... ... 1 1 2 ... ... ... 4 Cancer, malignant disease (Sarcoma, Rodent Ulcer, etc.) ... ... ... ... ... 30 139 94 263 Bronchitis 18 5 2 1 ... 16 114 189 345 Broncho-Pneumonia 68 37 17 5 2 14 23 29 195 Pneumonia (all other forms) 7 14 10 7 12 40 71 32 193 Other diseases of Respiratory Organs 2 ... ... ... 1 4 7 1 15 Diarrhoea and Enteritis (all deaths from Diarrhoea, except those secondary to some well defined disease) 143 27 3 ... ... 2 5 ... 180 Appendicitis and Typhlitis ... ... 1 6 5 6 6 3 27 Alcoholism, Delirium Tremens, acute and chronic alcoholism (but not those from organic disease due to alcoholism) ... ... ... ... ... 1 1 ... 2 Cirrhosis of Liver ... ... ... ... ... 1 4 7 12 Nephritis and Bright's Disease 2 ... 1 1 5 9 47 21 86 Puerperal Fever ( Pyaemia, Septicaemia, Saprasmia, Pelvic Peritonitis,Peri- and EndoMetritis occurring in the Puerperium) ... ... ... ... 2 5 1 ... 8 Other accidents and diseases of Pregnancy and Parturition 13 ... ... ... ... 2 ... ... 15 Congenital Debility and Malformation, includ ing Premature Birth, Atrophy, Marasmus, want of Breast Milk, but not from Atelectasis 210 ... ... ... ... ... ... ... 210 Violent Deaths, excluding Suicide 11 3 5 15 6 17 24 25 106 Suicides ... ... ... ... 1 7 13 7 28 Heart Disease 1 1 ... 9 16 39 122 126 314 Old Age ... ... ... ... ... ... 1 150 151 Other Defined Diseases 36 11 7 24 16 81 174 147 496 Diseases ill-defined or unknown 3 3 1 ... 1 1 1 3 13 Encephalitis Lethargica 1 ... ... ... ... 2 1 1 5 Acute Poliomyelitis ... ... ... 1 ... ... ... ... 1 Polio Encephalitis ... ... ... ... 1 ... ... ... 1 Total 550 161 111 126 131 412 878 875 3,244 Follow page 62 64 Cases of Infectious Disease notified during the Year. 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) 956 33 340 466 75 35 7 ... 197 146 452 161 951 Erysipelas 132 8 3 11 20 31 45 14 14 17 58 43 32 Scarlet Fever 1996 22 561 1245 117 49 2 ... 299 390 768 539 1970 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 20 ... 2 8 3 4 3 ... 3 5 10 2 19 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ...... ... ... ... ... Puerperal Fever 21 ... ... ... 6 14 1 ... 3 2 8 8 21 Cerebro - spinal Meningitis 6 3 2 ... ... 1 ... ... 4 ... 2 ... 6 Poliomyelitis 1 ... 1 ... ... ... ... ... ... ... ... 1 1 Polioencephalitis 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 Ophthalmia Neonatorum 42 42 ... ... ... ... ... ... 11 6 17 8 11 Pulmonary Tuberculosis 573 1 9 83 103 234 130 13 110 98 244 121 377 Other forms of Tuberculosis 110 3 28 69 18 12 9 1 38 23 55 24 63 Encephalitis Lethargica 17 ... ... 4 6 2 4 1 2 3 8 4 10 Total 3905 112 946 1886 349 382 201 29 681 690 1623 911 3462 Follow page 63 65 Infant Mortality. Deaths from stated Causes at Various Ages under One Year of Age for the whole Borough. 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 ... ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 2 3 6 11 Scarlet Fever ... ... ... ... ... ... ... ... 2 2 Diphtheria and Croup ... ... ... ... ... ... ... 3 3 6 Whooping Cough ... ... ... ... ... 2 2 2 2 8 Diarrhoea 1 3 3 ... 7 29 54 29 24 143 Enteritis ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 2 3 6 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Congenital Malformations 6 ... ... ... 6 2 3 ... ... 11 Premature Birth 69 9 13 2 93 4 ... ... ... 97 Atrophy, Debility & Marasmus 6 5 2 6 19 19 16 7 3 64 Atelectasis 11 1 ... 1 13 ... ... 1 ... 14 Injury at Birth 12 1 ... ... 13 ... ... ... ... 13 Erysipelas ... ... 1 ... 1 ... ... ... ... 1 Syphilis ... ... ... 1 2 1 ... ... ... 3 Rickets ... ... ... ... ... ... ... ... 1 1 Meningitis (not tuberculous) ... ... ... ... ... ... 4 3 2 9 Convulsions 7 2 3 ... 12 8 3 ... ... 23 Gastritis ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 2 1 3 3 7 5 ... 18 Pneumomia (all forms) 1 ... 2 l 4 15 24 14 18 75 Suffocation, overlying 4 ... 1 l 6 1 1 ... ... 8 Other causes 3 7 5 l 16 7 5 3 4 35 Encephalitis Lethargica ... ... ... ... ... ... ... ... 1 1 Total 121 28 32 14 195 91 122 72 70 550 METROPOLITAN BOROUGH OF STEPNEY. ANNUAL REPORT OF THE BOROUGH ANALYST For the Year 1921 BY HERBERT HAWLEY, M.Sc., F.I.C., Borough Analyst. Vail & Co., London, E C.l. 67 METROPOLITAN BOROUGH OF STEPNEY. BOROUGH ANALYSTS REPORT To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to present my second Annual Report, dealing with the work carried out in the Borough Laboratories during the year 1921. During the year 1,427 samples were submitted to me for analysis. Of these 1,402 samples were submitted by Inspectors under the Food and Drugs Acts, 17 samples were analysed for the Public Health Department, 7 samples were submitted by private purchasers and 1 sample was examined in accordance with the provisions of the Rag Flock Act. The 1,402 samples taken under the Food and Drugs Act were made up of 935 formal samples and 467 informal samples. Table A shows the nature of the samples taken under the Food and Drugs Acts and gives the numbers and percentages found to be adulterated. Table A. Number of Samples. Number Genuine. Number Adulterated. Percentage Adulterated. Milk 824 787 37 4.5 Margarine 187 179* 8 4.3 Butter 125 122 3 2.4 Cream & Preserved Cream 23 9 14 60.9 Vinegar ... 22 20 2 9.1 Sausage 19 15 4 211 Rice 12 12 — — Whisky 10 6 4 400 Baking Powder 9 9 — — Epsom Salts 9 9 — — Glycerine 9 9 — — Olive Oil 9 9 — — Zinc Ointment 9 9 — — Boric Ointment 8 7 1 12.5 Camphorated Oil 8 8 — — Cocoa 8 8 — — Pure Borax 8 4 4 50.0 Coffee 7 7 — — Gin 7 5 2 28.6 Carried forward 1,313 1,234 79 * 53 samples were not labelled in accordance with the Butter and Margarine Acts. 68 Table A. — Continued. Number of Samples. Number Genuine. Number Adulterated. Percentage Adulterated. Brought forward 1,313 1,234 79 - Ammoniated Tincture of Quinine 6 6 - - Castor Oil 6 6 - — Ground Ginger 6 6 — — Honey 6 6 — — Pepper 6 6 — — Seidlitz Powders 5 3 2 40.0 Lime Water 4 2 2 50.0 Lard 8 8 — — Separated and Skimmed Milk 4 4 - - Sugar 4 4 — — Arrowroot 3 3 — — Glauber Salt 3 3 — — Milk Sugar 3 3 — — Mustard Condiment 3 3 — — Pearl Barley 3 3 — — Rice 3 3 — — Saffron 3 3 — - White Precipitate Ointment 3 2 1 33.3 Bread and Butter 2 — 2 100.0 Self-raising Flour 2 2 — — Tea 3 3 — — Bread and Margarine 1 1 — — Mustard 1 1 — — Sterilised Milk 1 1 — — 1,402 1,316 86 6.1 The number of samples found to be adultered was 86 or 6.1 per cent. Table B shows the number of samples analysed and the number found to be adulterated during the past seven years. Table B. Year. Number of Samples. Number Adulterated. Percentage Adulterated. 1915 1213 154 12.7 1916 1202 147 12.2 1917 1123 120 10.6 1918 1124 123 10.9 1919 1175 70 6.0 1920 1190 55 4.6 1921 1402 86 6.1 69 As there has been a considerable change in the method of administering the Food and Drugs Acts in the Borough during 1921, I do not think it is possible to conclude from these figures that adulteration increased in 1921The table does show, however, that there has been much less adulteration during the last three years than during the war. The percentage of adulteration for the whole of England and Wales in 1920 was 7.1, for the Metropolitan Boroughs 5.1. In previous years each inspector only took samples in the district to which he is attached for sanitary work. These districts are small and the inspectors well known to the inhabitants of them. A fraudulent vendor must have been able to reduce considerably the chances of his being detected by watching the movements of the district inspector. Another point against the old system was that as the inspectors worked independently of each other sampling was very erratic. During some weeks there would be more samples than this laboratory could conveniently deal with, whilst during other weeks there would be very few samples. For 1921 it was arranged that the inspectors should take a week in turn for Food and Drugs sampling only, and that each inspector should cover the whole of the Borough taking a proportion of his samples in each of the districts. This system is much more satisfactory than the old one. There is now always one inspector on sampling duty, and as there is a period of roughly 15 weeks between the same inspector's turns, he works for most of his time in a district in which he is not known and has a much better chance of obtaining samples of adulterated articles. Further, now that samples arrive in the laboratory regularly, I have been able to increase the number per year by about 200. Table C shows the distribution of the 1,402 samples, taken under the Food and Drugs Acts, amongst the various districts. Table C. Number of Samples. Adulterated. Adulterated and Unlabelled. Number. Percentage. Number. Percentage. Mile End 470 29 6.2 44 9.4 Whitechapel 387 21 5.4 42 10.8 St. George's 284 19 6.7 28 9.9 Limehouse 261 17 6.5 25 9.6 1,402 86 6.1 139 9.9 70 Table D shows the number of samples taken by each inspector and gives particulars of offences and proceedings. Table D. Inspector. Samples Taken. Number of Samples. Number of Prosecutions. Adulterated. Unlabelled. Food & Drugs Acts. Butter & Margarine Acts Cook 94 5 - - — Crook 90 1 7 — 2 Dee 91 4 - 4 — Flint 90 5 6 3 4 Johnson 91 6 2 2 2 Mills 95 4 1 4 1 Pavitt 96 15 2 11 2 Quaintrell 101 7 8 2 3 Shepherd 97 5 3 2 — Simpson 92 5 3 3 1 Stiles 90 6 3 4 1 Twaits 90 8 13 1 10 Waterman 100 11 4 — 2 White 92 2 1 2 — Wrack 93 2 — 1 — Total 1,402 86 53 39 28 Legal Proceedings. Legal proceedings were taken in 67 cases, 11 more than in 1920. 39 of the prosecutions were for adulteration and 27 for offences under the Butter and Margarine Acts. The results of the separate proceedings are given later. The total fines imposed amounted to £'109 2s. 6d. Total costs allowed were £109 19s. 6d. The average fine per summons was £1 12s. 7d., and the average of fines and costs together £3 5s. 5d. Table E compares these figures with the fines and costs imposed during the previous six years. Table E. Year. Number of Prosecutions. Total Fines. Total Costs. Average Fine. Average of Fines and Costs. £ s. d. £ s. d. £ s. d. £ s. d. 1915 70 231 18 0 62 11 0 3 6 3 4 4 1 1916 84 416 16 0 66 10 0 4 19 3 5 15 1 1917 55 277 1 0 42 6 0 5 0 9 5 16 2 1918 73 137 12 0 91 6 6 1 17 9 3 2 9 1919 45 90 0 0 75 14 0 2 0 0 3 15 10 1920 56 170 13 0 106 13 0 3 0 11 5 9 6 1921 67 109 2 6 109 19 6 1 12 7 3 5 5 71 Last year a large proportion of the prosecutions were for offences under the Butter and Margarine Acts. This accounts for the reduced average penalty In general magistrates are much more severe in dealing with the offences under the Food and Drugs Acts than when dealing with the offences under the Butter and Margarine Acts. Of the summonses taken out under the Food and Drugs Acts in connection with Milk, 24 led to penalties. The average penalty (fines and costs together) in these 24 cases was £6 2s. l0d. in spite of the fact that in several instances the vendor convinced the court that his wholesale dealer was responsible for the adulteration and had his summons dismissed on payment of costs. Milk. 824 samples of milk were analysed, of which 37, or 45 per cent., were adulterated. Table F shows the number of samples of milk examined and the percentage of adulterated samples for the past seven years. Table F. 1913. 1916. 1917. 1918. 1919. 1920. 1291. Number of samples 868 850 739 737 665 858 824 Percentage of Adulteration 15.0 11.6 12.4 16.0 8.6 5.7 4.5 These figures show that there has been a gradual improvement in the Milk suppy of the Borough since the war. To some extent I consider that the improvement during 1921 may be attributed to the very considerable fall in the price of condensed milk, leading to a reduced demand for new milk. Thus milk vendors found themselves with surplus milk on their hands and there was less temptation to adulterate. The fall in the price of condensed milk was particularly marked during the second half of the year and accounts for the fact that during the first six months of the year 5.2 per cent. of the milk samples were adulterated whilst the corresponding figure for the last half of the year was 36 per cent. The average composition of all the samples of milk analysed, for each month of the year, is shown in table G. 72 Table G. Period Average Composition Total Solids per cent. of all Samples. Solids-not-fat per cent. Fat. per cent. January 12.23 8.58 3.65 February 12.24 8.64 3.60 March 12.42 8.67 3.75 April 12.37 8.70 3.67 May 12.10 8.71 3.39 June 12.11 8.74 3.37 July 11.98 8.54 3.44 August 12.05 8.67 3.38 September 12.26 8.68 3.58 October 12.46 8.80 3.66 November 12.79 8.87 3.92 December 12.42 8.73 3.69 Whole Year 12.30 8.79 3.60 Legal Minimum 11.50 8.50 3.00 In calculating these figures all samples of milk, no matter how grossly adulterated, have been included. As was the case last year the averages show that the bulk of the milk sold in Stepney is of good quality, they also show that the legal minimum for solids-ot-fat is a fair one. The limit for fat appears to me to be too low. Of course certain cows do yield milk containing as little as 3 0 per cent., particularly at the morning milking in the spring months, but as all up-to-date milk production is now under analytical control, I consider that farmers might reasonably be required to reserve such milk for the manufacture of cheese, butter, etc., that the limit for fresh milk shculd be raised, and that it should be made an offence to sell milk below the legal limits, whether the deficiency be due to the cow or to adulteration. Table H gives particulars of the adulterated samples of milk. Table H. Number. Deficient of Fat. per cent. Deficient of Solids-not-fat. per cent. Result. S13 13 9 Vendor paid £2 2s. costs. J16 — 14 Dismissed. Warranty defence. C20 — 7 Vendor cautioned. A25 10 8 Vendor paid £2 4s. costs. N6 — 5 Vendor cautioned. D20 10 - Fined £3 with £2 2s. costs. T17 30 41 Vendor fined £20 with £2 2s. costs. Assistant fined £20 with £3 3s. costs. 73 Table H.— Continued. Number Deficient of Fat. per cent. Deficient of Solids-not-fat. per cent. Result. T19 20 - Dismissed. Warranty defence. B22 - (contained 8 parts per million of Formaldehyde.) Same vendor. Vendor cautioned. B23 - (contained 8 parts per million of Formaldehyde.) L10 16 3 Vendor cautioned. E37 - 4 Fined £2 with £2 2s. costs(same vendor was fined £2 with £2 2s. costs under the Dairies and Cowsheds Orders). E49 3 12 Vendor paid £3 3s. costs. E50 3 14 Vendor paid £3 3s. costs. M49 — 8 Vendor paid £2 2s. costs. M54 13 — Dismissed. Warranty defence. M64 20 — Dismissed. Warranty defence. G35 16 — Vendor paid £2 2s. costs. G50 10 - Fined £1 with £2 2s. costs. G51 13 — Fined £1 with £2 2s. costs. N54 — 4 Vendor cautioned. K53 6 - Vendor cautioned. K55 13 — Vendor paid £5 5s. costs K58 13 — Dismissed. Warranty defence. A50 - 14 Vendor paid £1 1s. costs. S75 26 — Vendor paid £2 costs. H37 10 6 Fined £1 with £2 costs. B39 — 25 Vendor paid £4 4s. costs. E72 10 — Dismissed. Warranty defence. E73 23 14 Vendor paid £5 5s. costs. E77 - 4 Informal sample. Vendor fined £5 with £5 5s.costsforobstructing the Inspector. Summons for refusal to serve withdrawn. J70 — 12 Vendor paid £2 costs. T39 — 10 Vendor paid £4 4s. costs. K79 36 — Fined £5. H84 — 13 Fined £5 with £2 2s. costs (previous conviction). F90 — 9 Vendor cautioned. B76 46 - Fined £15 with £5 5s. costs (previous conviction). N.B.— Solids-not-fat are in solution in milk. They do not separate on standing, and cannot be removed by mechnical means. Accordingly a deficiency of solids-not-fat points to the addition of water. Watering, of 74 course, lowers the percentage of fat equally with that of the solids-not-fat, but when the deficiency of fat exceeds that of the solids-not-fat, or is the only deficiency, then some of the fat has been removed by skimming or,—what comes to the same thing,—the proportion of fat has been lowered by the addition of skimmed or separated milk. The deficiencies in table H. are calculated from the legal minimum figures. As these are below the average figures for the milk sold in the Borough (see table G.), it can safely be assumed that the percentages of adulteration shown in the table considerably underestimate the extent of adulteration in the great majority of cases. The warranty defence was pleaded successfully in 6 cases, no summonses were dismissed for any other reason. Butter. One hundred and twenty-five samples were analysed, of which three or 2.4 per cent. were returned as adulterated. C 25 (informal). Contained 1.6 per cent. of excess water. Subsequent sample was genuine. E 56. Consisted of Margarine. Vendor fined £2 0s. 0d. with £3 3s. 0d. costs. T 37 (informal). Contained 3.4 per cent. of excess water. Subsequent sample was genuine. The only preservative detected in butter samples was Boric Acid. The amount was estimated in each case. The results are shown in Table J. Table J. Amount of Boric Acid per cent. Number of Samples. Percentage of Samples. nil. 45 36.0 0.1 27 21.6 0.2 26 20.8 0.3 16 12.8 0.4 8 6.4 0.5 3 2.4 A Departmental Committee on Preservatives in Food recommend that the amount of boric acid permitted in butter and margarine shall not exceed 0 5 per cent., accordingly no action could be taken in connection with the amount of boric acid in any of the above samples. There is little question 75 that boric acid is injurious to infants and certain invalids and it appears to me unfortunate that vendors are not obliged to notify purchasers of its presence in butter. Such a notification is required in the case of cream. In any case the permissible amount might well be reduced to 0.25 per cent.; 78 per cent. of the samples taken in Stepney during 1921 would pass this standard, a fact which shows the higher limit to be unnecessary. Margarine. One hundred and eighty-seven samples were examined of which eight or 4.3 per cent. were adulterated. In each case the adulteration consisted of the presence of an excessive amount of water. Details of the adulterated samples are given in Table K. Table K. Number. Excess water per cent. Action. H47 (informal) 3.2 Same vendor as H62. E91 (informal) 7.2 Same vendor as E96. E96 9.6 Vendor paid £4 4s. 0d. costs. H62 6.1 Vendor paid £2 2s. 0d. costs. D75 (informal) 1.5 Same vendor as D86. E88 (informal) 3.5 Subsequent sample genuine. D86 1.2 Vendor cautioned. S93 (informal) 2.3 Subsequent sample genuine. Of recent years samples of margarine containing excess moisture have been very uncommon. All the above samples were of a brand guaranteed free from animal fat and specially prepared for the Jewish market. As none of the retailers pleaded a warranty it was impossible to take any action against the wholesaler. 173 of the samples, or 92.5 per cent. contained boric acid, the average amount present being 0.23 per cent. No sample contained more than 0'5 per cent. of boric acid. In 53 cases the vendors had not complied with the requirements of the Butter and Margarine Acts with regard to labelling. The proportion of the samples unsatisfactory in this respect was about the same as in 1920. In 1920 73 samples were taken and 20 or 27.4 per cent. did not comply with the Acts. In 1921, 28.4 per cent. of the samples did not comply. These figures are very unsatisfactory. Table L gives details of the action taken in each case. Summonses were taken out in 27 instances. It is to be hoped that this action may lead to an improvement in 1922. 76 Table L. Number. Action. Number. Action. S21 (informal) Same vendor as C1. G61 Fined £2. C42 (informal) Same vendor as C53. C1 Vendor paid £2 2s. costs. J21 (informal) Same vendor as B1. C53 Fined £5 with £2 2s. costs. D46 Vendor paid £2 4s. costs. B1 Fined £2 and .£1 1s. costs. D51 Vendor paid 2s. costs. C15 (informal) Same vendor as K1. D52 Vendor paid 2s. costs. D53 Pined £1 on one summons, paid 2s. costs on another. K1 Fined £3 and £1 1s. costs on two summonses. D34 Fined 10s. with £3 3s. costs. G30 (informal) Same vendor as M35. K40 (informal) Subsequent sample in order. M35 Fined 10s. and £1 1s. costs. K51 (informal) Same vendor as K59. D5 (informal) Same vendor as F30. K52 (informal) Same vendor as K60. F30 Vendor paid £1 3s. costs on each of two summonses. K59 Vendor paid £2 2s. costs. D9 (informal) Same vendor as B2. K60 Vendor paid £2 2s. costs. A59 Fined £1. B2 Fined £2 and £2 2s. costs. A60 Fined 10s. D11 (informal) Subsequent sample in order. H41 (informal) Subsequent sample in order. D22 (informal) Further samples unobtainable. H42 (informal) Same vendor as H64. B25 (informal) Subsequent sample in order. H64 Fined £2 with £1 1s. costs. F49 Vendor cautioned. B30 (informal) Subsequent sample in order. F56 Vendor cautioned. B58 (informal) Same vendor as B65. F22 (informal) Subsequent sample in order. B65 Summons not served owing to death of vendor. F26 (informal) Subsequent sample in order. G73 Vendor cautioned. F27 (informal) Subsequent sample in order. D64 Fined 10s. with 10s. 6d. costs. D84 Fined 5s. with 10s. 6d. costs. F28 (informal) Subsequent sample in order. D85 Fined 7s. 6d. and 10s. 6d. costs. S59 (informal) Same vendor as S62. D87 Vendor paid 10s. 6d. costs. B72 (informal) Same vendor as B101. S62 Vendor cautioned. E46 (informal) Same vendor as E54. B101 Fined 10s. with 10s. 6d. costs. E54 Vendor paid 10s. 6d. costs on each of two summonses. 77 Vinegar. Twenty-two samples were analysed of which two or 9.1 per cent. were adulterated. In each case the adulteration consisted of a deficiency of acetic acid. All the samples were "artificial" vinegar, i.e., a dilute solution of acetic acid, coloured with caramel with, in a few cases, a little malt vinegar added. Details of the adulterated samples are given in Table M. Table M. Number. Adulteration. Action. E28 Deficient of 37 per cent. of the minimum amount of acetic acid allowed. Fined £3 with £1 1s. costs. M36 Deficient of 22 per cent. of the minimum amount of acetic acid allowed. Vendor paid £2 2s. costs. In 1920. three of eleven samples taken, or 27.2 per cent., were adulterated. Cream and Preserved Cream The Milk and Cream Regulations, made under the Public Health Act 1907, prohibit the addition of any preservative to milk or cream containing less than 35 per cent. of fat. Cream containig more than 35 per cent. of fat may be preserved with boric acid or hydrogen peroxide. Conditions are laid down for the sale of such "preserved cream." It must bear a label stating that it is unsuitable for infants or invalids and in the case of boric acid the amount present must be given, this amount must not exceed 0.4 per cent. Six samples of preserved cream were examined of which one was adulterated. A 38. This sample had the usual label stating that the sample contained 0.4 per cent. of boric acid, and was unsuitable for infants or invalids. The sample was found to contain 0.7 per cent. of boric acid. The vendor was cautioned. Seventeen samples of cream were examined. Of these thirteen contained boric acid, but had no label to notify the fact. In no case did the amount of boric acid exceed 0.4 per cent. In one case only 27 per cent. of fat was present. The vendors of the samples were cautioned. The Milk and Cream Regulations do not seem to have been well understood in the Borough, and a circular letter explaining them was sent to all registered milk vendors. 78 Sausage. Nineteen samples of sausage were analysed, of which four, or 21.1 per cent. were adulterated. In each case the adulteration consisted of the presence of an excessive amount of boric acid. Particulars are given in table N. Table N. Number. Boric acid present grains per lb. Action. A35 35 Informal sample. Same vendor as E33. A28 97 Informal sample. Two subsequent samples from the same vendor were genuine. E33 24½ Vendor cautioned. L93 35 Fined £5 0s. 0d. with £2 2s. 0d. costs. The vendor was a wholesaler and three retailers whom he had supplied had been convicted and fined in another borough. Sausage should not contain more than 17½ grains per lb. of boric acid. The excess in the case of A 28 was very serious. As subsequent samples were genuine this excess was probably due to the sausage-meat having been badly mixed. Spirits. Seventeen samples of spirits were analysed, these being made up of ten samples of whisky and seven of gin. Six, or 35.3 per cent. were found to be adulterated. Particulars are given in table O. Table O. Number. Nature. Adulteration and action. E62 Whisky Informal sample, contained 9 per cent. of excess water. Same vendor as E65. E65 Whisky Contained 1½ per cent. of excess water. The vendor was cautioned. E61 Whisky Informal sample. The sample was served from a bottle on which the purchaser saw the figure "43" and other matter, in small print which he could not read. It was submitted as whisky of 43° U.P., and was found to contain 9 per cent. of excess water. Same vendor as E64. 79 Table O.— Continued. Number. Name. Adulteration and action. E64 Whisky This formal sample following up E61 was served from a similar bottle. After dividing the sample in the usual manner, the inspector examined the bottle from which his assistant had been served, and found that the label stated that the sample was "below" 43° U.P., the word "below" being in very small type. The sample was submitted as 43° U.P., and was found to contain 7 per cent. of excess water. The vendor was prosecuted. The Magistrate, taking into consideration that there had been no overcharge (the Spirits Prices Order was then in force) dismissed the summons on the vendor undertaking to adopt a label giving greater prominence to the word "below." B51 Gin Informal sample. A notice was exhibited in the bar stating that all spirits were diluted but not below "half proof strength." Compared with this very low standard the sample contained 4 per cent. of excess water. Same vendor as B63. B63 Gin Compared with whisky of "half proof strength," this sample contained 2 per cent. of excess water. The vendor was cautioned. At the present time the position of spirits with regard to the Food and Drugs Acts is very unsatisfactory. The law requires that spirits shall not be weaker than 35° U.P., but vendors of diluted spirits can protect themselves by the exhibition of notices to the effect that the spirits they sell are weaker. These notices are often very misleading. Thus two samples of gin were purchased at a bar where a notice was shown stating that spirits were "below 43° U.P." The samples were 55° U.P. and 56° U.P., and compared with gin of 43° U.P., contained 21 and 22 per cent. of water respectively. No ordinary purchaser would be likely to think that the notice was intended to cover such a high degree ot dilution. I consider that there should be a statutory form of notice, stating the dilution of the spirits sold, in words that the general public can understand. Notices are commonly met with stating that "to meet the requirements of the Food and Drugs Acts all spirits are sold as diluted spirits." Such notices are to evade the Acts and should be required to make this clear. Drugs. Ninety samples were analysed of which ten, or 11.1 per cent. were adulterated. Samples of the following drugs were taken:— Ammoniated Tincture of Quinine, Boric Ointment, Borax, Camphorated Oil, Castor Oil, Epsom Salts, Glauber's Salts, Glycerine, Lime Water, Milk Sugar, Olive Oil, Seidlitz Powders, White Precipitate Ointment, Zinc Ointment. 80 Particulars of the adulterated samples are given in table P. Table P. Number. Nature. Adulteration. Action. S30 White precipitate ointment. Prepared with a basis of Paraffin wax instead of Benzoated Lard. Informal sample. No further action as it was thought probable that the basis was to suit Jewish requirements. H26 Lime water. Deficient of 99 per cent. of the proper amount of Lime. Informal sample. Same vendor as H31. H31 Lime water. Deficient of 98½ per cent. of the proper amount of Lime. Vendor paid £2 costs. C75 Pure Borax. Contained 200 parts per million of Arsenic. Informal sample Same vendor as C91. C82 Pure Borax. Contained 100 parts per million of Arsenic. Informal sample. Same vendor as C90. C90 Pure Borax. Contained 100 parts per million of Arsenic. Vendor cautioned. C91 Pure Borax. Contained 200 parts per million of Arsenic. Vendor cautioned. G65 Seidlitz powder. The blue packet contained a 50 per cent. excess of Rochelle Salt. Informal sample. Subsequent sample genuine. G66 Seidlitz powder. The white packet contained a 25 per cent. excess of Tartaric Acid. Informal sample. Subsequent sample genuine. B91 Boric ointment. Deficient of 70 per cent. of the proper amount of Boric Acid. Informal sample. Subsequent sample genuine. 81 A circular letter was sent to all pharmacists in the Borough, cautioning them as to the liability of borax to contain Arsenic and advising them to take suitable precautions to see that their supplies were pure, as proceedings would be taken on subsequent occasions. The two informal adulterated samples of Seidlitz powder, each consisted of a single powder. Fcr the formal samples it was necessary to purchase a box of twelve pow ders. It is possible that the boxes were not of the same brands as the single powders, as the four powders submitted for each formal sample were all carefully prepared. Public Health (Milk and Cream) Regulations. 1. Milk and Cream not sold as preserved cream:— (a) No. of Samples examined for preservative. (b) No. in which preservative was reported to be present. Milk 824 2 Cream 17 13 For particulars of the adulterated samples see the body of this report. 2. Cream sold as preserved cream. (a) (1) Correct statements made 5 (2) Statements incorrect 1 Total 6 (b) Determinations made of milk fat in cream sold as preserved cream:— (1) Above 35 per cent. 6 (2) Below 35 per cent. 0 Total 6 The Rag Flock Act. The Rag Flock Act, 1911, requires that the cleanliness of the samples shall be such that the soluble chlorine shall not exceed 30 parts per 100,000 of the flock. The single sample examined was satisfactory. Other Samples. Public Health Department— The 17 samples included:— Milk, 3; Butter, 2; Condensed Milk, 2; Disinfectant Powder, 2; Urine, 2; Water, 2; Margarine, 1; Dried Milk, 1 ; Stains on Linen, 1 ; Bread, 1. 82 Samples submitted by Private Purchasers— The 7 samples included :—Dried Milk, 2; Arachis Oil, 1; Cocoa Butter, 1; Palm-Kernel Oil, 1; Vegetable Lard, 1; Wine Vinegar, 1. I have to express my thanks for the valuable assistance afforded me in the laboratory by Miss J. Brown. I have the honour to be, Ladies and Gentlemen, Your Obedient Servant, HERBERT HAWLEY. Public Analyst. Chemical Laboratory, 43, White Horse Street, E. 1. May, 1922. 83 INDEX. A PAGE Analyst's Report 66 to 82 B Births 4, 10 Birth, illegitimate 10 Births, still-births 26 C Canal Boats Acts 34, 35 Cancer 25 Cerebro-Spinal Fever 13 Clinics in the Borough, Ante-natal 30 Cowhouses 56, 62 Creches in the Borough 30 D Deaths 4, 10, 63 Diphtheria and Membranous Croup 12 Disinfection 40 Dysentery 25 E Encephalitis Lethargica 12 Enteric Fever 12 Erysipelas 12 F Factory and Workshops Acts 58 to 61 Fines and costs (total) 58 Food and Drugs Acts, samples taken, proceedings, etc. 66 to 82 G General Sanitary Work 39, 40 H Health Visitors, visits, etc. 27,28,29 House to House Inspection 7, 35 to 38, 57 Houses let in Lodgings 39,56 Housing of the Working Classes Act 56 84 I Page Ice Cream Premises 56 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 34 Infant Welfare Centres, etc., in the Borough 29, 30 Infantile Mortality 4, 5, 26, 65 Infants, Feeding of 29 Infectious Disease 6, 64 Influenza 25 Inquests and post mortem examinations 34 K Knacker's yards 62 M Malaria 25 Marriages 10 Measles 16, 17 Membranous Croup 12 Milk and Cream Regulations 77, 81 Milk Distribution Scheme 5, 6, 31 Milkshops 56 Mortuary and Coroner's Court 34 Municipal Centres, work at 30 N Notifiable Diseases 11 Notification of Births Act 26 O Offensive Trades 56 Ophthalmia Neonatorum 13 to 16 Outworkers 58,60 Overcrowding 39 P Phthisis, number of notifications and deaths 18 Pneumonia 25 Police Court Proceedings 41 to 54, 58 Poliomyelitis 13 Population 3,8, 9 Puerperal Fever 12 R Rag Flock Act 81 Rats and Mice Destruction Act, 1919 34 Respiratory Diseases 25 85 S Page Sanitary Inspectors' Report Between 38 and 39 Scarlet Fever 11 Sewing Classes 28, 30 Slaughter Houses 56, 62 Small-pox 11 Spotted Fever 13 Statistics:— Housing Conditions—Ministry of Health Table 54, 55 „ ,, etc., etc.— London County Council Table 56, 57 Cases of Infectious Diseases notified during the year 64 Causes of, and ages at death, during the year 63 Infantile Mortality during the year 65 Summer Diarrhœa 16 T Trench Fever 25 Tuberculosis 6, 7 „ Other Forms, number of notifications and deaths 19, 20 „ Dispensaries, Report on 20 to 24 U Underground Rooms 57 Unhealthy Areas 55 Unsound Food destroyed 31 to 33 Y Verminous persons 34 Vital Statistics 63 to 65 W Water Supply 39 Whooping Cough 17 Workshops 58 to 61 Wrong Diagnosis of Infectious Disease 11 Z Zymotic Diseases 18 <v.