AC 4367 STE 21 Metropolitan Borough of Stepney. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1923 BY D. L. THOMAS, M.R.C.S., L.R.C.P., D.P.H., BARRIS TER-AT-LAW. Medical Officer of Health and Administrative Tuberculosis Officer. together with the REPORT OF THE PUBLIC ANALYST Vail & Co., 170, Farringdon Road, London, E.C.1. PUBLIC HEALTH COMMITTEE. (November, 1922 to October, 1923.) Chairman: Alderman G. R. Boustred. Vice-Chairman: Councillor (Miss) M. Moses, J.P. Alderman (Mrs) F. W. Reidy. Alderman O. Tobin. Councillor A. Barber. Councillor W. G. Peacock. „ G. F. Brady ,, R. Prescott. „ D. Dela Fuente. „ C. Raby. „ C. Edser. „ (Miss) I. Samuels „ (Mrs.) F. Fardell. „ F. Simms. „ (Miss) M. Hughes, J.P. „ (Rev.) J. F. Stern: „ D. Hume. „ (Mrs.) S. Tobin. „ A. W. Jones. „ (Rev.) L. S. Wainfight. MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1922 to October, 1923.) The Members of the Public Health Committee, together with the following Members:— Mrs. E. C. Grenfell. Mrs. A. Model. Mrs. M. H. Hesman. Mrs. F. Newell. Miss Hopkins. Miss B. M. Page. Chairman: Alderman (Mrs.) F. W. Reidy. Vice-Chairman: Councillor (Mrs.) F. Fardell. 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.IC. (resigned 14th Dec., 1923). Food Inspector: H. Abson. Sanitary Inspectors: G. Bottomley. H. Mills. R. 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. Goodfellow. H. A. Whitty. A. m. cordwell. D. mlchell. 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. Tapolski. Temporary Clerics engaged at the Maternity Centres and in the distribution of milk; R.Butler, M. Gray, L. Hannington, A. Healey, M. W. Hunt, E. Worsell. Chief Administrative Tubercidosis Officer: D. L. Thomas, m.r.c.s., l.r.c.p. Senior Tuberculosis Officer: W. E. Goss, m.b., Ch.B. (Ed.) Tuberculosis Officcr: A. Ferguson, m.b., B..lond.), D.P.H. Tubercidosis Officer: T. S. Gibson, m.r.c.s., l.r.c.p. Surses: E. P. Colledge. M. Prickman. H. M. Tayler. M. F. Weatherilt. Nurse Dispensers: M. Coulman. A. O. Jones. Dispenser: A. Wager. Clerk and Secretary to Care Committee: L. Nugent, REPORT of the MEDICAL OFFICER OF HEALTH for the METROPOLITAN BOROUGH OF STEPNEY FOR THE YEAR 1923. Public Health Department, 43, White Horse Street, May, 1924. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I beg to submit herewith my twenty-third Annual Report on the health and sanitary condition of the Borough for the year 1923. I desire to draw y6ur attention to the following facts:— (1) The birth-rate is the lowest on record. The birth-rate in the Limehouse district is 29.3 per 1,000 of the population, and remains very nearly the figure it was 20 years ago, but the birth-rate for the Whitchapel district is only 16.3 per 1,000, or less than one-half what it was 20 years ago. The births in the Whitechapel district in 1903 numbered 2,867, and in 1923, 894 only. (2) The death-rate is 11.4 per 1,000, and is the lowest ever recorded in the Borough. It is only slightly higher than that of London as a whole. The death-rate during the last five years has been below 14 per 1,000, whereas during the first ten years of the existence of the Borough Council, it was always above 21 per 1,000. (3) The decrease in the number of deaths from Zymotic diseases, which numbered 189 in 1923, and 333 in 1922. (4) The low incidence of Scarlet Fever, Diphtheria and Enteric Fever. There was not a single death from the latter disease during the year, and 21 cases only were notified. Compare this with 1903, when 179 cases were notified, and 27 proved fatal. The decline in Enteric Fever has been most parked. 4 (5) The deaths from Tuberculosis are less than in any previous year, and was less than one-half what they were 20 years ago. (6) The deaths from Cancer are 46 more in the previous year, and are unfortunately, higher than they have ever been. The disease is steadily on the increase. (7) The maternal mortality rate (the number of deaths of mothers as a result of diseases or accidents associated with child-birth) is less than 2.2 per 1,000 births, which is very satisfactory, and compares very favourably with other districts in London. This is partly due to the ante-natal inspection, which is done in the Borough, and to the fact that 27 per cent. of all the births occur in Lying-in Hospitals and other Institutions, where the mothers have skilled attention and cleanliness is more observed than it is possible to obtain at their own homes. According to a report by Dr. Janet Campbell to the Ministry of Health, the Maternal Mortality in the Borough of Stepney for the four years, 19191922, was 2.42 per 1,000 births. This rate was the lowest, not only of any district in London, but it was lower than in any County Borough or Administrative County in England and Wales. (8) The Infant Mortality rate is most satisfactory, as it is only 62 per 1,000 births, and is also the lowest on record in the Borough. The decrease occurred in each of the districts forming the Borough, with the exception of St. George's, where it was 1 per 1,000 greater than in the previous year. When I was first appointed Medical Officer of Health by the late Limehouse District Board of Works, the infantile mortality in that district which comprised Limehouse, Ratcliff, Shadwell and Wapping, was generally above 200 per 1,000 births. During the two last years previous to its being merged in the Borough Council, the infantile mortality was 216 per 1,000 in 1899, and 227 per 1,000 births in 1900, and even in the first year of the Borough Council, the rate was 211 per 1,000 births. I was very disturbed in my mind with regard to this high mortality among infants, and I was ultimately able to convince the Limehouse District Board of the necessity of appointing a Health Visitor to visit the homes of newly-born babies, and to instruct the mothers in the proper way of feeding the babies, &c. The members agreed, on the understanding that the Local Government Board would pay one-half of her salary. Unfortunately, the Local Government Board reluctantly declined to do so, as at that time the Board had no power to pay a moiety of the salary. I was very disappointed, as she would have been the first Municipal Health Visitor appointed in London, if not in the 5 whole country. A voluntary committee was formed, of which I was a member, and through the instrumentality of the Chairman—the Bishop of Stepney (now the Archbishop of York)—Lord Derby paid for the services of a voluntary health visitor for four years. I mapped out the worst district for her, and supplied her with a list of births. The arguments used against the appointment of a Health Visitor were, that the mothers would resent the interference of a stranger—as they term it—with their domestic affairs. It was also claimed that the weaklings died, and by the survival of the fittest, more children would survive after the first year. Both opinions have been proved to be fallacious. It was very seldom that the visit of the first Health Visitor was resented, and at present it is always welcomed. Mothers would now resent any neglect on the part of Health Visitors, if visits were not systematically paid to them. With regard to the alleged survival of the fittest, in the years 1896-1899, when the death-rate of infants under one year of age was so high, 20 per cent. of the remaining deaths were between 1 and 5 years of age. In 1923, in the same district, 9 per cent. only of the remaining deaths were between 1 and 5 years of age. Although the general death-rate in 1923 was exceptionally low for the whole Borough, excluding the deaths of children under 1 year of age, 7 per cent. of the remaining deaths were between 1 and 5 years of age. The decrease in the mortality among children between 1 and 5 years of age has been equally great. Wherever the death-rate of infants under one year of age is high, the deathrate of children above one year of age is also high. The infantile mortality for the whole Borough for the four years 19011904 was from 150-170 per 1,000 births. The improvement has been steady and regular, but has been more marked in recent years. What are the causes that have effected this change, in which there has been a reduction of 75 per cent. in some parts of the Borough:— (a) Better education by improving the general intelligence of the parents. Twenty-five years ago it was held by many that the health of the children was the concern of the parents only. This idea has been modified, and it is now recognised that the health of the children is also the concern of the State as well. Special education by health visitors in the course of home visiting and at the infant welfare centres. It has led to a healthy rivalry among mothers who attend at the Centres. (b) Improved Sanitation.—I do not think this has had as much effect as in the reduction of the general death-rate and the death-rate from Tuberculosis. During the War. the houses deteriorated, due to the want of labour and materials, yet the infantile mortality declined even during these years. 6 (c) Overcrowding.—Less number of persons to the acre may have been a factor. During the years 1901-1921 the population of the Borough decreased by nearly 50,000. (d) Clean milk and dried milk.—Milk is certainly less contaminated than it used to be. The shops and the milk receptables are cleaner than formerly. Milk is no longer sold in shops where coal and paraffin, etc., are also sold which was the case until 1909. Previous to that year paraffin and other objectionable materials were sold, in 420 registered milk-shops, and in 42 of them coal was sold as well. They were either struck off the register, or they gave up the sale of coal and paraffin, and improved the condition of the premises generally. Dried milk undoubtedly plays an important part in the reduction of infantile mortality, especially with regard to summer diarrhoea. Dried milk is recommended and distributed at the infant welfare centres during the hot weather, because it not only provides a nourishing food, but is in a form which limits the probabilities of pollution in homes which have unsatisfactory means of storage. The free supply of dried milk and of fresh milk have been a great factor in the reduction of the mortality during the last few years. (e) Ante-natal inspection may have some influence on the infantile mortality, but it has more effect in reducing the maternal mortality. (f) Decrease of alcoholic intemperance has been a beneficial factor. The restricted hours in the opening of public-houses have no doubt had an effect in reducing the harmful effects resulting from the domestic neglect due to alcoholic over-indulgence. (g) Climatic conditions.—The effect of a hot summer used to be considered the greatest factor in causing a high infantile mortality by causing epidemics of summer diarrhoea. The summer of 1921 was very hot and dry, and yet the infantile mortality was only 89 per 1,000 births. The year 1921 was hotter and drier than in the previous years, and resembled 1911 in this respect, when the infantile mortality was 149 per 1,000. (h) Reduction in the birth-rate.—It is considered by many authorities that the reduction in the birth-rate causes a reduction in the infantile mortality. In our Borough there has been a great reduction in the birth-rate in all districts, with the exception of the Limehouse district, where the birth-rate has been nearly stationary, and is only slightly lower than it was 25 years ago, whereas in St. George's and Whitechapel it is less than one-half what it was then. Yet the reduction in the infantile mortality has been greater in the Limehouse district than in any other part of the Borough. (i) The National Health Insurance Acts is another important, if indirect factor in the decrease of maternal mortality. 7 Before the Acts came into force, many girls of the working classes, particularly those employed in factories and warehouses, suffered from anaemia and general ill-health. Their circumstances made it imperative that they should not be off work for any appreciable period. Many of them could not afford regular medical attention or extra nourishment. But directly these became available, nearly all cases of chronic anaemia disappeared, and the general health of these women and girls was tremendously improved. The result was that when they married, their physical condition was much more fitted to the burden and strain of child bearing than in the old days, when malnutrition and anaemia were widespread in this class of worker. The National Insurance Maternity Benefit is also of great use in relieving the mother of pressing financial strain during her lying-in. All the above-mentioned causes have some bearing on the question. Climate has more effect on occasional fluctuations of the infantile mortality than with the general trend of the decline, by causing a higher mortality from diarrhoea in years with a high summer temperature. In my opinion, however, the greatest factors are the organised maternity and child welfare activities—both voluntary and municipal—and the supply of free milk by the Borough Council. (9) The systematic house-to-house inspection was continued during the year, and on pages 49-54 a list of streets is given where every house was inspected as a result thereof. I also include the records of work done by the Sanitary Inspectors, Health Visitors, the Staff of the three Tuberculosis Dispensaries, and the Disinfecting Staff, to whom I am indebted for their loyal assistance, as well as for the assistance given by the Clerical Staff of the Public Health Department. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, D. L. THOMAS, Medical Officer of Health and Administrative Tuberculosis Officer. Population. The estimated population is 253,850, distributed as follows:— Limehouse, Ratcliff, Shadwell and Wapping 53,070 St. George-in-the-East 41,120 Mile End Old Town 104,900 Whitechapel, Spitalfields, Mile End New Town, &c 54,760 8 The density of the population exceeds 200 persons per acre, the greatest density being in the north-east ward of St. George's. Births. The total number of births during the year was 5,914—3,033 males, and 2,881 females,—or 88 less than in the previous year. The birth-rate was 23.3 per 1,000 of the population, while that for the whole of London was 20.2 per 1,000. 1,559 of the births belonged to the Limehouse District, or at the rate of 29.3 per 1,000 of the population. 999 of the births belonged to St. George-in-the-East, or at the rate of 21.8 per 1,000 of the population. 2,462 of the births belonged to Mile End Old Town, or at the rate of 23.4 per 1,000 of the population. 894 of the births belonged to the Whitechapel District, or at the rate of 16.3 per 1,000 of the population. The birth-rate for the whole Borough is again lower than in the previous year, and is, as I have already stated, the lowest on record. 985 births occurred in the Mothers' Lying-in Home, Commercial Road : 205 belonged to Mile End Old Town. 232 belonged to the Limehouse District. 48 belonged to the Whitechapel District. 77 belonged to St. George-in-the-East. 423 belonged to outlying Districts. 357 births occurred in the London Hospital:— 65 belonged to Mile End Old Town. 30 belonged to St. George-in-the East. 17 belonged to the Limehouse District. 31 belonged to the Whitechapel District. 214 belonged to outlying Districts. 120 births occurred in the St. George's Hospital, Raine Street:— 105 belonged to St. George-in-the-East. 15 belonged to the Limehouse District. 9 112 births occurred in Bancroft Lodge:— 93 belonged to Mile End Old Town. 3 belonged to the Limehouse District. 2 belonged to St. George-in-the-East. 14 belonged to outlying Districts. 49 births occurred in the St. Peter's Hospital, Vallance Road:— 37 belonged to the Whitechapel District. 2 belonged to Mile End Old Town. 3 belonged to St., George-in-the-East. 7 belonged to outlying Districts. 275 births occurred at 24, Underwood Street:— 95 belonged to Mile End Old Town. 109 belonged to the Whitechapel District. 1 belonged to the Limehouse District. 23 belonged to St. George-in-the-East. 47 belonged to outlying Districts. 203 births belonging to this Borough occurred at the City of London Lying-in Hospital, 102, City Road. Of these, 13 belonged to the Limehouse District, 45 to St. George-in-the-East, 79 to Mile End Old Town, and 66 to the Whitechapel District. 10 births belonging to this Borough occurred at the Queen Charlotte's Hospital. 2 belonged to the Limehouse District, 2 to St. George-in-the-East, 4 to Mile End Old Town, and 2 to the Whitechapel District. 57 births occurred at the Mothers' Hospital, Clapton. 2 belonged to the Limehouse District, 8 to St. George-in-the-East, 38 to Mile End Old Town, and 9 to the Whitechapel District. 34 births occurred at 2, Queensdown Road, Hackney. 2 belonged to St. George-in-the-East, 2 to the Limehouse District, 14 to Mile End Old Town, and 16 to the Whitechapel District. 4 births occurred at the Royal Free Hospital. 1 belonged to Mile End Old Town, 2 to Whitechapel, and 1 to Limehouse. 4 births occurred at the Middlesex Hospital. 2 belonged to the Whitechapel District, and 2 to St. George-in-the-East. 14 births occurred at 73a, Devons Road, and 13 at 50a, St. Leonard's Street. All belonged to the Limehouse District. 10 3 births occurred at 21 Endsleigh Gardens, St. Pancras. 1 belonged to the Limehouse District, and 2 to the Whitechapel District. 8 births occurred at Queen Margaret's Hospital, Stratford. 2 belonged to St. George-in-the-East, 4 to Mile End Old Town, and 2 to the Whitechapel District. 2 births occurred at the Military Families' Hospital, Woolwich. 1 belonged to Mile End Old Town, and 1 to the Whitechapel District. 12 births occurred at 4, Navarino Road, Hackney. 4 belonged to Mile End Old Town, 4 to St. George-in-the-East, and 4 to the Whitechapel District. 4 births occurred at St. Bartholomew's Hospital. 2 belonged to the Whitechapel District, 1 to St. George-in-the-East, and 1 to Mile End Old Town. 1 birth occurred at All Saints, Poplar, 1 at Horton Hospital, 1 at the French Hospital, 2 at Guy's Hospital, 2 at 65, Lauriston Road, Hackney. All belonged to Mile End Old Town. 2 births occurred at 18, Thavies Inn, Holborn, and one at the Bethnal Green Workhouse. All belonged to the Limehouse District. 1 birth occurred at the Mildmay Mission Hospital, which belonged to St. George-in-the-East. 54 births occurred at various nursing homes and private houses outside the Borough. Of these, 11 belonged to the Limehouse District, 8 to St. George-in-the-East, 22 to Mile End Old Town, and 12 to the Whitechapel District. Marriages. The total number of marriages was 2,091. The proportion of persons married was 16.4 per 1,000 of the population. 368 of the marriages were registered in the Limehouse District. 244 ,, ,, ,, St. George's District. 1,077 ,, ,, ,, Mile End Old Town. 402 ,, ,, ,, 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, the total number was 2,917—1,595 males and 1,322 females—or 576 less than in the previous year. 655 of the deaths belonged to the Limehouse District, or at the rate of 12.3 per 1,000 of the population. 11 474 of the deaths belonged to St. George-in-the-East, or at the rate of 11.5 per 1,000 of the population. 1,118 of the deaths belonged to Mile End Old Town, or at the rate of 10.6 per 1,000 of the population. 670 of the deaths belonged to the Whitechapel District, or at the rate of 12.2 per 1,000 of the population. The death-rate was 11.4 per 1,000 of the population, while that for the whole of London was 11.2 per 1,000. Notifiable Diseases. 1,799 notifications of infectious diseases were received, or 448 less than in the previous year, and 2,106 less than in 1921. 1,452 were removed to fever hospitals and infirmaries. 362 belonged to the Limehouse District, or at the rate of 6.82 per 1,000 of the population. 307 belonged to St. George-in-the-East, or at the rate of 7.46 per 1,000 of the population. 687 belonged to Mile End Old Town, or at the rate of 6.45 per 1,000 of the population. 443 belonged to the Whitechapel District, or at the rate of 8.09 per 1,000 of the population. Wrong Diagnosis. 150 cases of Infectious Disease were removed to the Metropolitan Asylums Board Hospitals, which were subsequently returned home because the patients were found not to be suffering from the disease stated on the certificates, or from any other notifiable disease. 73 of the cases were notified by private practitioners, 45 from the London Hospital, and 32 from other Public Institutions. This number referred to 49 cases of Scarlet Fever, 100 of Diphtheria, and 1 of Enteric Fever. Bacteriological Examinations. 799 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. Swabs (for Diphtheria bacilli) 49 472 521 Sputa (for Tubercle bacilli) 33 224 257 Cerebro-spinal fluid (for Tubercle bacilli) Nil 1 1 Blood (for Typhoid bacilli) 4 16 20 86 713 799 12 Small Pox. No case of Small Pox was notified during the year. Scarlet Fever. 468 cases were notified during the year, or 149 less than in the previous year. 464 were removed to fever hospitals. 68 belonged to the Limehouse District, with 2 deaths. 83 belonged to St. George-in-the-East, with 1 death. 169 belonged to Mile End Old Town, with 2 deaths. 148 belonged to the Whitechapel District, with 1 death. The death-rate for the whole Borough was .023 per 1,000, while that for the whole of London was .024 per 1,000 of the population. Diphtheria and Membranous Croup. 510 cases were notified during the year, or 267 less than in the previous year. 506 were removed to the fever hospitals. 133 belonged to the Limehouse District, with 12 deaths. 73 belonged to St. George-in-the-East, with 4 deaths. 214 belonged to Mile End Old Town, with 10 deaths. 90 belonged to the Whitechapel District, with 2 deaths. The death-rate for the whole Borough was .11 per 1,000 of the population. The death-rate for the whole of London was .13 per 1,000. Enteric Fever. 21 cases were notified, or 6 less than in the previous year. All were removed to hospitals. 3 belonged to the Limehouse District. 2 belonged to St. George-in-the-East. 7 belonged to Mile End Old Town. 9 belonged to the Whitechapel District. All the patients recovered, consequently there were no deaths from Enteric Fever during the year. The number of deaths in the whole of London was 39. Puerperal Fever. 15 cases were notified during the year, or 8 less than in the previous year. 12 were removed to hospitals. 1 belonged to the Limehouse District, with no death. 4 belonged to St. George-in-the-East, with no deaths. 4 belonged to Mile End Old Town, with 1 death. 6 belonged to the Whitechapel District, with 1 death. 18 Erysipelas. 133 cases were notified, or 43 more than in the previous year. 29 were removed to hospitals and infirmaries. 23 belonged to the Limehouse District, with no deaths. 35 belonged to St. George-in-the-East, with 1 death. 42 belonged to Mile End Old Town, with no deaths. 33 belonged to the Whitechapel District, with 1 death. Encephalitis Lethargfica. 9 cases were notified, or 5 more than in the previous year. 2 belonged to the Limehouse District, 1 to St. George's, 4 to Mile End Old Town, and 2 to Whitechapel. 1 proved fatal, which was one of the persons notified in Mile End. Cerebro-Spinal Fever or "Spotted Fever." 4 cases were notified, or 5 less than in the previous year. 1 belonged to St. George's, 1 to Mile End, and 2 to Whitechapel. All recovered. Polio-Myelitis and Polio-Encephalitis. 5 cases were notified during the year—3 in Limehouse, and 2 in St. George's. One proved fatal. Ophthalmia Neonatorum. 39 cases were notified, or 7 less than in the previous year. 12 occurred in Limehouse, 7 in St. George's, 13 in Mile End, and 7 in Whitechapel. One could not be traced, but the others were visited and kept under observation. Of these 38, 24 were treated at home, and 14 at various hospitals. Vision was unimpaired in all of them. Anthrax. One case of Anthrax was notified, which occurred in St. George's. Epidemic Diarrhoea. The number of deaths was 75, or 17 more than in the previous year, but 10G less than in 1921. 15 belonged to the Limehouse District, or at the rate of .28 per 1,000 of the population. 26 belonged to St. George-in-the-East, or at the rate of .63 per 1,000 of the population. 14 20 belonged to Mile End Old Town, or at the rate of .19 per 1,000 of the population. 14 belonged to the Whitechapel District, or at the rate of .25 per 1,000 of the population. 65 of the deaths—or nearly 88 per cent.—were those of infants under 1 year of age. I beg to call your attention to the following facts in connection with Diarrhoea which I mentioned in my previous report. The first is the small number of deaths of infants under 1 year of age from this disease as compared with the years previous to 1917. The second is the small proportion of deaths from diarrhoea from the beginning of July to the end of November. Fortytwo per cent. of the deaths certified as Epidemic Diarrhoea of infants did not occur during the period usually associated with this disease. Nearly 30 per cent. occurred during the four coldest months of the year—January, February, March and December. The following table shows the number of deaths of infants under one year of age from diarrhoea and the period of the year, &c., for the years 1913-1923:— 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 1923 13 8 26 12 6 65 58 9 Measles. The number of deaths from Measles was 63, or 1 more than in the previous year. 21 belonged to the Limehouse District, or at the rate of .39 per 1,000 of the population. 15 12 belonged to St. George-in-the-East, or at the rate of .29 per 1,000 of the population. 25 belonged to Mile End Old Town, or at the rate of .23 per 1,000 of the population. 5 belonged to the Whitechapel District, or at the rate of .09 per 1,000 of the population. The death-rate for the whole Borough was .24 per 1,000. The deathrate for the whole of London was .08 per 1,000 of the population. Whooping Cough. The number of deaths from Whooping Cough was 17, or 107 less than in the previous year. 8 belonged to the Limehouse District, or at the rate of .15 per 1,000. 3 belonged to St. George-in-the-East, or at the rate of .07 per 1,000. 5 belonged to Mile End Old Town, or at the rate of .04 per 1,000. 1 belonged to the Whitechapel District, or at the rate of .01 per 1,000. The death-rate for the Borough was .06 per 1,000, while that for the whole of London was .09 per 1,000 of the population. Zymotic Diseases. The total deaths from diseases of a Zymotic character was 189, or 144 less than in the previous year. They include all deaths from Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever and Diarrhoea. 58 belonged to the Limehouse District, or at the rate of 1.09 per 1,000. 46 belonged to St. George-in-the-East, or at the rate of 1.11 per 1,000. 62 belonged to Mile End Old Town, or at the rate of .05 per 1,000. 23 belonged to the Whitechapel District, or at the rate of .42 per 1,000. The death-rate for the whole Borough was .74 per 1,000 of the population. Phthisis. 455 new cases were notified, or 89 less than in the previous year. Notifications of New Cases. Deaths. Death Rate. Limehouse 83 62 1.16 St. George's 73 49 1.19 Mile End Old Town 175 95 .90 Whitechapel 124 59 1.07 Whole Borough 455 265 1.04 16 Number of deaths from Consumption from 1901 to 1923:— Limehouse 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 1923 62 49 95 59 265 Of the 455 deaths certified to be due to Phthisis, 47 had not been notified during life-time. Other Forms of Tuberculosis. 139 new cases were notified, or 41 more than in the previous year:- Notifications. Deaths. Death-rate per 1,000. Limehouse 34 15 .28 St. George's 25 11 .26 Mile End Old Town 58 18 .17 Whitechapel 22 7 .12 Whole Borough 139 51 .20 17 Deaths from diseases of a Tubercular nature, other than Phthisis, from 1901 to 1923:— Limehouse 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 1923 15 11 18 7 51 Of the 51 deaths certified to be due to Tuberculosis other than Phthisis 27 had not been notified during life-time. Tuberculosis Dispensaries. During the past year various changes have taken place in the work of the three Dispensaries of the Borough. In the first place the areas served by each Dispensary have been altered in order to make each district, as far as is possible, the same size. This has necessitated the transference of a number of patients from the Stepney Green Dispensary to the St. George-in-the-East and Whitechapel Dispensaries. 18 The problem of the prevention and treatment of tuberculosis has been approached by the Dispensaries under gradually improved conditions, mainly due to new arrangements, which serve to render co-operation between the Dispensaries and the various other authorities, dealing with tuberculosis, much closer. The arrangements with the L.C.C. School Medical Officers for the examination of "contacts," which were mentioned in last year's report, have worked satisfactorily, and practically no "contacts" of school age now remain unexamined. During the year the three Tuberculosis Officers have been appointed, for consultative purposes, as far as tuberculosis is concerned, to the visiting staffs of the Poor Law Hospitals serving their districts. This step will doubtless prove to be most helpful, as it introduces personal contact between the Hospital Medical Superintendents and the Tuberculosis Officers, without which proper co-operation is almost impossible. Unfortunately, the problem of the long-standing infective case remains unsolved. Many of these patients are sent to Sanatoria for a period of a few months, but arrest of the disease is in most cases impossible, and they eventually return to their homes, and are a source of danger to the remainder of the family. One feature of the work, which becomes more satisfactory each year, is the increasing co-operation between the private doctors in the Borough and the Dispensaries. A large number of patients have been examined at each Dispensary during the year at the request of private practitioners, either for assistance in diagnosis, or for advice and help regarding suitable treatment. The fact that the Tuberculosis Officers also are available for consultative assistance at the homes of patients, when required, is also more widely known among the doctors. Close co-operation between private practitioners and the Tuberculosis Officers is essential in any effective campaign against the disease. New Patients. The following tables show the number of patients examined for the first time. Table 1 includes the "contacts" examined. Analyses of the new patients and of the "contacts" are appended. 19 TABLE 1. Stepney Green Dispensary 1,071 Whitechapel Dispensary 1,007 St. George-in-the-East Dispensary 874 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 Tuberculosis. Under observation on December 31st pending diagnosis. Ceased attendance before completion of diagnosis. Stepney and Mile End Whitechapel (a) All persons (including contacts). 82 989 1071 170 22 789 53 37 14 993 1007 157 22 787 25 16 St. George-in-the East 38 836 874 133 28 619 40 54 Total 134 2818 2952 460 72 2195 118 107 Analysis. Under observation on January 1st pending diagnosis. Examined for the first time during the year. Total Suffering from Pulmonary Tuberculosis. Suflering 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 (a) "Contacts" (included in (a)). 52 630 682 73 5 566 31 7 7 633 640 16 8 602 10 4 St George-in-the-East 10 514 524 17 7 471 21 8 Total .. 69 1777 1846 106 20 1639 62 19 "Contacts." Partly owing to the co-operation with the L.C.C. School Medical Officers, it has proved possible to arrange for the examination of most of the "contacts." There is still some difficulty in persuading the adults, particularly the men, to be examined, but people are, as time goes on, becoming educated to the value of early diagnosis in tuberculosis, and it is therefore gradually proving possible to examine a larger percentage each year. 20 Tuberculosis in Childhood. There is, unfortunately, some chaos in London with respect to the diagnosis and necessity for treatment of tuberculosis in childhood. 1 he medical profession is itself much divided on this point. It is admitted, I think, by almost all medical men that the great majority of children at the age they leave school are infected with tuberculosis. As the age of the child increases, the percentage of those infected in each age group rapidly increases. Various post-mortem investigations and tuberculin tests have established this fact. The difficulty and divergence of opinion arise more with regard to exactly what signs, symptoms, &c., in childhood are an indication of active disease. There is no uniformity in this respect, and therefore there is lack of uniformity as to whether special treatment is necessary or desirable. The past histories of many cases of adult tuberculosis point strongly to infection in childhood, which has remained dormant until adult life. It is obviously impossible, and indeed undesirable, to place every infected child under Sanatorium treatment. Open Air Schools, no doubt, help to prevent these infected children becoming definite consumptives in later years, but the solution of this problem rests with improved housing conditions and a general improvement in the hygienic life of the people. With the present methods of treatment for tuberculosis at our disposal, there is little doubt that the disease will never be eradicated so long as we have overcrowding and poverty in our midst. Tuberculosis produces poverty, poverty encourages tuberculosis. Insured Patients. Table II. shows an analysis of the Insured patients. 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 (c) Insured persons. (Included in (a) ). 8 190 198 67 2 118 6 5 2 190 192 81 3 97 5 6 5 167 172 68 6 87 8 3 Total 15 547 562 216 11 302 19 14 21 Ministry ok Pensions. The Tuberculosis Officers have acted as referees for the Ministry of Pensions, and a considerable part of the time of the Dispensary staffs is occupicd by work in connection with the Ministry. The results of industrial training for tuberculosis ex-service men have been unsatisfactory in Stepney, largely owing to the impossibility of obtaining adequately paid work after discharge from training colonies. Table III. shows the number of War Pensioners dealt with by the three Dispensaries. TABLE III. War Pensions Cases. New cases. Cases in attendance during the year. Stepney 12 97 Whitechapel 16 33 St. George-in-the-East 24 79 Total 52 209 After-Care. The after-care work remains one of the most difficult problems in connection with the anti-tuberculosis campaign in the Borough. The prevalence of unemployment at the present time renders it almost impossible to obtain suitable work for patients on leaving the Sanatoria. It has already been indicated that the possible value of special training is nullified by the same lack of facilities for obtaining work. 22 TABLE IV. Table IV. shows a general statement of the work 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 of cases in 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 respect 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 visit3 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 284 3,511 151 32 184 11 25 12 167 2,275 521 Whitechapel 237 3,223 140 60 166 0 29 2 194 2,256 594 St. George-in-the-East 212 2,481 136 28 176 0 11 15 215 1,477 407 Total 733 9,215 427 120 526 11 65 29 576 6,008 1,522 23 Table referring to persons residing in the area which is served by the Stepney Green Dispensary. 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 fr m Tuberculosis. Not suffering from Tuberculosis. Pulmonary. NonPulmonary. (a) All persons (including "Contacts.") Adults. I M. 19 221 240 69 4 149 12 6 F. 19 240 259 56 6 185 9 3 Children under 15. M. 23 260 283 24 8 220 18 13 F. 21 268 289 21 4 235 14 15 Total 82 989 1071 170 22 789 53 37 (6) "Contacts" (included in (")). Adults. M 12 115 127 21 2 94 7 3 F. 14 139 153 16 0 132 5 0 Children under 15. M. 11 179 190 19 1 155 13 2 F. 15 197 212 17 2 185 6 2 (c) Insured persons (included in (a) ). M. 5 118 123 43 1 72 4 3 F. 3 72 75 24 1 46 2 2 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 284 2. Total number of attendances of patients at the Dispensary during the year Insured 1012 Uninsured 2499 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 151 4. Number of cases in which the period of observation at the Dispensary exceeded two months 32 5. Number of insured patients under domiciliary treatment on December 31st† 184 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 11 7. Number of persons referred to affiliated hospital for consultation 25 8. Number of consultations with medical practitioners at the homes of patients Insured 10 Uninsured 2 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 167 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2275 11. Number of specimens of sputum examined in connection with the work of the Dispensary 521 *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. 24 Table referring to persons residing in the area which is served by the Whitechapel Dispensary. Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined tor 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. 5 253 258 96 3 140 10 9 F. 4 295 299 45 3 240 5 6 Children under 15. M. 3 221 224 11 10 193 5 0 F. 2 224 226 5 6 209 5 1 Total 14 993 1007 157 22 787 25 16 (b) "Contacts" (included in (a)). Adults. M. 3 109 112 6 1 101 2 2 F. 2 186 188 6 1 177 3 1 Children under 15. M. 1 161 162 3 1 156 2 0 F. 1 177 178 1 5 168 3 1 (c) Insured persons (included in (a) ). M. 1 142 143 69 2 63 4 5 F. 1 48 49 12 1 34 1 1 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 237 2. Total number of attendances of patients at the Dispensary during the year Insured 919 Uninsured 2304 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 140 4. Number of cases ia which the period of observation at the Dispensary exceeded two months 60 6. Number of insured patients under domiciliary treatment on December 31st† 166 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 2 Uninsured 0 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 194 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2256 11. Number of specimens of sputum examined in connection with the work of the Dispensary 594 *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. 25 Table referring to persons residing in the area which is served by the St. George's Dispensary. 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. 3lst pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary. NonPulmonary. (a) All persons (including "Contacts.") Adults. M. 5 164 169 66 6 85 4 8 F. 8 235 241 49 1 160 12 19 Children under 15 M. 11 227 238 9 11 198 12 8 F. 14 212 226 9 10 176 12 19 Total 38 836 874 133 28 619 40 54 (b) "Contacts" (included in (a) ). Adults. M. 0 72 72 8 1 63 0 0 F. 1 120 121 5 1 109 5 1 Children under 15. M 5 175 180 2 3 163 8 4 F. 4 147 151 2 2 136 8 3 (c) Insured persons (included in (a) ). M 3 113 116 53 5 51 6 1 F. 2 54 56 15 1 36 2 2 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 212 2. Total number of attendances of patients at the Dispensary during the year Insured 1041 Uninsured 1440 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 136 4. Number of cases in which the period of observation at the Dispensary exceeded two months 28 5. Number of insured patients under domiciliary treatment on December 31st† 176 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 11 8. Number of consultations with medical practitioners at the homes of patients Insured 10 Uninsured 5 9 Number of other visits paid by Tuberculosis Officers to the homes of patients 215 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 1477 11. Number of specimens of sputum examined in connection with the work of the Dispensary 407 *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. 26 List of Municipal Tuberculosis Dispensaries. Stepney Dispensary, Hours. 35, Stepney Green. Monday, 9.30 a.m.—5.30 p.m. Tuesday, 9 30 a.m.—8 p.m. Whitechapel Dispensary, Wednesday, 9.00 a.m.—lp.m. 18, Gt. Prescot Street. Thursday, 9.30 a.m.—5.30 p.m. St. George's Dispensary, Friday, 9.30 a.m.—5.30 p.m. 208, High Street, Shadwell. Saturday, 9.30 a.m.—12 noon. Finsen Light Treatment. Arrangements are made with the London Hospital to undertake Finsen Light Treatment respecting patients needing such treatment and residing in this Borough, for which payments are made by the Borough Council. Eleven applications have been received during the year from the London Hospital respecting five patients, and payment has been guaranteed for 132 attendances. Pneumonia, Malaria, Dysentery and Trench Fever Regulations. 358 cases were notified under these Regulations. Of these, 354 were Pneumonia and 4 Malaria. The cases occurred in the Districts as follows:- Limehouse St. George's Mile End Whitechapel Pneumonia 130 31 167 26 Malaria — 4 — — Dysentery — — — — Diseases of the Respiratory Organs. 676 deaths were due to diseases of the Respiratory Organs, or 270 less than in the previous year. 156 belonged to the Limehouse District, or at the rate of 2.99 per 1,000 of the population. 116 belonged to St. George-in-the-East, or at the rate of 2.82 per 1,000 of the population. 238 belonged to Mile End Old Town, or at the rate of 2.26 per 1,000 of the population. 166 belonged to the Whitechapel District, or at the rate of 3.03 per 1,000 of the population. The death-rate for the whole Borough was 2.66 per 1,000 of the population. 27 Influenza. 34 deaths were due to Influenza, or 96 less than in the previous year. 5 belonged to the Limehouse District, or at the rate of .09 per 1,000 of the population. 7 belonged to St. George-in-the-East, or at the rate of .17 per 1,000 of the population. 16 belonged to Mile End Old Town, or at the rate of .15 per 1,000 of the population. 6 belonged to the Whitechapel District, or at the rate of .10 per 1,000 of the population. The death-rate for the whole Borough was at the rate of .13 per 1,000 and that for London was .16 per 1,000 of the population. Cancer. 320 deaths were due to Cancer, or 46 more than in the previous year. 67 belonged to the Limehouse District, or at the rate of 1.26 per 1,000 of the population. 47 belonged to St. George-in-the-East, or at the rate of 1.11 per 1,000 of the population. 136 belonged to Mile End Old Town, or at the rate of 1.29 per 1,000 of the population. .70 belonged to the Whitechapel District, or at the rate of 1.27 per 1,000 of the population. The death-rate for the whole Borough was at the annual rate of 1.26 per 1,000 of the population. Cancer of the breast was responsible for 27 of these. Operations had been performed in 16 out of the 27, but the disease had recurred and proved fatal six years afterwards in two cases, four years in one case, three years in four, two years in three, and one and a half years in three cases. Death had occurred in less than a year after the operation in three instances. The increase in the number of deaths is shown in the following table, although the population was gradually decreasing:- 1916 232 1917 235 1918 239 1919 234 1920 244 1921 263 1922 274 1923 320 28 Infantile Mortality. 372 infants died under one year of age, or 104 less than in the previous year. 93 belonged to the Limehouse District, or at the rate of 59 per 1,000 births. 83 belonged to St. George-in-the-East, or at the rate of 83 per 1,000 births. 142 belonged to Mile End Old Town, or at the rate of 57 per 1,000 births. 54 belonged to the Whitechapel District, or at the rate of 60 per 1,000 births. The infantile mortality for the whole Borough was 62 per 1,000 births, while that for the whole of London was 60 per 1,000. Of the 106 illegitimate births, 18 died before they were a twelvemonth old. or at the rate of 169 per 1.000 births. The average infantile mortality for five-year periods from 1890-1919, and for the years 1920-1923:- 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 1923 59 83 57 60 62 There were 70 sets of twins born during the year. The rate of infantile mortality is again low, and on reference to the above table it will be observed that it is the lowest on record. 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. 29 The Maternity and Child Welfare Scheme is on the following lines: — X. 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, and thus we keep in touch with the entire family. The Health Visitors visit 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, the Health Visitors visit and report, upon all cases of Stillbirth and Ophthalmia Neonatorum throughout the Borough. •3. Centres. There are five Municipal centres where a doctor attends weekly. There is also a clinic for women at the LimehouseTown Hall where the Assistant Medical Officer of Health attends every Thursday morning. The cases examined 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. 4. Hospitals and Convalescent Homes. We find no difficutly 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 one year, who are in urgent need of skilled nursing and attention. Delicate illnourished babies do very well in this Home. Mothers and babies are sent to convalescent homes from time to time, and toddlers are sent to the Marjorie Lumley Holiday Home, at Maidenhead. 5. Sewing Classes. A sewing class is held once a week at Spitalfields, Wapping and St. George's Centres. We hope to re-open the Limehouse sewing class shortly. 30 6. 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 a week at the Burdett Road Centre. 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 is in addition to the primary visiting, which we undertake for practically the whole of the Borough, and ensures mutual help and co-operation between Municipal and Voluntary workers. The following is a list of Centres, Clinics and Creches in the Borough: — 1. Municipal Centres. Limehouse Centre, Town Hall, Commercial Road. Monday : Afternoon 2—5 p.m. (Consultation & Sales). Thursday : Morning 10.30 a.m.—12 noon. (Consultation & Sales). St. George's Centre, Town Hall, Cable Street. Tuesday: Afternoon 2—5 p.m. (Consultation & Sales). Wednesday : Afternoon 2—5 p.m. (Sewing Class). Friday: Morning 10—11.30 a.m. (For Sales). Spitalfields Centre, Bedford Institute, Quaker Street. Tuesday : Afternoon 2.30—5.30 p.m. (Consultation & Sales). Wednesday : Afternoon 2—5 p.m. (Sewing Class). Wapping Centre, 52, Red Lion Street. Monday : Morning 10 a.m.—12 noon. (For Sales). Monday : Afternoon 2-5 p.m. (Sewing Class). Wednesday: Afternoon 2—5 p.m. (Consultation & Sales). Friday: Morning 10 a.m.—12 noon. (For Sales). Whitechapel Centre, St. Phillip's Institute, Newark Street. Monday: Morning 10 a.m.—12 noon. (For Sales). Thursday: Afternoon 2—5 p.m. (Consultation & Sales). 2. Voluntary Centres. Mission Hall, Carr Street. Friday afternoons. Stepney Infant Welfare Centre and Babies' Nursing Home, 587, Commercial Road. Monday and Friday afternoons. 31 The Memorial Hall, High Street, Shadwell. Wednesday afternoons. Jewish Centre, 220, Cable Street. Monday and Wednesday afternoons. Congregational Buildings, Burdett Road. Wednesday and Thursday afternoons. Dame Colet House, 3, St. Helen's Terrace, Mile End. Monday afternoons. Jewish, Wednesday afternoons. The Cottage, 10, Duckett Street. Tuesday afternoons. Jewish Centre, 24, Underwood Street. Tuesday and Thursday afternoons. Monday and Wednesday—Sewing Class. Monday (Dental) 10 a.m.—1 p.m. 49, Church Street, Minories, Wednesday afternoons. Jewish Centre, 14, Great Alie Street. Wednesday afternoons 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. Marie Hilton Creche, Stepney Causeway. St. Paul's Day Nursery, Wellclose Square. Nursery School, Rectory Square. 32 VISITS BY THE HEALTH VISITORS:— E. Addis (8 months) D. Chabot (9 months) E. Clements A.M. Cordwell M. Davis A. E. Gibbs E. Goodlellow D. Mitchell I. Virtue H. A. Whitly Total Primary 498 676 458 789 561 509 226 549 380 562 5,208 Revisits:— To infants under 1 year 490 767 1,139 721 741 531 790 809 934 818 7,740 To children between 1-5 years 374 1,049 1,034 1,060 1,526 1,186 1,033 627 1,419 1,292. 10,600 Ante-natal:— Primary 9 5 146 50 — 16 80 225 — 144 675 Subsequent — 2 27 8 — 10 5 200 — 37 289 Miscellaneous 334 397 70 479 307 447 1,252 173 44 451 3,954 Total 1,705 2,896 2,874 3,107 3,135 2,699 3,386 2,583 2,777 3,304 28,466 CENTRES ATTENDED:— Municipal 61 87 61 56 15 81 339 112 90 103 1,005 Voluntary — 2 — 45 83 — — — — 40 170 Total 61 89 61 101 98 81 339 112 90 143 1,175 33 Feeding of Infants ;— Breast fed 4,866 Artificially fed 101 Mixed feeding 241 5,1208 No. dead before first visit of Health Visitor 75 Municipal Centres. Limehouse. St. George's. Spitalfields. Wapping. Whitechapel No. of sessions held — 2 50 256 65 No. of attendances of infants 1,662 1,823 434 1,519 1,513 No. of attendances of children 1-5 years of age 974 711 236 534 928 No. of doctors' consultations 48 46 20 51 61 No. of doctors' morning consultations 36 - - - - Attendances of mothers 261 - - - - Sewing Classes:— No. of classes held 6 22 43 32 — No. of attendances 55 173 342 194 — 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 Applications No. of Persons Quantity Cost Cows Milk— £ s. d. Free 7,797 11,260 39,434½ gafs. 4,529 0 0 Half-price 78 130 455 „ 26 16 1 Dried Milk— Free 785 893 6,152 lbs. 437 3 0 Half-price 14 18 124 „ 4 6 6 Virol— Free 112 133 133 lbs. 8 17 4 Half-price 1 2 2 „ - 1 4 34 The following is a 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. Preserved Meats. Tons. cwts. qrs. lbs. 76,698 tins of beef 144 2 1 18 154 tins of chicken — — 2 23 1,566 tins of tongue 1 11 3 25 Preserved Fish. 116 tins of pilchards — 1 0 4 36,444 tins of salmon 15 18 1 4 Fresh Fruit and Vegetables. 202 packages of apricots 1 16 0 8 593 crates of bananas 10 11 0 0 110 packages of blackcurrants 1 5 0 16 42 packages of carrots 1 0 3 12 189 packages of cherries 1 13 2 18 326 bags of chestnuts 16 0 0 20 921 packages of cucumbers 4 6 3 4 193 packages of gooseberries 2 8 0 0 1 package of grapes — — — 14 26 packages of greengages — 4 2 16 69 casks of horseradish 3 15 3 0 17 packages of lettuce — 3 0 4 121 bags of onions 5 18 1 0 8 boxes of oranges — 9 1 12 454 packages of pears 4 9 0 20 615 packages of plums 5 12 1 13 42 packages of raspberries — 9 0 0 17 packages of redcurrants — 3 2 4 1,238 packages of strawberries 2 15 0 0 251 packages of tomatoes 1 8 0 20 35 Preserved Fruit and Vegetables. Tons. cwts. qrs. lbs. 1,195 tins of apples 3 4 0 8 2,764 tins of apricots 3 2 2 10 9 casks of gherkins 1 14 1 0 720 tins of fruit pulp 3 8 2 0 720 tins of jam 1 1 0 8 59 tins of peaches 1 1 0 8 2,627 tins of pears 2 18 2 6 70,361 tins of pineapples 69 5 0 26 331 boxes of prunes 3 9 3 7 42 boxes of raisins — 9 0 12 770 tins of tomatoes 2 2 3 16 Sundries. 12,246 tins of assorted canned goods 11 0 0 20 95 bags of Cocoa (in bean) 5 19 1 16 116 boxes of chocolate — 5 1 6 8 barrels of glucose 1 12 3 0 8 bags of winkles — 11 0 0 337 10 1 6 II.—Diseased Meat and Offal destroyed from the Slaughter-houses and Offal Dealers:- 37 pieces of beef — 1 2 10 23 pieces of mutton — — 3 3 116 rabbits — 3 0 5 9 ox tongues — — — 18 7 bullocks' heads — 1 3 7 2 bullocks' livers — — — 23 55 sheep's livers — 1 0 22 1 calf's liver — — — 7 1 sheep's pluck — — — 5 58 sets of sheep's lungs — 1 0 25 — 10 0 13 36 III.—Unsound Food seized by, or surrendered to the District Sanitary Inspectors:— Fish. Tons. cwts qrs lbs. Bleak — 2 0 4 Bream — 18 0 16 Codling — 1 3 2 Conger Eel — 1 0 7 Haddock — 4 0 2 Haddocks — — 2 4 Herrings 2 7 0 0 Herrings (pickled) — 3 2 18 Mackerel — — 2 24 Perch — 2 0 16 Plaice — — 3 10 Roach — 3 3 0 Salmon (smoked) — 10 0 5 Salmon and Shrimp Paste — 15 0 0 Skate — — 3 16 Fruit. Apples — 17 0 22 Apricot Pulp 7 1 3 0 Black Currants — 2 2 0 Dried Fruits — 5 3 0 Gooseberries 2 2 0 0 Grapes — 3 2 0 Greengages — 9 3 0 Oranges (Seville) — 2 2 0 Pears 16 6 3 22 Plums — 7 1 10 Raspberries — 2 2 0 Red Currants — 17 2 0 Strawberries 1 15 0 16 Meat. Beef — 1 2 4 Corned Beef — — - 18 Geese — 5 2 15 Rabbits — 1 0 14 37 Vegetables. Tons. cwts. qrs. lbs. Horse Radish 1 0 0 0 Onions — 10 0 0 Potatoes 1 5 0 0 Tomatoes 12 10 2 20 Miscellaneous. Biscuits — — — 10 Canned Goods (assorted) 1 8 0 0 Eggs 1 13 0 0 Flour 1 8 3 0 Milk (Condensed) 40 12 3 4 Turtle Soup — 15 0 0 Walnuts — 4 2 0 Yeast — 2 0 0 Total 130 9 0 4 Disinfecting Station. 1,542 rooms were fumigated, and the bedding, etc., were removed and disinfected by steam. Of these, 1,318 rooms were fumigated because of notifiable diseases, 188 as a result of Pulmonary Tuberculosis, and 36 because they were verminous. In addition to these, Scabies occurred in 226 families where the bedding was taken away and disinfected by steam. 260,605 articles were disinfected. Of these, 236,424 were second-hand articles of clothing for export abroad, 17,297 were from premises where infections diseases occurred, and 6,884 because they were in a verminous condition. 603 articles of bedding were destroyed with the owner's consent. The Mortuary. The number of bodies deposited in the Mortuary during the year was 265. Of these, 212 were removed by the Coroner's Order, 38 by the Police, 2 at the request of deceased's friends, and 13 on my instructions. 42 bodies were placed in the Jewish part of the Mortuary, but only 21 were officially " watched." 244 inquests were held in the Coroner's Court, and 89 post-mortem examinations were made. 38 Verminous Persons. 519 persons were cleansed during the year, and had their clothing disinfected—472 males and 47 females. In addition, 1,067 school children were cleansed, of which 381 were children suffering from Scabies. Increase of Rent and Mortgage Interest (Restrictions) Act, 1923. 25 applications for certificates were made during the year. Of these, 20 were granted and 5 were refused. Sale of Food and Drug's Act, 1899, and the Butter and Margarine Act, 1907. We have had 4 applications for registration during the year of premises under the above Acts:—2 as Wholesale Dealers in Margarine, 1 for Margarine blending, and 1 as a Butter Factory. The certificates were duly issued. Milk (Special Designations) Order, 1923. One application was received during the year under this Order for a Dealer's Supplementary Licence to sell Grade A Milk, and this was duly granted. Canal Boats Acts, 1877 and 1884. Pursuant to the Third Section of the Canal Boats Acts, 1884, the Metropolitan Borough of Stepney, being the Registration Authority under the above Acts, has to report as follows with regard to the execution of such Acts and of the Regulations made thereunder, and as to the steps taken by them as such authority during the year to give effect to the provisions of the said Acts and Regulations, viz. : — (1) Canal Boats coming within the district are Inspected by a Sanitary Inspector, who receives a sum of £10 per annum for the performance of this duty. His inspection is irrespective of the examination of Boats made by the Examining Officer prior to their registration. (2) The number of Boats inspected in 1923 was 63, and the condition of the Boats and their occupants, as regards the matters dealt with in the Acts and Regulations was very good. 39 (3) Infringments 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. (A) Ventilation Nil. (i) Painting Two. (7) Provision of Water Cask Nil. (k) Removal of bilge water Nil. (I) Notification of Infectious Diseases Nil. (m) Admittance of Inspector Nil. (4) No legal proceedings were taken. (5) No infringements were found. (6) No cases of Infectious Diseases occurred. (7) No boats were detained for cleansing and disinfection. (8) The total number of Boats on the register on the 31st December, 1923 : (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 1923. Rats and Mice Destruction Act, 19i9. Complaints received 435 Number of Drains tested 485 Number of drains found to be defective 95 Number of Notices served 95 Number referred to the Borough Engineer 340 General Sanitary Work. 37,985 inspections were made to houses. 53,193 re-visits were made by the Inspectors to supervise the abatement of the nuisances found in 14,802 houses. 7,350 statutory notices were served. 69 summonses were taken under the Public Health (London) Act, 1891. 5,195 drains were tested with smoke, and 134 were re-tested; 1,671 drains were either constructed or re-constructed, cleansed or repaired; 381 were trapped. 40 197 new soil pipes were fixed and ventilated; 1,197 new closet pans and traps were fixed; 3,380 closets were either cleansed or repaired, or provided with additional light and ventilation; 1,754 water closets were provided with a proper flushing apparatus. 1,692 yards were cleansed, paved or repaired; 17 areas and stables were paved and drained; and 255 washhouses and forecourts were paved. There were 73 nuisances under the Public Health (London) Act, 1891 with respect to the keeping of animals, and these were all abated. 9 nuisances with respect to open fires in yards were remedied. Notices were served to provide 1,432 sanitary dust receptacles, and 16 manure receptacles were provided or re-constructed ; 563 offensive accumulations were removed from the rear of dwelling houses. 75 houses were ventilated under the lower floor. 15 underground rooms, which were illegally occupied, were discontinued from being used as such. 21 urinals have been fixed. 45 notices were served for the abatement of smoke nuisances. 318 visits were made to bakehouses, and 314 cleansings were carried out. 7,539 notices were served to have houses cleansed. 251 sink, bath, lavatory, or rain-water pipes, which were communicating directly with the drain, were disconnected. 15,124 miscellaneous repairs to roofs, floors, gutters, etc., were carried out as a result of notices served. 96 rooms were provided with additional light and ventilation, and the damp walls of 901 rooms were remedied. 1,460 verminous premises were cleansed during the year. 53 cisterns were cleaned or provided with a cover. 85 cases of overcrowding were abated. There were 3 sheds occupied as dwellings, and these were discontinued as such. The water supply to houses had been reinstated in 121 instances. The number of registered milkshops is 442, and the number of visits made to them during the year was 1,403. There are 2,645 houses on the register for houses-let-indodgings. 3,398 inspections were made to them during the year. Ice cream is manufactured at 231 premises, and 420 inspections were made to them. SANITARY INSPECTORS' REPORT. A. COOK. E. T. CROOK. T. W. DRE. E. W. FLINT. J.W. JOHNSON. H. MILLS. Gr. O- PAYITT. H. QUAINTRELL. W.SHEPHERD. R. SIMPSON. A. W. STILES. J. TWAITS. R H. WATERMAN. J. WHITE. T. P. WRACK. H. BOMOMLEY. H. O. HARRIS. S. H. V. TRIMMING. W. T. TWYNHAM. TOTALS. Number of Inspections— House to house 404 601 633 398 412 621 924 502 884 835 531 864 511 465 599 550 762 184 216 10891 Micellaneous 2355 242 1105 1259 2090 1861 584 1825 1352 934 1207 525 1342 1220 1560 920 635 329 391 21636 Complaints 405 313 117 227 78 316 592 259 86 147 126 454 55 96 426 29 126 132 32 4016 Infectious diseases 90 60 48 64 156 76 185 166 58 84 74 130 79 70 102 ... ... ... ... 1442 Re-visits—Number of 2460 1787 2098 2172 4578 3635 3753 2889 2818 4412 2512 3337 2377 2115 2352 3437 3885 1501 1625 53193 Intimations served 703 653 533 521 917 996 1289 675 848 1106 1162 1041 634 601 718 893 697 434 381 14802 Statutory notices served 398 522 355 434 213 548 928 188 217 721 522 856 156 407 455 57 219 94 60 7350 Summonses taken out under the Public Health (London) Act, 1891 11 ... 1 2 2 1 3 6 ... 8 15 6 11 ... 2 ... 1 ... ... 69 Food and Drugs Acts, etc.—No. of samples taken 102 60 90 98 90 92 124 95 126 90 62 93 90 93 93 ... ... ... ... 1898 „ „ No. of summonses taken 4 • •• ... 2 5 1 7 2 ... 3 1 1 1 ... 1 ... ... ... ... 28 Animals kept so as to constitute a nuisance, removed 7 7 8 4 ... 2 13 2 4 3 5 1 ... 1 1 6 7 1 1 73 Areas and stables paved and drained 3 ... 4 1 ... ... ... 2 ... 1 ... 2 ... ... ... ... ... 1 3 17 Bakehouses—No. of inspections to 22 30 8 22 26 30 22 22 12 22 30 28 14 10 20 ... ... ... ... 318 „ No. cleansed 22 30 8 22 22 30 22 22 12 22 30 28 14 10 20 ... ... ... ... 314 Cisterns cleansed and covered 13 1 ... 3 ... 11 2 ... 5 ... 2 ... ... 6 3 ... 3 4 ... 53 Damp walls remedied 41 90 52 33 70 47 54 30 35 34 74 94 70 30 30 7 65 34 11 901 Drains—Cleansed or repaired 63 125 36 36 146 39 173 67 19 157 129 70 65 62 90 27 27 11 8 1350 Constructed or reconstructed 17 30 12 8 21 12 12 24 9 38 17 38 48 4 31 ... ... ... ... 821 Soil pipes fixed and ventilated 17 9 24 4 17 21 ... 4 3 12 10 1 45 3 27 ... ... ... ... 197 Trapped 35 46 7 21 32 80 ... 4 6 12 18 47 5 18 49 ... 1 ... ... 381 Dust receptacles provided 49 40 54 70 64 82 132 59 107 149 100 142 97 42 22 60 67 40 56 1432 Houses or parts of houses cleansed 453 400 382 380 341 360 718 246 380 576 412 727 410 338 298 419 301 237 161 7539 ,, ventilated beneath the lower floor 3 5 7 2 6 1 5 ... ... ... 17 20 4 3 ... ... ... ... 2 75 Light and ventilation provided to rooms ... 12 24 1 ... ... ... 3 7 ... 4 15 20 ... ... ... 10 ... ... 96 Manure receptacles provided or reconstructed 3 ... ... 1 ... 2 3 ... ... 2 1 4 ... ... ... ... ... ... ... 16 Offensive accumulations removed 59 27 26 7 7 107 5 24 35 14 67 17 15 9 112 5 19 10 8 563 Open fires in yards abolished 3 ... ... ... ... ... ... ... ... 2 3 ... ... 1 ... ... ... ... ... 9 Overcrowding in dwellings abated 1 1 7 4 8 3 ... 9 1 6 4 4 3 8 1 12 7 3 3 85 Sheds occupied as dwellings discontinued ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... ... ... ... ... 8 Sink, bath, lavatory pipes and rainwater pipes disconnected 7 16 33 ... 10 9 9 4 ... 15 ... 19 106 4 19 ... ... ... ... 251 Smoke nuisances abated 1 4 10 3 1 ... 2 ... ... 2 1 3 ... 14 4 ... ... ... ... 45 Underground rooms—Illegal occupation discontinued ... ... 2 3 ... ... ... ... ... ... 4 ... 2 ... ... ... 2 2 ... 15 Urinals fixed 3 ... 2 1 6 1 ... ... 1 2 ... ... 4 1 ... ... ... ... ... 21 Verminous rooms cleansed 93 160 23 88 67 103 108 67 64 143 96 88 49 32 48 31 81 100 19 1460 Wash-houses, forecourts, &c., paved 5 1 12 5 86 8 17 14 ... 10 2 44 15 23 2 7 1 ... ... 255 Waterclosets—Cleansed or repaired 198 145 142 136 144 360 110 83 247 219 362 218 102 31 156 157 119 153 121 3203 „ Light and ventilation provided 3 7 3 2 47 25 ... 3 5 ... 3 ... 58 1 17 ... 3 ... ... 177 „ Pans and traps fixed 198 160 32 17 113 51 51 48 33 98 ... 54 166 39 96 10 ... 3 7 1197 ,, Water supply or flushing apparatus provided 198 184 73 44 129 168 39 40 41 142 148 64 218 45 129 ... 38 57 47 1754 Water supply to houses reinstated 8 2 6 1 2 4 16 9 1 20 11 ... 5 3 16 2 3 9 8 121 Yards cleansed, paved, or paving repaired 41 115 94 96 76 97 111 64 20 183 97 184 99 64 58 105 62 48 78 1692 Miscellaneous repairs to roofs, gutters, floors, sashes, fireplaces, coppers, etc. 572 650 509 933 1175 789 1150 604 1014 1183 1139 1681 534 527 513 626 681 428 416 15124 [To face page 40]. 41 POLICE COURT PROCEEDINGS. (1) UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. On 3rd January, David Galinsky was summoned for failing to comply with a Magistrate's order to abate a nuisance arising from defective roof, etc., at 02, Pelham Street. He was fined £b with £2 2s. costs. On 3rd January, David Galinsky was summoned for failing to comply with a Magistrate's order to abate a nuisance arising from defective roof, etc., at 68, Pelham Street. He was fined £b with £2 costs. On 3rd January, J. Ilinoff was summoned for failing to quit the premises, 87, Underwood Street, a closing order having been made on 3rd October, 1922. He was fined £2, or 6 days' in default. On l2th January, Joseph Barleyman was summoned for failing to comply with a Magistrate's order, made on 15th September, 1922, to remedy the dirty and dilapidated condition of 38, Carlton Road. The Magistrate adjourned the summons sine die on the defendant giving an undertaking to surrender the property to the freeholders. On the day of the re-hearing of the summons the defendant was carrying out the necessary work, and the house was being put into a thorough state of repair. The summons was dismissed, but no costs were allowed. On 19th January, Albert J. Benabo was summoned for failing to remedy the dilapidated condition of 255, Bow Common Lane. The work having been completed at the time of the hearing of the summons, he was fined 20s., with £2 2s. costs. On 1st February, Samuel Cohen, occupier of second-floor room at 16, Artichoke Hill, was summoned for keeping animals (cats) in such a state as to be a nuisance. A prohibition order was made, with 4s. costs. On 1st February, Frederick Harms, owner of a shed at the rear of 48, Bridge Street, was summoned for allowing the shed to be used and occupied as a dwelling, the same being unfit for human habitation. The Magistrate adjourned the summons, and directed the defendant to proceed under the Small Tenements Act for the ejectment of the occupants of the shed. On 9th February, Philip Abrahams was summoned for failing to comply with a Magistrate's order to remedy the defective drains at 50 White Horse Lane. He was fined £b, with £3 3s. costs. 42 On 9th February, Morris Samuel Abrahams was summoned for failing to comply with a Magistrate's order made to remedy the defective branch drains at 50, White Horse Lane. The summons was withdrawn, no costs being allowed. On 9th February, Isaac Samuel Abrahams was summoned for failing to comply with a Magistrate's order made to remedy the defective branch drains at 50, White Horse Lane. The summons was withdrawn, no costs being allowed. The three defendants were summoned as it was impossible to find out otherwise who was the actual owner. On 14th February, Messrs. Frost Bros., of 340, Commercial Road, were summoned for permitting black smoke to issue from their chimney (tall shaft), in such quantities as to be a nuisance. They were fined £5 with £2 costs. On 14th February, Claude M. Leigh was summoned for failing to provide w.c. accommodation to the workshop at 3-4, Durer Place. He was fined £2 with £2 costs. On 14th February, Abraham Stoppler was summoned for failing to repair the water cistern at 23, Stutiield Street. The work had been done at the time of the hearing of the summons. He was fined 10s., with £2 costs. On 23rd February, Harry Warman was summoned for failing to remedy the defective gutters of 8, Belgrave Street. The work having been done at the time of the hearing of the summons, he was ordered to pay £2 2s. costs. On 23rd February, Henry Neale was summoned for failing to remedy the dilapidated condition of 2, Union Terrace. An order was made to complete the work within 14 days, with £2 8s. costs. On 27th February, Hyman Freedman was summoned for failing to remedy the defective condition of the roof of the workshop and yard paving at 19, Alder Street. An order was made to do the work within 14 days, with £2 8s. costs. On 27th February, Hyman Freedman was summoned for failing to remedy the defective condition of the roofs of house and workshop of 21, Alder Street. An order was made to do the work within 14 days, with £2 8s. costs. On 6th March, Messrs. Martineau, Ltd., of the Sugar Refinery, King Edward Street, were summoned for permitting black smoke to issue from a brick shaft on their premises in such a manner as to be a nuisance. They were fined £5. 43 On 13th April, Henry Jarratt was summoned for failing to remedy defective drain of 29, Skidmore Street. An undertaking being given to do the necessary work, the Magistrate adjourned the summons sine die. On 20th April, C. C. Benabo & Son were summoned for failing to remedy the defective roof and gutter of 33, Halley Street. The work having been completed at the time of the hearing of the summons, they were ordered to pay £2 4s. costs. On 24th April, Jennie Levy, of 43, Brick Lane, was summoned for the top floor back room being overcrowded. The overcrowding having been abated before the time of the hearing of the summons, she was ordered to pay 5s. costs. On 2nd May, Jones, Son & Day were summoned for failing to remedy sanitary defects at 2, Causeway Court. An order was made to do the work within 14 days, with £2 8s. costs. On 2nd May, Jones, Son & Day were summoned for failing to remedy sanitary defects at 5, Causeway Court. An order was made to do the work within 14 days, with £2 8s. costs. On 2nd May, Jones, Son & Day were summoned for failing to provide a proper dustbin at 5, Causeway Court. A dustbin having been provided at the time of the hearing of the summons, they were ordered to pay £1 1s. costs. On 4th May, A. J. Benabo was summoned for failing to remedy sanitary defects at 18, Sage Street. He was fined £\, with £2 8s. costs. On 4th May, A. Levine was summoned for failing to remedy the damp wall of the workshop at 96, Commercial Road. An order was made to do the work within 21 days, with £1 5s. costs. On 4th May, J. Rymer was summoned for failing to repair the defective roof of 13, Umberston Street. An order was made to do the work within 7 days, with £2 8s. costs. On 8th May, the owner of 1, Fulbourne Street was summoned for noncompliance with notice to abate a nuisance caused by defective W.C. He was ordered to do the work in 7 days, with £1 3s. costs. On 8th May, the owner of 221a Whitechapel Road was summoned for non-compliance with notice to abate a nuisance caused by defective W.C. He was ordered to do the work in 7 days, with £1 3s. costs. On 13th June, Day, of the firm of Jones, Son & Day, was summoned for failing to comply with the Council's notice to provide a proper sanitary dustbin at 1, Causeway Court. He was fined 40s., with 42s. costs. 44 On 13th June, Day, of the firm of Jones, Son & Day, was summoned for failing to comply with the Council's notice to repair defective flooring, and to cleanse the walls and ceilings of 3, Causeway Court. He was ordered to do the work within 7 days, with 27s. costs. On 13th June, Day, of the firm of Jones, Son & Day, was summoned for failing to comply with Council's notice to repair defective flooring, and to to cleanse the walls and ceilings of 4, Causeway Court. He was ordered to do the work within 7 days, with 27s. costs. On 13th June, Day, of the firm of Jones, Son & Day, was summoned for failing to comply with Council's notice to repair the defective drain, flooring and pavement of 7, Causeway Court. He was ordered to do the work within 7 days, with 27s. costs. On 13th June, Day, of the firm of Jones, Son & Day, was summoned for failing to comply with Council's notice to provide a proper sanitary dustbin at 8, Causeway Court. He was fined 40s., with 42s. costs. On 22nd June, M. Horwitz was summoned for failing to comply with Council's notice to repair defective rainwater pipe and to cleanse the dirty walls and ceiling of the kitchen at 12, Venour Road. He was ordered to do the work within 7 days, with £2 8s. costs. On 29th June, N. Franks was summoned for failing to comply with the Council's notice to repair the defective roof of 6, Golding Terrace. The work having been done at the time of the hearing of the summons, he was fined 20s., with £2 4s. costs. On 29th June, N. Franks was summoned for failing to comply with the Council's notice to provide a door to the bedroom of 13, Golding Terrace. The work having been done at the time of the hearing of the summons, he was fined 20s., with £2 4s. costs. On 29th June, N. Franks was summoned for failing to comply with the Council's notice to repair the yard paving of 20, Golding Terrace. The work having been done at the time of the hearing of the summons, he was fined 5s., with 23s. costs. On 29th June, N. Franks was summoned for failing to comply with the Council's notice to repair the defective flooring of 31, Golding Terrace. The work having been done at the time of the hearing of the summons, he was fined 5s., with 23s. costs. On 29th June, A. J. Benabo was summoned for failing to comply with the Council's notice to repair the defective roof of 66, Christian Street. He was fined £1, with £2 4s. costs. 45 On 29th June, Mrs. Lolofsky was summoned for failing to comply with the Council's notice to repair the defective roof, sashlines and sash fasteners, and to cleanse the walls and ceilings of 54, Tredegar Square. She was ordered to do the work within 14 days, with 27s. costs. On 6th July, Leah Goodman was summoned for failing to comply with the Council's notice to repair the defective rainwater pipe of back addition, sashlines and sash fasteners, and washhouse roof, and also for failing to cleanse the walls and ceilings of 19, Maidman Street. She was ordered to do the work within 7 days, with £2 8s. costs. On 23rd July, Robert Nelson, of 81, Thomas Street, was summoned for not complying with the Magistrate's Closing Order, made on 6th November, 1922. He was fined £2 10s., or 21 days' imprisonment. On 24th August, David Galinsky was summoned for not providing a proper water supply to 83, Underwood Street. The water supply having been re-instated before the time of the hearing of the summons, the summons was withdrawn on payment of £1 1s. costs. On 24th August, David Galinsky was summoned for not providing a proper water supply to 85, Underwood Street. The water supply having been re-instated before the time of the hearing of the summons, the summons was withdrawn on payment of £1 1s. costs. On 7th September, C. C. Benabo & Sons were summoned for failing to remedy the defective roof and to cleanse and repair 36, Halley Street. The work having been done at the time of hearing of the summons, they were fined £2, with £2 2s. costs. On 14th September, William Smellie was summoned for failing to remedy the defective roof, etc., of 29, Bow Common Lane. The work having been done at the time of hearing of the summons, he was fined 10s., with £2 2s. costs. On 14th September, William Smellie was summoned for failing to remedy the defective drain of 33, Bow Common Lane. An order was made to do the necessary work within 14 days, with £2 8s. costs. On 14th September, William Smellie was summoned for failing to remedy the defective drain of 35, Bow Common Lane. An order was made to remedy the defective drain within 14 days, with £1 6s. costs. On 4th October, Dunn, Soman & Coverdale were summoned for failing to remedy the defective roof and flooring of 146, Cable Street. An order was made to do the work within 14 days, with £2 8s. costs. 46 On 11th October, A. & A. Field were summoned for failing to provide a proper sanitary dust receptacle at 3, Vine Court. They were fined 10s., with £2 2s. costs. On 18th October, Solomon Rymer was summoned for failing to remedy the defective roof of 13, Umberston Street. An order was made to do the necessary work within 7 days, with £2 8s. costs. On 18th October, Lawrence Smith was summoned for failing to remedy the defective stairs and doors, and to cleanse the walls and ceilings of 55, Cable Street. An order was made to do the work within 14 days, with £2 8s. costs. On 30th October, R. E. Lloyd was summoned for failing to remedy the defective roof of 95, Cephas Street. An order was made to do the work within 7 days, with £2 7s. costs. On 31st October, R. E. Lloyd was summoned for failing to remedy the defective roof and gutter, and to cleanse and repair dirty and dilapidated walls and ceilings of 25, Norfolk Street. An order was made to do the work within 14 days, with £2 8s. costs. On 1st November, Anne Joseph was summoned for failing to remedy defective flooring, sashes and stairs of 148, Commercial Road. An order was made to do the work within 14 days, with £2 8s. costs. On 1st November, G. Crang was summoned for failing to remedy the defective roof and door, and to cleanse the walls and ceilings of 79, Cable Street. The work having been done at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. On 5th November, A. Goodrich was summoned for failing to remedy the defective drain at 79, Ben Jonson Road. An order was made to do the work within 14 days, with £2 8s. costs. On 15th November, Franks & Simons were summoned for failing to remedy the defective yard paving, rainwater pipe and w.c. fittings of 14, Mayfields Buildings. An order was made to do the work within 14 days, with £2 8s. costs. On 15th November, M. Barnett was summoned for failing to remedy the defective roof of 24, Cable Street. The work having been done at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. 47 On 16th November, Robert Nelson, of 81, Thomas Street, was summoned for failing to quit the premises after a closing order had been made. The summons was adjourned sine die. On 11th December, David Galinsky was summoned for failing to remedy the defective roof of 62, Pelham Street. He was ordered to do the work within 14 days, with £2 7s. costs. On 11th December, David Galinsky was summoned for failing to remedy the defective roof of 66, Pelham Street. He was ordered to do the work within 14 days, with £2 7s. costs. On 11th December, David Galinsky was summoned for failing to remedy the defective roof of 68, Pelham Street. He was ordered to do the work within 14 days, with £1 6s. costs. On 12th December, W. H. Hamilton & Son were summoned for failing to remedy the defective roof of 59, Carr Street. The work being in hand at the time of the hearing of the summons, they were ordered to complete it within 7 days, with £2 8s. costs. On 17th December, C. C. Benabo & Sons were summoned for failing to remedy the defective drain of 61, Elsa Street. The work having been done at the time of the hearing of the summons, the summons was withdrawn on payment of £2 4s. costs. On 17th December, Samuel Winterman was summoned for failing to remedy the defective drain of 151, Jubilee Street. He was ordered to do the work within 14 days, with £2 8s. costs. II. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1908. On '27th February, Morris Warchawsky was summoned for keeping toffee, intended for sale, at 107, New Road, under dirty conditions on 2nd February. He was fined 10s., with £1 1s. costs. On 27th February, Morris Warchawsky was summoned for keeping toffee, intended for sale, at 107, New Road, under dirty conditions on 14th February. He was fined 10s., with £1 1s. costs. III. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1922. On 2nd November, Solomon Levene, occupier of 83, Wellesley Street, was summoned for failing to strip, stop and cleanse walls and ceiling, and to cleanse the bed, bedding and bedstead in first floor back room and free them from vermin. He was fined £1, with £2 2s. costs. 48 On 9th November, Isaac Letchman, occupier of first floor front room at 19, Stepney Green, was summoned for failing to strip, stop and cleanse the walls and ceiling, and to cleanse the bed, bedding and bedstead, and free them from vermin. He was fined £1, with £2 4s. costs. IV. UNDER THE LONDON COUNTY COUNCIL BYE-LAWS. On 20th November, Wickens, Pease & Co., Ltd., were summoned for causing offensive matter to be conveyed through the Borough in improper receptacles on September 8th. They were fined £5, with £2 2s. costs. On 20th November, David Brooker was summoned for conveying offensive matter through the Borough during prohibited hours. He was fined £2. V. UNDER THE DAIRIES, COWSHEDS AND MILKSHOPS ORDER, 1885. On 20th April, Fanny Lazarus, of 5, Coborn Road, was summoned for failing to keep her milk utensils in a cleanly state. She was fined 10s., with 10s. 6d. costs. VI. UNDER HOUSING OF THE WORKING CLASSES ACT, 1903. On 16th November, Robert Nelson, of 81, Thomas Street, was summoned for failing to quit the premises after a closing order had been made. The Magistrate made an order for possession in 28 days. Total Fines and Costs. Fines. Costs. £ s. d. £ s. d. Under the Public Health (London Act) for various nuisances. 44 10 0 113 9 0 Under the L.C.C. Bye-Laws 7 0 0 2 2 0 L.C.C. (General Powers) Act, 1908 1 0 0 2 2 0 L.C.C. (General Powers) Act, 1922 2 0 0 4 6 0 Dairies, Cowsheds and Milkshops Orders - 10 0 - 10 6 Food and Drugs Acts 20 0 0 13 13 0 Butter and Margarine Acts 33 0 0 13 5 6 £108 0 0 £149 8 0 49 List of streets in which all the houses have been inspected as a result of house-to-house inspection during the year 1923. (a) Limehouse. Mr. Johnson. Agnes Street Notgrove Court Amoy Place Oak Lane Beccles Street Padstow Place Birchfield Street Parnham Street Bridge Terrace Pennon Cottages Bungay Street Ropemakers Fields Claydens Buildings Rose Lane Commercial Road St. Anne's Row The Cottages, Chivers Court St. Anne's Street Dalgleish Place Spenlow Street Dod Street Streatfield Street Garricks Buildings Tile Yard Grenade Street Trinidad Street Holker Place Waterloo Street Island Road West India Dock Road Lance Street White Hall Place Mill Place Willow Row New Alley Wilson Place New Alley Square Mr. Quaintrell. Anchor Street Heath Street Antill Terrace Hope Place Beards Place Mays Cottages Burtons Entry Neats Cottages Carr Place Old Church Road Charles Street Reform Place Dakin Street Repton Street Durham Row Taylors Place Eagle Place Troon Street Eltham Place Union Terrace Fair Street West Arbour Street Gold Street White Horse Street 50 Mr. Waterman. Beachcroft Buildings James Place Brook Street Medland Street Calcutta Street Sage Street Caroline Street Schoolhouse Lane Dellow Buildings Thirza Street Devonport Street Three Compasses Court Edward Manns Buildings Twine Court Heckford Street Warton Place Mr. Bottomley (Mr. Johnson's district;. Acland Street Selsey Street Burgess Street Walker Street Dora Street Wallwood Street Rhodeswell Road (b) Mile End. Mr. Crook. Bromhead Road Harlow Place Cameron Place Horsley Buildings Cannon Place Jamaica Street Charles Street John's Place Commercial Mansions, Fordham Jubilee Street Street Sidney Square Dempsey Street Storer's Buildings Fieldgate Mansions Turner Houses, Nelson Street Gateshead Place Winwood Street Gray Street Wolsey Street Greenwood Street Mr. Pavitt. Assembly Passage Hayfield Place Braintree Street Key Street Cambridge Mansions Louisa Gardens Cressy Houses Louisa Street Cressy Place Smiths Place Doveton Street Stayners Road Dunstans Houses Stepney Green Buildings Eagle Cottages Terrace Place Entick Street Tillotson Street Essex Street Wellesley Street Faith Street Willow Street Hardys Place XX Place 51 Mr. Harris (Mr. Crook's district). Clark Street Railway Place Hadleigh Street Rutland Street Hawkins Street Sceptre Street James Street Varden Street Lindley Street Wickford Street Nelson Street (odd Nos.) Williams Buildings Mr. Simpson. Alderney Place Jewell Street Bude Place, Globe Road Lomas Buildings Cadiz Street Mays Buildings Dongola Street Mile End Buildings Drivers Buildings Monteagle Street Duckett Street Mile End Place Ernest Street Ocean Place Ferriers Court, Globe Road Shandy Street Goveys Place, Mile End Road Skidmore Street Grebe Court Waley Street Harford Street White Horse Lane (East Side) Mr. Bottomley (Mr. Simpson's district). Bridge Street Little Bridge Street Commodore Street Monsey Street Elizabeth Cottages Single Place Emmott Street (remainder of, part Victoria Building Emmott Street was done in 1922) Mr. Twynham (Mr. Simpson's district). Eaton Place Floreston Street Ely Terrace Trafalgar Square Calverley Street Mr. Twaits. Alma Road Rhodeswell Road Bow Common Lane Robeson Street Bridge Street Rowsell Street Canal Road (part of) St. Pauls Road Coutts Road Single Street Hall Street Wilson Street Mossford Street 52 (c) St. George's. Mr. Dee. Boarded Entry Pennington Street Bostock Street Plough Alley Breezers Hill Prusom Street (part) Bushell Street Prusom Street Buildings Chandler Street Queeus Head Alley Chigwell Hill Raymond Street Choppins Court Red Lion Court Clegg Street Red Lion Street Cuttle Place Redmead Lane Dundee Street Rygate Street Greenbank St. George Street (South Side) Hilliards Court Sampsons Gardens John's Court Seven Star Alley Juniper Court Ship Street Lavender Place Taylors Rents Lowder Street Twenty-nine-and-a-half Court Mary Place Watts Street Meeting House Alley Whitethorn Court Old Gravel Lane (part) Worcester Court Pennington Place Worcester Street Mr. Stiles. Amazon Street Golding Terrace Beatrice House, Phillip Street Grove Street Bcrneys Buildings, Grove Street Hogarth Houses Berneys Buildings, Burslem Street Lilian House, Phillip Street Burslem Street London Terrace Challis Court Muriel Houses, Phillip Street Doris House, Phillip Street Norfolk Buildings Durer Place Normans Buildings Ellen Houses Splidts Street Felix Houses Turners Buildings Ficklin Buildings, Burslem Street Wellington Buildings Globe Court Western Passage 53 Mr. Flint. Barnett Street Sly Street Brownings Court Swedenborg Street Mayfields Buildings Tait Street Mertons Court Upper Chapman Street Neptune Street Virginia Place North East Passage Walburgh Place Prospect Place Well Street Russell Court Mr. Whitd. Dunch Street Star Place Fenton Street Station Place Hungerford Street Tarling Street (partly done) Lower Fenton Street Whites Gardens Martha Street Winterton Street (partly done) Shadwell Place (d) Whitechapel. Mr. Cook. Albert Cottages Lytton House Albert Street Osborne House Bulwer House Pelham House Buttress Street Pelham Street, Nos. 37 to 145, and Clinton House 50 to 98 Durward Street Pelham Street Buildings Hobsons Cottages Selby Street Hobsons Place Spring Gardens Hunton Court Victoria Cottages Hunton Street Weaver Street Mr. Wrack. Adler Street Katherine Buildings, Cartwright Albert Buildings, Cartwright Street Street Plough Street Buildings Aldgate East Chambers Rupert Mansions Allan House, Plough Street Rupert Street Cable Street (part of) Sugar Loaf Court Chamber Street Tenter Buildings, St. Marks Street Fieldgate Street (part of) Union Mansions, Alder Street Gowers Walk Victoria Buildings, Cartwright Great Eastern Buildings, Street Fieldgate Street Webbs Place Greenfield Street (part of) White Hart Court Griggs Court 54 Mr. Shepherd. Artillery Passage Fleur-de-lis Street Blossom Place Fort Street Brunswick Buildings Nantes Place Castle Court Newcastle Place Cobb Street Newcastle Street Davis Mansions, New Goulston Old Castle Street Street Rosetta Place Duval Street Sandys Row Eastmans Court Wentworth Court, East and West Elder Court Wentworth Street Buildings Elder Street Whites Row Emery's Place Mr. Mills. Black Lion Yard Old Montague Street (Nos. 1 to 69) Boundary Court Pelham Street Casson Place Ramah Place Chicksand Place Ruth House, Flower and Dean College Buildings, Wentworth Street Street St. George's House, Gunthorpe Ely Place Street Garden Place St. George's Residences, GunGodfrey House, Thrawl Street thorpe Street Gunthorpe Street Samuel Court Helena House, Lolesworth Street Saul Street Henderson House, Wentworth Spelman Court Street Spencer House, Lolesworth Street Irene House, Flower and Dean Spital Street (West side) Street Strafford House, Wentworth Street Josephine House, Thrawl Street Thrawl Street Keate House, Lolesworth Street Wentworth Street Luntley Place Winifred House, Thrawl Street Masons Court 55 Housing- Conditions—Statistics, 1923. Ministry of Health Table. 1.—General. (1) Estimated population 253,850 (2) General death-rate 11.4 per 1,000 (3) Death-rate from tuberculosis 1.04 per 1,000 (4) Infantile mortality 62 per 1,000 (5) Number of dwelling-houses of all classes 31,692 (6) Number of working-class dwelling-houses 31,692 (7) Number of new working-class houses erected 51 2.—Unfit Dwelling Houses. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 24,183 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 10,891 (3) Number of dwelling-houses found to be in a state dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 14,802 II.—Remedy of Defects without service of formal notices. Number of defective dwelling-houses rendered lit in consequence of informal action by the Local Authority or their Officers 7,452 III.—Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 8 (2) Number of dwelling-houses which were rendered fit: — (a) By owners 5 (b) By Local Authority in default of owners 3 56 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close— (£) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 7,350 (2) Number of dwelling-houses in which defects were remedied : — (a) By owners7,350 (b) By Local Authority in default of owners — (c) Proceedings 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 renderedfit- (4) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — 3.—Unhealthy Areas. Areas represented to the Local Authorities with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890: — (1) Name of area — (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 - 6.—Staff engaged on Housing work with briefly, the duties of each Officer- No special Inspectors engaged, but 17 district inspectors proceed from time to time under the H. & T. P. Acts. 57 London County Council Table. Premises. No. on register at end of 1923. Number of inspections. Number of prosecutions. Cowsheds 24 63 - Milkshops 442 1,403 1 Houses let in lodgings 2,645 3,398 — Ice cream premises 231 420 — Slaughterhouses 1 5 — Offensive trades 6 25 - Smoke Nuisances. No. of observations - 312 No. of nuisances and complaints - 57 No. of notices—Intimations - 33 No. of summonses - 2 Statutory - 11 No of convictions obtained - 2 Amount of penalties and costs imposed £10 fines £2 costs. 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 — 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 — 58 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 3 the Housing Act, 1919 - 8 No. of houses closed on notice by owner that they could not be made fit — Total number of houses in the No. of houses occupied by the borough31,692 working-classes - 31,692 No. of houses for the workingclasses :— (a) erected during year - 51 (b) in course of erection 136 flats Underground Rooms. No. illegally occupied - 17 No. closed or illegal occupation discontinued 15 Overcrowding. No. of rooms overcrowded - 86 No. remedied 85 Prosecutions 1 Cleansing. No. of adults cleansed 519 No. of rooms or premises No. of children cleansed 1,067 cleansed (verminous) - 1,460 Water Supply to Tenement Houses. Premises supplied 3 Prosecutions — Sale of Food. No. of premises used other No. of inspections- - 1,407 than ice cream premises, milk shops and cowsheds - 434 Disinfection Shelter. Persons accommodated - - 37 Ophthalmia Neonatorum Regulations. No. of notifications received during the year - from certified midwives - 2 59 Sanitary Officers. No. of Sanitary Inspectors (Whole time)—Male, 18. Female, — ,, „ (Part time)—Male, — Female, — No. of Health Visitors—Whole time, 11. Part time, — Factories and Workshops. The total number of workshops on the Register was 3,036; but this does not include factories, workplaces and out-workers' premises. 4,536 inspections to factories, workshops and workplaces revealed defects, which necessitated the service of 1,336 written notices. 56 of the notices referred to factories, 1,251 to workshops including workshops laundries, and 29 to workplaces other than out-workers' premises. Cleanliness.—423 notices were served to cleanse workshops. Ventilation.—The ventilation of 23 workshops was improved. Overcrowding.—Overcrowding was abated in 33 workshops. Sanitary Acconvnodation.—The sanitary accommodation was improved in 186 workshops by providing additional and suitable water-closets. 567 other nuisances were remedied in workshops. Out-workers' Premises.—627 inspections were made to out-workers' premises during the year; 60 premises were found to be insanitary, and 112 cases of notifiable infectious disease occurred therein. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—INSPECTIONS. Premises. (1) Number. Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories - (Including Factory Laundries) 605 56 ... Workshops (Including Workshop Laundries) 3,686 1,251 ... Workplaces (Other than Outworkers' premises) 245 29 ... Total 4,536 1,336 ... 60 2.—DEFECTS FOUND. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts.—* Want of cleanliness 423 423 ... ... Want of ventilation 23 23 ... ... Overcrowding 33 33 ... ... Want of drainage of floors 1 1 ... ... Other nuisances 566 566 ... ... Sanitary Accommodation insufficient 42 42 ... ... unsuitable or defective 134 134 ... ... not separate for sexes* 10 10 ... ... 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) 5 5 ... ... Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) 2 2 ... ... Total 1,239 1,239 ... ... *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 61 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS. SECTION 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made Prosecutions Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) Making, &c. 150 474 906 28 10 116 .. .. .. .. .. .. 108 .. .. (2) Cleaning and Washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Household linen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Curtains and furniture hangings .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. Electro plate .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. File making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur pulling (Furriers) .. .. .. 1 .. 4 .. .. .. .. .. .. 2 .. .. Cables and chains .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c. .. .. .. .. .. .. .. .. .. .... .. .. 1 .. .. Artificial flowers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sacks 4 .. 9 1 .. 3 .. .. .. .. .. .. .. .. .. Racquet and tennis balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper, &c., boxes, paper bags 6 139 1 .. 3 .. .. .. .. .. .. .. .. .. Brush making 2 .. 3 1 .. 2 .. .. .. .. .. .. 1 .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Stuffed toys 2 .. 5 .. .. .. .. .. .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chocolates and sweetmeats .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cosaques, Christmas crackers, Christmas stockings, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Textile weaving •• .. •• •• .. .. .. .. .. .. .. .. .. .. .. Total 166 476 1,064 32 10 128 •• •• .. .. .. .. 112 •• •• 62 4—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year 1923. (1) Number. (2) Bakehouses 157 Boot, Shoe and Slipper Making 141 Cabinet Making 138 Furriers 159 Hat and Cap Manufacturers 83 Miscellaneous 430 Laundries 19 Rag Sorting, etc. 59 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) 1,850 Total 3,036 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:- Failure to affix Abstract of the Factory and Workshop Acts (s. 133,; 1901) 2 Action taken in matters referred by H.M. Inspectoras remediable under the Public. Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H.M. Inspector 275 Reports (of action taken) sent to H.M. Inspector 243 Other 32 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 44 63 Cases of Infectious Disease notified during the Year, 1923. Metropolitan Borough of Stepney. Notifiable Disease. Number of Cases notified. Total Cases notified in each Locality. Total cases removed to Hospital At all Ages At Ages—Years. 1 2 3 4 Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Limehouse St. George's Mile End Whitechapel Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 510 17 216 215 47 14 1 ... 133 73 214 90 506 Erysipelas 133 3 8 16 14 34 33 25 23 35 42 33 29 Scarlet Fever 468 3 196 241 19 9 ... ... 68 83 169 148 464 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 21 ... 3 4 8 5 1 ... 3 2 7 9 21 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 15 ... ... ... 1 14 ... ... 1 4 4 6 12 Cerebro-spinal Meningitis 4 1 1 ... ... 1 1 ... ... 1 1 2 4 Poliomyelitis 3 1 2 ... ... ... ... ... 2 1 ... ... 3 Polioencephalitis 2 ... ... 2 ... ... ... ... 1 1 ... ... 2 Ophthalmia Neonatorum 39 39 ... ... ... ... ... ... 12 7 13 7 11 Pulmonary Tuberculosis 455 ... 5 38 95 198 103 16 83 73 175 124 302 Other forms of Tuberculosis 139 ... 34 53 22 22 6 2 34 25 58 22 91 Encephalitis Lethargica 9 ... ... 2 4 2 1 ... 2 1 4 2 6 Anthrax 1 ... ... ... ... ... 1 ... ... 1 ... ... 1 Total 1799 64 465 571 210 299 147 43 362 307 687 443 1452 64 Infant Mortality. Deaths from stated Causes at Various Ages under One Year of Age for the whole Borough during the Year 1923. Cause of Death Under 1 week 1-2 weeks. 2-3 weeks. 3 4 weeks. Total under 1 month. 13 months. 3-6 months. 6-9 months. 9-12 months Total Deaths under One Year All Causes. Certified ... ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 9 17 26 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... 2 2 3 7 Diarrhoea ... ... 1 2 8 11 27 11 12 64 Enteritis ... ... ... 1 1 ... ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... 1 ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 3 ... 1 1 5 Congenital Malformations 6 1 4 2 13 7 ... ... 1 21 Premature Birth 49 6 3 2 60 6 1 ... ... 67 Atropby, Debility & Marasmus 7 2 ... 2 11 19 11 5 1 47 Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Injury at Birth 9 ... 1 ... 10 ... ... ... ... 10 Erysipelas ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... 1 1 2 ... 4 Convulsions 4 3 1 ... 8 1 2 1 1 13 Gastritis ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 l ... 2 2 ... ... l 5 Pneumomia (all forms) 1 4 3 3 11 12 17 15 11 66 Suffocation, overlying 1 ... ... 1 2 2 1 ... ... 5 Other causes 5 ... ... ... 5 5 8 5 2 25 Influenza ... ... ... ... ... ... ... ... ... ... Total 86 17 14 13 130 69 71 51 51 372 65 Causes of, and Ages at Death during the Year, 1923. 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 ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... Measles 26 25 11 1 ... ... ... ... 63 Scarlet Fever ... 3 2 ... 1 ... ... ... 6 Whooping Cough 7 5 5 ... ... ... ... ... 17 Diphtheria and all deaths from Croup (except "spasmodic" "False" "stridulous" and "catarrhal") 1 5 13 7 2 ... ... ... 28 Influenza ... ... 1 2 1 4 11 15 34 Erysipelas ... ... ... ... ... ... 2 ... 2 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... Typhus Fever ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... Lead Poisoning ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) ... ... 1 6 49 108 82 19 265 Tuberculous Meningitis (Acute Hydrocephalus) 1 8 6 5 2 1 ... ... 23 Other Tuberculous Diseases 5 2 3 ... 5 5 6 2 28 Rheumatic Fever ... ... ... 1 ... ... ... ... 1 Cancer, malignant disease (Sarcoma, Rodent Ulcer, etc.) ... ... ... 2 3 43 159 113 320 Bronchitis 5 3 2 1 2 14 127 165 319 Broncho-Pneumonia 50 20 9 3 3 11 27 48 174 Pneumonia (all other forms) 16 7 8 3 9 21 64 36 164 Other diseases of Respiratory Organs ... ... 2 1 ... 5 5 3 16 Diarrhoea and Enteritis (all deaths from Diarrhoea, except those secondary to some well defined disease) 65 10 ... ... ... ... ... ... 75 Appendicitis and Typhlitis ... ... ... 6 5 2 3 1 17 Alcoholism, Delirium Tremens, acute and chronic alcoholism (but not those from organic disease due to alcoholism) ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... 2 4 3 9 Nephritis and Bright's Disease ... ... ... 1 1 6 36 32 76 66 PUBLIC ANALYST'S REPORT. During the year 1,414 samples were submitted for analysis. Of these 1,398 were purchased by Inspectors under the Food and Drugs Acts, 14 samples were analysed for the Public Health Department, 1 sample was Submitted by the Borough Engineer, and 1 sample was examined for a private purchaser, The 1,398 samples taken under the Food and Drugs Acts consisted of 913 formal samples and 485 informal samples. Table A shows the nature of the samples taken under the Food and Drugs Acts and gives the numbers and percentages of adulteration. Table A. Number of Samples. Number Genuine. Number Adulterated. Percentage Adulterated. Milk 837 824 13 1.5 Sterilized Milk 1 1 — — Skimmed Milk 1 1 — — Margarine 180 180 — — Butter 141 137 4 2.8 Cream & Preserved Cream 22 18 4 1.8 Coffee 24 — — — Coffee and Chicory 1 1 — — Sausages 6 6 — — Pepper 7 6 1 14.2 Cake Flour 7 6 1 14.2 Sponge Cakes 13 13 — — Baking Powder 6 6 — — Ground Almonds 4 4 — — Arrowroot 4 4 — — Lard 6 6 — — Rice 6 6 — — Self Raising Flour 6 6 — — Cream of Tartar 6 6 — — Vinegar 8 8 — — Mustard 3 3 — — Tinned Tomatoes 1 1 — — Whisky 5 4 1 20.0 Prescriptions 14 14 — — 67 Table A.—Continued. Number of Samples. Number Genuine. Number Adulterated. Percentage Adulterated. Seidlitz Powders 8 8 - - Lime Water 13 12 1 7.7 Glauber's Salts 4 4 — — Boric Acid 6 6 — — Glycerine 7 5 2 28.5 Tincture of Iodine 9 9 — — Ammoniated Tincture of Quinine 4 4 - - Saffron 3 3 — — Zinc Ointment 3 3 — — Borax 4 4 — — Olive Oil 9 9 — — Camphorated Oil 12 12 — — Cod Liver Oil 3 3 — — Castor Oil 4 4 — — 1,398 1,371 27 1.9 The number of samples found to be adulterated was 27 or 1.9 per cent. Table B shows the number of samples analysed and the number found to be adulterated during the past nine 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 1923 1,398 27 1.9 The decrease in the percentage of adulteration in 1923 is very striking and the fact that adulteration in Stepney is on the decrease is well illustrated by the above figures. 68 Table C shows the distribution of the 1,398 samples, taken under the Food and Drugs Acts, amongst the four districts of Stepney, Table C. District. Number of Samples. Number Adulterated. Percentage Adulterated. Offences under Gutter and Margarine Acts. Mile End 444 6 1.3 22 Whitechapel 408 10 2.4 12 St. George's 293 3 1.0 5 Limehouse 253 8 3.1 5 1,398 27 1.9 44 Table D shows the number of samples taken by each Inspector, and gives particulars of offences and prosecutions. Table D. Inspector. Samples Taken. Number of Samples. Number of Prosecutions. Adulterated. Unlabeled. Food & Drugs Acts. Butter & Margarine Acts. Johnson 90 1 4 1 4 Quaintrell 95 1 2 1 1 Waterman 90 3 2 — 1 Twaits 93 1 6 — 1 Pavitt 124 3 6 3 4 Crook 60 — 1 — — Simpson 90 1 6 1 2 Stiles 62 1 — 1 — White 93 1 4 — — Flint 98 — 2 — 2 Wrack 93 3 — 1 — Mills 92 6 3 — 1 Cook 102 2 7 1 3 Shepherd 126 1 1 — — Dee 90 3 — — — Total 1,398 27 44 9 19 Legal Proceedings. Legal proceedings were taken in 28 cases. Details of the individual prosecutions are given later under the various headings. 69 Table E summarises the results and compares them with the results of proceedings during the years 1921 and 1922. Table E. Year. Number of Summonses. Total Fines. Total Costs. Average Fine. Average Total Penalty. £ s. d. £ s. d. £ s. d. £ s. d. 1923 9 Food and Drugs Acts 20 0 0 13 13 0 2 4 5 3 14 9 19 Butter and Margarine Acts 33 0 0 13 5 6 1 14 8 2 8 8 28 Total 53 0 0 26 18 6 1 17 10 - 19 2 1922 39 Food and Drugs Acts 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 4 8 0 28 Butter and Margarine Acts 21 2 6 26 6 6 - 15 1 1 13 11 67 Total 109 2 6 109 19 6 1 12 7 3 5 5 Compared with the two previous years the number of prosecutions during ]923 shows a very marked decrease. MilK. 837 samples of milk were analysed, of which 13, or 15 per cent., were adulterated. Table F shows the number of samples of milk examined and the percentage of adulteration during the last eight years. 70 Table F. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. Number of samples 868 850 739 737 665 858 824 838 837 Percentage of adulteration 15.0 11.6 12.4 16.0 8.6 5.7 4.5 3.1 1.5 These figures show the great improvement in the quality of the milk sold in Stepney during the last two or three years. The average composition of all the samples of milk analysed, for each month of the year, is shown in table G. Table G. Month. Numbered examined. Total Solids per cent. Solids-not fat per cent. Fat per cent. January 89 12.69 8.81 3.88 February 67 1248 8.77 3.71 March 82 1249 8.68 3.81 April 66 1244 8.70 3.74 May 66 12.45 8.79 3.66 June 73 12.29 8.73 3.56 July 86 12.25 8.68 3.57 September 76 12.36 8.65 3.71 October 89 12.72 8.72 4.00 November 73 12.50 8.78 3.71 December 70 12.7.2 8.83 3.89 Whole Year 837 12.49 8.74 3.75 Legal Minimum 11.50 8.50 3.00 No samples were taken during August. The figures are similar to those in the corresponding table of the report for 1922. The figures for the solids-not-fat are extremley steady, showing practically no seasonal variation. The figures for fat show the usual fall during the spring months and then an increase until the highest fat occurs in October. Table H gives particulars of the adulterated samples of milk. 71 Table H. Number. Deficient of Fat. per cent. Deficient of Solids-not-fat. per cent. Action taken or result of Proceedings, L 41 10 Fined £1 with £2 2s. costs. G 32 30 — Fined £3 E 66 20 20 Fined £10 with £2 2s. costs. S 78 — 3 Vendor cautioned. T 44 6 3 Vendor cautioned. M 27 — 4 Vendor cautioned. M 71 — 5 Vendor cautioned. C 69 — 4 Vendor cautioned. A 86 — 14 Summons withdrawn. B 78 — 13 Vendor paid £6 6s. costs. N 61 — 14 Dismissed. Warranty defence. H 47 10 Fined £5 with £2 2s. costs. D 52 6 - Vendor cautioned. Two 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 results of the proceedings were as follows:— E 4 Receptacle not properly inscribed. Fined £1 with £1 £s. costs. E 93 Receptacle not properly inscribed. Summons dismissed. The warranty defence was pleaded successfully in one case; while in the case of A 86, the summons was withdrawn by the Public Health Committee. Butter. 141 samples were examined of which 4 or 2.8 per cent. were returned as adulterated. J 90 (informal). Contained 1.8 per cent. excess moisture. Subsequent sample genuine. E 98 consisted of Margarine. Vendor fined £20 with £2 2s. costs. E 110 consisted of Margarine. Vendor fined £3 with £2 2s. costs M 78 (informal). Contained 1.6 per cent. excess moisture. Subsequent sample genuine. 72 The only preservative detected in butter was boric acid and the amount was estimated in each case. The results are shown in Table J. and are compared with the corresponding figures for 1921 and 19'22. Table J. Amount of Boric Acid per cent. Percentage of Samples, 1923. Percentage of Samples, 1922. Percentage of Samples, 1921. nil. 89.4 56 36 01 7.8 29 22 0..2 1.4 10 21 0.3 1.4 2 13 0.4 — 3 6 0.5 — — 2 under 0.25 98.5 95 79 The above figures show that the use of preservative in butter is decreasing. Margarine. 180 samples were examined and none were adulterated. The only preservative found, as in the case of butter, was boric acid The maximum amount permitted by law is 0.5 per cent. 4, or 2 per cent. of the samples were free from boric acid. 69, or 38 per cent. of the samples contained 0') per cent. boric acid. 75 ,, 42 „ ,, ,, 0.2 „ ,, 21 ,, 12 „ „ ,, 0.3 „ ,, 11 ,, 6 „ ,, ,, 0 .4 ,, ,, None contained 0'5 per cent boric acid. In 44 cases the vendors had not complied with the requirements of the Butter and Margarine Acts with regard to labelling. Thus 24.4 per cent of the samples were unsatisfactory in this respect. The figure, however, shows an improvement on previous years. During 1921, 28.4 per cent. of the samples did not comply with the labelling regulations, while 27.4 per cent was the figure for 1922. The 44 samples consisted of 9 informal and 35 formal samples. Proceedings were taken in 17 cases, and 18 vendors were cautioned for small infringements of the regulations. The results of the proceedings are shown in Table K. 73 Table K. Number. Offence. Action taken or result of proceedings. G 24 Improperly stamped wrapper Fined 7s. 6d. G 39 Unstamped wrapper Fined 10s. E 67 Improperly stamped wrapper Vendor paid £1 3s. costs. E 75 Improperly stamped wrapper Vendor paid £1 3s. costs. M 84 Unstamped wrapper Fined £1 C 53 Improperly stamped wrapper Fined £2 with £2 2s, costs. A 28 Improperly stamped wrapper Fined 10s. A 29 Improperly stamped wrapper Vendor paid £1 1s. costs. A 30 Improperly stamped wrapper Fined £ 1 with 10s. 6d. costs. Unlabelled bulk Fined £2 with 10s 6d. costs. B 65 Unstamped wrapper Fined 10s. N 20 Improperly stamped wrapper Vendor paid £1 1s. costs. N 98 Improperly stamped wrapper Fined 10s. with £1 1s. costs. N 99 Improperly stamped wrapper Fined 5s. with £1 1s. costs. D 42 Improperly stamped wrapper Fined 7s. 6d. with 10s. 6d. costs K 98 Improperly stamped wrapper Fined 10s. with 10s. costs. Unlabelled bulk Fined 10s. with 10s. costs. Cream and Preserved Cream 22 samples were submitted for analysis, of which 20 were sold as Preserved Cream and 2 as Cream. The 20 samples of Preserved Cream were satisfactory. Each contained more than the legal minimum of 35 per cent. of fat and each was labelled with a label stating the nature and amount of preservative present. Analysis showed that in no case did the amount exceed the legal minimum of 04 per cent. In three cases, printing on the carton in which the sample was supplied, described the contents as "Rich Cream" or "Thick Rich Cream" without the word "Preserved" accompanying the expression in letters of equal prominence. These samples were:— M 62 Described as "Thick Rich Cream." Subsequent sample to M 56 which was bought as Cream since it had no declaratory label. The Vendor was cautioned. C 49 Described as "Thick Rich Cream" and the can containing the Cream was not labelled in accordance with the regulations. The vendor was cautioned. C 50 Described as "Rich Cream." The vendor was cautioned. 74 Of the 2 samples sold as Cream, only one was fresh Cream without any preservative. The other sample, M 56, contained 0.1 per cent. boric acid. A subsequent sample was labelled. Pepper. 7 samples were taken, of which 1 was adulterated. The latter, L 1, was a subsequent sample to a sample submitted in 1922, which was found to contain 3 per cent. of foreign starch. Sample L 1 also contained 3 per cent foreign starch, and the vendor was cautioned. Lime Water. 13 samples were submitted for analysis, of which 12 were genuine. The remaining one, L 26, was deficient of 56 per cent. of Ca (OH)2. The subsequent formal sample was genuine. Glycerine. 7 samples were taken, of which 2 or 28.5 per cent. were adulterated. The particulars of these two are as follows:— T 47 Informal sample. Contained 5 per cent added water. T 84 Subsequent sample to T 47, contained 4½ per cent. added water The vendor was cautioned. Whisky One sample of Whisky was adulterated with 15 per cent. excess water. The vendor was cautioned. Cake Flour. 7 samples were taken, of which 1 or 14.2 per cent. was adulterated. The adulterated sample contained 56 grains per lb. excess Ca S04. It was an informal sample and the subsequent one proved to be genuine. Public Health (Milk and Cream) Regulations. 1. Milk and Cream not sold as preserved cream:— (a) No. of Samples (b) No. in which examined for preservative was preservative. reported to be present. Milk 837 0 Cream 2 1 2. Cream sold as preserved cream. (a) Correct statements made 20 Statements incorrect 0 Total 20 75 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:— Above 35 per cent. 20 Below 35 per cent 0 Total 20 (c) Instances where (apart from analysis) the requirements as to labelling cr declarations of preserved cream had not been observed:— (For instances see body of report.) Miscellaneous Samples. Private Purchaser.—Only 1 sample consisting of a Cream of Tartar substitute, was analysed for a private purchaser. Borough Engineer.—The 1 sample of disinfectant powder was examined for the Borough Engineer. Public Health Department.—14 samples were analysed for the Public Health Department consisting of:— Egg Yolk 2, Dried Milk 2, Tinned Salmon 2, Tinned Cabbage 2, Butter 2, Margarine 1, Lemonade 1, Acetic Acid 1, Butter and Margarine Mixture 1. 76 INDEX. A page Analyst's Report 66 to 75 Anthrax 13 B Bacteriological Examinations 11 Births 8 to 10 Birth, illegitimate 28 C Canal Boats Acts 38 & 39 Cancer 27 Cerebro-Spinal Fever 13 Clinics (Ante-natal) 31 Cowhouses 57 Creches, List of 31 D Deaths 10 & 1165, Diphtheria and Membranous Croup 12 Disinfecting Station 37 E Encephalitis Lethargica 13 Enteric Fever 12 Epidemic Diarrhoea 13 & 14 Erysipelas 13 F Factory and Workshops Acts 59 to 62 Fines and costs (total) 48 Finsen Light Treatment 26 Food and Drugs Acts, samples taken, proceedings, etc 66 to 75 Food and Drugs Act 1899, Registration of premises 38 G General Sanitary Work 39 & 40 H Health Visitors, visits, etc 32 Housing to House Inspection 49 to 54 Houses let in Lodgings 57 77 I Page Ice Cream Premises 57 Increase of Rent and Mortgage Interest (Restrictions) Act, 1923 38 Infant Welfare Centres, etc 30 & 31 Infantile Mortality 28 Infants, Feeding of 33 Infectious Diseases 11 to 17 & 63 Influenza 27 Inquests and post mortem examinations 37 M Malaria 26 Marriages 10 Maternity and Child Welfare Committee 1 Maternity and Child Welfare Scheme 29 & 30 Measles 14 & 15 Membranous Croup 12 Milk and Cream Regulations 74 & 75 Milk Distribution Scheme 33 Milk, Special Designations Order 38 Milkshops 57 Mortuary and Coroner's Court 37 Municipal Centres, work at 33 „ „ List of 30 N Notifiable Diseases 11 O Offensive Trades 57 Ophthalmia Neonatorum 13. Outworkers 59 & 61 P Phthisis, number of notifications and deaths 15 & 16 Pneumonia 26 Police Court Proceedings 41 to 48 Poliomyelitis 13 Population 7 & 8 Puerperal Fever 12 Public Health Committee 1 78 R Page Rats and Mice Destruction Act 39 Respiratory Diseases 26 S Sanitary Inspectors' Report Table facing 40 & 41 Scarlet Fever 12 Sewing Classes 29 & 33 Slaughter Houses 57 Small-pox 12 Staff of the Public Health Department 2 Statistics: — Housing Conditions—Ministry of Health Table 55 & 56 „ „ etc.—London County Council Table 57 to 59 Cases of Infectious Diseases notified during the year 63 Causes of, and ages at death, during the year 65 Infantile Mortality during the year 64 Form R.—Work carried out at the Tuberculosis Dispensaries 23 to 25 T Tuberculosis Other Forms, number of notifications and deaths 16 & 17 „ Dispensaries, Report on 17 to 25 „ „ List of 26 „ After Care 21 U Underground Rooms 40 Unsound Food destroyed 34 to 37 Y Verminous persons 38 Vital Statistics 55 & 63 to 65 Voluntary Centres, List of '30 & 31 W Whooping Cough 15 Workshops 59, 60 & 62 Wrong Diagnosis of Infectious Disease 11 Z Zymotic Diseases 15