ST&2-0 PUBLIC HEALTH COMMITTEE. (November, 1921 to October, 1922.) Councillor J. Sullivan, Chairman. Councillor J. Alberts, Vice-Chairman. Alderman G. R. Boustred. Alderman Mrs. J. Collins. Councillor A. Barber. Councillor A. Kershaw. „ H. Beber. „ F. Lawrence. „ E. J. Bigden. „ (Miss) Moses, J.P. „ F. R. Ellis. „ (Mrs.) F. W. Reidy. „ P. Hartigan. „ J. J. Reidy, J.P., M.D., D.P.H. „ J. Hartman. „ T. S. Selwood. „ (Miss) M. Hughes, J.P. „ E. Sexton. „ D. Hume. „ I. Sharp. MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1921 to October, 1922.) The Members of the Public Health Committee, together with the following Members:— Mrs. E. C. Grenfell. Mrs. C. J. Matthew. Mrs. A. Model. Miss Page. Miss H, L. Cartwright. Mrs. A. Walsh. Alderman O. Tobin, J.P., Chairman. Councillor H. Beber, Vice-Chairman, STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: D. L. Thomas, m.r.c.s., l.r.c.p., d.p.h., barrister-at-law. Assistant Medical Officer of Health: J. M. Browne, m.b., b.ch., d.p.h. (Maternity and Child Welfare). Public Analyst: H. Hawley, m.sc., f.i.o. Food Inspector: H. Abson. Sanitary Inspectors: G. Bottomley. H. Mills. E. Waterman. A. Cook. G. O. Pavitt. J. White. E. T. Crook. H. Quaintrell. T. P. Wrack. T. W. Dee. W. Shepherd. S. H. V. Trimming E W. Flint. R. Simpson. (Temporary). H. O. Harris. A. W. Stiles. W. T. Twynham J. W. Johnson. J. Twaits. (Temporary). Health Visitors : E. Addis. M Davis. H. M. Phillips. D. Chabot. A. E. Gibbs. I. Virtue. E. Clements. E. Goodpellow. H. A. Whitty. A. M. Cordwell. D. Michell. Clerical Staff: W. F. Lellow, Chief Clerk. G. Boulton (M. & C. W.) S. Embleton. J. G. McCarthy. A. C. Brown. W. P. Howard. J. McMullon. R. Day. H. T. Kightley. D. Tapolsky. zmporary Clerics engaged at the Maternity Centres and in the distribution of milk : B. Butler, M. Gray, A. Healey, H. Ililes, M. W. Hunt, E: Worsell. Tubercidosis Dispensaries : Stepney Green Dispensary, 35, Stepney Green. St. George's Dispensary, 208, High Street, Shadwell. Whitechapel Dispensary, 18, Gt. Prescob Street. Chief Administrative Tuberculosis Officer : D. L. Thomas, m.r.c.s., l.r.c.p. Senior Tuberculosis Officer : W. E. Goss, m.b., ch.b.Ed. Tuberculosis Officer: A. Ferguson, m.b., b.s. (lond.), d.p.h. Tubercidosis Officer: T. S. Gibson, m.r.c.s., l.r.cp. Nurses : E. P. Colledge. M. Prickman. H. M. Tay^er. M. F. Weatheritt. Nurse Dispensers : M. Coulman. A. O. Jones. Dispenser: A. Wager. Clerk and Secretary to Care Committee: L. N ugent, REPORT of the MEDICAL OFFICER OF HEALTH for the METROPOLITAN BOROUGH OF STEPNEY FOR THE YEAR 1922. Public Health Department, 43, White Horse Street, April, 1923- To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have much pleasure in submitting to you my twenty-second Annual Report, which deals with the Vital and Sanitary Statistics of the Borough of Stepney for the year 1922. Population. The estimated population of 252,170 has been based on that of the Census of 1921, after allowance has been made for the varying rate of increase as evidenced by the births and deaths, and of the migration returns of the Board of Trade, &c. The density of the population exceeds 200 persons per acre, the greatest density being in the North East Ward of St, George's, where it is 258 per acre—the most densely populated of any ward in the Metropolis. The acreage density does not necessarily provide any index to overcrowding from the housing point of view. In the calculation of densities the acreage used is that of all land and inland water together. The presence of parks, docks, &c., will tend to an understatement of the population pressure in the areas where they occur. Compared with 1911, the density figure shows an improvement, there being a decrease of nearly 50,000 in the population for the ten years 1911-1921. The number of persons living more than two persons to a room was three thousand less than in 1911. The number in the Census of 1911 was roughly 92,000, and in that of 1921 it was 69,000. In respect of room accommodation in houses, according to the Census of 1921, Stepney had an average of 4,49 rooms per dwelling, with an average of 1.52 families to each dwelling. 4 The biggest families were found in the poorest districts in London, Stepney being the highest with an average of 4.26 persons per family, it had the biggest average families in the previous Census (1911). The East-end Boroughs naturally exhibit the worst conditions with regard to housing, especially the room density, or average number of rooms per person, but Stepney is not the worst, (.69 rooms per person), three other Eoroughs being in a worse position. The worst ward in the Borough is Spitalfields East Ward with .60 rooms per person. The excess of females over males is not so marked as in West End Boroughs. There were 1,038 females for every 1,000 males. With regard to occupation, 20 per 1,000 of all persons above 12 years of age are engaged as boot and shoe makers, 8 per 1,000 as hairdressers, 7 per 1,000 as bargemen, and 6 per 1,000 as furriers. Men engaged in the tailoring trade are more numerous in Stepney than in any other Metropolitan Borough,—127 per 1,000,—the next Borough having only 33 per 1,000. The Borough of Stepney contains the largest number of aliens, both absolutely and relatively, with 37,288, representing over 30 per cent, of the aliens in the County of London, and about 15 per cent, of the local population. Births. The total number of births during the year was 6,002.—3,041 males, and 2,961 females,—or 167 less than in the previous year. The birth-rate was 23.8 per 1,000 of the population, while that for the whole of London was 20.6 per 1,000. 1,575 of the births belonged to the Limehouse District, or at the rate of 29.6 per 1,000 of the population. 1,049 of the births belonged to St. George-in-the-East, or at the rate of 25.7 per 1,000 of the papulation. 2,488 of the births belonged to Mile End Old Town, or at the rate ot 23.8 per 1,000 of the population. 890 of the births belonged to the Whitechapel District, or at the rate of 16.4 per 1,000 of the population. The birth-rate for the whole of the Borough is again lower than in the previous year, which is equally true for the whole country- The only part of the district where the rate has been fairly stationary is the Limehouse District (Limehouse, Shadwell, Ratcliff and Wapping), where the birth-rate had not been below 32 per 1,000 of the population previous to 1922. In St. George-in-the-East, the birth-rate was higher than in the previous year, but much below former years. During the first few years of the 5 Borough Council's existence it ranged from 40 to 44 per 1,000 of the population in St. George's. The birth-rate in Mile End Old Town has not been so high as in St. George-in-the-East, but a similar reduction has occurred during the last 15 years. It was again lower in Mile End in 1922 than in the previous year. The greatest reduction has been in the Whitechapel District (Whitechapel, Mile End New Town, Spitalfields, &c.). It was lower in 1922 than in the previous year. At one time it was above 40 per 1,000 of the population and was never below 30 per 1,000 previous to 1912. Since the latter year It has gradually become lower, and during the last 7 years it has been under 20 per 1,000. In fact, the death-rate is nearly as high as the birth-rate. 1,036 births occurred in the Mothers' Lying-in Home, Commercial Road: 205 belonged to Mile End Old Town. 274 belonged to the Limehouse District. 38 belonged to the Whitechapel District. • 72 belonged to St. George-in-the-East. 447 belonged to outlying Districts. 336 births occurred in the London Hospital:— 50 belonged to Mile End Old Town. 27 belonged to St. George-in-the-East. 18 belonged to the Limehouse District. 45 belonged to the Whitechapel District186 belonged to outlying Districts. 100 births occurred in the St. George's Infirmary:— 89 belonged to St. George-in-the-East. 10 belonged to the Limehouse District. 1 belonged to the Whitechapel District. 89 births occurred in the Mile End Infirmary:— 77 belonged to Mile End Old Town. 2 belonged to the Limehouse District. 2 belonged to the Whitechapel District. 8 belonged to outlying Districts. 70 births occurred in the Whitechapel Infirmary.— 55 belonged to the Whitechapel District. 2 belonged to Mile End Old Town. 1 belonged to the Limehouse District12 belonged to outlying Districts. 6 278 births occurred at 24, Underwood Street:— 90 belonged to Mile End Old Town. 98 belonged to the Whitechapel District. 2 belonged to the Limehouse District. 46 belonged to St. George-in-the-East. 42 belonged to outlying Districts. 179 births occurred at the City of London Lying-in Hospital, .102, City Road. Of these, 10 belonged to the Limehouse District, 39 to St. Georges, 63, to Mile End and 67 to the Whitechapel District. 10 births occurred at the Queen Charlotte's Hospital. 3 belonged to the Limehouse District, 2 to St. George's, 4 to Mile End and 1 to the Whitechapel District. 34 births occurred at the Mothers' Hospital, Clapton. 2 belonged to Limehouse, 6 to St. George's, 19 to Mile End and 7 to Whitechapel. 12 births occurred at 2, Queensdown Road, Hackney, 2 belonged to St. George's, 5 to Mile End and 5 to Whitechapel. 8 births occurred at the Royal Free Hospital. 3 belonged to Mile End and 5 to Whitechapel. 3 births occurred at the Middlesex Hospital- All belonged to Whitechapel. 11 births occurred at 117 Mount Pleasant Lane, Hackney. ^ belonged to St. George's, 4 to Mile End and 4 to Whitechapel. 7 births occurred at 73a, Devons Road, 11 at 50a, St. Leonard Street, and 1 at Poplar Workhouse. All belonged to the Limehouse District. 6 births occurred at 21, Endsleigh Gardens, St. Pancras. 1 belonged to St. Georges, 3 to Mile End and 2 to Whitechapel. 1 birth occurred at Queen Margaret's Hospital, Stratford, 1 at the Military Families Hospital, Woolwich, and 1 at the General Lying-in Hospital, Lambeth. All belonged to Mile End. 2 births occurred at St. Pancras Workhouse, 1 belonged to Mile End and 1 to Whitechapel. 1 birth occurred at St. Bartholomew's Hospital, and 1 at Charing Cross Hospital. Both belonged to Whitechapel. 1 birth occurred at St. Mary's Hospital, 1 at Queen Mary's Hospital, and 1 at 79a, Bishops Road. All belonged to St. George's. 1 birth occurred at Marylebone Infirmary which belonged to Limehouse. 7 47 births occurred at various nursing homes and private houses. Of these, 13 belonged to the Limehouse District, 4 to St. George's, 21 to Mile End, and 9 to the Whitechapel District. Marriages. The total number of marriages wais 2,266. The proportion of persons married was nearly 18 per 1,000 of the population. 399 of the marriages were registered in the Limehouse District. 294- „ „ „ St- George's District 1160 „ „ „ Mile End Old Town. 413 „ „ „ Whitechapel District. Deaths. After deducting the deaths of non-residents who died in the Borough, and adding those of residents who died in outlying Institutions, tlv. total number was 3,493—1,863 males and 1,630 females,—or 249 more than in the previous year. 766 of the deaths belonged to the Limehouse District, or the rate of 14.4 per 1,000 of the population. 572 of the deaths belonged to St. Georges-in-the-East, or at the rate of 14.0 per 1,000 of the population. 1,354 of the deaths belonged to Mile End Old Town, or at the rate of 12.9 per 1,000 of the population. 801 of the deaths belonged to the Whitechapel District, or at the rate of 14.8 per 1,000 of the population. The death-rate was 13.8 per 1,000 of the population, while that for the whole of London was 13.4 per 1,000. The death-rate is low when compared with previous years, although not quite so low as that of 1921. For the first ten years of the existence of the Borough Council, the death-rate had not been below 21 per 1,000, but during the last four years it has been below 15 per 1,000 of the population. Notifiable Diseases. 2,247 notifications were received, or 1,658 less than in the previous year. 1,928 were removed to fever hospitals and infirmaries. 459 belonged to the Limehouse District, or at the rate of 8.64 per 1,000 of the population. 397 belonged to St. George-in-the-East, or at the rate of 9.73 per 1,000 of the population. 894 belonged to the Mile End Old Town, or at the rate of 8-56 per 1,000 of the population. 497 belonged to the Whitechapel District, or at the rate of 9.20 per 1,000 of the population. 8 Wrong Diagnosis. 93 cases of Infectious Disease 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 disease stated on the certificates, or from any other notifiable disease. 51 of the cases were notified by private practitioner, 27 from the London Hospital, and 15 from other Public Institutions. This number referred to 31 cases of Scarlet Fever, 61 of Diphtheria, and 1 of Enteric Fever. Bacteriological Examinations. 1,284 bacteriological examinations were made on behalf of the Public Health Department during the year. The specimens and the results were as follows:— Positive result. Negative result. Total. Sputa (for Tubercle bacilli) 153 670 823 Swabs (for Diphtheria bacilli) 31 419 450 Blood (for Typhoid bacilli) Nil 9 9 Bristles (for Anthrax) Nil 2 2 Small Pox. Five cases were actually notified as haying occurred in our district, although other residents contracted the disease. None of the five patients died. Prior to dealing with cases occurring in our district it is necessary to give a short history of the outbreak in other districts. A "cheap jack" was taken ill in Stanhope Street, St. Pancras, on July 22nd last. He was notified to be suffering from Scarlet Fever, but was removed to the Small Pox Hospital on July 26th. He died from Small Pox. He used to buy a number of articles for his trade in various shops in Houndsditch, and in one shop in our district, in Cobb Street. It is known that he was in the neighbourhood on July 10th and at that shop on that date. The second case was that of Mrs. G., Canning Town. She was taken ill on July 24th, the rash appearing on July 26th, and was removed to Orsett Isolation Hospital, on July 29th. She was employed at a blouse warehouse in Moorfields, and went to, and returned from, her work daily, by taking a bus to Aldgate and walking through Houndsditch. She had no connection with our district except parsing through it along the Mile End Road in a motor bus. The third case, H. S., aged 16, lived at Cobb Street, but developed the disease while he was away on holiday at Southend. He went to Southend on July 22nd, he fell ill on the 24th, the rash appearing on the 26th, and he was removed to the Isolation Hospital on the 30th. 9 The fourth case was that of G.S.B., aged 38, who worked in Fashion Street, Whitechapel, but lived at East Road, West Ham. He was taken ill on July 26th, the rash appearing on the 28th, and he was removed to thd Orsett Isolation Hospital on the 30th. From the dates of the appearance of the rash, it is probable that the four cases were infected between July 10th and 14th, and the source of the infection indicated the probability of an unrecognised case of a mild type being the common origin of the four. All had a connection with that part of London between Commercial Street and Houndsditch. It was possible for the unrecognised case to be in our Borough, and I immediately took all possible steps to try and trace it. As three weeks had elapsed before I commenced to make enquiries, the difficulties were great, and I was not too sanguine of success. I circularised the Doctors and asked them to report to me immediately, if a patient consulted them, who had a fading rash on his skin. I asked the boys in the neighbourhood of Cobb Street if they had seen any boy or girl in their neighbourhood who had Chicken Pox or a rash on their face three weeks previously. As a result of these enquiries, Mr. Shepherd, the Sanitary Inspector for the district was informed on August 3rd that S. L., aged 16, of Crispin Street, had Chicken Pox. I visited him immediately and found that L. was taken ill on July 1st, and a rash appeared on the 4th. He went to the London Hospital on the same date, where he was told he was suffering from Chicken Pox. The appearance of the skin at the time of my visit was consistent with the assumption that the rash which appeared on the 4th was that of Small Pox. The eruption had been scanty, and the disease was of a mild character. The patient was in his bedroom for three or four days after the date of the appearance of the rash, i.e., from July 4th to the 7th or 8th. On July 8th he assisted his mother in serving customers with cups of tea and selling tobacco and cigarettes. On Wednesday, July 12th, he met H.S. (case No. 3) in the street. S. asked him what the spots were. L. replied that it was Chicken Pox. H.S. told the other boys to "come away from him, he has Chicken Pox." It appears, therefore, that on this date, the contact was not a close one. He saw H.S. again on Friday, the 14th, when S. gave L. the address of a mutual friend. Although the scabs had disappeared with the exception of one on the instep, which was typical of Small Pox, yet the distribution of the rash was very significant, and I came to the conclusion that he had had Small Pox and not Chicken Pox. Acting on this, I examined the other inmates in the house, and found an Indian named D.J. K., actually with the Small Pox eruption. He had been 10 taken ill on July 20th, the rash appearing on the 22nd. The disease was of a mild character, and he had been out "every day since the onset. On the 22nd, he went to see his doctor. The doctor afterwards admitted that K. had a rash when he saw him on the 22nd, and his temperature was above the normal; the doctor thought the rash was that of Chicken Pox- The doctor saw him again on the 25th, '26th, and 30th. Fortunately, on each occasion there was no other patient in the waiting room. I caused him to be removed to the Small Pox Hospital immediately, and all steps were taken to disinfect the premises and ascertain the names of persons who had been in contact with him. The latter were kept under observation until the incubation period had expired. It seems that on July 12th L. called at a barber's shop to have his hair cut, but the barber refused to do so on account of the rash on his face and on his scalp. The barber's premises are situate next door to the shop in Cobb Street, where it is known the first person who was notified called on July 10th (A. of St. Pancras). It is possible that A. called on July 12th as well, as he was in the habit of buying articles at this shop two or three times a week. It is not known whether G.S.B. (case No. 4) called at the shop in Crispin Street. It is quite possible that he did. B. died. He worked near by and he was in the habit of going out at lunch time and may have possibly called for a cup of tea, or tobacco. As far as I was able to discover, Mrs. G. (case No. 2), had no connection with L. except that she walked throuth Houndsditch on going to, and returning from business, and L. was often in Houndsditch. L. went to the London Hospital in a tram-car on July 4th, but he is positive he was the only passenger. The contacts were kept under daily observation and the proprietors ot the factory next door to the shop in Crispin Street promised to let me know whenever any of their employees were away through illness. In this, it was hoped that further cases from this source would be immediately discovered, and steps taken to prevent the spreading of the disease. L. and K. were in the streets when in a most infectious condition- On August 8th, a doctor reported a suspicious illness at Dunstan Houses, Stepney Green—Aaron L., aged 7. His mother, Mrs. L.,was taken ill on July 22nd, and a rash appeared on July 28th. The patient kept a fancy goods stall on the Mile End Waste, and was in the habit of buying goods at the shop in Cobb Street (mentioned above), as well as at shops in Houndsditch. She was attended by a doctor on July 22nd, 23rd and 24th, but the disease was not correctly diagnosed. She attended the London Jewish Hospital on July 26th and 31st, when the rash was thought to be that of Chicken Pox. On August 5th, the son, A.L., aged 7, was taken ill, the rash appearing on August 8th- Both 11 were removed to the Small Pox Hospital on August 8th. The other inmates were taken to the Council's Shelter and the premises were disinfected. The names and addresses of all contacts were obtained as far as passible and they were kept under observation. One of the contacts, M. L., of Jubilee Street, a brother-in-law of Mrs. L., was taken ill on August 4th, the rash appearing on August 7th- He was removed to the Small Pox Hospital on August 9th. Mrs. L. stored her goods in his house in Jubilee Street, but was not at the stall selling her goods during the infected stage of the illness except on Saturday, August 5"th. A sister of Mrs. L. E. C., aged 20, of Cressy Houses, Stepney Green, was admitted an in-patient at the London Hospital, on August 10th, suffering from Appendicitis and operated upon the same day. At the time she was admitted she had a rash which was undoubtedly that of Small Pox. On the following day (August l1th) the rash was thought to be that of Measles, and she was removed to the South Eastern Hospital. Before she was admitted to the Fever Hospital, she was seen by the Medical Superintendent, who caused her to be removed to the Small Pox Hospital. Her name had not been given to us as a contact, probably she was an in-patient at the London Hospital at the time enquiries were made. It is remarkable that A. the first case, and Mrs. L. were in the same kind of trade, and dealt in the same shops. The families of L. and C. were removed to the Council's Shelter for observation, and vaccination was offered and accepted by them. No other case occurred. At the London Hospital all the patients in the ward as well as the resident Doctors and nurses, dressers, porters, and others who could in any way be regarded as contacts were vaccinated on August 11th. The ward itself was regarded as in quarantine for 16 days, no cases being admitted or discharged. Visitors were not allowed to patients in this ward except to those on the "danger list," and in these cases the " visitors " were afterwards kept under observation in their own homes. A special Resident MedicaJ Officer was appointed solely to look after all patients in this ward. Letters from the patients were sterilised before being posted. As a result of these precautions no other case occurred either at tMe London Hospital or in the rest of the district. 12 Scarlet Fever. 617 cases were notified during the year, or 1,379 less than in the previous year. 612 were removed to fever hospitals. 95 belonged to the Limehouse District with 2 deaths. 120 belonged to the St. George-m-the-East, with 2 deaths241 belonged to the Mile End Old Town, with 3 deaths. 161 belonged to the Whitechapel District, with 2 deaths. The death-rate for the whole Borough was .03 per 1,000 of the population, while that for the whole of London was .07 per 1,000. Diphtheria and Membranous Croup. 777 cases were notified during the year or 179 less than nn the previous year. 770 were removed to fever hospitals. 209 belonged to the Limehouse District, with 25 deaths118 belonged to the St. George-in-the-East, with 14 deaths. 342 belonged to the Mile End Old Town, with 33 deaths. 108 belonged to the Whitechapel District, with 8 deaths. The death-rate for the whole Borough was .31 per 1,000 of the population, that for the whole of London being .25 per 1,000. Enteric F ever. 27 cases were notified, or 7 more than in the previous year; 25 were removed to hospitals. 5 belonged to the Limehouse District, with no deaths. 4 belonged to the St. George-in-the-East, with no deaths11 belonged to the Mile End Old Town, with no deaths. 7 belonged to the Whitechapel District, with 1 death. The death-rate for the whole Borough was .003 per 1,000 of the population, and that for London was .01 per 1,000. Puerperal Fever. 23 cases were notified, or 3 more than in the previous year. All were removed to hospitals. 6 belonged to the Limehouse District, with 4 deaths. 5 belonged to the St. George-in-the-East, with 1 death4 belonged to the Mile End Old Town, with 1 death. 8 belonged to the Whitechapel District, with 1 death. 13 Erysipelas. 90 cases were notified, or 42 less than in the previous year; 30 were removed to hospitals or infirmaries. 12 belonged to the Limehouse District, with 1 death. 13 belonged to the St. George-in-the-East, with 1 death. 40 belonged to the Mile End Old Town, with 2 deaths. 25 belonged to the Whitechapel District, with 1 death. Encephalitis Lethargica. 4 cases were notified, or 13 less than in the previous year. 2 belonged to Mile End Old Town, and 2 to Whitechapel. 2 proved fatal. Cerebro-Spinal Fever or "Spotted Fever." 9 cases were notified or 3 more than in the previous year; 2 belonged to Limehouse, 2 to St. George-in-the-East, 2 to Whitechapel, and 3 to Mile End. One proved fatal. Polio-Myelitis. 1 case was notified during the year, which occurred in Limehouse. Ophthalmia Neonatorum. 46 cases were notified, or 4 more than in the previous year; 6 occurred in the Limehouse District, 7 in St. George-in-the-East, 19 in Mile End Old Town and 14 in the Whitechapel District. Epidemic Diarrhoea. The number of deaths was 57, or 123 less than in the previous year; the death-rate for the whole Borough was .22 per 1,000. 19 belonged to the Limehouse District, or at the rate of .35 per 1,000 of the population. 12 belonged to St. George-in-the-East, or at the rate of .29 per 1,000 of the population. 14 belonged to Mile End Old Town, or at the rate of .13 per 1,000 of the population. 12 belonged to the Whitechapel District, or at the rate of .22 per 1,000 of the population. 51 of the deaths, or nearly 90 per cent. were those of infants under 1 year of age. 14 Summer Diarrhoea is now generally believed to be an infectious disease, capable of spreading from the sick to the healthy. Direct infection may be conveyed by the milk or other foods, as well as by other means such as the use of comforters, placing the babies on dirty floors, etc. The disease is believed to be due to many different species of microorganisms, and that they reside in the superficial layers of the earth which contain suitable food for them, that is, soil polluted with decomposing organic matter. The development and multiplication of the micro-organisms depend on a high temperature, not of the air itself, but of the superficial layers of the soil. It is well known that warm summers are generally associated with excessive prevalence of diarrhoea. As long ago as 1887, Dr. Ballard in his special report to the Local Government Board pointed out the connection of diarrhoea with air temperature, and with earth temperatures at depths of 1 ft. and 4 ft. He stated that the prevalence of summer Diarrhoea in epidemic form, was in proportion to the temperature at the depth of 4 feet, and that the ascent of the curve began when the earth thermometer recorded a temperature of about 56° F. The amount of Diarrhoea attained its maximum when the 4 ft. thermometer attained its mean weekly maximum. There is no doubt that temperature and weather conditions are associated with epidemic diarrhoea. But more important than a general average temperature is the correlation which has been shown to exist between the morbidity rate of infants and the maximum daily temperature. When these are both high,the cases of Infantile Diarrhoea are markedly increased,particularly among artificially-fed children. The babies who are entirely breast-fed are relatively free from infantile diarrhoea even during the hottest summers. This goes to show that the increase in temperature acts indirectly as a cause of Infantile Diarrhoea. In warm weather, artificial foods are a suitable nidus of infection under bad home conditions. Excessive rainfall during the summer causes a diminution in the number of deaths from Diarrhoea. This may be due, however, to the fact that with excessive rainfall the temperature of the air is reduced. The prevalence of flies has been stated to be a cause of Diarrhoea. It is very difficult to prove or disprove this statement, because if you have a hot dry summer you have flies in increased numbers. It is true flies have diminished in recent years in London due to the change from horse to mechanical transport. This has naturally resulted in the reduction of the amount of manure stored near houses, with the elimination of breeding ground for flies. It is also partly due to the propaganda by handbills, posters and cinema films, 15 etc., advocating people to "kill the flies" and do away with accumulations of manure and rubbish which are their breeding grounds. Table showing the number of deaths of infants under one year of age from diarrhoea, and the period of the year, etc., for the years 1913-1922:— Year. 1st qtr. 2nd qtr. 3rd qtr. Oct. & Nov. Dec. Total under 1. Percentage of deaths occurring from 'July 1st to end of November, per cent. Deaths from Diarrhoea over 1 and under 2 years of age. 1913 31 21 131 58 8 249 75 38 1914 16 15 131 60 8 230 83 39 1915 9 13 121 45 4 192 86 43 1916 14 6 53 28 1 102 80 25 1917 5 20 52 24 7 108 70 31 1918 9 9 17 23 7 65 61 7 1919 12 8 60 9 — 89 77 15 1920 4 13 41 16 3 77 74 5 1921 16 10 96 18 3 143 80 27 1922 6 11 13 16 5 51 56 6 There are two striking facts in connection with the deaths from Diarrhœa, in 1922. The first is the exceptionally small number of deaths. The second is the small proportion of deaths from diarrhoea from the beginning of July to the end of November. Forty-six per cent. of the deaths certified as Epidemic Diarrhoea of infants did not occur during the period usually associated with Epidemic Diarrhœa. In fact, more than 20 per cent, occurred during the four coldest months of the year. If the summer and autumn months are only included, the death rate from "Summer" Diarrhoea would be found to be exceptionally low during 1922. In view of the foregoing table, the term "Summer Diarrhœa," appears to be misleading. A large percentage of deaths occurred during the colder months when the obvious causes were infection through the food. Though a baby's heat-regulating mechanism cannot adjust itself quickly to changes of temperature, yet that fact does not play a large part in infantile mortality. The chief cause is infection, and at whatever season of the year the infection occurs, the mortality is high. Naturally, hot weather favours the development of the germs, but as infantile diarrhœa is not confined to the Summer months alone, " Epidemic diarrhoea "would appear to be a more useful and exact description. 16 Measles. The number of deaths was 62, or 21 more than in the previous year. Although higher than in recent years, the number is low compared to what it used to be in former years. The death-rate for the whole Borough was at the rate of '24 per 1,000, while that for the whole of London was .35 per 1,000 of the population. 16 of the deaths belonged to the Limehouse district, or at the rate of .30 per 1,000. 12 of the deaths belonged to St. George-in-the-East, or at the rate of .29 per 1,000. 21 of the deaths belonged to Mile End Old Town, or at rate of .20 per 1,000. 13 of the deaths belonged to the Whitechapel district, or at the rate of .24 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 1922 63 17 Whooping Cough. The number of deaths from Whooping Cough was 124, or 100 more than in the previous year. 30 belonged to the Limehouse district, or at the rate of .56 per 1,000. 17 belonged to St. George-in-the-East, or at the rate of .41 per 1,000. 64 belonged to Mile End Old Town, or at the rate of .61 per 1,000. 13 belonged to the Whitechapel district, or at the rate of .24 per 1,000. The death-rate for the Borough was '49 per 1,000 of the population while that for the whole of London was .25 per 1,000. Zymotic Diseases. The total deaths from diseases of a zymotic character was 333, or 24 less than in the preceding year. They include all deaths from Small-pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever and Diarrhœa. 92 belonged to the Limehouse district, or at the rate of 173 per 1,000 of the population. 57 belonged to St. George-in-the-East, or at the rate of 1.39 per 1,000 of the population. 135 belonged to Mile End Old Town, or at the rate of 1.29 per 1,000 of the population. 49 belonged to the Whitechapel district, or at the rate of .90 per 1,000 of the population. The zymotic death-rate for the whole Borough was 1.32 per 1,000. 18 Phthisis. 546 new cases were notified, or 27 less than in the previous year. Notifications of New Cases. Deaths. Limehouse 104 53 St.George's 99 54 Mile End Old Town 197 109 Whitechapel 146 98 Number of deaths from Consumption from 1901 to 1922 :— 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 1922 53 54 109 98 314 19 Other Forms of Tuberculosis. 98 new cases were notified, or 42 less than in the previous year :— Notifications . Deaths. Limehouse 17 11 St. George's 27 10 Mile End Old Town 31 12 Whitechapel 23 9 Deaths from diseases of a Tubercular nature, other than Phthisis, from 1901 to 1922:— 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 1922 11 10 12 9 42 Of the 314 deaths certified to be due to Phthisis, 77 had not been notified during life-time Of the 239 notified during life-time, 32 were notified at the same time that the deaths were certified, 33 died within a month of their being notified, 16 between 1 and 3 months, and 27 between 3 and 6 months after the date of notification. 20 Of the 77 deaths which had not been notified during life-time, 24 occurred at their own homes, 20 in Infirmaries, 16 in Mental Hospitals, 7 in Sanatoria and Chest Hospitals, and 10 in other Institutions. Of the 42 deaths from Tubercular diseases other than Phthisis, 28 had not been notified during lifetime, and six were notified at the same time that the deaths were certified. Tuberculosis Dispensaries. The accompanying tables of figures give an analysis of the work done at the three Dispensaries during the year. The lines upon which they have worked have varied little from those of the previous year, and particular attention has been given to the preventive side of the problem. Treatment has remained small in comparison with past years, the Dispensaries functioning more as "clearing houses" for the tuberculosis coming under their notice. New Patients. Table I. shows the number of patients examined for the first time. These figures do not include the "contacts" examined, an analysis of which will be found in Table II. TABLE I. Stepney and Mile End 503 Whitechapel 193 St. George-in-the-East 236 Analysis. Under observation on January 1st pending diagnosis. Examined for the first time during the year. Total Suffering from Pulmonary Tuberculosis. Suffering from Non-Pulmonary Tuberculosis. Not suffering from 1 Tuberculosis. Under observation on December 31st pending diagnosis. Ceased attendance before completion of diagnosis. Stepney and Mile End Whitechapel St. George-in-the-East (a) All persons (including contacts) 260 1429 1689 263 46 1241 82 57 318 716 1034 107 17 858 52 38 86 710 796 94 25 607 38 32 Total 664 2855 3519 464 88 2706 172 127 21 "Contacts.'' The examination of "contacts" has been more satisfactory than in previous years. It has been found possible to arrange for a much larger percentage to be examined. Recently an arrangement has been made with the L.C.C. School Medical Officers, which ensures that no "contact" of school age will remain unexamined. If the Dispensaries are unable to arrange an examination, the School Medical Officers are notified and the examination is carried out at school. The result of examination of all "contacts" of school age also is communicated to the School Medical Officers and reciprocal reports arei exchanged as appears necessary. The above arrangements have been in force only for a comparatively short time, making it yet too early to appreciate results, but the fact that no "contact" of school age now remains unexamined, is of great value. The desirability of routine "contact" examination has on a number of occasions been proved recently by the discovery of advanced and very infective cases, which have evidently disseminated infection to the other members of the family for years past and have remained undiscovered and untreated until routine "contact" examination has revealed the source of infection. In the case of one family most of the members were already under treatment for tuberculosis and had evidently all become infected by one member, who had advanced disease, but who had never sought medical advice. Infection from this one case had apparently been going on lor a number of years. It is, of course, impossible to estimate how many other members of the community may have contracted tuberculosis as a result of infection from this case. It is these unknown cases which are particularly likely to spread infection owing to the fact that they take no precautions against infecting others. The analysis of "contact" examination will be found in Table II. 22 TABLE II. Under observation on January 1st pending diagnosis. Examined for the first time during the year. Total Suffering from Pulmonary Tuberculosis. Suffering from Non-Pulmonary Tuberculosis. Not suffering from Tuberculosis. Under observation on December 31st pending diagnosis. Ceased attendance before completion of diagnosis. Stepney and Mile End Whitechapel St. George-in-the-East (b) "Contacts " (included in (a)). 82 926 1008 71 28 822 52 35 163 523 686 28 8 618 32 25 10 474 484 8 3 458 10 5 Total 255 1923 2178 107 39 1898 94 65 Table III. shows an analysis of the Insured patients. TABLE III. Under observation on January 1st pending diagnosis. Examined for the first time during the year. Total Suffering from Pulmonary Tuberculosis. Suffering from Non-Pulmonary Tuberculosis. Not suffering from Tuberculosis, Under observation on December 31st pending diagnosis. Ceased attendance before completion of diagnosis. Stepney and Mile End Whitechapel St. George-in-the-East (c) Insured persons. (Included in (a) ). 32 215 247 92 1 143 8 3 20 109 129 32 2 92 3 1 9 148 157 47 2 79 5 24 Total 61 472 533 171 5 314 16 28 A considerable part of the time of the Dispensary Staffs has been devoted to work in connection with the Ministry of Pensions. The Tuberculosis Officers have continued to act as referees for the Ministry as regards tuberculosis 23 Table IV. shows the number of Pensioners dealt with during the year. TABLE IV. War Pension Cases. New cases. Cases in attendance during the year. Stepney 38 123 Whitechapel 21 60 St. George-in-the-East 36 81 Total 95 264 After-Care. After-care remains one of the chief problems to be solved in the campaign against Tuberculosis. During the year, the Interim Tuberculosis Care Committee has ceased to exist and its place had been taken by the Care Committee of the Borough Council. Adequate help and supervision of the tuberculous adult in particular after discharge from Sanatorium is probably the most difficult problem to be faced. Much work has been done in Great Britain in the past few years with regard to the training of such patients at Training Colonies of one description or another, but at present there is a certain amount of chaos. The Ministry of Pensions has instituted Training Colonies, where a number of Stepney War Pensioners have received further treatment and instruction in various suitable occupations. The chief difficulty arises after training is completed and efforts are made to find work in the particular occupations learnt. In a few cases only has it proved possible to obtain such work, and at present it would appear that the time and money spent has in consequence been largely wasted. There is clearly little advantage to be gained by such training (beyond the extended course of treatment) unless work, adequately remunerated, can be found for these patients on the completion of training. 24 Table V. Table V. shows a general analysis of the work of the Dispensaries during the year. 1. Number of Patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on December 31st. 2. Total number of attendances of Patients at the Dispensaries during the year. 3. Number of persons placed during the year under observation at the Dispensaries for purpose of diagnosis. 4. Number ofcasesin which the period of observation at the Dispensary exceeded two months. 5. Number of Insured persons under domiciliary treatment on December 31st. 6. Number of reports received from Insurance Practitioners in reipeet of insured patients under domiciliary treatment during the year. 7. Number of persons referred to affiliated hospital for consultation. 8. Number of consultations with Medical Practitioners at the homes of Patients. 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes. 11. Number of specimens of sputum examined in connection with the work of the Dispensaries. Stepney and Mile End 325 5,864 218 92 212 12 42 11 181 2,321 368 Whitechapol 167 3,145 150 102 113 — 29 — 248 1,880 289 St. George-in-the-East 162 2,750 96 33 117 3 19 20 228 1,180 291 Total 654 11,759 464 227 442 15 90 31 657 5,381 948 25 TUBERCULOSIS DISPENSARIES IN STEPNEY—Form R (Revised). Return as to work carried oat in connection with the Stepney Green Dispensary, 35, Stepney Green, E. 1 for the Year 1922. (Tha return relates only to persons residing in the area which is served by the Dispensary under the scheme of the Metropolitan Borough Council ) Number of Under observation at the Dispensary oa Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary NonPulmonary. (a) All persons (including "Contacts.") Adults. M. 27 345 372 96 9 241 19 7 F. 62 395 457 83 6 340 19 9 Children under 15. M. 105 365 470 45 17 361 23 24 F. 66 324 390 39 14 299 21 17 Total 260 1429 1689 263 46 1241 82 57 (b) " Contacts" (included in a)). Adults. M. 15 188 203 17 9 161 12 4 F. 13 253 266 24 4 219 14 5 Children under 15. M. 30 260 290 16 9 237 11 17 F. 24 225 249 14 6 205 15 9 (c) Insured persons (included in (a) ). M. 8 144 152 56 1 89 5 1 F. 24 71 95 36 0 54 3 2 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 325 2. Total number of attendances of patients at the Dispensary during the year Insured 1608 Uninsured 4256 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 218 4. Number of cases in which the period of observation at the Dispensary exceeded two months 92 5. Number of insured patients under domiciliary treatment on December 31st † 212 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 12 7. Number of persons referred to affiliated hospital for consultation . 42 8. Number of consultations with medical practitioners at the homes of patients Insured 10 Uninsured 1 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 181 10 Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2321 11. Number of specimens of sputum examined in connection with the work of the Dispensary 368 * Insured persons under domiciliary tieatment by Insurance practitioners are excluded, even though they may attend the dispensary at intervals for examination or consultation. Such cases are Included under Head 5. t AH insured persons in the dispensary area who are actually receiving domiciliary treatment from Insurance practitioners are included, irrespective of the date upon which they were plaoed under domiciliary treatment and of any attendance at the dispensary. 26 Return as to work carried out in connection with the Whitechapel Dispensary, 18, Gt. Prescot Street. for the year 1922. (The return relates only to persons residing in the area which is served by the Dispensary under the scheme of the Metropolitan Borough Council ) Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to bo Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary NonPulmonary. (a) All persons (including "Contacts.") Adults M. 23 185 208 51 2 146 9 4 F. 80 223 303 20 1 271 11 7 Children under 15. M. 138 160 298 23 9 248 18 15 F. 77 148 225 13 5 193 14 12 Total 318 716 1034 107 17 858 52 38 (b) "Contacts" (included in (a)) Adults. M. 13 106 119 3 0 111 5 2 F. 28 171 199 3 1 190 5 3 Children under 15. M. 73 127 200 16 4 165 15 14 F. 49 119 168 6 3 152 7 6 (c) Insured persons (included J in (a) M. 6 87 93 31 1 59 2 1 F. 14 22 36 1 1 33 1 0 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 167 2. Total number of attendances of patients at the Dispensary during the year Insured 717 Uninsured 2428 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 150 4. Number of cases in which the period of observation at the Dispensary exceeded two months 102 5. Number of insured patients under domiciliary treatment on December 31st† 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 0 7. Number of persons referred to affiliated hospital for consultation 29 8. Number of consultations with medical practitioners at the homes of patients Insured 0 Uninsured 0 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 248 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 1880 11. Number of specimens of sputum examined in connection with the work of the Dispensary 289 *Insured persons under domiciliary treatment by Insurance practitioners are excluded, even though they may attend the dispensary at intervals for examination or consultation. Such cases are included under Head 5. All insured persons in the dispensary area who are actually receiving domiciliary treatment from Insurance practitioners are Included, irrespective of the date upon which they were placed under domiciliary treatment and of any attendance at the dispensary. 27 Return as to work carried out in connection with the St. George-in-the-East Dispensary, 208, High Street, Shadwell, for the year 1922. (The return relates only to persons residing in the area which is served by the Dispensary under the scheme of the Metropolitan Borough Council). Number of Under observation at the Dispensary on Jan.1st pending diagnosis Examined for the first time during the year. Total. Found to be Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary. NonPulmonary. (a) All persons (including "Contacts.") Adults. M. 12 133 145 43 2 88 5 7 F. 17 220 237 34 4 177 8 14 Children under 15. M. 22 170 192 7 10 155 11 9 F. 35 187 222 10 9 187 14 2 Total 86 710 796 94 25 607 38 32 (b) "Contacts" (included in (a)). Adults. M. 1 51 52 1 0 50 0 1 F. 2 89 91 2 1 87 1 0 Children under 15. M. 4 153 157 2 1 147 6 2 F. 3 181 184 3 1 174 4 2 (c) Insured persons (included in (a)). M. 6 95 101 36 1 48 3 13 F. 3 53 56 11 1 31 2 11 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 162 2. Total number of attendances of patients at the Dispensary during the year Insured 815 Uninsured 1935 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 96 4. Number of cases in which the period of observation at the Dispensary exceeded two months 33 5. Number of insured patients under domiciliary treatment on December 31st† 117 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 3 7. Number of persons referred to affiliated hospital for consultation 19 8. Number of consultations with medical practitioners at the homes of patients Insured 12 Uninsured 8 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 228 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 1180 11. Number of specimens of sputum examined in connection with the work of the Dispensary 291 *Insured persons under domiciliary treatment by Insurance practitioners are excluded, even though they may attend the dispensary at intervals for examination or consultation. Such cases are included under Head 5. †All insured persons in the dispensary area who are actually receiving domiciliary treatment from Insurance practitioners are included, irrespective of the date upon which they were placed under domiciliary treatment and of any attendance at the dispensary. 28 Pneumonia, Malaria, Dysentery and Trench Fever Regulations. 566 cases were notified under these Regulations. Of these, 565 were Pneumonia and 1 Malaria. The cases occurred in the Districts as follows:— Limehouse St. George's Mile End Whitechapel Total Pneumonia 232 11 269 53 565 Malaria — — — 1 1 Dysentery — — — — — Diseases of the Respiratory Organs. 946 deaths were due to diseases of the Respiratory Organs, or 198 more than in the previous year. 241 belonged to the Limehouse District, or at the rate of 4.53 per 1,000 of the population. 169 belonged to St. George-in-the-East, or at the rate of 4.14 per 1,000 of the population. 346 belonged to Mile End Old Town, or at the rate of 3.31 per 1,000 of the population. 190 belonged to the Whitechapel District, or at the rate of 3.52 per 1,000 of the population. The death-rate for the whole Borough was 3.75 per 1,000 of the population. Influenza. 130 deaths were due to Influenza, or 88 more than in the previous year. 19 belonged to the Limehouse District, or at the rate of .35 per 1,000 of the population. 27 belonged to St. George-in-the-East, or at the rate of .66 per 1,000 of the population. 55 belonged to Mile End Old Town, or the rate of .52 per 1,000 of the population. 29 belonged to the Whitechapel District, or at the rate of .53 per 1,000 of the population. The death-rate for the whole Borough was at the rate of .51 per 1,000 and that for London was .57 per 1,000 of the population. 29 Cancer. 274 deaths were due to Cancer, or 11 more than in the previous year. 50 belonged to the Limehouse District, or at the rate of .94 per 1,000 of the population. 34 belonged to St. George-in-the-East, or at the rate of .83 per 1,000 of the population. 129 belonged to Mile End Old Town, or at the rate of 1.23 per 1,000 of the population. 61 belonged to the Whitechapel District, or at the rate of 1.13 per 1,000 of the population. The death-rate for the whole Borough was at the annual rate of T08 per 1,000 of the population. The number of people who die from Cancer is steadily increasing year by year in the Borough. This is partly due to the fact that being a disease of advanced life, a gradual and regular decline in the death-rate means that more people live to an age susceptible to Cancer. The increase in the number of deaths is shown in the following table, although the population was gradually decreasing:— 1916 232 1917 235 3918 239 1919 234 1920 244 1921 263 1922 274 Infantile Mortality. 476 infants died under 1 year of age, or 74 less than in the previous year. 121 belonged to the Limehouse District, or at the rate of 76 per 1,000 births. 87 belonged to St. George-in-the-East, or at the rate of 82 per 1,000 births. 187 belonged to Mile End Old Town, or at the rate of 75 per 1,000 births. 81 belonged to the Whitechapel District, or at the rate of 90 per 1,000 births. 30 The infantile mortality for the whole Borough was 79 per 1,000 births, while that for the whole of London was 74 per 1,000. Of the 102 illegitimate births, 21 died before they were a twelvemonth old, or at the rate of 207 per 1,000. The average infantile mortality for five-year periods from 1390-1919, and for the years 1920-1922:— Limehouse. St. George's. Mile End. Whitechapel. Whole Borough. 1890-1894 186 197 175 163 178 1895-1899 204 187 166 147 168 1900-1904 201 162 148 135 157 1905-1909 153 142 120 112 129 1910-1914 143 137 112 103 122 1915-1919 107 123 90 93 100 1920 86 98 84 98 90 1921 98 77 89 83 89 1922 76 82 75 90 79 There were 64 sets of twins born during the year, and two of triplets. The rate of infantile mortality is again low, and by reference to the above table it will be observed that it is the lowest on record. Previous to the existence of the Borough Council, the infantile mortality varied from about 160 to 200 per 1,000 births, and in some parts of the District which now form the Borough of Stepney it was above 200 per 1,000 births (notably the Limehouse District). During the last four years, the infantile mortality has been less than 100 per 1,000 births in each year, not only for the whole Borough, but in each of the four districts which comprise the Borough of Stepney. The most satisfactory feature is the gradual and regular lowering irrespective of what the weather has been during the summer. As a rule, if the summer has been warm and dry, the infantile mortality has been high, due to the increased number of deaths from Summer Diarrhoea. In 1922, the summer was cold and wet, and it was only natural to expect a lowered infantile mortality because the number of deaths of infants from Summer Diarrhoea would be low. We had, however, a rather severe outbreak of Whooping Cough which accounted for 39 deaths of infants under one year of age, or five times the number in the previous year. 150 deaths under one were due to Bronchitis and Pneumonia, or nearly twice as much as in the previous year, many of these being complications or the result of Whooping Cough. Even in 1921, the hottest and driest year probably on record, the infantile mortality was 90 per 1,000. Compare this with 1911, a year that most nearly approached 1921 in character, when the infantile mortality was 149 per 1,000 births. 31 The Maternity and Child Welfare Scheme is on the following lines:— 1. Ante-Natal Clinics. There are five ante-natal clinics in the Borough so that the expectant mother may be seen by a doctor at any stage of her pregnancy. The Health Visitors visit the homes to help and advise the women on matters of hygiene and health. 2. Health Visiting. When the baby is ten days old our Health Visitors pay their first visit. They urge the mother to attend the nearest infant welfare centre with her child, in this way the young mother soon gets "the centre habit" and as her other children are born she brings them along too, so that we keep in touch with the entire family. The Health Visitors go to see the older children at intervals of every three months, and no child is lost sight of until it goes to school, or is five years of age. In addition to giving lectures on practical subjects to the mothers at the centres, they also visit and report upon all cases of Stillbirth and Ophthalmia Neonatorum throughout the Borough. 3. Maternity and Child Welfare Centres. Owing to the large attendances at these centres throughout the year it became necessary to sort out cases to be seen by the Doctor each week. The delicate ailing children are seen weekly by the Doctor and the healthier ones at intervals of one month. It is difficult to define the exact limits of an infant welfare centre. Though its work is first and foremast of a preventive nature, yet a certain amount of actual treatment is necessary if the centre is to be of any practical use. The Ministry of Health approve of the treatment of minor ailments such as sores or discharging eyes and ears. Rickets and disorders of metabolism are also suitable cases for an infant welfare centre. Any mother or child who is definitely ill, is at once referred to hospitals or private practitioners, and no treatment or advice is given at the centre while the case is known to be under their care. 4. Clinic jor Women. It was found at the various infant welfare centres, that several mothers needed special advice from the Doctor. As there is neither time nor opportunity for giving such advice at the infant welfare consultations, a special morning was set aside on which any mother could attend. The cases treated are either ante or post natal, and if they appear to be in need of treatment, they are referred elsewhere. Only women who cannot afford a private doctor are seen at this clinic. 32 5. Hospitals and Convalescent Homes. We find no difficulty in securing Hospital treatment for any cases. The Borough Council maintains a bed at the East End Lying-in Home for women whose husbands are out of work, and who are not eligible for maternity benefit. A cot is reserved at the Stepney Nursing Home for Babies over one year, who are in urgent need of skilled nursing and attention. Delicate illnourished babies do very well at this Home. Mothers and babies are sent to Convalescent Homes from time to time, and toddlers go to the Marjorie Lumley Holiday Home, at Maidenhead. 6. Dental Clinic. Expectant and nursing mothers, and children under five years of age, are given dental treatment at the London Hospital. One afternoon per week is set aside for this purpose, so that the mothers do not have to wait long. A charge of 2s. is made for the entire treatment. Dentures are supplied at the usual Hospital rates. 7. Sewing Classes. The sewing classes are run by the Health Visitors themselves, so that expenditure in this connection is practically nil. Owing to changes on the staff it has been found necessary to close down the Limehouse and Whitechapel sewing classes. The Limehouse mothers, in particular, very much regret the closing down of the class, and we hope to re-open for them at the first opportunity. 8. Co-operation with Voluntary Agencies. The Borough Council pays for the Medical Officer attending Burdett Road and Shadwell voluntary infant welfare centres. In addition, a Municipal Health Visitor attends twice per week at Burdett Road. Dame Colet Centre, and Stepney Centre (587, Commercial Road), are both attended by a Municipal Health Visitor. Revisiting is also undertaken for any voluntary area which is in need of help. This in addition to the primary visiting, which we undertake for practically the whole of the Borough, ensures mutual help and co-operation between Municipal and Voluntary workers. 33 The following is a list of Centres, Clinics and Creches in the Borough:— 1. Municipal Centres. Limehouse Centre, Town Hall, Commercial Road. St. George's Centre, Town Hall, Cable Street. Spitalfields Centre, Bedford Institute, Quaker Street. Wapping Centre, 52, Red Lion Street. Whitechapel Centre, St. Phillip's Institute, Newark Street. 2. 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. 3. Ante-natal Clinics. East End Mothers' Lying-in-Home, Commercial Road. London Hospital. Limehouse Town Hall. 24, Underwood Street. 587, Commercial Road. 4. 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. Nursery School, Rectory Square. Feeding of Infants:— Breast fed 4,880 Artificially fed 115 Mixed feeding 177 5,172 No, dead before first visit of Health Visitor 118 34 Ophthalmia Neonatorum. Total No. of cases notified 46 „ ,, visited 45 (1 was not traced) „ „ treated at home 33 „ „ treated in hospital 12 Total No. of cases in which vision was impaired 4 „ „ „ „ unimpaired 40 Total No. of cases of total blindness — Total number of deaths 1 Municipal Centres. Limehouse. St. George's. Spitalfields. Wapping. Whitechapel No. of sessions held 47 50 51 199 98 No. of attendances of infants 1,539 1,682 572 1,514 1,871 No. of attendances of children 1-5 years of age 548 635 229 493 984 No. of doctors' consultations 47 50 51 65 98 Sewing Classes:— No. of classes held 49 46 44 36 47 No. of attendances 355 349 445 174 311 Supply of Milk to Expectant and Nursing Mothers and to Children. The approximate quantity of milk, etc., distributed during the year, together with the cost, was as follows:— No. of persons 13,506 Cows' milk, 45,888 gallons Cost, £5,349 Dried milk, 5,944 lbs. Cost, £497 Virol, 85½ lbs. Cost, £5 14s. 0d. VISITS BY THE HEALTH VISITORS:— Addis Chabot Clements Cordwell Davis Gibbs Goodfellow Mitchell Phillips j Virtue Whitty Total Primary 236 656 447 542 531 557 240 589 535 370 469 5,172 Revisits:— To infants under 1 year 1,000 605 958 560 633 1,006 375 617 701 834 877 8,166 To children between 1-5 years 1,194 585 626 951 1,061 531 387 609 1,324 702 1,118 9,088 Ante-natal:— Primary 12 3 145 77 — 19 63 89 19 — 90 517 Subsequent 24 3 52 11 — 57 8 93 — — 36 284 Miscellaneous 60 387 46 610 299 520 1,100 135 128 — 542 3,827 Total 2,526 2,239 2,274 2,751 2,524 2,690 2,173 2,132 2,707 1,906 3,132 27,054 CENTRES ATTENDED:— Municipal 137 131 94 66 49 110 199 144 100 120 112 1,262 Voluntary — 4 — 32 80 — — — 46 — 13 175 Total 137 135 94 98 129 110 199 144 146 120 125 1,437 35 36 List and quantity of the foodstuffs destroyed during the year under the Unsound Food Series and the Public Health (Foreign Meat) Regulations 1908. I.—At the wharves. Fresh Meat and Poultry. Tons. cwts. qrs. lbs. 3 pigs' carcases — 6 2 8 2 sheep's carcases — — 3 20 2 hind-quarters of beef — 1 0 22 6 legs and loins of pork — 1 1 9 61 turkeys — 4 1 19 4 fowls — — — 10 2 geese — — — 14 Preserved Meats. 54,936 tins of beef 111 8 1 13 72 tins of rabbit — 1 1 4 1,390 tins of tongue 2 6 2 19 4,041 glasses of tongue 1 19 0 0 Preserved Fish. 8 tons of anchovies — 2 1 6 7,725 tins of salmon 4 3 0 19 9,744 tins of potted sardines 3 18 0 0 85 tins of sardines — 3 3 0 Fresh Fruit and Vegetables. 2,322 crates of bananas 31 8 2 0 166 bags of chestnuts 5 5 0 0 112 bags of onions 5 3 0 16 50 boxes of oranges 2 14 2 14 718 baskets of plums 6 0 3 0 2,967 bags of potatoes 146 8 0 0 5,416 boxes of tomatoes 49 14 3 22 Preserved Fruit and Vegetables. 12,964 tins of apples 16 9 1 3 6,346 tins of fruit pulp 76 17 0 0 518 tins of assorted fruits — 9 0 24 6,470 tins of tomatoes 27 9 2 22 Carried forward 492 17 1 12 37 Sundries. Tons. cwts. qrs. lbs Brought forward 492 17 1 12 22,044 tins of assorted canned goods 18 12 2 0 111 tins of Benger's food — — 3 27 133 bags of Cocoa (in bean) 8 10 0 11 2,016 tins of condensed milk — 18 0 0 617 packages of dried fruits 8 4 0 0 13 tins of Glaxo — — 1 4 990 tins of Horlick's Food tablets — 4 1 19 2,045 tins of jams 1 11 0 17 432 tins of meat essence — 1 0 5 74 tins of pearl barley — 10 0 12 92 tins of soup — 2 2 15 531 12 2 10 18 boxes of pigs' kidneys and 1 cask of pieces of pork were refused admission, and were re-exported to the country of origin, as the goods came within the description of, Foreign Meat Class III. II.—Diseased Meat and Offal destroyed from the Slaughter-houses and Offal Dealers:— Tons. cwts. qrs. lbs. 9 calves' carcases and organs — 6 1 6 5 sheep's carcases and organs — 2 2 8 6 forequarters of mutton — — 1 23 45 bullocks' livers — 4 3 23 7 sheep's livers — — — 13 3 calf's livers — — — 6 4 sets of bullocks' lungs — — 1 20 4 sets of sheep's lungs — — — 10 4 sheep's plucks — — 1 3 1 calves' pluck — — — 11 42 bullocks' spleens — — 3 0 4 bullocks' heads — 1 0 8 1 bullocks' tongue — — — 8 — 17 0 27 38 III.—Unsound Food seized by, or surrendered to the District Inspectors:- Tons. cwts. qrs. lbs. Anchovies — — — 27 Apples 2 5 3 17 Asparagus — 3 0 0 Bacon — 7 0 22 Bananas 2 0 0 0 Beef and Mutton — 1 2 22 Brawn — — — 6 Bream 1 10 0 0 Canned Goods (Assorted) 3 12 0 0 Cheese — 17 0 0 Cherries — 1 0 0 Cob-nuts — 1 0 8 Cods' Rows — — 1 2 Corned Beef — — 1 14 Damsons 1 17 0 0 Dates — 2 2 14 Dutch Herrings 1 7 3 0 Eggs — 1 1 6 Fish (Flat) — 3 0 0 Fish (Freshwater) — 1 3 6 Gooseberries — 4 0 0 Grapes — 4 3 14 Haddock — 1 1 14 Herrings 4 11 0 4 Jam 3 18 0 24 Kippers — 2 2 8 Macaroni — — 2 0 Milk (Condensed) 32 6 1 4 Milk (Dried) 2 0 0 0 Peaches — 4 1 17 Pea-nuts — 1 3 17 Pears 7 4 3 2 Perch — 1 1 20 Plaice — 1 3 3 Plums 3 12 1 16 Pork — 8 0 0 Potatoes 3 7 0 0 Raisins — 2 0 2 Skate — 1 2 16 Skate Wings — 2 3 16 Tomatoes 56 17 0 17 Walnuts — 1 2 2 Total 130 9 0 4 89 Disinfecting Station. 1,735 rooms were fumigated and the bedding, etc., were removed and disinfected by steam. Of these, 1,581 rooms were fumigated because of infectious disease, 186 as a result of Pulmonary Tuberculosis, and 68 because they were verminous. In addition to these, Scabies occurred in 257 families and the bedding was taken away and disinfected by steam. 221,932 articles were disinfected. Of these 195,016 were second-hand articles of clothing for export abroad, 19,446 were from premises where infectious disease occurred, and 7,470 because they were in a verminous condition. 580 articles of bedding were destroyed with the owners' consent. The Mortuary. The number of bodies deposited in the Mortuary during the year was 255. Of these, 205 were removed by the Coroner's Order, 36 by the Police, 1 at the request of deceased's friends, and 13 on my instructions. 35 bodies were placed in the Jewish part of the Moriuary, but only 11 were officially "watched." 241 inquests were held in the Coroner's Court, and 75 post-mortem examinations were made. Verminous Persons. 351 persons were cleansed during the year and had their clothing disinfected—317 males and 34 females. In addition, 1;042 school children were cleansed, of which 322 were children suffering from Scabies. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. 42 applications for certificates were made during the year under Sec. 2 (2) of the Act. Of these, 31 were granted, 9 were refused, and 2 were withdrawn by the applicants. 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 1922 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. 40 (2) The number of Boats inspected in 1922 was 32 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 One. (j) Provision of Water Cask Nil. (k) Removal of Bilge Water Nil. (l) Notification of Infectious Disease Nil. (m) Admittance of Inspector Nil. (4) No legal proceedings were taken. (5) No infringements were found. (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, 1922 (a) Number of boats believed to be in use or available was—4. Boats propelled by motor—Nil. (b) Number of boats that cannot be traced—Nil. (9) No boats were registered during the year. General Sanitary Work. 41,610 inspections were made to houses. 58,329 re-visits were made by the Inspectors to supervise the abatement of the nuisances found in .1.8,091 houses. 8,569 statutory notices were served. 117 summonses were taken under the Public Health (London) Act, 1891. 4,074 drains were tested with smoke, and 145 were re-tested; 580 drains were either constructed or re-constructed, cleansed or repaired; 382 were trapped. 156 new soil pipes were fixed and ventilated; 843 new closet pans and traps were fixed; 3,800 closets were either cleansed or repaired, or provided with additional light and ventilation; 1,708 water closets were provided with a proper flushing apparatus. SANITARY INSPECTORS' REPORT. COOK. CROOK. DEE. FLINT. JOHNSON. MILLS. PAVITT. QUAINTRELL. SHEPHERD. SIMPSON. STILES. TWAITS. WATERMAN. WHITE. WRACK. BOTTOMLE. HARRIS. TRIMMING. TWYNHAM. TOTALS. Number of Inspections— House to house 385 687 430 443 762 713 829 695 994 899 952 830 938 557 471 1039 1079 312 382 13397 Micellaneous 1689 863 1493 1275 1363 2071 724 1545 1310 969 1582 1090 1220 1207 1059 361 195 898 1010 21874 Complaints 317 436 143 152 142 431 480 137 90 321 162 424 75 130 676 15 36 266 111 4544 Infectious disease 73 180 80 59 246 107 111 132 55 131 93 228 125 70 105 ... ... ... ... 1795 Re-visits—Number of 1798 2500 2519 1909 5324 3534 3419 1396 2662 4836 2616 3744 2992 2230 1865 3930 3731 3926 3398 58329 Intimations served 574 1108 803 639 1132 1099 1239 656 806 1384 1415 1254 970 687 698 750 819 999 1059 18091 Statutory notices served 271 812 456 473 273 593 845 224 174 931 491 965 248 406 443 80 261 854 269 8569 Summonses taken out under the Public heath (London) Act, 1891 14 ... 3 2 3 1 4 7 ... 14 29 8 6 ... 6 ... 2 13 5 117 Food and Drugs Acts, etc.—No. of samples taken 86 98 90 91 91 101 95 93 100 94 94 97 97 90 91 ... ... ... ... 1408 ,, ,, No. of summonses taken 2 6 6 3 2 2 12 1 4 4 3 9 1 2 ... ... ... ... ... 57 Animals kept so as to constitute a nuisance, removed 6 4 3 8 1 7 6 5 2 2 4 ... 1 2 ... 1 4 5 5 66 Areas and stables paved and drained 1 7 3 2 ... ... 8 7 ... ... ... 11 1 ... ... ... ... 8 ... 48 Bakehouses—No. of inspections to 22 30 8 22 22 30 22 22 12 22 30 28 14 10 20 ... ... ... ... 314 ,, No. cleansed 22 30 8 22 22 30 22 22 12 22 30 28 14 10 20 ... ... ... ... 314 Cisterns cleansed and covered 10 3 ... 4 ... 7 4 7 6 ... ... 7 10 8 6 ... 5 2 ... 79 Damp walls remedied 89 52 112 30 94 45 55 58 17 22 58 78 61 46 23 19 106 55 21 991 Drains—Cleansed or repaired 57 124 40 26 100 50 134 86 23 146 127 66 73 56 67 19 34 39 2 269 Constructed or reconstructed 15 50 12 12 30 16 16 14 10 24 14 39 26 10 23 ... ... ... ... 311 Soil pipes fixed and ventilated 15 30 6 3 21 6 3 ... 2 12 22 4 21 3 8 ... ... ... ... 156 Trapped 34 26 7 14 44 68 5 6 10 7 38 55 7 20 34 ... 7 ... ... 382 Dust receptacles provided 36 68 73 98 221 107 169 120 142 333 240 316 127 70 85 163 10 167 154 2699 Houses or parts of houses cleansed 421 385 414 406 524 309 707 348 402 718 290 640 573 354 253 564 727 504 609 9098 ,, ventilated beneath the lower floor 2 20 3 4 2 1 17 4 11 4 17 20 6 4 ... ... 10 15 1 141 Light and ventilation provided to rooms. ... 4 8 2 ... 1 6 7 ... 1 1 15 3 ... ... ... 17 ... ... 65 Manure receptacles provided or reconstructed 3 ... ... 2 2 1 ... 8 ... 3 ... 3 ... ... ... ... ... ... ... 17 Offensive accumulations removed 67 25 24 9 6 140 3 10 30 13 60 14 20 5 83 ... 10 19 2 540 Open fires in yards abolished 4 12 ... 5 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 22 Overcrowding in dwellings abated 5 1 3 7 3 3 4 3 2 1 2 8 1 6 3 ... 1 2 3 53 Sheds occupied as dwellings discontinued ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 Sink, bath, lavatory pipes and rainwater pipes disconnected 14 57 31 1 ... 6 ... 10 ... 6 ... 64 35 5 8 ... ... ... ... 237 Smoke nuisances abated 1 ... 9 2 9 ... 4 1 ... ... 1 ... 3 8 1 ... ... ... ... 39 Underground rooms—Illegal occupation discontinued ... 1 2 2 ... 1 ... ... ... ... 2 ... ... ... ... ... ... 1 ... 9 Urinals fixed 4 ... ... 1 3 1 6 2 4 5 2 8 8 ... ... ... ... ... ... 44 Verminous rooms cleansed 87 208 42 98 148 189 192 94 66 214 153 207 125 26 79 56 256 232 116 2588 Wash-houses, forecourts, &c., paved 7 27 52 4 98 3 4 20 2 8 7 33 34 24 1 35 40 8 63 470 Waterclosets—Cleansed or repaired 164 106 105 151 146 365 98 97 256 219 318 206 141 43 141 161 255 421 323 3716 „ Light and ventilation provided 2 3 2 2 4 3 2 ... 7 ... 1 15 23 ... 15 ... 5 ... ... 84 ,, Pans and traps fixed 164 14 46 12 94 54 46 23 20 74 15 88 61 32 45 6 22 9 18 843 ,, Water supply or flushing apparatus provided 164 110 78 56 102 171 76 46 10 157 122 72 135 66 70 4 64 98 107 1708 Water supply to houses reinstated 7 4 31 ... ... 3 24 6 1 9 2 1 10 2 3 2 ... 6 3 114 Yards cleansed, paved, or paving repaired 39 130 198 106 136 91 91 79 16 194 149 172 93 84 68 143 84 173 252 2298 Miscellaneous repairs to roofs, gutters, floors, sashes, fireplaces, coppers, etc. 549 735 862 836 1750 951 979 726 400 1609 1530 1608 882 650 503 913 1361 1780 1426 20050 Face page 41. 41 2,298 yards were cleansed, paved or repaired ; 48 areas and stables were paved and drained ; and 470 washhouses and forecourts were paved. There were 66 nuisances under the Public Health (London) Act, 1891 with respect to the keeping of animals, and these were all abated. 22 nuisances with respect to open fires in yards were remedied. Notices were served to provide 2,699 sanitary dust receptacles, and 17 manure receptacles were provided or re-constructed; 540 offensive accumulations were removed from the rear of dwelling houses. 141 houses were ventilated under the lower floor. 9 underground rooms, which were illegally occupied, were discontinued from being used as such. 44 urinals have been fixed. 39 notices were served for the abatement of smoke nuisances. 310 visits were made to bakehouses, and 310 cleansings were carried out. 9,098 notices were served to have houses cleansed. 237 sink, bath, lavatory, or rain-water pipes, which were communicating directly with the drain, were disconnected. 20,050 miscellaneous repairs to roofs, floors, gutters, etc., were carried out as the result of notices served. 65 rooms were provided with additional light and ventilation, and the damp walls of 991 rooms were remedied. The number of registered milkshops at the end of the year was 430 and 1,409 visits were made to inspect the condition of the premises, milk receptacles, etc. Ice cream was manufactured at 200 premises, and 365 inspection were made to them. 2,588 verminous premises were cleansed during the year. TOTAL FINES AND COSTS. Fines. Costs. £ s. d. £ s. d. Under the Public Health (London) Act, for various nuisances 105 16 0 213 2 0 Unsound Food 9 0 0 — — — Bye-laws for Houses-let-in-lodgings 3 0 0 2 8 0 Housing & Town Planning Act, 1919 1 0 0 2 1 0 Metropolis Local Management Act 1 0 0 1 1 0 Food & Drugs Acts 175 17 0 102 2 0 Dairies, Cowsheds & Milkshops Orders 1 0 0 1 0 0 Butter & Margarine Acts 20 1 0 15 15 0 Total £316 14 0 £337 9 0 42 POLICE COURT PROCEEDINGS. (1) UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. On 5th January, A- Wilks was summoned for failing to comply with a Magistrate's order to abate a nuisance at 6£, Red Lion Court. He was fined £2 with £2 2s. costs. On 5th January, A. Wilkes was summoned for failing to comply with a Magistrate's order to abate a nuisance at 7, Red Lion Court. He was fined £5 with £2 2s. costs. On 12th January, H. J. Bliss & Sons were summoned for failing to reconstruct a defective drain at 65, Diggon Street, in accordance with the Council's notice. An order was made to do the work within 28 days with £2 8s. costs. On 12th January, H. J. Bliss & Sons were summoned for failing to — reconstruct a defective drain at 67, Diggon Street, in accordance with the Council's notice. An order was made to do the work within 28 days with £2 8s. costs. On 12th January, H. J. Bliss & Sons were summoned for failing to reconstruct a defective drain at 69, Diggon Street, in accordance with the Council's notice. An order was made to do the work within 28 days with £1 7s. costs. On 19th January, the Owner of 1, Lichfield Road, was summoned for failing to remedy the dirty and dilapidated condition of the premises. An order was made to do the work within 14 days with £2 8s. costs. On 19th January, Innes & Son were summoned for failing to remedy the defective roof and dirty condition of 90, Lichfield Road. An order was made to do the work within 14 days with £1 7s. costs. On 19th January, Innes & Son were summoned for failing to provide a proper sanitary dust receptacle at 90, Lichfield Road. They were ordered to pay £2 8s. costs. On 21st January, David Galinsky was summoned for failing to repair the defective roof, etc., at 3, White Horse Lane. An order was made to do the work within 14 days with £2 8s. costs. On 23rd January, Woolf Rutkowski was summoned for failing to comply with a Magistrate's order to repair the roof, floors, sashes, and to cleanse the walls and ceilings at 19, Pinchin Street. He was fined £15 with £3 3s. costs. 43 On 27th January, Woolf Rutkowski was summoned for failing to repair the roof of 6, Stutfield Street. The work having been done at the time of the hearing of the summons he was ordered to pay £1 Is. costs. On 27th January, Woolf Rutkowski was summoned for failing to repair the roof of 8, Stutfield Street. The work having been done at the time of the hearing of the summons he was ordered to pay £1 Is. costs. On 27th January, Woolf Rutkowski was summoned for failing to repair the roof of 18, Stutfield Street. An order was made to do the work within 7 days with £2 costs. On 9th February, Joseph Hodges was summoned for failing to repair the defective roof, etc., at 119, Coutts Road. An order was made to do the work within 7 days with £2 8s. costs. On 23rd February, the Owner of 50, White Horse Lane, was summoned for failing to remedy the defective drain at the premises. An order was made to do the work within 28 days with £2 8s. costs. On 28th February, Albert Benabo was summoned for failing to remedy a defective waste pipe at 11, Edward Street. He was fined 8s., with £2 2s. costs. On 28th February, David Galinski was summoned for failing to remedy the defective roof of 5, Tenter Street East. The work having been done at the hearing of the summons, it was withdrawn, no costs being allowed. On 2nd March, Hood & Son, were summoned for failing to remedy the defective roof and to cleanse the walls and ceilings at 13, Old Gravel Lane. An order was made to do the work within 7 days, with £2 8s. costs. On 2nd March, Richard E. Lloyd, was summoned for failing to remedy the defective floors, and to cleanse the walls and ceilings at 25, Norfolk Street. An order was made to do the work within 21 days, with £2 8s. costs. On 2nd March, Richard E. Lloyd, was summoned for failing to cleanse the dirty walls and ceilings, and to provide proper gutters to the washhouse at 27, Norfolk Street. An order was made to do the work within 21 days, with £2 8s. costs. 44 On '2nd March, Richard E. Lloyd, was summoned for failing to provide a proper sanitary dust receptacle at 27, Norfolk Street. He was ordered to pay £1 Is. costs. On 8th March, L. Greenberg, was summoned for failing to repair the roof, sashes, skylights, w.c's., water fittings, and to cleanse and repair the walls and ceilings, at 98, Commercial Eoad. The Magistrate ordered the premises to be closed, with £2 8s. costs. On 9th March, Betsy Gales was summoned for failing to remedy the defective eaves gutters and damp walls, etc.. at 7, Anthony Street. An order was made to do the work within 14 days, with £2 8s. costs. On 9th March, B. Nordheim was summoned for failing to remedy the defective roofs, etc., at 132, Cable Street. An order was made to do the work within 14 days, with £2 8s. costs. On 14th March, Arthur Gwinn, of 4a, Lombard Street, was summoned for failing to abate a nuisance arising from an offensive trade (fish curing). The nuisance having been abated, he was ordered to pay ,£5 5s. costs. On 30th March, A. Stoppler, was summoned for failing to provide a proper sanitary dust receptacle, at 15, Christian Street. He was fined 10s., with £1 Is. costs. On 30th March, A. Stoppler was summoned for failing to repair the gutters, rainwater pipe and flue, at 15, Christian Street. An order was made to do the work within 14 days, with £1 5s. costs. On 30th March, A. Stoppler, was summoned for failing to repair the drain, at 15, Stutfield Street. The work having been done at the time of the hearing of the summons, he \yas fined 5s., with £2 2s. costs. On 30th March, George Billings & Co., were summoned for failing to repair the roof of 30, Christian Street. The work having been done at the time of hearing of the summons, they were fined 10s. with £2 2s. costs. On 11th April, Wilks & Co., were summoned for failing to repair the yard paving, etc., at 46, St. Peter's Road. An order was made to do the work within 28 days, with 10s. 6d. costs. On J 1th April, David Galinsky, was summoned for failing to repair the defective roof of 44, Weaver Street. An order was made to do the work within 7 days with £1 3s. costs. 45 On 11th April, Franks & Simons were summoned for failing to cleanse the dirty walls and ceilings at 138, Buxton Street. The work having been done at the time of the hearing of the summons, they were ordered to pay 10s. 6d. costs. On 12th April, A. Denenberg, was summoned for failing to comply with the Magistrate's order to vacate the premises, 98, Commercial Road, after a closing order had been made. Having left the premises at the time of the hearing of the summons, he was fined 10s. with £2 6s. costs. On 12th April, R. I. Barnet, was summoned for failing to repair the defective roof and flushing apparatus at 7, Fieldgate Mansions. The work having been done, on the date of hearing, the summons was withdrawn on payment of £2 4s. costs. On 4th May, Woolf Levy was summoned for failing to remedy the defective water closet, roof and gutters, at 16, White Horse Lane. Having completed the necessrry work, at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. On 11th May, C. C. & T. Moore, were summoned for failing to repair and cleanse 1, Love Court. An order was made to do the work within 14 days with £2 8s. costs. On 11th May, C. C. & T. Moore were summoned for failing to repair and cleanse 2, Love Court. An order was made to do the work within 14 days with £2 8s. costs. On 11th May, H. Rubens was summoned for failing to repair and cleanse 1, Twine Court. The case was adjourned for one month. On 12th May, Franks & Simons were summoned for failing to repair the defective roof, walls, and skylight of staircase at 56, Ben Jonson Road. An order was made to do the work within 14 days with £2 8s. costs. On 15th May, C. C. & T. Moore were summoned for failing to repair and cleanse the walls and ceilings at 97, Maroon Street. The work being in hand at the time of the hearing of the summons, an order was made to complete the same within 14 days with £2 8s. costs. On 15th May, C. C. & T. Moore were summoned for failing to repair and cleanse the walls and ceilings at 99, Maroon Street. An order was made to complete the work within 14 days with £2 8s. costs. 46 On 16th May, Harris Woolf was summoned for failing to provide a proper sanitary dust receptacle at 66, Cleveland Street. Having provided the dust receptacle before the hearing of the summons he was ordered to pay i'l 3s. costs. On 18th May, David Galinsky was summoned for failing to repair the rainwater pipe and eaves gutters to the roof of 131, Jubilee Street. An order was made to complete the work within 14 days with £2 8s. costs. On 18th May, David Galinsky was summoned for failing to repair the rainwater pipe, eaves gutters, etc., at 133, Jubilee Street. An order was made to complete the work within 14 days with £2 8s. costs. On 24th May, A. Stoppler was summoned for failing to comply with the Magistrate's order to repair the gutters, rainwater pipes and drain at 15, Christian Street. He was fined £5. On 24th May, A. Stoppler was summoned for failing to provide a proper sanitary dust receptacle at 15, Christian Street. He was fined £2 2s. On 25th May, David Galinsky was summoned for failing to repair the roof, etc., at 38, Scarborough Street. An order was made to complete the work within 14 days with £2 8s. costs. On 25th May, M. S. Critchett was summoned for failing to cleanse the walls and ceilings and repair the rainwater pipe at 74, St. Pauls Road. An order was made to complete the work within 28 days with £2 8s. costs. On 30th May, Benabo & Sons were summoned for failing to repair the roof of 16, Golding Terrace. The work having been done at the time of the hearing of the summons, they were ordered to pay £1 3s. costs. On 30th May, Benabo & Sons were summoned for failing to repair the walls and ceilings, window sashes and floors at 19, Golding Terrace. An order was made to complete the work within 7 days with £1 7s. qosts. 47 On 30th May, Benabo & Sons were summoned for failing to repair the yard paving, and provide water to the water closet at 25, Golding Terrace. The work having been done at the time of the hearing of the summons, they were ordered to pay £1 3s. costs. On 30th May, Benabo & Sons were summoned for failing to repair the roof and cleanse the walls and ceilings at 32, Goldmg Terrace. The work having been done at the time of the hearing of the summons they were ordered to pay £1 3s. costs. On 30th May, Benabo & Sons were summoned for failing to repair the yard paving, rainwater pipe, gutters and sashes at 17, Golding Terrace. An order was made to complete the work within 7 days with £2 8s. costs. On 30th May, Benabo & Sons were summoned for failing to repair and cleanse the walls and ceilings at 8, Golding Terrace. An order was made to complete the work within 7 days with £'.2 8s. costs. On 13th June, G. R. Dix was summoned for failing to repair the yard paving and guttering at 44, Sceptre Street. The work having been done, before the time of the hearing of the summons, the summons was withdrawn on payment of £2 4s. costs. On 15th June, F. Payne & Son were summoned for failing to repair the roof and ceilings at 64, Shandy Street. The work having been done before the hearing of the summons they were ordered to pay £2 4s. costs. On 20th June, David Galinsky was summoned for failing to repair the defective roof and cleanse dirty and verminous rooms at 48, Weaver Street. An order was made to complete the work within 7 days with £2 7s. costs. On 20th June, David Galinsky was summoned for failing to repair the defective roof and eaves gutter at 85, Underwood Street. An order was made to complete the work within 7 days with £1 6s. costs. On 20th June, David Galinsky was summoned for failing to repair the defective roof, etc., at 87, Underwood Street. An order was made to do the work within 7 days with £1 6s. costs. On 20th June, David Galinsky was summoned for failing to repair the defective roofs of the washhouse and water closet, etc., at 89, Underwood Street. An order was made to do the work within 7 days with £1 6s, costs. 48 On 27th June, R. I. Barnett was summoned for failing to repair the roof at 18, Scarborough Street. An order was made to do the work within 14 days with £2 8s. costs. On 27th June, David Galinsky was summoned for failing to comply with the Magistrate's order to repair the roof of 38, Scarborough Street. He was fined £1 with £2 2s. costs. On 5th July, H. L. Hutchins was summoned for failing to repair and cleanse the walls and ceilings at 34, Halley Street. The work being in hand at the time of the hearing of the summons, an order was made to complete same within 14 days with £2 8s. costs. On 5th July, H. L. Hutchins was summoned for failing to provide a proper sanitary dust receptacle at 34, Halley Street. He was fined £1 with £1 Is. costs. On 6th July, Benabo & Sons were summoned for failing to provide water supply to water closet at 32, Burslem Street. The supply having been provided before the time of the hearing of the summons they were fined 10s. with £2 4s. costs. On 6th July, H. Warman was summoned for failing to repair the roof of 67, Cable Street. The summons was dismissed. On 6th July, }. Katz was summoned for failing to cleanse walls and ceilings at 60, Umberstone Street. An order was made to do the work within 7 days with £2 8s. costs. On 6th July, A. Lithman was summoned for failing to repair the roof of 14, Everard Street. The work having been done at the time of the hearing of the summons he was fined 5s. with £2 4s. costs. On 11th July, R. I. Barnett was summoned for failing to repair the roof at 30, St. Mark Stree't. The work having been done at the time of the hearing, the summons was dismissed. On 21st July, David Galinsky was summoned for failing to repair the roof of 135, Jubilee Street. An order was made to do the work within 14 days with £2 8s. costs. 49 On 4th August, the Owner of 628, Mile End Road was summoned for failing to abate a nuisance arising from the dilapidated condition of the premises. An order was made to abate the nuisance within 14 days with £2 8s. costs. On 8th August, Ada Tolosky was summoned for failing to repair the defective roof, etc., at 6, Court Street. The work having been done at the time of the hearing of the summons she was ordered to pay £2 2s. costs. On 10th August, H. Woolf was summoned for failing to provide w.c. accommodation for females at 41, Leman Street. He was fined 10s. with £2 2s. costs. On 11th August, I. J. Galinsky was summoned for failing to repair the yard paving at 13, Philpot Street. He was fined £3 with £2 2s. costs. On 11th August, I. J. Galinsky was summoned for failing to repair w.c. roof, etc., at 13, Philpot Street. He was ordered to do the work within 14 days with £2 8s, costs. On 11th August, I. J. Galinsky was summoned for failing to provide a proper sanitary dust receptacle at 15, Philpot Street. The receptacle was provided before the time of the hearing of the summons, but he was fined 10s. with £1 Is. costs. On 22nd August, David Galinsky was summoned for failing to repair the defective roof, etc., at 62, Pelham Street. An order was made to do the work within 21 days with £2 7s. costs. On 22nd August, David Galinsky was summoned for failing to repair the defective roof, etc., at 68, Pelham Street. An order was made to do the work within 21 days with £2 7s. costs. On 22nd August, David Galinsky was summoned for failing to provide a proper sanitary dust receptacle at 62, Pelham Street. He was fined 10s. On 28th August, Harry Warman was summoned for failing to repair and cleanse the walls and ceilings at 29, Belgrave Street. The work being in hand at the time of the hearing of the summons he was fined £2 with £1 costs and an order was made to complete the work within 14 days. 50 On 28th August, Harry Warman was summoned for failing to repair and cleanse the walls and ceilings at 49, Belgrave Street. The work being in hand at the time of the hearing of the summons he was fined £2 with £1 costs and an order was made to complete the work within 14 days. On 31st August, H. Rubens was summoned for failing to repair and cleanse 1, Twine Court. The house was empty on the date of the hearing of the summons but he was fined 6s. with £2 4s. costs. On 1st September, Michael Deckett was summoned for failing to abate a nuisance caused by the dilapidated condition of 55, Grove Road. The work having been done at the time of the hearing of the summons, he was fined £1 with £2 2s, costs. On 1st September, Michael Deckett was summoned for tailing to provide a proper sanitary dust receptacle at 55, Grove Road. He was fined £1 with £2 2s. costs. On 1st September, David Galinsky was summoned for failing to comply with the Magistrate's order to repair the roof of 135, Jubilee Street. He was fined £16, with £2 2s. costs. On 5th September, Philip Peizer, was summoned for failing to repair the defective roof of 100, Brick Lane. The work having been done at the time of the hearing of the summons, he was ordered to pay £2 2s. costs. - On 5th September, I. J. Galinsky was summoned for failing to remedy the defective roof and gutter at 58, Nicholas Street. An order was made to do the work within 7 days, with £2 7s. costs. On 6th September, A. Ryman was summoned for falling to repair the roof and rainwater pipe at 13, Umberstone Street. An order was made to do the work within 14 days, with £2 8s. costs. On 15th September, Joseph Barleyman was summoned for failing to repair the defective roof, etc., at 38, Carlton Road. An order was made to do the work within 21 days, with £2 8s. costs. On 20th September, J. Cohen was summoned for failing to repair the roofs and sashes at 3, William Street. The work having been done at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. 51 On 20th September, J. Jacobs was summoned for failing to repair the floors, and to cleanse the walls and ceilings at 19, Grove Street. The work having been done at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. On 27th September, I. J. Galinsky was summoned for failing to repair the yard paving at 13, Philpot Street. The work having been done at the time of the hearing of the summons, he was fined £3, with £1 2s. costs. On 29th September, W. Rutkowski was summoned for failing to repair the roof and sashes at 5, Severne Street. The work having been done at the time of the hearing of the summons, he was ordered to pay £2 2s. costs. On 29th September, W. Rutkowski was summoned for failing to repair the gutter and rainwater pipes at 14, Mary Ann Street. The work having been done at the time of the hearing of the summons, he was ordered to pay £1 Is. costs. On 29th September, W. Rutkowski was summoned for failing to repair the roof and cleanse the walls and ceilings at 6, Stutfield Street. The work having been done at the time of the hearing of the summons, he was ordered to pay £1 Is. costs. On 29th September, I. J. Galinsky was summoned for failing to repair the yard paving at 19, Philpot Street. The work having been done at the time of the hearing of the summons, he was fined £5, with £2 2s. costs. On 29th September, I J. Galinsky was summoned for failing to cleanse and repair the choked drain, and to cleanse the dirty and dilapidated walls and ceilings at 232, Devonshire Street. An order was made to do the work within 14 days, with £2 8s. costs. On 3rd October, David Galinsky was summoned for failing to carry out the necessary repairs at 87, Underwood Street, which rendered the house unfit for occupation. A Closing Order was made, with £2 7s. costs. On 4th October, I. J. Galinsky was summoned for failing to comply with the Magistrate's order to remedy the damp walls at 13, Philpot Street. He was fined £4, with £2 2s. costs. 52 On 6th October, I. J. Galinsky was summoned for failing to repair the w.c., roof, etc,, at 17, Philpot Street. An order was made to do the work within 14 days with £2 8s. costs. On 6th October, I. J. Galinsky was summoned for failing to remedy the damp wall of the back basement room, etc., at 21, Philpot Street. An order was made to do the work within 14 days with £2 8s. costs. On 6th October, I. J. Galinsky was summoned for failing to repair the dilapidated walls of w.c., and to remedy the damp wall of the back basement room at 23, Philpot Street. An order was made to do the work within 14 days with £2 8s. costs. On 6th October, I. J. Galinsky was summoned for failing to remedy the dirty and dilapidated walls of w.c., etc., at 25, Philpot Street, An order was made to do the work within 14 days with £2 8s. costs. On 6th October, I. J. Galinsky was summoned for failing to repair the front area paving, etc., at 27, Philpot Street. An order was made to do the work within 14 days with £2 8s. costs. On 9th October, Kate Goldberg was summoned for failing to cleanse the dirty bed and bedding in the first floor back addition room at 138, Stepney Green. She was ordered to cleanse the bed and bedding within 7 days. On 12th October, J. Trevor was summoned for failing to repair the roof, eaves gutters, etc., at 16, Great Alie Street. An order was made to do the work within 21 days. On 12th October, J. Trevor was summoned for failing to cleanse the walls and ceilings of tenements, Nos. 6, 7, and 8, at 16, Great Alie Street. He was fined £3 with £2 2s. costs. On 31st October, David Galinsky was summoned for failing to comply with the Magistrate's order to repair the defective roof, etc., at 62, Pelham Street. He was fined £3 with £2 2s. costs. On 31st October, David Galinsky was summoned for failing to comply with the Magistrate's order to repair the defective roof, etc., at 68, Pelham Street. He was fined £3 with £1 Is. costs. 53 On 31st October, David Galinsky was summoned for failing to repair the defective roof, etc., at 38, Weaver Street. An order was made to do the work within 7 days with £2 7s. costs. On 6th November, the Owner of 81, Thomas Street, was summoned for failing to repair the roof and to repair and cleanse the walls and ceilings. A Closing Order was made with £2 8s. cost. On 17th November, I. J. Galinsky was summoned for failing to comply with a Magistrate's order to remedy the defectiver roof and the dirty and dilapidated walls and ceilings at 232, Devonshire Street. He was fined £24, with £3 3s. costs. On 17th November, Fanny Galinsky was summoned for failing to remedy the defective roof, and the dirty and dilapidated walls and ceilings at„ 25, Argyle Road. An order was made to do the work within 7 days, with £2 8s. costs. On 21st December, Herman Miller, of 18, Hessel Street, was summoned for having in his shop for sale, or preparation for sale, 134, unsound eggs. The defendant's solicitor produced a number of receipts, showing that a large number of unsound eggs had been removed by the Council for destruction, and stated that the eggs in question were not for sale, but were awaiting removal. The Magistrate dismissed the summons. II. UNDER THE METROPOLIS LOCAL MANAGEMENT ACT, 1855 (Section 85). On 5th January, Albert Donn was summoned for failing to amend a defective drain under the premises 61, Skidmore Street. The summons was dismissed, no costs being allowed. The Magistrate agreed to state a case on the points of law raised. On 15th February, Matthew Charles Liell, owner of 63, Skidmore Street, was summoned for failing to amend a defective drain under the house, No. 61 Skidmore Street. He was fined 10s. with £1 Is. costs. On 15th February, Matthew Charles Liell, owner of 65, Skidmore Street, was summoned for failing to amend a defective drain under the house, No. 61, Skidmore Street. He was fined 10s. No costs were allowed. 54 III. UNDER THE HOUSING AND TOWN PLANNING ACT, 1919 (Section 29). On 26th July, J. S. Abrahams was summoned for not having the name and address of the Owner and of the Medical Officer of Health inscribed in the rent book respecting 30, Ratcliff Cross Street. He was fined 20s. with 41s. costs. IV. UNDER THE DAIRIES, COWSHEDS, AND MILKSHOPS ORDER, 1885. On 7th February, Thomas Jenkins, of 274, Hoxton Street, N., was summoned for selling milk in Thrawl Street without being registered. He was fined 20s. with 20s. costs. Housing-. Clearance Schemes.— (1) Official representations have been made to, and approved by, the London County Council, and an Inquiry has already been held by the Ministry of Health with respect to:— (a) Bell Lane Area. (b) Back Church Lane Area. (2) Official representation made to the London County Council, but no Local Inquiry has yet been held by the Ministry of Health. 1. (a) Bell Lane Area.—The official representation was made on December 2nd, 1919, that the houses in the area were unfit for human habitation and dangerous to the health of the inhabitants of the buildings therein. Further, that the most satisfactory method of dealing with the evils connected with such houses, and the sanitary defects in such area was an improvement scheme for the re-arrangement and reconstruction of the streets and houses within such area- The area is situated in Spitalfields to the west of Commercial Street, and to the east of Bell Lane, and is bounded on the north by Butler Street, and on the south by Wentworth Street, but includes six houses to the south sule of Wentworth Street. It includes Bell Lame (east side), Bell Court, Tenter Street, Butler Street (south side), Freeman Street, Palmer Street, Tilley Street, Shepherd Street and Buildings, Emery Place, Eastman's Court, Katherine Terrace, Wentworth Street (31 to 73 and 52 to 62), Wentworth Courts, and Ann's Place. 55 The area covers about 4 acres, and consists of 293 houses with a population of about 1,351 people. 23 houses were unoccupied, 33 were used for business premises only, and the remaining 235 were occupied by members of the working classes. The houses are not all equally bad—some are much worse than others. Most of the houses in Bell Lane, Wentworth Court and Wentworth Street were probably built previous to 1800, and the remainder between 1800 and 1850. The Ministry of Health held a public inquiry at the St. George's Town Hall on October 29th, 1920. The inquiry lasted three days, but the result is not yet known. No communication of any kind has since been received from the Ministry of Health on the matter. In this area there aire nearly thirty houses which were purchased by the Postmaster-General nearly 10 years ago for the purpose of constructing a Telephone Exchange. Sixteen of the houses have been unoccupied for many years, viz., ten in Butler Street, three in Tenter Street and three in Freeman Street. At the time they became vacant, 8 or 9 years ago, they were in a fair condition, but after the lapse of so many years they have become dilapidated, and no doubt it would cost a considerable sum of money to put them in a haibitable condition. In the meantime they have been empty, and for over two years, the Ministry of Health have been silent as to whether a clearance or re-housing scheme is to be approved under the Housing and Town Planning Act. The remaining houses in the area are becoming worse because the owners refuse to spend money on property which they believe will be demolished without compensation. Included in this area aire Shepherd Street Buildings, consisting of 42 apartments with shops underneath. The buildings are badly built and ill-lighted. The washhouses on the second, third, fourth and fifth floors were condemned as dangerous structures by the District Surveyor eight or nine years ago, and are now in a dismantled condition. This resulted in eight of the flats or apartments being empty and inaccessible, due to the passage to them being demolished. The owner refused to reconstruct the demolished part of the buildings, and to put the property in habitable condition because of the "uncertainty of the result of the Ministry of Health's inquiry of 1920." He says that he does not feel justified in laying out any large sum of money- [b) Back Church Lane Area.—The official representation was made on August 6th, 1919. 56 This area is situated in St. George-in-the-East to the south of Commercial Road. It is bounded on the west by Back Church Lane, on the east by Berner Street, on the north by Boyd Street, and on the south by Ellen Street. It includes all the houses in Everard Street, Nos. '70 to 82 in Berner Street 2 to 52, Boyd Street, the houses on the north side of Ellen Street (Nos. 1 to 51). The area consists of 112 houses with a population of 533. The number of persons suffering from Scarlet Fever, Diphtheria, Erysipelas, Small Pox and Spotted Fever, was, in proportion, twice that for the whole of the Borough of Stepney in 1916 and 1917, and eight times as much in 1918. In 1799 this area had a few houses adjoining Back Church Lane. The remaining houses were built in the early part of the 19th century. The narrowness, closeness, and bad arrangement of the streets and houses, and the bad condition of the houses with sanitary defects connected therewith are dangerous to health, and the most satisfactory method of dealing with the evils connected with such houses is an improvement scheme for the rearrangement and reconstruction of the houses and streets therein. The local inquiry by the Minister of Health was held in October, 1920, but the result of that inquiry has not yet been communicated to the Council. (2) Prusom Street Area.—Official representation was made to the London County Council on June 7th, 1920, that this Area was an insanitary area, and that the most satisfactory method of dealing with the evils connected with the houses was by an improvement scheme for the rearrangement and reconstruction of the streets and houses within such area. The area is bounded on the west by Red Lion Street and Dundee Street, on the east by Ship Street and Queen's Head Alley, on the north by Worcester Street, Watts Street and Prusom Street, and on the south by Greenbank, Hilliard's Court and High Street, Wapping. It consists of 79 houses in Red Lion Street, 2 houses in Red Lion Court, 17 houses in Worcester Court and Worcester Street, 15 houses in Bostock Street, 9 houses in Chandler Street, 5 houses in Taylor's Rents, 16 houses in Meeting House Alley, 14 houses in Watts Street, 22 houses in Raymond Street, 18 houses in Lowder Street, 23 houses in Greenbank, 6 houses in Choppin's Court, 24 houses in Old Gravel Lane, 24 houses in Prusom Street, 10 houses in Clegg Street, 17 houses in Rygate Street, 3 houses in Hilliard's Court, 6 houses in Ship Street, 12 houses in Queen's Head Alley 3 houses in High Street, Wapping, and 13 houses in Dundee Street. 57 There is a great deal of empty space as well as empty dilapidated houses in this area. My suggestion to the London County Council was to prepare a comprehensive scheme for re-building and to start building on the part of the site which is now unoccupied. Having put up one block, the people in a part of the occupied area could be accommodated, and their houses demolished. When another block had been competed, this could be occupied, and so on, until the whole area had been cleared with as little disturbance as passible. The vast majority of the houses in the Borough are old, and many are worn out. The gardens or open spaces at the rear have been partly or wholly built over in hundreds of houses. Factories or workshops have been erected in many, and sculleries or back addition rooms in others. The general character of the defects found in the houses inspected are due to dilapidations following inattention or neglect during the war years. At their meeting on January, 1920, the Public Health Committee decided to recommend the Council to appoint five temporary Sanitary Inspectors to inspect, report, and carry out their work generally under the Housing of the Working Classes Act, 1919, and thus to assist the district inspectors working under the Public Health Act, 1891, and by-laws, including those of houseslet-in-lodgings, in making a house to house inspection of the Borough as rapidly as possible. ! These five Inspectors were appointed and commenced their duties in August, 1920. A house to house inspestion was organised throughout the Borough. It was operated simultaneously in 20 districts and great progress was made. The five temporary inspectors made a house to house inspection in their respective areas, and served an intimation notice in the ordinary way. If the defects were net remedied, a second inspection took place and a specification was drawn up of the whole work required and submitted to the Council for their approval and for authority to serve a notice under Section 28. Notices were served on the owners under Section 28 of the Housing and Town Planning, &c., Act, 1919, requiring them within a reasonable time to execute such works as may be necessary to make the houses in all respects reasonably fit for human habitation. If the notices were not complied with, the Borough Engineer, after reasonable notice to the owners was instructed tc ei.ter upon the premises and to carry out the work specified. 58 The number of inspections made in 1920 under Section 28 of the Housing and Town Planning Act, 1919, was 2,995, which necessitated the serving of 2,772 intimation notices, followed by 707 statutory notices authorised by the Council and served by the Town Clerk. The owners did not comply with the notices and the Borough Engineer carried out the necessary work in 50 houses. 50,201 inspections were made to houses in 1920,14,812 being the result of house-to-house inspections. 25,518 intimation notices were served for the abatement of the various nuisances, and it was necessary for these to be followed by 15,007 statutory notices. The owners carried out the necessary work in 10,406 bouses without waiting for the statutory notices. The readiness on the part of the owners to remedy any nuisance immediately it is brought to their notice, is not so marked as it was before the war, due probably to the increased cost of labour and building materials, and to their scarcity. All the statutory notices were not complied with until police court proceedings were taken, which became necessary in 140 cases. During 1921 statutory notices were served to remedy defects in 12,124 houses. The intention of the Borough Council was to continue serving notices under the Housing and Town Planning Act, and to carry out the work themselves if the owners failed to do so. When the estimated cost was submitted to the proper Committee, it was so large that it was not thought practicable to incur this amount out of current rate, and an attempt was made to obtain authority from the Ministry of Health and the London County Council to raise a loan which could be repaid from the rents of the houses which were repaired under the Act. The Council was informed that this was illegal, and that it was not possible to authorise the raising of a loan for this purpose. The activity of the Council was thus restricted, and the Inspectors were instructed to serve notices under the Public Health Act, except in very urgent cases, when the authority of the Finance Committee had to be specially obtained. Recovery of the money by taking the rents can only be obtained by applying to the Police Court Magistrate, who has the power to spread the repayment over a period of 30 years. The result of continuing the work under the Housing and Town Planning Act would be the raising of a large sum of money by means of the current rate, the benefits from the rents being available for succeeding years to the advantage of Councils following. This was not considered satisfactory and therefore very few repairs comparatively were actually done by the Borough Council. 2,835 inspections were made during the year 1922 under Section 28, and in most instances they were complied with before they were reported to the Council. 27 notices were 'served by the Council giving 59 the owners 21 days to do the necessary work. The notices were not complied with, in regard to 10 houses, and the houses were rendered fit for habitation by the Council's workmen in default of the owners. If a District Surveyor considers a part of the wall of a house to be in a dangerous condition he serves a notice on the owner. If the notice is not complied with, he serves another notice and has the wall demolished. The District Surveyor has no power to order re-instatement, and the matter becomes one for the Sanitary Authority to deal with. A notice is then served under Section 28 of the Housing and Town Planning Act, and if the owner does not comply with it, a further notice is served that at the end of 21 days the Council's workmen will do the necessary work, if it is not done by the owner. It therefore follows that even if the Council is prepared to do the work it must take several months before the work can be completed by the Council. In the meantime one of the walls is down and the occupiers are exposed to the inclemency of the weather. This is not all; the owner can appeal to the Ministry of Health to have the house closed as unfit for human habitation as the repairs cannot be executed without re-construction. The rebuilding of the demolished wall is considered to be reconstruction. Many owners have taken .advantage of this clause which has resulted in a number of empty houses in the Borough. This could be avoided if the District Surveyor could have the houses secured instead of demolished. Where there is imminent danger and necessity of demolition without delay, the District Surveyor should have the consequent power of compelling re-instatement when .such is essential. SUGGESTIONS WITH REGARD TO AMENDING THE PUBLIC HEALTH AND HOUSING ACTS. (1) In Section 28 of the Housing and Town Planning Act, 1919 the words "reasonably fit for habitation" should be followed by the words ''or in a reasonable state of repair." (2) When a notice is served under the preceding Section (Sec. 28), there should be a provision for an appeal to a Court of Summary Jurisdiction before the work is commenced by the Local Authority. As it stands at present, the Local Authority has to do the work and then apply to the Court for an order to recover the expenses incurred. The Court may decide that all the work done by the Local Authority was not necessary, and refuse to allow the expenses so incurred. The defaulting owner will then have his property improved to that extent, at the expense of the ratepayers. This course is the one adopted under the Public Health Act. 60 (3) Repairs are often not carried out 'because the owner is financially barrassed, although he may desire to do so, if he could borrow the necessary money. At the present time the Local Authority may do the work and may app'y for an order to declare such expenses incurred to be payable by instalments within a period not exceeding 30 years with interest at the rate not exceeding 5 per cent. I think it would be better if the Local Authority was empowered to advance the money subject to proper safeguards, at any rate until the housing shortage is overcome. * (4) Difficulty often arises when the lease is almost expired,or it has only a few years to run and the premises are in a dilapidated condition, or the terms of the lease are oppressive. Provision should be made for the lessee (and the Local Authority in certain cases) to have the terms of the lease reviewed by the County Court. (5) A number of houses are unoccupied which are, or could easily be made fit for occupation, but for various reasons are kept empty. Even if the Local Authority repair empty houses, there is no power to compel the owner to let them. When there is such a serious housing shortage the owner should be called upon to show cause why the houses should not be let. Housing- Conditions—Statistics,—192 2. Ministry of Health Table. 1.—General. (1) Estimated population 252,170 (2) General death-rate 13-8 per 1,000 (3) Death-rate from tuberculosis 1*24 per 1,000 (4) Infantile mortality 79 per 1,000 (5) Number of dwelling-houses of all classes - - - 31,639 (6) Number of working-class dwelling-houses - - - 31,639 (7) Number of new working-clacs houses erected - - - 34 2—Unfit Dwelling Houses. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) - - 22,914 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 - - - - - - . 13,397 61 (3) Number of dwelling-houses found to be in a state dangerous or injurious to health as to be unfit for human habitation --------- 3 (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 - - 18,091 II.—Remedy of Defects ivithout serviceof formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 9,522 III.—Action tinder Statutory Powirs. (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 ------ 27 (2) Number of dwelling houses which were rendered fit:— (a) By owners ... - 9 (b) By Local Authority in default of owners - 13 (3) N umber of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close — (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied - - - 16,625 (2) Number of dwelling-houses in which defects were remedied (a) By owners 16,625 (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 - — 62 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 ......... — (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 - 15 tenements 5.—Staff engaged on Housing work with briefly, the duties of each Officer ----------- 2* * 2 Sanitary Inspectors are temporarily engaged in the administration of the Housing Acts, more especially with respect to Section 28 of the Housing, Town Planning, &c., Act, 1919. London County Council Table. Premises. No. on register at end of 1922. Number of inspections. Number of prosecutions. Cowsheds - 24 92 Milkshops ----- 430 1,409 — Houses let in lodgings - 2,512 3,315 2 Ice cream premises 200 365 — Slaughterhouses - 3 9 — Offensive trades - 7 28 Smoke Nuisances. No. of observations - - 377 No. of nuisances and complaints 39 No. of notices - - - 24 No. of summonses - - — Housing of the Working Classes. No. of houses inspected - — No. of houses dealt with under Section 15 of the Housing, Town Planning, &c., Act., 1909 — No. of representations by No. of Closing Orders - - — householders - - - — 63 Housing of the Working Classes—continued. No. of representations by No. of houses included in such Medical Officer - - - — Closing Orders - - - — No. of houses included in such No. of Closing Orders deter- representations - - - — mined - - - - — No. of houses remedied without Closing Orders - - — No. of demolition orders - — No. of houses demolished:— (a) in pursuance of orders - — (b) voluntarily - - - — Obstructive Buildings. . No. of representations under No. of buildings demolished - — Section 38 of the Housing Act, 1890 - - - — No. of representations still under consideration- - — No. of Orders for repairs No. of houses repaired by issued under Section 28 of Local Authorities - - 13 the Housing Act, 19® - 27 No. of houses closed on notice by owner that they could no be made fit - - - — Total number of houses in the No. of houses occupied by the borough - - - 31,639 working-classes - 31,639 No. of houses for the workingclasses :— (a) erected during year - 34 (b) in course of erection - — Underground Rooms. No. illegally occupied - - 9 No. closed or illegal occupation discontinued - - 9 Overcrowding. No. of rooms overcrowded - 54 No. remedied - - - 52 Prosecutions - - - — Cleansing. No. of adults cleansed - - 351 No. of rooms or premises No. of children cleansed -1,042 cleansed - - - 2,588 Water Supply to Tenement Houses. Premises supplied - - 2 Prosecutions - - - — 64 Sale of Food. No. of premises used other No. of inspections- - 1,934 than ice cream premises, milk shops and cowsheds - 443 Disinfection Shelter. Persons accommodated- - 24 Ophthalmia Neonatorum Regidations. No. of notifications received during the year from certified midwives - nil. Sanitary Officers. No. of Sanitary Inspectors (Whole time)—-Male, 18. Female, Nil. „ „ (Temporary) „ 2. ,, „ (Part time)—Male, Nil. Female, Nil. No. of Health Visitors—Whole time, 11. Part time, Nil. Factories and Workshops. The total number of workshops on the Register was 2,915; but this does not include factories, workplaces and out-workers' premises. 3,902 inspections to factories, workshops and workplaces revealed defects, which necessitated the service of 1,270 written notices. 65 of the notices referred to factories, 1,155 to workshops including workshop laundries, and 50 to workplaces other than out-workers' premises. Cleanliness.—493 notices were served to cleanse workshops. Ventilation.—The ventilation of 40 workshops was improved. Overcrowding.—Overcrowding was abated in 24 workshops. Sanitary Accommodation.—The sanitary accommodation was improved in 185 workshops by providing additional and suitable water-closets. 506 other nuisances were remedied in workshops. Oiit-workers' Premises.—1,238 inspections were made to out-workers' premises during the year; 240 premises were found to be insanitary, and 187 cases of notifiable infectious disease occurred therein. 65 FACTORIES. WORKSHOPS. LAUNDRIES. WORKPLACES AND HOMEWORK. 1.—INSPECTIONS. Premises. Number. (1) Inspections. Written Notices. (3) Prosecutions. (4) Factories ------ 509 65 (Including Factory Laundries) Workshops ------ 3,375 1,155 (Including Workshop Laundries) Workplaces ------ (Other than Outworkers' premises) 118 50 ... Total 3,902 1,270 ... 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 ... 493 493 Want of ventilation 40 40 ,,, Overcrowding ... - 24 24 Want of drainage of floors - 2 2 Other nuisances - - - - 506 506 Sanitary Accommodation insufficient 30 30 unsuitable or defective 142 142 not separate for sexes* 13 13 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) 16 16 Other offences - (Excluding offences relating to outwork which are included in Part 3 of this report.) 4 4 Total 1,270 1,270 ... ... "Includi' g those specified in Sections ?, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts, 66 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS. SECTION 107. Ootwork 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 Work men. Contractors. Workmen. Wearing Apparel— • (1) Making, &c... 144 359 1,021 20 23 68 236 236 183 (2) Cleaning and Washing Household linen Lace, lace curtains and nets .. Curtains and furniture hangings o o Furniture and upholstery Electro plate File making Brass and brass articles.. Fur pulling (Furriers) .. Cables and chains Anchors and grapnels Cart gear Locks, latches and keys Umbrellas, &c. Artificial flowers Nets, other than wire nets Tents Sacks i Racquet and tennis balls Paper, &c., boxes, paper bags .. 4 40 Brush making 4 Pea picking Feather sorting Carding, &c., of buttons, &c. .. Stuffed toys Basket making Chocolates and sweetmeats Cosaques, Christmas crackers, Christmas stockings, &c. Textile weaving .. Total 156 359 1,070 22 23 91 •• 240 240 •• 187 67 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year 1922. Number. (1) (2) Bakehouses ------- 162 Boot, Shoe and Slipper Making 136 Cabinet Making ------ 139 Furriers - - 147 Hat and Cap Manufacturers - - - - 72 Miscellaneous ------ 338 Laundries 19 Rag Sorting, etc. 59 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) ----- 1,764 Total - 2,836 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 J Inspector under the Public Health Acts, Reports (of action but not under the Factory and! taken) sent to H.M. Workshop Acts (s. 5, 1901) I Inspector 268 234 Other 34 Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year - 56 I beg to express my indebtedness to all the members of my Staff for the manner in which they have assisted me in carrying out the duties of my office. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, D. L. THOMAS, Medical Officer of Health and Administrative Tuberculosis Officer, 68 Infant Mortality. Deaths from stated Causes at Various Ages under One Year of Age for the whole Borough. Cause of Death V <u £ rH U <v XI c p C/5 <D <U z rH CO a) <D £ CO CQ C/3 <u <D £ CO Ui D "8 s 3 c — o rt g fS-1 cn XS 5 o 6 co rH (A rG a o e CO CO (/: £ a o 6 °? CD t/) a 0 6 CM rH 01 Total Deaths under One Year All Causes. j Certified ... ... ... ... • • ... ... ' Uncertified ... ... ... ... ... • ... ... ... ... Small-pox Chicken-pox Measles 1 1 3 10 15 Scarlet Fever . . . ... • • • .. . • . • 1 1 Diplithf ria and Croup 1 1 3 5 10 L Whooping Cough ... ... ... 5 7 8 20 40 I o o Diairhoea 1 2 13 18 8 10 51 Enteritis ... ... ... Tuberculous Meningitis ... ... ... ... ... ... Abdominal Tuberculosis ... Other Tuberculous Diseases ... 1 ... 1 2 Congenit-il Malformations 8 ... 3 2 • . • 1 6 Pr mature Birth 59 4 3 68 2 ... 70 Atrophy, Debility & Marasmus 8 2 4 18 14 14 3 ... 49 A V J 1 •/ Atelectasis 4 1 5 ... • • • ... 5 Injury at Birth 15 ... 15 ... ... ... 15 J J Erysipelas ... 1 1 Syphilis 3 8 Rickets Mtningilis [not tuberculous) 1 1 4 2 7 Convulsions 2 b 3 1 9 4 1 3 17 Gastritis ... ... Laryngitis •.. *.. ... Bronchitis 2 3 5 10 7 3 1 26 Pneumomia (all forms) 3 2 3 3 11 26 20 28 37 122 Kuffoca-ior, overling 1 • • • . . . » • • 1 3 • • • • • • • • • 4 Oth< realises 2 3 2 1 8 3 3 6 5 25 Influenza • • • • • • • • • • * * 2 8 • • • 2 7 Total 97 14 18 17 146 86 83 64 97 476 69 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 Small Pox ... ... ... ... Measles ... 15 29 15 3 ... 62 Scarlet Fever 1 1 4 2 1 9 Whooping Cough 40 51 32 1 ... 124 Diphtheria and all deaths from Croup (except, "spasmodic" "False" " stridulous " and "catarrhal") 10 17 36 16 1 80 Influenza 7 3 4 2 6 22 50 36 130 Erysipelas 1 1 1 1 1 5 Cerebro-Spinal Fever... 1 1 Typhus Fever ... ... ... ... Continued Fever ... Dysentery 2 2 4 Glanders... ... Anthrax ... i ... 1 Lead Poisoning Phthisis (Pulmonary Tuberculosis) 3 6 62 116 106 21 314 Tuberculous Meningitis (Acute Hydrocephalus) 5 6 3 2 2 1 19 Other Tuberculous Diseases 2 2 6 2 2 4 3 2 23 Rheumatic Fever 1 2 ■I 2 7 Cancer, malignant disease (Sarcoma, Rodent Ulcer, etc.) 2 31 153 88 274 Bronchitis 26 9 2 3 18 128 196 382 Broncho-Pneumonia ... 92 67 28 7 5 15 33 22 269 Pneumonia (all other forms) 30 32 22 8 7 41 87 35 262 Other diseases of Respiratory Organs Diarrhoea and Enteritis (all deaths from Diarrhoea, except those secondary to some 2 1 7 15 8 33 57 well defined disease) 51 6 ... ... ... Appendicitis and Typhlitis Alcoholism, Delirium Tremens, acute and chronic alcoholism (but not those from 1 3 7 5 6 1 23 organic disease due to alcoholism) 1 1 Cirrhosis of Liver 2 9 1 12 Nephritis and Bright's Disease ... Puerperal Fever (Pyaemia, Bepticsemia, Saprsemia, Pelvic Peritonitis,Peri- and Endo- ... 1 4 8 17 49 28 107 Metritis occurring in the Puerperium) ... 1 6 ... 7 Other accidents and diseases of Pregnancy 25 and Parturition Congenital Debility and Malformation, including Premature Birth, Atrophy, Marasmus, want of Breast Milk, but not from 15 2 7 1 Atelectasis 149 ... 149 Violent Deaths, excluding Suicide 7 4 4 12 8 23 21 23 102 Suicides ... 10 11 2 23 Heart Disease * ... i 1 ... 20 17 51 130 133 353 Old Age ... ... ... 1 157 158 Other Defined Diseases 27 18 8 26 19 61 159 144 462 Diseases ill-defined or unknown 1 5 1 ... ... ... 1 1 9 Encephalitis Lethargica . .. ... 1 1 2 Acute Encephalitis ... 1 ... 1 Acute Encephalitis Myelitis 1 1 Uncertified Death 1 ... 1 Total 476 256 173 129 151 446 964 898 3,493 70 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 --- - 5 1 2 2 ... 4 1 5 Cholera - - ... Plague - ••• Diphtheria (including Membranous Croup) 777 35 347 310 51 34 209 118 342 108 770 Erysipelas - 90 3 5 11 14 22 28 7 12 13 40 25 30 Scarlet Fever 617 7 213 344 36 16 1 95 120 241 161 612 Typhus Fever 1 1 1 1 Enteric Fever 27 9 13 4 1 5 4 11 7 25 Relapsing Fever - Continued Fever- 1 1 1 1 Puerperal Fever - 23 6 17 6 5 4 8 23 Cerebro-spinal Meningitis - 9 3 3 3 2 2 3 2 9 Poliomyelitis 1 1 1 1 Polioencephalitis Ophthalmia Neonatorum - 46 46 6 7 19 14 12 Pulmonary Tuberculosis 546 1 10 48 118 224 132 13 104 99 197 146 378 Other forms of Tuberculosis 98 24 43 17 11 3 17 27 31 23 56 Encephalitis Lethargica 4 1 3 — • 2 2 3 Anthrax * 2 2 2 2 Total 2247 95 603 769 258 337 165 20 459 397 894 497 1928 71 BOROUGH ANALYSTS REPORT To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to present mv third Annual Report, dealing with the work carried out in the Borough Laboratory daring the year 1922. During the year 1,458 samples were submitted to me for analysis. Of these 1,417 samples were purchased by Inspectors under the Food and Drugs Acts, 28 samples were analysed for the Public Health Department, 7 for the Borough Engineer's Department, 5 for private purchasers, and 1 sample was examined in accordance with the provisions of the Rag Flock Act. The 1,417 samples taken under the Food and Drugs Acts were made up of 927 formal samples and 490 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 838 812 26 31 Butter 142 139 3 21 Margarine 141 139* 2 1-4 Prescriptions under the National Health Insurance Act 35 20 15 42-9 Coffee 32 32 — — Cream & Preserved Cream 26 16 10 38-5 Pure Borax ... 21 21 — — Vinegar 21 19 2 95 Lime Water ... 14 7 7 50-0 Ammoniated Tincture of Quinine 12 12 • ___ Camphorated Oil 12 12 Cream of Tartar 12 12 Sausage 12 10 2 16-7 Dripping 11 10 1 91 Sponge Cakes 10 5 5 50-0 Castor Oil 7 7 — — Carried forward ... 1,346 1,273 73 — * In 39 cases the vendors had not complied with the requirements of the Butter and Margarine Acts. 72 Table A.—Continued. Number of Samples. Number Genuine. Number Adulterated. Percentage Adulterated. Brought forward 1,346 1,273 73 Glycerine 7 7 — — Cocoa 6 6 — — Epsom Salts 6 6 — — Rice 6 6 — — Sugar of Milk 6 6 — — Boric Ointment 5 5 — — Ice Cream 5 5 — — Pepper 5 4 1 20.0 Cod Liver Oil 3 3 — — Honey 3 3 — — Patent Foods 3 3 — — Whisky 3 — 3 100.0 Separated Milk 4 4 — — Coffee and Chicory 2 2 — — Malt Vinegar 2 2 — — Marmalade 2 2 — — Plum Pulp 1 1 — — Saffron 1 1 — — Tinned Peas 1 - 1 100.0 1,417 1,339 78 5 5 The number of samples found to be adultered was 78 or 5*5 per cent. Table B shows the number of samples analysed and the number found to be adulterated during the past eight years. Table B. Year. Number of Samples. Number Adulterated. Percentage Adulterated. 1915 1,213 154 12.7 1916 1,202 147 12.2 1917 1,123 120 10.6 1918 1,124 123 10.9 1919 1,175 70 6.0 1920 1,190 55 4.6 1921 1,402 86 6.1 1922 1,417 78 5.5 73 In my report last year, I explained that I considered the increase in the percentage of adulterated samples in 1921, as compared with 1920, as probably due to an improvement in the method of administering the Food and Drugs Acts in the Borough. This method has been continued during 1922, and I think there can be no question that the above figures show that there has been less adulteration of foods and drugs in Stepney in 1922 than in 1921. An abstract of reports of Public Analysts for 1921, issued by the Ministry of Health, enables some comparisons to be made between Stepney, and (1) the remainder of the Metropolitan Boroughs as a whole, (2) the other three Eastern Metropolitan Boroughs (Bethnal Green, Poplar and Shoreditch) as a whole. Table C shows the percentages of adulteration and the number of samples, taken under the Food and Drugs Acts, per 10,000 of population. Table C. Stepney. Other Metropolitan Boroughs, 1921, Other Eastern Metropolitan Boroughs, 1921, 1922. 1921. Total samples per 10,000 of population 57 56 61 67 Percentage of total samples adulterated 55 6.1 5.1 5.2 Samples of Milk per 10,000 of population 34 33 29 38 Percentage of Milk samples adulterated 3T 4.56 5.1 6.0 Table D shows the distribution of the 1,417 samples, taken under the Food and Drugs Acts, amongst the four districts of Stepney. Table D. Number of Samples. Number Adulterated, Percentage Adulterated. Offences under Butter and Margarine Acts. Mile End 485 23 4.7 6 Whitechapel 410 22 5.4 11 St. George's 294 23 7.8 15 Limehouse 228 10 4.4 7 1,417 78 55 39 74 Table E shows the number of samples taken by each inspector and gives particulars of offences and proceedings. Table E. Inspector. Samples Taken. Number of Samples. Number of Prosecutions. Adulterated. Unlabelled. Food & Drugs Acts. Butter & Margarine Acts. Cook 93 3 2 2 — Crook 98 8 7 2 4 Dee 90 9 4 5 1 Flint 91 6 — 3 — Johnson 91 — 2 — 2 Mills 101 12 2 3 1 Pavitt 95 6 1 11 — Quaintrell 93 3 — 1 — Shepherd 101 6 2 4 — Simpson 94 7 5 4 — Stiles 94 3 2 — 2 Twaits 97 7 9 2 7 Waterman 97 1 2 1 — White 91 4 1 1 1 Wrack 91 3 — — — Total 1,417 78 39 39 18 Legal Proceedings. Legal proceedings were taken in 57 cases. Details of the individual prosecutions are given later under the separate headings. Table F summarises the results and compares them with the results of proceedings instituted during 1921. Table F. Year. Number of Summonses. Total Fines. Total Costs, Average Fine. Average Total Penalty. 1922 39 Food and Drugs Acts £ s. d. £ s. d. £ s. d. £ s. d. 175 17 0 102 2 0 4 10 2 7 2 6 18 Butter and Margarine Acts 20 1 0 15 15 0 1 2 3 1 19 6 57 Total 195 18 0 117 17 0 3 8 9 5 10 1 1921 39 Food and Drugs Acts 88 0 0 83 13 0 2 5 2 4 8 0 28 Butter and Margarine Acts 21 2 6 26 6 6 0 15 1 1 13 11 67 Total 109 2 6 109 19 6 1 12 7 3 5 5 75 Compared with last year, there has been a considerable fall in the number of prosecutions instituted. The average penalty for adulteration of Foods and Drugs shows a large increase. On numerous occasions, the magistrates have said that they regard adulteration as a serious matter, and the heavy penalties which have been inflicted in several instances should have a salutary effect. Nothing will prevent adulteration so surely as the knowledge that it does not pay. Of the summonses taken out under the Food and Drugs Acts in connection with Milk, 18 led to penalties. The average penalty (fines and costs together) in these 18 cases was £10 17s. 7d. The corresponding figure for 1921 was £6 '2s. 10d. (exclusive of summonses for failing to inscribe name and address on vehicle or receptacle for which offence the maximum penalty is £2). Milk. 838 samples of milk were analysed, of which 26, or 3T per cent., were adulterated. Table G shows the number of samples of milk examined and the percentage adulterated for the past eight years. Table G. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. Number of samples 868 850 739 737 665 858 824 838 Percentage of adulteration 15.0 11.6 12.4 16.0 8.6 5.7 4.5 3.1 These figures appear to me very satisfactory. The gradual improvement in the quality of the milk sold in the Borough since the war, on which I commented in my last report, has been very well maintained. The average composition of all the samples of milk analysed, for each month of the year, is shown in table H. 76 Table H. Period Total Solids per cent. Solids-not-fat per cent. Fat. per cent. January 12.44 8.76 3.68 February 12.48 8.78 3.70 March 12.26 8.69 3.57 April 12.28 8.65 3.63 May 11.98 8.62 3.36 June 12.33 8.69 3.64 July 12.32 8.71 3.61 August 12.22 8.60 3.62 September 12.25 8.68 3.57 October 12.67 8.69 3.98 November 12.88 8.84 4.04 December 12.71 8.81 3.90 Whole Year 12.40 8.71 3.69 Legal Minimum 11.50 8.50 3.00 These average figures are very similar to those given in the corresponding table of my report for 1921, As in 1921, the figures for solids-not-fat are very steady, showing hardly any seasonal variation. The spring fall in the percentage of fat again occurs in May, but whereas in 1921 the figure remained low for several months, in 1922 the low period was only about a month; this is probably due to the spell of very warm weather at the end of last May. The highest percentage of fat again occurs in November. The figures further support the view I expressed last year, that the legal minimum for fat in milk is too low. A very large proportion of milk production is under analytical control. I consider that the milk from all cows should be periodically examined, and that the farmer should be required to reserve the milk from such cows as yield samples of poor quality, for the production of butter, cream, cheese, etc. The legal limit for fat could then be raised to at least 3'5 per cent. for nine months of the year, with a slightly lower minimum for the spring months. It should be made an offence to supply milk of inferior quality, whether due to adulteration or not. Farmers can have analyses made through their associations at a low rate. 77 Table J gives particulars of the adulterated samples of milk. Table J. Number. Deficient of Fat. per cent. Deficient of Solids-not-fat. per cent. Action: Result of Proceedings. E 1 6 - Vendor cautioned. B 2 10 — Vendor cautioned. H 28 13 2 Vendor cautioned. E 55 16 22 Fined £2 with £2 costs. C 59 10 — Fined 19s. with £1 1s. costs. G 37 22 — Summons dismissed. Warranty defence. T 57 16 — Fined £2 with £2 2s. costs. T 59 16 — Summons dismissed. Warranty defence. N 41 16 — Fined £2 with £2 2s. costs. N 52 26 — Fined £2 with £2 2s. costs. D 41 26 3 Vendor paid £1 1s. costs. K 33 16 — Fined £2 with £2 2s. costs. K 35 10 — Fined £2 with £2 2s. costs. K 38 6 2 Vendor cautioned. K 46 20 — Summons dismissed. Warranty defence. L 39 — 5 Vendor cautioned. J 69 - — Vendor cautioned. (Contained artificial colouring matter.) S 69 10 — Fined £1 with £1 costs. E 62 6 4 Vendor fined £20 with £10 10s. costs. Vendor's husband fined £20 with £10 10s. costs, for aiding and abetting. E 63 6 5 Same vendor as E 62. Vendor fined £20 with £5 5s. costs. Vendor's husband fined £20 with £5 5s. costs, for aiding and abetting. E 66 — 8 Vendor paid £2 2s. costs. E 67 23 — Fined 18s. with £2 2s. costs. M 85 13 — Vendor cautioned. B 67 — 4 Vendor cautioned. B 76 — 7 Fined £5 with £1 1s. costs. F 67 10 — Vendor cautioned. Three vendors were summoned under Section 9 of the Food and Drugs Act, 1899, which requires milk-vendors to inscribe their vehicles and receptacles with their name and address. The penalties imposed were:—£1 fine with £1 costs; £2 fine with 1s. costs; £1 fine with £1 1s. costs. 78 One vendor, on an inspector asking for a sample of milk, poured his supply into the road. He was summoned for obstructing an inspector in the course of his duty and was fined £'20 (the maximum penalty) with £3 3s. costs (see below). Another vendor was summoned for refusing to serve an inspector, he was fined £10 with £10 10s. costs. This case illustrates a weakness in the Food and Drugs Acts. The vendor in question had been fined on numerous occasions, including fines of £50 and £100; had he supplied the inspector and had the sample proved to be adulterated, he could have been sent to prison for three months or fined £100. In view of his record a very heavy penalty would in any case have be imposed. The actual penalty inflicted was the maximum for refusal to serve an inspector. The vendor of E 62 and E 63 was the wife of the vendor who was fined £20 for obstructing an inspector (see above). The husband had a very bad record, including a fine of £100. After the conviction in which he was fined £100, the business was transferred into the wife's name, though apparently carried on as usual. Samples E 62 and E 63 were taken early on a Sunday morning. Inspector Pavitt saw four milk cans outside the vendor's premises. The male defendant removed two cans inside on the approach of the inspector, but had not time to remove the others. Samples taken from the remaining cans gave the results shown in the table. It was necessary for the summonses to be taken out in the wife's name, as owner of the business. This meant that the case could only be treated as a first offence (maximum penalty £20) there being no convictions in the wife's name. As it appeared that the male defendant was still interested in the business, he was prosecuted for aiding and abetting. The magistrate considered the case a serious one and imposed fines and costs as above, amounting in all to £111 10s. Solids-not-fat are in solution in milk. They do not separate on standing, and cannot be removed by mechanical means. Accordingly, a deficiency of solids-not-fat points to watering. Watering, of 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 J are calculated from the legal minimum figures. As these are below the average figures for the milk sold in the Borough (see Table H), it can safely be assumed that the percentages of adulteration, shown in the table, considerably underestimate the extent of the adulteration in the great majority of cases. 79 The warranty defence was pleaded successfully in three cases; no summonses were dismissed for any other reason. Butter. 142 samples were analysed, of which 3 or 2.1 per cent. were returned as adulterated. H 9 (informal). Contained T4 per cent. of excess water. Subsequent sample was genuine. M 55 (informal). Contained 12.4 per cent. of excess water. Subsequent sample was genuine. L 53 (informal). Contained 45 per cent. of margarine. 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 K, and compared with the corresponding figures for 1920 and 1921. Table K. Amount of Boric Acid per cent. Percentage of Samples, 1922. Percentage of Samples, 1921. Percentage of Samples, 1920. nil. 56 36 46 0.1 29 22 26 0.2 10 21 18 0.3 2 13 5 0.4 3 6 5 0.5 — 2 — under 0.25 95 79 90 In a previous report I suggested that vendors of preserved butter should be required to affix a label to each package similar to that required in the sale of preserved cream and stating the nature and amount of the preservative, with a notification that the article is unsuitable for infants and invalids. Alternatively I suggested that the proportion of boric acid allowed, might well be reduced from 0 5 per cent. to 0.25 per cent. Of the samples examined in 1922, 95 per cent. would pass if such a reduced standard were enforced. There is little question that boric acid may be injurous to infants and certain invalids, and under certain conditions to women. Further, I consider that the addition of chemical substances to food-stuffs by men without any medical or scientific knowledge, should be strongly discouraged. 80 Margarine. 141 samples were analysed of which 2, or T4 per cent., were returned as adulterated. T 47 (informal). Contained 06 per cent of boric acid. No further action. H 63. Contained 60 per cent. of butter. (The Butter and Margarine Acts prohibit the sale of Margarine containing more than 10 per cent. of butter). The vendor was prosecuted for other offences against the Butter and Margarine Acts. (See below). The only preservative detected was boric acid. The maximum amount of boric acid allowed is 0.5 per cent. 7, or 5 per cent. of the samples were free from boric acid. 30, or 21 per cent. of the samples contained 0.l per cent. boric acid. 42 „ 30 „ „ „ 0.2 32 ,, 22 ,, ,, „ 0.3 ,, ,, 25 ,, 18 ,, ,, ,, 0.4 ,, ,, 4 „ 3 „ ,, ,, 0.5 ,, ,, 1,, 1 ,, ,, 0.6,, ,, The Butter and Margarine Acts require that each parcel of margarine exposed for sale shall be clearly marked " MARGARINE" in printed capital letters of not less than one and a half inches, and that it shall be sold in a wrapper on which the word " MARGARINE" is printed in half inch letters. The Acts further provide that no other printed matter shall appear on the wrapper. In 39 cases the vendors had infringed these regulations. Thus, offences were committed in connection with 27.7 per cent. of the samples purchased. The corresponding figure in 1921 was 28.4 per cent. and in 1920 27.4 per cent. There appears to be great laxity in carrying out the requirements of the law. During 1920 and 1921, summonses were taken out in 40 cases, 8 vendors were individually cautioned and a circular letter on the subject was sent to all retailers. In spite of this action in the previous years there was no improvement in 1922. In a number of cases improper wrappers were supplied with " Kosher " (Jewish) margarine, which is free from animal fat. These margarines are usually put up in half-pound packages with a fancy wrapper which contains other printed matter besides the word "MARGARINE." In some cases, when a quarter of a pound was purchased, the only wrapper was a half of one of these wrappers, the printed matter consisting of a portion of the word " MARGARINE " together with other words or portions of words. There is no objection to these labels provided a properly printed wrapper, having the word " MARGARINE " and nothing else on it, is used in addition. 81 The 39 cases consisted of 16 informal samples and 23 formal samples. Proceedings were taken in 18 cases and the results are shown in Table L. Five vendors were cautioned for minor infringements of the regulations. Table L. Number. Offence. Action. Result of proceedings. J 26 Improperly stamped wrapper Vendor paid 2s. costs. T 30 Improperly stamped wrapper Fined £2 with £1 costs. F 24 Unstamped wrapper Fined £3 with £2 4s. costs. D 48 Unstamped wrapper Fined 10s. with 10s. 6d. costs D 50 Unstamped wrapper Fined 10s. with 10s. 6d. costs D 51 Unstamped wrapper Fined 10s. with 10s. 6d. costs A 49 Unstamped wrapper Fined £1 with £1 1s. costs. A 52 Unstamped wrapper Fined £1 with £1 1s. costs. F 55 Improperly stamped wrapper Vendor paid 7s. 6d. costs. F 56 Unstamped wrapper Vendor paid 7s. 6d. costs. H 63 Unlabelled bulk and unstamped wrapper. The sample also contained excess butter. (See above.) Fined £5 with £2 2s. costs for selling from an unlabelled bulk, and ordered to pay £2 costs for selling in an unstamped wrapper. M 79 Improperly stamped wrapper Fined £1 with £2 2s. costs. D 74 Unstamped wrapper FinedlOs with 10s. 6d. costs D 77 Improperly stamped wrapper Fined £1 with £1 1s. costs. D 84 Unstamped wrapper Fined 10s. 6d. D 87 Improperly stamped wrapper Fined 10s. 6d. F 98 Unstamped wrapper Fined £1 with £2 5s. costs. Cream and Preserved Cream. The 26 samples consisted of 13 which were sold as Preserved Cream and 13 which were sold as Cream. The 13 samples of preserved cream were all satisfactory. Each of them contained more than the statutory minimum of 35 per cent. of fat and was labelled with the statutory declaratory label stating the nature and amount of preservative present, and that the sample was unsuitable for infants and invalids. In each case, the label stated that boric acid was present in amount not exceeding 0.4 per cent. Analysis bore out these statements. In three cases, printing on the carton in which the sample was supplied, described the contents as " Thick Rich Cream " or " Rich Cream." The Milk and Cream Regulations require that "'preserved cream " shall, under no circumstances, be described as " Cream "; whenever the word " Cream " is used, the word " Preserved " must accompany it in letters of equal prominence. The three vendors were cautioned and a circular letter on the subject was sent to all registered milk vendors in Stepney. 82 Of the 13 samples sold as Cream, only one consisted of fresh cream without any preservative. Two samples consisted of cream sterilised by heat and supplied in sealed tins. The remaining ten samples contained boric acid; particulars are given in Table M, Table M. Number. Boric Acid per cent. Fat per cent. Action, Result of Proceedings. M 47 (informal) 0.2 . 64 Same vendor as M 68. M 68 0.5 46 Vendor cautioned. M 54 (informal) 0.2 54 Same vendor as M 69. M 69 0.25 57 Vendor paid £1 10s. costs. G 42 (informal) 0.3 54 Same vendor as G 64. G 47 (informal) 0.2 55 Further supply unobtainable. G 49 (informal) 0.2 54 Same vendor as G 63. G 63 0.4 55 Fined £2. G 64 0.4 51 Fined £2. M 58 (informal) 0.4 39 Further supply unobtainable. Sponge Cakes. Ten samples were examined. In five cases, considerable quantities of boric acid were found to be present. The presence of this preservative is due to the use by the bakers of liquid egg, manufactured from foreign eggs and preserved with boric acid. As sponge cakes are largely eaten by children and invalids, the use of boric acid in their preparation is particularly undesirable. In respect of two formal samples, summonses were taken out but were afterwards withdrawn on payment of costs, on an undertaking being given by the Bakery Allied Traders' Association, that liquid eggs containing boric acid is not to be used in the preparation of sponge fingers, sponge biscuits, and small plain sponge cakes, these being the forms of sponge cakes mostly used by children and invalids. The Ministry of Health has since issued a circular to Local Authorities on the subject. Particulars of the adulterated samples are given below:— F 69 (informal) Boric Acid 15 grains per lb. Subsequent sample free from boric acid. F 70 (informal) Boric Acid 24 grains per lb. Same vendor as F 95. F 79 (informal) Boric Acid 26 grains per lb. Same vendor as F 97. F 95 Boric Acid 20 grains per lb. Summons withdrawn on payment of £2 2s. costs. F 97 Boric Acid 28 grains per lb. Summons withdrawn on payment of £2 2s costs. 83 Vinegar. Of the 23 samples examined, 2 were sold as Malt Vinegar and the remaining 21 as Vinegar. The samples of Malt Vinegar were genuine. None of the remaining samples was a brewed vinegar. All were artificial vinegar, i.e., a dilute solution of acetic acid, coloured with caramel, with, in some cases a little malt vinegar added. It is impossible to take any action for this substitution unless malt vinegar is asked for. Two of the samples of vinegar were deficient of acetic acid. F 28 (informal) Deficient of 7 per cent. of Same vendor as F 31. the proper amount of Acetic Acid. F 31 ... ... Deficient of 7 per cent.of Vendor cautioned. the proper amount of Acetic Acid. Sausage. Of the 12 samples examined, 2, or 16.7 per cent. were adulterated. The maximum amount of boric acid allowed to be present in sausages is 0.25 per cent. (17½ grains per lb.). The adulterated samples contained excessive amounts of boric acid. K 28 Boric Acid 0"39 per cent. Vendor cautioned. (27 grains per lb.). N 47 (informal) Boric acid 0.42 per cent. Subsequent sample (29 grains per lb.). genuine. Whisky. In my report for 1921, I commented on the fact that the position of spirits, in relation to the Food and Drugs Acts, is very unsatisfactory in London. The law requires that spirits, sold as such, shall not be weaker than 35° U.P. When spirits are sold as whisky, brandy, etc. without qualification, Food and Drugs Acts Inspectors protect the interests of the public by taking samples in the usual manner. The percentage of adulteration in such samples is very high; 15 per cent. of the samples of spirits taken in England and Wales during 1921 were adulterated. On the other hand, licensees can exhibit a notice stating that " to meet the requirements of the Food and Drugs Acts, all spirits are sold as diluted spirits." I am informed by your inspectors that such a notice is exhibited in the very great majority of licensed houses in Stepney, so much so that it is practically useless 84 trying to get samples, on which we could take any action in the event of their being adulterated. I feel sure that the significance of these notices is not realised by purchasers of spirits in Stepney. The fact that these notices are posted in nearly all bars in the Borough must suggest to many people that they are of little significance and are merely shown to comply with some general regulation. I think few purchasers realise that such a notice as I have given above, would legalise the sale of a mixture of one per cent. of whisky and ninety-nine per cent of water. I consider that there should be a statutory form of notice for the use of publicans who are not prepared to sell spirits of the full legal strength. Such notices should state in clear language that they are posted to legalise the sale of spirits below the standard strength, and should state the actual strength of the spirits sold. Particulars of the three samples examined are as under :— M 14 (informal) Contained 6 per cent, excess Same vendor as M 28* water. M 28 Contained 6 per cent excess Summons withdrawn. water. G 17 (informal) Contained 23 per cent. On a subsequent visit excess water. by the inspector, a notice was displayed. Other Foods. Of the foods not dealt with above, 3 samples were adulterated. Particulars are given below:— Dripping.—An informal sample (K 76) contained 40 per cent. of foreign fat. A subsequent sample was genuine. Pepper.—An informal sample (L 84) contained 3 per cent. of foreign starch. A subsequent sample, taken in 1923, had a similar composition and the vendor was cautioned. Tinned Peas.—An informal sample (S 66) contained 0.7 grains of Copper per lb. Further supplies of the same brand were unobtainable, Prescriptions under the National Health Insurance Act. Previous to 1922, none of the Metropolitan Boroughs had taken samples under the Food and Drugs Acts of prescriptions dispensed for panel patients under the National Health Insurance Act, though such samples had been taken in the provinces. The Public Health Committee considered the matter and suggested that taking samples of panel prescriptions was desirable. The London Insurance Committee readily gave their consent, and authorised medical practitioners to give prescriptions on the official forms, for the use of inspectors under the Foods and Drugs Acts. The first batch of samples, analysed, showed the necessity for some control (6 out of 11 samples were returned as adulterated). The results of these analyses were reported to the Insurance Committee, who circularised all the Metropolitan Boroughs, asking their authorities to take samples. I understand that sampling in London is now fairly general. Of the 35 samples taken in Stepney, 15, or 42.9 per cent. were adulterated. 85 Particulars of the adulterated samples are given below in table N. Table N. Number. Prescription. Adulteration. Action. Result of proceedings. T 7 (informal) Mist. Pot. Bromid. 38 per cent. deficient of Potassium Bromide. Same vendor as T 33 T 33 Mist. Pot. Bromid 33 per cent. deficient of Potassium Bromide. Vendor paid £5 5s. costs T 10 (informal) Mist. Sod. Sal. 27 per cent. deficient of Sodium Salicylate. Same vendor as T 31 Fined £20 with £5 5s. costs. T 31 Mist. Sod. Sal. 27 per cent. deficient of Sodium Salicylate. T 11 (informal) Mist. Sod. Sal. 23 per cent. excess of Sodium Salicylate- Same vendor as T 32 T 32 Mist. Sod. Sal. 62 per cent. excess of Sodium Salicylate. Fined £12 with £3 3s. costs. J 52 (informal) Mist.Ferri.et Quin. 28 per cent. deficient of Quinine. Subsequent sample genuine. J 62 (informal) Mist. Sod. Sal. 25 per cent. excess of Sodium Salicylate. Same vendor as J 60 J 60 Mist. Sod. Sal 18 per cent. excess of Sodium Salicylate. Summons withdrawn andvendor cautioned. D 52 (informal) Mist. Bismuth. et Morph. 25 per cent. deficient of Bismuth Carbonate. Same vendor as D 66 D 66 Mist. Bismuth. et Morph. 37 per cent. excess of Bismuth Carbonate, and 51 per cent. deficient Sodium Bicarbonate. Vendor cautioned. D 53 (informal) Mist. Quinin. 50 per cent. deficient of Hydrobromic Acid. Subsequent sample genuine. D 54 (informal) Mist. Bismuth. et Morph. 13 per cent. deficient of of Bismuth Carbonate and 63 per cent. deficient of Sodium Bicarbonate. Same vendor as D 65 D 65 Mist. Bismuth. et Morph. 28 per cent. deficient of Bismuth Carbonate and 68 per cent. deficient of Sodium Bicarbonate. Vendor paid £2 2s. costs. D 59 (informal) Mist. Bismuth. et Morph. 10 per cent. deficient of Bismuth Carbonate. Subsequent sample genuine. There can be no question that the above results show that there has been very great laxity in the dispensing of prescriptions under the National Health Insurance Act. The importance of accurate dispensing is so obvious as to need no comment, but, in his evidence at the hearing of the summonses in 86 connection with T31 and T32, Dr.Thomas further emphasised the importance of consistency. Dr. Thomas gave a concrete example. He stated Sodium Salicylate is used in the treatment of Rheumatic Fever, when it is usual to increase, gradually, the dose to just short of the point at which the drug becomes dangerous. Panel patients may have their medicines dispensed by any of the appointed pharmacists. Now, suppose a patient had his prescriptions made up by the vendor of T 31 (a 27 per cent. deficiency), a doctor would order increasing doses until he thought the patient was taking as much as was safe. If then the patient decided to have a bottle of medicine made up by the vendor of T 32 (a 62 per cent. excess) the result might be extremely serious. If the first medicine was too strong and later the patient got a medicine which was too week, there would not be danger to the patient from the drug, but there would be danger in that the doctor's treatment of a serious illness was interfered with. In the case of D 65, the pharmacist was an old man and apparently in a very poor state of health. He explained to the magistrate that he had been ill and had no assistant and further that he had been in business for 40 years and that this was his first offence of any kind. The magistrate adjourned the hearing for him to substantiate these statements and on his doing so the defendant was allowed to pay the costs of the summons only, on his agreeing to make other arrangements for the dispensing of National Health Insurance Act prescriptions. Lime Water. Fourteen samples were analysed of which seven, or 50.0 per cent. were adulterated. Particulars are given below :— S 60 (informal) Deficient of 61 per cent. of the proper amount of Lime. Same vendor as S 64. S 64 Deficient of 67 per cent. of the proper amount of Lime. Fined £2 with £2 costs. S 62 (informal) Deficient of 63 per cent. of the proper amount of Lime. Same vendor as S 65. S 65 Deficient of 43 per cent. of the proper amount of Lime. Defendant Company fined £2 with £2 2s. costs. Manager of shop fined £2 with £2 2s. costs. M 71 (informal) Contained 2 parts per million of Lead. Same vendor as M 101. M 101 Contained 2 parts per million of Lead. Vendor paid £5 5s. costs. M 76 (informal) Deficient of 42 per cent. of the proper amount of Lime. Subsequent sample genuine. 87 M 101 is interesting in that all three parts of the formal sample were analysed by qualified analysts. The vendor's analyst found 2.0 parts per million, the Government analysts 1.6 parts, and my analysis gave 2.4 parts. The mean of the three analyses being 2.0 parts. As each analyst only received about 6 ounces of the Lime Water, the agreement may be considered very satisfactory, the total amount of lead in each bottle being only just over one two-hundredth part of a grain. The danger of lead as a poison lies in the fact that it is cumulative. An infant may take small quantities of lime water regularly for a considerable time. If such lime water contain traces of lead, the child would in time accumulate sufficient lead into its system to cause lead poisoning. I can find no record of any previous proceedings for selling lime water containing lead. It is to be hoped that the publicity given to this case in the technical press, will put pharmacists on their guard. 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 838 0 Cream 13 10 (For particulars see body of report.) 2. Cream sold as preserved cream. (a) Correct statements made 13 Statements incorrect 0 Total 13 In each case the statutory label stated that not more than 0.4 per cent, of boric acid was present. (b) Determinations of milk fat in cream sold as preserved cream :— (1) Above 35 per cent. 13 (2) Below 35 per cent. 0 Total 13 (c) Instances where (apart from analysis) the requirements as to labelling cr declaration of preserved cream had not been observed:— In three cases the requirements of section 6 of the schedule to the regulations had been ignored. (For particulars see body of report.) Miscellaneous Samples. Rag Flock.—One informal sample contained 64 parts of Chlorine per 100,000. Borough Engineer's Department.—The 7 samples analysed consisted of 1 sample of disinfecting fluid and 6 samples of disinfectant powder. In several cases the disinfectant powders did not comply with the specification. 88 Private Purchasers' Samples.—The 5 samples consisted of Milk 1, Edible Oil 1, Vegetable Cooking Fat 1, Synthetic Milk Powder 2. The sample of edible oil was adulterated with 98 per cent. of mineral oil. Public Health Department.—The 28 samples consisted of Confectionery 1, Condensed Milk 2, Dried Milk 2, Fruit Pulp 1, Milk 1, Malted Milk Tablets 2, Pineapple Chunks 2, Miscellaneous Tinned Meats and Fish 17. The tinned meats and fish consisted of samples which had been packed a considerable time and were suspected of contamination with metallic tin. In general tinned food-stuffs only attack the tin coating of the containers very slowly, provided the container is properly made. The samples examined had all been packed for a considerable time, some of the tins being dated as earlv as 1917. The majority were not dated, but were known to have been packed several years. I consider that the presence of more than two grains per lb. of metallic tin renders a food-stuff likely to be injurous to the health of some individuals, and when a representative sample contained tin in excess of this amount, the batch was condemned. In several cases a considerable number had to be destroyed. The amounts of tin found were as under:— Number. Nature. Metallic Tin. (grains per lb.) Y 12 Salmon 0.15 Y 13 Salmon 0.33 Y 14 Salmon 0.77 Y 15 Salmon 0.52 Y 16 Salmon 0.63 Y 17 Salmon 0.84 Y 21 Sardine Paste 2.06 Y 22 Sardine Paste 1.15 Y 23 Sardine Paste 1.54 Y 24 Sardine Paste 1.12 Y 25 Sardine Paste 1.71 Y 26 Sardine Paste 1.85 Y 29 Mutton Essence 4.7 (tinned 1917) Y 30 Mutton Broth 0.2 (tinned 1918) Y 31 Roast Fowl 0.2 (tinned 1919) Y 32 Extract of Meat 3.0 Y 33 Essence of Chicken 2.3 (tinned 1917) The malted milk tablets were old stores prepared during the war. They had developed some acidity and were condemned. None of the other samples call for any comment. 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. Chemical Laboratory, Borough Analyst. 43, White Horse Street, E. 1. April, 1923. 89 INDEX. A PAGE Analyst's Report B Bacteriological Examinations 8 Births 4 Birth, illegitimate 30 C Canal Boats Acts 39,40 Cancer 29 Cerebro-Spinal Fever 13 Clinics in the Borough 31,33 Cowhouses 62 Creches in the Borough 33 D Deaths 7 Dental Clinic 32 Diphtheria and Membranous Croup 12 Disinfecting Station 39 Dysentery 28 E Encephalitis Lethargica 13 Enteric Fever 12 Epidemic Diarrhoea 13 to 15 Erysipelas 13 F Factory and Workshops Acts 674to64 Fines and costs (total) 41 Food and Drugs Acts, samples taken, proceedings, etc. 71to88 G General Sanitary Work 40,41 H Health Visitors, visits, etc. 35 Houses let in Lodgings Housing 54to 62 „ Bell Lane Area 54 „ Back Church Lane Area 55 „ Prusom Street Area 56 90 Page Ice Cream Premises Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 39 Infant Welfare Centres, etc., in the Borough 33 Infantile Mortality 29,30 Infants, Feeding of 33 Infectious Diseases Influenza . 28 Inques'.s and post mortem examinations 39 M Malaria 28 Marriages 7 Maternity and Child Welfare Scheme 31,32 Measles 16 Membranous Croup 12 Milk and Cream Regulations 89 Milk Distribution Scheme 34 Milkshops 62 Mortuary and Coroner's Court 39 Municipal Centres, work at 34 N Notifiable Diseases 7 Offensive Trades o Ophthalmia Neonatorum 13,34 Outworkers 66 Overcrowding 63 P Phthisis, number of notifications and deaths 18 Pneumonia 28 Police Court Proceedings 42 to 54 Poliomyelitis 13 Population 3 Puerperal Fever 12 R Rag Flock Act 84 Respiratory Diseases 28 91 S Page Sanitary Inspectors' Report Table facing 41 Scarlet Fever 12 Sewing Classes 32 Slaughter Houses Small-pox 8 to 11 Spotted Fever 13 Statistics:— Housing Conditions—Ministry of Health Table . 61, 62 „ ,, etc., etc.—London County Council Table 62.63, 64 Cases of Infectious Diseases notified during the year 70 Causes of, and ages at death, during the year 69 Infantile Mortality during the year 68 Form R.—Work carried out at the Tuberculosis Dispensaries 25 to 27 Summer Diarrhoea 14,15 T Tuberculosis 18,19 „ Other Forms, number of notifications and deaths 19 „ Dispensaries, Report on 20 to 27 „ After Care 23 U Underground Rooms Unhealthy Areas 64to57 Unsound Food destroyed 36 to 38 Y Verminous persons 39 Vital Statistics 3 to 7 W Water Supply 63 Whooping Cough 17 Workshops 64to64 Wrong Diagnosis of Infectious Disease 8 Z Zymotic Diseases 17