Metropolitan Borough of Stepnen. ANNUAL REPORT For Ike Year 1928 BY D. L. THOMAS, M.R.C.S-, L.R.C.P., D.P.H., BARRISTER-AT-LAW Medical Officer ctf Health AND Adiministative Tuberculosis Officer. TOGETHER WITH THE REPORT OF THE PUBLIC ANALYST 78.932 VAil, & Co., 170, FsxriUgdon Road, Let, don, E.C.1 75 E ackd. 2/8/29 R.f. PUBLIC HEALTH COMMITTEE, (November, 1927, to October, 1928.) Chairman: Councillor D. Frankel. Vice-Chairman: Councillor J, Johnson. Alderman (Mrs.) E. Pritchard. Alderman (Mrs.) F. W. Reidy. Councillor | C. A. Baker | Councillor A. E. Magen. „ A. Conn. „ (Miss) M. Moses, J.P. „ C. Edser. ,, (Mrs.) M. M. E. Phillips, J.P. „ F. R. Ellis. „ J. W. Rosenthal, J.P. „ M. Gilbert. „ (Miss) I. Samuel, J.P. „ J. Hurley, J.P. ,, (Miss) K. Slattery. „ A. W, Jones. „ J. Sullivan. „ (Dr.) D. F. Kennard. ,, (Mrs.) A. Walsh. ,, T. Lane. MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1927, to October, 1928.) The Members ot the Public Health Committee, together with the following Members:— Mrs. C. Aylward. Mrs. G. Lawder. Mrs. L. Frankel. Mrs. E. E. S. Markham. Mrs. F. E. Grenfell Mrs. A. Model. Mrs. M. Groves. Mrs. J. O'Brien. Mrs. H. S. Jones. Miss B. M. Page. Chairman: Alderman (Mrs.) E. Pritchard. Vice-Chairman: Councillor (Mrs.) A. Walsh. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and Administrative Tuberculosis Officer: D. L. Thomas, m.r.c.s., d.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: I). Henville, f.i.C. Analytical Assistant: W. M. Paulley. Food Inspector: H. Abson. Sanitary Inspectors: G. Bottomley. C. F. Guy. W. F. Smith A. C. Brown. H. O. Harris. S. H. V. Trimming. T. W. Dee. j. G. McCarthy j. Twaits. E. J. Edwards. G. O. Pavitt. W. T. Twynham. E W. Flint. W. Shepherd. R. H. Waterman. H. J. Green. R. Simpson. Healtii Visitors: e. Addis. n. w. Dudfield. D. Michell. e. Clements. S. Foucar. I. Virtue. Ak M. Cordweld. A. E. Gibbs. H. A. Whitty. M. Davis. E. Goodfeddow. Clerical Staff: W. F. Lellow, Chief Clerk. R. Bach. W. P. Howard. C. H. Lowry (temporary) G. Boulton (M. & C. W.) H. T. Kightley. D. Tapolski. R. Day. j. McMullon. S. Vogler. S. Embleton. M. Pliskin. Temporary Clerks engaged at the Maternity Centres and in the distribution of milk L. Hannington, H. Hiles, M. W. Hunt, E. Worsell. Senior Tuberculosis Officer: W. E. Goss, m.b., Ch.b. (Ed.) • Tuberculosis Officer: A. Ferguson, m.b., b.s. (Lond.),d.p.h. Tubercidosis Officer; T. S. Gibson, m.r.c.s., d.r.c.p. Nurses: E. P. Codledge. M. Prickman. H. M. Tayder. M. F. Weatherilt Nurse Dispensers: M. Coulman. A. O. Jones. Dispenser: A. Wager. Clerk and Secretary to Care Committee: M. Grant. REPORT of the MEDICAL OFFICER OF HEALTH for the metropolitan borough of stepney FOR THE YEAR 1928. Public Health Department, 43, White Horse Street, July, 1929. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to present to you my twenty-eigth Annual Report upon the Vital Statistics and Sanitary condition of the Borough for the year 1928. Population. The resident population of the Borough of Stepney for 1928 is estimated by the Registrar-General to be 244,000, which is 7,580 less than in the previous year and 5,338 less than in the Census year of 1921. This estimate does not make, in my opinion sufficient allowance for local conditions, and is much less, therefore, than the actual population. In the Census of 1921 the population was 249,738, and the RegistrarGeneral estimated that in 1927 it was 251,580—an increase of 1,842 in six years;—practically it remained stationary. Yet from the middle of 1927 to the middle of 1928 it is estimated that it had decreased by 7,580. It is true that many families have left the district for Becontree, but this emigration has been going on for several years and is not limited to 1928. On the other hand it must be remembered that there has been a natural increase in the population, of 15,510 more births than deaths since the census of 1921. Overcrowding was worse in 1928 than in any previous year, and in most cases it was impossible to abate it. 331 houses and flats were built on unoccupied ground in Milk Yard, Brunton Place and other places in 1928. 4 For these reasons, I believe the estimated population is much less than the actual population and therefore the birth rate and death rate are lower than that recorded in the following pages. Births. The total number of births during the year was 4,577—2,314 males and 2,263 females—or 16 more than in the previous year. The birth-rate was 18.7 per 1,000 of the population, while that for the whole of London was 15.9 per 1,000. 1,228 of the births belonged to the Limehouse District, or at the rate of 24.1 per 1,000 of the population. 814 of the births belonged to St. George-in-the-East, or at the rate of 20.6 per 1,000 of the population. 1,802 of the births belonged to Mile End Old Town, or at the rate of 17.7 per 1,000 of the population. 733 of the births belonged to the Whitechapel district, or at the rate of 13.9 per 1,000 of the population. The total number of births and the birth-rate have been declining year by year until this year, when the number is slightly higher. The increase was slight in the Limehouse district, but more pronounced in St. George-in-the-East and the Whitechapel district. The number of births was less in Mile End than in the previous year. Births in Public Institutions in the Borough. 1,258 births occurred in the East End Maternity Hospital, Commercial Road:— 196 belonged to Mile End Old Town. 276 belonged to the Limehouse District. 33 belonged to the Whitechapel District. 85 belonged to St. George-in-the-East. 668 belonged to outlying Districts. 649 births occurred in the London Hospital:— 126 belonged to Mile End Old Town. 48 belonged to St. George-in-the-East. 5 36 belonged to the Limehouse District. 65 belonged to the Whitechapel District. 374 belonged to outlying Districts. 284 births occurred in the St. George's Hospital (3, Raine Street):— 200 belonged to St. George-in-the-East. 61 belonged to the Limehouse District. 4 belonged to Mile End Old Town. 19 belonged to the Whitechapel District. 361 births occurred in the Mile End Hospital, Bancroft Road :— 290 belonged to Mile End Old Town. 62 belonged to the Limehouse District. 3 belonged to the Whitechapel District. 6 belonged to outlying Districts. Ill births occurred in the St. Peter's Hospital, Vallance Road:— 85 belonged to the Whitechapel District. 14 belonged to Mile End Old Town. 1 belonged to St. George-in-the-East. 11 belonged to outlying Districts. 700 births occurred at 24, Underwood Street:— 189 belonged to Mile End Old Town. 162 belonged to the Whitechapel District 98 belonged to St. George-in-the-East. 9 belonged to the Limehouse District. 242 belonged to outlying Districts. Births occurring outside the district, the parents being residents of the Borough. 61 births occurred at the City of London Lying-in Hospital, 102, City Road. Of these:— 1 belonged to Limehouse. 11 belonged to St. George's. 20 belonged to Mile End. 29 belonged to Whitechapel. 2 births occurred at the Queen Charlotte's Hospital:— 1 belonged to Whitechapel. 1 belonged to Mile End. 6 30 births occurred at the Mothers' Hospital, Clapton:— 22 belonged to Mile End. 8 belonged to Whitechapel. 22 births occurred at 2, Oueensdown Road, Hackney:— 4 belonged to St. George's. 10 belonged to Mile End. 8 belonged to Whitechapel. 15 births occurred at the Royal Free Hospital:— 2 belonged to Mile End. 10 belonged to Whitechapel. 3 belonged to St. George's. 1 birth occurred at the Middlesex Hospital which belonged to Mile End. 5 births occurred at 18, Thavies' Inn, Holborn, all belonged to Whitechapel. 5 births occurred at St. Bartholomew's Hospital, 2 belonged to Mile End and 3 to Whitechapel. 10 births occurred at Queen Mary's Hospital, Stratford:— 7 belonged to Mile End. 3 belonged to Limehouse. 3 births occurred at Charing Cross Hospital:— 1 belonged to Mile End. 2 belonged to Limehouse. 4 births occurred at 13, Tomlin's Grove, Hackney. 3 belonged to Mile End and 1 to St. George's. 6 births occurred at 4, Navarino Road, Stoke Newington:— 4 belonged to Mile End. 1 belonged to Whitechapel. 1 belonged to St. George's. 4 births occurred at All Saints' Maternity Hospital, Poplar:— All belonged to Limehouse. 1 birth occurred at St. Mary's Hospital which belonged to St. George's. 1 „ „ „ Guy's „ „ „ Whitechapel. 2 „ „ „ King's College Hosp., both belonged to Mile End. 7 1 birth occurred at the Royal Northern Hosp., which belonged to Whitechapel. 1 birth occurred at the University College Hosp., which belonged to Whitechapel. 2 births occurred at 65, Lauriston Road, both belonged to Mile End. 1 birth occurred at the Sussex Maternity Hospital, Brighton, which belonged to Mile End. 2 births occurred at the Forest Gate Sick Home, one belonged to Mile End and one to Limehouse. 35 births occurred in private houses outside the Borough:— 7 belonged to Limehouse. 4 belonged to St. George's. 15 belonged to Mile End. 9 belonged to Whitechapel. Marriages. The total number of marriages which took place during the year was 2,236, or 97 more than in the previous year. The proportion of persons married was 18.3 per 1,000 of the population. Deaths. Number of deaths in Institutions within the Borough. Persons belonging to the Borough. Persons not belonging to the Borough. London Hospital 198 507 East London Hospital for Children 51 73 St. Peter's Hospital, Vallance Road 309 15 St. George's Hospital, Raine Street 389 9 Mile End Hospital, Bancroft Road 430 7 Stepney Institution, South Grove 69 3 East End Maternity Hospital, Commercial Road 16 7 London Jewish Hospital, Stepney Green 55 32 Sick Room Help Society, 24, Underwood Street 6 12 Spanish ann Portuguese Hospital 1 - 8 Deaths of persons belonging to the Borough in various Institutions outside the Borough:— Name of Institution, Number of Deaths. Asylums. London County Mental Hospital, Cane Hill, Bexley 7 Colney Hatch 2 Horton, Epsom 8 Tooting Bee 27 „ „ „ „ West Park, Epsom 9 Brook House Mental Hospital, Upper Clapton 2 Fountain Mental Hospital 1 Leavesden Mental Hospital 4 West Ham Mental Hospital 2 Hospitals for Infectious Diseases. Brook Fever Hospital 14 Eastern Fever Hospital 30 Joyce Green Fever Hospital 3 Grove Fever Hospital 3 London Fever Hospital 1 North Eastern Fever Hospital 8 North Western Fever Hospital 1 Park Fever Hospital 14 South Eastern Fever Hospital 14 South Western Fever Hospital 2 General Hospital. Charing Cross Hospital 3 The German Hospital 8 Guy's Hospital 8 Kings College Hospital 1 Metropolitan Hospital, Kingsland Road 4 Middlesex Hospital 7 Royal Free Hospital 5 St. Bartholomew's Hospital 21 St. Thomas' Hospital 2 University College Hospital 1 Westminster Hospital 5 9 Special Hospitals. Brompton Chest Hospital 8 Cancer Hospital, Fulham Road l Central London Throat and Ear Hospital 1 Children's Hospital, Great Ormond Street 5 City of London Maternity Hospital 2 Hampstead General Hospital l Hospital for Women, Westminster 2 Infants' Hospital, Vincent Square 3 National Hospital, Queen Square 1 Poplar Hospital for Accidents 9 Queen's Hospital for Children, Bethnal Green 6 Queen's Hospital for Children, Chislehurst 1 Royal Hospital for Diseases of the Chest, City Road 1 Seamen's Hospital, Greenwich 7 Sanatorium, Colindale 3 Sanatorium, Grove Park 5 St. Marks Hospital, City Road 2 St. Peter's Hospital, Covent Garden 2 City of London Chest Hospital, Victoria Park 4 Other Institutions. Bethnal Green Infirmary 3 73a Devons Road 4 Downs Hospital, Sutton 4 Epileptic Colony, Edmonton 1 Friern Barnet Infirmary 29 Home and Hospital for Jewish Incurables, Tottenham 13 Hundred Acres, Epsom 4 King George Sanatorium, Bramshot 1 1a Manor Road, Ilford 12 Metropolitan Hospital, Caterham 1 Mile End Old Town Institution, Bromley 2 10 Mildmay Mission Hospital 1 Poplar Institution, High Street, Poplar 4 Prince of Wales's Hospital, Tottenham 1 2, Queensdown Road, Hackney 1 Queen Mary's Hospital, Carshalton 1 Queen Mary's Hospital, Wandsworth 1 St. Andrew's Hospital, Dollis Hill 1 St. Anthony's Hospital, Sutton 2 St. David's Home, Ealing 1 St. George's Home, Chelsea 2 St. Joseph's Hospice, Hackney 1 St. Luke's Hospital, Paddington 3 St. Margarets Hospital, St. Pancras 1 St. Pancras Home 1 1 a Shepherdess Walk, Shoreditch 1 West End Hospital, St. Pancras 1 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 2,868—1,539 males and 1,329 females—or 62 less than in the previous year. 637 of the deaths belonged to the Limehouse District, or at the rate of 12.5 per 1,000 of the population. 474 of the deaths belonged to St. George-in-the-East, or at the rate of 12.0 per 1,000 of the population. 1,092 of the deaths belonged to Mile End Old Town, or at the rate of 10.7 per 1,000 of the population. 665 of the deaths belonged to the Whitechapel District, or at the rate of 12.6 per 1,000 of the population. The death-rate for the whole Borough was 11.7 per 1,000 of the population, while that for the whole of London was 11.6 per 1,000. Notifiable Diseases. 2,784 notifications of infectious diseases were received, or 293 more than in the previous year:— 658 belonged to the Limehouse District, or at the rate of 12.9 per 1,000 of the population. 11 466 belonged to St. George-in-the-East, or at the rate of 11.8 per 1,000 of the population. 1,132 belonged to Mile End Old Town, or at the rate of 11.1 per 1,000 of the population. 528 belonged to the Whitechapel District, or at the rate of 10.4 per 1,000 of the population. 2,504 were removed for treatment to fever hospitals and infirmaries. Wrong Diagnosis. 231 cases of infectious disease removed to the Metropolitan Asylums Board Hospitals, 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. 104 of the cases were notified by private practitioners, 55 from the London Hospital, and 72 from other Public Institutions. This number referred to 98 cases of Scarlet Fever, 132 of Diphtheria, and 1 of Ophthalmia Neonatorum. Bacteriological Examinations. 1771 bacteriological examinations were made on behalf of the Public Health Department during the year. The specimens and the results were as follows:— Positive. Negative. Total. Swabs (for Diohtheria bacilli) 152 1604 1756 Blood (for Typhoid bacilli) 4 11 15 Small Pox. 4 cases of Small Pox were notified during the year. 1 belonged to Limehouse and 3 to Mile End. Scarlet Fever. 1324 cases were notified during the year, or 396 more than in the previous year:— 294 belonged to the Limehouse District, with 2 deaths. 238 belonged to St. George-in-the-East, with 1 death. 548 belonged to Mile End Old Town, with 1 death. 244 belonged to the Whitechapel District, with 1 death. 1313 were removed to fever hospitals. The death-rate for the whole Borough was .02 per 1,000 of the population; that for the whole of London was .02 per 1,000 12 Diphtheria 646 cases were notified during the year, or 122 less than in the previous year. 044 were removed to fever hospitals:— 101 belonged to the Limehouse District, with 8 deaths. 110 belonged to St. George-in-the-East, with 2 deaths. 238 belonged to Mile find Old Town, with 15 deaths. 107 belonged to the Whitechapel District, with 6 deaths. The death-rate for the whole Borough was .12 per 1,000, while that for the whole of London was -0!) per 1,000 of the population. Enteric Fever. 52 cases were notified during the year, or 20 more than in the previous year:— 4 belonged to the Limehouse District, with no deaths. 5 belonged to St. George-in-the-East, with no deaths. 34 belonged to Mile End Old Town, with 2 deaths. 9 belonged to the Whitechapel District, with 3 deaths. The death-rate for the whole Borough was .02 per 1,000, while that for the whole of London was .01 per 1,000 of the population. Enteric fever is a specific disease, infectious chiefly or entirely through the excretions. The incubation period is variable. As a rule it is about a fortnight but in exceptional cases it may be as short as 5 days or as long as 22 or 23 days. Generally, it is shorter in cases infected through the milk supply. The beginning of the disease is often very little marked. The patient feels ill, depressed, unfit for work; he may have a headache, pains in the limbs and back, loss of appetite, &c. These may come upon him so that he scarcely knows when they began, but not uncommonly he fixes a day on which he first felt ill. There may be diarrhoea in the first few days, sometimes there is constipation; he takes a purgative and the bowels continue loose. He may go about his work for a week before he lays up. The temperature is characteristic in the first 4 or 5 days: it goes up two degrees in the evening and down one degree in the morning, but it so often happens that the temperature is not taken, and if it is, it is not taken night and morning. 13 A rash does not always appear, but when it does it is usually from the sixth to the twelfth day. It consists of rose-pink spots, circular, slightly raised above the surface, generally on the abdomen and chest. They vary in number from half a dozen to 20 or 30. Diarrhoea is one of the characteristic symptoms, but is variable in duration and severity; but sometimes there is constipation throughout. The stools are of the colour of yellow ochre and are of a peculiarly offensive odour. The spleen generally is enlarged. There are few diseases more variable than Typhoid Fever. As a rule it lasts about three weeks, but sometimes it may last much longer. Enteric fever generally occurs in the autumn, but an outbreak occurred in Mile End during the months of February and March, which I was able to trace to the local milk supply, the milkman being a carrier. 12 cases occurred in February, 0 being children under 12 years of age, and 9 in March. All the patients drank milk. One of the patients was a nurse at the Mile End Hospital. As all the patients (with the exception of the nurse) had milk from the same dairy, I went to the dairyman's premises and examined each member of the family. All denied that they had been ill during the previous few months. The first difficulty that I met with, was that the father and son carried on a separate and distinct business at the address. That is, they bought their milk from a different wholesale firm, kept their receptacles apart, and each washed his own cans, &c., in the same building, and yet, customers of each, contracted Typhoid Fever. The son is married and lives away from the business premises. I called at his house and examined his wife and two children. One boy, aged looked pale and ill, and I was informed that he had been an in-patient at the Mile End Hospital from January 11th to February 3rd. I took a sample of his blood and submitted it to the Bacteriologist for a Widal test. I then went to the Mile End Hospital and saw Dr. Wilson, the Medical Superintendent. We inspected the boy's chart and history sheets, and his symptoms during the time he was an in-patient were certainly not inconsistent with those of Typhoid Fever. In fact, the District Medical Officer had called attention in his notes to a red spot which he had queried before he was admitted. On making enquiries I found that the Nurse who had contracted the Enteric Fever was engaged in a ward continuous to the one in which the boy was a patient, and the Medical Superintendent stated 14 it was probable that she would occasionally assist the nurse who nursed him. Dr. Wilson had made exhaustive enquiries as to the cause of infection of the nurse, but had not been able to trace it to a previous case. In view of the probability of her having come in contact with the boy, the mystery was cleared up. On the following day the Bacteriologist reported that the Widal Reaction was positive, 1 in 20. There is therefore no doubt in my mind that he had recently suffered from Typhoid Fever. The next question that arose was, whether he was the cause of the illness of the other customers, or was he infected like the others from some still undiscovered cause. I was informed that he was taken suddenly ill on January 4th, and taking into consideration the fact that he had a few spots on him on January 11th, I came to the conclusion that he was not the cause, although he had been at the dairy on many occasions previous to January 4th. He had not been there between January 4th and February 3rd, when some of the others were infected. In spite of the denial of the rest of the family, I had the blood examined of the dairyman, his wife, daughter and the assistant. The latter two gave negative results, but that of the dairyman was positive I in 25 and slight I in 50. Curiously enough, the blood of the dairyman's wife was positive for Paratyphoid B 1 in 25, and partial in 1 in 50. We had no cases of Paratyphoid fever. I have not the slightest doubt that the dairyman was the cause, probably an innocent cause, of the outbreak. His stools were examined bacteriologically and were found to be positive. The stools of the boy (the dairyman's grandson) gave negative results. The dairyman's wife admitted afterwards that her husband complained about three months previously of a severe headache and that he would like to take two or three days' rest, but did not do so. The dairyman was removed to the North Western Fever Hospital, and after he had been there a month the bacteriological examinations of his stools showed that he was an intestinal carrier of typhoid bacilli. The man's general condition was good, and he could not be kept in the hospital indefinitely. The only active measure of treatment which was likely to terminate his "carrier" state was an operation on the gall bladder. Rather than be operated upon at his age (63) the dairyman preferred to give up his trade and sell his business. A Notice was therefore served upon him under Section 19 of the Milk and Dairies Order, 1926, prohibiting him from handling vessels 15 used for containing milk, or in any way take part in the distribution or storage of milk. The dairyman complied with the Notice, and disposed of his business. Typhus Fever. 2 cases were notified. Both occurred in Whitechapel. L. G., aged 48 years, of Wilkes Street, was taken ill on Tuesday, April 24th, but continued at his work until Friday, April 27th. He returned home mid-day and took to his bed on April 28th. He was notified to be suffering from Pneumonia and was admitted to the St. Peter's Hospital on April 30th. He had a temperature reaching 103° for 4 or 5 days and then it became normal gradually. He was seen by the consultants of the hospital, in consultation with the resident medical officers. His blood was tested and the Wasserman reaction was strongly positive. Even after the temperature had become normal he was delirious, although not suffering from maniacal delirium that he had for a few days after he entered the hospital. A rash of petechial character appeared about May 4th. I was asked to see the patient on May 12th. At this time the temperature was normal and had been normal for several days. The rash had disappeared. The patient was still delirious and complained of intense headache. Blood was taken and examined by the Clinical Research Association; the Widal test was negative, but the Weil-Felix test was positive 1 in 100. I informed the Ministry of Health. A specimen of the blood was sent to the Ministry, which was positive 1 in 1,000. He was officially notified to be suffering from Typhus Fever by Dr. Randle of St. Peter's Hospital, on May 23rd. The patient was a tailor engaged in making ladies' dresses from new material. At one time he was engaged in dealing in second-hand clothing, but has not been engaged in this trade for two or three years. There were no secondhand rags or clothing on the premises. He had not been abroad and he showed no signs of vermin on admission to the hospital. He and his wife lived in one room in Wilkes Street. The room was not particularly dirty and there were no signs of vermin. On the ground floor one room was used as a furrier's workshop. No raw material was used, the skins being cleaned and dressed before they were delivered at the workshop. The occupier had been there for three or four months, the room being previously occupied as a bedroom by L. G. 16 On May 24th Mrs. G. and her daughter were taken to the Council's shelter where they received a bath and their clothing was disinfected in the steam disinfector. The premises were fumigated with sulphur and all the clothing was brought away and disinfected by steam. Mrs. G. returned home on May 25th and at this time she said that she was not feeling well and had a headache. On May 26th she felt worse and took to her bed. She complained of headache and the back of her neck felt stiff. She was admitted to the St. Peter's Hospital on May 30th, when she had a temperature of 102°. She had rhonchi in her chest, but there were no definite signs of pneumonia. On the 2nd May, after admission, her temperature reached 103*8°, but came down gradually after this. Blood was taken and sent to the Ministry of Health and was returned positive on Saturday, June 2nd, when she was notified and removed to the fever hospital. The daughter was again brought to the shelter and received another bath and her clothing disinfected. The premises were again fumigated and all the clothing disinfected. The place was closed and thoroughly done up before it was again reoccupied. No further cases occurred. Puerperal Fever. 13 cases of Puerperal Fever and 14 of Puerperal Pyrexia were notified during the year. 8 belonged to the Limehouse District, with no deaths. 4 belonged to St. George-in-the-East, with 2 deaths. 10 belonged to Mile End Old Town, with 1 death. 5 belonged to the Whitechapel District, with no deaths. 25 were removed to hospital. Erysipelas. 146 cases were notified, or 73 less than in the previous year. 20 belonged to the Limehouse District. 27 belonged to St. George-in-the-East. 58 belonged to Mile End Old Town. 32 belonged to the Whitechapel District. 69 were removed to hospitals. All the patients recovered. Pneumonia, Malaria and Dysentery Regulations. 378 cases of Pneumonia and 8 of Malaria were notified under these Regulations. 17 The cases occurred in the Districts as follows:— Limehouse. St. Georges. Mile End. Whitechapel. Pneumonia 91 76 121 90 Malaria 2 — — 2 Malaria (Induced) 2 — 1 1 Ophthalmia Neonatorum. 34 cases were notified, or 2 more than in the previous year. 10 belonged to the Limehouse District, 2 to St. George-in-the-East, 17 to Mile End Old Town, and 5 to the Whitechapel District. Total number of cases visited 34 „ „ treated at home 17 „ „ treated in hospital 17 Total No. of cases in which vision was impaired nil „ „ „ „ unimpaired 34 Total number of cases of total blindness nil Total number of deaths nil Polio-Myelitis and Polio-Encephalitis. 2 cases were notified, or 2 less than in the previous year. Both belonged to Mile End. Encephalitis Lethargica, 5 cases were notified, or 2 less than in the previous year. 2 belonged to the Limehouse District, I to St. George-in-the-East, 1 to Mile End Old Town, and 1 to the Whitechapel District. Cerebro-Spinal Fever or "Spotted" Fever. 5 cases were notified, or 1 more than in the previous year. 3 occurred in Mile End Old Town. 1 occurred in the St. George's District. I occurred in the Whitechapel District. Measles. The number of deaths from Measles was 92, or 82 more than in the previous year. 23 of the deaths were infants under one year of age. 35 belonged to the Limehouse District, or at the rate of .68 per 1,000 of the population. II belonged to St. George-in-the-East, or at the rate of .27 per 1,000 of the population. 18 30 belonged to Mile End Old Town, or at the rate of .29 per 1,000 of the population. 16 belonged to the Whitechapel District, or at the rate of .30 per 1,000 of the population. The death-rate for the whole Borough was .37 per 1,000. The death-rate for the whole of London was .30 per 1,000 of the population. Whooping Cough. The number of deaths from Whooping Cough was 25, or 18 less than in the previous year. 10 belonged to the Limehouse District, or at the rate of .19 per 1,000 of the population. 4 belonged to St. George-in-the-East, or at the rate of .10 per 1,000 of the population. 10 belonged to Mile End Old Town, or at the rate of .09 per 1,000 of the population. 1 belonged to the Whitechapel District, or at the rate of .01 per 1,000 of the population. The death-rate for the whole Borough was .10 per 1,000, and that for the whole of London was -09 per 1,000 of the population. Epidemic Diarrhœa. The number of deaths was 64, or 7 more than in the previous year. 20 belonged to the Limehouse District, or at the rate of .39 per 1,000 18 „ St. George-in-the East „ „ .45 „ 23 „ Mile End Old Town „ „ .22 „ 3 „ the Whitechapel District „ „ .05 „ The death-rate for the whole Borough was at the annual rate of .26 per 1,000. 57 of the deaths, or over 89 per cent., were those of infants under one year of age. Diseases of the Respiratory Organs. 651 deaths were due to diseases of the Respiratory Organs, or 45 less than in the previous year. 153 belonged to the Limehouse District, or at the rate of 3.0 per 1,000 126 „ St. George-in-the-East „ „ 3.1 „ 235 „ Mile End Old Town „ „ 2.3 „ 137 „ the Whitechapel District „ „ 2.6 „ 1 he death-rate for the whole Borough was 2.6 per 1,000 of the population. 19 Influenza. 23 deaths were due to Influenza, or 42 less than in the previous year. 5 belonged to the Limehouse District, or at the rate of .09 per 1,000 5 „ St. George-in-the-East „ „ .12 6 „ Mile End Old Town „ „ .05 7 „ the Whitechapel District „ „ .13 „ The death-rate for the whole Borough was at the rate of .09 per 1,000, and that for London as a whole was .13 per 1,000 of the population. Cancer. 310 deaths were due to Cancer, or 34 less than in the previous year. 62 belonged to the Limehouse District, or at the rate of 117 per 1,000 47 „ St. George-in-the-East „ „ 1.19 137 „ Mile End Old Town „ „ 1.35 „ 64 „ the Whitechapel District „ „ 1.21 „ The death-rate for the whole Borough was at the annual rate of 1.26 per 1,000 of the population. There has been a reduction in the number of deaths as compared with the previous year, but for some years the number has been steadily increasing. No. of Deaths. 1921 263 1922 274 1923 320 1924 301 1925 298 1926 307 1927 344 1928 310 Zymotic Diseases. The total deaths from diseases of a Zymotic character was 222, or 85 more than in the previous year. They include all deaths from Measles, Scarlet Fever, Whooping Cough, Diphtheria, Enteric Fever and Diarrhoea. 75 belonged to the Limehouse District, or at the rate of 1.47 per 1,000 36 „ St. George-in-the-East „ „ .91 81 „ Mile End Old Town „ „ .79 „ 30 „ the Whitechapel District „ „ .57 The death-rate for the whole Borough was .90 per 1,000 of the population. 20 Phthisis. 409 new cases were notified, or 6 less than in the previous year. Notification of new cases. Number of deaths from Phthisis. Death rate per 1,000. Limehouse District 89 62 1.21 St. George-in-the-East 55 39 .98 Mile End Old Town 170 94 .92 Whitechapel District 95 49 .93 Whole Borough 409 244 .99 Number of deaths from Consumption from 1918 to 1928:— Limehouse District. St. George's. Mile End. Whitechapel. Whole Borough 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 1924 57 44 102 69 272 1925 58 45 106 82 291 1926 50 37 88 64 239 1927 68 34 77 40 219 1928 62 39 94 49 244 Other Forms of Tuberculosis. 128 new cases were notified, or 13 more than in the previous year:— Notifications. Deaths. Death-rate per 1,000 Limehouse District 30 6 .11 St. George-in-the-East 23 5 .12 Mile End Old Town 48 17 .16 Whitechapel District 27 5 .09 Whole Borough 128 33 .13 Deaths from diseases of a 1 ubercular nature, other than Phthisis, from 1918 to 1928. Limehouse District. St. George's. Mile-End. Whitechapel Whole Borough. 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 1924 19 9 16 7 51 1925 13 15 13 12 53 1926 7 14 13 7 41 1927 10 11 13 5 39 1928 6 5 17 5 33 21 Of the 277 deaths certified to be due to Phthisis and all other forms of Tuberculosis:— Number dying unnotified 23 Poor Law 5 Other institutions 9 General practitioners 9 Number notified at death 32 Poor Law 21 Other institutions 6 General practitioners 5 Number notified within one month of death 35 Number notified within three months of death 26 Number notified within six months of death 19 Incidence in various trades:— Of the 537 new cases of Tuberculosis notified during the year:— 78 are of no occupation, 70 are engaged in tailoring, 63 are housewives, 35 are labourers, 12 are engaged in dressmaking, 8 are seamen, 8 are clerks, 8 are dock labourers, 9 are carmen, 9 are warehousemen 6 are dealers, 4 are engaged in charing, 5 are employed in factories 5 are engaged in boot-making, 5 deal in newspapers, 4 are porters, 3 are electrical engineers, 3 are hawkers, 3 are furriers, 3 are hairdressers, 3 are cabinet makers, and the remainder are engaged in miscellaneous occupations. 31 are children under 5 years, and 83 are between 5 and 15 years of age. Mortality from various trades:— Of the 277 deaths from tuberculosis that occurred during the year:— 25 were housewives, 18 were dock labourers, 11 were clerks, 36 were engaged in tailoring, 5 were carmen, 75 were of no occupation, 5 were seamen, 5 were engaged in bootmaking, 4 were hawkers, 4 were engaged in millinery, 3 were cigarette makers, 3 were stevedores, 3 were cabinet makers, 3 were waiters, and the remainder were engaged in miscellaneous occupations. 3911 cases of Tuberculosis remained on the Registers of Notifications on December 31st, 1928. pulmonary. non-pulmonary. Males. Females. Total. Males. Females. Total. 1,810 1,099 2,909 523 479 1,002 22 Form T.137. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1928, to the 29th December, 1928, in the area of the Metropolitan Borough of Stepney. Age-Periods Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. 0 to 1 l to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total all ages. Under 5 to 10 10 to 15 Total 0 to 15 Pulmonary: Males 1 7 7 6 21 25 53 36 18 32 9 245 293 — — 1 1 2 113 194 „ Females — 1 6 8 26 36 38 20 13 7 6 161 188 — - 2 2 2 40 112 Non-pulmonary: Males 2 16 25 5 6 7 7 6 2 2 - 78 82 — 3 — 3 4 9 33 „ Females 1 3 10 6 7 6 5 1 3 1 — 43 48 — 3 1 4 4 2 20 23 SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health or Chief (Administrative) Tuberculosis Officer during the period from the 1st January, 1928, to the 29th December, 1928, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912.* Age periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Cases. Pulmonary: Males - - - - - 1 4 4 2 4 — 15 „ Females — 1 — — — 2 1 3 — - 1 8 Non-Pulmonary: Males 1 3 — 1 2 - — 1 - — 1 9 „ „ Females — 3 - - - - - - - - - 3 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. No. of Cases. Pulmonary. Non-Pulmonary. Death Returns (i.e., from local Registrars, or transferable deaths from Registrar General) 14 9 ''Transfers" from other areas (other than transferable deaths) 9 3 Forms C & D (in respect of cases not previously known to the M.O.H.) - - Other Sources, e.g., posthumous notifications - - 24 Tuberculosis Dispensaries. The figures setting out the statement of the work of the three Tuberculosis Dispensaries will be found in the following pages. There is a gradual diminution in the number of patients suffering from active tuberculosis, which has been going on for some years. In the light of this satisfactory state of affairs, it is probable that the decrease will continue. This is particularly noticeable with respect to patients suffering from advanced disease. The number of advanced cases examined now is considerably less than in former years. With respect to the Open Air School at the back of 35, Stepney Green, it is satisfactory to note that the building which was obstructing the light and and air and also taking up much wanted space has now been removed. X-ray Reports. The Council's arrangement with the London Hospital for X-ray reports, has proved distinctly satisfactory. It is possible for the Tuberculosis Officers to go to the London Hospital and to see their own cases X-rayed. War Pensioners. The Table below shows that the number of war pensioners has decreased not as much as was anticipated in the last report. There have been several more new cases, but against this the numbers in attendance or under observation have decreased. New Cases. Cases in attendance during the year. Stepney Dispensary 3 25 Whitechapel Dispensary 2 29 St. George-in-the-East Dispensary 2 33 Institutional Treatment. It has been possible to obtain sanatorium treatment for many patients, but we are still faced with the old difficulty of dealing with the medium and advanced cases, so that they may have the best available treatment and at the same time be no danger to others. A few patients have been sent to Papworth Colony in Cambridgeshire, but the main difficulty is that patients require to be both physically and mentally adaptable to colonization. 25 (Memo. 37/T.: Table I.) Form T.53. Return showing the work of the Dispensaries during the year 1928:— Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults Children Adults. Children Adults. Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 134 104 16 7 8 2 10 16 142 106 26 23 (b) Doubtfully tuberculous — — — - — — — — 56 51 14 24 (c) Nun-tuberculous - - - - - - - — 110 128 90 68 B.—Contacts examined during the year:— (a) Definitely Tuberculous 5 14 7 6 1 1 2 2 6 15 9 8 (b) Doubtfully tuberculous - - - - - - — — 7 14 9 9 (c) Non-tuberculous - - - - - - - - 153 284 263 252 C.—Cases written off the Dispensary Register as (a) Cured 31 42 17 7 4 3 11 8 35 45 28 15 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) 326 465 379 359 D.— Number of Persons on Dispensary Register on December 31st (a) Diagnosis completed 789 522 86 83 28 20 79 60 817 542 165 143 (b) Diagnosis not completed - - - - - - - - 28 23 18 19 1. Number of persons on Dispensary Register on January 1st 1,771 2. Number of patients transferred from other areas and of "lost sight of" cases returned 39 3. Number of patients transferred to other areas and cases "lost sight of" 127 4. Died during the year 143 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 62 6. Number of attendances at the Dispensary (including contacts) 7,686 7. Number of attendances of non-pulmonary cases at Orthopaedic stations for treatment or supervision — 8. N umber of attendances, at General Hospitals or other Institutions approved for the purpos", of patients for (a) "Light" treatment 107 (b) Other special forms of treatment 79 9. Number of patients to whom Dental Treatment was given, at or in nection with the Dispensary 196 10. Number of consultations with medical practitioners:— (a) At Homes of Applicants 38 (b) Otherwise 271 11. Number of other visits by Tuberculosis Officers to Homes 288 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4,724 13. Number of (a) Specimens of sputum, &c., examined 1,128 (b) X-ray examinations made in connection with Dispensary work 34 14. Number of Insured Persons on Dispensary Register on the 31st December 803 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 555 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 7 (b) Form G.P. 36 4 1 Cured case came under observation. Memo, 37/T Table IV. Form T56. (a) PULMONARY TUBERCULOSIS. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensaries at the end of 1928, arranged according to the years in which the Patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. 1926. 1927 1928. Class T.B. minus. Class T.B. plus. Class T B minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Gr up 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Alive. Discharged as cured. Adults M. 4 - - - - - - - - - - - - - - F. 1 - - - - - - - - - - - - - - Children M. - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - Disease arrested. Adults M. 20 1 - - 1 9 - - - - 2 - - - - F. 8 3 1 — 4 8 — — - — 3 - - — — Children M, 5 - - - - 1 - - - - 1 - - - - F. 1 - - - - 1 - - - - - - - - - Disease not arrested. Adults M. 20 8 23 8 39 35 12 29 9 50 35 13 48 12 73 F. 5 6 14 5 25 26 4 18 5 27 34 10 31 5 46 Children M. 2 - - - - 4 - 1 - 1 - - - - - F. 4 — — - — 3 — 3 — 3 — — — — — Condition not ascertained during the year - - - - - - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register 18 4 15 3 22 6 1 10 - 11 5 1 - - 1 Dead. Adults M. 1 - 13 25 38 - 1 11 11 23 3 - 8 5 13 F. 2 — 11 7 18 l - 12 12 24 - — 2 5 7 Children M. - - - - - - - - - - - - 1 - 1 F. — - — — — 2 — 1 1 2 — — - 1 1 Totals 91 22 77 48 147 97 18 85 38 141 83 24 90 28 142 26 27 (b) NON-PULMONARY TUBERCULOSIS. Annual Return showing in summary form the condition of all Patients whose case records are in possession of the Dispensaries at the end of 1928, arranged according to the years in which the Patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. 1926. 1927 1928. Bones and Joints. Abdominal. Other Organs, Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Alive. Discharged as cured. Adults M. - - - - - - - - - - - - - - - F. - - - - - - - - 1 1 - - - - — Children M. 1 - - 1 2 - - - - - - - - - - F. - - - 2 2 - - - - - - - - - - Disease arrested. Adults M. 5 - - 2 7 2 - - - 2 - - - 1 1 F. 3 - - 2 5 1 1 - - 2 - - - - Children M. 4 1 - 1 6 3 1 - 7 11 1 1 - 3 5 F. 3 — — 2 5 1 - - 1 2 2 - 1 2 5 Disease not arrested. Adults M. 1 - - - 1 2 - 1 - 3 4 1 1 1 7 F. 1 - 1 — 2 2 - 1 1 4 1 1 - 1 3 Children M - - - - - 1 - 1 2 4 1 - 2 3 6 F. - - - - - 1 1 - 1 3 2 — 2 5 9 Transferred to Pulmonary - - - - - - - - - - - - - - - Condition not ascertained during the year - - - - - - - - - - - - - - - Lost sight of or otherwise removed from Dispensary Register - 1 - 2 3 - 1 - 2 3 - - - - - Dead Adults M. - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - Children M. 1 - - - 1 - - - - - - - - - - F. 1 - - - 1 - - - - - - - - - - Totals 20 2 1 12 35 13 4 3 15 35 11 3 6 16 36 28 Finsen Light Treatment and the Supply Pneumo-Thorax Refills. The Council pay for attendances of certain patients undergoing Finsen Light Treatment at the London Hospital and for the supply of PneumoThorax Refills to certain patients attending the Brompton Hospital and the City of London Hospital, Victoria Park. Finsen Light Treatment. No. of patients 6 No. of applications 11 No. of attendances 107 No. of attendances guaranteed 132 Pneumo-Thorax Refills. No. of patients 8 No. of refills supplied. 79 Employment of Tuberculosis Patients. The employment of tuberculous patients who had been in sanatoria was considered by the Committee on several occasions. The problem is similar to that of the unemployed generally, except that the patients who have been discharged from sanatoria are capable only of light work under suitable conditions, and their working capacity is seldom more than 50 per cent. of the normal worker. Their disability varies in degree from time to time, and their labour in consequence is often unreliable as well as inefficient. For these reasons the difficulty of obtaining work is greater than among healthy or strong persons who are unemployed. Many patients who are discharged from sanatoria are incapable of work or fit only for light work. Some deteriorate rapidly and soon become permanently disabled. As a general rule the consumptive worker who leaves his job to undergo treatment returns to it if he makes a good recovery. If his original occupation is a suitable one, and still open to him, it is not to his advantage to seek another occupation in the open air which may be more arduous, and where he is exposed to all weathers. It would also probably entail a diminution in his wages resulting in less nourishing food and an increase of worry. It is in those cases in which a patient's original occupation under his former employer is not open to him, or is not a suitable one, that the chief difficulty arises. The After Care Committees endeavour to find applicants suitable jobs. Large employers of labour are directors of public companies and their principal consideration is the success of their business and the interests 29 of the shareholders. Why should they, they ask, employ men with 50 per cent. capacity for work, when they can have their choice of strong and healthy men who are unemployed. I know of only five persons who have found such employment through the agency of the Stepney Tuberculosis Care Committees. This is partly due to the fact that they have no funds except from voluntary sources. The After Care Committees inaugurated a handicraft class at St. George's Dispensary. The class is held on Thursday afternoons, from 2.30 to 4.30. There are eighteen on the roll call, and an average of about twelve attend. All these patients have been to sanatoria and were unable or unfit to resume their own work. Several are ex-Service pensioners and live are female patients. Some are engaged in the manufacture of simple leather bags, etc., some on Raffia work, such as mats, and one is engaged in designing work such as flower designs on bowls and patterns of leather work. The teacher is paid by the London County Council and the class is affiliated to the Dalston Literary Institute. Friends of the patients, nurses and members of the Committee have up to the present bought all the articles manufactured. Tools and implements are bought out of the profits so that work can be carried on at their own home as well. A jumble sale realised £40, which formed the original capital. The Committee appreciated the work done by the Care Committee in this direction, but they were of opinion it should be extended. A subcommittee was appointed to go further into the matter. The Committee consulted the Tuberculosis Officers who were of the opinion that no scheme could be devised which was self-supporting among the type of Tuberculosis patients that the scheme would draw in this Borough. The amount of absenteeism would be so great that to be at all successful the scheme would require a sum which would be prohibitive, and they thought that the handicraft class should be given an extended trial. Dental Clinic. The Dental Clinic at 35, Stepney Green, for the treatment of tuberculous patients, expect and nursing mothers and children under school age, has continued its work on the same lines as in previous years. During the year a constant attendance of patients has been maintained. The total number of attendances recorded; is 376,—representing an average of a little over 7 per session. Of this number 196 have been expectant or nursing mothers, 56 children under school age and 124 tuberculous patients, 30 During the year the number of attendances for extractions has totalled 118, the number of teeth extracted reaching 459. The number of attendances for fillings being 27, and the number of fillings 30. The number of artificial dentures fitted during the year was 21. 190 patients were seen at the Dental Clinic during the year:— Maternity 112 Children 36 Tuberculous:—Women 33 Men 15 Of these, 81 were new patients: Maternity 41 Children 20 Tuberculous 20 Infantile Mortality. 325 infants died under one year of age, or 13 more than in the previous year. 84 belonged to the Limehouse District, or at the rate of 68 per 1,000 births. 57 belonged to the St. George-in-the-East District, or at the rate of 70 per 1,000 births. 120 belonged to the Mile End Old Town District, or at the rate of 69 per 1,000 births. 58 belonged to the Whitechapel District, or at the rate of 79 per 1,000 births. The infantile mortality for the whole Borough was 71 per 1,000 births, while that for the whole of London was 67 per 1,000. Maternal Mortality. The number of women dying in, or in consequence of childbirth, was 11, 3 being due to Puerperal Fever. This is equivalent to a rate of 2.4 per 1,000 births, which is higher than in the previous year. It is low compared with London as a whole, as well as for the whole of England and Wales. Notification of Births Acts. No. of births notified by Doctors 1,065 „ „ „ Midwives 3,406 „ „ „ Parents 16 No. of stillbirths notified. 145 No. of births notified by Institutions in the Borough belonging to Outlying Districts.. 1,179 No. of stillbirths ditto 52 No. of sets of twins notified 62 31 VISITS BY THE HEALTH VISITORS:— DISTRICT Mile End, S.W. St George's, North Limehouse, North Mile End, S.E Ratcliffe, Shadwell and Pt. of St. George's Mile End, North East Mile End, Central and Pt. of Limeh'se Wapping Whitcchapel and Spitalfields Limehouse, South Mile End North and Fart of Whitechapel • NAME E. Addis E. Clements A. M. Cordwell M. Davis N. W. Dudfield (4 months) S. Foucar A. E. Gibbs E. Goodlellow D. Mitchell I. Virtue H. A. Whitty Total Primary 673 350 365 424 567 125 412 189 351 362 316 4,134 Revisits:— To infants under 1 year 247 631 1,047 692 739 309 406 1,169 531 852 650 7,273 To children between 1-5 years 297 1,103 1,621 1,885 874 896 1,543 912 549 1,233 1,068 11,981 Ante-natal:— Primary 130 99 14 4 43 1 16 38 98 - 104 547 Subsequent 30 7 29 4 27 — 6 2 174 - 37 316 Miscellaneous 544 618 701 488 570 521 389 631 892 114 914 6,382 Total 1,921 2,808 3,777 3,497 2,820 1,852 2,772 2,941 2,595 2,561 3,089 30,633 CENTRES ATTENDED:— Municipal 56 143 145 - 110 39 47 159 90 187 136 1,112 Voluntary - - - 87 26 50 118 - 9 - - 290 Total 56 143 145 87 136 89 165 159 99 187 136 1,402 32 MUNICIPAL CENTRES. Limehouse (Mondays) Limehouse (Wednesdays) Mile End St. George's Spitalfields Wapping Whitechapel No. of sessions held 48 51 51 48 49 98 51 No. of attendances of infants 1,408 1,243 1,590 2,436 1,634 1,404 700 No. of attendances of children 1 -5 years of age 593 819 980 1,455 971 605 815 No. of Doctor's consultations 48 50 50 47 48 48 50 No. of Doctor's morning consultations on Thursdays 43 - — — - — — No. of new cases 123 - - - - — — No. of subsequent attendances 202 - — — - — — 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 granted. No. of persons Quantity Cost. £ s. d. Cows Milk— Free 2,682 3,735 13,093½ gals. 1,428 19 10 Half-price. 990 1,351 4,7421 „ 259 9 11 Dried Milk— Free 656 697 4,880 lbs. 367 17 4 Half-price. 246 259 1,898 „ 71 3 2 Virol, Oil and Malt— Free 190 204 206 lbs. 12 6 0 Half-price. 57 59 59 „ 1 13 2 Total 4,821 6,305 17,830 gals. 2,141 9 5 7,043 lbs. 33 Feeding of Infants:— Breast fed 3,818 Artificially fed 136 Mixed feeding 180 No. dead before first visit of Health Visitor 64 No. removed before first visit of Health Visitor 87 Convalescent Treatment. Convalescent treatment for nursing or expectant mothers and for children up to five years of age was provided in 108 cases during the year—44 mothers and 64 children. They were sent to either of the undermentioned homes for periods ranging from one week to two months, the average being two weeks. Home. No. of cases. Mothers. Children. John Madocks Home, Arkley. — 1 All Saints' Convalescent Home, Eastbourne 1 2 Invalid Children's Aid Association—Bexhill, Seaford and Beaconsfield - Church Army Convalescent Homes—Merrowcroft, Surrey, and St. Leonards. 19 28 St. Mary's Convalescent Home, Birchington 13 12 St. Mary's Convalescent Home, Dover 4 6 St. Edith's Convalescent Home, Leigh-on-Sea 7 10 Ministry of Health. Form M.C.W.96 MATERNITY AND CHILD WELFARE. STATISTICS FOR THE YEAR 1928. POPULATION according to the Census of 1921, 249,738. Births. Registered (Live Births only). (1) Legitimate 4,480 (2) Illegitimate 97 (3) Total 4,577 Notified within 36 hours of birth. (1) Live Births 4,487 (2) Still Births 145 (3) Total 4,632 (1) By Midwives 3,406 (2) By Parents and Doctors 1,081 Infant Deaths. Number (1) Legitimate 304 (2) Illegitimate 21 (3) Total 325 Rate per 1,000 births (1) Legitimate 67 (2) Illegitimate 216 (3) Total 71 34 Maternal Deaths. Number of Women dying in, or in consequence of, Childbirth - (a) From Sepsis, (b) Other causes (1) (County Councils) Whole administrative County — — (2) (All Maternity and Child Welfare Authorities) Maternity and Child Welfare Area 3 8 Midwives. Number practising in the District (1) Trained — (2) Untrained — Number of cases attended in 1928 — Number of cases in which medical aid was summoned — Number of maternal deaths notified in accordance with Rule E 22 (1) (b) of the Central Midwives Board — Health Visitors. Visits paid by Health Visitors during the year:— To Expectant Mothers (1) First Visits 547 (2) Total Visits 863 To Infants under 1 (1) First Visits 4,134 (2) Total Visits 11,407 To Children 1-5 Total Visits 11,981 Municipal Homes and Hospitals for Children Under 5. Number of beds — Number of Children under 5 received during the year—None. Total number of weeks spent in the Homes by such cases — Municipal Day Nurseries. Total number of attendances of Children under 5 during the year—None. Municipal centres and clinics. Address. Whether Sessions are held weekly, fortnightly, etc. Day and Time of Meeting Average Attendance per Session Number who Attended for the First Time Present arrangements for medical supervision Expectant Mothers Children Expectant Mothers Children Town Hall, Commercial Road, Limehouse 3 times per week Monday, 2-5 p.m. •• 41 •• 220 Dr. J. M. Browne Wedn'sy 2-5 p.m. .. 40 .. 161 Dr. N. Cotter Thurs. 10.30a.m 1 p.m. 4 •• 129 •• Dr. J. M. Browne 401 Mile End Road weekly Thurs. 2-5 p.m. •• 50 .. 143 Dr. N. Cotter Town Hall, Cable Street, St. George's do, Tues. 2-5 p.m. •• 81 •• 419 Dr. J. M. Browne 279 Whitechapel Road do. Thurs. 2-5 p.m. .. 53 • • 205 „ 52 Red Lion Street, Wapping do. Wedn'sy. 2-5 p.m. .. 40 • • 224 „ St. Philip's Institute, Newerk Street do. Wedn'sy. 1-4 p.m. •• 30 • • 100 „ 35 INFECTIOUS DISEASES. Number of cases notified Number of cases visited Arrangements made for nursing, and terms Number of cases nursed Number of cases removed to hospital Ophthalmia Neonatorum 34 34 East London Nursing Society 1/3 per visit 20 17 Puerperal Fever 13 12 .. 3 11 Puerperal Pyrexia 14 12 •• 3 14 Measles and German Measles (children under 5) not notifiable 2510 East London Nursing Society 1/3 per visit 107 456 Whooping Cough (do.) „ •• •• — — Epidemic Diarrhoea (do.) „ •• •• — — Poliomyelitis 2 2 •• — 2 List of Maternity and Child Welfare Centres, Ante-natal Clinics, Creches and Tuberculosis Dispensaries in Stepney:— When open Municipal Centres:— Limehouse Town Hall, Mondays 2 to 5. Commercial Road. Wednesdays 2 to 5. Thursdays 10.30 to 1 p.m. (women). Riverside Mansions, Mondays 10 to 12 noon. New Gravel Lane. Wednesdays 2.30 to 5. Fridays 10 to 12 noon. St. George's Town Hall, Tuesdays 11 to 12.30 and 2 to 5. Cable Street. Fridays 2 to 4 p.m. St. Phillip's House, Thursdays 2 to 5. 401, Mile End Road. Hughes Mansions, Tuesdays 2 to 6. Vallance Road. Thursdays 10 to 12.30 and 2 to 5] St. Philips' Institute, Wednesdays 2 to 5. Newark Street. Voluntary Centres:— Mission Hall, Carr Street. Friday afternoons. Stepney Infant Welfare Centre Mondays 10.30 to 12.30 (Light and Babies' Nursing Home, treatment). 587, Commercial Road. Monday afternoons. Thursdays 10 to 12 noon (Dental). Fridays 10.30 to 12 noon (Light treatment). Friday afternoons, 36 The Memorial Hall, Wednesday afternoons. High Street, Shadwell. Jewish Centre, Monday afternoon and 38, Betts Street. Wednesday afternoons. Congregational Buildings, Wednesday afternoons and Burdett Road. Thursday afternoons. Dame Colet House, Monday afternoons and 29, Duckett Street. Tuesday afternoons. Jewish Maternity Home, Mondays 10 to 1 (Dental) and 24, Underwood Street. afternoons (Sewing Class). Tuesday afternoons. Wednesday afternoons (Sewing Class). Thursday afternoons. Monday and Friday mornings, (Ante-natal). 12, St. Clare Street, Minories. Monday afternoons and Friday afternoons. Jewish Centre, Tuesday afternoons and Camperdown House, Wednesday afternoons. Half Moon Passage. 2nd Wednesday morning in each month (Ante-natal). Jewish Centre, Monday afternoons and East Stepney, Beaumont Hall, Thursdays 9.30 to 12 noon. Beaumont Square. Ante-Natal Clinics:— Limehouse Town Hall Thursdays 10.30 to 1 p.m. Commercial Road. (Municipal). London Hospital, Tuesdays 8.30 a.m. and Whitechapel Road. Wednesdays 8.30 a.m. East End Maternity Hospital Mondays 2 to 6. 396, Commercial Road. Wednesdays 9 to 1 p.m. Fridays 9 to 1 p.m. Jewish Maternity Home, Mondays and Fridays 11.30. 24, Underwood Street. Ailing Mothers' Clinic:— 587, Commercial Road Second Tuesday in each month at 10.30 a m. 37 Creches: — Day Nursery Memorial Hall, High Street, Shadwell. Jewish Day Nursery 23, New Road. Port of London Day Nursery. 5, Pier Head, Wapping. Marie Hilton Creche. Stepney Causeway. St. Paul's Day Nursery. Wellclose Square. Tuberculosis Dispensaries: — 35, Stepney Green. 18, Gt. Prescot Street. 208, High Street, Shadwell. Canal Boats Acts, 1877 and 1884. Pursuant to the Third Section of the Canal Boats Acts 1884, the Council, being the Registration Authority under the above Acts, has to report 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 received 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 during the year was 44. In only one instance was there any infringement of the Acts and Regulations, viz., Means of ventilation defective. These defects have since been remedied. No legal proceedings were taken. Three children of school age and four under school age were found on the boats. One of the children was born on the boat whilst lying in the Limehouse Cut. The mother was attended by Nurses from a local Maternity Home, One boy who was living on the boat with his father and who last year was reported to the Education Authorities, has now been placed in a school. There is now only one boat on the register. No boats were registered during the year. 38 Unsound Food. The following is a list and quantity of the Foodstuffs destroyed during the year under the Public Health (Imported Food) Regulations, 1925. 1. At the Wharves. Fresh Meat. Tons cwts. qrs. lbs 8 carcases of Mutton — 4 0 13 2 sides of Pork — — 1 27 1 cask of Scrap Meat — 5 0 13 Preserved Meats. 32,727 tins of Beef 49 2 2 12 32 „ Brawn. — 1 0 24 646 „ Tongues. 1 1 2 27 Preserved Fish. 10,025 tins of Crab 2 4 3 11 192 „ Crayfish. — 1 0 8 2,000 „ Herrings — 8 0 20 1,887 „ Lobster. — 8 1 16 3,306 „ Salmon 1 7 1 7 Fresh Fruit and Vegetables. 36 packages of Apricots. — 3 3 16 130 crates of Bananas 4 12 0 0 140 bags of Cabbages 5 6 0 0 30 „ Carrots. 1 10 0 0 2 crates of Grapes — — — 24 1 crate of Lettuce — — — 12 10 boxes of Oranges — 7 2 0 1 package of Peaches — — — 10 1 „ Pears — — — 10 87 packages of Plums — 8 0 4 1,002 „ Potatoes. 50 5 0 0 72 boxes of Tomatoes — 15 3 14 Preserved Fruit and Vegetables. 2,015 tins of Assorted Fruits 1 17 0 9 44 packages of Dried Apricots 1 13 0 18 149 „ Dates 5 14 3 11 39  tons cwts. qrs. lbs. 166 packages of Currants. 10 3 3 8 9 bags of Figs - 12 0 26 1,596 tins of Fruit Pulp 10 3 0 16 94 packages of Dried Peaches 1 8 0 3 1 package of Pears — — 1 22 9,592 tins of Pineapples 8 12 2 8 Prunes 4 5 2 23 Raisins 5 0 0 0 Sultanas. 3 3 1 8 1,440 tins of Tomatoes 1 13 0 24 Dried Peas 2 19 0 24 Sundries. 380 bags of Cocoa (in bean) 37 10 3 21 1 bag of Cocoa Powder. — — 2 2 6,172 tins of Assorted canned goods 4 19 2 24 18 bags of Butter Beans. — 16 1 22 Cornflour 5 16 3 8 Desiccated Cocoanut 3 8 1 5 Flour 5 0 2 0 Wheat — 15 2 15 Lentils — 3 0 0 Malt 1 16 2 8 Tapioca — 1 1 0 Pearl Barley 1 10 0 0 455 bags of Root Ginger 23 5 3 4 Oatmeal 4 1 0 0 Nuts 25 10 1 19 30 bags of Rice 2 18 1 14 985 „ Tea 53 17 0 21 20 boxes of Force Food — 1 1 0 8 „ Eggs — 8 2 8 Total 348 2 0 23 5,351 casks of Tallow, weighing 2,140 tons, 8 cwts, have been detatiled, the casks not being officially certificated, also 6,697 casks of Tallow, weighing 2,678 tons, 16 cwts., have been released for export or for manufacturing purposes. 40 54 casks of Scrap Meat, weighing 13 tons, 8 cwts., have been detained as Prohibited meat. 53 of the same were allowed to be exported to Hamburg and 1 cask was used for fat extraction to be used for soap making in this country. 148 carcases of Australian Sheep were detained, and after examination, 7 carcases were condemned for Caseous Lymphadenitis. 50 carcases of New Zealand Sheep were detained and after examination, all were passed as free from disease. II. At Bishopsgate Street Station, ex Zeebrugge-Harwich Train Ferry— tons cwts. qrs. lbs. 77 packages of Apricots. — 5 1 4 2 „ Grapes — — 1 12 58 „ Melons — 4 0 12 22 „ Peaches - 2 2 10 136 „ Pears 1 0 0 22 659 „ Plums 4 1 2 15 187 „ Tomatoes. 1 1 3 6 6 15 3 25 79 special midnight and early morning inspections were made by the Sanitary Inspectors. The total weight of fruit and vegetables examined at Bishopsgate Goods Station was 13,450 tons. This was of Belgian, Italian, French and Dutch origin. Eggs and Poultry of Belgian and Italian origin were examined at Spitalfields. Unsound food seized by, or surrendered to, the District Sanitary Inspectors:— Fish. tons cwts. qrs. lbs. Assorted — — - 75 Dabs — — 3 0 Dutch Herrings — 3 2 0 Flat Fish — 1 2 22 Haddock — 6 2 0 Kippers — - 3 20 41  tons cwts. qrs lbs. Pilchards in Tomato Soup. - — — 25 Plaice — 3 2 17 Salmon, Smoked — — — 5 Skate — — 1 8 Soles - — 3 0 Whiting — 1 2 0 Fruit. Bananas - 18 2 0 Figs — 5 2 0 Lemons 1 10 3 0 Oranges 9 3 0 0 Pears — — 2 0 Peach Pulp — 2 0 14 Pineapple — 5 3 0 Plums — — 2 24 Pears — — — 11 Spanish Nuts — — — 5 Tomatoes 1 2 0 0 Meat. Bacon. — — 3 6½ Beef — — — 16 Beef, Roast — 1 0 12 „ Smoked — — — 10½ Calves' Tongues — 1 1 18 Mutton, Boiled — — 3 16 Ox Liver - — — 6 Sheeps' Tongues — — 2 14 Vegetables. Cauliflower — 12 3 0 Lettuce — 10 0 0 Potatoes 4 14 0 0 Red Cabbage — 1 2 0 Miscellaneous. Cocoanut Sweets — 1 3 2 Eggs — — — 6 Tea. — — 3 16 20 15 2 13 42 Milk (Special Designations) Order 1923. 28 applications for licences under the above Order were received during the year. All the licences were granted and the description and number of licences issued are as follows:— Dealer's Licences:— "Grade A (Tuberculin tested)" Milk. 12* "Certified" Milk. 2 Dealer's Supplementary Licences:— "Grade A (Tuberculin tested)" Milk 4 "Certified" Milk 3 "Pasteurised" Milk 7 * 1 is in respect to a bottling establishment Rats and Mice Destruction Act, 1919. Complaints received 572 Number of drains tested. 572 Number of drains found to be defective.. 113 Number of notices served. 113 Number referred to the Borough Engineer. 452 Increase of Rent and Mortgage Interest (Restrictions) Acts. 17 applications were received during the year for Certificates under these Acts. 14 were granted and 3 were refused. In addition, 1 application for a Report was received. This was issued. Water Certificates. Certificates were granted under the provisions of the Public Health (London) Act, 1891, as to dwelling-houses having a proper and sufficient supply of water, with respect to 377 houses and flats. The Mortuary and Shelter. The number of bodies deposited in the Mortuary during the year was 224. Of these, 195 were removed by the Coroner's Order, 22 by the Police, 6 at the request of the deceased's friends, and 1 on my instructions. 38 bodies were placed in the Jewish part of the Mortuary, but only 17 were officially "watched." 175 inquests were held in the Coroner's Court, and 126 post-mortem examinations were made. 11 persons were accommodated at the Council's Shelter—i.e., 2 men, 4 women, and 5 children. 43 Verminous Persons. 589 persons were cleansed during the year and had their clothing disinfected—559 males and 30 females. Disinfecting Station. 3,081 rooms were fumigated and the bedding, etc., were removed and disinfected by steam. Of these, 2,368 rooms were fumigated because of infectious disease, 221 as a result of pulmonary tuberculosis, and 492 because they were verminous. In addition to these, scabies occurred in 274 families and the bedding was taken away and disinfected by steam. 189,503 articles were disinfected. Of these, 116,036 were second-hand articles of clothing for export abroad. 60,387 were from premises where infectious disease occurred, and 13,080 because they were in a verminous condition. 3,057 articles of bedding were destroyed with the owners' consent. Overcrowding. At two meetings of the Public Health Committee I submitted special reports on overcrowding, giving particulars of gross overcrowding in 73 premises and asking for instructions as to what further action should be taken beyond serving statutory notices. Many of these premises were illegally occupied, being underground rooms, and many were indecently occupied. In one case, in Bale Street, a man and wife with 2 sons and 2 daughters above 12 years of age, and 4 children under 12, lived and slept in one room of 1,120 cubic feet capacity. Ten persons lived in a room sufficient for 3 adults only. In a house in Ben Jonson Road, a man and wife with 5 children lived and slept in one room. In Caroline Street, in a room not large enough for 2 people, a man and wife with 4 children lived and slept. Two rooms in College Buildings were occupied by a man with 4 grown up daughters and a grandchild. The eldest daughter, aged 21, had been to a Sanatorium and to Brompton Hospital. In a house in Copley Street one room was occupied by a man and wife with 2 sons and 3 daughters. A room in Dalgleish Street, sufficient for 2 adults only, was occupied by a mother, 2 sons and 3 daughters. Another room of a similar size, in Duckett Street, was occupied by a man and wife with one son and 3 daughters. 44 In Endive Street a man and wife with one son and 4 daughters lived and slept in one room. A man and wife with 4 sons and 3 daughters occupied 2 rooms in Great Pearl Street. Three rooms in Harford Street were occupied by a man and wife with 6 sons and 4 daughters. The eldest son was 23 and the eldest daughter was 24 years of age. These rooms were overcrowded to the extent of 7 adults. One small room in Juniper Street was occupied by a man and wife with 3 children. Another room, in Lower Fenton Street, large enough for the man and wife with one child, had 6 children in excess. A room in Margaret Buildings in Whites Row was occupied by a man and wife with 3 grown up sons. A room in Martha Street, sufficient for the man and wife, had 5 children in excess of the space required, and another room in the same street but in a different house was occupied by a man and wife with 7 children, being overcrowded to the extent of 7 children. Two rooms in Muriel House were occupied by a man and wife with 6 sons, the eldest being 26 years of age, and one daughter, aged 18. Two rooms in Norfolk Buildings were occupied by a man and wife with 5 sons, the eldest being 22, and 5 daughters, the eldest being 18 years of age— 3 in excess—as well as being indecently occupied. A room in Pearl Street was occupied by a man and wife and 5 children— 4 children in excess. A room in Raymond Street was occupied by a man and wife with 6 children, 4 children in excess. A room in Tarling Street was occupied by a man and wife with 9 children, being overcrowded to the extent of 7 children. Two rooms in Tasburgh Buildings were indecently occupied, and overcrowded to the extent of 3 adults and one child. In addition to the parents there were 3 sons, the eldest being 25, and 5 daughtrrs, the eldest being 24 years of age. Another family in Tasburgh Buildings was similarly overcrowded. In Tench Street, one room was occupied by a man and wife with one daughter and four sons, the eldest being 16 years of age—4 children too many. A room in Bedford Street was occupied by a man and wife with 3 sons and 3 daughters, the eldest being 17 years of age; 4 children in excess. 45 One room each in three houses in Cable Street was overcrowded and illegally occupied, all the three rooms being underground. The same applied to a house in Grove Street, Walden Street and three houses in Princelet Street. The rooms had no proper ventilation, and the walls were damp in the three latter. One room in a house in Wilkes Street was occupied by a man and wife with 7 children—3 children in excess. A room in Hogarth Houses was overcrowded and illegally occupied, a man and wife with 2 children occupying one room only, which was underground. A room in Sutton Street was occupied by 8 persons, having 3 adults and 2 children in excess. The same thing occurred in Dora Street—8 persons occupying one room, Anchor Street—8 persons occupying one room, and Red Lion Street—8 persons in one room. In Commercial Road, 3 persons occupied one room which was entirely undergorund with no means of ventilation into the open air and no light except artificial light. The above, as well as others, were considered by the Public Health Committee. If the Statutory notices were followed by Police Court proceedings, it was felt that no good would result therefrom. If the Magistrate made an Order to abate the overcrowding, the people would have no place to go to except the Poor Law Institution. They could not be accommodated in any of the Borough Council or London County Council flats as the wages of the heads of the families, if at work, would not be sufficient to pay for the flats. The wages were possibly sufficient to pay rent for houses in Becontree but the nature of their employment would not permit them to live so far away from their work. In the majority of the cases the families were receiving out-door relief on account of unemployment. General Sanitary Work. 40,023 inspections were made to houses. 45,634 re-visits were made by the Inspectors to supervise the abatement of the nuisances found in 14,965 houses. 10,832 statutory notices were served; 102 summonses were taken under the Public Health (London) Act, 1891. 3,446 drains were tested with smoke, 483 of which were found to be defective, and 142 were re-tested; 1,516 drains were either constructed or re-constructed, cleansed or repaired; 169 were trapped. 46 219 new soil pipes were fixed and ventilated; 1,043 new closet pans and traps were fixed; 3,110 closets were either cleansed or repaired, or provided with additional light and ventilation; 1,214 water closets were provided with a proper flushing apparatus. 78 cisterns were cleansed and covered. Water supply to houses was reinstated in 83 instances. 1,439 yards were cleansed, paved or repaired; 15 areas and stables were paved and drained; 179 washhouses and forecourts were paved. There were 34 nuisances under the Public Health (London) Act, 1891 with respect to the keeping of animals, and these were abated. 11 nuisances with respect to open fires in yards were remedied. Notices were served to provide 1,842 sanitary dust receptacles, and 17 manure receptacles were provided or re-constructed. 323 offensive accumulations were removed. 139 houses were ventilated under the lower floor. 10 underground rooms, which were illegally occupied, were discontinued from being used as such. 35 urinals were fixed. 29 smoke nuisances were abated. 7,659 notices were served to have houses or parts thereof cleansed. 62 sink, bath, lavatory, or rain-water pipes, which were communicating directly with the drain, were disconnected. 15,584 miscellaneous repairs to roofs, floors, gutters, etc., were carried out as the result of notices served. 40 rooms were provided with additional light and ventilation, and the damp walls of 1,758 rooms were remedied. 725 verminous premises were cleansed. 3,846 written complaints were made which were duly investigated and dealt with where necessary—501 were from H.M. Inspector of Factories relating to workshops, 119 from the L.C.C. respecting verminous school children, and 3,226 related to the condition of houses, etc. 47 sanitary inspectors' report-1928. G. Rottomley. a. c. Brown. t. w. Dee. e. j. Edwards E. W. FLINT. H. J. GREEN c. i. guy h. o. harris. j. g. McCarthy g. o. pavitt. w. shepherd. r. simpson. w. f. smith s. h. v. trimming j. twaits. w. t. twynham. r. h. Waterman. Totals Number of Inspections— House to house 233 276 385 232 428 404 429 309 292 639 435 611 287 227 711 323 328 6544 Miscellaneous 2315 1233 1332 991 1471 874 1281 1787 1380 675 1181 999 1707 1008 1170 1596 1185 22185 Complaints 111 872 199 885 331 769 493 487 782 507 133 358 836 933 537 377 38 8648 Infections diseases 177 213 152 246 110 168 124 133 309 103 67 125 106 129 193 110 181 2646 Re-visits—Number of 2446 2062 2129 2413 2209 8023 2353 3040 2278 3432 2070 3890 2604 3618 3132 2984 1956 45634 Intimations served 701 913 722 928 785 1039 734 782 775 807 746 1067 927 1235 955 1224 625 14965 Statutory notices served 497 801 618 805 708 326 545 752 667 699 266 781 683 511 845 1093 235 10832 Summonses taken out under the Public Health (London) Act, 1891, etc. 2 3 ... 21 10 18 2 2 8 2 ... ... 16 10 1 5 2 102 Food and Drugs Acts, etc.—No. of samples taken 98 92 90 65 60 92 94 89 103 90 96 94 92 94 91 91 93 1524 „ „ No. of summonses taken 1 5 ... 2 ... 7 2 2 4 2 ... 2 1 5 2 1 2 38 Animals kept so as to constitute a nuisance, removed 3 2 1 5 4 3 ... ... 2 ... ... 2 3 2 ... 5 ... 34 Areas and stables paved and drained 2 ... ... ... 8 3 1 ... ... ... 6 ... ... ... ... ... ... 15 Bakehouses—No. of inspections to 37 52 7 38 24 20 15 14 44 4 16 14 119 30 28 82 15 509 „ No. of cleansings of 18 26 7 24 19 6 14 14 8 4 14 14 31 8 28 11 10 256 Cisterns cleansed and covered 1 2 ... 2 9 7 1 2 ... 1 8 ... 4 8 1 32 ... 78 Damp walls remedied 58 150 73 75 53 147 71 180 79 120 34 28 241 200 70 105 74 1758 Drains—Cleansed or repaired. 73 141 54 63 29 58 46 51 45 69 19 110 101 74 71 107 54 1168 Constructed or reconstructed 28 19 15 24 10 13 36 15 8 54 4 21 31 12 17 8 33 348 Soil pipes Axed and ventilated 19 12 14 3 6 35 39 9 ... 11 10 11 17 13 ... 12 8 219 Trapped 10 3 3 ... 24 11 36 3 ... 15 12 9 11 ... 20 ... 12 169 Dust receptacles provided 66 168 59 189 73 62 53 85 156 130 42 165 151 107 159 141 36 1842 Houses or parts of houses cleansed. 259 345 453 519 601 569 458 301 374 454 490 521 647 245 557 472 394 7659 „ ventilated beneath the lower floor. 2 ... 10 4 8 3 6 11 ... 6 ... 3 2 1 62 5 21 139 Light and ventilation provided to rooms ... ... 2 ... 2 3 1 21 1 1 ... ... 1 8 ... ... ... 40 Manure receptacles provided or reconstructed 1 3 1 ... 1 2 1 ... ... ... ... 1 ... 2 4 1 ... 17 Offensive accumulations removed 2 30 23 18 10 53 5 17 6 8 30 8 15 34 12 50 7 323 Open fires in yards abolished 1 3 ... ... 2 ... ... ... ... ... 5 ... ... ... ... ... ... 11 Overcrowding in dwellings abated 6 1 5 ... 9 2 6 3 3 1 ... 1 2 2 ... 3 6 50 Sheds occupied as dwellings discontinued. ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Sink, bath, lavatory pipes and rainwater pipes disconnected ... ... 17 ... 1 5 1 ... 1 3 ... 4 ... ... 10 ... 20 62 Smoke nuisances abated 9 ... 7 ... 2 ... 2 1 ... 2 ... 1 1 1 ... 3 ... 29 Underground rooms—Illegal occupation discontinued 2 ... 2 ... ... 1 ... 2 1 ... ... ... 2 ... ... ... ... 10 Urinals fixed 15 1 1 ... ... 6 4 1 ... 3 ... 1 1 ... 2 ... ... 35 Verminous rooms cleansed 27 54 35 21 109 60 42 32 26 5 40 10 118 75 12 ... 17 725 Wash houses, forecourts, &c., paved 7 6 5 7 2 15 2 8 6 33 ... 4 7 ... 47 14 16 179 Waterclosets—Cleansed or repaired 202 189 146 127 65 160 158 163 156 56 258 95 123 399 139 390 168 2994 „ Light and ventilation provided ... ... 1 ... 4 64 4 6 2 5 9 ... 8 1 8 6 8 116 „ Pans and traps fixed 83 36 63 48 23 88 66 12 10 85 70 74 56 140 49 83 52 1043 Water supply or flushing apparatus provided 4 84 106 87 56 79 35 82 34 35 50 104 ... 101 53 183 121 1214 Water supply to houses reinstated ... ... 2 16 3 7 2 ... 3 2 6 2 ... 6 1 11 22 83 Yards cleansed, paved, or paving repaired. 59 145 89 34 81 64 60 57 36 134 12 128 117 78 140 123 82 1439 Miscellaneous repairs to roofs, gutters floors, sashes, fireplaces, coppers, etc. 554 1050 456 831 9.8 856 673 582 858 703 510 1378 1471 1616 1029 1365 744 15584 To face page 46. 48 POLICE COURT PROCEEDINGS. I.—PUBLIC HEALTH (LONDON) ACT, 1891. On 5th January, J. Michells, of 30, Durham Row, was summoned for failing to repair the defective roof, floor and damp walls at 10, Ben Jonson Road. The work having been completed at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. On 16th January, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the defective roof at 42, Three Colt Street. An order was made to do the work within 7 days, with £2 8s. costs. On 17th January, Hyman Cohen, of 6, Great Garden Street, was summoned for failing to repair the defective roof, firestove and flooring at 86, Hanbury Street. The work having been completed at the time of the hearing of the summons, he was fined 2s., with £2 2s. costs. On 17th January, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the defective roof at 19, Chicksand Street. An order was made to do the work within 14 days, with £l 5s. costs. On 17th January, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the roof and defective windows and stair treads at 136, Buxton Street. An order was made to do the work within 7 days, with £1 5s. costs. r On 17th January, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the defective roof and damp and dilapidated walls at 38, Spital Street. An order was made to do the work within 14 days, with £1 5s. costs. On 18th January, Arthur Benabo, of 53, Commercial Road, was summoned for failing to repair the roof, rainwater gutters, etc., at 48, Ocean Street. An order was made to do the work within 14 days, with £2 8s. costs. 49 On 18th January, F. Leigh Pollitt, of 5, West Hill, Sydenham, was summoned for failing to repair the roof and cleanse the walls and ceilings at 36, Lydia Street. An order was made to do the work within 14 days, with £2 8s. costs. On 18th January, F. Leigh Pollitt, of 5, West Hill, Sydenham, was summoned for failing to repair the roof at 7, Lydia .Street. An order was made to do the work within 14 days, with £\ 7s. costs. On 19th January, Franks & Simons, of 354, Mile End Road, were summoned for failing to abate nuisances, i.e., dirty and dilapidated walls and ceilings, defective flooring and eaves gutter at 6, Hope Place. An order was made to do the work within 7 days, with £2 8s. costs. On 20th January, Pinhorn & Pinhorn, of 534, Commercial Road, were summoned for failing to abate nuisances arising from defective roof and yard paving at 3, Shadwell Place. I lie work having been completed at the time of the hearing of the summons, they were ordered to pay £2 8s. costs. On 23rd January, Harris Bresloff, of Coutts Villa, Whipps Cross Road, was summoned for failing to repair the defective roof at 28, Commodore Street. The work having been completed at the time of the hearing of the summons, lie was ordered to pay £2 4s. costs. On 23rd January, David Galinski, of 135, Clapton Common, was summoned for failing to abate a nuisance arising from the defective roof, gutter and rain water pipe at 3, East Tenter Street. An order was made to do the work within 7 days, with £2 8s. costs. On 24th January, David Galinski, of 135, Clapton Common, was summoned for failing to abate nuisances arising from the defective roof, manhole cover, etc., at 15, Wolsey Street. An order was made to do the work within 7 days, with £2 8s. costs. On 24th January, David Galinski, of 135, Clapton Common, was summoned for failing to abate nuisances arising from the damp walls, defective rainwater pipes, etc., at 129, Jubilee Street. An order was made to do the work within 14 days, with £2 8s. costs. 50 On 24th January, Franks & Simons, of 354, Mile End Road, were summoned for failing to abate nuisances arising from the defective water closets, vent shaft, yard paving, workshop roofs, and accumulation of refuse at 9|, Chicksand Street. The work having been done at the time of the hearing of the summons, they were ordered to pay £2 6s. costs. On 27th January, Arthur Benabo, of 53, Commercial Road, was summoned for failing to abate a nuisance arising from the defective eaves gutters at 4, Masons Flats, Watney Street. An order was made to do the work within 7 days, with £2 8s. costs. On 31st January, Franks & Simons, of 354, Mile End Road, were summoned 'for failing to abate a nuisance arising from damp walls at 21, Spelman Street. The work having been completed at the time of the hearing of the summons, they were ordered to pay £2 4s. costs. On 1st February, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the defective roof, eaves gutters, yard paving and ram water pipe at 10, Goldmg Terrace. The work having been done at the time of the hearing of the summons, they were ordered to pay £2 4s. costs. On 1st February, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the defective roof, eaves gutters, yard paving and rain water pipe at 12, Golding Terrace. The work having been done at the time of the hearing of the summons, they were ordered to pay £2 4s. costs. On 14th February, Lewis Raine, of 16, Bacon Street, Bethnal Green, wac summoned for failing to repair the defective roof, rainwater pipe, dirty and dilapidated walls, etc., at 8, Hunton Street. An order was made to do the work within one month, with £2 8s. costs. On 21st February, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the roof, paving, flooring, etc., at 11, Mayfields Buildings. An order was made to do the work within 7 days, with £2 8s. costs. On 2.1st February, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the roof, ceiling, rain-water pipe, sashes, etc., at 12, Mayfield Buildings. An order was made to do the work within 7 days, with £2 8s. costs. 51 On 22nd February, B. Sukmanski, of 14, Woodberry Down, N.4., was summoned for failing to repair the defective roof at 6, East Mount Street. An order was made to do the work within 21 days, with £2 8s. costs. On 8th March, Moses Lisman, of 77, Plumbers Row, was summoned for having deposited on his premises unsound food in preparation for sale for human consumption. He was fined £20, with £h 5s. costs. On 13th March, D. H. Klausner, of 22 and 24, Finch Street, was summoned for failing to remedy the damp walls at .13, Old Montague Street. The work having been completed at the time of the hearing of the summons, he was ordered to pay £2 2s. costs. On 16th March, Isidore Weinberg, of 114, Mile End Road, was summoned for failing to abate nuisances arising from the defective roof, eaves gutter, yard paving, etc., at 152, St. George Street. The work having been completed at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. On 21st March, Harry Warman, of 497, Commercial Road, was summoned for failing to remedy the defective roof, damp walls, etc., at 28, Belgrave Street. The work having been completed at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. On 26th March, Bradshaw & Waterson, of 85, East India Dock Road, were summoned for failing to comply with a Notice with regard to 11, Brightlingsea Place, which premises were in such a dilapidated state as to be unfit for habitation. A Closing Order was made, to lie in the Office for 28 days, and to pay £2 8s. costs. On 27th March, Samuel Morris, of 6, Whitechapel High Street, was summoned for letting a house newly erected, the same being without a proper supply of water for sanitary and domestic purposes, viz., 180, Old Montague Street. He was fined £2, with £2 2s. costs. On 5th April, William F. Laing, of 148, Whitechapel Road, was summoned for failing to repair the roof of house, back addition and water closet apartment, and the dirty and dilapidated ceiling of first floor back addition room at 12, Trafalgar Square. An order was made to do the work within 21 days, with £2 8s. costs. 52 On 25th April, David Muscovitch, of 42, Cannon Street Road, was summoned for failing to abate nuisances arising from defective flooring and hearth, and dirty and defective walls and ceilings, etc., at 52, Cannon Street Road. An order was made to do the work within 7 days, with £2 8s. costs. On 26th April, Abraham Markovitch, of 47, Navarino Road, Dalston, was summoned for failing to remedy a nuisance arising from the defective roof, and dampness in first floor room at 42, St. Mark Street. An order was made to do the work within 7 days, with £2 8s. costs. On 14th May, Arthur Benabo, of 53, Commercial Road, was summoned for failing to remedy the defective condition of copper chimney and eaves gutter at 20, Cottage Grove. The work having been completed at the time of the hearing of the summons, he was ordered to pay £2 4s. costs. On 23rd May, Arthur Benabo, of 53, Commercial Road, was summoned for failing to remedy the defective floor boards in kitchen, and flue of ground floor front room fireplace at 161, Ernest Street. The work having been completed at the time of the hearing of the summons, he was fined £1, with £2 2s. costs. On 23rd May, Arthur Benabo, of 53, Commercial Road, was summoned for failing to repair the defective sink waste pipe and the dirty and dilapidated ceiling of first floor front room at 44, Ocean Street. An order was made to do the work within 7 days, with £2 8s. costs. On 23rd May, Lewis Deitsch, of 41, King Edward Road, E.8, was si'Timoned for failing to abate nuisances arising from the dirty, dilapidated and verminous walls and ceiling, defective fireplace and flooring of first floor room, and broken flooring of passage at 93, Grove Street. The work having been completed at the time of the hearing of the summons, the same was dismissed under the Probation of Offenders Act. On 23rd May, Abraham Goldstine, of 230, Whitechapel Road, was summoned for failing to remedy the defective stove, and dirty and dilapidated walls and ceiling at 11, William Street. An order was made to do the work within 7 days, with £\ 7s. costs. On 1st June, Isaac Solomons, of 9, Old Castle Road, Llanelly, was summoned for failing to repair the defective roof and rain-water gutters at Paragon Mansions. An order was made to do the work within 14 days, with £2 8s. costs. 53 On 1st June, Isaac Solomon, of 9, Old Castle Road, Llanelly, was summoned for failing to repair the defective roof at 40, Paragon Mansions. An order was made to do the work within 14 days, with £2 8s. costs. On 1st June, Isaac Solomon, of 9, Old Castle Road, Llanelly, was summoned for failing to repair the defective roof at 39, Paragon Mansions. An order was made to do the work within 14 days, with £1 7s. costs. On 12th June, Isaac Gropper, of 12, Cannon Street Road, was summoned for failing to abate a nuisance arising from overcrowding at 12, Cannon Street Road. The nuisance having been abated at the time of the hearing of the summons, he was ordered to pay 5/- costs. On 13th June, Iasac Solomon, of 9, Old Castle Road, Llanelly, was summoned for failing to supply a proper dust receptacle at 38, Tredegar Square. He was fined 10/- with £2 0s. costs. On 13th June, Albert A. Kliman, of 81, Commercial Road, was summoned for letting the basement front room at 81, Commercial Road, the same being an underground room that did not comply with the regulations. He was fined £b, with £2 2s. costs. On 13th June, Thomas Blake, of 81, Commercial Road, was summoned for occupying the basement front room at 81, Commercial Road, the same being an underground room that did not comply with the regulations. He was fined 10/-., or one day's imprisonment, which he elected to serve. On 14th June, Franks & Simons, of 354, Mile End Road, were summoned for failing to abate nuisances arising from defective roof, window, and damp and dirty walls at 1, Taylors Place. An order was made to do the work within 7 days, with £2 8s. costs. On 14th June, Franks & Simons, of 354, Mile End Road, were summoned for failing to abate nuisances arising from defective roof, stair treads and floor at 2, Taylors Place. An order was made to do the work within 7 days, with £2 8s. costs. On 22nd June, Louis Galinsky (trading as James Field), of 130, High Street, Whitechapel, was summoned for failing to abate nuisances arising from the defective roof, damp walls, etc., at 30, Little Turner Street. An order was made to do the work within 14 days, with £2 8s. costs. On 27th June, W. T. Fowles, of 77, Sclater Street, Bethnal Green, was summoned for failing to repair the defective water closet at 67, Plumbers Row. An order was made to do the work within 7 days, with £2 8s. costs, 54 On 12th July, Arthur Benabo, of 53, Commercial Road, was summoned for failing to abate nuisances arising from defective trap to the water closet at 14, Bermuda Street. He was fined £1, with £2 2s. costs. On 25th July, Henry Slater, of 76, Umberson Street, was summoned for failing to abate a nuisance arising from defective windows, and dirty walls and ceilings, etc., at 66, Umberston Street. An order was made to do the work within 14 days, with £2 8s. costs. On 7th August, Louis Galinski, of 130, High Street, Whitechapel, was summoned for failing to abate a nuisance arising from the defective roof at 21, Philpot Street. An order was made to do the work within 14 days, with £2 8s. costs. On 25th September, H. Assistant, of 412, Commercial Road, was summoned for failing to abate a nuisance arising from the defective roof at 27, Steel's Lane. An order was made to do the work within 7 days, with £2 8s. costs. On 3rd October, W. Bassett, of 72, Coalville Road, Leyton, was summoned for failing to abate nuisances arising from the defective roof, chimney, back door and sash lines at 110, Anthony Street. An order was made to do the work within 14 days, with £2 8s. costs. On 3rd October, Franks & Simons, of 354, Mile End Road, were summoned for failing to abate nuisances arising from the defective roof, ceiling and paving at 11, Mayfields Buildings. An order was made to do the work within 14 days, with £2 8s. costs. On 24th October, Arthur Benabo, of 53, Commercial Road, was summoned for failing to abate a nuisance arising from the defective roof at 2a, Duckett Street. An order was made to do the work within 7 days, with £2 8s. costs. On 24th October, Arthur Benabo, of 53, Commercial Road, was summoned for failing to abate nuisances arising from the defective roof and walls and ceiling of ground floor left room at 2, Duckett Street. An order was made to do the work within 7 days, with £2 8s. costs. On 24th October, Zelig Cohen, of 1, Crellm Street, was summoned for failing to repair the defective windows, flooring, and roof at 5, Crellin Street. An order was made to do the work within 7 days, with £2 8s. costs. 55 On 24th October, Bessie Cohen, of 64a, Wicker Street, was summoned for failing to remedy the defective ventilation pipe to drains at 64a, Wicker Street. The work having been completed at the time of the hearing of the summons, she was fined 2s. 6d., with £1 1s. costs. On 24th October, Bessie Cohen, of 64a, Wicker Street, was summoned for failing to remedy the defective roof, windows and flooring at 64, Wicker Street. The work having been completed at the time of the hearing of the summons, she was fined 2s. 6d., with £1 1s. costs. On 5th November, Franks & Simons, of 354, Mile End Road, were summoned for failing to remedy the damp walls of the ground floor front room at 19, Taylors Place. An order was made to do the work within 7 days, with £2 8s. costs. On 5th November, Franks & Simons, of 354, Mile End Road, were summoned for failing to provide proper water closet accommodation at 62, Ben Jonson Road. An order was made to do the work within 7 days, with £2 8s. costs. On 7th November, James Field, of 130, High Street, Whitechapel, was summoned for failing to repair the defective roof at 1, East Tenter Street. An order was made to do the work within 14 days, with £2 8s. costs. On 13th November, Frederick Leigh Pollitt, of 5, West Hill, Sydenham, was summoned for failing to remedy the dirty and dilapidated walls and ceiling of the kitchen, floor boards of kitchen, front room and attic, at 19, Lydia Street. The work having been completed at the time of the hearing of the summons, he was fined 10/-, with £2 4s. costs. On 13th November, Frederick Leigh Pollitt, of 5, West Hill, Sydenham, was summoned for failing to remedy the defective seat of the water closet, the dirty and dilapidated walls and ceiling of first floor back room and the defective roof of 20, Lydia Street. The work having been completed at the time of the hearing of the summons, he was fined 5/-, with £2 4s. costs. On 13th November, Frederick Leigh Pollitt, of 5, West Hill, Sydenham, was summoned for failing to remedy the defective treads and lisers to stairs, floor boards in passage, and walls and ceilings of stairs and off room at 21, Lydia Street. The work having been completed at the time of the hearing of the summons, he was fined 5/-, with £1 3s. costs. 56 On 13th November, Frederick Leigh Pollitt, of 5, West Hill, Sydenham, was summoned for failing to remedy the defective roof, and the dirty and dilapidated ceiling of kitchen at 22, Lydia Street. The work having been completed at the time of the hearing of the summons, he was fined 5/-, with £1 3s. costs. On 13th November, Frederick Leigh Pollitt, of 5, West Hill, Sydenham, was summoned for failing to remedy the defective roof of house, the dirty and dilapidated ceiling of kitchen, and defective treads and risers to stairs at 24, Lydia Street. The work having been completed at the time of the hearing of the summons, he was fined 5/-, with £1 3s. costs. On 20th November, Rebecca Benabo, trading as Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to remedy the damp, dilapidated and dirty walls and ceilings, and provide a dust receptacle at 32, •Spital Street. An order was made for the work to be done within 14 days, with £2 6s. costs. On 20th November, Rebecca Benabo, trading as Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to repair the defective roof, rain-water pipe, windows and damp and dilapidated walls at 38, Spital Street. An order was made to do the work within 14 days, with £2 6s. costs. On 20th November, Rebecca Benabo, trading as Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to repair the defective roof, windows and dirty walls at 132, Buxton Street. An order was made to do the work within 14 days, with £1 5s. costs. On 20th November, Rebecca Benabo, trading as Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to repair the damp and dilapidated walls and defective windows and doors at 134, Buxton Street. An order was made to do the work within 14 days, with £1 5s. costs. On 20th November, Rebecca Benabo, trading as Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to repair the dirty and dilapidated walls at 138, Buxton Street. An order was made to do the work within 14 days, with £1 5s. costs. On 21st November, Franks & Simons, of 354, Mile End Road, were summoned for failing to remedy the damp walls, dirty and defective walls and ceilings of house, defective stair treads, yard paving and roof at 28, Golding Terrace. An order was made to do the work within 14 days, with £1 7s. costs. 57 On 21st November, Rebecca Benabo, trading as Charles Benabo & Sons, of 210, Mile End Road, was summoned for failing to remedy the defective roof, eaves gutters, door and frame of first floor room and ceiling of passage, and the dirty, dilapidated and damp walls and ceiling of first floor room at 27, Golding Terrace. An order was made to do the work within 21 days, with £1 7s. costs. On 21st November, H. Bookatz, of 51, Grove Street, was summoned for failing to remedy the defective condition of the water closet at 51, Grove Street. The work having been completed at the time of the hearing of the summons, he was ordered to pay £2 5s. costs. On 21st November, W. Rutkowski, of Unity Works, Hollybush Gardens, E.2, was summoned for failing to remedy the defective roof at 1, Ellen Place. An order was made to do the work within 7 days, with £2 8s. costs. On 21st November, Rebecca Benabo, trading as Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to remedy the defective roof, dilapidated and damp walls and ceiling and defective and dangerous flooring of first floor room, and the defective eaves gutter at rear of 8, Golding Terrace. An order was made to do the work within 21 days, with £1 7s. costs. On 21st November, Rebecca Benabo, trading as Charles Benabo & Sons, of 210, Mile End Road, was summoned for failing to remedy the defective roof, dilapidated walls and ceiling of ground floor room and defective eaves gutters at 16, Golding Terrace. An order was made to do the work within 21 days, with £1 7s. costs. On 23rd November, Franks & Simons, of 354, Mile End Road, were FHimmoned for failing to remedy the defective roof, dirty and defective walls and ceilings, etc., at 68, Ben Jonson Road. An order was made to do the work within 7 days, with £2 8s. costs. On 23rd November, Franks & Simons, of 354, Mile End Road, were summoned for failing to remedy the defective roof, window frame, etc., at 2, Taylors Place. An order was made to do the work within 7 days, with £2 8s. costs. On 26th November, Rebecca Benabo, trading as Charles Benabo & Sons, of 2 10, Mile End Road, was summoned for failing to remedy the defective roof of back addition, and dilapidated ceiling of washhouse at 51, Rectory Square. An order was made to do the work within 7 days, with £2 8s. costs. 58 On 20th November, Rebecca Benabo, trading at Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to remedy the defective roof of back addition, and dilapidated ceiling of wash house at 51, Rectory Square. An crder was made to do the work within 7 days, with £2 8s. costs. On 28th November, W. T. Fowles, of 77, Sclater Street, Bethnal Green, was summoned for failing to repair the basement stair treads and floors, and provide a proper bustbin at G9, Plumbers Row. An order was made to do the work within 7 days, with £2 8s. costs. On 6th December, Isaac Solomon, of 9, Old Castle Road, Llanelly, South Wales, was summoned for failing to remedy the defective manhole cover to dram in the main passage at Paragon Mansions. The work was completed at the time of the hearing of the summons, but was fined £3, with £2 2s. costs. On 6th December, Isaac Solomon, of 9, Old Castle Road, Llanelly, South Wales, was summoned for failing to remedy the choked condition of the water closet at 26, Paragon Mansions. The work was completed at the time of the hearing of the summons, but was fined £3, with £2 2s. costs. On 18th December, Woolf Rutkowski, of Unity Works, Hollybush Gardens, E.2, was summoned for failing to abate a nuisance arising from the defective rain-water pipe at 22, Mulberry Street. An order was made to do the work within 14 days, with £2 8s. costs. On 18th December, Woolf Rutkowski, of Unity Works, Hollybush Gardens, E.2, was summoned for failing to repair the defective rain-water pipe and yard paving at 24, Mulberry Street. An order was made to do the work within 14 days, with £2 8s. costs. On 21st December, Franks & Simons, of 354, Mile End Road, were summoned for failing to abate nuisances arising from the defective paving, eaves gutters, dirty walls and ceilings, etc., at 14, Mayfields Buildings. An order was made to do the work within 14 days, with £2 8s. costs. On 21st December, Franks & Simons, of 354, Mile End Road, were summoned for failing to abate nuisances arising from the defective roof, dirty walls and ceilings, etc., at 17, Mayfields Buildings. An order was made to do the work within .14 days, with £2 8s. costs. On 24th December, William Laing, of 148, Whitechapel Road, was summoned for failing to repair the defective roof of 1, Rhodeswell Road. An order was made to do the work within 7 days, with £2 8s. costs. 59 On 28th December, Robert Edmond Golding, of Riffame Dairy Cottage, Little Baddow, near Chelmsford, was summoned for s. lling the carcase of a pig to B. W. Crowe, of 43, Burdett Road, knowing at the time of sale that it was liable to be seized. He was fined £20, with £10 10s. costs. On 28th December, Kate Fowles, of 77, Sclater Street, Bethnal Green, was summoned for failing to comply with an Order made on the 28th November, with regard to remedying certain defects at 69, Plumbers Row. She was fined £3, with £2 2s. costs. II.—LONDON COUNTY COUNCIL BYE-LAWS. On 17th January, Franks & Simons, of 354, Mile End Road, were summoned for failing to repair the defective yard paving at 136, Buxton Street. They were fined 2/-, with £2 2s. costs. On 28th March, Herman Feiner, of 2, Little Alie Street, was summoned for fixing a sink waste at 37, St. Marks Street. The same having been altered before the time of the hearing of the summons, he was ordered to pay £2 4s. costs On 15th October, Samuel Morris, of 6, High Street, Whitechapel, was summoned for failing to limewash his premises between September 1st and 15th, the same being used for the carrying on of the business of a fried fish vendor. He was fined £3, with £2 4s. costs. On 21st November, Rebecca Benabo, trading as Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to provide a proper ashpit at 26, Golding Terrace. She was fined £1, with £1 7s. costs. On 26th November, Rebecca Benabo, trading as Charles Benabo & Sons, of 240, Mile End Road, was summoned for failing to provide a suitable ashbin at 51, Rectory Square. She was fined £2, with £2 2s. costs, and ordered to provide an ashbin within 7 days. III.—LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1902. On 30th May, Nicholas Halkidis, of la, Burslem Street, was summoned for selling ice cream from dirty utensils on a barrow outside Deal Street school. He was fined £1, with 10/- costs. 60 On 24th October, Morris Fleishman, of 37, White Horse Lane, was summoned for failing to observe due cleanliness of utensils and premises used in connection with the manufacture and sale of ice cream. He was fined £l, with £1 Is. costs. IV.—LONDON COUNCIL (GENERAL POWERS) ACT, 1908. On 8th March, Moses Zisman, of 77, Plumbers Row, was summoned for keeping food in a dirty place (flour store in bakehouse) at 77, Plumbers Row He was fined £1, or thirteen days' imprisonment. V.—METROPOLIS LOCAL MANAGEMENT ACT. On 29th October, Harry Steigman, of 65, Greenfield Street, was summoned for executing sanitary work, viz.:—bath installed, and a gully with branch laid in garage at 64, Greenfield Street, without having given notice to the Council of his intention. He was fined £1, with £2 4s. costs. On 29th October, John Bennet, of 36, Abbots Street, Dalston, was summoned for executing sanitary work, viz.:—bath and gully with branch installed at 64, Greenfield Street, without having given notice to the Council of his intention. The summons was withdrawn on the conviction of the defendant, Harry Steigman in the previous case. VI.—HOUSES LET IN LODGINGS BYE-LAWS. On 25th July, Henry Slater, of 76, Umberston Street, was summoned for failing to keep in a cleanly condition the common staircases, landings and passages at 66, Umberston Street. He was fined 7s. 6d., with 10s. 6d. costs. On 25th July, Henry Slater, of 76, Umberston Street, was summoned for failing to maintain artificial lighting on the common staircase in efficient working order at 66, Umberston Street. He was fined 7s. 6d., with 10s. 6d. costs. VII.—MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. On the 10th April, Harris Gertler, of 85, Jamaica Street, was summoned for selling milk from a hand can not bearing his name and address. He was fined £2. 61 On 2r»th June, Mary Ann Jones, of 64, White Horse Lane, was summoned for failing to have her proper name and address on the receptacle from which milk was sold. She was ordered to pay £2 4s. costs. On 3rd July, David Solomons of 5, Lombard Street, was summoned for selling milk from a hand can not inscribed with the vendor's address. Hi; was ordered to pay £l 3s. costs. VIII.—MILK (SPECIAL DESIGNATIONS) ORDER, 1923. On 3rd July, David Solomons, of 5, Lombard Street, was summoned for selling Grade A (Tuberculin Tested) Milk when not having a distributor's licence on 6th June. 1 le was ordered to pay £1 3s. costs. IX.—MILK AND DAIRIES ORDER, 1926. On I llh April, William George Appleton, of 152, Rhodeswell Road, was summoned for Tilling a bottle with milk and closing same, otherwise than on registered premises, viz.:—in White Horse Street, on 17th February. He was fined 10s., with 10s. 6d. costs. On IIth April, George Martin, of 29, Silver Street, was summoned for partly filling a bottle with milk and closing same, otherwise than on registered premises, viz., in Oley Place, on 29th February. He was lined 10s., with 10s. 6d. costs. On 11th April, Ruben Pyzcr, of 110, Stepney Green, was summoned for filling bottles with milk and closing same, otherwise than on registered premises, viz., in Adler Street, on 8th March. lie was fined 10s., with 10s. 6d. costs. On 23rd April, Israel Rochlin, of 15, Scarborough Street, was summoned for filling and scaling milk bottles intended for delivery, with milk from a churn on the pavement outside 15, Scarborough Street, on 18th March. Tie was fined £1, with £1 1s. costs. On 20th June, Morris Leigh, of 8, Leslie Street, was summoned for filling and sealing milk bottles outside 9, Greenfield Street, on 8th May. He was fined £1, with £1 1s. costs. ()n 22nd August, Stanley Gittles, of 18, Greenway, Becontree (a roundsman in the employ of E. II. lhomas, of 15, Maroon Street), was summoned for bottling milk other than on registered premises, viz., outside 16, Bohn Street, on 6th July. He was lined £2. 62 On 6th September, Thomas G. Evans, of 64, Pelham Street, was summoned for filling and sealing milk bottles outside 46, Gun Street, on 24th July. He was ordered to pay £2 2s. costs. On 31st December, Frederick Christopher Hallam, of 34, Harford Street, was summoned for filling a bottle with milk and closing same, otherwise than on registered premises, viz., in Stepney Green, on 29th November. He was fined £2. On 31st December, George Coe, of 2, Lockhart Street, was summoned for filling a bottle with milk and closing same, otherwise than on registered premises, viz., in Harlow Place, on 16th November. He was fined £2. Total Fines and Costs. Fines. Costs. Butter and Margarine Acts 4 2 6 5 17 6 Food and Drugs Acts 33 0 0 68 13 0 House Let in Lodgings By-laws 0 15 0 1 1 0 London County Council By-laws 6 2 0 9 19 0 London County Council (General Powers) Act, 1902 2 0 0 1 11 0 London County Council (General Powers) Act, 1908 1 0 0 - Metropolis (Local Management) Act 1 0 0 2 4 0 Milk & Dairies (Consolidation) Act, 1915 2 0 0 3 7 0 Milk & Dairies Order, 1926 9 10 0 5 15 6 Milk (Special Designations) Order, 1923 - 1 3 0 Public Health (London) Act, 1891 60 17 0 198 13 0 £120 6 6 298 4 0 House to House Inspection. List of streets in which all the houses have been inspected as a result of house to house inspection during the year 1928. (a) Limehouse. Mr. Bottomley. Bridge Terrace. Chivers Court. Claydens Buildings. Dalgleish Place. Dod Street. Garrick Buildings. Gill Place. Lance Street. Lydbrook Street. New Alley. New Alley Square. Notgrove Court. Notgrove Street. Park Street. Parnham Street. Spenlow Street. Tomlins Terrace. Whitehall Place. Williams Place. Willow Row. 63 Mr. McCarthy. Brunton Cottages. Charles Street. Durham Row. Fair Street. Gold Street. Hardie House. Heath Street. Railway Place. Ratcliff House. Regent House. Wellesley Street. Wright's Buildings, Salmon York Road. Lane. Mr. Waterman. Boulcott Street. Brook Street Buildings. Caroline Street Buildings. Causeway Courti Dellow Street. Devonport Street. Edward Mann Buildings. Havering Street. Hilton Street. James Place. Love Court. Love Lane. Lowood Street. Market Buildings. Narrow .Street. New Gravel Lane. Ratcliff Orchard. Solander Street. Twine Court. (b) Mile End. Mr. Brown. Adelina Place. Assembly Passage. Brown's Buildings, Jubilee Street. Cook's Buildings, Jubilee Galinski's Buildings, Jubilee Street. Street. Grove Dwellings, Adelina Grove. Jubilee Houses, Jubilee Street. Jubilee Mansions, Jubilee Street. Lewins Buildings. Pattison Street. Redman's Cottages. Mr. Edwards. Bohn Street. Eaton Place. Knott Street. Louvaine Street. Lydia Street. Ocean Street. Single Place. Wades Place. Mr. Harris. Bakers Court. Fordham Street. John's Place. Nelson Street. Newark Street. Raven Row. Varden Street. 64 Mr. Pavitt Antill Road. Ashcroft Road. Bridge Street. Clinton Road. College Street. Cordelia Street. Ewing Street. Forester Street. Lichfield Road. Lincoln Street. Longfellow Road. South Grove. Tredegar Terrace. Venour Road. Mr. Simpson. Argyle Road. Ashburton House, Globe Rd. Bradwell Street. Colmar Street. Eagle Place. Entick Street. Essex Street. Frimley Street. Globe Buildings, Globe Road. Holford Street. Longnor Road. May's Buildings. Mile End Buildings. Moody Street. Raphael House, Mile End Road. Rose Place, Globe Road. Sceptre Street. Stayner's Road. Willow Street. X X Place. Mr. Twaits. Albion Street. Bridge Street. Burgess Street. Canal Road. Copperfield Road. Eric Street. Georgeina Place. Kirk's Place. Lee Street. Maplin Street. Mossford Street. Rhodeswell Road. Selsey Street. Silas Street. Single Street. South Grove. Thomas Street. Treby Street. Woodison Street. (c) St. George's. Mr. Dee. Boarded Entry. Bushell Street. Cinnamon Street. Johnson's Buildings, Wapping High Street Lavender Place. Mary Place. Monza Street. Pearl Street. Pennington Street. Plough Alley. 05 Mr. Dee (continued). Raines Mansions, Old Gravel Lane. Royal Jubilee Buildings, Wapping 11igh St reel. St. George Street. St. Katherine's Way. Sarah Street. Wapping High Street. Whitethorn Place. Woodside Mansions, Old Gravel Lane. Mr. Flint. Harnett Street. Brittcns Court. Clifford House. Day Place. Denmark Street. Graces Alley. Lawrence Buildings. Little Turner Street. Ludens Place. Mayfields Buildings. Mertons Court. Neptune Street. Pell Street. Richard Court. Rogers Court. Russell Court. Sliij) Alley. Sly Street. Walburgh Place Wright's Row. Mr. Guy. Buross Street. Coburg Buildings. Dunch Street. Elizabeth Cottages. Hardinge Street. Star Place. Sutton Street. Tarling Street. Whites (iardens. Mr. Smith. Amber Place. Beatrice House, Philip St. Doris House, Philip Street. Ellen Place. Elsie House, Philip Street. Globe Court. London Terrace. Muriel House, Philip Street. Philip Street. Sanders Street. Stutfield Street. Umberston Street. Wicker Street. Wicker 'Terrace. (U) Whitfxhapel. Mr. Green. Brownsons Court. Gt. Eastern Buildings, Fieldgate Street. Lambeth Street. Morrison Buildings North. Munday's Place. Royal Mint Square. Settles Court. Synagogue Place. Tenter Buildings. Victoria Buildings. Zion Lodge, 66 Mr. Shepherd. Alexander Buildings, Brunswick Buildings, Commercial Street. Goulston Street. High Street, Whitechapel. Newcastle Place. Newcastle Street. Margarets Buildings, Whites Row. Newmans Buildings, Leyden St. Old Castle Street. Poole Square. Popes Head Court. Quaker Court. Rosetta Place, Sandys Row. Sheba Street. Mr. Trimming. Clinton House, Pelham Street. Crashawe Place. Deal Street. Hughes Mansions, Vallance Road. St. Mary Street. Wodeham Street. Mr. Twynham. Montague Place. Nathaniel Buildings. Pelham Street. Perry's Avenue. Spelman Street. 67 [Home Office Form 572. FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—INSPECTIONS. Premises. Number of. Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 691 143 ... Workshops (Including Workshop Laundries) 3,891 1,203 1 Workplaces (Other than Outworkers' premises) 237 31 ... Total 4,819 1,377 1 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 572 572 ... ... Want of ventilation 93 93 ... ... Overcrowding 16 16 ... ... Want of drainage of floors 1 1 ... ... Other nuisances 718 718 • • • ... Sanitary Accommodation insufficient 23 23 • • • • • • unsuitable or defective 315 315 ... ... not separate for sexes 39 39 ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Other offences (Excluding offences relating to outwork which are included in Part 3 of this report.) 10 10 ... ... Total 1,787 1,787 ... ... •Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as em ediable under the Public Health Acts. 68 3—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year 1928. Number. Bakehouses 145 Boot, Shoe and Slipper Making 142 Cabinet Making 152 Furriers 175 Hat and Cap Manufacturers 77 Laundries 5 Rag Sorting, etc. 57 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) 2,431 Miscellaneous 433 Total 3,617 4.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 17 Action taken in matters referred by H.M. Inspectoras remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5, 1901) Notified by H.M. Inspector 501 Reports (of action taken) sent to H.M. Inspector 501 Other 5 Underground Bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 47 69 5.—OUTWORKERS. The net number of outworkers in the Borough engaged in the various trades is as follows:— Making, cleaning, etc., of wearing apparel 2,557 Furriers 51 Umbrellas 82 Boots and shoes 89 Paper bags and cardboard boxes 22 Artificial flowers 5 Xmas crackers 8 Brushes 6 Furniture 2 Bag making 1 Tooth brushes 2 Feathers 1 Ties 11 Millinery 2 Total 2,779 The number of inspections made to outworkers' premises was 1,797, and the number of premises where sanitary defects were found to exist was 308 Notifiable infectious disease occurred in 187 outworkers' premises. There are 121 firms in the Borough employing Outworkers, and of these firms 118 sent in lists twice in the year and 3 once. These related to a net number of 877 outworkers, of which 534 were resident in this Borough and 343 were transferred to other Districts. In addition, 536 lists relating to a net number of 2,245 outworkers were received from other Boroughs during the year. Outworkers' premises where sanitary defects were found to exist,— Nature of Work. Instances. Notices served. Wearing Apparel— Making, &c. 297 297 Furriers 1 1 Paper, &c., boxes, paper bags 2 2 Boots and Shoes 5 5 Xmas Crackers 1 1 Umbrellas 2 2 Total 308 308 70 L.C.C. Report— Premises. No. in borough at end of 1928. No. of Inspections. No. of Prosecutions. Cowsheds 20 89 — Milkshops 393 1,176 — Ice Cream Premises 262 527 2 Slaughterhouses 1 1 — Offensive Trades 55 395 - Restaurants and Eating Houses 335 564 - Houses Let in Lodgings 2,635 2,997 2 Housing of the Working Classes— No. of houses inspected— (a) On account of complaints or illness (P.H. Act) 11,294 (b) House-to-housj (Housing Consolidated Regulations, 1925) 6,544 No. of notices served— (a) Under P.H. Act:— (i) Intimation 14,965 (ii) Statutory 10,832 (b) Under Housing Act — No. of houses repaired or nuisances remedied under P.H. Act 12,795 No. of houses repaired under Sec. 3 of Housing Act— (a) By owners — (b) By L.A. in default of owners — No. of houses closed on notice by owner that they could not be made fit No. of houses for the working classes— (a) Erected during the year 290 (b) In course of erection 24 No. of representations by Medical Officer or other person — No. of houses included in such representations — No. of Closing Orders made 1 No. of Closing Orders determined (i.e., Houses made fit) — 71 No. of Demolition Orders — No. of houses demolished— (a) In pursuance of orders — (b) Voluntarily — Total No. of houses in the borough 38,553 No. of houses occupied by the working classes 31,763 Underground Rooms— No. illegally occupied 16 No. closed or illegal occupation discontinued 10 Overcrowding— No. of cases of overcrowding found 115 No. of prosecutions 1 No. remedied 50 Smoke Nuisances— No. of observations 139 No. of notices— (a) Intimations 24 (b) Statutory notices 7 No. of complaints 30 No. of summonses — Cleansing and Disinfection— No. of adults cleansed 589 No. of children cleansed — No. of premises cleansed— (a) after infectious diseases 2,589 rooms fumigated (b) for vermin 492 ,, „ Water Supply to Tenement Houses— No. of premises supplied 3 No. of prosecutions — Sanitary Officers— No. of Sanitary Inspectors (whole time) Male 18; Female nil „ „ ,, (part time) Male nil; Female nil No. of health visitors (whole time) n „ „ „ (part time) nil 72 Housing Conditions—Statistics, 928, Ministry of Health Table. Area (in acres) 1,902.766 Population (census 1921) 249,738. Estimated 1928 244,000 General death-rate 11.7 per 1,000 Death-rate from Tuberculosis 1.13 „ „ Infantile Mortality 71 „ „ No. of inhabited houses, 1921 38,461 No. of families or separate occupiers, 1921 55,832 Rateable value £1,743,988. Sum represented by 1d. rate £7,117 No. of dwelling houses of all classes 38,553 No. of working class dwelling houses 31,763 No. of houses erected during the year 331 With State assistance under the Housing Acts by Local Authority 314 I.—Inspection of dwelling houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 25,671 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 6,544 (3) Number of dwelling-houses found to be in a state dangerous or injurious to health as to be unfit for human habitation 2 (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 9,984 II.—Remedy of defects without service of formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 4,133 III.—Action under statutory powers. (a) Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners — (b) By Local Authority in default of owners — 73 (3) Numbers of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 12,625 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 10.832 (b) By Local Authority in default of owners (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 (1) Number of representations made with a view to the making of Closing Orders — (2) Number of dwelling-houses in respect of which Closing Orders were made — (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — I beg to express my indebtedness to all the members of my staff for the manner in which they have assisted me in carrying out the duties of my office. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, D. L. THOMAS, Medical Officer of Health and Administrative Tuberculosis Officer. 74 Causes of, and Ages at Death during the Year, 1928 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. Chicken Pox 1 ... ... ... ... ... ... ... 1 Enteric Fever ... 1 ... 1 1 2 ... ... 5 Small Pox ... ... ... ... ... ... ... ... ... Measles 23 41 21 7 ... ... ... ... 92 Scarlet Fever 1 ... 3 1 ... ... ... ... 5 Whooping Cough 11 10 4 ... ... ... ... ... 25 Diphtheria and all deaths from Croup (except "spasmodic" "false" "stridulous" and "catarrhal") 2 3 12 11 2 1 ... ... 31 Influenza ... ... 1 ... ... 6 8 8 23 Erysipelas ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... 1 1 1 ... ... ... ... 3 Typhus Fever ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... 1 ... ... 1 Lead Poisoning ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) ... ... 2 8 59 87 74 14 244 Tuberculous Meningitis (Acute Hydrocephalus) 3 5 6 2 ... ... ... ... 10 OtLer Tuberculous Diseases 3 2 3 1 1 4 2 1 17 Rheumatic Fever ... ... ... 1 ... 1 ... ... 2 Cancer, malignant disease (Sarcoma, Rodent Ulcer, etc.) ... ... ... ... 1 29 163 117 310 Bronchitis 16 1 ... 1 ... 10 96 193 817 Broncho-Pneumonia 63 24 15 3 3 17 44 38 207 Pneumonia (all other forms) 9 3 3 3 3 11 40 34 106 Other diseases of Respiratory Organs ... ... 2 ... ... 4 4 11 21 Diarrhoea and Enteritis (all deaths from Diarrhoea, except those secondary to somewell defined disease) 57 6 1 ... ... ... ... ... 64 Appendicitis and Typhlitis ... ... 1 4 1 1 1 2 10 Alcoholism, Delirium Tremens, acute and chronic alcoholism (but not those from organic disease due to alcoholism) ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... 1 7 ... 8 Nephritis and Bright's Disease 1 ... 2 ... 4 16 51 49 123 Puerperal Fever ( Pyæmia, Septicemia, Sapræcmia, Pelvic Peritonitis,Peri- and EndoMetritis occurring in the Puerperium) ... ... ... ... 1 2 ... ... 3 Other accidents and diseases of Pregnancy and Parturition 8 ... ... ... 2 5 1 ... 16 Congenital Debility and Malformation, including Premature Birth, Atrophy, Marasmus, want of Breast Milk, but not from Atelectasis 94 ... ... ... ... ... ... ... 94 Violent Deaths, excluding Suicide 2 3 5 21 12 10 33 26 112 Suicides ... ... ... ... 5 2 8 6 21 Heart Disease 2 2 2 16 20 30 126 157 355 Old Age ... ... ... ... ... ... ... 104 104 Other Defined Diseases 29 8 8 20 25 47 174 219 530 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... 1 ... ... 1 ... ... 2 Total 35 110 93 101 140 288 882 979 2,868 75 Cases of Infectious Disease notified during the Year, 1928. Metropolitan Borough of Stepney. Notifiable Disease. Number of Cases notified. Total Cases notified in each Locality. Total removed Hospital At all Ages At Ages—Years. Lime- house St. George's Mile End White- Under 1 1 to 6 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox 4 ... ... ... 2 2 ... ... 1 ... 3 ... 4 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 646 22 254 301 48 19 2 191 110 238 107 644 Erysipelas 146 3 15 11 19 40 42 16 29 27 58 32 69 Scarlet Fever 1324 9 387 815 92 20 1 ... 294 238 548 244 1313 Typhus Fever 2 ... ... ... ... ... 2 ... ... ... ... 2 2 Enteric Fever 52 ... 7 19 7 11 8 ... 4 5 34 9 52 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 13 ... ... ... 2 11 ... ... 3 4 3 3 11 Puerperal Pyrexia 14 ... ... ... 3 11 ... ... 5 ... 7 2 14 Cerebro-spinal Meningitis 5 1 4 ... ... ... ... ... ... 1 8 1 5 Polio-Myelitis 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 Polio-Encephalitis 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 Ophthalmia Neonatorum 34 34 ... ... ... ... ... ... 10 2 17 5 17 Pulmonary Tuberculosis 409 1 8 30 108 147 100 15 89 55 170 95 295 Other forms of Tuberculosis 128 3 19 53 26 19 8 ... 30 23 48 27 71 Encephalitis Lethargica 5 ... 1 1 ... 3 ... ... 2 1 1 1 5 Totals 2784 73 697 1230 307 283 163 31 658 466 1132 528 2504 76 Infant Mortality, 1928. Deaths from stated Causes at Various Ages under One Year of Age for the whole Borough. Cause of Death Under 1 week 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months Total Deaths under One Year All Causes. Certified ... ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... 1 ... ... 1 Measles ... ... ... ... ... ... ... 7 16 23 Scarlet Fever ... ... ... ... ... ... ... ... 1 1 Diphtheria and Croup ... ... ... ... ... 1 ... 1 ... 2 Whooping Cough ... ... ... ... ... 1 5 2 3 11 Diarrhoea ... 1 ... ... 1 8 30 14 3 56 Enteritis ... ... ... ... ... ... 1 ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... 2 ... 1 3 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... 2 ... 1 3 Congenital Malformations 7 1 ... 2 10 1 ... ... ... 11 Premature Birth 34 8 ... 3 45 2 ... ... ... 47 Atropby, Debility & Marasmus 6 2 4 ... 12 7 8 1 ... 28 Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Injury at Birth 7 1 ... ... 8 ... ... ... ... 8 Erysipelas ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 1 2 1 ... ... ... 3 Pickets ... ... ... ... ... ... ... ... 1 1 Meningitis (not tuberculous) ... 1 ... ... 1 ... 1 2 2 6 Convulsions 8 ... ... 1 4 1 2 1 2 10 Gastritis ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ...... 2 ... 2 4 5 3 2 16 Pneumomia (all forms) 1 1 2 ... 4 22 15 17 14 72 Suffocation, overlying 1 ... ... ... 1 ... ... 1 ... 2 Other causes 1 4 1 ... 6 ... 4 4 2 16 Total 64 19 10 7 100 48 76 53 48 325 77 BOROUGH ANALYST'S REPORT. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to submit to you my fifth Annual Report, dealing with the work carried out in the Borough Laboratory during the year 1928. During the year 1,557 samples were submitted to me for analysis. Of these, 1,528 were purchased by Inspectors under the Food and Drugs Acts; 14 samples were analysed for the Public Health Department; 14 for the Borough Engineer's Department, and 1 for the Borough Electrical Engineer's Department. The 1,528 samples taken under the Food and Drugs Acts comprised 968 formal samples and 560 informal samples. Table A shows the nature of the samples taken under the Food and Drugs Acts, and gives the numbers and percentages found to be adulterated. Table A. Number of Samples. Number Genuine. Number Adulterated. Percentage Adulterated. Milk 923 885 38 4.1 Butter 164 150 14 8.5 Margarine 148 148 — — Vinegar 23 17 6 26.1 Cream 20 20 — — Coffee 19 19 — — Sausage 12 12 — — Ginger 11 5 6 54.5 Condensed Milk 10 10 — — Zinc Ointment 10 9 1 10.0 Sponge Cake 9 9 — — Pepper 9 9 — — Epsom Salts 9 9 — — Glycerine 9 9 — Purified Borax 9 9 — — Camphorated Oil 7 7 —' — Milk Sugar 7 7 — — Flour 6 6 — — Dried Milk 6 6 — — Glauber's Salt 6 6 — Fruit Wines 6 6 — - Boric Ointment 6 6 - — Jam 6 6 — — Tincture of Iodine 6 6 — — Cream of Tartar 6 6 — — 78 Table A.—Continued. Number of Samples. Number Genuine. Number Adulterated. Percentage Adulterated. Cheese 6 6 - - Ice Cream 6 6 — — Pearl Barley 6 6 — — Rice 5 5 — — Ammoniated Tincture of Quinine 5 2 3 60.0 Castor Oil 5 5 — - Honey 5 5 - Cod Liver Oil 5 5 — - Arrowroot 4 4 — - Spirits 4 4 — - Tea 3 3 — - Corn Flour 3 3 — - Cocoa 3 3 — - Sulphur Ointment 3 3 — - Seidlitz Powder 3 3 — - Ground Almonds 3 3 — - Lemonade Powder 3 3 — - Sal Volatile 3 3 — - Sweets 3 3 — - Baking Powder 3 3 — - 1,528 1,460 68 4.5 The number of samples found to be adulterated was 68 or 4.5 per cent. Table B shows the number of samples analysed and the number found to be adulterated during the past ten years. Table B. Year. Number of Samples. Number Adulterated. Percentage Adulterated. 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 1924 1,456 45 3.1 1925 1,378 44 3.2 1926 1,341 37 2.8 1927 1,292 42 3.3 1928 1,528 68 4.5 79 Table C shows the distribution of the 1,524 samples, taken under the Food and Drugs Acts, amongst the four districts of Stepney. Table C. District. Number of Samples. Number Adulterated, Percentage Adulterated. Other Offences. Mile End 481 16 3.3 11 Whitechapel 404 12 3.0 12 St. George's 328 17 5.2 2 Limehouse • 311 22 7T 4 1,524 67 4.4 29 The remaining 4 samples, of which one was adulterated, which were taken in Shoreditch, bring the total number of samples to 1,528, of which 68 or 4.5 per cent. were adulterated. Details of "other offences" are given on page 92. 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. Other offences. Adulterations. Other Offences. Bottomley 98 9 — 1 — Brown 92 3 4 1 4 Dee 90 2 — - — Edwards 65 2 3 - 2 Flint 60 — — - — Green 92 10 3 3 3 Guy 94 4 2 1 l Harris 89 3 - 2 - McCarthy 103 5 1 4 Pavitt 90 7 2 1 l Shepherd 96 1 1 - - Simpson 94 3 1 l 1 Smith 92 2 - 1 - Trimming 94 4 5 1 4 Twaits 91 9 2 1 1 Twynham 91 — 1 - 1 Waterman 93 3 4 - 2 1,524 67 29 17 20 Bishop (Shoreditch) 4 1 - 1 - Total 1,528 68 29 18 20 80 Four samples of milk taken in Shoreditch are included in the tables. These samples were obtained from a wholesale firm, which supplied milk for sale in Stepney, and the analyses of the samples were carried out in this laboratory. Similarly samples of milk taken from wholesalers in Stepney by our Inspectors at the request of another Borough, in which the milk is retailed, are analysed in the laboratories of that Borough. Legal Proceedings. Legal proceedings were taken in 38 cases. Details of the individual prosecut 10.ns are given later under the various headings. In 35 cases the vendor was cautioned. Table E summarises the results and compares them with the results of proceedings taken during the years 1926 and 1927. Table E. Year. Summonses. Total Fines. Total Costs. Average Fine. Average Total Penalty. £ s. d. £ s. d. £ s. d. £ s. d. 1928 18 Foods and Drugs (Adulteration) 33 0 0 68 13 0 1 16 8 5 12 11 7 Margarine (Other offences) 4 2 6 5 17 6 0 11 9 1 8 7 13 Milk (Other offences) 11 10 0 10 5 6 0 17 8 1 13 6 38 Total 48 12 6 84 16 0 1 6 1 3 10 3 1927 11 Food and Drugs Acts 13 0 0 23 12 6 1 3 8 3 6 7 1926 9 Food and Drugs Acts 7 0 0 14 14 0 0 15 7 2 8 3 6 Butter and Margarine Acts, etc. 2 18 0 4 0 6 0 9 8 1 3 1 15 Total 9 18 0 18 14 6 0 13 2 1 18 2 81 Milk. 923 samples of milk were analysed, of which 38 or 4.1 per cent. were adulterated. Table F shows the number of samples of milk examined and the percentages of adulteration during the last ten years. Table F. 1919. 1920 1921. 1922 1923. 1924. 1925. 1926. 1927. 1928. Number of samples 665 858 824 838 837 895 825 809 854 923 Percentage of adulteration 8.6 5.7 4.5 3.1 1.5 3.0 2.9 1.6 1.4 4.1 The average composition of all the samples of milk analysed for each month of the year is shown below. Table G. Month. Number examined. Fat per cent. Solids-not- fat per cent. Total Solids per cent. January 79 3.80 8.67 12.47 February 79 3.70 8.60 12.30 March 84 3.53 8.58 12.11 April 58 3.52 8.54 12.06 May 62 3.51 8.62 12.13 June 73 3.41 8.68 12.09 July 90 3.56 8.66 12.22 August 86 3.54 8.62 12.16 September 72 3.76 8.68 12.44 October 98 3.88 8.75 12.63 November 76 3.92 8.73 12.65 December 66 3.86 8.66 12.52 Whole Year 923 3.67 8.65 12.32 Legal Minimum - 3.00 8.50 11.50 The average quality of the milk supply compares closely with that of previous years. The percentage of fat is again highest in November, from which month there is a gradual fall to the summer months, when the percentage of fat is the lowest. The legal minimum of 3.0 per cent. of fat could certainly be raised to 3.25 per cent. A sample of milk containing the average proportion of 3.7 per cent. of fat can be deprived of about one-fifth of its fat and would still be regarded as genuine. 82 There is little monthly variation in the percentages of solids-not-fat obtained, the highest figure—8.75 per cent.—occurring in October and the lowest—8.59 per cent.—in May. The highest average figure for solids-not-fat since 1921 has been 8.79 per cent., and this figure is slowly dropping, the lowest average figure—8.65 per cent.—being reached this year. The actual yearly averages are given below:— Year. Fat. Solids-not-fat. Total Solids. 1921 3.60 8.79 12.39 1922 3.69 8.71 12.40 1923 3.75 8.74 12.49 1924 3.68 8.70 12.38 1925 3.64 8.72 12.36 1926 3.71 8.71 12.42 1927 3.68 8.67 12.35 1928 3.67 8.65 12.32 In my first Annual Report I referred to the fact that good quality milks are "adjusted" to what is considered to be a margin of safety as compared with the legal standard, e.g., a sample of milk having a solids-not-fat content of 8.80 per cent. would require 3.4 per cent. of added water to bring it down to the legal minimum of 8.5 per cent. It is interesting to compare the quality of the Stepney milk supply with that obtained in other districts. The following figures have been obtained from recent Annual Reports:— Fat. Solids-not-fat. Total Solids. Salford 3.80 8.81 12.61 Birmingham 3.63 8.82 12.45 Lancashire 3.76 8.94 12.70 Hull 3.61 8.82 12.43 Kent 3.74 8.83 12.57 Portsmouth 3.67 8.83 12.50 Stepney,1928 3.67 8.65 12.32 It will be seen that although Stepney has a satisfactory average as regards fat content, the milk supply compares unfavourably with that of other districts as regards the average proportion of solids-not-fat. These figures suggest that Stepney milk is toned down by the addition of about 2 per cent. of water before it reaches the consumer, as the addition of this quantity would reduce 8.83 per cent. to 8.65 per cent., this latter figure 83 being still well above the legal minimum, and the sample of milk so treated would therefore be regarded as genuine milk. Similarly when a sample of milk is reported as containing 5 per cent. of added water, the actual water added is about 8 per cent., if the milk adulterated be one of average quality. In one case a milk vendor stated that he carried a lactometer to check the quality of the milk he received. The readings of this instrument which vary greatly with temperature and the fat content, for which factors he could make no correction, would be quite misleading. This may have accounted for his presence in the Police Court. Table H shows the extent of the adulteration and the action taken in each case. Table H. Number. Deficient in Fat. per cent. Deficient in Solids-not-fat = Added water per cent. Action; Result of Proceedings. A 9 6.6 Vender cautioned. A 10 - 6.2 Vendor cautioned. A 12 - 6.7 Vendor cautioned. A 18 - — Vendor cautioned. Contained 6 parts formaldehyde per million. G 17 5.0 — Vendor cautioned. X 66 13.7 19.3 Vendor fined £2 with £1 Is. costs. X 67 - 7.6 Vendor cautioned. T 10 - 5.5 Vendor cautioned. A 44 5.0 - Vendor cautioned. A 48 4.0 - Vendor cautioned. D 4 3.3 - Vendor cautioned. D 7 13.3 - Vendor cautioned. D 14 3.0 - Vendor cautioned. D 26 - 3.3 Vendor cautioned. L 48 12.7 — Vendor cautioned. N 5 - 6.3 Vendor paid £2 2s. costs. F 28 14.0 - Vendor cautioned. F 29 10.3 7.5 Summons withdrawn on payment of £3 3s. costs. B 20 - 7.6 Vendor paid £1 1s. costs. B 22 - 4.5 Vendor paid £1 1s. costs. P 57 - 4.0 Vendor cautioned. H 41 7.3 1.8 Vendor cautioned. H 55 5.0 — Vendor cautioned. 84 Table H (continued). Number. Deficient in Fat. per cent. Deficient in Solids-not-fat= Added water per cent. Action: Result of Proceedings. E 35 10.3 — Vendor paid £2 4s. costs. C 24 (A) 35.0 — Informal sample. N 31 - 4.6 Vendor cautioned. G 31 10.0 — Vendor paid £2 4s. costs. G 48 4.0 — Vendor cautioned. J 46 - — Vendor paid 17s. 6d. costs. Contained 5 parts formaldehyde per million. X 102 8.3 - Vendor cautioned. D 36 - 4.1 Summons dismissed on payment of £3 3s. costs. P 65 3.3 - Vendor cautioned. L 77 9.3 — Vendor paid £2 4s. costs. P 87 - 9.5 Summons dismissed on production of a warranty. 442 H. H. - 5.3 The wholesaler paid £5 5s. costs. D 72 - 5.3 Vendor cautioned. F 90 — 10.4 Vendor fined £5. B 102 - 6.8 Vendor cautioned. It will be seen from the above list of 38 adulterated samples of mi k that one sample was an informal one, and that in one case the summons was dismissed on production of a warranty. Of the remaining 36 samples, the vendor was cautioned in 24 cases, in 10 cases the vendor paid costs, and in only two cases was a fine imposed. There is a very marked increase in the adulteration of milk supplied in the Borough, the percentage of adul eration —4.1 per cent.—being the highest obtained since 1921. (See Table F). Butter. 164 samples were examined, and of these 14 samples were found to be adulterated. In 12 cases the adulteration consisted of the addition of boron preservative, and in 2 cases the sample was adulterated with margarine. The addition of any preservative to butter was prohibited from January 1st, 1928. The following samples contained boron preservative:— S 19 (Informal). Contained 0.02 per cent. boric acid. E 10 (Informal). Contained 0.02 per cent. boric acid. E 11 (Informal). Contained 0.02 per cent. boric acid. 85 E 12 (Informal). Contained 0.05 per cent. boric acid. E 22 (Same vendor as E 10). Contained 0.01 per cent. boric acid- Vendor cautioned. E 23 (Same vendor as E 11). Contained 0.03 per cent. boric acid. Vendor cautioned. E 24 (Same vendor as E 12). Contained 0.09 per cent. boric acid. Vendor cautioned. J 16 (Informal). Contained 0.03 per cent. boric acid. J 24 (Same vendor as J 16). Contained 0.02 per cent. boric acid. Vendor cautioned. T 40 (Informal). Contained 0.03 per cent. boric acid. A further sample purchased formally from the same vendor contained no preservative. B 28 (Informal). Contained 0.43 per cent. boron preservative expressed as boric acid. B 35 (Same vendor as B 28). Contained 0.40 per cent. boron preservative expressed as boric acid. Proceedings were taken against the vendor of this sample and against the wholesale dealer who had supplied the vendor. The case against the vendor was dismissed under the Probation of Offenders Acts, with 7s. 6d. costs. The wholesale dealer was fined £3 with £l 1s. costs. The following samples were adulterated with margarine:— N 61 (Informal). Contained at least 15 per cent. of margarine. P 98 (Same vendor as N 61). Contained not less than 10 per cent. of foreign fat of vegetable origin. The vendor of the above samples owns a margarine factory and also sells butter and margarine retail from a shop within a few yards of the factory. An Inspector of the Ministry of Agriculture and Fisheries obtained from the margarine factory samples of butter, which were certified by the Government Chemist to consist of butter containing 10 per cent. of margarine. Proceedings were taken against the owner for unlawfully manufacturing margarine containing more than 10 per cent. of butter fat. The Inspector stated that the margarine factory contained butter and margarine in the proportion of 6½ of butter to one of margarine, and that butter was blended on the premises; he was informed that the blended butter was to be repacked and used at a later date to improve margarine. (Margarine is allowed to contain not more than 10 per cent. of butter fat). The analyst for the defence stated that the 86 sample consisted of genuine butter. The magistrate expressed the opinion that what the prosecution alleged was being done, but as the two analysts disagreed the summons would be dismissed. As a sequel to this case, a series of samples of butter was taken by our inspectors from the retail shop. Ten samples in all were taken, and it was apparent from the composition of these samples that the butter was being consistently adulterated with small additions of margarine. Water was also being incorporated to the maximum legal limit of 16 per cent. In three cases the water present exceeded 16 per cent., and in 4 cases very slight traces of boric acid were present. Owing to the fact that butter is a natural product and therefore subject to variations in composition, the detection of small quantities of added margarine is an exceedingly difficult matter, as the resultant mixture may still give figures within the range of those said to be given by genuine butter. The ninth sample of the series P 98 was, however, definitely condemned as being adulterated with not less than 10 per cent. of foreign fat. The remainder, with the exception of N 61, an informal sample which was adulterated with at least 15 per cent. of margarine, and one sample bought at the highest price which was genuine, were reported as of suspicious or highly suspicious character. Legal proceedings were taken in the case of sample P 98. In a communication to our inspector, the solicitors for the defence stated that their analyst had certified the sample to be genuine, but that it contained a slight excess of water. They suggested that the Borough Analyst had made a mistake and that the summons should be withdrawn, and further that it was their intention to send the third part of the sample to the Government Chemist, and finally to rely on a warranty defence. The third part was sent to the Government Chemist, who stated that the sample consisted of "butter mixed with about 10 per cent. of margarine," thus confirming my analysis. The defence then raised a technical objection to the summons in that it was taken out under the new Food and Drugs (Adulteration) Act, 1928, which came into operation on January 1st, 1929, whereas the sample was taken under the old Acts on December 19th, 1928. The magistrate decided against the objection, upon which it was stated that an appeal would be made and the case was again adjourned. Later the decision to appeal against the magistrate's decision was withdrawn. At the next hearing a warranty defence was pleaded. Evidence was given that Argentine butter was received in square boxes in the basement, turned out from these boxes in the shop and " wired," forming a number of square blocks ; 87 it was also stated that the same butter which cost 1s. 7½d. per pound was sold at two prices, 1s. 8d. per pound and 1s. l0d. per pound. As our inspector had stated that the butter in the shop was cylindrical in shape and also as the same butter was sold at two different prices, the magistrate decided that the warranty defence could not stand. Leave was given to appeal. The magistrate then wished the differences in the three analytical certificates to be explained to him. This was done and it was pointed out how the figures obtained definitely showed the presence of a vegetable fat. Mr. Snell decided to convict and the defendant was fined £20 with £25 costs. Ground Ginger. Of 11 samples examined, 6 were found to be adulterated. These 6 samples all contained sulphur dioxide. P 50 Ground Ginger (Informal). Contained 30 parts sulphur dioxide per million. P 62 Dried Ginger (Same vendor as P 50). Contained 40 parts sulphur dioxide per million. Vendor cautioned. P 51 Ginger (Root). Informal. Contained 1,260 parts sulphur dioxide per million. P 61 Dried Ginger (Same vendor as P 51). Contained 1,250 parts sulphur dioxide per million. Vendor cautioned. C 22 Ground Ginger. (Informal). Contained 944 parts sulphur dioxide per million. C 32 Ground Ginger (Same vendor as C 22). Contained 990 parts sulphur dioxide per million. Vendor cautioned. An article of food may contain preservative if it is to be used in the preparation of one of the foods in which preservative is permitted. Ginger wines, alcoholic and non-alcoholic, may contain sulphur dioxide preservative. These are made from an alcoholic or aqueous extract of the ginger root. Cakes and puddings for which ground ginger is bought may not contain preservative, and therefore ground ginger or ginger bought for this purpose may not contain preservative. Margarine. 148 samples examined were genuine and all were free from added preservative. Practically all margarine is dyed, but in no case were any of the colouring matters prohibited by the Regulations detected. 88 Vinegar. Out of 23 samples examined, 6 samples were found to be adulterated. D 50 (Informal). 26.5 per cent. deficient in acetic acid. D 51 (Informal). 5.5 per cent. deficient in acetic acid. D 57 (Informal). 26.5 per cent. deficient in acetic acid. P 80 (Same vendor as D 50). 60.0 per cent. deficient in acetic acid. Vendor fined £l with £2 4s. costs. P 81 (Same vendor as D 51). 10.5 per cent. deficient in acetic acid" Vendor cautioned. A further sample purchased from the vendor of D 57 was genuine. N 88 57.0 per cent. deficient in acetic acid. Vendor cautioned. All the samples were sold as vinegar and consisted of artificial vinegar, that is, dilute acetic acid coloured with caramel. Cream. 20 samples of cream were genuine and free from preservatives and thickening substances. Preserved cream may no longer be sold, the addition of preservative to cream was prohibited from January 1st, 1928. The fat content of all the samples averaged 53.1 per cent. Fruit Wines, etc, Six beverages of various kinds were examined, particularly for the presence of preservatives and prohibited colouring matters. All the samples were genuine. The 6 samples comprised:— 2 samples "Kaola" and 1 sample of "Muscatel." These were free from any added preservative. 1 Lemon Squash. Contained 137 parts sulphur dioxide per million. 1 Orange Wine (non-alcoholic). Contained 259 parts sulphur dioxide per million, and 0.6 per cent. of alcohol. 1 Elderberry Wine. Contained 131 parts sulphur dioxide per million and 10.8 per cent. of alcohol. The samples were free from any other preservatives and prohibited colouring matters. Non-alcoholic wines, cordials, fruit juices, etc., are allowed to contain sulphur dioxide preservative up to a limit of 350 parts per million. Alcoholic wines are allowed to contain 450 parts sulphur dioxide per million. 89 Sausages. 12 samples analysed were found to be genuine. Two of these contained 163 and 25 parts of sulphur dioxide per million respectively. A maximum limit of 450 parts sulphur dioxide per million is permitted. In each case the presence of the preservative was declared by the vendor. Jam. Of 6 samples of jam, two contained 37 and 14 parts of sulphur dioxide per million respectively. All the samples were genuine. Jam must not contain more than 40 parts of sulphur dioxide per million. Drugs. Of 92 drugs examined, 4 or 4.3 per cent., were adulterated. J 27 Zinc Ointment (Informal). Deficient in zinc oxide to the extent of 11.3 per cent. A further sample from the same vendor was satisfactory. A 91 Ammoniated Tincture of Quinine (Informal). 15.8 per cent. deficient in ammonia. A 92 Ammoniated Tincture of Quinine (Informal). 14.9 per cent. deficient in ammonia. A 97 Ammoniated Tincture of Quinine (Same vendor as A 92). 15.8 per cent. deficient in ammonia. A repeat sample taken from the vendor of A 91 was of satisfactory strength. In the case of A 97 legal proceedings were taken. The vendor stated that he had had one pint of the tincture in stock for three days only and that it must have been received by him at practically the same strength as he had sold it. The wholesale chemists concerned made themselves responsible for his defence. A public analyst appearing for the defence agreed with the figures of analysis—his figures showed a 17.7 per cent. deficiency of ammonia as compared with the 15.8 per cent. deficiency shown above—but regarded the loss of ammonia as negligible and due to loss in filtration during manufacture and in opening the bottle while dispensing. Similar evidence was given by the analyst to the wholesale firm, but neither analyst produced figures to support his statements. For the prosecution, the results of a series of experiments made in this laboratory to ascertain the amount of loss of ammonia caused by dispensing a pint of the tincture in small quantities over a period of three days were 90 given. This loss amounted to less than 1 per cent. Further evidence for the prosecution was given by a public analyst and manufacturing chemist, who gave figures showing the slight loss of ammonia during manufacture. Although both chemists giving evidence for the defence had admitted the theoretical standard on which my certificate was based, a pamphlet was produced, described as "Local Government Dept., Revised Standard for Pharmacopoeial Preparations," which, it was stated, contained a standard for ammonia in the Tincture. No intimation as to the origin of this pamphlet was given, and the supposed standard was a minimum figure only. On inquiry at the Ministry of Health, it was stated that no such pamphlet could be traced, but it was eventually found that this was a publication of the Irish Free State. The case was adjourned a number of times and numerous points were raised and argued, but finally the vendor was fined £2 with £15 15s. costs. Poor Quality Samples. These include samples of inferior grade or of suspicious nature and consist chiefly of milk. 43 or 4.7 per cent. of the total milk samples showed slight deficiencies in either fat or solids-not-fat. Other poor quality samples comprised:—1 boric ointment (slightly deficient in boric acid), 1 jam (containing 15 per cent. of glucose), 2 ground ginger ("limed" ginger of inferior grade), and 1 baking powder which was deficient in available carbon dioxide. (There is no legal standard for available carbon dioxide in baking powder). To these are added 8 samples of butter, taken in connection with butter sample P 98, which were returned as being of suspicious or highly suspicious character. The Artificial Cream Aot 1929. This Act comes into operation on June 1st, 1929. Briefly this Act provides (1) that in any description of cream or artificial cream for sale, which is artificial cream, the word "cream" must be immediately preceded by the word "artificial"; (2) that receptacles used for conveying or containing artificial cream when exposed for sale must be labelled with the words "artificial cream" in large and legible type; 91 (3) that with certain specified exceptions premises where artificial cream is manufactured or sold must be registered; and (4) that cream or artificial cream sold on registered premises shall be presumed to be artificial cream unless the contrary is proved. In this Act "Artificial cream" means "an article of food resembling cream and containing no ingredient which is not derived from milk except water or any ingredient or material which may lawfully be contained in an article sold as cream." Note.—Reconstituted or artificial cream is indistinguishable from ordinary cream, either directly to the taste or when used in tea, etc., and it is manufactured in considerable quantity. It is made from dried separated milk, saltless butter and water combined in correct proportions so that the finished product contains about 50 per cent. of butter fat. The Food and Drugs (Adulteration) Act 1928. This Act, which came into force on January 1st, 1929, is described as an "Act to consolidate the Sale of Food and Drugs Acts." Since the first Food and Drugs Act in 1875 numerous Acts and Regulations safeguarding the purity of food have been introduced and it was hoped that the older Acts which contain many defects would be amended according to modern knowledge and requirements, and together with the many new Regulations would be consolidated to form one Act. Some obvious instances where legislation is required are:— (1) Misdescription of articles of food.—Custard powder and egg powder may have none of the constituents of either custard or egg. (2) Labelling of mixed articles.—Very small print is used to deceive the public. (3) Standards of composition.—There are no standards of composition for cheese, cream, cream cheese, etc. Unfortunately the consolidating Act now passed does not bring under one Act all the Acts and Regulations which concern public analysts and all interested in the production and control of food, and further the Act contains a number of inconsistencies and contradictions which should have been corrected, and in addition many defects of the old Acts are perpetuated. 92 Offences other than Adulteration. Margarine.—In 16 cases the vendor had not complied with the requirements of the Butter and Margarine Acts with regard to labelling. In 7 cases the sample had been purchased informally, in 2 cases the vendor was cautioned, and in the remaining cases legal proceedings were taken. D 31 Improperly labelled. Vendor paid £1 3s. costs. H 59 Unstamped wrapper. Vendor fined 7s. 6d. E 38 Improperly labelled. Vendor cautioned. N 58 Unstamped wrapper. Vendor cautioned. C 52 Improperly labelled. Vendor paid 7s. 6d. C 53 Improperly labelled. Vendor paid 7s. 6d. M 88 Improperly labelled. Vendor fined £l with 10s. 6d. costs. G 89 Unstamped wrapper. Vendor fined £1 with £2 2s. costs. J 94 Unstamped wrapper. Vendor fined £1 with £2 2s. costs. Milk.—In three cases for offences in connection with the omission of, or incorrect inscription of, the name and address of the vendor on the receptacle from which milk was sold, fines totalling £2 were imposed and costs amounting to £3 7s. were paid. In nine cases for offences in connection with the bottling of milk otherwise than on registered premises, fines totalling £9 10s. were imposed and costs amounting to £5 15s. 6d. paid. In one case in which "Grade A, Tuberculin Tested" milk was sold without a distributor's licence, the vendor paid £l 3s. costs. Miscellaneous Samples, Borough Electrical Engineer.—1 sample of Carbon Deposit was examined. The deposit was obtained from the cylinder of a motor vehicle which had been running on Ethyl Petrol, which contains Lead Tetraethyl. The sample was found to contain 17.1 per cent. of lead or 21.3 per cent. of lead on the oil free substance. From the total sample 2.86 jgrammes (=one tenth of an ounce) of metallic lead, mostly in a very finely divided state, were obtained. 93 Borough Engineer:—12 samples of Carbolic Powder and 2 samples of Disinfectant Fluid were submitted for analysis. Public Health Department.—14 samples examined for the Public Health Department consisted of:— Tinned Fruit 2, Pepper 2, Crystallised Fruit 1, Butter 1, Condensed Milk 1, Oleomargarine 1, Atophan 1, Eggs 1, Quaker Oats 1, Sweets 1, Bacon 1 and Carbolic Powder 1. I desire to express my appreciation of the able assistance given me in the laboratory by Mr. W. M. Paulley, B.A., F.I.C. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, DOUGLAS HENVILLE, Borough Analyst. Chemical Laboratory, 43, White Horse Street, E.l. May, 1929. 94 INDEX. A PAGE. Analyst's Report 77 to 93 B Bacteriological Examinations 11 Births 4 to 7 Bishopsgate Station, Food Inspection at 40 C Canal Boats Acts 37 Cancer 19 Cerebro-Spinal Fever 17 Clinics 36 Convalescent Treatment 33 Coroner's Court 42 Cowhouses 70 Creches 37 D Deaths 7 to 10, 74 Dental Clinic 29 Diphtheria and Membranous Croup 12 Disinfecting Station 43 E Encephalitis Lethargica 17 Enteric Fever 12 to 15 Epidemic Diarrhœa 18 Erysipelas 16 F Factory and Workshops Acts 67 to 69 Fines and costs (total) 62 Finsen Light Treatment 28 Food and Drugs Acts, samples taken, proceedings, etc. 77 to 93 Food Inspection 38 to 41 95 G PAGE. General Sanitary Work 45, 46 H Health Visitors, visits, etc. 31 Houses let in Lodgings 70 House to House Inspection 62 to 66 Housing 62, 70, 72 I Ice Cream Premises 70 Increase of Rent and Mortgage Interest (Restrictions) Acts 42 Infant Welfare Centres, etc. 32, 34 Infantile Mortality 30, 76 Infants, Feeding of 33 Infectious Diseases 10 to 17, 75 Influenza 19 Inquests and post-mortem examinations 42 L L.C.C. report 70, 71 M Marriages 7 Maternal Mortality 30 Maternity and Child Welfare 30 to 36 „ „ ,, ,, Committee 1 Measles 17 Membranous Croup 12 Milk Distribution Scheme 32 Milk (Special Designations) Order 42 Milkshops 70 Ministry of Health—Tables 1 and 4. Memo 37 T. 25 to 27 Tuberculosis notifications, summary of 22, 23 Housing statistics 72, 73 Maternity statistics 33 to 35 Mortuary and Coroner's Court 42 Municipal Centres, list of 35, 36 ,, ,, work at 32, 34 N Notifiable Diseases 10 to 17, 75 Notification of Births Acts 30 96 O PAGE. Offensive Trades 70 Ophthalmia Neonatorum 17 Outworkers 59 Overcrowding 43 to 45 P Phthisis, number of notifications and deaths 20, 21 Pneumonia, etc., Regulations 16 Pneumo-thorax treatment 28 Police Court Proceedings 48 to 62 Poliomyelitis 17 Population 3 Public Health Committee 1 Puerperal Fever and Puerperal Pyrexia 16 R Rats and Mice Destruction Act 42 Respiratory Diseases 18 Restaurants, etc. 70 S Sanitary Inspectors' Report 47 Scarlet Fever 11 Second-hand Clothing, disinfection of 43 Shelter 42 Slaughterhouses 70 Small-pox 11 Spotted Fever 17 Staff 2 Statistics:— Housing Conditions, etc. 70 to 73 Cases of Infectious Diseases notified 75 Causes of, and ages at death 74 Infantile Mortality 76 Table I and IV. Memo 37 T.—Work carried out at the Tuberculosis Dispensaries 25 to 27 Tuberculosis—Summary of notifications 22, 23 Maternity and Child Welfare 33 to 35 97 T PAGE. Tuberculosis 20 to 29 Tuberculosis Dispensaries, list of 37 ,, Dispensaries, Report on 24 to 27 ,, Employment of Patients 28, 29 ,, Other Forms, number of notifications and deaths 20, 21 ,, Summary of notifications 22, 23 ,, Tables I and IV. Memo 37 T. 25 to 27 ,, War Pension Cases 24 Typhus Fever 15, 16 U Unsound Food 38 to 41 V Verminous persons 43 Voluntary Centres 35, 36 W Water Certificates 42 Whooping Cough 18 Workshops 67, 68 Wrong Diagnosis of Infectious Disease 11 Z Zeebrugge—Harwich Train Ferry Service 40 Zymotic Diseases 19 • ■' •„ : . \ ■ - - ' . ■ ■ , ' ■