Metropolitan Borough of Stepney. ANNUAL REPORT For the Year 1932 BY J. M. BROWNE, M.B., B Cb., D.P.H., Medical Officer of Health AND Administrative Tuberculosis Officer. TOGETHER WITH THE REPORT OF THE PUBLIC ANALYST. 78.932 Vail & Co., Printers to the Council, 170, Farringdon Road, E.C.l. ' - • . . • . ■ ' ' Metropolitan Borough of Stepney. ANNUAL REPORT For the Year 1932 BY J. M. BROWNE, M B., B.Ch., D.P.H., Medical Officer of Health AND Administrative Tuberculosis Officer. TOGETHER WITH THE REPORT OF THE PUBLIC ANALYST. 4 Public Health Department, 43, White Horse Street, Stepney, London, E.l. May, .1933. To the Mayor, Aldermen and, Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to present to you my third annual report on the vital statistics and sanitary condition of the Borough of Stepney for the year 1932. A survey by an official of the Ministry of Health on the Public Health services of the Borough was undertaken during the months of May to July. I his dealt with the whole of the Public Health Department (including the 1 uberculosis and Maternity Sections), Public Cleansing, etc. The report of the Ministry of Health dated 4th November, states:— "I am directed by the Minister of Health to state that he has had under consideration the report made by his officers after their recent survey of the public health services of the Council. It appears that, so far as can be judged from a general survey, a reasonable standard of efficiency is being maintained in the administration of those services. In particular the Minister recognises that valuable work has recently been done in the development of the maternity and child welfare services, both directly and through voluntary associations, and that notable improvements and economies have resulted from the establishment of a separate department for the public cleansing service." The report went on to deal with matters of administration in reference to the Maternity and Child Welfare Scheme, the co-operation between various health services and the officers, and made suggestions as to the Tuberculosis work and the working of the Food and Drugs (Adulteration) Act, 1928. There was such a small number of cases of Small Pox occurring in the Borough that Chicken Pox ceased to become notifiable after 8th May. It is very encouraging to mention the big decline in the infantile mortality rate. In 1920 the rate was 90 per 1,000 births and now it is 61.6 per 1,000, the lowest rate ever recorded in the Borough. The average rate for the period 1890-1894 was 178 per 1,000. In view of the question raised in the House of Commons relative to maternal mortality, on the instructions of the Public Health Committee, I forwarded statistics on maternal deaths in the Borough during the past ten years to our three Members of Parliament and the Ministry of Health. The statistics compared remarkably well with England and Wales and with London as a whole, especially during the last four years, the rates of which are as follows:— Stepney. London. England & Wales. 1928 2.4 3.59 4.42 1929 2.7 3.6 4.33 1930 2.1 3.2 4.40 1931 2.2 3.8 4.11 This was a very interesting and noteworthy fact, as one of the reasons for ameliorating slums is that better home conditions lead to fewer deaths of mothers in childbirth. 5 We have been suffering somewhat lately from publicity, both in the newspapers and wireless talks on the "Stepney Slums." In view of the fact that our maternal mortality was among the lowest in London, I think it is most important that attention should be called to this fact. There is no doubt that these very good figures are due to the fact that a large number of women go into hospital for their confinement, where they are under the best conditions and away from home worries, e.g., overcrowding and housekeeping on small means. A very sad case was that of a woman who after her confinement heard two of her children quarrelling and she jumped up out of bed to stop them. She fell back dead, the cause of death being pulmonary embolism following childbirth. All the services of the Public Health Department have been well maintained during the year as my report will show. It is with pleasure that I draw attention here to the wonderfully successful health week and exhibition which we arranged at the Whitechapel Art Gallery during the week 15th to 20th February. 34,000 persons visited the exhibition during that week, and there was no doubt that the exhibition itself was a tremendous draw, being partly trade and partly stalls representing our own various activities. A health exhibition is useful in this way, that people come to visit it and when there, they are encouraged to attend the various health lectures proceeding elsewhere in the building. A health week on a big scale is hardly necessary every year but alternatively lectures on health subjects can be given at various halls throughout the Borough. In March the London County Council considered the question of inquest accommodation in London and decided that no further inquests were to be held at our Coroner's Court, Branch Road. I am glad to say that after correspondence with them pointing out the accessibility of the place they decided to still use it as in previous years. This being my last Annual Report, I wish to take this opportunity of stating that I appreciate the honour that the Council has done me in making me the first woman Medical Officer of Health in London. I have been very happy in the work, and I hope I have carried out my duties to the credit of the Council in this very important Borough a Borough which is rich in its large commercial industries and fruit markets to mention only a few of its many activities. My thanks are due to the members of the Council and of the various Committees which I attended, for their kind support and guidance, and to the chief officials of each department, particularly to Mr. W. L. McCarty, the Town Clerk, during my time as Medical Officer of Health, for their warm co-operation and help. My thanks are also due to Dr. Ferguson, my deputy, and Mr. Lellow, the Chief Clerk, who have worked with energy and enthusiasm, and also to the whole Staff for assisting me in the work of the department. I remain, yours obediently, J. M. Browne, Medical Officer of Health. 6 SUMMARY OF STATISTICS, 1932. Area of Borough (in acres) 1902.766 Population (Census 1931) 225,238 Number of inhabited houses (end of 1932) according to Rate Books 37,900 Rateable; value £1,720,722 Sum represented by a penny rate £6,849 Total. Male. Female. Live Births Legitimate 3,617 1,854 1,763 Illegitimate 111 58 53 Birth rate 16.7 Still Births 120 62 58 Deaths 2,754 1,512 1,242 Rate per 1,000 total births 32 Death rate 12.3 Number of women dying in, or in consequence of childbirth : From sepsis 3 From other causes 7 Death rate of Infants under one year of age per 1,000 live births : Legitimate 61.6. Illegitimate 63. Total death-rate 61.6. Deaths from Measles (all ages) 67 ,, ,, Whooping Cough (all ages) 12 ,, ,, Diarrhœa (under 2 years of age) 45 ,, ,, Respiratory Tuberculosis 190 ,, ,, Other Tuberculous Diseases 30 ,, ,, Cancer 379 ,, ,, Heart Disease 578 ,, ,, Zymotic diseases 154 1.- STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Population. The Census taken on the 26/27 April, 1931, ascertained that Stepney had a population of 225,238 persons—110,087 males and 115,151 females. This represents a decrease of 54,566 over that of 1911 and 24,419 over that of 1921. The estimate of the Registrar-General to the mid-year 1932 is 223,000. Births. The total number of births of Stepney residents during the year was 3,728 —1,912 males and 1,816 females—or 282 less than in the previous year. 1,000 of the births belonged to Limehouse. 614 of the births belonged to St. George-in-the-East. 7 1,492 of the births belonged to Mile End Old Town. 622 of the births belonged to Whitechapel. The birth-rate was 16.7 per 1,000 of the population. 3,929 births occurred in Public Institutions in the Borough; of which 2,200 belonged to Stepney and 1,729 belonged to other Boroughs. 1,420 births occurred in the East End Maternity Hospital:— 173 belonged to Mile End Old Town. 240 belonged to Limehouse. 42 belonged to Whitechapel. 65 belonged to St. George-in-the-East. 900 belonged to outlying Districts. 662 births occurred in the London Hospital:— 114 belonged to Mile End Old Town. 58 belonged to St. George-in-the-East. 46 belonged to Limehouse. 81 belonged to Whitechapel. 363 belonged to outlying Districts. 304 births occurred in the St. George-in-the-East Hospital:— 198 belonged to St. George-in-the-East. 51 belonged to Limehouse. 6 belonged to Mile End Old Town. 35 belonged to Whitechapel. 14 belonged to outlying Districts. 625 births occurred in the Mile End Hospital:— 420 belonged to Mile End Old Town. 134 belonged to Limehouse. 5 belonged to St. George-in-the-East. 7 belonged to Whitechapel. 59 belonged to outlying Districts. 161 births occurred in the St. Peter's Hospital:— 101 belonged to Whitechapel. 12 belonged to St. George-in-the-East. 21 belonged to Mile End Old Town. 1 belonged to Limehouse. 26 belonged to outlying Districts. 157 births occurred at 24, Underwood Street:— 161 belonged to Mile End Old Town. 142 belonged to Whitechapel. 63 belonged to St. George-in-the-East. 24 belonged to Limehouse. 367 belonged to outlying Districts. Births in Public Institutions in the Borough 8 Births in Outlying Districts. 16.1 births occurred outside the Borough, the parents being residents of Stepney. 25 belonged to Limehouse. 14 belonged to St. George-in-the-East. 62 belonged to Mile End Old Town. 60 belonged to Whitechapel. Triplets. One set of triplets was born in the Borough during the year. Notification of Births Act. The Notification of Births Act applies to the notification of any child which is born after the 28th week of pregnancy whether alive or dead. The number of births notified was 3,843—3,738 live births and 105 stillbirths. 2,612 were notified by midwives and 1,231 by doctors and parents. Marriages. The total number of marriages which took place during the year was 2,050, or 6 more than in the previous year. The proportion of persons married was 18.3 per .1,000 of the population. Deaths, The total number of deaths, after deducting deaths of non-residents who died in the Borough and adding those residents who died in Outlying Institutions was 2,754—1,512 males and 1,242 females—or 204 less than in the previous year. 612 of the deaths belonged to Limehouse. 438 of the deaths belonged to St. George-in-the-East. 1,031 of the deaths belonged to Mile End Old Town. 673 of the deaths belonged to Whitechapel. The death-rate for the whole Borough was 12.3 per .1,000 of the population. Deaths in Public Institutions in the Borough 2,115 deaths occurred in Public Institutions in the Borough, of which 1,381 belonged to Stepney and 734 belonged to other Boroughs. Belongingto Stepney, Belonging to other Boroughs East End Maternity Hospital, Commercial Road 13 26 Princess Elizabeth of York Hospital for Children, Shadwell 42 66 London Hospital, Whitechapel Road 161 507 London Jewish Hospital, Stepney Green 62 23 Mile End Hospital, Bancroft Road 360 24 St. George's Hospital, Raine Street 315 12 St. Peter's Hospital, Vallance Road 295 45 Sick Room Help Society, 24, Underwood Street 6 11 Stepney Institution, South Grove 127 20 9 There were 465 deaths of persons belonging to the Borough in various Institutions outside the Borough:— Mental Hospitals:— Bigods Hall, Gt. Dunmore 1 Cane Hill, Bexley 6 Fountain Hospital, Wandsworth 3 Horton, Epsom 7 Leavesden 6 Peckham House, Camberwell 1 Royal Earlswood Institution, Redhill 1 Tooting Bec 36 The Infirmary, Friern Barnet 39 Three Counties Hospital, Biggleswade 1 la, Manor Road, Ilford 25 1, Uxbridge Road, Norwood 3 1, West Park Road, Epsom 1 Hospitals for Infectious Diseases:— Brook Fever Hospital 12 Eastern Fever Hospital 27 Grove Fever Hospital 1 Joyce Green Fever Hospital 1 North-Eastern Fever Hospital 18 Park Fever Hospital 13 South-Eastern Fever Hospital 9 South-Western Fever Hospital 3 Hospitals and Institutions:— Albert Dock Hospital, West Ham 1 All Saints Hospital, Southwark 1 Ashford Hospital, Ashford 1 Bromley and District Hospital 1 Brompton Hospital 2 Cancer Hospital, Fulham Road 3 Central London Throat Hospital 1 Charing Cross Hospital 2 Charity Farm, Fareham 1 Children's Hospital, Great Ormonde Street 2 Chest Hospital, Bethnal Green 7 Colindale Hospital 5 Daneswood Sanatorium 2 Darenth Training Colony 1 Down's Hospital, Surrey 2 East Anglian Sanatorium, Nayland 1 East Ham Memorial Hospital 1 Deaths in Outlying Districts, 10 Hospitals and Institutions—continued. French Hospital 1 Fulham Hospital, Fulham 1 Grosvenor Sanatorium, East Ashford 1 Grove Park Hospital 2 Guy's Hospital 5 Holy Cross Hospital, Farnham 1 Home and Hospital for Jews, Tottenham 8 Lambeth Hospital 6 London Temperance Hospital 1 Makings Farm Sanatorium 4 Metropolitan Hospital, Kingsland Road 6 Middlesex Hospital 9 Mildmay Mission Hospital 4 Military Hospital, Tidworth 2 Mount Vernon Hospital 2 National Hospital, Queen's Square, W.C. 2 Northern Hospital, Southgate 1 Poplar Hospital 11 Princess Beatrice Hospital 1 Prince of Wales Hospital, Tottenham 2 Queen Charlotte's Hospital 1 Queen Mary's Hospital, Carshalton 4 Queen's Hospital for Children 4 Redhill Hospital, Hendon 1 Royal Free Hospital 3 Royal Herbert Hospital, Greenwich 1 Royal National Orthopaedic Hospital 1 Royal United Hospital, Bath 2 Royal Victoria Hospital, Folkestone 1 St. Albans and Mid. Herts Hospital 1 St. Bartholomew's Hospital 17 St. Benedict Hospital 1 St. Columbus Hospital, Hampstead 3 St. George's Hospital, Westminster 3 St. John of God Hospital, Richmond 1 St. John and Elizabeth Hospital 2 St. Joseph's Hospice 3 St. Luke's Hospital, Paddington 1 St. Margaret's Hospital, St. Pancras 1 St. Nicholas Hospital, Woolwich 2 St. Peter's Hospital, Westminster 1 St. Thomas' Hospital 1 Seaside Convalescent Hospital, Seaford 1 Seamen's Hospital, Greenwich 9 11 Hospitals and Institutions—continued. Southend Hospital, Southend 2 The Retreat, Billericay 1 The German Hospital 7 University Hospital 4 Wandle Valley Hospital, Carshalton 1 West End Hospital, St. Pancras 1 Westminster Hospital 1 2a, Bow Road, Poplar 21 179a, Bishop's Road, Bethnal Green 1 5, Brunswick Square, Camberwell 1 214a, Cambridge Road, Bethnal Green 3 73a, Devons Road, Poplar 12 230, High Street, Homerton 2 86, High Street, Poplar 8 204, Hoxton Street 1 48a, Lower Road, Rotherhithe 1 107, Nightingale Lane, Wandsworth 8 1, Old Church Road, Romford 2 46, Onsley Road, Balham 1 48, Vanburgh Hill, Greenwich 2 Vicarage Road, Watford 1 82, Westmoreland Road, Walworth 1 In addition there were 20 deaths of Stepney residents in private houses outside the Borough. The number of deaths from cancer was 379, or 37 more than in the previous year. 64 belonged to Limehouse. 54 belonged to St. George-in-the-East. 161 belonged to Mile End Old Town. 100 belonged to Whitechapel. The death-rate for the whole Borough was 1.6 per 1,000 of the population. 182 were between 45 and 65 years of age—103 males and 79 females 111 were between 65 and 75 years of age—65 males and 46 females 51 were 75 years of age and over—25 males and 26 females. The organs and parts of the body affected were as follows:— Male. Female. Mouth, Throat and alimentary canal 121 66 Abdominal 2 7 Genital organs 4 27 Breast — 22 Skin 3 2 Lung and Pleura 24 10 Brain and Meninges 4 3 Bones 5 2 Other specified Organs 40 31 Other undefined 6 — Totals 209 170 Cancer. 12 Heart Disease There were 578 deaths from Heart disease (296 males and 282 females) or 53 more than in the previous year. 107 belonged to Limehouse. 70 belonged to St. George-in-the-East. 233 belonged to Mile End Old Town. 108 belonged to Whitechapel. The death-rate for the whole Borough was 2.5 per 1,000 of the population. Diseases of the Respiratory Organs. The number of deaths from diseases of the Respiratory Organs (excluding Tuberculosis) was 432, or 155 less than in the previous year. 116 belonged to Limehouse. 67 belonged to St. George-in-the-East. 145 belonged to Mile End Old Town. 104 belonged to Whitechapel. The death-rate for the whole Borough was 1.9 per 1,000 of the population. Zymotic Diseases. The total deaths from diseases of a Zymotic character was 154, or 11 more than in the previous year. They include all deaths from Small Pox, Scarlet Fever, Diphtheria, Typhoid Fever, Measles, Whooping Cough and Diarrhoea. 49 belonged to Limehouse. 29 belonged to St. George-in-the-East. 54 belonged to Mile End Old Town. 22 belonged to Whitechapel. The death-rate for the whole Borough was .69 per 1,000 of the population. Influenza The number of deaths from Influenza was 22, or 4 less than in the previous year. 7 belonged to Limehouse. 3 belonged to St. George-in-the-East. 6 belonged to Mile End Old Town. 6 belonged to Whitechapel. The death-rate for the whole Borough was .09 per 1,000 of the population. Diarrhoea. There were 15 deaths from Diarrhoea, or 21 less than in the previous year. 5 belonged to Limehouse. 10 belonged to St. George-in-the-East. 18 belonged to Mile End Old Town. 12 belonged to Whitechapel. The death-rate for the whole Borough was .2 per 1,000 of the population. 41 of the deaths, or 91 per cent. were under one year of age. 13 The number of deaths from Whooping Cough was 12, or 17 less than in the previous year. 9 belonged to Limehouse. 1 belonged to St. George-in-the-East. 2 belonged to Mile End Old Town. The death-rate for the whole Borough was .05 per 1,000 of the population. Whooping Cough. There were 67 deaths from Measles, or 43 more than in the previous year. 30 belonged to Limehouse. 9 belonged to St. George-in-the-East. 20 belonged to Mile End Old Town. 8 belonged to Whitechapel. The death-rate for the whole Borough was .3 per 1,000 of the population. Measles. There were 220 deaths from Tuberculosis or 34 less than in the previous year. Pulmonary Non-Pulmonary Males. Females. Males. Females. Limehouse 30 15 7 3 St. George-in-the-East 24 6 5 5 Mile End 45 21 5 2 Whitechapel 39 10 2 1 Totals 138 52 19 11 The death-rate for the whole Borough was .9 per 1,000 of the population. Tuberculosis* There were 279 deaths from Pneumonia, or 38 less than in the previous year. 159 were over 45 years of age. 70 belonged to Limehouse. 51 belonged to St. George-in-the-East. 94 belonged to Mile End Old Town. 64 belonged to Whitechapel. The death-rate for the whole Borough was 1.2 per 1,000 of the population. Pneumonia. 230 infants died under one year of age, or 83 less than in the previous year. 69 belonged to Limehouse. 48 belonged to St. George-in-the-East. 72 belonged to Mile End Old Town. 41 belonged to Whitechapel. The infant mortality-rate for the whole Borough was 61.6 per 1,000 births. 7 of the deaths were illegitimate children. Infantile Mortality. The number of registered unemployed on the 30th January, 1933, was 10,521 men, and 2,241 women. The following figures show the grants of outdoor relief in the Stepney district during the last weeks in January and December : — Weekended Men. Women. Children. Total Persons. 30th January, 1932 ... 2,078 3,213 3,473 8,764 31st December, 1932 ... 2,045 3,062 3,344 8,451 Social Conditions. 14 Infantile Mortality. It is gratifying to record the wonderful decrease in infantile mortality in the past year as compared with other years. The following table shows the death rate of children under one year of age since 1920. 1920 90 per 1,000 births. 1925 73 per 1,000 births. 1929 88 per 1,000births. 1921 89 ,, „ 1926 65 „ 1930 76 ,, 1922 79 ,, ,, 1927 68 „ „ 1931 78 ,, 1923 62 ,, „ 1928 71 ,, „ 1932 61.6,, 1924 74 ,, The deaths from stated causes at various ages under one year of age are shown in the table below:— 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 M. 27 9 4 3 43 11 34 16 21 125 F. 22 6 3 4 35 22 22 13 13 105 Uncertified ... ... ... ... ... ... ... ... ... ... ... Small-pox M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Chicken-pox M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Measles M. ... ... ... ... ... ... ... 1 8 9 F. ... ... ... ... ... ... ... ... 3 3 Scarlet Fever M. • • • ... ... ... ... ... ... ... ... ... F. ... ... ... • • • ... ... ... ... ... ... Diphtheria and Croup M. ... 1 ... ... 1 ... ... ... ... 1 F. ... ... ... ... ... ... ... 1 ... 1 Whooping Cough M. ... ... ... ... ... ... ... 2 2 4 F. ... ... ... ... ... 1 ... 1 1 3 Diarrhoea M. ... ... ... ... ... ... 1 3 ... 4 F. ... ......... ... ... ... 1 ... 1 ... 2 Enteritis M. ... ... ... ... ... 2 15 2 1 20 F. ... ... ... 1 1 3 5 5 2 16 Tuberculous Meningitis M. ... ... ... ... ... ... 2 ... 1 3 F. ... ... ... ... ... ... 1 ... ... 1 Abdominal Tuberculosis (b) M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Congenital Malformations (c) M. 4 2 ... 1 7 1 1 ... ... 9 F. 4 ... 1 ... 5 1 1 ... ... 7 Premature Birth M. 10 3 ... ... 13 1 ... ... ... 14 F. 15 1 1 1 18 1 ... ... ... 19 Atrophy, Debility & Marasmus M. 1 ... 1 1 3 3 1 ... 1 8 F. 1 1 ... ... 2 3 ... ... ... 5 Atelectasis M. 4 ... ... ... 4 1 ... ... ... 5 F. 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth M. 3 ... ... ... 3 ... ... ... ... 3 F. 1 1 ... ... 2 ... ... ... ... 2 Erysipelas M. ... ... ... ... ... ... ... ... ... ... F. ... ... • •• ... ... ... ... ... ... ... Syphilis M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... 1 1 ... ... 2 Rickets M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) M. ... ... ... ... ... ... 1 1 ... 2 F. ... ... 1 1 1 ... 3 Convulsions M. 1 ... ... ... 1 ... ... ... ... 1 F. ... ... ... ... ... ... 1 ... ... 1 Gastritis M. ... 1 1 ... 2 ... 1 ... ... 3 F. ... ... ... ... ... 1 ... ... ... 1 Laryngitis M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Bronchitis M. ... 1 ... 1 2 ... 2 ... 3 7 F. ... ... ... ... ... 1 2 ... 1 4 Pneumonia (all forms) M. 2 1 1 1 5 2 6 6 3 22 F. ... 3 1 1 5 6 8 3 3 25 Suffocation, overlying M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Other causes M. 2 ... 1 ... 3 1 4 1 2 11 F. ... ... ... ... ... 2 2 1 3 8 Totals 49 15 7 7 78 33 66 29 34 230 15 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF STEPNEY. CAUSES OF DEATH. Sex. All Ages 0— 1— 2— 5— 15— 25— 45— 65— 75— ALL CAUSES M. 1212 125 38 34 30 58 146 499 350 232 F. 1242 105 46 36 36 51 111 309 291 257 1. Enteric Fever M. 1 - — — — 1 — — — — F. - - — — — - — — - — 2. Measles M. 37 9 11 13 4 — — — — — F. 30 3 16 10 1 — — — — — 3. Scarlet Fever M. 3 — — — 3 — — — — — F. 4 — 2 2 — — — — — — 4. Whooping Cough M. 6 4 2 — — — — — — — F. 6 3 3 — — — — — — — 5. Diphtheria M. 8 1 1 4 2 — — — — — F. 14 1 2 6 5 — — — — — 6. Influenza M. 11 — — — — 1 2 5 2 1 F. 11 — 1 1 1 1 — 2 3 2 7. Encephalitis Lethargica M. 5 — — — — 1 1 2 1 — F. — — — — — — — — — 8. Cerebrospinal Fever M. 8 — — 2 1 2 3 — — — F. 11 3 — 3 1 1 1 2 — — 9. Tuberculosis of respiratory system M. 138 — I — 1 19 47 56 12 2 F. 52 1 2 — 1 12 21 13 9 — 10. Other Tuberculous diseases M. 19 2 2 1 2 4 6 2 - — F. 11 — 1 2 3 2 1 1 1 — 11. Syphilis M. 7 — — 1 — 2 4 - — F. 4 2 — — — - - — 1 1 12. General Paralysis of the Insane, Tabes dorsalis. M. 9 — - — — — 3 5 1 — F. 1 - - — — - - 1 - — 13. Cancer, Malignant disease M. 209 1 - — — 1 14 103 65 25 F. 170 — - — — 4 15 79 46 26 14. Diabetes M. 21 — 1 — — - 2 12 3 3 F. 26 - - — — — 2 11 11 2 15. Cerebral haemorrhage, etc. M. 96 2 - - - — 2 27 36 29 F. 90 - - - - 1 3 28 32 26 16. Heart disease M. 296 5 1 1 1 6 11 91 100 80 F. 282 1 1 - 4 7 19 64 95 91 17. Aneurysm M. 5 - - — — — 2 3 — — F. 3 - - — — — 1 — 1 1 18. Other circulatory diseases M. 37 - - — — — — 11 18 8 F. 25 - - - - - - 6 12 7 19. Bronchitis M. 72 6 1 - - - - 30 21 14 F. 62 6 - — — 1 1 15 15 24 Causes of death at age periods. 16 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF STEPNEY. CAUSES OF DEATH. Sex. All Ages. 0— 1— 2— 5— 15— 25— 45— 65— 75— 20. Pneumonia (all forms) M. 144 22 11 4 3 2 12 36 35 19 F. 135 24 12 6 7 5 12 25 29 15 21. Other respiratory diseases M. 15 2 - — — 1 — 7 2 3 F. 4 — - — — — — 2 1 1 22. Peptic Ulcer M. 22 — - — — — 2 17 3 - F. 3 — - — — — - 3 - - 23. Diarrhoea, etc. (Under 2 years) M. 27 23 4 — — — - — - - F. 18 18 - - - - - - - - 24. Appendicitis M. 10 — — — 2 2 2 4 - - F. 6 - - - 2 1 1 1 - 1 25. Cirrhosis of Liver M. 4 - — — - - 2 2 - - F. 4 - - - - - 1 1 1 1 26. Other diseases of liver, etc M. 6 1 - - - - 2 3 - - F. 11 1 - - - - 1 4 4 1 27. Other digestive diseases M. 21 5 - - - - 1 12 3 - F. 20 1 - - - 2 2 7 8 - 28. Acute and chronic nephritis M. 45 1 — — — 2 3 14 13 12 F. 48 - - - 1 5 4 17 9 12 29. Puerperal sepsis F. 3 - - - - 1 2 - - - 30. Other puerperal causes F. 7 - - - - - 7 - - - 31. Congenital debility, premature birth, malformations, etc. M. 37 37 - - - - - - - - F. 34 34 - - - - - - - - 32. Senility M. 29 - - - - - - 1 5 23 F. 38 - - - - - - 2 4 32 33. Suicide M. 26 - - - - - 7 12 6 1 F. 9 - — — - - 2 6 1 - 34. Other violence M. 63 - — 4 8 9 11 18 8 5 F. 38 1 1 2 3 3 2 8 10 8 35. Other defined causes M. 75 4 3 5 2 7 9 22 16 7 F. 62 6 5 4 7 5 13 11 5 6 36. Causes ill-defined or unknown M. — — - - - - - - - - F. - — — — — — — — — — Totals 2,754 230 84 70 66 109 257 808 641 489 Special Causes:— * Included in No. 35 above Polio Myelitis M. 2 - 1 - - - - 1 - - F. 2 - 2 - - - - - - - * Do. Tetanus M. 1 - - - - - 1 - - - F. - - - - - - - - - - * Do. Anthrax M. 1 - - - - - l - - - F. - - - - - - - - - - * Do. Erysipelas M. 1 - — - - - - - - 1 F. 1 - — - — - 1 — — - 17 II. GENERAL PROVISION OF HEALTH SERVICES. There have been few changes in the staff during the year. Miss Goodfellow, a Health Visitor, ceased duty on the 20th August owing to her having reached the age limit. The vacancy thus caused will be filled in the coming year. The Council decided to continue the services of Mr. Roper, who had been engaged as a temporary Sanitary Inspector for three years. Mr. H. J. Mead, a temporary clerk, left the service of the Council in May to take up a position elsewhere. Messrs. S. Lowther and J. Keniry, temporary clerks, were placed on the permanent staff to fill the vacancies caused by two clerks having been made permanent Sanitary Inspectors. With regard to the vacancy for Tuberculosis Officer at the Shadwell Dispensary, Dr. W. J. Auld is still carrying on in a temporary capacity. Staff. A list of the staff of the Public Health Department and their qualifications is given on page 3. The arrangements made with the East London Nursing Society for the nursing of cases of Measles, Pneumonia following Measles, Ophthalmia Neonatorum, Puerperal Fever, Puerperal Pyrexia and Pemphigus Neonatorum were continued. The Council pay this Society 1s. 3d. per visit to such cases and 1,321 visits were made by them during the year, i.e., 1,255 Measles, 58 Ophthalmia Neonatorum and 8 Pemphigus Neonatorum. Nursing in the home. There are 11 midwives practising in the Borough, and in addition there are 2G employed by the voluntary associations. Midwives. The midwives are under the supervision of the London County Council. The Council has arrangements with the London County Council for the bacteriological examination at the Mile End Hospital of certain specimens sent by medical practitioners. Laboratory Facilities. The number of bacteriological examinations made on behalf of the Public Health Department during the year was 2,204. These consisted of:— No. No. Positive. Negative. Totals Swabs (for Diphtheria bacilli) 236 1,966 2,202 Blood (for Typhoid bacilli) — 2 2 There were 399 specimens of sputa examined at our Tuberculosis Dispensaries for general practitioners. 39 of these were found to be positive. 1—The Agricultural Produce (Grading and Marking) (Malt Flour and Malt Extract) Regulations, 1932. The Regulations prescribe grade designations to indicate the quality of malt flour produced from barley and/or wheat grown in England and Wales, also certain grade designation marks. The Regulations came into operation on the 16th February. The Regulations of 1929 are revoked. Legislation during the Year. 18 2.—The Importation of Raw Cherries Order, 1932. This Order was made for the prevention of the introduction of the Cherry Fruic Fly. The Order imposes certain restrictions on the importation of raw cherries grown in France, Italy and Germany. The Order came into operation on the 3rd May. 3.—The Agricultural Produce (Grading and Marking) (Plums) Regulations, 1932. The Regulations prescribe grade designations to indicate the quality of plums produced 'n England and Wales, and grade designation marks The Regulations came into operation on the 18th May. 4.—The Agricultural Produce (Grading and Marking) (Bottled Fruits) Regulations, 1932. The Regulations prescribe grade designations to indicate the quality of plums (including greengages, damascenes and damsons), loganberries, black currants, cherries, raspberries, red currants, blackberries, bilberries, gooseberries, and apples, produced and bottled an England and Wales, also grade designation marks. The Regulations came into operation on the 25th May. 5.—The Agricultural Produce (Grading and Marking) (Bottled Vegetables) Regulations, 1932. The Regulations prescribe grade designations to indicate the quality of peas, beans, asparagus, beetroots, carrots, turnips and rhubarb, produced and bottled in England and Wales, also grade designation marks. The Regulations came into operation on the 25th May. 6.—The Agricultural Produce (Grading and Marking) (Honey) Regulations, 1932. The Regulations prescribe grade designations to indicate the quality of all honey made by bees from nectar in England and Wales, and also certain grade designation marks. The Regulations came into operation on the 17th June. 7.—The Merchandise Marks (Imported Goods) No. 1 Order, 1932. The Order relates to the sale or exposure for sale in the United Kingdom of any imported butter. Such commodity must be marked in accordance with the provisions of the Order. The Order came into force on the 17th June. 8.—The London County Council (General Powers) Act, 1932. This Act deals with the notification of cases or suspected cases of food poisoning, the registration of food premises, and amends certain sections of previous Acts respecting the registration of ice cream premises. 19 All the medical practitioners of the Borough were circulated as to the notification of food poisoning. During the year 23 cases were notified, but none of them was of a serious character. Particulars of the cases were forwarded to the London County Council. In my opinion suspected cases should not be notifiable, and medical practitioners before notifying cases should have in mind which article of food was suspect. In many cases, the patient's illness could not be attributed to any particular food and in nearly every case other members of the family were not affected. With regard to the registration of food premises, power is given to the London County Council to make bye-laws respecting such premises. The bye laws have not yet been made. The Act received the Royal Assent on the 12th July. 9.—The Agricultural Produce (Grading and Marking) (Canned Fruits) (Amendment) Regulations, 1932. The Regulations prescribe grade designations to indicate the quality of Select Dessert Cherries, and Select Morello Cherries, produced and canned in England and Wales, also grade designation marks. The Regulations came into operation on the 24th August. 10.—The Agricultural Produce (Grading and Marking) (Cider) Regulations, 1932. I hese Regulations prescribe grade designations to indicate the quality of cider produced from apples and pears grown in England and Wales and also certain grade designation marks. The Regulations came into operation on the 24th August. The previous Regulations of 1931 are revoked. 11.—'The Importation of Meat, etc. (Wrapping Materials) Order, 1932. This Order relates to (a) Imported Meat to be wrapped in cloths of prescribed pattern; (b) the prohibition of landing of feeding stuffs, fertilisers or horticultural produce packed in bags or sacks made from meat wrappers; and (c) the prohibition against packing, carrying, selling, feeding, or using for animals, of feeding stuffs or bedding, or of fertilisers or horticultural produce, in sacks made from meat wrappers. The Order came into operation on the 1st November. 20 Hospital facilities. There are adequate hospital facilities in the Borough, and the following is a list of them showing particulars of each:— Situation. No. of beds. In-patients admitted during the year. Out-patients. No. dealt with during the year. Purpose. Management London Hospital, Whitechapel Road. Male 420 14,634 101,242 General. Voluntary. Female 419 Mile End Hospital, Bancroft Road. Male 155 6,315 4,461 General. L.C.C. Female 278 Children 140 St. George-in-the-East Hospital, Raine Street. Male 202 5,022 6,189 General. L.C.C. Female 208 St. Peter's Hospital, Vallance Road. Male 220 4,323 5,327 General. L.C.C. Female 186 Children 68 South Grove Institution, South Grove. Male 444 550 - General. L.C.C. Female 237 London Jewish Hospital, Stepney Green. Male 40 1,394 16,758 General. Voluntary. Female 51 Children 12 Other 5 Princess Elizabeth of York Hospital for Children, Glamis Road. Children 140 1,834 13,868 General. Voluntary. East End Maternity Hospital, Commercial Road. 56 1,466 472 Maternity. Voluntary. Jewish Maternity Hospital, Underwood Street. 30 793 115 Maternity. Voluntary. The Borough Engineer has kindly supplied me with the following information:— Baths & Washhouses. The Baths and Washhouses Committee is responsible for the management and supervision of four bathing establishments in the Borough. The premises are situated as follows:— Mile End Municipal Baths.—Mile End Road. Whitechapel Baths.—Goulston Street. St. George's Baths.—Betts Street. Ratcliffe Baths.—White Horse Street. 21 The accommodation provided is as set out hereunder:— Mile End. Whitechapel. St. George's Ratcliffe Warm Baths. Ladies' 1st class 20 25 9 2 '2nd ,, 40 50 11 7 Gent's 1st ,, 15 28 13 4 ,, 2nd ,, 35 59 19 15 Swimming Bath. 1st class 1 (85'*30') 1 99'*32') — — 2nd ,, — 1 75' *27'6") 1 (73'6"*30') — Ladies' special bath. — 1 66'*25') — — Swimming Bath dressing accommodation 1st class 52 boxes 59 boxes — — — 84 lockers - - 2nd ,, — 44 boxes - — — 60 lockers 56 boxes — Ladies' special bath. — 27 boxes - — Turkish Baths. Cubicles, 11 — - — Russian Vapour Baths. Cubicles. 11 — - — Hand Wash house, Tubs. — — 30 — Mechanical Laundry. Max. no. of persons per day. - — — 54 The following table shows the average weekly returns of persons using the various sections of the establishments:— Mile End per wk. Whitechapel per wk. St. George's per wk. Ratcliffe per wk. Warm baths 4740 6900 2925 1570 Swimming baths 807 2475 1050 — Mechanical laundry — — — 234 Public washhouse - — 460 — Turkish baths 136* - - — Russian baths 168* - - — *Average of four recent weeks. In the warm bath sections there is a small excess of women bathers over men. The charges are as follows:— Warm Bath 1st class (including 2 towels) 6d. Warm Bath 2nd class (including .1 towel) 2d. Swimming Bath 1st class (including 2 towels) 6d. Swimming Bath 2nd class (including 1 towel) 2d. ( During certain periods mixed bathing is permitted in the first class baths) 22 Turkish Bath 1st class (including shampoo) 2/6 Turkish Bath 2nd class (including shampoo) 1/6 Russian Vapour Bath 1/Public Washhouses 1 hour l½d. up to 11 hours for 1/4 Mechanical Laundry—Use of washing machine, 1/-. Use of other apparatus, l½d. per hour. At all establishments except Mile End, special reduced rates are in force for warm baths between the hours of 9 a.m. and 6 p.m. on Mondays to Thursdays inclusive, viz., First class 3d., Second class 1d. The Mile End Municipal Baths were opened to the public during May, 1932. The site, in spite of its awkward shape and constructional difficulties that had to be overcome, houses a building which contains more bathing facilities than can be found in some of the more modern establishments of much greater size. The water in the swimming pool is maintained in a pure and clean condition by means of continuous filtration, having a turnover once every four hours. The Turkish Baths consist of cooling room, lounge, plunge, steam, ablution, shampoo and three hot rooms. The Russian Vapour Baths comprise lounge, ablution and steam room. Light refreshments can be obtained at this establishment. The Swimming Bath Flail (size 97 feet by 45 feet) is utilised during the winter months for dances and entertainments, etc. There is also a Committee Room. The Whitechapel Baths date back to 1878, when washhouses were built, but closed after 18 years' use. The First and Second Class Baths were added in 1886, and in 1896 the Second Class Bath was enlarged and the Ladies' Bath added. The First and Second Class Swimming Pools have recently been reconstructed and equipped with a raised parapet edge. This, in addition to making the baths deeper, prevents all dirt from entering the pools. The St. George's Baths were opened during 1888. The Ratcliffe Baths were opened in 1900, and the Mechanical Laundry in 1928. 23 Memo. 37/T (Revised). Ministry of Health Form T. 145. A. Return showing the work of the Dispensaries for the year 1932:— Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 152 99 23 12 10 8 23 18 162 107 46 30 851 (b) Diagnosis not completed .. - - - - - - - - 24 26 17 14 (c) Non-tuberculous - - - - - - - - 114 153 87 71 b—Contact6 examined during the year!— (a) Definitely tuberculous 6 2 4 3 0 0 0 0 6 2 4 3 735 (b) Diagnosis not completed .. - - - - - - - - 2 4 3 5 - - - - - - - - 101 199 211 195 C.—Cases written off the Dispensary Register as:— (a) Recovered 20 30 5 3 4 3 6 7 26 33 11 10 1,273 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - 232 371 310 280 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 812 533 95 89 68 63 126 98 880 596 221 187 1,973 (b) Diagnosis not completed - - - - - - - - 20 24 21 24 1. Number of cases on Dispensary Register on January 1st 1,904 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 29 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 144 4. Cases-written off during the year as Dead (all causes) 129 5. Number of attendances at the Dispensary (including Contacts) 7,741 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 611 7. Number of consultations with medical practitioners:— (а) Personal 60 (b) Other 328 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 183 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 6,249 10. Number of:— (a) Specimens of sputum, etc., examined 939 (b) X-ray examinations made in connection with Dispensary work 146 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(b) above 1 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 878 B. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 3 Provided by Voluntary Bodies 0 24 Ministry of Health. Form T145a. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. (a) PULMONARY TUBERCULOSIS. Condition at the time of the last record made during the year to which the return relates Previous to 1926 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 Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B.plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December Disease Arrested. Adults M. 17 29 22 - 51 4 4 3 — 7 12 5 5 — 10 14 5 5 — 10 F. 11 19 9 — 28 1 7 3 - 10 8 9 3 — 12 11 12 2 — 14 Children 9 4 — — 4 4 1 — — 1 3 6 — — 6 13 7 — — 7 Disease not Arrested Adults M. 23 28 28 3 59 2 3 7 2 12 5 5 6 1 12 7 5 10 1 16 F. 19 25 20 1 46 4 2 4 — 6 5 4 4 — 8 3 10 4 — 14 Children 1 2 — — 2 3 - - - - 1 - - - - 1 - - - - Condition not ascertained during the year 61 22 20 1 43 11 5 2 1 8 15 6 5 — 11 16 5 5 1 11 Total on Dispensary Register at 31st December 141 129 99 5 233 29 22 19 3 44 49 35 23 1 59 66 44 26 2 72 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 8 2 1 — 3 3 4 — — 4 3 1 — — 1 — — — — — F. 13 9 — — 9 2 2 — — 2 3 — 1 — 1 — — — — — Children ' 3 1 — — 1 1 - - - - 3 - - - - - - - - - Lost sight of, or otherwise removedfromDispensary Register 11 3 8 — 11 2 - 2 — 2 1 — 1 — 1 1 2 4 - 6 Dead. Adults M. 2 — 12 6 18 1 1 2 - 3 2 1 6 2 9 — — 2 3 5 F. 1 2 5 — 7 — — 1 2 3 — — 2 — 2 1 1 1 1 3 Children - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register. 38 17 26 6 49 9 7 5 2 14 12 2 10 2 14 2 3 7 4 14 Grand Totals 179 146 125 11 282 38 29 24 5 58 61 37 33 3 73 68 47 33 6 86 25 (a) PULMONARY TUBERCULOSIS.—continued. Condition at the time of the last record made during the year to which the return relates 1929 1930 1931 1932 Class T.B. minus Class T.B. plus 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 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 21 7 8 - 15 9 4 4 — 8 - - - - - - - - - - F. 18 11 1 - 12 6 12 4 - 16 - - - - - - - - - - Children 8 - 1 - 1 3 2 1 - 3 - - - - - - - - - - Disease not Arrested. Adults M. 11 11 19 3 33 20 10 21 6 37 42 16 35 3 54 47 31 45 5 81 F. 4 6 6 2 14 12 7 9 2 18 23 23 27 5 55 34 28 26 5 59 Children 10 - 1 - 1 13 - - - - 25 5 - - 5 32 1 - - 1 Condition not ascertained during the year 22 10 7 - 17 4 15 13 1 29 2 4 7 - 11 - - - - - Total on Dispensary Register at 31st December 94 45 43 5 93 67 50 52 9 111 92 48 69 8 125 113 60 71 10 141 (b) Not now on Dispensary Register | | and reasons for removal therefrom. | Discharged as Recovered Adults M. - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 5 1 3 - 4 6 5 - 2 7 13 8 7 - 15 3 3 4 - 7 Dead Adults M. 2 - - 1 1 1 3 2 1 6 - 1 8 6 15 — 1 7 8 16 F. - - 2 - 2 - - 1 3 4 - - 3 1 4 - - 3 3 6 Children - - - - - - 2 - - 2 - - - - - 1 1 - 1 Total written off Dispensary Register 7 1 5 1 7 7 10 3 6 19 13 9 18 7 34 4 5 14 11 30 Grand Totals 101 46 48 6 100 74 60 55 15 130 105 57 87 15 159 117 65 85 21 171 26 Form T.145a—continued. (b) NON-PULMONARY TUBERCULOSIS. Condition at the time of the last record made during the year to which the return relates. Previous to 1926 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 Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 2 - 2 2 6 2 1 - 2 5 3 - - - 3 4 - - 1 5 F. 1 - - 2 3 1 - 2 1 4 1 1 1 2 5 - - 1 2 3 Children 13 1 - 3 17 5 3 - 3 11 4 3 - 10 17 6 1 1 13 21 Disease not Arrested Adults M. - - - - - 1 - - - 1 - - - - - - 1 - - 1 F. - - 1 - 1 - - 2 - 2 - - - 1 1 1 - - - 1 Children 1 - 1 1 3 - - - - - 1 - 1 - 2 - - 3 - 3 Condition not ascertained during the year 5 2 4 9 20 - 1 - 3 4 2 - 1 1 4 2 - 1 3 6 Total on Dispensary Register at 31st December 22 3 8 17 50 9 5 4 9 27 11 4 3 14 32 13 2 6 19 40 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - - - . (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - 1 2 3 - - - - - - - - - - - - - 1 1 F. - - - 1 1 - - - 1 1 - - - - - - - - - - Children 3 - 1 2 6 - - - 2 2 - - - - - - - - 3 3 Lost sight of, or otherwise removed from Dispensary Register 1 1 1 5 8 - 1 - 1 2 - - - 2 2 - - 1 - 1 Dead Adults M. - - - 1 1 - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - 1 - 1 2 - - - - - 1 - - 1 2 - - - - - Total written off Dispensary Register 4 2 3 12 21 - 1 - 4 5 1 - - 3 4 - - 1 4 5 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 26 5 11 29 71 9 6 4 13 32 12 4 3 17 36 13 2 7 23 45 to -3 (b) NON-PULMONARY TUBERCULOSIS—continued. Condition at the time of the last record made during the year to which the return relates. 1929 1930 1931 1932 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 Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 1 1 - 4 5 - - 2 1 3 1 - - 1 2 2 1 1 - 4 F. 2 - 1 2 5 3 - 1 4 8 2 - - - 2 - 1 - 1 2 Children 4 4 4 8 20 1 2 3 10 16 2 1 3 7 13 1 2 - 2 5 Disease not Arrested Adults M. 1 - - 2 3 2 - 1 1 4 2 1 3 2 8 - 1 1 2 4 F. - - 1 - 1 1 - 2 2 5 2 - 2 1 5 - 1 1 4 6 Children 6 - - - 6 5 1 1 6 13 5 2 1 10 18 8 2 2 19 31 Condition not ascertained during the year 2 - 2 1 5 2 1 - 1 4 - 3 1 1 5 2 - - - 2 Total on Dispensary Register at 31st December 16 5 8 17 46 14 4 10 25 53 14 7 10 22 53 13 8 ! 5 28 54 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - - - | (b) Not now on Dispensary Register ! and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - - - - - - F. - - 1 - 1 - - - - - - - - - - - - - - - Children - - - 2 2 - - - - - - - - - - - - - - - Lost sight of, or otherwise removed fromDispensary Register 2 1 - 1 4 - 2 1 1 4 1 - 1 2 4 2 - - - 2 Dead Adults M. - - - - - - - - 1 1 - 1 - - 1 - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - 3 - 3 Total written off Dispensary Register 2 1 1 3 7 - 2 1 2 5 1 1 1 2 5 2 - 3 - 5 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 18 6 9 20 53 14 6 11 27 58 15 8 1 24 58 15 8 8 28 59 28 Tuberculosis There are three Municipal Tuberculosis Dispensaries in the Borough. Dispensaries Their situation and hours of sessions are as follows:— 18, Great Prescot Street, Whitechapel. New Patients. Women and Children Monday and Wednesday, 10-12 noon. Men Friday, 10-12 noon. Workers Tuesday, 6-8 p.m. Attendances of old patients by appointment. Women and Children Thursday, 2-5 p.m. Men Friday, 2-3 p.m. 208, High Street, Shadwell. New Patients. Women and Children Monday and Wednesday, 10-12 noon. Men Friday, 10-12 noon. Workers Tuesday, 6-8 p.m. Attendances of old patients by appointment. Women and Children Monday and Thursday, 2-5 p.m. Men Friday, 2-5 p.m. 35, Stepney Green. Women and Children Monday and Thursday, 2-5 p.m. (New and old patients) Men Friday, 2-5 p.m. (New and old patients) Workers Tuesday, 6-8 p.m. (New and old patients) New patients by appointment. Daily at 10 a.m. 29 Children were boarded out. There has been a general increase in the amount of work done at the Dispensaries, as compared with the previous year. 1931 1932 Increase or decrease. New cases examined 840 851 + 11 Cases found to be Tuberculous 305 345 + 40 Contacts examined 689 735 + 46 Contacts found to be Tuberculous 13 15 + 2 No. of patients on Register on Dec. 31st 1,904 1,973 + 69 Attendances 6,543 7,741 + 1,198 Consultations (personal) 39 60 + 21 ,, (other) 244 328 + 84 Visits by Tuberculosis Officers 134 183 + 49 Visits by Health Visitors 6,609 6,249 + 640 Sputum examinations 1,028 939 -89 X-ray examinations 84 146 + 62 The increases in the above figures which call for chief comment are those referring to the new cases found to be tuberculous, to the number of consultations and to the number of X-ray examinations. 29 Although there were only 11 more new cases examined, there was a striking increase in the number of those who were found to be suffering from Tuberculosis. 40 more such cases were discovered. Of these 40 cases, 20 were men, 13 were boys, 2 were women and 5 were girls. The biggest proportion of this increase was therefore in the male sex. It is very pleasing to note that the general practitioners are using the Tuberculosis Dispensaries more. They asked for the opinion of the Tuberculosis Officers in 105 more cases. This is a very good sign, because no Tuberculosis Scheme can be a complete success without this active co-operation between the general practitioners and the Tuberculosis Officers. It is possible that the increase in the number of new cases found to be tuberculosis is due partly to this increased co-operation. The number of X-ray examinations has gone up by 62 and this points to the fact that the new arrangement with the Mile End Hospital is proving satisfactory The Tuberculosis After-Care Committee of the Borough is comprised of After-Care. three sub-committees for convenience and working in this scattered district. One serves the area attached to Stepney Green Dispensary, one of the St. George's Dispensary, and the other of the Whitechapel Dispensary. 30 meetings were held—27 of these being sub-committees. During the year the Committee considered 445 special cases. Of these, 360 were in connection with assessment for contributions towards sanatorium treatment, and 85 were necessitous cases needing various kinds of assistance. In most of these cases help was procured through the co-operation of the various voluntary charitable organisations. The Invalid Kitchens allowed nourishments and dinners in several cases where the patients' means were not sufficient to allow of their having enough good food. The Red Cross Society and the United Services Fund have assisted many of the ex-soldiers. The Charity Organisation Society have given help with dentures, and paid the fare for a man who was out of work to visit his wife in sanatorium. They also gave clothing to this patient. They supplied spectacles to another man who was doing a little work, but had no margin of funds for any extras. The Friends of the Poor gave the money for a patient to redeem the suit of clothes he had pawned before he went to sanatorium, and they gave 10/- for the purchase of a second-hand perambulator for a woman patient who had to carry her baby in her arms whenever she went out, as she could not afford to buy a perambulator for him. The Jewish Board of Guardians have helped nearly fifty of our Jewish patients during the year. They rarely refuse any reasonable application for help which the After-Care Committee makes to them. They have started suitable patients with loans for trading, and helped one man to buy a grocery business on his return from sanatorium. They have given clothes, blankets, and allowances for nourishments in many cases. 30 A number of patients have been referred to the Public Assistance Committee, and have been supplied with clothing for sanatorium, and when possible, a little extra relief has been allowed for special nourishments. Eleven patients have had the loan of single beds and bedding from the Borough Council in order that they could sleep alone and lessen the risk of infection for other members of the family. In all these cases patients who are definite cases of tuberculosis had been sharing a bed with one or more members of the family, often with children. Handicraft Class. The Handicraft Class has had another successful year's work. The outstanding events were the Stall at the Health Week in February and the Exhibition at the Carpenter's Hall in October. As the result of the sales during the Health Week £14 of goods were sold, and several orders were taken. Apart from this, valuable attention was drawn to the class, and many who had not known of its existence before displayed a very kindly and practical interest. 46 classes were held during the year. The Class did well at the Exhibition at the Carpenter's Hall, where work is exhibited and sold from the handicraft classes all over London. One of our patients has since been kept occupied with orders for gloves. Special Treatment The Council has arrangements by which they pay for the attendances of patients undergoing certain forms of treatment at various hospitals as follows: No of Patients. No. of Attendances Finsen Light treatment at the London Hospital 6 146 Pneumo-Thorax Refills at Brompton ,, 4 67 ,, ,, ,, Victoria Park ,, 26 186 ,, „ ,, Colindale ,, 2 9 „ ,, „ Grove Park „ 2 16 Artificial light at the London Hospital 3 121 Supply of Extra Nourishment. The Council continued the arrangements whereby grants of extra nourishment are made to persons suffering from Tuberculosis who attend our Tuberculosis Dispensaries. The grants are made on the recommendation of the Tuberculosis Officers for a period of 28 days in the first instance, and the grant consists of one and a half pints of Grade A.T.T. Milk per day, seven eggs per week, and a half pound of butter per week. During the year 242 grants were made to 88 persons, the total cost being £280 18s. 2£d. Health Propaganda The arrangement made last year with the National Association for the Prevention of Tuberculosis to give a series of Lectures on Tuberculosis during the winter months at the Public Libraries in the Borough was continued during the early months of the year. They were much appreciated. 31 A Health Week and Exhibition was held in February, 'and the following is a copy of the report submitted by the Public Health Committee to the Council:— We have had submitted to us a report by the Medical Officer of Health upon the holding of Stepney "Health Week," and for the information of the Council we submit a copy thereof as follows, namely:— STEPNEY HEALTH WEEK. The sixth Stepney Health Week was held from the 15th to 20th February last, and various lectures, health talks, cinema films and demonstrations were given daily at the Whitechapel Art Gallery. The ground floor of the gallery was occupied by 28 stalls and the plan was well arranged so that the middle block of stalls showed the Public Health activities in the Borough, i.e., 1. One showed drainage models, drain testing appliances, specimens of diseased meat, blown canned goods, and samples of unsound sweets condemned in the Borough. 2. Another was a rats and mice exhibit, which consisted of various stuffed rats and mice, baits, traps and poisons. 3. A Tuberculosis Stall consisted of a display of various articles made by Tuberculous patients at our Tuberculosis Handicraft class. 4. This stall had an Exhibit—"Babies of all Nations." This was a display of dolls, showing how babies in various parts of the world are dressed. 5. Another stall had articles of baby clothing which were supplied by the Voluntary Centres. Around the hall were various exhibits, comprising different kinds of food, disinfectants, dental work and housing models, etc. The opening ceremony was performed by Her Worship the Mayor of Stepney (Councillor (Miss) M. Moses, J.P.), on Monday the 15th February, the Chairman being Alderman (Mrs.) C. B. Lankester, J.P. The Chairman in introducing Her Worship said that the Public Health work spoke for itself and she was very pleased to see so many prominent people present that afternoon. It was a great honour for her to be the Chairman as she was also Chairman of the Public Health Committee. The Mayor said how pleased she was to be present and how interested she was in the work of the Public Health Department, which was an asset to the Borough. Great strides had been made in the Welfare Centres—Municipal and Voluntary. To-day was the day of youth and it must be the day of the baby. She referred to the difficulties to-day in combating overcrowding, and to the work done at the Tuberculosis dispensaries which were doing such good preventive work that they hoped to stamp out the disease. Reference was also made to the work of the Sanitary Inspectors and to the importance of watching the foodstuffs arriving in the Borough. She hoped that the Health Week would be a success and that the results be far-reaching. The other speakers included the High Commissioner for the Irish Free State (J. W. Dulanty, Esq., C.B., C.V.E.); B. Janner, Esq., J.P., M.P.; W. J. O'Donovan, Esq., M.D., M.P., O.B.E.; Councillor (Mrs.) M. Tovey; Councillor The Countess Winterton; and Councillor Miss I. Samuel, J.P., L.C.C., M.B.E. About 300 persons were present. Cooking demonstrations and lectures to organised parties of mothers attending the Infant Welfare Centres of the Borough were given daily. They proved to be very popular and were much appreciated. There was a daily average of 130 attending the cooking demonstrations and 106 at the lectures to mothers. The lectures each evening were well attended and proved very interesting and instructive. The subjects dealt with were— " London Housing Conditions and Problems."—By F. Hunt, Esq., C.V.O., Valuer to the London County Council. "Cancer."—-By W. Cramer, Esq., D.Sc., M.R.C.S., L.R.C.P., of the Imperial Cancer Research Fund. "Food, Health and Happiness." By Dr. E. Sloan Chesser. "The Menace of Ignorance." By I. Feldman, Esq., M.R.C.S., L.R.C.P., of the British Social Hygiene Council. 32 "Tuberculosis." By Harley Williams, Esq., M.D., D.P.H., Medical Commissioner, National Association for the Prevention of Tuberculosis. "Secrets of Good Health." By Sir W. Arbuthnot Lane, Bt., C.B., M.S., F.R.C.S., President of the New Health Society. The average attendance each evening was 390. Cinema films and lantern slides were also shown. The Exhibition was very well patronised—one day alone there were over 9,300 visitors, the total for the week being 34,386. The week was undoubtedly a huge success. A statement of the accounts and expenditure has been furnished to the Borough Treasurer. J. M. BROWNE, Medical Officer of Health. The undoubted success of the week was due, in the main, to the unstinted efforts of the Medical Officer of Health, the Chief Clerk (Mr. W. F. Lellow) and the other members of the Staff of the Public Health and Maternity and Child Welfare Departments, and we have expressed to them our appreciation of the work which they ungrudgingly performed to make the "week" the success that it was. (Signed) Alderman C. B. Lankester, J.P., Chairman. 33 (b) MATERNITY. Women 644 56 - 43 - 18 154 1054 49 46 - - 4 113 291 70 Children 50 - - - - - 21 94 - - - - - 24 - 19 Total 694 56 - 43 - 18 175 1148 49 46 - - 4 137 291 89 No. of Ordinary sessions held 30 No. of gas 35 Denial Clinic SUMMARY OF WORK DONE AT THE DENTAL CLINIC—(a) TUBERCULOSIS. Particulars of Patients. Number of Fillings. Number of Scalings. Extraction Cases. Dentures. Number of Dressings. Number for Advice. Denture Visits. Number of New Patients. Number of Attendances. Simple. Root. Without Anaesthetic. Local Administrations. Gas Administrations. Number of Teeth Extracted. Upper. Lower. Re-models Repairs. Women 133 14 - 9 - 10 30 179 7 5 - - - 22 64 9 Children - - - - - - - - - - - - - - - - Men 73 3 - - - - 9 59 10 9 - - - 13 51 5 Total 206 17 - 9 - 10 39 238 17 14 - - - 35 115 14 No. of Ordinary sessions held 21 No. of Gas ,, „ 19 34 Maternity List of Maternity and Child Welfare Centres, Ante-natal Clinics and Centre and Clinics. Creches in Stepney:— Municipal:— Day. Centre. Hours. Mondays Limehouse. Town Hall, Commercial Road. 2 to 5 p.m. Tuesdays St. George's. Town Hall, Cable Street. Wapping. Riverside Mansions. Spitafields. Hughes Mansions, Vallance Road. 10a.m. to 12noon and 2 to 5 p.m. 10a.m. to 12 noon and 2 to 5 p.m. 2 to 5 p.m. (No Doctor atten ls). Wednesdays Limehouse. Town Hall, 2 to 5 p.m. Commercial Road. Mile End. 2 to 5 p.m. Congregational Buildings, Burdett Road. Whitechapel. 2 to 5 p.m. St. Phillips Institute, Newark Street. Thursdays Limehouse. Town Hall, Commercial Road. 10 a.m. to 1 p.m. (A.N. Clinic). Mile End. 401, Mile End Road. 2 to 5 p.m. Spitalfields. Hughes Mansions, Vallance Road. 2 to 5 p.m. Fridays . St. George's. Town Hall, Cable Street Wapping. Riverside Mansions. 2 to 5 p.m. 10 a.m. to 12 noon (No Doctor attends) Voluntary:— Mission Hall, Carr Street. Tuesday afternoons 2 p.m. Stepney Infant Welfare Centre Mondays, Wednesdays and Fridays and Babies' Nursing Home, 10.30 to 12.30 (Light treatment). 587, Commercial Road. Monday afternoons. Thursdays 10 to 12 noon (Dental) Friday afternoons. The Memorial Hall, Tuesday and Wednesday afternoons High Street, Shadwell. 2 p.m. Jewish Infant Welfare Centre, Monday and Wednesday afternoons. Bernhard Baron Settlement, Berner Street. 35 Jewish Mothers Welcome, Tuesday afternoons. Bernhard Baron Settlement, Thursdays 2 to 4 p.m. Berner Street. Dental Clinic held at 17, Leman St. Dame Colet House, Sunlight Clinic at 10, Duckett Street 29, Duckett Street. on Mondays, Wednesdays and Fridays at 2.30 p.m. Monday and Tuesday afternoons. Wednesdays. Sewing Class. Alternate Friday evenings at 6.15 Dental Clinic at 10, Duckett Street. Jewish Maternity Home, Monday and Friday mornings—Ante- 24, Underwood Street. Natal. Mondays 10 to 1 (Dental). Mondays and Thursdays (Sewing Class) Tuesday and Wednesday afternoons. 12, St. Clare Street, Minories. Mondays 2 p.m. clinic. Tuesdays 2.30 p.m. Bootmending. Wednesdays 2.30 p.m. Sewing Class and Health Talk. Thursdays 2.30 p.m. clinic. Jewish Centre, Mondays at 10 a.m. to 12 noon and East Stepney, Beaumont Hall, 2 p.m. to 5 p.m. and Thursdays Beaumont Square. 9.30 to 12 noon. Ante-Natal Clinics:— Limehouse Town Hall, Thursdays 10.30 to 1 p.m. Commercial Road. (Municipal). Mile End Hospital, Mondays and Wednesdays 2.30 p.m. Bancroft Road. St. George-in-the-East Hospital, Tuesdays 2 p.m. Raine Street. St. Peter's Hospital, Tuesdays 2 p.m. Vallance Road. London Hospital, Tuesdays and Wednesdays Whitechapel Road. 8.30 a.m. East End Maternity Hospital, Mondays 2 to 6.p.m. 396, Commercial Road. Wednesdays 9 a.m. to 1 p.m. Fridays 9 a.m. to 1 p.m. Jewish Maternity Home, Mondays and Fridays 11.30 a.m. 24, Underwood Street. Ailing Mother's Clinic:— 587, Commercial Road. Second Tuesday in each month at 10.30 a.m. 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, 36 Maternal mortality. Special investigations into all maternal deaths were carried out and reports sent to the Ministry of Heath. 2 of these were made by the Council's consultant. 10 deaths occurred—3 from sepsis and 7 from other causes. Health Visiting. There are 7 Municipal Infant Welfare Centres and 9 Voluntary Centres in the Borough. Each centre has its own particular area, thus there is no overlapping in the visiting of the districts. Details of the work of the Health Visitors and Centres are given on pages 41 and 42. Maternity and Child Welfare Services. Form M.C.W. 96 revised) Maternity and Child Welfare. Return (1) showing the arrangements made for maternity and child welfare by the Council and by Voluntary Associations providing maternity and child welfare services in respect of which the Council pay contributions under Section 101 of the Local Government Act, 1929, or otherwise; and (2) giving particulars of the work done during the year 1932. 1.—Population of the area served by the Council:—223,000. 2 —Number of births notified in that area during the year under the tion of Births Act, 1907:— (a) Live births, 3,738. (b) Still births, 105. (c) Total, 3,843. (d) By midwives, 2,612. (e) By doctors and parents, 1,231. 3 —Health Visiting. (i) Number of officers employed for health visiting at the end of the year; (a) by the Council, 11. (b) by Voluntary Associations, 15. (ii) Equivalent of whole-time services devoted by the whole staff to health visiting (including attendance at infant welfare centres): — (a) in the case of Health Visitors employed by the Council, 11. (b) in the case of Health Visitors employed by Voluntary Associations, 14.5. (iii) Number of visits paid during the year by all Health Visitors : — (a) To expectant mothers:—First visits, 1,403. Total visits, 3,498. (b) To children under 1 year of age:—First visits, 3,398. Total visits, 21,663. (c) To children between the ages of 1 and 5 years:—Total visits, 39,680. 4 —Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council, 7. (b) Number of Centres provided and maintained by Voluntary Associations, 9. 37 (c) lotal number of attendances at all Centres during the year:— (i) By children under I year of age, 34,747. (ii) By children between the ages of 1 and 5 years, 22,095. (d) Total number of children who attended at the Centres for the first time during the year: (i) Children under 1 year of age, 2,774. (ii) Children between the ages of 1 and 5 years, 534. (e) Total nutnber of children who were in attendance at the centres at the end of the year: (i) Children under 1 year of age, 2,646. (ii) Children between the ages of 1 and 5 years, 3,823. (f) Percentage of total notified live births represented by the number in (d) (i), 74.2. 5.—Ante-natal clinics (whether held at Infant Welfare Centres or at other premises):— (a) Number of Clinics* provided and maintained by the Council, 1. (b) Number of Clinics provided and maintained by Voluntary Associations, 3. (c) Total number of attendances by expectant mothers at all Clinics during the year, 20,791. (d) Total number of expectant mothers who attended at the Clinics during the year, 4,953.† (e) Percentage of total notified births (live and still) represented by the number in (d), 77.5. *Including Ante-Natal Clinics provided at institutions transferred to the Council under Part I. of the Local Government Act, 1929. † This includes non-residents. 6.—Maternity Homes and Hospitals. I. Separate maternity institutions provided by the Council Institutions (with maternity wards) transferred to the Council under Part I of the Local Government Act, 1929. Institutions provided by Voluntary Associations and subsidised by the Council. Number of Institutions nil nil The Stepney Borough Council make a grant of £100 per annum to the East End Maternity Hospital. Number of maternity beds (exclusive of isolation and labour beds) nil nil 56 Total number of women admitted to these beds during the year nil nil 1.466 38 II. Number of women (if any) sent by the Council during the year to other Maternity Institutions, nil. 7.—Homes and Hospitals for Sick or Ailing Children under 5 years of age. I. Separate Institutions provided by the Council for these cases Institutions (with accommodation for these cases) transferred to the Council under Part I of the Local Government Act, 1929. Institutions provided by Voluntary Associations and subsidised by the Council. Number of Institutions nil nil nil Number of beds provided for such children nil nil nil Total number of children admitted to these beds during the year.. nil nil nil II. Number of such children (if any) sent by the Council during the year to other institutions, 2. 8.—Convalescent Homes. (a) Number of convalescent institutions with accommodation for expectant or nursing mothers or children under 5 years of age:— (i) provided by the Council nil (ii) provided by Voluntary Associations 1 (b) Number of beds for such cases in convalescent institutions:— (i) provided by the Council* nil (ii) provided by Voluntary Associations 12 (c) Total number of cases admitted to the beds included in (b) during the year, 156. (d) Total number of such cases sent by the Council during the year to other convalescent institutions, 86. 9 —Homes for Mothers and Babies. (a) Number of such Homes:— (i) provided by the Council nil (ii) provided by Voluntary Associations nil (b) Number of beds in Homes:— (i) provided by the Council nil (ii) provided by Voluntary Associations nil (c) Total number of cases admitted to these Homes during the year:— (i) expectant mothers nil (ii) mothers and babies nil (iii) babies nil 39 (d) Total number of such cases sent by the Council during the year to other homes for mothers and babies, nil. *Including any beds for convalescent cases of these classes in institutions transferred to the Council under Part I. of the Local Government Act, 1929. 10.—Day Nurseries. (a) Number of day nurseries:— (i) provided by the Council nil (ii) provided by Voluntary Associations 5 (b ) Number of places for children under 5 years of age in the nurseries:— (i) provided by the Council nil (ii) provided by Voluntary Associations 193 (c) Total number of attendances of children at these nurseries during the year, 33,374. 11.—Infectious Diseases Disease. Number of cases notified during the year. Number of cases visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals. (1) Ophthalmia Neonatorum 33 33 16 17 (2) Pemphigus Neonatorum - - - - (3) Puerperal fever 9 9 1 8 (4) Puerperal pyrexia 31 31 5 26 (5) Measles and german measles (in children under 5 years of age) - 1,291 87 495 (6) Whooping Cough (do.) - - - - (7) Epidemic diarrhoea (do.) - - - - (8) Poliomyelitis (do.) 10 10 - 9 12.—Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever:— (i) by the Council nil (ii) by Voluntary Associations 3 (b) Total number of cases attended during the year by these nurses, 175. 40 13.—Midwives. I. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 11. (b) Number (i) employed by the Council nil (ii) subsidised by the Council nil (iii) employed by Voluntary Associations 26 (c) Number of cases during the year in which the Council paid or contributed to the fee of a midwife nil II. (a) Number of cases attended by midwives during the year:— (i) as midwives nil (ii) as maternity nurses nil (b) Number of cases during the year in which medical aid was summoned by a midwife under Sec. 14 (1) of the Midwives Act, 19.18 nil 14 —Maternal Deaths. (a) Number of women who died in, or in consequence of, childbirth in the area served by the Council for maternity and child welfare during the year:— (i) from sepsis 3 (ii) from other causes 7 (b) Number of these cases which died :— (i) at home 1 (ii) in institutions 9 Feeding of Infants. Breast fed 3,236 Artificially fed 162 No. of infants dead before the visit of Health Visitor 58 No. of infants removed before the visit of the Health Visitor 129 Maternity Outfits. Sterilized Maternity Outfits are supplied at cost price through the Municipal Ante-natal Clinic. During the year two outfits were supplied. 41 "SJOJISIyY q»iw»H xq sjist^ ICT Ratcliffe, Shadwell, St. George's, pt. , Mile End. S.W. Whitechapel, pt. St George's, North Mile End, S.E. Mi'e End, N.E. Mile End Central. Limehouse, N pt Wapping Whitechapel and Spitalfields Mile End, N. Whitechapel, (Pt,) Limehouse. Ncrth pt., and South, pt. Wapping NAME Miss Railey Miss Brazier Miss Clements Miss Cordwell miss Fuucar Miss Gibbs Miss Goodllow (8 months) Mjss Mitchell Miss Paice Miss Styles Miss Whjtty Total Visits:— Primary 441 425 239 222 232 350 85 497 253 339 315 3,398 Revisits:— To infants under 1 year 322 184 455 638 546 702 498 462 568 427 547 5,349 To children between 1-5 years 943 350 1,208 1,132 1,303 1,187 737 469 1,090 1,184 780 10,383 Ante-natal:— Primary 26 70 52 3 5 21 20 114 60 9 95 475 Subsequent 1 1 3 9 1 2 4 163 18 4 24 230 Ophthalmia Neonatorum 2 5 1 1 3 6 - 6 4 4 1 33 Puerperal Fever - 2 - - - - - 3 1 1 2 9 „ Pyrexia 4 3 2 5 3 4 - - - 2 2 31 Measles 288 400 102 131 94 177 54 312 131 124 287 2,100 ,, Revisits 12 22 2 28 9 - 7 58 91 42 208 479 Miscellaneous 380 669 455 589 407 401 369 594 527 299 731 5,421 Total 2,419 ! 2,131 2,519 2,758 2,603 2,850 1,774 2,684 2,743 2,435 2,992 27,908 CENTRES ATTENDED:— Municipal 194 181 176 72 114 12 91 128 137 208 125 1,438 Voluntary 4 - - - 87 141 - - - 2 - 234 Total 198 181 176 72 201 153 91 128 137 210 125 1,672 42 Municipal Details of the work at the Municipal Centres will be seen in the following Centres. , . , table. MUNICIPAL CENTRES. Limehouse. Mile End. St. George's. Spitalfields. Wapping. Whitechapel. Total.  Mile End Road Burdett Road Mon. Wed. Thurs. Thurs. Wed. Tues. Fri. Tues. Thurs. Tues. Fri. Wed. No. of Sessions (total) 48 51 51 52 52 50 51 51 52 55 50 52 615 Attendances of Infants 1,688 1,575 - 2,145 2,208 1,878 1,261 621 1,446 1,075 259 1,252 15 ,408 „ „ Children 1 to 5 934 935 - 1,490 1,120 1,659 1,161 496 1,233 448 227 810 10,513 „ Infants on Registers at end of the year 197 - 106 131 201 146 124 66 971 „ Children on Registers at end of the year 466 - 211 182 453 250 132 155 1,849 „ Ante-Natal Sessions - - 51 - - - - - - - - - 51 „ „ New Cases - - 143 - - - - - - - - - 143 ,, ,,Subsequent Attendances - - 274 - - - - - - - - - 274 „ Doctors' Consultations 48 51 51 51 52 50 51 51 50 - 52 507 13 Arrangements were continued during the year for the medical records at the Infant Welfare Centres to be forwarded to the Head Teachers of Schools in the Borough. Cards are received from the Education Department of the London County Council of children under 5 years of age entered on the rolls of the infants departments. The medical records are filled in on these cards by the Health Visitors and forwarded to the schools concerned. If no record is available at the centre the particulars are obtained at the homes. Medical Records of School Children. During the year, mothers and children were sent away to the homes mentioned below:— Home Mothers Children. St. Mary's, Birchington 5 5 Invalid Children's Aid Association - 3 St. Mary's, Dover 13 16 Church Army Convalescent Homes, Merrow 11 15 All Saints' Convalescent Home, Eastbourne - 16 Roseneath Convalescent Home, Broadstairs 1 1 30 56 Convalescent Treatment. The following table shows the approximate quantity and cost of milk, etc. distributed during the year:— No. of Applications granted. No. of persons. Quantity. £. Cost s. d. Cows Milk— Free 6,980 8,874 31,086¼ gals. 3,382 19 1 Half-Price 44 56 196 „ 10 7 1 Dried— Free 3,308 3,727 18,074 lbs. 1,421 17 5 Half-Price 34 38 182 „ 7 3 1 Virol, etc. Free 2,018 2,306 l,879½ lbs. 137 19 3 Half-Price 7 8 5½„ 4 3 Total 12,391 15,009 31,282¼. gals. 20,141 lbs. 4,960 10 2 Provision of Milk and Meals to Expectant and Nursing Mothers and to Children. Dinners are supplied by the Stepney Invalid Kitchen, White Horse Street, on the grounds of health, to expectant and nursing mothers who are in necessitous circumstances. The Council pay (id. towards the cost of each of the dinners and the period during which the dinners are supplied is four weeks. The number of dinners supplied during the year was 2,242, at a cost to the Council of £56 1s. 0d. 44 III. SANITARY CIRCUMSTANCES OF THE AREA. Scavenging The Public Cleansing Officer has kindly supplied me with a report on the work of his department for the year. In September, 1931, it was decided to set up a separate department for Street and Market Cleansing, Collection and Disposal of House and Trade Refuse, the Removal of Snow, Street Watering, Street Gritting, &c., and to form a new Committee for the administration thereof, i.e., the Public Cleansing Committee. It was found necessary, in the course of this reorganisation, to divide the Borough into 6 sections, each of which is under the supervision of a foreman, who in his turn reports to the responsib'e Official to the Committee, viz., the Public Cleansing Officer. Collection of House and Trade Refuse.—Since the inauguration of the department up to the 3.1st December, .1932, a great amount of detailed information has been collected regarding this service with the view to giving a more frequent collection with dustless loading. Street Cleansing.—To improve this service the Committee purchased three new sweeping and swilling machines which, in conjunction with the other swilling machines already owned by the Council, work day and night. During the night most of the main roads are swilled and swept. There is a large number of Street Markets in Stepney; to increase the efficiency of cleansing these markets it was decided to employ men working in two shifts, thereby giving constant attention to the markets between 7 a.m. and 8.40 p.m. Monday to Friday, and 7 a.m. and 9.40 p.m. Saturday, sweeping the refuse and collecting same into trucks, a vehicle purchased specifically for the purpose, calling at intervals to collect the refuse from the trucks and to take the same to the disposal centre. The Council employ a large number of men on cleansing at night. It was found practicable to employ motor vheicles (which the Council already possessed) for night cleansing, picking up the sweepings and taking them to the disposal centres, thereby enabling the Committee to dispense with the services of horses on this work. 1 here are many main and important thoroughfares in Stepney and it was decided to employ scavengers on shift work on the main roads from 7 a.m. to 8.40 p.m. Disposal.—(a) Destructor, Gunthorpe Street.—The destructor was a 10 cell top fed, and had been erccted for 30 years. Many complaints had been received regarding this destructor, and during July, 1932, the refuse hitherto dealt with at this depot was diverted to Devonshire Street Depot to be disposed by barge and the destructor closed. 45 (b) Devonshire Street Depot.—There was a two grate refuse destructor at this depot which was demolished in July, 1932, and the whole depot re-constructed, including the erection of a ramp which improved facilities for loading barges. A number of umbrella canvas covers were erected, which suspend over the barges during loading, to which are fitted water sprays, obviating dust blowing about when tipping is in operation. (c) Duke Shore Wharf.—This Wharf is situate on the River Thames and is the main disposal centre for the Borough. Five new tipping platforms have been erected, surrounded by canvas screens and canvas curtains hung therefrom totally enclosing the barges. Water sprays are fitted to each shoot, thereby enabling the barges to be loaded with very little dust. (d) Pinchin Street Depot.—This depot is situate at the west end of the Borough and has been used for many years in connection with the disposal of street sweepings by means of either rail or road. This depot is now considered unsuitable and the Committee are seriously considering alternative methods to enable disposal of refuse to be discontinued from this depot. 46 inspection The following tables show the work of the Sanitary Inspectors: — INSPECTIONS, Ere. BY THE SANITARY INSPECTORS 1932. H Abson. G. Bottomley. A. C. Brown R. W. G. Day T. W. Dee. E. J. Edward3. E. W. Flint. H. J. Green. C. F. Guy. H. O. Harris. J. G. McCarthy. R. Roper (Temporary). W. Shepherd. | R. Simpson. W. F. Smith. S. H. V. Trimming W. T. Twynham. S. Vogler R. H. Waterman. Totals Bakehouses - 52 64 36 11 44 6 22 25 27 17 2 18 15 43 27 25 30 10 474 Butter and Margarine Premises - - - - - 2 - - - - 2 - - - 17 - - - - 21 Butchers' Shops 12 222 51 96 23 14 23 19 166 22 81 - 35 11 125 - 39 41 2 982 Butchers' Stalls - 221 - 1 - - 7 - 177 - 84 - 6 - 34 12 3 - - 545 Complaints - 108 675 788 142 714 329 839 363 443 805 350 114 318 561 882 742 850 40 9,063 Cowsheds - - 11 15 - 10 - 3 - 6 21 - - - 20 - 9 30 10 135 Factories 3 142 63 98 9 61 45 109 47 47 18 - 46 7 80 8 174 141 59 1,157 Houses let in Lodgings - 175 172 303 105 234 114 198 362 3 195 - 210 - - 1 243 330 133 2,778 House to House - 223 174 193 363 171 285 101 266 216 83 1,485 371 666 224 129 314 252 482 5,998 Ice Cream - 41 39 18 6 38 22 31 27 10 12 - 22 18 10 19 41 17 32 403 Infectious Disease - 168 207 97 53 373 151 110 122 127 351 40 87 177 104 327 89 120 149 2,852 Milkshops - 8 87 176 35 68 42 122 108 56 144 4 72 38 84 21 105 132 75 1,453 Offensive Trades - 32 58 13 2 12 8 12 7 13 15 - 5 3 85 6 17 26 8 324 Outworkers - 94 157 102 27 56 58 167 239 5 5 - 63 83 104 4 128 308 5 1,605 Restaurants and Eating Houses - 93 38 20 55 42 21 60 7 15 9 4 44 13 31 24 49 31 37 593 47 INSPECTIONS, Etc. BY THE SANITARY INSPECTORS—1932—Continued. H. Abson. G. Bottomley. A. C. Brown R. W. G. Day T. W. Dee. E. J. Edwards. E. W. Flint. | H. J. Green. C. F. Guy. H. O. Harris. J. G. McCarthy. R. Roper (Temporary). W. Shepherd. R. Simpson. W. F. Smith. S. H. V. Trimming. W. T. Twynham. S. Vogler R. H. Waterman. Totals. Wharves 1,234 26 - - 125 2 - - - - - - - - - - - - - 1,387 Workplaces - 84 47 3 37 15 12 22 15 11 7 22 42 20 11 - 73 134 17 572 Workshops - 170 175 170 100 29 82 160 243 83 55 12 137 148 121 8 239 429 110 2,471 Bishopsgate Station 27 - - - - - - - - - - - - - - - - - - 154 Miscellaneous - 1,922 805 2,092 723 826 821 773 1,389 462 1,135 1,447 1,031 709 1,228 716 1,556 1,269 1,284 20,180 Observations re Smoke Nuisance - 130 3 2 6 14 3 3 - - 6 6 - 1 6 2 15 11 12 220 Re-Visits - 2,078 1,398 1,299 1,434 1,634 1,453 2,719 2,125 1,706 1,834 1,466 1,746 3,581 1,330 2,310 2,861 1,573 2,552 35,099 Intimations served - 716 796 629 429 903 628 1,095 563 498 778 570 731 1,108 651 986 1,141 836 764 13,822 Statutory Notices served - 114 465 230 138 382 284 309 263 200 132 201 194 652 270 276 333 361 175 4,979 Summonses taken out under Public Health (London) Act 1891. L.C.C. (General Powers) Acts, Byelaws, etc. - - 11 5 2 7 10 7 - 2 - - - - 4 8 2 12 - 70 Food & Drugs (Adulteration) Act. No. of samples taken - 123 102 95 71 108 91 66 64 30 71 - 94 62 90 114 97 100 90 1,468 Food & Drugs (Adulter-, ation) Act. No. of Summonses taken - - 1 2 1 - - 2 - 3 - - - 2 1 1 - 2 8 23 € w o 1>> •i d ** {j* ' 5» RETURN OF SANITARY WORK, 1932. G. Bottomley. A. C. Brown R. W. G. Day T. W. Dee. E. J. Edwards. E. W. Flint. H. J. Green. C. F. Guy. H. O. Harris. J. G. McCarthy. R. Roper (Temporary) W. Shepherd. R. Simpson. W. F. Smith. S. H. V. Trimming. W. T. Twynham. S. Vogler R. H. Waterman. Totals. Animals kept so as to constitute a nuisance removed 1 5 1 - 1 2 3 - - 1 - 1 2 - - 6 - 1 24 Bakehouses: No. of cleansings 26 29 17 6 23 4 36 15 14 22 - 10 14 35 28 27 25 11 342 Cisterns cleansed and covered - - 1 2 2 3 12 1 5 - 8 16 1 - 2 9 2 8 72 Damp walls remedied 63 187 81 63 72 91 161 72 118 102 112 53 56 201 189 104 160 105 1,980 Drains—Cleansed or repaired 97 77 69 40 55 46 67 45 53 61 86 41 125 11 90 89 43 13 1,108 Constructed or reconstructed 19 7 37 6 11 12 12 30 70 15 7 9 13 17 27 8 29 23 352 Soil pipes fixed and ventilated 15 5 12 5 5 7 17 34 3 - 4 6 10 21 1 6 13 17 181 Trapped 12 2 22 3 - 36 4 19 5 1 8 12 10 - - 1 8 9 152 Dust receptacles provided 93 151 28 48 222 69 112 43 83 119 60 44 301 117 236 94 75 52 1,927 Houses or parts of houses cleansed 298 186 291 344 317 521 521 341 243 341 432 490 447 407 514 452 378 419 6,942 Houses ventilated beneath the lower floor - 2 2 7 - 3 10 6 6 - 26 - 6 7 8 4 6 28 121 Light and ventilation provided to rooms 2 5 1 6 2 2 30 3 28 2 4 - - 1 18 2 1 3 109 Manure receptacles provided or reconstructed 1 - - 4 1 - - - - - - - - - - 3 2 1 14 Offensive accumulations removed 9 36 23 28 33 15 42 3 28 14 26 57 20 6 20 96 42 12 510 Overcrowding in dwellings abated 11 2 7 9 2 2 4 6 - 2 1 1 3 9 4 4 4 - 71 Roofs, gutters and rain water pipes fixed or repaired 262 90 201 129 337 201 184 199 175 387 274 254 511 411 687 452 267 311 5.332 48 Return of sanitary work G. Bottomley. A. C. Brown R. W. G. Day T. W. Dee. E. J. Edwards. | E. W. Flint. H. J. Green. C. F. Guy. H. O. Harris. J. G. McCarthy. R. Roper (Temporary) W. Shepherd. R. Simpson. W. F. Smith. S. H. V. Trimming W. T. Twynham. S. Vogler R. H. Waterman. Totals. Sheds occupied as dwellings discontinued - - - - - - - - - - - - - - - - 2 - 2 Sink, bath and lavatory pipes disconnected or fixed 57 29 13 35 32 17 72 10 25 — 17 10 43 2 13 54 14 55 498 Smoke nuisances abated 10 1 - 4 — 2 15 - 5 5 - - 2 — 1 2 7 4 58 Stables paved and drained - - - 1 - 2 - - - 1 - - 2 - - - - - - Underground rooms — illegal occupation discontinued - 1 3 - - 13 4 2 3 — - 1 - 5 - 4 - - 36 Urinals fixed 30 — 2 2 — 1 20 6 — - - — 2 - 2 1 — 6 72 Verminous rooms cleansed 15 22 12 6 8 56 34 27 48 1 37 59 7 101 30 22 30 21 536 Waterclosets—Cleansed or repaired 126 152 101 79 92 88 290 93 128 120 137 269 97 112 267 359 144 156 2,810 ,, Light and ventilation provided 2 2 4 6 - 3 13 11 12 - 14 - - 3 9 7 1 31 118 ,, Pans and traps fixed 61 34 58 31 51 46 22 54 13 26 42 55 91 35 89 63 36 99 906 ,, Water supply or flushing apparatus provided 29 43 33 46 54 47 156 27 61 22 74 162 103 - 69 98 54 114 1,192 Water supply to houses reinstated 2 2 9 2 3 - 6 - 4 3 1 3 2 - 5 3 - 21 66 Yards, areas and forecourts cleansed, paved, or paving repaired 50 87 47 52 83 83 62 41 62 33 34 46 107 89 155 121 60 75 1,287 Floors, windows, fireplaces and coppers repaired 259 302 215 119 411 203 226 183 246 472 464 164 502 373 1,046 496 419 428 6,528 Miscellaneous repairs 277 241 132 39 74 551 228 72 206 307 183 253 96 563 429 415 151 185 4,402 50 Legal Proceeding Proceedings. Date. Matter of information or complaint. Result. 1932. Public Health (London) Act, 1891. 4th January Failing to abate nuisances arising from dirty and defective walls and ceilings; defective flooring, roofs, etc., at 39, Tredegar Square. The work having been done at the time of the hearing of the summons, defendant was ordered to pay £2 5s. 0d. costs. 28th January Failing to abate nuisances arising from damp walls, dirty and defective walls and ceilings; defective roofs, etc., at 18, Cottage Grove. Ordered to do the work within 14 days. Pay costs (£2 8s. 0d.) 28th January Failing to abate nuisances arising from defective roof, water-closet and damp walls, dirty and defective walls and ceilings, etc., at 19, Cottage Grove. Ordered to do the work within 14 days. Pay costs (£2 8s. 0d.') 28th January Failing to abate nuisances arising from defective roof, dirty walls and ceilings, defective sashlines, etc., at 37, Tredegar Square. Ordered to do the work within 21 days. Pay costs (£2 8s. 0d.) 16th February 11th March Failing to abate nuisances arising from defective roof, damp walls and defective water-closet at 87, Varden Street. Failing to repair a defective drain at 66, Upper East Smithfield. Ordered to do the work within 7 days. Pay costs (£2 8s. 0d.) Ordered to do the work within 14 days. Pay costs (£2 8s. 0d.) 21st March Failing to abate nuisances arising from damp wall of ground floor back room, defective yard paving and defective windows at 16, Deal Street. The work having been carried out at the time of hearing, the summonses were withdrawn on payment of costs (£2 5s. 0d.). 19th April Failing to abate nuisances arising from damp walls, defective floors, hearth, dirty walls and ceilings, etc., at 43, Frederick Place. Ordered to do the work within 14 days. Pay costs (£2 8s. 0d.). 19th April Failing to abate nuisances arising from defective roof, sashlines, sashes, dirty walls and ceiling, etc., at 443, Mile End Road. Ordered to do the work within 14 days. Pay costs (£2 8s. 0d.). 14th April Slaughtering fowls on premises not sanctioned by the L.C.C. at 2, Turner House on 25th February, 1932. Ordered to pay £5 0s. 0d. fine within 7 days, or in default, 1 month's imprisonment. 14th April Slaughtering fowls on premises not sanctioned by the L.C.C., i.e at yard rear of 14, Salmen Street, on 25th February, 1932. Fined £6 0s. 0d. 9th May Failing to supply ash-pit at 7, Bohn Street. Dismissed under the Probation of Offenders Act. 9th May Failing to abate nuisance arising from dirty and dilapidated walls and ceilings, etc., at 7, Bohn Street. Ordered to do the work within 7 days and pay costs (£2 8s. 0d.). 9th May Failing to abate nuisance arising from defective drain at 107, Grove Street. The work having been done at the time of hearing, the summons was withdrawn on payment of costs (£2 5s. 0d.). 51 Date. Matter of information or complaint. Result. 1932. Public Health (London) Act, 1891—continued. 5th July Failing to cleanse walls and ceilings and repair defective sank and sashlines at 79, Turners Road. Order to pay costs (£2 5s. 0d.). 5th July Failing to repair water-closet and sink and cleanse walls and ceilings at 59, Turners Road. Order to pay costs (£2 5s. 0d.). 5th July Failing to provide a dustbin at 79, Turners Road. A dustbin having been provided at the time of hearing, the summons was, on the suggestion of the Magistrate, withdrawn. 5th July Failing to provide a dustbin at 59, Turners Road. A dustbin having been provided at the time of hearing, the summons was, on the suggestion of the Magistrate, withdrawn. 21st July Failing to abate nuisances arising from defective roof, dirty walls and ceilings, damp walls, etc., at 7, Frederick Place. Order to do the work within 7 days days and pay costs (£2 8s. 0d.). 21st July Failing to abate nuisances arising from defective woodwork of windows, damp walls and dirty walls and ceilings, etc., at 14, Frederick Place. Order to do the work within 14 days and pay costs (£2 8s. 0d.). 6th September Failing to remedy defective roof and dirty walls and ceiling of top front room at 15, Brady Street. The work having been completed at the time of hearing, the summons was withdrawn on payment of costs (£2 5s. 0d.). 6th September Failing to remedy defective roof and damp wall of top front room at 38, Weaver Street. The work having been completed at the time of hearing, the summons was withdrawn on payment of costs (£2 5s. 0d.). 7th September Keeping her room at 265, Brady Street Dwellings, in such a foul and filthy condition as to be a nuisance or injurious or dangerous to health. Order to abate the nuisance within 48 hours and to pay costs (10s.). 13th September Failing to abate nuisances arising from defective roof and flooring at 13, Tredegar Square. Order to abate nuisances within 7 days and pay costs (£2 8s. 0d.). 14th September Failing to repair defective skylights at 400, Mile End Road. Order to do the work within 7 days 14 days and to pay costs (£2 8s. 0d.). 21st September Failing to abate nuisances arising from defective roof, dirty and damp walls, defective flooring, etc., at 19, Cottage Grove. Order to abate the nuisances within 14 days and to pay costs (£2 8s. 0d.) 6th October Failing to repair defective watercloset and eaves gutters at 22, Rowsell Street. The work having been completed before the hearing, the summons was withdrawn on payment of costs (£2 8s. 0d.). 52 Date. Matter of information or complaint. Result. 1932. Public Health (London) Act, 1891. —contd. 7th October Failing to comply with an Order made at the Thames Police Court on Gth September, 1932, to abate a nuisance arising from the foul and filthy condition of her room at 265, Brady Street Dwellings. Defendant was allowed 7 more days to comply with the Order. 13th October Failing to abate a nuisance arising from an accumulation of rubbish in cellar at 104, Whitechapel Road. The work having been completed before the hearing, the summons was withdrawn on payment of costs (£2 5s. 0d.). l4th October Failing to comply with an Order made at the Thames Police Court on 6th September, 1932, to abate a nuisance arising from the foul and filthy condition of her room at 265, Brady Street Dwellings. The case was adjourned sine die with a view to arrangements being made for the Stepney Borough Council to carry out the Order to clear the room. 14 th October Failing to repair defective yard paving and sink waste at 105, St. Dunstans Road. Defendant was ordered to do the work within 7 days and pay costs (.£2 8s. 0d.). 20th October Failing to repair defective watercloset, flushing apparatus, passage flooring, and supply a dust receptacle at 68, Thomas .Street. The work was completed before the hearing. Defendant was ordered to pay costs (£2 5s. 0d.). 4th November 11th November Failing to repair a roof at 5, Fieldgate Street. Failing to abate a nuisance caused by a defective rain-water pipe at 38, St. Mark Street. Defendant was ordered to do the work within 14 days and pay costs (£1 Is. 0d.). The work having been completed before the hearing, Defendant was ordered to pay costs (£3s.0d.). 24th November Failing to repair defective roof at 141, Ernest street. Defendant fined £3 with £2 8s. 0d. costs, and ordered to do the work within 7 days. 9th December Failing to abate nuisances arising from defective walls, dustbin and yard paving at 93, Grove Street. Defendant ordered to do the work within 7 days. Pay costs (£2 8s. 0d.). 9th December Failing to abate nuisances arising from defective walls, ceiling, floors and drain at 99, Grove Street Defendant ordered to do the work within 7 days. Pay costs (£2 8s. 0d.). 9th December Failing to abate nuisances arising from defective yard paving, dirty and dilapidated walls and ceilings, and defective flooring at 101, Grove Street. Defendant ordered to do the work within 7 days. Pay costs (£2 8s. 0d.). 20th December Depositing for the purposes of sale at 158, Commercial Road Fast, 1½ lbs. of chocolates which were unwholesome and unfit for the food of man. Defendant ordered to pay costs (£2 2s. 0d.). London County Conncil Drainage Bye-laws, 1930. 19th January for failing to deposit plans of the construction of five lavatory hasins at hairdresser's establishment, at 189, Hanbury Street Case dismissed under the Probation of Offenders Act. Pay costs (£1). 53 Date. Matter of information or complaint. Result. 1932. London County Council Drainage Byelaws, 1930—contd. 30th May Failing to deposit drawings before executing drainage work at No. 18, Newnham Street. Case dismissed under the Probation of Offenders Act. 30th May 13th September Constructing a sink-waste pipe contrary to the bye-laws at No. 18, Newnham Street. For continuing to contravene the bye-laws at No. 18, Newnham Street. Case dismissed under the Probation of Offenders Act. The bye-laws having been complied with before the hearing, the case was withdrawn. London County Council Bye-laws for Houses let in Lodgings. 25th October Failing to provide efficient means for carrying off waste water from under taps at 38, Yalford Street. Metropolis Management Act. Case dismissed under the Probation of Offenders Act, the Defendant expressing his willingness to do the necessary work. Pay costs (£3 3s. 0d.). 31st March Failing to repair a drain at 20, Wilson Street, which was in bad order and condition. Fined £1. Pay costs (£3 3s. 0d.). London County Council Bye-laws relating to Offensive Businesses. 4th January Carrying on business of slaughterers of poultry in premises not sanctioned by the London County Council at 87, Buxton Street, on 5th November, 1931. Fined £20. Pay costs (£2 2s. 0d.). London County Council Bye-laws. —Removal of offensive matter. 1st April Conveying offensive matter through the streets on 10th March, 1932, otherwise than in properly closed receptacles. Fined 5s. 1st April Conveying offensive matter through the streets on 10th March, 1932, otherwise than in properly closed receptacles. Summons dismissed. 1st April Conveying offensive matter through the streets on 10th March, 1932, otherwise than in properly closed receptacles. Fined 5s. 4th November Conveying offensive matter through the streets during prohibited hours on 24th August, 1932 4th November Causing offensive matter to be conveyed through the streets during prohibited hours on 24th August, 1932. Not dealt with, see proceedings on the next page. 4th November Causing offensive matter to be conveyed through the streets during prohibited hours on 24th August, 1932. 54 Date. Matter of information or complaint. Result. 1932. London County Council Byelaws—Removal of offensive matter.—contd. 4th November 4th November Conveying offensive matter through the streets otherwise than in proper receptacles on 24th August, 1932. Causing offensive matter to be conveyed through the streets otherwise than in proper receptacles on 24th August, 1932. The case was dismissed under the Probation of Offenders Act. Case dismissed under the Probation of Offenders Act. 4th November Causing offensive matter to be conveyed through the streets otherwise than in proper receptacles on 24th August, 1932. Case dismissed under the Probation of Offenders Act. Defendant ordered to pay costs (£4 4s. 0d.). Food and Drugs (Adulteration) Act, 1928. 21st January Selling milk being 11 per cent, deficient in fat on 10th December, 1931. (C 78). Fined 10s Pay costs (£1 1s. 0d.). 21st January Selling milk adulterated with 6.6 per cent. added water on 10th December, 1931. (C 81). There were two partners in the business and two summonses were issued. One case was dismissed under the Probation of Offenders Act. Pay costs (£1 1s. 0d.). The other case was dismissed. 25th January Selling milk adulterated with 4.7 per cent, added water on 11th December, 1931. (C 85). Fined £5. Pay costs (£1 1s. 0d.). 25th January Selling milk adulterated with 7.2 per cent, added water on 11th December, 1931. (C 86). Fined £5. Pay costs (£1 1s. 0d.). 26th January Selling milk containing 4.6 per cent, added water on 14th December, 1931. (F 66). Fined £3. Pay costs (£1 1s. 0d.). 1st February Selling milk adulterated with 4.7 per cent, added water on 11th December, 1931. (C 84). Summons dismissed on payment of £5 5s. 0d. costs. 16th February Selling milk containing 5.4 per cent. added water in Aston Street, on 6th January, 1932. (P 4). The employee was fined £2 or one month imprisonment. 16th February Selling milk with 5.4 per cent. added water. Milk sold by an employee above in Aston Street on 6th January, 1932. (P 4). Case was withdrawn following conviction of employee. 18th February Selling milk on December 8th, 1931, containing 4.2 per cent. added water. (C 65). Dismissed under the Probation of Offenders Act and ordered to pay £2 2s. Od. costs. 6th May Selling milk on 23rd March, 1932, which was 63.7 per cent, deficient in milk fat. (C 16). Fined £4. 5th May For selling milk on 20th March, 1932, 16 per cent. deficient in fat, and containing 7.1 per cent, added water. (L, 15). Fined £3 or 1 month imprisonment. 55 Date. Matter of information or complaint. Result. 1932. Food and Drugs (Adulteration) Act 1928. 12th May Selling milk on 7th April, 1932, which was 13.3 per cent.deficient in milk fat. (N 27). Case dismissed on payment of costs (£2 2s. 0d.). 19th May Selling milk from a barrow on 17th April, 1932, which contained 5.4 per cent. added water and was 5 per cent. deficient in fat. (D 37). Fined £1. 23rd May Selling milk which contained 3.5 per cent. of added water Taken in course of delivery on 19th April, 1932, at Dower Chapman Street School. (D 54). Case dismissed under Probation of Offenders Act on payment of costs (£2 2s. 0d„). 9th June Selling milk 13 per cent. deficient in fat. (F 1). There were two summonses, one against each defendant because they are partners. One was ordered to pay £2 2s. 0d. costs, the summons against the other was dismissed. 18th July Selling milk 47.3 per cent.deficient in fat on 31st May, 1932. (E 73). Dismissed under the Probation of Offenders Act, with costs (£2 2s. 0d.). 18th July Selling milk 1.1 per cent, deficient in solids-not-fat and 14 per cent. deficient in fat on 4th June, 1932. (E 96). Case dismissed. The Magistrate held that the milk was sold as produced from the cow. 19th August Selling milk containing 9.6 per cent, of added water on 6th July, 1932. (G 46). Dismissed under the Probation of Offenders Act on payment of costs (£2 2s. 0d.). 6th October Selling milk containing 8.1 per cent.added water on 14th August, 1932. (C 64). Defendant fined £1. 20th December Selling milk containing 5.6 per cent, of added water. (T 53). Defendant ordered to pay costs (£2 2s. 0.). 30th December Exposing for sale margarine improperly labelled. (G 91). Defendant fined £2 0s. 0. Pay costs (£2 2s. 0.). Milk and Dairies Order, 1926. 4th January For bottling milk other than on registered premises, viz., in street outside 53, Russell Street, on 5th November, 1931. Fined £2. Pay costs (£1 Is. 0d.). 14th January Selling milk without being registered. (X 73). Case dismissed under the Probation of Offenders Act. Pay costs (£1 Is. 0d.). 19th April Bottling and sealing milk other than on registered premises, i.e., outside 17, Richard Street, on 18th February, 1932. Case dismissed under the Probation of Offenders Act. Pay costs (£1 1s. 0d.). 56 Date. Matter of information or complaint. Result. 1932. Milk and Dairies Order, 1926—contd. 27th June Filling, sealing and delivering a pint bottle of milk in Old Montague Street, at 12.55 p.m., on Friday, 10th June, 1932. Fined £1. 26th July Bottling milk other than on registered premises, i.e., in White Lion Street, on 7th July, 1932. Fined 10s. 0d. 6th Octob Bottling and sealing milk other than on registered premises, i.e., outside 14, Wilkes Street, on the 18th August, 1932. Defendant fined £2. Milk and Dairies (Amendment) Act, 1922. 7th January Selling reconstituted milk. (D 30) Case dismissed. 7th January .Selling reconstituted milk. (D 31) Case dismissed. Milk (Special Designations) Order, 1923. 7th January Selling ordinary milk as "pasteurised." (D 1). Case dismissed under the Probation of Offenders Act. Pay costs (£1 1s. 0d.). 7th January Labelling ordinary milk "perfectly pasteurised." (X 64). Case dismissed under the Probation of Offenders Act. 11th January Selling pasteurised milk containing an excess of bacteria. (T 79). The Magistrate, after hearing expert evidence for the defence, held that the bulk from which the sample was taken was not mixed by plunging and that the sample should have been packed in ice while being conveyed from the place of delivery to the laboratory. The case was dismissed with .£26 5s. Od. costs against the Council. 11th January Selling pasteurised milk in a vessel which was unlabelled. (X 80). This case should have followed immediately after the above case but, at the Magistrate's suggestion, was not heard. 15th February Selling pasteurised milk in vessels which were not labelled. Summons dismissed on payment of £\ Is. Od. costs. Public Health (Preservatives, &c., in Food) Regulations. 25th April Wilfully neglecting to obey the above-mentioned Regulations by selling ground ginger containing sulphur dioxide. Fined £1. Pay costs (.£5 5s. 0d.). 12th August Selling minced meat containing 1,080 parts per million sulphur dioxide. (M 48). Fined £5. 27th October Failing to declare by means of a label the presence of sulphur dioxide in pork sausages. (H 95). Defendant fined 10s. 57 * This case is important because of the appeal by the Council against the previous decision of the Magistrate in dismissing the case against a wholesaler with costs against the Council on 27th April, 1931. At the hearing of the appeal, Mr. J. Scholefield, K.C., for the Stepney Borough Council, said that under the Food and Drugs Act proceedings had been taken against the retailer of the ginger and he had been convicted. Afterwards proceedings were started against the wholesaler and the complaint was that the Magistrate had held that it was essential for success that there should be a fresh sample purchased, the sample divided and analysed. Mr. FoxAndrewes, K.C., for the respondent, argued that not only was a second sample essential but that there was no evidence on which the Magistrate could find that his client wilfully sold the ginger. He relied on the invoice description. The Lord Chief Justice (Justices Avory and Hawke concurring), in giving judgment, said that the allegation against the wholesaler was that he wilfully disobeyed the Act because he took no steps to see that the ginger was free from preservative but relied on the invoice description received from a vendor who had made no analysis for four years. It was impossible to say there was no evidence on which the Magistrate could find that the wholesaler was guilty of wilful neglect. The Magistrate refused to convict because he thought that before the wholesaler could be convicted the same process of taking samples and having them analysed must be repeated. For that there was no warrant. The appeal was upheld and the case remitted to the Magistrate with a direction to convict, with the result set out above. †This case, on page 52, was rather unusual, and I give a short account of the action taken:— In November a notice was served with regard to the dirty condition of the room and contents belonging to a woman living by herself in a one-roomed flat. The notice, not being complied with, she was summoned and after the third hearing the Magistrate made an Order for the Council to remove the articles. This removal was done on the 18th November under the supervision of a Sanitary Inspector and with the assistance of eight men. Over two cartloads of old paper, rags, jars, tins, were carted away by the Public Cleansing Department. This large quantity must have been the accumulation of a good number of years and reached from floor to ceiling, impeding light and ventilation and rendering the room insanitary. Great publicity to this case was given in the Press but the accounts were rather exaggerated. 58 Total Fines and Cost No. of Fines. Costs. £ s. d. £ s. d. Food and Drugs (Adulteration) Act, 1928 monses 23 26 10 0 27 6 0 London County Council Bye-laws 15 20 10 0 10 9 0 Milk and Dairies Order, 1926 6 5 10 0 3 3 0 Public Health (London) Act, 1891 39 14 0 0 72 13 0 Public Health (Preservatives, &c., in Food) Regulations 3 6 10 0 5 5 0 Metropolis Local Management Acts 1 1 0 0 3 3 0 Milk (Special Designations) Order, 1923 5 - 2 2 0 Milk and Dairies (Amendment) Act, 1922 2 - - Total 74 0 0 124 1 0 Smoke. Nuisances. 232 observations were made by the Sanitary Inspectors for the detection of nuisances from smoke, and in only 19 cases was the nuisance found to exist. Notices were served to remedy the nuisance. Complaints 3,168 written complaints were made to me during the year, which were duly investigated and dealt with where necessary. 66 were from H.M. Inspector of Factories relating to workshops, 75 from the London County Council respecting verminous school children, and 3,027 related to the condition of houses, etc. Drainage. The Sanitary Inspectors supervise all drainage work. Full particulars as to the work done by them are given on pages 48 and 49. 4,558 drains were tested during the year. Of these, 641 were found to be defective. Rats and Mice. During the year 634 complaints were received as to nuisances from rats or mice. As a consequence 609 drains were tested and in 262 instances they were found to be defective. 548 complaints were forwarded to the Borough Engineer, so that the Council's ratcatchers could call and assist the tenants concerned. I am indebted to the Borough Engineer for the following information as to procedure and work carried out by his department:— Under the provisions of the Rats and Mice (Destruction) Act, 1919, the occupier of any premises is himself liable for the destruction and extermination of the vermin. I he Council only employ ratcatchers to assist those who cannot afford the expense of buying poisons or engaging ratcatchers. The men do not visit wharves, warehouses or premises where the owners or occupiers are in a position to deal with the matter for themselves. Two men are at present employed all the year round, giving their whole time to visiting premises from which complaints have been received and putting down poisons and setting traps. Authority has now been obtained for the employment of an additional ratcatcher, and he will shortly be commencing his duties. 59 A record is kept of the number of visits made by each ratcatcher, the poisons used, and the results obtained. The poisons used are those recommended by the Board of Agriculture and Fisheries, viz., Rodine, barium, carbonate, phosphor paste, and extract of squills. They are varied in order of use from time to time as there is a tendency for the rats to become wary and avoid poisons which have just been successful in destroying other vermin in the same house. A considerable number of rats are found poisoned or caught alive in the baited traps throughout the year. Valuable assistance is thus given to the ratepayers generally, in clearing their premises of rats. Protective clothing is issued (one suit of overalls every six months to each man), and two pairs of rubber gloves per man per annum. Poisons and bait are also provided. In addition to the regular ratcatchers, the Council's sewermen are also engaged from time to time in placing poisons in the manholes and side entrances of the sewers, special attention to this work being given during the "National Rat Week" held every year in November. Notices, drawing the attention of the public to the matter, were inserted in four local newspapers. Communications were sent to .12 local cinemas, requesting that notices be displayed on the screen, drawing attention to National Rat Week. Seventy-nine chemists and oilmen in the Borough were supplied with copies of the Ministry's Form 264R.T. and Bulletin No. 30 and with bills "Rat Poison Sold Here" and were requested to display the same in their shop windows. Rat poison, consisting of extract of squills, barium carbonate, phosphor paste and Rodme, was placed in the sewer manholes and side entrances at 168 different positions. At 124 of these places the bait was entirely taken by the rats, at 37 places it was partly taken, and only in 7 positions was it untouched. Reports on Rat Destruction are made regularly to the Public Health Committee and the following is the record of rat extermination carried out during the year 1932:— No. of premises visited 1,052 ,, ,, visits 12,273 ,, ,, dead rats found poisoned 406 * ,, ,, rats caught in our traps 2,406 ,, ,, premises cleared of rats as reported by the occupiers 505 ,, ,, new rat complaints during this period 570 *494 of these were actually brought into the depot and destroyed. The poisons used were as follows:— Rodine 20,553 cubes Barium Carbonate 26,410 ,, Phosphor Paste 18,126 ,, Haller's extract of Squills .14,164 2 oz. portions 60 Increase of Rent and Mortgage Interest (Restrictions) Acts 16 applications were received during the year for Certificates that certain houses were not in a reasonable state of repair. 18 were granted and 3 were refused. In addition, 2 applications were received for Reports that the work mentioned on the Certificates had been satisfactorily executed. Both were granted. 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 12 houses and 184 tenements. Hairdressers' Shops. Annual certificates are granted respecting Hairdressers' Shops in the Borough, which come up to a certain standard of cleanliness. 3 applications were received during the year for certificates, all of which were granted. Report required by the L.C.C. Premises. No. in borough on 31st Dec., 1932. No. of Inspections. No. of Prosecutions. Cowsheds 19 135 — Poultry Slaughterhouses 40 289 - Offensive Trades 9 35 - Milkshops 422 1,453 - Ice Cream Premises 273 403 - Restaurants and Eating Houses 365 593 - Smoke Nuisances— (1) No. of observations 232 (2) No. of intimations served 19 (3) No. of complaints received 22 (4) No. of Statutory notices served 2 (5) No. of legal proceedings - (6) No. of convictions - (7) Amount of penalty and costs imposed in each case - Cleansing and Disinfection— No. of adults cleansed 320 No. of children cleansed 10 No. of premises cleansed— (a) after infectious diseases 1,977 (b) for vermin 303 61 Water Supply to Tenement Houses— No. of premises supplied 6 No. of prosecutions 1 Sanitary Officers— No. of Sanitary Inspectors (whole time) Male 19; Female nil „ ,, ,, (part time) Male nil; Female nil No. of health visitors (whole time) 11 „ „ ,, (part time) nil Total No. of houses in the borough 37,900 No. of houses occupied by the working classes 31,810 No. of houses inspected— (a) On account of complaints or illness (P.H. Act) 9,063 (b) ,, ,, Infectious disease 2,852 (c) Housing Consolidated Regulations, 1925 798 No. of notices served— (a) Under P.H. Act:— (i) Intimation 13,822 (ii) Statutory 4,979 (b) Under Housing Act - No. of houses repaired or nuisances remedied under P.H. Act, 1891 11,960 No. of houses repaired under Sec. 17 of Housing Act, 1930 — (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 57 (b) In course of erection 28 No. of representations by Medical Officer or other person - No. of houses included in such representations - No. of Closing Orders made - No. of Closing Orders determined (i.e., Houses made fit) - No. of Demolition Orders - No. of houses demolished— (a) In pursuance of orders - (b) Voluntarily Underground Rooms— No. illegally occupied 54 No. closed or illegal occupation discontinued 36 62 Overcrowding— No. of cases of overcrowding found 94 No. remedied 71 No. of prosecutions - Houses let in Lodgings— No. on register 2,658 No. of inspections made 2,778 No. of prosecutions 3 Canal Boats Acts 1877 and 1884. Pursuant to the Third Section of the Canal Boats Acts, 1884, the Metropolitan Borough of Stepney, being the Registration Authority under the above Acts, has to report as follows with regard to the execution of such Acts and of the Regulations made thereunder, and as to the steps taken by them as such authority during the year 1932 to giye effect to the provisions of the said Acts and Regulations, viz.: — (1) Canal Boats coming within the district are inspected by a Sanitary Inspector, who receives a sum of £10 per annum for the performance of this duty. His inspection is irrespective of the examination of Boats made by the Examining Officer prior to their registration. (2) The number of boats inspected in 1932 was 35. Only three children were found on the boats. There were no contraventions of the Acts and Regulations. There is only one boat on the register. Factories, Workshops and Workplaces No boats were registered during 1932. 1.—Inspections. Home Office Form 572 Premises. Number of. Inspections. Written Notices. Prosecutions. Factories 1,157 200 - (Including Factory Laundries) Workshops 2,471 588 - (Including Workshop Laundries) Workplaces - (Other than Outworkers' premises) 572 75 - Total 4,200 863 - 63 2.—Defects found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health A cts:— Want of cleanliness 369 369 1 - Want of ventilation 42 42 - - Overcrowding 4 4 - - Want of drainage of floors 1 1 - - Other nuisances 367 367 - - Sanitary insufficient 22 22 - - Accom unsuitable or defective 230 230 - - modation not separate for sexes 17 17 - - Offences under the Factory and Workshop A ct:— Illegal occupation of underground bakehouse (s. 101) - - - - - Other offences - 3 3 - - (Excluding offences relating to outwork which are included in Part 3 of this report.) Total 1,055 1,055 1 - 3.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year 1932. Number. Bakehouses 138 Boot, Shoe and Slipper Making 103 Cabinet Making 105 Furriers 154 Hat and Cap Manufacturers 41 Laundries 6 Rag Sorting, etc. 41 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) 1,943 Miscellaneous 502 Total 3,033 64 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 20 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 Reports (of action taken) sent to H.M. 66 66 Inspector Other 2 Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year 44 The number of inspections made to outworkers' premises was 1,605, and the number of premises where sanitary defects were found to exist was 391. Notifiable infectious disease occurred in 114 outworkers' premises. There are 111 firms in the Borough employing outworkers, and of these firms 101 sent in lists twice in the year and 10 once. These related to a net number of 1,002 outworkers, of which 618 were resident in the Borough and 384 were transferred to other Districts. In addition, 639 lists relating to a net number of 1,661 outworkers were received from other Boroughs during the year. Outworkers The net number of outworkers in the Borough engaged in the various trades is as follows:— Making, cleaning, etc., of wearing apparel 2,113 Furriers 38 Umbrellas 20 Boots and shoes 58 Paper bags and cardboard boxes 8 Christmas crackers 3 Brushes 6 Flag making 2 Ties 4 Feather bedding 2 Toys 2 Christmas cards 1 Small wares 1 Carnival hats 7 Art needlework 6 Cap making 4 Artificial flowers 2 Baby linen 1 Braces 1 2,279 65 Outworkers' premises where sanitary defects were found to exist:— Nature of work. Instances where defects found. Notices served. Wearing Apparel— Making, etc 332 296 Cleaning and Washing 4 4 Boots and Shoes 23 21 Household linen 1 1 Furniture and Upholstery 19 18 Fur Pulling 1 1 Umbrellas, etc. 3 2 Paper, etc., boxes, paper bags 6 6 Brush Making 2 1 391 350 The number of bodies deposited in the Mortuary during the year was 298. 34 Jewish bodies were officially "watched." 205 inquests were held in the Coroner's Court, and 131 post-mortem examinations were made. The shelter is used for the accommodation of contacts of infectious disease while their homes are being disinfected. During the year there were 18 persons admitted to the shelter: 9 adults and 9 children. Mortuary and Shelter. Eight inspections were made during the year to premises subject to the provisions of these Acts. One sample of rag flock was examined and found to be satisfactory. There are 19 cowsheds in the Borough licensed to accommodate a total of 493 cows. During the year, 135 inspections were made to the cowsheds, but it was only found necessary to serve two notices for defects or nuisances under the Rag Flock Acts 1911 and 1928. Cowsheds, Public Health Act. The following is a list of cowsheds in the Borough:— Address. No. of Cows licensed to be kept. 21, Black Lion Yard 46 63, Brook Street 19 134, Charles Street 14 77, Commercial Road 26 Railway arches, Nos. 185 and 186, Drewton Street 41 18, Fairclough Street 56 37, Hanbury Strest 18 12, Hilton Street 10 42, Jubilee Street 43 15, Maroon Street 12 46/52, Old Church Road 67 64, Pelham Street 16 56, Princes Square 36 5, Russell Street 8 33, St. Ann's Road 19 1, Sidney Street 20 9, Umberston Street 14 1. Upper Chapman Street 12 64, White Horse Lane 16 Authorised Offensive Businesses. 36 324 inspections were made during the year to various offensive businesse (including 40 poultry slaughter houses) carried on in the borough. Knacker.—19, Winthrop Street. Soap Boiler.—High Street, Wapping. Tripe Boilers.—5, High Street, Whitechapel; 94, Wentworth Street. Dressers of Fur Skins.—15, Gill Street; 54 and 56, Old Church Road; 29, Spelman Street; 34, Love Lane; 27b, Upper East Smithfield. Slaughterers of Poultry.— 29, Bedford Street. 75, Hessel Street. 16 and 18, Betts Street. 6, Hope Street. 131, Bridge Street. Fish Hall, Hope Street. 80, Burdett Road. 13, Leyden Street. 28, Burslem Street. 15, Leyden Street. 59, Buxton Street. 49, Lindley Street. .152, Cannon Street Road. 26, Maplin Street. 161 -163, Cannon Street Road 600, Mile End Road. 13, Cobb Street. 82, Oxford Street. 16 and 18, Cobb Street. 98, Oxford Street. 21, Fordham Street. 114, Oxford Street. 22, Fordham Street. 217, Oxford Street. 49, Globe Road 39, Pelham Street, 31, Great Pearl Street. 116, Redmans Road. 29, Greenfield Street. 117, Redmans Road. 8, Gun Street. 56, Richard Street. 9, Gun Street. 182 & 183, St. George St. 37, Harford Street. 150, Stepney Green. 46. Hawkins Street. 27, Sutton Street. 8a, Hessel Street. 51, Varden Street. 14, Hessel Street. 56, Weaver Street. 36, Hessel Street. 64, Wellesley Street. 42, Hessel Street, 70, White Horse Lane. Common Lodging Houses. There are 20 common lodging houses with a total accommodation of 3,005 beds. Some of them arc entirely used by women. The following is a list of Common Lodging Houses in the Borough. Premises. No. of Lodgers 28 to 42, Betts Street 149 men 19 and 19£, Brick Lane 82 men 27 and 29, Brick Lane, and 58, Flower and Dean St. 79 women 63$, Brick Lane, and 12, Princelet Street 254 men 22 and 22a, Crellin Street (Ground floors) 10 men 16, 17, 19 and 20, Duval Street 156 men F inch Street and Chicksand Street (Salvation Army) 306 women 5, Flower and Dean Street 103 men 56 and 57, Flower and Dean Street 102 women 67 15 and 16, Great Pearl Street 48 couples 194, Hanbury Street (Salvation Army) 249 women 66, Leman Street 74men 63, Mansell Street (Jews' Temporary Shelter) 63 men & 64 women 41a, Quaker Street (Salvation Army) 207 men 37, Stepney Causeway 55 men 28, Thrawl Street 173 men 18, Upper East Smithfield 80 men 40, Upper East Smithfield 157 men 42, West India Dock Road 52 men 20 and 22, Whitechapel Road (Salvation Army) 238 men 177, Whitechapel Road (Salvation Army) 547 men In addition to the above there are 14 Seamen's lodging houses to accommodate a total of 765 lodgers. Premises. No. of I No. of Lodgers. 5, Church Row 5 8, East India Dock Road 30 9, Limehouse Causeway 16 15, Limehouse Causeway 5 13, Rich Street 3 The Empire Memorial Hostel, Salmon Lane and Commercial Road East 217 25a, Three Colt Street 8 The Sailors' Home and Red Ensign Club, Well Street and Dock Street 235 3, Well Street 6 The Lord Charles Beresford Memorial Seamen's Rest, 18-19, Wellclose Square 44 The Asiatic & Overseas Home, West India Dock Road 170 28, West India Dock Road 3 Samaritan Home, 32, West India Dock Road 19 46, West India Dock Road 4 Seamen's Lodging Houses. On the 28th April human remains were discovered during excavation at. the L.C.C. training centre, Old Montague Street. I communicated the facts to the Home Office, who, in due course, issued a licence for their reinterment. The skeletons were of six human beings. These were reinterred under the supervision of a Sanitary Inspector at the City of London and Tower Hamlets Cemetery, South Grove, on the 12th May. The site mentioned was formerly used as a burial place attached to an old chapel. Human Remains. From time to time I receive requests for the compulsory removal of persons to Institutions who are (a) aged and infirm or physically incapacitated and living in insanitary premises or under insanitary conditions, or (b) are suffering from any grave chronic disease; such persons being unable to have proper care and attention. During the year 3 such requests were made, but it was not necessary to resort to legal action, as in two instances they went into hospital voluntarily, and in the other case the woman died through an accident at home, Aged Persons. 68 IV.—HOUSING. Statistic*. I.—Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 21,140 (b) Number of inspections made for the purpose 28,646 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 798 (b) Number of inspections made for the purpose 1,903 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 12,503 11.—Remedy of defects during the year without service of formal notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 6,140 III.—Action under Statutory Powers during the Year:- (a) Proceedings under sections 17, 18 and 23 of the Housing Act, 1930:— (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 - (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 11,960 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 5,820 (b) By local authority in default of owners - (c) Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made - (2) Number of dwelling houses demolished in pursuance of Demolition Order - 69 (d) Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made - (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit - (e) Proceedings under section 3 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which notices became operative 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 - (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close - (f) Proceedings under sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which Closing Orders became operative - (2) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit ... (3) Number of dwelling houses in respect of which Demolition Orders became operative ... - (4) Number of dwelling houses demolished in pursuance of Demolition Orders - The Housing Committee is fully alive to the importance of the Housing question in the Borough. They meet monthly and at such other times as may be necessary. Rent is a very serious and important item in considering the re-housing of the people and the question of economic rents will have to be considered. In making a survey of the housing problem, attention has been drawn by the Government and other departments to the desirability of speeding up the housing schemes. With regard to our own particular Borough one has to face present-day facts. There is a great tendency for Stepney to become more industrialised year by year. Changes are always going on whereby small dwelling houses are being acquired by firms for the extension of their works These firms either re-house the tenants displaced or compensate them. 70 Market Buildings Area. The great difficulty then is to acquire a ready-made clearance area which could he used for decanting people who have been dehoused whilst other areas are being built on. As I have so often pointed out, Stepney has a large number of dock workers, either casual or regular, and it is most important that these men should be housed near their work. If the London County Council undertook slum clearance on a large scale in Stepney and became responsible for re-housing the people so displaced, the danger is that the London County Council are not compelled to re-house Stepney people only. Largs numbers of people might be sent out of the Borough to live elsewhere while the people from other areas may be brought in to live in the new dwellings. Like residents of other districts, Stepney people like to remain in Stepney because of their old associations and upbringing. In my annual report last year I reported on the Market Buildings Area which the Council after considering a representation by me under the Housing Act, 1930, declared it a Clearance Area. An official enquiry was conducted by an Inspector of the Ministry of Health in January, and on the 2nd August the Confirming Order was made with certain modifications by the Minister of Health. Underground rooms. Housing Accomodation provided From time to time I received communications from the London County Council in regard to applicants for housing accommodation on their estates. They stated that the applicants resided in basement rooms and as the London County Council provide a limited amount of accommodation in connection with operations under Section 20 of the Housing Act, 1930, they asked whether the cases are such where action might properly be taken by this Council. Though there are hundreds of basement rooms in the Borough, many of them do not come within the legal definition of an underground room habitually used as a sleeping place as defined by the Housing Act, 1930. The Council in December made Regulations for securing the proper ventilation and lighting of rooms to which Section 18 (1) of the Housing Act, 1925, applies, and the protection thereof against dampness, effluvia or exhalation. 675 families in the Borough took accommodation on the London County Council's housing estates as follows:— Becontree Estate 410 Beachy House, Wapping 1 Vancouver House, ,, 21 Franklin House, ,, 1 Fenner House, ,, 3 Welch House, ,, 14 Parry House, ,, 1 Jackson House, ,, 40 Frobisher House, ,, 1 Brune House 38 Kingshold Estate 33 Stamford Hill Estate 20 Boundary Street Estate 17 Cable Street Estate:— Chancery Buildings 4 Dellow Buildings 1 Bewley Buildings 4 Lowood Buildings 1 Whitemore Estate 9 Brightlingsea Buildings 5 St. Helier Estate 5 Collingwood Estate 9 71 White Hart Lane Estate 3 Downham Estate 1 Laleham Bldgs., Bethnal Green 1 Henley Buildings, Bethnal Green 1 Werlake Buildings, Old Street 1 Clapham Park Estate 1 Merrow Buildings, Blackfriars 1 Stringer Houses, Shoreditch 1 Wessen Buildings, N. 19 1 Barnard House, Holland Estate 2 Chad worth Buildings 1 Rutherford House 2 Beachcroft Buildings, Ratcliff 1 Bekesbourne Buildings, Ratcliff 2 Torney House, Shore Place, Hackney 2 Valetta, Buildings, Hackney 2 Darcy Buildings, Hackney 2 Whiston House, Shoreditch 1 Freemantle House, Bethnal Green 1 Birchfield House, Poplar 1 Toronto Buildings, Poplar 1 Ottowa Buildings, Poplar 1 Council's Buildings, Preston Rd., Poplar 1 Cookham Bldgs., Bethnal Green 1 Redman Buildings, Holborn 1 Millbank Estate 1 Hartnoll House, Islington 1 Chamberlain House, St. Pancras 1 Elfrida Crescent, Bellmg-ham 1 Full particulars of bad cases of overcrowding are forwarded to the Borough Treasurer for special consideration with a view to obtaining alternative accommodation. During the year, 94 fresh cases of overcrowding were found, and 71 cases of overcrowding were abated. Overcrowding. List of streets in which all the houses have been inspected as a result of House to House inspection during the year 1932. (a) Limehouse. Mr. Bottomley. Agnes Street. Oak Lane. Batson Street. Pelling Street. Calcutta Street. Prosperous Place. Chusan Place. Whites Rents. Mill Place. Mr. McCarthy. Barnes Street Flats. Halley Street. Blount Street. Hope Place. Burtons Entry. Taylors Place. Eltham Place. Mr. Roper. Arno Place. New Alley Square. Beccles Street. Padstow Place. Gill Place. Rich Street. Grenade Street. Tenbury Place. New Alley. Whitehall Place. Mr. Waterman. Albert Square. Hilton Street. Barnardo Street. Market Buildings. Brook Street. Narrow Street. Caroline Street. Ronald Street. Causeway Court. Sage Street. Devonport Street. Steels Lane. Dorset Street. Stepney Causeway. Drew's Buildings, Juniper Street. Solander Street. Elbow Lane Buildings. Twine Court. Giles Place. Whitaker Buildings. Havering Street. House to House Inspections. 72 (b) Mile End. Mr. Brown. Antcliff Street. Sidney Square. Brilliant Street. Terrace Place. Redmans Road. Winwood Street. Mr. Edwards. Bohn Street. Lydia Street. Eaton Place. Ocean Street. Hayfield Place. Paragon Mansions. Knott Street. Wades Place. Mr. Flint. Canal Road. Maplm Street. Frederick Place. Maplin Place. Grove Buildings. Murdock Cottages. Lawton Road. Mr. Harris. Cameron Place. Sidney Street. Gray Street. Turner Street. Settle Street. Mr. Roper. Bermuda Street. Mr. Simpson. Bradwell Street. Leatherdale Street. Braintree Street. Longnor Road. Buckeridge Street. Moody Street. Cambridge Mansions. Moses and Solomons Almshouses, Eagle Place. Devonshire Street. Faith Street. Pelican Passage. Frimley Street. Sceptre Street. Key Street. Wickford Street. Mr. Timming. Baggally Street. Woodison Street. St. Dunstan's Road. (c) St. George's. Mr. Day. Cable Street (171 to 201 odd). St. George Street (104 to 152 consec.) Clifford House. Swedenborg Street. Lawrence Buildings. Well Street. Luden's Place. Wright's Row. Mr. Dee. Brewhouse Lane. Old Tower Buildings. Burr Street. Raines Mansions. Coleman Street. Raine Street. Globe Street. Redmead Lane. Great Hermitage Street. Sarah Street. Mary Place. Tench Street. Monza Street. Twenty Nine and a Half Court. New Gravel Lane. Wapping Wall. New Tower Buildings. 73 (c) St. George's—cont. Mr. Guy. Agra Place. Shadwell Place. Coburg Buildings. Spencer Street. Cross Court. Tarling Street. Johnson Street. Watney Passage. Little Ann Street. Whites Gardens. Morris Street (odd Nos. & 2 to 10). Mr. Roper. Artichoke Hill. John's Court. Burslem Street. Lavender Place. Bungay Street. Old Gravel Lane. Christian Street. Pennington Street. Cuttle Place. Pennington Place. Chigwell Hill. Prusom Street Buildings. Grove Street. St. George Street. Golding Terrace. Umberston Street. Hessel Street. Woodside Mansions. John's Hill. Mr. Smith. Challis Court. Langdale Mansions, Block 71-80. Ellen Place. ,, ' ,, 181-190. Globe Court. Phillips Buildings, Crellin Street. Langdale Mansions, Block 1-10. Wicker Terrace. „ 11-20 „ 61-70. (d) Whitechapel. Mr. Green. Chamber Street. Kersteins Mansions. Christopher Court. Lambeth Street. Fieldgate Street. Mundy's Place. Griggs Court. South Tenter Street. Mr. Roper. Brady Street. Montague Place. Buxton Street. Old Montague Street. Dunk Street. Pelham Street, Augustine House. Easington Buildings. ,, Clinton House. Fleur de Lis Buildings. ,, Bulwer House. Finch Street. ,, Osborn House. Fulbourne Street. ,, Pelham House. Hope Street. ,, Lytton House. Mr. Shepherd. Fleur de Lis Street. Nantes Place. Great Pearl Street. Old Castle Street. Newcastle Place. Pool's Square, Quaker Street. Newcastle Street. Rosetta Place, Sandys Row. 74 (b) Whitechapel—cont. Mr. Twynham. Casson Place. Keate House. Chicksand Place. Montague Houses. Ely Place. Mason's Court. Flower and Dean Street. Puma Court. Garden Place. Perry's Avenue. Green Dragon Yard. Ramar Place. Helena House. Ruth House. Henderson House. Samuel Court. Irene House. Spencer House. Josephine House. Mr. Vogler. Blackwall Buildings, Fulbourne St. Selby Street. Crashawe Place. Wodeham Street. Milk Supply v.—INSPECTION AND SUPERVISION OF FOOD. There are 422 dairy premises on the register and 1,453 inspections were made to them during the year. It was found necessary to serve 37 notices for minor matters. In addition there are registered in the Borough 259 purveyors who sell milk in sealed bottles, 46 dairymen who have premises outside the Borough and 19 cowsheds. Milk and Dairies Order, 1926. During the year five summonses were issued under this Order. Details are given on pages 55 and 56. Milk (Special Designations) Order, 1923. 54 licences under this Order were issued during the year, being 7 than the previous year. The description of the licences are as follows:— Dealers Licences. Dealers Supplementary Licences. Certified Milk 4 2 Grade A. (T.T.) 17 5 Grade A Milk Pasteurised 1 1 Grade A 3 1 Pasteurised 12 8 Legal proceedings were taken in 5 instances, the details of which are given on page 56. 75 Agricultural Produce . . (Grading and There were no infringements of the various Regulations made under this Marking) Act during the year which required legal action to be taken. Act' 1928, It was not found necessary to take legal proceedings under this Act, Merchandise Marks Act, 1926. In October I received information from a neighbouring County Council that a firm in the Borough was receiving butter from New Zealand, Australia, Esthonia, Argentine and Siberia, and blending them, calling these mixtures by various proprietary names. They stated that the butter was labelled in paper describing various named brands and packed in boxes which were alleged to contravene the Merchandise Marks Acts. I caused investigation to be made. The firm concerned was a reputable one and there was no infringement of the Act, as each brand was described as " including imported butter." Unfortunately under the present Order it is only necessary to add to foreign butter the smallest proportion of Empire butter and there is no obligation to mark the mixture "foreign." It can have applied to it the mark " including imported " butter. This is misleading. A better way would be to mark the butter of the country of origin which supplied the highest percentage in the blending. 982 inspections were made to butchers' shops and 545 to butchers' stalls Butchers' in the Borough. 38 notices were served for minor infringements of the Meat stalls! a"d Regulations. There are 273 premises registered whereon Ice Cream is manufactured, ice Cream stored or sold. Premises. 403 inspections were made and 25 notices were served. There are 7 Butter and Margarine factories and 45 premises used by Factories, Wholesale Dealers in Margarine on the Register. 21 inspections were carried Wholesale Dealers in out during the year. Margarine, etc. 474 inspections were made to the bakehouses in the Borough, and 342 Bakehouses, cleansings were carried out. As Certifying Officer, I have issued 27 certificates for the export of con- Certification signments of potted meats (prepared within the Borough) to Canada, Australia, products for etc. Export. 1,387 inspections were made at the various wharves in the Borough. Food. Inspection. The following is a list and quantity of the Foodstuffs from the wharves destroyed during the year under the Public Health (Imported Food) Regulations, 1925. 76 Fresh Meat Tons. cwts. qrs. lbs. 12 carcases of Frozen Mutton — 6 0 7 6 prs. of Hind Quarters Frozen Mutton — 2 1 2 Bacon — 4 2 3 Preserved Meats. 771 tins of Beef 2 0 3 22 139 „ Tongues — 5 1 14 33 „ Ox Tails — 1 3 2 Fresh Fruit and Vegetables 2750 packages of Apricots 31 12 0 24 44 crates of Bananas — 18 0 0 1 cask of Blackcurrants — 1 0 3 178 bags of Onions 7 11 2 0 3 boxes of Oranges — 3 2 0 3 packages of Peaches — — 1 14 647 „ Plums 6 18 0 25 5121 „ Potatoes 256 9 0 16 6 „ Tomatoes — — 3 4 Preserved Fruit and Vegetables. 1,753 tins of Assorted Fruits 1 16 2 25 3,029 „ Fruit Pulp 10 3 2 10 7 „ Apples — — 3 0 48„ Grape Fruit — — 3 12 6,389 „ Pineapples 6 15 1 3 1,334„ Tomatoes 28 16 1 27 7 boxes of Raisins — 1 3 0 Preserved Fish. 1,350 tins of Brisling — 13 0 0 49 „ Crab — — — 25 200 „ Crayfish — — 3 16 2,989 „ Lobsters 1 6 2 11 1,365 „ Pilchards 7 2 2 5 9,206 „ Salmon 3 18 1 21 812 „ Sardines — 5 0 23 Sundries. 9,237 tins of Assorted Canned Goods 12 18 3 25 48 jars of Chow Chow — 2 0 0 3 bags of Cocoa — 3 0 15 21 tins of Condensed Milk — — — 21 75 „ Cream — — 1 I 621 bags of Flour 37 4 3 4 5 casks of Sheeps Casings — 13 3 9 22 pockets of Sugar — 19 2 16 120 barrels of Tamarinds 6 7 2 0 50 packets of Herbal Tea — — — 16 Total 426 8 2 1 77 Zeebrugge-Harwich Train Ferry. At Bishopsgate Goods Station.—110 special midnight and early morning visits were made by the Sanitary Inspectors. The total weight of fruit and vegetables examined was 10,306 tons. This was of Belgian, Italian, Dutch, French, Hungarian, Jugo-Slavian, Spanish and Czecho-Slovakian origin. Poultry and Rabbits of Italian and Hungarian origin were also examined, and samples of Belgian Fruit Pulp were taken for analysis. At Spitalfelds Goods Station.—Eggs of Belgian and Italian origin were examined at Spitalfields Goods Station. The following foodstuffs were found to be unsound and were destroyed : — (a) ex Zeebrugge-Harwich Train Ferry. Tons cwts. qrs. lbs. 2 packages of Apricots — — 1 12 1 drum of Black Currant Pulp — 1 0 3 50 packages of Greengages — 7 0 16 12 ,, Melons — 6 1 20 64 Melons — 5 3 1 26 packages of Peaches — 2 3 4 212 ,, Pears 2 7 0 0 1,433 ,, Plums 14 19 3 9 1 bag of Potatoes — 1 0 0 12 Turkeys — 1 2 10 18 12 3 19 (b) Ex Dutch Steamer via Harwich. 15 packages of Brussels Sprouts — 3 2 8 Total 18 16 1 27 Unsound food, seized by, or surrendered to, the District Sanitary Inspectors :— Fish. Tons. cwts. qrs. lbs. Sprats 1 0 2 0 Salmon — — — 4 Anchovies — — — 4 78 Meat.  Tons. cwts. qtrs. lbs. Liver — — — 5 Spleen — - - 1 Tongue — - - h Bacon — 1 2 19½ Ham — — 2 21 Pork — — - 18 Rabbits — — 1 11 Fowls 1 5 0 0 Fruit. Gooseberries — 4 0 0 Apples — 1 0 0 Pears 4 17 0 3 Oranges 1 9 0 14 Grapes — - 1 2 Tomatoes — - - 20 Blackcurrants — - — 18 Apricots — 12 0 0 Walnuts — - 2 8 Bananas — 15 0 0 Vegetables. Cabbages and Lettuce — 2 0 0 Potatoes 4 5 0 0 Miscellaneous Mixed Sweets 2 5 0 0 Condensed Milk — — 1 8 Mixed Tinned Foods 1 17 0 0 Chocolate — — 1 24 Tinned Tomatoes — 1 0 0 Hams — — — 12 Jellied Veal — 1 3 18 Assorted Meat, Food, Fish and Fruit 2 1 1 12 Pearl Barley — — — 8 Rice — — — 17 Oatmeal — — — 6 Blue Peas — — — 7½ Flour — — — 24½ Desiccated Coconut — — — 4 Macaroni — 17 0 21 Dried Fruit, Dates and Figs 1 11 0 0 Sultanas — — 3 25 Currants — 13 0 0 Total 24 4 3 5½ 79 5,773 casks of Tallow, weighing 2,309 tons 4 cwts., were detained owing to the contents not being officially certificated; also 5,542 casks of Tallow, weighing 2,221 tons 16 cwts., were released for export or for manufacturing purposes, other than for human food. 29,927 carcases and hind-quarters of Frozen Mutton were detained. Of these, 3,013 had the important Lymphatic Glands incised at the wharf, and 18 carcases and hind-quarters were condemned and destroyed owing to the presence of Caseous Lymphadenitis. The percentage found diseased was slightly under 0.6% of all carcases cut. This is a great reduction in the percentage of 1931, which was 1.1%. 48 tons 19 cwts. 2 qrs. 12 lbs. of Tea Sweepings or damaged Tea were removed from the wharves and warehouses in the Borough and allowed to be exported to America for the extraction of Caffeine. In the early part of the year 66 casks of Raspberry Pulp from Holland were landed at the wharf. The Customs had an analysis made of one sample, which was found to contain sulphur dioxide in excess of the statutory allowance specified in the Public Health (Preservatives, &c., in Food) Regulations. The Customs notified the Ministry of Health, who passed the information on to me. As this consignment was sent to a jam manufacturer in the Borough who had now taken delivery of the goods, 7 samples were taken at their premises and submitted to our Public Analyst. 6 of these were found to contain sulphur dioxide in excess. At the request of the owners we analysed the remaining 59 casks. Of these, 41 contained an excess of sulphur dioxide. The firm agreed to return the 41 casks to Holland. In February I received information that 50 cases of jellied veal containing boric acid had been despatched from Harwich to a firm in this Borough. Steps were immediately taken to put a "stop" on the consignment pending the result of the Public Analyst's examination. Upon examination the veal was found to contain 0.07% Boron Compounds expressed as Boric Acid, or 4.9 grains Boric Acid per lb. As no preservative is allowed in meat this was a contravention of the Public Health (Preservatives, &c., in Food) Regulations. The firm informed me that the cases of Jellied Veal had been shipped in error, and in view of this, I gave permission for them to be exported to the consignors in Denmark. This was done under our supervision and that of the Harwich authorities. A report was submitted to the Ministry of Health on the 19th February. During the month of June large consignments of potatoes from Spain were being landed at the wharves in the Borough. Many of the potatoes were affected with black spots and the question arose as to whether they were fit for human consumption. I communicated with the Ministry of Health and sent 80 them some of the potatoes for examination and advice. They informed me that "the potatoes were suffering from a form of dry rot caused by a species of Fusarium which differs from Fusarium caeruleum, the common potato dry rot fungus of the British Isles, and which produces in the tubers symptoms differing slightly from those due to F. caeruleum in the initial stages of the disease, allthough they closely resemble them in the final stages." The Ministry were further of opinion that from the standpoint of public health the case was relatively unimportant as before consumption the decayed portions would certainly be removed and they could not be regarded as dangerous to health. The potatoes were in a perishing condition and 4,700 bags of them, weighing 235 tons 13 cwts., were destroyed. About 70 bunches of bananas were surrendered to this department in August last and destroyed as they appeared to be affected with some definite disease. They had brown and black spots which did not seem to be the result of bruises. All the bananas were affected though many were quite green. The fruit came from Jamaica and the whole of the 70 bunches was more or less affected. In view of the important matters which might have been involved I communicated with the Ministry of Agriculture and Fisheries and sent specimens for examination. They stated that" the bananas were suffering from ripe rot due to Gloeosporium musarum. This fungus invariably attacks bruised and old bananas. The only known method of avoiding such rotting is to avoid bruising." A box of 45 Borax-preserved Hams from America were consigned to a neighbouring Borough in December last to be smoke-cured on behalf of a firm in this Borough. Borax is a prohibited preservative in meat but this particular consignment was to be used as ships stores for foreign bound ships and would not be used in this country for human consumption. The goods were allowed to be sent away for the purpose for which they were consigned and were disposed of to certain ships between 25th October and 10th November. 81 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to submit to you my ninth Annual Report, dealing with the work carried out in the Borough Laboratory during the year 1932. During the year 1,769 samples were submitted to me for examination, these samples were made up as under :— Foods 1,460 | 1,546 Drugs 86 Public Health Department 151 Milk (for bacteriological examination) 38 Borough Engineer 24 Public Cleansing Officer 4 Private 4 Borough Electrical Engineer 1 Miscellaneous 1 1,769 The 1,546 samples of foods and drugs were purchased or taken by Inspectors under the Food and Drugs (Adulteration) Act, and consisted of :— Formal samples 934 Informal samples 612 1,546 Out of 934 formal samples 32 or 3.4 per cent, were adulterated and of 612 informal samples 16 or 2.6 per cent. were adulterated, making a total of 1,546 samples out of which 48 samples or 3.1 per cent. were adulterated. Samples of milk taken for bacteriological examination and found to be adulterated or chemically unsatisfactory are not included in the above totals. 82 Table A shows the nature of the samples taken under the Food and Drugs (Adulteration) Act, and gives the numbers and percentages found to be adulterated, and the number of samples found to contain preservative. Table A. Number of Samples. Number Genuine Number Adulterated Percentage Adulterated Preservative Found. Milk 974 949 25 2.6 None Butter 149 149 — — None Margarine 145 145 — — None Cream 21 21 — — None Sausage 17 14 3 176 4 Spirits 15 14 1 6.7 — Coffee 13 13 — — — Dried Fruit 12 10 2 167 9 Pepper 11 11 — — Vinegar 11 9 2 182 - Pearl Barley 10 8 2 200 2 Epsom Salts 9 9 — — — Flour 9 9 — — None Milk Sugar 9 8 1 11.l - Minced Meat 9 4 5 55.6 5 Glauber's Salt 7 7 . . — Rice 6 6 - - — Tincture of Iodine 6 6 - - — Purified Borax 6 6 - - - Cream of Tartar 6 6 - - — Glycerine 6 6 - - — Boracic Powder 6 6 - - - Cod Liver Oil 6 6 - - - Citric Acid 6 6 - - - Arrowroot 6 6 - - None Sweets 6 6 - - None Castor Oil 5 5 - - - Ammoniated Tincture 5 3 2 40.0 — of Quinine Ground Ginger 4 2 2 50.0 2 Condensed Milk 3 3 - - None Cheese 3 3 - - None Dried Milk 3 3 - - None Jelly 3 3 - - 2 Jam 3 3 - - None Tea 3 2 - - - Boric Ointment 3 2 1 33.3 Lard 3 3 - - None Candied Peel 3 3 - - None 83 Table A.—Continued  Number of Samples. Number Genuine. Number Adulterated Percentage Adulterated Preservative Found Honey 3 3 - - - Zinc Ointment 3 1 2 66.7 - Cocoa 3 3 — - - Sugar 3 3 - - None Lemon Curd 3 3 - - None Corn Flour 3 3 - - None Camphorated Oil 2 2 - - - Sponge Cake 2 2 - - None Olive Oil 1 1 - - - Separated Milk 1 1 - - None 1,546 1,498 48 3.1 24 Details of samples, shown in the above table to contain preservative, are given under the respective headings in those cases where an offence had been committed. Table B shows the number of samples taken under the Act with the percentage of adulteration and also the total number of samples examined during the past ten years. Table B. Year. Samples taken under the Act. Number Adulterated. Percentage Adulterated. Bact. Examination Miscellaneous Samples Total Samples 1923 1,398 27 19 16 1,414 1924 1,456 45 3.1 — 40 1,496 1925 1,378 44 3.2 — 36 1,414 1926 1,341 37 2.8 — 41 1,382 1927 1,292 42 3.3 — 55 1,347 1928 1,528 68 4.5 - 29 1,557 1929 1,537 63 4.1 - 72 1,609 1930 1,518 35 2.3 1 83 1,602 1931 1,488 43 2.9 46 173 1,707 1932 1,546 48 3.1 38 185 1,769 Offences were committed in 56 cases. These were dealt with as shown below :— Adulterated. Other offences. Total. Legal Proceedings Formal Proceedings 17 5 22 Caution 13 — 13 No action . 2 — 2 Informal 16 3 19 48 8 56 84 In addition to the above, the vendors of two bacteriological milk samples (J 51, genuine but unsatisfactory and S48 adulterated and unsatisfactory) were cautioned while in the case of one bacteriological milk sample (G 92, satisfactory but adulterated) no action was taken, a further sample being taken formally (See adulterated milk sample, G 86, Table D). Milk 974 samples of milk were analysed. Of these 25 or 2.6 per cent.were adulterated. Table C shows the number of samples of milk examined and the percentages of adulteration during the last ten years. Table C. 1923. 19-24. 1925. 1926 1927. 1928. 1929. 1930. 1931 1932. Number of samples. 837 895 825 809 854 923 923 900 881 974 Percentage of adulteration. 1.5 3.0 2.9 1.6 1.4 4.1 3.9 2.2 3.0 2.6 Table D shows the extent of the adulteration and the action taken in each case. Table D. N umber. Deficient in Fat. per cent. Deficient in Solids-not-fat = Added water per cent. Action : Result of Proceedings. j P 4 — 5.4 Vendor to pay a fine of £2 or to be imprisoned for one month. J 7 — 3.3 Vendor cautioned. L 19 8.3 2.4 - L 15 16.0 7.1 Vendor to pay a fine of £3 or to be imprisoned for one month. C 16 63.7 - Vendor fined £4. N 27 13.3 - Vendor paid £2 2s. costs. D 37 5.0 5.4 Vendor fined £1. D 43 23.7 — Vendor cautioned. D 54 - 3.5 Summons dismissed under the Probation of Offenders Act. Vendor paid £2 2s. costs. F 1 13.0 — Vendor paid £2 2s. costs. 85 Table d—continued. Number. Deficient in Fat per cent. Deficient in Solids-not-fat= Added water per cent Action : Result of Proceedings. P 17 9.0 - Vendor cautioned. E 70 10.3 — Vendor cautioned. E 73 47.3 - Summons dismissed under the Probation of Offenders Act. Vendor paid £2 2s. costs. E 96 14.0 1.1 Summons dismissed. No costs. E 97 3.3 2.0 Vendor cautioned. S 39 13.7 — Vendor cautioned. G 46 - 9.6 Summons dismissed under the Probation of Offenders Act. Vendor paid £2 2s. costs. C 64 — 81 Vendor fined £1. E 13 10.0 — Vendor cautioned. M 64 5.0 — Vendor cautioned. T 53 - 5.6 Summons dismissed under the Probation of Offenders Act. Vendor paid £2 2s. costs. G 86 9.3 - Summons dismissed under the Probation of Offenders Act. Vendor paid £2 2s. costs. L 91 26.7 — — J 77 15.0 - Vendor fined £2 with £1 Is. costs. D 16 - 100 Vendor fined £3 with £2 2s. costs. J 7 and D 54. School samples. L 19. Grade A (T.T.) milk taken informally. L 91. Sample taken informally. G 86. Grade A (T.T.) milk taken formally. 86 The average composition of all samples of milk analysed during the year is shown below. Table E. Month. Number examined. Fat per cent. Solids-not fat per cent. Total Solids per cent. January 71 | 3.57 8.61 12.18 February 76 3'69 8.61 12.30 March 70 3.46 8.6O 12.06 April 75 3.53 8.59 12.12 May 61 3.32 8.64 11.96 June 97 3.43 8.69 12.12 July 75 3.45 8.69 12.14 August 100 3.62 8.73 12.35 September 72 3.68 8.71 12.39 October 105 3.83 8.83 12.66 November 101 3.78 8.78 . 12.56 December 71 3.70 869 12.39 Whole Year 974 3'60 8.69 1 2.29 Legal Minimum - 300 8.50 - 82 of the above samples were taken in connection with an investigation made by the Medical Officer of Health, to determine the cause of the low composition of the Stepney milk supply. The yearly averages are given in the following table :— Table F. Year. Fat per cent. Solids not-fat per cent. Total Solids per cent. 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 1929 362 8.65 12.27 1930 3.65 8.70 12.35 1931 3.69 8.69 12.38 1932 3.60 8.69 12.29 The above figures are disappointingly low when compared with the results obtained in other parts of the country. Samples of milk which are slightly below the legal standard of composition are reported as " Genuine, poor quality, slightly deficient in solids.not-fat." Poor Quality Milk Samdles 87 The presumptive standard requires a minimum of 8.5 per cent. of solidsnot-fat. The system of classification adopted is as under:— Solids-not-fat, 8.43 per cent. and over—Genuine. Solids-not-fat, 8.25 per cent. to 8.42 per cent.—Poor quality. Solids-not-fat, less than 8.25 per cent.—Adulterated. During the year 26 samples have been classified as " Poor Quality." In every case a letter has been sent by the Medical Officer of Health to the vendor asking for an explanation of the deficiency of solids-not-fat. One vendor produced a number of analytical certificates showing that the samples were genuine. The figures given for percentage of solids-not-fat were about 0.5 per cent. higher than those obtained in this laboratory. As an example the laboratory figures obtained for one poor quality sample were:—Fat 3.15 per cent. and solids-not-fat 8.38 per cent. The figures produced by the vendor were:—Fat 3.20 per cent. and solids-not-fat 8.64 per cent. As similar differences in analytical results were shown on another occasion by the same vendor, a sample of milk was analysed and a portion sent to the analyst in question. The laboratory figures were:—Fat 2.75 per cent. and solids-not-fat 8.20 per cent. The analyst's figures were:—Fat 278 per cent. and solids-not-fat 8.64 per cent. The vendor also showed results of analysis of genuine samples which had been purchased from him formally, the percentage of solids-not-fat being given in some cases as 9 4 and even higher. These results are obviously absurd. Figures obtained by different analysts for percentage of solids-not-fat generally agree to within 0 05 per cent. so that it will be seen that the large discrepancy shown in the above results must have been caused by a serious and constant error. The vendor was advised to check the results by sending the samples to a Public Analyst. It was then found that the results of analysis which he had been previously obtaining were incorrect, and it was admitted later by the analyst in question that his results were incorrect owing to the use of inaccurate apparatus. These faulty analyses were not carried out by a qualified analyst. 88 Hospital, 47 samples of milk were taken on delivery for chemical examination from etc., 6 institutions in the Borough. All the samples were genuine. The average Samples. composition of the milk was:—Fat 3.49 per cent. and solids-not-fat 8.70 per cent. School 110 samples of milk were taken on delivery at 75 schools in the Borough. Samples. of these samples 13 were reported as being of poor quality and two samples were found to be adulterated. The average composition of all the samples was:—Fat, 3.47 per cent, and solids-not fat 8.60 per cent. The Hortvct The determination of the freezing point of milk by means of the Hortvet Ctyoscope. apparatus, affords useful information in doubtful and other cases of adulteration. The method is based on the fact that the freezing point of milk depends on the osmotic pressure and as the osmotic pressure is for biological reasons practically constant, the freezing point of genuine milk varies only within a limited range. The freezing point of milk which is naturally deficient in solids-not-fat will fall within this range. It therefore becomes possible to say definitely from the freezing point, without reference to the presumptive standard of 8.5 per cent. solids-not-fat that a milk containing an appreciable amount of added water, has been adulterated. The freezing point of milk is unaffected by sterilisation, pasteurisation or variations in the percentage of milk fat but the method can only be used when the milk is fresh; a preservative solution of a certain strength can however be added so as to keep the sample sufficiently long for a determination to be made. The freezing point of milk as determined by means of the Hortvet apparatus ranges from —0.535°C to — 0.560°C, an extreme difference of onefortieth of a degree, A depression of less than 0.530°C may be regarded as definite proof of adulteration. Some of the results obtained are given below; an average figure of 0.54°C has been taken as a basis for calculation. 89 Table G. Number. Fat per cent. Solids-notfat per cent. Deficient in Solids-not-fat per cent. Added water. Hortvet:. Freezing Point. Calculated added water. Calculated original Solids-notfat. S 2 9.60 8.70 _ -.0.540° C - - E 95 3.00 8.45 — -0.544° C. - — E 96 2.60 8.45 — -0.543° C. - — A 99 3.50 8.50 — -0.521° C. 3.5 8.81 M 22 4.45 8.30 2.4 -.0.517° C. 4.3 8.67 D 25 3.80 8.45 — -.0.519° C. 3.9 8.79 D 53 3.25 8.28 2.6 -.0.513° C. 5.0 8.72 D 54 3.30 8.23 3.2 -.0.509° C. 5.7 8.73 C 20 3.60 8.30 2.4 -.0.517° C. 4.3 8.67 S 48 2.75 8.20 3.5 -.0.512° C. 5.2 8.65 G 92 2.90 8.48 - -.0.540° C. - - Notes on the above results :— S 2. Milk abnormally high in fat. E 95 and E 96. Cowshed samples—naturally inferior milk, genuine. A 99. An investigation scheme sample taken from wholesaler, apparently genuine.—adulterated. M 22. School contract sample with a high fat—adulterated. D 25. School contract sample—apparently genuine—adulterated. D 53. School contract sample, reported as poor quality—adulterated. D 54. School contract sample—adulterated. C 20. Poor quality sample—adulterated. S 48. Grade A (Tuberculin tested) Milk, deficient in fat and solids.not.fat— adulterated. G 92 Grade A (Tuberculin tested) Milk, deficient in fat and low in solids. not-fat—apparently genuine. Of the 30 samples taken for bacteriological examination 25 samples were taken from licensed vendors and 5 samples were taken from Institutions in logical Examination the Borough. of Milk The average chemical composition of these samples was:—Fat, 344 per cent. and solids-not-fat 8.68 per cent. Graded milk should be of considerably better quality than that shown by these figures. 90 2 of the samples failed to comply with the requirements of the Regulations, one of these being also adulterated. Of the samples which were satisfactory bacteriologically one was adulterated and one was of poor quality. Certified Milk and Grade A Milk (Pasteurised). The milk must not contain more than 30,000 organisms per c.c. and must not contain coliform bacillus in 1/10 c.c. 1 sample of Certified Milk showed 1,000 organisms per c.c. and the coliform bacillus was absent in 1/10 c.c. 5 samples of Grade A Milk (Pasteurised) gave low bacteria counts as might be expected from Grade A Milk which has been pasteurised. The highest count showed 3,320 organisms per c.c. The coliform bacillus was absent in 1/10 c.c. in each case. Grade A (Tuberculin tested) Milk and Grade A Milk. The milk must not contain more than 200,000 organisms per c.c. and must not contain coliform bacillus in 1/100 c.c. In 14 samples of Grade A (Tuberculin tested) Milk, the highest bacteria count showed 81,100 organisms per c.c. In 2 of these samples the coliform bacillus was present in one out of three tubes which is regarded as satisfactory by the regulations, and in two cases J 51 and S 48 the coliform bacillus was present in 1/100 c.c. in all tubes. One of these samples S 48 was also 8 3 per cent. deficient in fat and contained at least 35 per cent, added water. One sample G92 otherwise satisfactory was deficient in fat to the extent of 3.3 per cent. and one sample was of poor quality. The vendors of samples J 51 and S 48 were cautioned. In the case of sample G92 no action was taken. A further sample G 86 taken formally from the same vendor was deficient in fat, this sample is shown in Table D. 1 sample of Grade A Milk contained 4,890 organisms per c.c., the coliform bacillus being absent in 1/100 c.c. Pasteurised Milk. The milk must not contain more than 100,000 organisms per c.c. (No test for the coliform bacillus is required). 9 samples complied with the standard, the highest count being 10,000 organisms per c.c. Examination for the Tubercle Bacillus. 8 samples of milk were tested elsewhere for the Tubercle Bacillus by the inoculation method. In one case a positive result was obtained. 91 149 samples were analysed. All the samples were genuine and free from Butter. preservatives and prohibited dyes. 18 samples were found to contain a slight amount of artificial colouring matter. 145 samples were genuine and free from preservative and prohibited dyes. Margarine. 144 of the samples were artificially coloured. Offences with regard to labelling were committed in four cases. 3 samples of condensed milk and 3 samples of dried milk were genuine Condensed and Dried and free from preservative. Mllk- These samples complied with the requirements of the Condensed Milk and Dried Milk Regulations respectively as regards percentage composition of milk fat and milk solids, and each tin contained sufficient condensed or dried milk to produce the number of pints of standard milk as stated on the label. Each sample was correctly labelled. 21 samples were genuine and free from preservative and thickening sub ¬Cream. stances. The content of milk fat varied from 42 7 per cent. to 58 4 per cent. with an average of 53 3 per cent. in 20 of the samples. The remaining sample consisted of tinned cream containing 22.4 per cent. of fat. The average fat content of all samples was 48.7 per cent. 17 samples were examined. Of these 13 samples were free from preser- Sausage, vative and one sample contained preservative in amount less than the permitted limit, the presence of preservative being declared. The following 3 samples contained preservative without declaration by notice or label, and were returned as adulterated. D 35. Contained 16 parts sulphur dioxide per million. Vendor cautioned. H 87. (Informal). Contained 115 parts sulphur dioxide per million. H 95. (Same vendor as H 87). Contained 280 parts sulphur dioxide per million Vendor fined 10s. 15 samples were analysed and one sample was found to be adulterated. Spirits. P 72. Contained 11.8 per cent. excess water. Vendor cautioned. 92 Dried Fruits. 12 samples were examined. Of these two samples were adulterated. No. 1. Raisins. Contained 1,000 parts sulphur dioxide per million No. 3. Raisins. Contained 960 parts sulphur dioxide per million. The bulks of the raisins from which the above sampiles were taken formally at the wharf were so treated by the importers to re luce the content of sulphur dioxide that further samples were found to contain less than the rriaximum limit of 750 parts sulphur dioxide per million and were therefore satisfactory. Of the remaining samples 3 were free from preservative and 7 contained less than the permitted amount. Vinegar- 2 samples out of 11 samples examined were adulterated, M 92 (Informal). 8.5 per cent. deficient in acetic acid. T 50 (Same vendor as M 92). 15.0 per cent. deficient in acetic acid. Vendor cautioned. The Local Government Board in 1911 stated their views regarding the composition of vinegar by suggesting definitions for Vinegar, Malt Vinegar and Artificial Vinegar, but at present there is no legal standard. All the above samples were sold as vinegar and consisted of artificial vinegar, that is, dilute acetic acid coloured with caramel. The content of acetic acid varied from 3.4 to 10.8 per cent., the suggested standard being 4.0 per cent. w/v. All these samples which were sold as vinegar should be labelled and sold as artificial vinegar. Pearl Barley. 10 samples were examined. Of these 2 samples were adulterated. D 31 (Informal). Contained 11 parts sulphur dioxide per million. N 104 (Same vendor as D 31). Contained 14 parts sulphur dioxide per million. Vendor cautioned. The sample was also condemned, as owing to the presence of residual matter, etc. from insects, it was unfit for human consumption. Minced Meat 9 samples were analysed and of these 5 were found to be adulterated. Sulphur dioxide is prohibited in meat. B 63 (Informal). Contained 315 parts sulphur dioxide per million A further formal sample could not be obtained. 93 A 60 (Informal). Contained 10 parts sulphur dioxide per million,, A 61 (Informal). Contained 570 parts sulphur dioxide per million A 62 (Informal). Contained 580 parts sulphur dioxide per million. M 48 (Same vendor as A 62). Contained 1,080 parts sulphur dioxide per million. Vendor fined £5 0s. Od. Of 4 samples examined, two were adulterated. Ground Ginger X 58 (Informal). Contained 190 parts sulphur dioxide per million. X 68 (Same vendor as X 58) Contained 140 parts sulphur dioxide per million. Vendor cautioned. Of 86 drugs examined 6 or 7.0 per cent. failed to comply with the re- Drugs quirements of the British Pharmacopoeia and were returned as adulterated. Ammoniated Tincture of Quinine. F 52 (Informal). Deficient in ammonia to the extent of 17.8 per cent. F 53 (Informal). Deficient in ammonia to the extent of 12.9 per cent. Further samples taken formally were genuine in each case. Boric Ointment L 81 (Informal). The base consisted of yellow paraffin ointment. The following samples complied with the requirements of the British Pharmacopoeia 1914 but failed to comply with those of the British Pharmacopoeia 1932 which was published in September. Milk Sugar. S 91 (Informal). Contained an excess of acidity. Zinc Ointment. K 66 and K 67 (Informal). The base consisted of benzoated lard in each case. These include samples of inferior grade or of a doubtful character and are Poor Quality Samples. 46 in number. 26 of these samples consisted of milk. Other poor quality samples were :— 9 margarine and 3 butter (contained a slight excess of water), 7 flour (contained persulphates) and 1 Tincture of Iodine (contained 0.3 per cent. fatty matter). 94 Offences These are 10 in number and include 2 unsatisfactory milk samples Adufteration previously referred to under the "Bacteriological examination of milk." The remaining offences are :— Milk. In 4 cases, for bottling milk other than on registered premises the defendants paid a fine of £2t a fine of £\, a fine of 10s., and £1 Is. Od. costs respectively. Margarine. In 4 cases the vendor had not complied with the requirements of the Act with regard to labelling. In 3 of these cases the sample had been purchased informally and in 1 case proceedings were taken. G 91. Un'abelled bulk, contained in a box marked " Butter." Vendor fined £2 with £2 2s. Od. costs. Miscellan- Public Health Department. 151 samples submitted by the Public Health eous Samples Department were made up as under :—- 107 samples were examined for the presence of preservative. Of these the following 65 samples either contained preservative in an amount less than that permitted by the Regulations or were free from preservative. These samples were satisfactory. Raisins (28), Raspberry Pulp (27), Sultanas (4), Strawberry Pulp (3), Black Currant Pulp, Meat Extract and Dried Apricots. The following 42 samples were unsatisfactory :— Raspberry Pulp (37), foreign origin, contained an excess of sulphur dioxide; Raisins (3) foreign origin, contained an excess of sulphur dioxide; Saveloy, contained 13 parts sulphur dioxide per million without declaration by notice or label, and Jellied Veal, foreign origin, contained 0 07 per cent, of boron compounds expressed as boric acid. 18 samples examined with regard to their fitness for human consumption were:— Unsatisfactory samples:—Chocolates (2) foreign origin : Chocolates (2), Rice (2), Flour, Oatmeal, Blue Peas, Dessicated Cocoanut. All the above samples contained insects in various stages of development (moths, caterpillars with excremental material, eggs, weevils, etc.) Mexican Tea (2), foreign origin, mouldy. Satisfactory samples:—Chocolates (3), Chocolate Cream, Custard Powder and Milk. 95 9 samples of water were examined. Of these 3 samples of well water examined for purity were satisfactory chemically but slightly turbid. 3 samples of drainage water suspected of sewage contamination were satisfactory, 2 samples examined for lead were free from lead and 1 sample, complaint of taste and smell, was satisfactory. Some of the figures obtained from the analysis of the well waters mentioned above are interesting. The analysis showed:—Free ammonia as NH3, 0.059 parts per 100,000; albuminoid ammonia as NH3, 0.001 parts per 100,000; oxygen absorbed 0.016 parts per 100,000 and chlorine, as sodium chloride, 27.7 parts per 100,000. The high free ammonia and chlorine figures are characteristic of waters obtained from deep wells (in this case 450 feet) in the London area. 6 samples said to have caused illness consisted of:— Butter, Pickled Onions, Apple Tart, Lettuce, Watercress and Smoked Salmon. All the above samples were free from impurities or added substances of a harmful nature. 5 samples of Olive Oil for export were satisfactory. 3 samples examined for tin were satisfactory, these were:— Japanese Pilchards (2) containing 1.7 grains and 0.7 grain tin per pound respectively and Russian Pilchards containing 0.77 grain tin per pound. Other samples analysed were:—Formalin (2) and Accumulator Scrap. Rag Flock Act. According to the standard of cleanliness required by the Rag Flock Regulations, rag flock must not contain more than 30 parts of chlorine in 100,000 parts of the flock. One informal sample examined was satisfactory, the chlorine content being less than 5 parts per 100,000. Borough Engineer.—24 samples comprised :—Bitumen 19, Carbolic Powder 3 and Water 2. Public Cleansing Officer.—4 samples of Carbolic Powder examined were satisfactory. Borough Electrical Engineer.—1 sample of Water was submitted for analysis. 96 Private Samples.—2 samples of Milk (genuine), 1 sample of Water (satisfactory) and I sample of Liqueur Chocolates (unsatisfactory) were analysed for private purchasers. 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, 1933. 97 VI. -PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 2,463 notifications of infectious disease were received, 2,284 less than in Notifiable Diseases. the previous year : — 488 belonged to Limehouse. 343 belonged to St. George-in-the-East. 1,182 belonged to Mile End Old Town. 450 belonged to Whitechapel. 1,961 were removed for treatment to fever hospitals and institutions. The rate for the whole Borough was 11.0 per 1,000 of the population. Scarlet fever • 952 cases were notified during the year, or 254 less than in the previous year. 165 belonged to Limehouse, with 1 death. 147 belonged to St. George-in-the-East, with 1 death. 447 belonged to Mile End Old Town, with 4 deaths. 193 belonged to Whitechapel, with 1 death. 946 were removed to hospital. The death-rate for the whole Borough was .03 per 1,000 of the population. 742 cases were notified during the year, or 151 more than in the previous Diphtheria. year. 145 belonged to Limehouse, with 3 deaths. 120 belonged to St. George-in-the-East, with 8 deaths. 354 belonged to Mile End Old Town, with 10 deaths. 123 belonged to Whitechapel, with 1 death. 740 were removed to hospital. The death-rate for the whole Borough was 0.9 per 1,000 of the population This serum is supplied on request to the general medical practitioners of diphtheritic the Borough. During the year, 59 tubes each containing 4,000 units were Serum, issued from the Public Health Offices. The number of cases of Scarlet Fever and Diphtheria being high in the Borough as compared with other Boroughs, I caused an investigation to be made into the possible reasons for this, and in the hope that it would be possible to mitigate some of the conditions which have been found to assist the spread of infection. These investigations covered a period of three months ended 30th September, when 179 cases of Scarlet Fever, and 166 of Diphtheria were reviewed. It was impossible to find the exact source of infection and it was decided to work on presumptive evidence. 98  Scarlet Fever. Diphtheria 1. No reasonable presumptive evidence 106 or 59.2% 108 or 65.0% 2. Probable school infection 51 or 28.4% 41 or 24.7% 3. Probable infection in patient's own family 8 or 4.4% 6 or 3.6% 4. Probably by infection in near house 5 or 2.8% 5 or 3.0% 5. Probable " returned " case infection 4 or 2.2% 1 or 0.6% 6. Probable infection in Hospital 3 or 1.7% 4 or 2.4% 7. Probable infection in other family in house 2 or 1.1% 1 or 0-6% 8. Probable infection in a waiting room 0 or 0.0% 0 or 0.0% Several astonishing presumptive facts are thus brought to light: — {a) The extremely small proportion of infection in the patients' own family or house. (b) Not one single case could be traced as having been infected by contact with a case in a waiting room of a hospital or surgery. At first sight 59.2% and 65% of untraced infection appears to be rather large. It must be remembered, however, that there is no evidence to show that these cases were infected in the family, or the house, or the waiting room, or the hospital. They must therefore have been infected in school or in neighbouring houses, streets or playgrounds, but there was insufficient evidence to say which. The only possible preventive measures (apart from school measures) appear to be: — 1. Immunisation. 2. Education of parents—infectious children kept at home and not allowed to go to school or into other homes. Enteric There were 11 cases of Enteric Fever notified during the year, 7 of which Fever • . _ were paratyphoid. 1 belonged to Limehouse, 5 to Mile End Old Town, and 5 to Whitechapel. All the patients were removed to hospital and there was only 1 death—that occurred in Limehouse. The death-rate for the whole Borough was .004 per 1,000 of the population. Chicken Pox. The compulsory notification of Chicken Pox was only continued up to the 8th May owing to the drop in the number of Small Pox cases occurring in the Borough. 396 cases were notified : — 90 belonged to Limehouse. 34 belonged to St. George-in-the-East. 221 belonged to Mile End Old Town. 51 belonged to Whitechapel. 40 were removed to hospital. 99 There were 26 actual cases of Small Pox during the year, or 323 less than Small Pox. in the previous year : — 20 belonged to Limehouse, and 6 belonged to Mile End Old Town. There were 12 typical cases notified, 8 males and 4 females. 11 of the Acute Poliomyelitis cases were children under 5 years of age, and 1 was a man 64 years old who died. Dr. Vernon Shaw, of the Ministry of Health, and myself went into the history of the latter case, and it appeared that the cause of death was due to myelitis. Because of the possibility of patients suffering from abortive attacks of this disease careful supervision of the contacts was undertaken. There were no secondary cases. 1 belonged to Limehoue, 6 to Mile End, 1 to St. George's and 4 to Whitechapel. One patient has been in hospital for a year and still has paralysis in the upper arm, but the fingers are responding to treatment. One is in hospital and making very satisfactory progress. 2 are making good recovery and attend the London Hospital three times a week for massage treatment. 4 patients fully recovered and 4 died. The death-rate for the whole Borough was .017 per 1,000 of the population. I received 3 notifications during the year. 1 belonged to Limehouse, 1 to Encephalitis Mile End and 1 to Whitechapel. 2 of the patients died and 1 completely Lethargicarecovered. There were 3 other deaths during the year which were old chronic cases of encephalitis lethargica. The death-rate for the whole Borough was .02 per 1,000 of the population. 33 cases of this disease were notified—19 males and 14 females. 15 of Cerebro Spinal Fever these cases fully recovered, I patient is still ill and 17 proved fatal. 6 belonged to Limehouse. 6 belonged to St. George-in-the-East. 12 belonged to Mile End Old Town. 9 belonged to Whitechapel. The death-rate for the whole Borough was .07 per 1,000 of the population. 33 cases were notified, or 10 more than in the previous year. 10 belonged Ophthalmia to Limehouse, 3 to St. George-in-the-East, 14 to Mile End Old Town, and 6 Neonatorum to Whitechapel. No. of cases treated at home 16 „ in hospital 17 Total number of cases in which vision was unimpaired 30 impaired 1 Total number of cases of total blindness — Total number of deaths 1 1 case could not be traced after leaving the hospital. 100 Puerperal 9 cases of Puerperal Fever and 31 of Puerperal Pyrexia were notified Puerperal during the year—3 less than in the previous year. All these cases were duly Pyrexia. investigated. 6 belonged to Limehouse, with 4 deaths. 5 belonged to St. George-in-the-East, with 2 deaths. 18 belonged to Mile End Old Town, with 3 deaths. 11 belonged to Whitechapel, with 1 death. 34 were removed to hospital. The death-rate was 2.68 per 1,000 births. Wrong 94 cases of infectious disease removed to hospital were found not to be Diagnose. suffering from the disease stated on the certificate. This number referred to 37 cases of Scarlet Fever, 56 of Diphtheria, and 1 of Small Pox. 42 of the cases were notified by Private Practitioners and 52 from Public Institutions. Pneumonia 370 Cases of Pneumonia and 1 of Malaria were notified under these Malana and . Dysentery lations. Regulations The cases occurred in the districts as follows : — Limehouse St Georges Mile End Whitechapel Pneumonia 92 52 195 30 Malaria — — — 1 The case of malaria referred to a seaman, taken ill before he landed and came to London. He went to a sailors' home in the Borough, where the case was diagnosed, and he was immediately removed to a home in Kent. Prior to his arrival, he had made several voyages to the West Coast of Africa. Cancer- There are excellent arrangements at the London Hospital for the research and treatment of cancer, particulars of which are as follows : — Research.—The whole of the clinical material of the London Hospital is available, as well as the use of a well equipped laboratory. At present, investigation is being made into the test for diagnosis of cancer and the well known researches of Dr. Lumsden in connection with serological treatment are being carried out. Investigation into the histological side has always been a thorough and complete aspect of the London Hospital system. Treatment.—The skilled surgical treatment is always available and there is also a well equipped radium department. The Radium Department has at its disposal over 2 grams of Radium and it is prepared to use all the known methods of Radium treatment including the preparation and application of Radon. There is a Radium Committee at the Hospital who keep in close touch with the surgeons so that all cases are carefully followed up, and an annual report is compiled. NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR, 1932. disease. Total Cases notified. Cases admitted to Hospital Total Deaths. In Age Groups. In Localities. Under 1 year. 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65 and over Total Limehouse Mile End St. Georges Whitechapel Small-pox - - 1 - — 3 7 4 6 - 5 - 26 20 6 — - 26 - Scarlet Fever 8 44 99 73 93 374 152 54 46 7 2 - 952 165 447 147 193 946 7 Diphtheria 14 33 76 78 88 241 118 48 40 5 1 - 742 145 354 120 123 740 22 Enteric Fever - - - 1 - 1 1 - 6 - 1 - 11 1 5 - 5 11 1 Puerperal Fever - - - - - - - 1 8 - - - 9 1 3 - 5 8 3 Puerperal Pyrexia - - - - - - - 3 23 5 - - 31 5 15 5 6 26 7 Erysipelas 2 3 2 2 3 10 7 16 36 28 67 15 191 35 86 25 45 100 2 Encephalitis Lethargica - - - - - - - 1 1 — 1 — 3 1 1 — 1 3 5 Anthrax - - - - - - - - - 1 - - 1 — 1 — — 1 1 Polio-Myelitis 3 4 1 1 2 - - - - - 1 - 12 1 6 1 4 11 4 Cerebo-spinal Meningitis 4 2 4 1 — 1 4 3 11 1 2 — 33 6 12 6 9 32 19 Ophthalmia Neonatorum 33 - - - - - - - - - - - 33 10 14 3 6 17 — Chicken Pox 15 21 28 28 45 203 47 7 1 - 1 — 396 90 221 34 51 40 ' Food Poisoning 1 — 1 1 4 3 2 4 1 4 2 - 23 8 11 2 2 - - Totals 80 107 212 185 235 836 338 142 179 51 83 15 2,463 488 1,182 343 450 1,961 61 101 102 Lead On the 4th June I received a notification that a person, resident in the Lead Poisoning. Borough, was suffering from lead poisoning. A copy of this I forwarded to the Home Office. Upon investigation it appeared that the patient was a refiner employed at a refinery in the Borough. He did not come in contact with lead in any form though there was a po sibility of lead impurities being carried in the fumes from the refining. He had done no painting or worked with lead at home recently. Two samples of drinking water from the patient's house and from his workplace were submitted to analysis and found to be free from lead. The water fittings appeared to be in good condition. No other cases were reported among the workpeople. Anthrax. A death, due to anthrax, occurred on the 15th May in a hospital in the Borough. I attended the inquest, when it was ascertained that the deceased had, three weeks previously, purchased a cheap shaving brush at a shop in the Borough. The brush was produced at the inquest and the Coroner directed me to have it examined. It was sent to the Government laboratories and was found to be infected with virulent anthrax. I immediately caused enquiries to be made at the shop where the brush had been purchased and ascertained that this was one of 16½ dozen purchased in January, 1931. I was able to obtain particulars of some of the other shops to whom the shopkeeper had sold them and also the wholesaler who supplied him with them in January. All the Medical Officers of Health of the Boroughs where the shops were situate were communicated with, and also the Ministry of Health. We managed to secure 2 dozen of the brushes which had been sold to a barber's shop in this Borough and sent them away for examination. These also were found to contain abundant colonies of virulent Anthrax. The man who sold the brush to deceased was only able to account for 92 out of the 16½ dozen. Of these 83 were secured and destroyed forthwith, but 9 had been sold over the counter at various shops outside the Borough. I again communicated with the Medical Officers of Health of the districts concerned and reported the facts to the London County Council, suggesting that the information be sent to all the Medical Officers of Health in London and Greater London. Dr. Shaw, of the Ministry of Health, called on me on the 30th May, and he appeared to be quite satisfied as to the extent of the investigations. The wholesaler had since removed but he was traced by Dr. Shaw, when it was ascertained that the brushes came from Japan ten years ago. It is of interest to know of the extremely long life of virulent Anthrax spores. 103 2,422 rooms were fumigated and the bedding, etc., removed and dis- Cleansing and infected by steam. Of these 1,977 rooms were fumigated because of infectious Disinfection, disease, 142 as a result of pulmonary tuberculosis, and' 303 because they were verminous. In addition to these, scabies occurred in 418 families and the bedding was taken away and disinfected by steam. The disinfection of second-hand clothing, prior to export to South Africa and the supervision of the packing of the goods was carried out as in previous years. The number of such articles dealt with last year reached 4G,8G7. In addition to South Africa we disinfect clothing to be sent to Ireland, Russia, etc. The total number of articles disinfected for all purposes was 100,67.1. 330 persons were cleansed during the year and had their clothing disinfected—320 adults and .10 children. 303 were cleansed because of vermin and 27 because of infectious disease. It was not found necessary for me to take action under the Public Health Vaccination. (Small Pox) Regulations, 1917, as the Public Vaccinators offered vaccination or re-vaccination to all contacts of cases of Small Pox. The study of some 1,433 cases of variola minor in the Metropolitan Borough of Stepney was undertaken by Dr. Percy Stocks, Reader in Medical Statistics, University College. In the foreword of his report, Dr. Stocks said that he undertook the work in the hope of answering some of the questions raised by the Ministry of Health on the sub ject of vaccination, thus making the path of the Health Administrator less difficult. He has given me permission to quote from his report referring to the Borough of Stepney, and the following is the summary of his conclusions : — 1. A statistical analysis of the records of an epidemic of variola minor in the Metropolitan Borough of Stepney during .1929-30, in which years 1,433 cases occurred, and of records of infant vaccination prior to 1930, leads to the following conclusions. 2. In the three years preceding the epidemic one-third of all infants surviving the first year in Stepney had been vaccinated, this rate being 70% of that in the country as a whole. It is estimated that in the general population of Stepney at the beginning of the epidemnc the proportions who had been vaccinated in infancy were about 35, 40 and 60% respectively in the first three decades of age, or adding the proportions estimated to have been primarily vaccinated after infancy, about 45, 65 and 80% respectively. I his did not 104 suffice to protect the community from an epidemic. Tn the 643 households attacked l>y small-pox, however, the corresponding proportions who had ever been vaccinated were only 12, 29 and 13%. 3. The liability of home contacts unprotected by vaccination to be attacked readied a maximal value in August and September, 1929, by which time most of tlie Borough was involved. From that point onwards the liability steadily declined, and a straight line fitted to either the declining apparent infectiousness or to the declining attack-rate in unprotected contacts, up to the end of 19:50, reached the zero point in July, 1932, Since the epidemic actually died out at the end of the second quarter in 1932, this may provide a means of predicting the duration of an epidemic. 4. The steady decline in attack-rate amongst unprotected home contacts after the epidemic had become diffused indicates that either the virus became progressively less infective or that latent immunity was being acquired by the population. Although no evidence in favour of the latter explanation is found from subsequent attack rates of contacts who escaped immediate infection, it is a curious fact, that the immediate attack-rate in unvaccinated children under 10 years of age who were exposed to infection was no lower in 1930 than in 1929, whereas in adults it was much lower. This would be difficult to account for on the first hypothesis, but could be explained if the bulk of the propagation of small-pox and latent immunisation associated with it, takes place in workplaces, factories and places where adults arc crowded together. 5. In the first year of the epidemic the mean number of persons per house allected by small-pox was 9.0, of whom 6.6 were unprotected by vaccination; in the second year the corresponding figures were 8.2 and 5.0. In the first 3 months of the epidemic two-thirds of the previously unvaccinated home contacts accepted vaccination, but after 6 months this proportion fell to 30%, and with recrudescence of the epidemic gradually rose again to 45%. At the start of the epidemic 55% of previously vaccinated home contacts accepted revaccination, but this proportion rapidly fell to about 17% and did not rise again. 6. I he incubation period of variola minor seems to lie outside the limits of 12-16 days in at least one-eighth of all cases, but it can only very rarely be less than 10 or more than 18 days. The mean interval from onset of symptoms to appearance of the rash was 2.7 days. When a small-pox case developed the rash 11-21 days after a previous case in the same house, it was regarded as being secondary to, that is to say infected by, the latter. When the interval was less than 11 or more than 24 days, some other source of infection was postulated. I he justification for selecting these limits is explained in Section (4). 7. When a small-pox case was removed to hospital on the day of appearance of the rash, the subsequent attack-rate amongst unprotected home contacts 106 was significantly less than in cases where removal was delayed. The attackrate also increased from 8% when 4 days elapsed from onset of symptoms to removal, to 25% when, 8, 9 10 or 11 days elapsed. 8. The cases of smallpox included 157 persons who had been vaccinated less than 24 days before attack, but in only five of these did the interval from vaccination to onset exceed 12 days, and only in one case was it greater than 16 days. Owing to the time required for complete protection to develop, which is presumably variable like the incubation period of small-pox itself, it is evident that immunity from attack cannot be guaranteed even if vaccination is performed immediately after exposure to infection. Of 145 previously unvaccinated home contacts who were vaccinated on the day of, or day following, the appearance of the rash in the first case in the house, six were attacked, which indicates that vaccination after exposure cannot reduce the risk to the previously unvaccinated below about 4%. Comparing the actual attacks with those expected in the same age distribution of unvaccinated persons, vaccination of unprotected contacts within 2 days of appearance of the rash in the first case reduced the risk of immediate attack to one-seventh, vaccination 3 to 4 days after reduced the risk to one quarter, vaccination 5, G or 7 days after reduced it to two-thirds, but with longer intervals here is no evidence that it was effectual. For statistical purposes "protection " has been regarded as adequate if vaccination was done within 4 days. There is definite advantage to be gained, however, by not postponing vaccination of contacts beyond the second day after appearance of the rash. 9. The primary cases of small-pox showed a relative excess of young adults in comparison with the secondary cases, which suggests that small-pox is spread in work-places more than in schools. The proportion of young adults in affected houses who had been previously vaccinated increased during the epidemic, owing no doubt to vaccination in factories, but this was not the case with children. The ages of maximal attack-rate in the whole population were 5-10, both for primary and secondary cases, but the change of attack-rate with age was greatly influenced by the differing proportions protected by vaccination at different ages, this proportion being highest at 20-25. The total effect of vaccination before and after exposure was to protect adequately about 30% of home contacts at ages 0-5, 40% at 5-.10, 50% at 10-15, 60% at .15-30, 45% at 30-45, 40% at 45-50, 30% at 50-60, and 8% after 60. 10. The susceptibility to attack in unprotected home contacts was highest at ages 15-20 and 30-50; at 20-30 it was significantly lower and after 50 it rapidly declined. The aggregate risk of immediate attack to the unprotected contacts of all ages was 1 in 4. At ages under 20 the risk to those vaccinated in infancy only was one-twentieth of that in the unvaccinated, at ages 20-40 about one-tenth, and at ages over 40 about one-half. This was also true when the vaccinated and unvaccinated living in the same houses were compared. Comparing the actual attacks with those expected in the same age distributions of unvaccinated contacts, vaccination less than 20 years before reduced the risk IO6 of immediate attack below one-twentieth, vaccination 20 to 30 years before reduced it below one-twelfth, vaccination 30 to 40 years before reduced it to one-ninth, and if more than 40 years before to less than one-half. For statistical purposes "protection" after vaccination may be regarded as adequate for 30 years, though it is no longer at its maximum potency after 20 years. Amongst persons vaccinated within 5 years about .1 in 150 may be expected to contract variola minor when exposed to infection in the house. It is estimated that in this epidemic prior vaccination saved 332 and subsequent vaccination saved 135 home contacts from attack, leaving out of account the persons infected by these cases. 11. The mean number of persons living per dwelling was higher in houses invaded by small-pox than for the Borough as a whole. The proportion of contacts unprotected did not show any relation to the number of persons in the house. The attack-rate amongst the unprotected contacts increased in general with the number of persons living in the house, but was definitely lower in households of 10-12 persons than in households of 4-6, this being no doubt due to separation into two or more families occupying different rooms. Although no evidence is found that a protection rate as high as 00% suffices to protect a community from the spread of an epidemic, as distinct from protecting the vaccinated persons in it, the risk to unvaccinated persons in an infected house appears to have been considerably reduced when more than half the persons living in the house were protected by vaccination, the important factor being the ratio of protected to unprotected persons rather than the actual numbers of each. The following is a summary of the work done by the Vaccination Officers with regard to Small Pox : — Whitechapel and Mile End. Limehouse and St. Georges. Visits to premises where cases of Small Pox have occurred 10 17 Visits to Seamen's Lodging Houses — 2 Visits to firms affected 3 6 V isits to schools affected 3 2 No. of contact notices served 220 196 RETURN RESPECTING THE VACCINATION OF CHILDREN WHOSE BIRTHS WERE REGISTERED IN STEPNEY FROM JANUARY 1st TO DECEMBER 31st, 1931 INCLUSIVE. M.379 Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the " Birth List Sheets '' as registered from 1st January to 31st December, 1931. Number of these Births duly entered by 31st January, 1933, in Columns I., II., IV. and V. of the " Vaccination Register " (Birth List Sheets), viz. : Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Died unvaccinated. Col. I. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. (1) (2) (3) (4) (5) (6) (7) (1) Limehouse 1,937 446 5 - 1,078 77 (2) St. Georges, East 723 244 — — 242 54 Total *2,660 690 5 - 1,320 131 (3) Whitechapel 1,784 906 1 - 428 99 (4) Mile End 1,043 256 — — 581 62 Total *2,827 1,162 1 — 1,009 161 •These do not include 29 re-registered births : 6 in Limehouse, 4 in St. Georges, 10 in Whitechapel, 9 in Mile End, 107 Registration Sub-Districts comprised in the Vaccination Officer's District. Number of these Births which on 31st January, 1933, remained unentered in the " Vaccination Register " on account (as shown by " Report Book") of Number of these Births remaining on 31st Jan., 1933, neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book " (columns 8, 9 and 10 of this Return). Total number of Certificates of Successful primary Vaccination of Children under 14 received during the Calendar Year 1932. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate, during the Calendar Year 1932. Postponement by Medical Certificate. Removal to Districts the Vaccination Officers of which have been duly apprised. Removal to places unknown, or which cannot be reached ; and cases not having been found. (8) (9) (10) (11) (12) (13) (1) Limehouse 195 41 95 695 1,019 (2) St. Georges, East - 13 13 157 396 234 Total - 208 54 252 1,091 1,253 (3) Whitechapel 3 290 13 44 1,061 422 (4) Mile End - 58 10 76 477 603 Total 3 348 23 120 1,538 1,025 . Limehouse and St. Georges. Whitechapel and Mile End dumber of children successfully vaccinated after declaration of conscientious objection had been made. These numbers are included in Column 6 9 8 Total number of certificates for the year 1932 sent to other Vaccination Officers 251 186 108 SUMMARY OF PRIMARY VACCINATIONS DURING THE YEAR JANUARY TO DECEMBER, 1932 (Form N). No. of cases in birth lists received during the year. No. of certificates of vaccination received. No. of certificates of postponement owing to No. of statutory declarations under section 1 of the Vaccination Act, 1907. No. of certificates of insusceptibility or of having had smallpox. No. of cases No. of entries in lists sent to public vaccinator Parents removed out of district. Otherwise not found. Health of child. Condition of house. Prevalence of infectious disease. Whitechapel 1,721 1,061 215 - - 422 2 885 14 498 Mile End 1.049 477 114 - - 603 1 182 17 470 Other vaccinations 59 - - - - - - - - Limehouse 1,912 716 9 - - 1,019 3 768 34 350 St. Georges 605 395 12 - - 234 1 22 ** 28 418 Other Vaccinations 27 - - - - - - - - Total 5,287 2,735 350 - - 2,278 7 1,857 93 1,736 5 re-registered births in Whitechapel, 2 in Mile End, 5 in Limehouse and 6 in St. Georges are included in the above, also, 1 invalid entry in St. Georges. 109 Return showing the number of persons successfully vaccinated and re-vaccinated at the cost of the Rates by the Medical Officers of Institutions and the Public Vaccinators during the year ended 30th September, 1932. m.379a. Name of Institution or Vaccination District. Name of Medical Officer or Public Vaccinator. Number of successful primary vaccinations of persons. Number of successful re-vaccinations i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under one year of age. One year and upwards. Total. Whitechapel District Dr. D. F, Kennard 426 47 473 21 Shadwell do. Dr. E. Lipman 99 150 249 8 Mile End do. Dr. S. Mikhail 279 103 382 10 Limehouse do. Dr. T, O'Keefe 89 54 143 nil St. George-in-the-East District Dr. B. R. Rygate 302 65 367 31 St. George-in-the East Hospital Dr. J. Carver nil nil nil 30 St. Peter's Hospital Dr. Cecil A. Coyle ni nil nil nil Mile End Hospital Dr. Alan Randle 21 59 80 nil 110 1ll Public Ministry of Health. Form T.157 Health 1932. (Tuberculosis) Regula- PART I —Summary of Notifications during the period from the 3rd January, tions, 1930. 1932, to the 31sfc December, 1932, in the area of the Metropolitan Borough of STEPNEY. Age periods Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis Total Notifications. 0— 1— 5— lO- 15— 20— 25— 35— 45- 55— 65— Total (all ages) Pulmonary Males - - 3 11 25 24 57 40 43 32 8 243 273 „ Females - 2 2 9 14 21 35 25 7 12 5 132 153 Non-pulmonary Males 2 11 17 6 6 3 — 3 3 - - 51 54 „ Females 1 5 18 12 2 1 5 - 1 - 1 46 47 SUPPLEMENTAL RETURN. PART IT.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age periods 0— 1- 5- 10— 15— 20— 25— 35— 45— 55— 65— Total Pulmonary Males - - - 1 1 3 4 6 1 1 4 21 „ Females - - 1 - - 1 3 1 - 2 — 8 Non-pulmonary Males 1 2 - - - - - 2 - 1 -— 6 „Females - - 1 - - 1 - 1 - 1 - 4 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 NonPulmonary. Death Returns from local Registrars 14 6 transferable deaths from Registrar General 10 2 Posthumous notilications f - — " Transfers " from other areas (other than transferable deaths) 5 2 Other Sources ... — - PART III. NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining at the 31st December, 1932, on the Registers of Notifications kept by the Medical Officer of Health. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total 1401 825 2226 465 456 921 3,147 Number of cases removed from the Register(s) during the year by reason inter alia of :— 1. Withdrawal of notification 19 18 37 1 6 7 44 2 Reco\ ery from disease 29 26 55 29 19 48 103 3. Death 254 125 379 35 16 51 430* 4. Removals 112 83 195 24 23 47 242 112 Notification A complete review of this register has taken place this year and the Register. register to all intents and purposes now contains only those cases who are known to be alive and to be living in Stepney. There are still a certain proportion of cases which it is hoped to be able to take off in the near future. These are the cases who have surely recovered by now. The difficulty here is that they cannot be taken off the register without first being examined by a Medical Officer, and it can be understood that it is not easy to persuade a patient who is feeling perfectly fit, to present himself for examination. The dispensary returns show that the condition of 188 such cases was not ascertained during the year. The majority of these cases could be taken off as " recovered " if they could only be examined. The Tuberculosis Officers have this constantly in mind, and it is hoped before long to be able to take most of these 188 cases off the register. New Cases Particulars of new cases of tuberculosis and of all deaths from the of I uber- culosis and disease in Stepney during 1932. Mortality, Age Periods. New Cases. Deaths. Pulmonary, Non-Pulmouary Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 - - 2 1 - 1 2 - 1 - 2 11 5 1 2 2 3 5 3 2 17 18 — — 3 — 10 11 9 6 12 1 1 1 3 15 25 14 6 2 3 2 4 2 20 24 21 3 1 16 10 — — 25 57 35 - 5 28 11 3 — 35 40 25 3 - 19 10 2 2 45 43 7 3 1 27 6 1 — 55 32 12 - - 29 7 1 1 65 and upwards 8 5 - 1 14 2 — — Totals 243 132 51 46 138 52 19 11 113 Occupation. New Cases Notified. Deaths. Occupation. New Cases Notified. Deaths. Incidence ot Tuberculosis in various occupations, Artist 1 - Motor drivers 3 1 Auctioneer 1 - Musicians 3 2 Attendants 2 - Messengers 2 — Builders 2 - Motor cycle engineer — 1 Barmen 4 1 Medical student - 1 Bootmakers and Repairers 4 3 No occupation 118 18 Bottlers 2 - Nurse 1 — Bakers 2 - Office cleaners 4 1 ,, Assistant - 1 Optician 1 — Bottle washer — 1 Printers 2 1 Carmen 3 4 Porters 5 — Clerks 14 5 Cafe manager 1 — Cycle mechanic 1 - Police constable - 1 Cellarman 1 - Rag worker 1 — Cabinetmakers 4 1 Road sweepers — 2 Carpenters 3 — Rag merchant — 1 Charwoman - 1 Seamen 22 5 Cap machinist — 1 Stevedores 3 2 Commercial Traveller - 1 Shop assistants 10 1 Caretaker — 1 Salesmen 4 — Domestic Servants 6 - Scholars 71 8 Dock Labourers 10 16 Ships firemen 2 5 Dressmakers 5 3 Stewards 2 — Draymen 2 - Silk winder 1 — Diamond Polishers 1 1 Ships' Cook 1 — Doctors 2 1 Students 2 — Dyers' Assistant — 1 Street traders — 3 Dustman - 1 Sick nurses — 2 Electricians 3 - Showman's Assistant — 1 Engineers 5 - Stock keeper — 1 Egg Tester 1 - Street singer — 1 . Egg Merchant - 1 Telegraphists 2' — Egg Packer 1 1 Tailoring 22 20 Furriers 1 1 Tobacco sorters 3 1 French Polishers 2 2 Tent maker 1 — Fish Porters - 2 Tinker 1 — Fitters - 2 Tobacconist — 1 Glass Silverer — 1 Theatre attendant — 1 Guardsman (Army) — 1 Ticket writer — 1 Hospital Nurse - 1 Telephone engineer — 1 General Dealers - 2 Upholsterer — 1 Housewives 36 22 Wireless engineers 2 2 Hawkers 9 1 Waitresses 3 1 Hairdressers 3 2 Watchmen 1 2 House decorators I 3 Widows — 6 Housemaids - 2 Warehousemen — 2 J ewellers manager - 1 Window dresser - 1 Jam packer - 1 Waiter — 1 Labourers 17 13 Infants (5 years and under) 22 14 Lightermen " 3 472 220 Licensed victualler — 1 Machinists 9 1 - These regulations provide that persons suffering from Tuberculosis of the Public Health (Prevention Respiratory tract shall not be employed in the handling of milk or milk receptacles. of Tuberculosis) Regulations, 1925. Power is given to the Council to cause such persons to discontinue their employment. It was not found necessary to take action under the regulations during the year. 114 VII.—STATISTICS PROVIDED BY THE REGISTRAR-GENERAL. Memo. 1, 1933, M.O.H. Met. B. C.B. Metropolitan Borough of Stepney. These statistics are forwarded for the information of the Medical Officer of Health in connection with paragraph 7 and Appendix II of Circular 1269 dated the 24th June, 1932, addressed to Medical Officers of Health from the Ministry of Health. (1) Numbers of stillbirths registered in Stepney during the calendar year, 1932 :— Stillbirths registered. Inward Transfers. Outward Transfers. Stillbirths allocated to the Borough. Total (Legitimate and Illegitimate) Male 86 2 31 57 Females 85 4 34 55 Illegitimate Males 4 1 — 5 Females 2 1 — 3 (2) Numbers of cases of infectious diseases notified.in Stepney during the 52 weeks ended 31st December, 1932. Smallpox 26 Puerperal Fever 9 Scarlet Fever 986 Puerperal Pyrexia 30 Diphtheria 802 Erysipelas 191 Enteric Fever 11 The case rates of these diseases for England and Wales per 1,000 population are respectively as follows :— Smallpox 0'05, Scarlet Fever 2T2, Diphtheria 108, Enteric Fever 0'06, Puerperal Fever 0"05, Puerperal Pyrexia 0.14, Erysipelas 0.36. The case rates for Puerperal Fever and Puerperal Pyrexia are better expressed in relation to the births registered rather than to the population. When calculated on this basis the rates are :— Puerperal Fever 3'3 and Puerperal Pyrexia 8*5 per 1,000 total births (i.e. live and stillbirths') reentered durin? the vear. Memorandum S.D. 52, 1933, M.O.H., Met. B., C.B (3) Metropolitan Borough of Stepney. Live Births 1932. Live Births registered (excluding reregistrations). Inward Transfers. Outward Transfers. Live births allocated to the Borough. Total Live Births (Legitimate and Illegitimate) Males 2,742 73 897 1918 Females 2,565 93 838 1,820 Illegitimate Males 61 7 10 58 Live Births Females 51 10 8 53 Memo, S D./E.P. (4) Metropolitan Borough of Stepney. Estimate of Resident Population mid-year 1932, 223,000. (As deaths of persons serving in H.M.'s Forces are now allocated to their area of residence in the same manner as civilian deaths this estimate of resident population should be used for the calculation of both birth and death rates.) (5) CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF STEPNEY. 1932. CAUSES OF DEATH. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— ALL CAUSES M. 1,530 121 40 35 31 60 65 76 196 314 353 239 F. 1,250 104 45 36 36 52 51 59 124 185 301 257 1. Typhoid and paratyphoid fevers M. 1 ... ... ... ... 1 ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles M. 37 8 12 13 4 ... ... ... ... ... ... ... F. 30 3 16 10 1 ... ... ... ... ... ... ... 3. Scarlet Fever M. 3 ... ... ... 3 ... ... ... ... ... ... ... F. 4 ... 2 2 ... ... ... ... ... ... ... ... 4. Whooping cough M. 7 5 2 ... ... ... ... ... ... ... ... ... F. 6 3 3 ... ... ... ... ... ... ... ... ... 5. Diphtheria M. 8 1 1 4 2 ... ... ... ... ... ... ... F. 14 1 2 6 5 ... ... ... ... ... ... ... 6. Influenza M. 15 ... ... ... 1 1 1 1 3 3 6) 3 £* 2 F. 21 ... 1 1 1 3 ... ... 1 2 6 6 7. Encephalitis lethargica M. 5 ... ... ... ... 1 1 ... 1 1 1 ... F. ... ... ... ... ... ... ... ... ... ... ... .... 8. Cerebro-spinal fever M. 8 . . . ... 2 1 2 3 ... ... ... ... ... F. 11 3 ... 2 1 1 1 ... 2 ... 1 ... 9. Tuberculosis of respiratory system. M. 139 ... ... ... 1 19 25 21 30 28 13 2 F. 51 ... 2 ... 1 12 13 6 6 9 2 ... 10. Other tuberculous diseases M. 20 2 3 2 4 3 3 1 1 1 ... ... F. 12 1 1 2 2 2 ... 1 1 1 1 ... 11. Syphilis M. 7 ... ... ... ... ... 1 1 2 3 ... ... F. 6 2 ... ... ... ... 1 1 ... ... I 1 12. General paralysis of the insane, tabes dorsalis. M. 11 ... ... ... ... ... 1 3 3 3 1 ... F. 1 ... ... ... ... ... ... ... ... 1 ... ... 13. Cancer, malignant disease M. 214 ... ... ... ... 1 3 10 39 70 64 27 F. 169 ... ... ... ... 4 3 13 32 42 50 25 14. Diabetes M. 24 ... 1 ... ... ... ... 2 2 9 5 5 F. 34 ... ... ... . . . . . . 1 1 3 12 14 3 15. Cerebral haemorrhage, etc M. 33 ... ... ... ... ... ... 1 2 10 8 12 F. 47 ... ... ... ... ... ... ... 9 8 20 10 16. Heart disease M. 335 ... ... ... 1 8 4 5 24 77 117 99 F. 318 ... ... ... 2 8 9 11 23 40 107 118 17. Aneurysm M. 7 ... ... ... ... ... ... 2 4 1 ... ... F. 3 ... ... ... ... ... 1 ... ... 1 1 18 Other circulatory diseases M. 63 1 ... ... ... ... ... ... 5 8 32 17 F. 46 ... ... ... ... ... ... ... 3 11 15 17 19. Bronchitis M. 60 3 1 ... ... 1 1 1 11 14 13 15 . F. 34 3 ... ... ... 1 ... 2 3 0 6 13 115 116 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF STEPNEY. CAUSES OF DEATH. Sex. All Ages. 0— 1- 2— 5— 15— 25— 35— 45— 55— 65— 75— 20. Pneumonia (all forms) M 116 22 12 3 o « 2 2 7 17 13 25 11 F. 93 20 9 5 1 3 3 7 4 11 22 8 21. Other respiratory diseases M. 18 1 ... 2 ... 1 1 ... 4 2 5 2 F 14 ... 1 1 ... 1 ... ... 1 3 2 5 22. Peptic ulcer M 21 ... ... ... ... ... 1 1 7 9 3 ... F 2 ... ... ... ... • • • ... ... 1 1 ... ... 23 Diarrhoea, etc. M 28 24 2 ... ... ... ... ... 1 ... ... 1 F. 23 18 1 ... ... 2 1 1 ... ... ... ... 24. Appendicitis M. 8 ... ... ... 2 2 ... 1 2 1 ... ... F. 7 ... ... ... 2 1 2 ... ... 1 ... 1 25. Cirrhosis of liver . M 3 ... ... ... ... ... ... 1 ... 1 ... 1 F 2 ... ... ... ... ... ... ... 1 ... 1 ... 26. Other diseases of liver, etc. M 5 ... ... ... ... ... 1 ... 1 3 ... ... F. 10 ... ... ... ... ... ... ... 3 1 4 1 27. Other digestive diseases M 25 3 ... ... ... ... 2 1 5 9 4 ... F 25 1 2 ... 2 ... 2 3 5 2 8 ... 28. Acute and chronic nephritis M 45 ... ... ... ... 1 2 ... 6 10 11 15 F. 48 ... ... ... 1 4 2 1 7 11 12 10 29. Puerperal sepsis F. 3 • • • • • • ... ... 1 2 ... ... ... ... ... 80. Other puerperal causes F. 6 ... ... ... ... ... 3 3 ... ... ... ... 31. Congenital debility, premature birth malformations etc. M. 45 43 1 1 ... ... ... ... ... ... ... F. 37 36 1 ... ... ... ... ... ... ... ... ... 32. Senility M. 9 ... ... ... ... ... ... ... ... ... 1 8 F. 15 ... ... ... ... ... ... ... ... 1 3 11 33. Suicide M. 26 ... ... ... ... ... 3 4 4 8 6 1 F. 9 ... ... ... ... ... 2 ... 4 2 1 ... 34 Other violence M. 62 ... ... 3 7 9 6 4 8 11 9 5 F. 45 2 1 3 3 4 1 1 4 5 11 10 35. Other defined diseases . M. 121 8 5 4 3 8 4 9 14 19 31 16 F. 100 10 3 4 14 5 4 8 11 14 11 16 36. Causes ill-defined, or unknown M. 1 ... ... ... ... ... ... ... ... ... 1 ... F. 4 • • • • • • ... ... ... ... ... ... 1 2 1 Males Females. Under 1 year Legitimate 119 98 Illegitimate 2 6 (6) BIRTH.RATE, DEATH.RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1932. (Provisional figures.) (The mortality rates for England and Wales refer to the whole population but for London and the towns to civilians only.) Rate per 1,000 Total Population. Annual Death.rate per 1,000 Population. Rate per 1,000 Live Birhts. Percent3ge of Total Deaths. Live Births. Still.births. All Causes. Typhoid and Paratyphoid Fevers. Small.pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under two years). T otalDeaths under one year. Certified by RegisteredMedical Practitioners. Inquest cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England and Wales 15.3 0.66 12.0 0.01 0.00 0.08 0.01 0.07 0.06 0.32 0.53 6.6 65 91.1 6.2 1.8 0.9 118 County Boroughs and Great Towns, including London 15.4 0.70 11.8 0.00 0.00 0.11 0.01 0.08 0.07 0.28 0.48 8.9 69 91.3 5.9 2.3 0.5 126 Smaller Towns Estimated Resident Populations, 25,000.50,000 at Census 1931 15.4 0.69 10.8 0.00 - 0.06 0.01 0.06 0.03 0.31 0.42 4.5 58 91.9 5.8 1.3 1.0 London 14.2 0.51 12.3 0.00 0.00 0.19 0.02 0.08 0.07 0.27 0.53 12.6 66 89.4 6.2 4.4 0.0 The maternal mortality rates for England and Wales are as follows per 1,000 Live Births Puerperal Sepsis 1.61 . Other 2.63 s. Total. 4.24 „ Total Births 1.54 2.52 4.06 117 INDEX. page. I. Statistics and Social Conditions of the Area 6 II. General Provision of Health Services 17 III. Sanitary Circumstances of the Area 44 IV. Housing 68 V. Inspection and Supervision of Food 74 VI. Prevalence of and Control over Infectious and other Diseases 17 VII. Statistics provided by the Registrar General 114 After care, Tuberculosis 29 Aged persons, removal of 67 Agricultural Produce (Grading and Marking) Act 75 Analyst's Report 81-S6 Ante-Natal Clinics 35-37 Anthrax 102 Area of Borough 6 Bacteriological Examinations - 17 Bakehouses 63, 75 Baths and Washhouses 20-22 Births 6-8 Births Act, Notification of 8 Bishopsgate Goods Station 77 Butcher Shops and Stalls 75 Butter Factories 75 Canal Boats Acts 62 Cancer - 11, 100 Cerebro-Spinal Fever 99 Chicken Pox 98 Cleansing of persons 2 Complaints of nuisances 58 Convalescent Treatment 38, 43 Cowsheds 60, 65 Crdches, List of 35 Dairies and Milkshops 74 Day Nurseries 39 Deaths 8-16 Dental Clinic 33 Diarrhoea 12 Diphtheria 97 Diphtheritic Serum 97 118 119 page. Disinfection 60, 103 Drainage 58 Dysentery 100 Eating Houses - 60 Encephalitis Lethargica 99 Enteric Fever 98 Extra Nourishment, Supply of 30 Factory and Workshops 62-64 Fines and Costs 58 Finsen Light 30 Food and Drugs Acts 81-96 Food Products, Certification of 75 „ Unsound 76-80 ,, Regulations (Imported) 75 76 ,, Harwich-Zeebrugge Ferry 77 Hairdressers' Shops 60 Handicraft Class 30 Health Propaganda 30-32 Health Visitors, work of 36, 41 Health Week 31 Heart Disease 12 Home nursing 39 Heme Office, report to 62-64 Hospital facilities 20 Houses let in Lodgings 62 Housing :—Statistics 68-70 ,, Accommodation 70 House to House Inspection 67 Ice Cream Premises 60, 75 Infantile Mortality 13, 14 Infant Welfare Centres, List of 34 Infants, Feeding of 40 Infectious Diseases . 97-102 ,, Summary of, 101 Influenza 12 ° * Laboratory facilities 17 Lead poisoning 102 Legal Proceedings 50-58 Legislation 17-19 Light Treatment 30 London County Council, Report to 60-62 120 page. Lodging Houses, Common and Seamen's (36-67 Malaria 100 Marriages 8 Margarine premises 75 Market Buildings Area 70 Maternal Mortality 36-40 Maternity and Child Welfare Centres, etc. 34 ,, ,, Services 36-40 „ Centres, Work at 42 ,, Outfits 40 Measles 13 Merchandise Marks Act 75 Midwives 17-40 Milk—(Special Designations) Order 74 „ Analysis of 84-90 Milk and Daries Older 55-56 ,, and Meals, Provision of 43 Milkshops 60, 74 Ministry of Health, Returns to 23-27, 36, 107-111 Mortuary 65 Nursing in the Home 17 Offensive Businesses 60,66 Ophthalmia Neonatorum 99 Outworkers 64-65 Overcrowding 62, 71 Phthisis 13, 111, ] 12 Pneumo-Thorax refills 30 Pneumonia 13, 100 Polio-Myelitis 99 Population 6 Public Cleansing 44 Puerperal Fever and Pyrexia 100 Rag Flock Act 65 Rats and Mice Destruction 58-59 Kent and Mortgage Interest etc., Act 60 Respiratory Diseases 12 Restaurants and Eating Houses 60 Sanitary Inspectors:—Inspections 46-47 Notices served 47,61 Return of sanitary work 48-49 Samples taken 47 Scarlet Fever 97 Scavenging 44 121 pagk. School Children, Medical Records of 43 Shelter (35 Slaughterhouses, Poultry 60 Small-pox 99 Smoke Nuisances 5$ Social Conditions 13 Special Treatment 30 Staff 3, 17 Statistics, Summary of, 6 Survey 4 Triplets 8 Tuberculosis: Dental clinic 33 „ Dispensaries, List of 28 „ Return of work (Forms T 145 & T 145a) 23-27 „ Incidence in and Mortality from occupations 113 „ Notifications, Summary of (Form T137 Rev.) 111 „ Regulations, 1930 111-112 1925 113 Deaths 13, 112 Underground Rooms 61, 70 Unsound Food 76-80 Vaccination 103-106 „ by Public Vaccinators 110 „ Officers, Returns by 107-109 Verminous persons and premises 60, 103 Water Certificates 60 Whooping Cough 13 Workshops and Workplaces 62-64 Wrong Diagnosis of Infectious Diseases 100 Zymotic Diseases 12