Metropolitan Borough of Stepney ANNUAL REPORT For the Year 1934 BY A. FERGUSON, M.B., D.P.H., Medical Officer of Health AND Administrative Tuberculosis Officer TOGETHER WITH THE REPORT OF THE PUBLIC ANALYST. Vail & Co. Ltd., Printers to the Council, 170, Farringdon Road, E.C.1. Metropolitan Borough of Stepney ANNUAL REPORT For the Year 1934 BY A. FERGUSON, M.B., D.P.H., Medical Officer of Health * AND Administrative Tuberculosis Officer TOGETHER WITH THE REPORT OF THE PUBLIC ANALYST. Vail & Co. L.t.d. Printers to the Council, 170, Farringdon Road, E.C.1. 2 PUBLIC HEALTH COMMITTEE (November, 1933, to October, 1934.) Ex Officio: His Worshit The Mayor (Councillor R. J. Woodham, J.P.) Chairman: Alderman (Mrs.) F. W, Reidy Vice-Chairman: Councillor (Rev.) B. N. Michelson, M.A. Alderman (Mrs.) C. B. Lankester, J.P. Alderman (Miss) M Moses, J.P. Councillor (Dr.) M. L. Barst Councillor (Mrs.) M.M. E.Phillips, J.P. „ C. Edser „ (Mrs.) H. Roberts „ J. Hurley, J.P. „ (Rev.) H. Shrubbs, M.A. ,, F. W. Jarvis „ L. Silver „ (Mrs.) H. Long „ (Mrs.) L. Stone „ J. Mulshaw ,, (Mrs.) M. Tovey „ G. Newton ,, The Countess Winterton „ (Mrs.) A. E. Perryman „ F. Withers MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1933, to October, 1934.) The Members of the Public Health Committee, together with the following Members:— Mrs. C. Aylward Mrs. F. E. Grenfeli. Mrs. P. Carew-Robinson Mrs. Michelson Mrs. R. Dubury Mrs. A. Model Mrs. R. Eicholz Mrs. O'Connor Mrs. L. Frankel Miss E. Symons Chairman : Councillor The Countess Winterton Vice-Chairman: Alderman (Mrs.) C. B. Lankester, J.P. Councillor F. Withers (from January, 1934) 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT on the 31st December, 1934. Medical Officer of Health and Administrative Tuberculosis Officer: A. Ferguson, m.b., b.s. (lond), m.r.c.s., l.r.c.p., d.p.h. Deputy Medical Officer of Health: F. Roantree O'Shiel. L.R.C.P., D.P.H. (Liverpool). Public Analyst: D. Henville, F.I.C. Analytical Assistant: W. M. Paulley, B.A., F.I.C. Food Inspector: H. Abson. (1, 2, 4) Sanitary Inspectors: G. Bottomley. (1,2,4) C. F. Guy. (2) W. F. Smith. (2,4) A. C. Brown. (2,4) H. O. Harris. (1,4) S. H. V. Trimming. (2) R. W. G. Day. (3) W. H. Haworth. (3) W. T. Twynham. (2) T. W. Dee. (2, 4) G. McCarthy. (3) S. Vogler. (3, 4) E. J. Edwards. (2, 4) R. Roper (3,4) R. H. Waterman. (1, 2, 4) E W. Flint. (1,4) W. Shepherd. (1) *Miss H A. Whitty. H. J. Green. (1, 2, 4) R. Simpson. (1, 4) (3, 4, 5, 6, 8) Clerical Staff: W. F. Lellow, Chief Clerk (2) R. Bach. M. Fitzgerald. (M. & C.W.) C. H. Lowry. G. Boulton. (M. & c.w.) H. Hiles (M. & C.W.) S. Lowther. (3, 4) C. F. Brockett. (3, 4) W. P. Howard. J. McMullon. G. A. Carthy. (M. & c.w.) M. W. Hunt. (M. & C.W.) M. Pliskin. W.J. Dixon. J. Keniry. P. Romaine. (M. & c.w.) S. Embleton. H. T. Kightley. Vaccination Officers: E. Price. (3) E. J. Robertson. Medical Officers for Maternity and Child Welfare (Part Time): N. COTTER. M.B., B.Ch. E. C. PHELPS, L.R.C.P., M.R.C.s. M. ward, M.B., Ch.B., D.P.H. Health Visitors: M. Bailey. (5, 6, 7) E. Clements. (5, 6) D. Michell. (2, 6) D. E. Blackmore. (5, 6, 7,) A. M. Cordwell. (1, 6, 8) M. F. E. Styles. (5, 6. 7) W. Brazier. (6, 7) S. Foucar. (2, 5, 6, 7) A. Carty, (5, 6, 7) A. E. Gibbs. (5, 6) Senior Clinical Tuberculosis Officer: W. E. Goss, M.B., Ch.B. (Ed.) Assistant Tuberculosis Officer: S. Kin, M.D., B.S., M.R.C.S., M.R.C.P.. D.P.h. Tuberculosis Visitors: M. C. Hurley. (5, 6, 7) M. F. Weatherilt. (5, 6, 7) E. Lindsley. (7) E. Wilton (temporary). M. Prickman. (5, 6, 7) Nurse Dispensers: M. Coulman, (5, 6, 7, 9), A. O. Jones. (7, 8, 9) Cleric and Secretary to Care Committee: M. Grant. Consulting Gynaecologist: R. Christie-Brown, M.B., M.S., F.R.C.S. Dental Surgeon (part-time): F. L. Payne. L.D.S. Anœesthetist (part-time): J. P. Reidy, b.a., M.R.C.S., L.R.C.P. 1. Certificate Royal San Inst. 5. Health Visitors Certificate. 2. ,, San Insp Exam. Bd 6. Central Midwives Bd. 3. „ Royal San. Inst. and San. Insp. 7. State Reg. Nurse. Joint Board. 8. Trained Nurse. 4. ,, Meat and Other Foods. 9. Certificate Soc. of Apothecaries * Also Infant Life Protection Officer and Supervisor of Common Lodging Houses for Women 4 Public Health Department, 43, White Horse Street, Stepney, London, E. 24th April, 1935. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Your Worship, Ladies and Gentlemen, I have the honour to present to you my second annual report on the vital statistics and the sanitary conditions of the Borough of Stepney for the year 1934. On the whole it has been a year of preparation rather than a year of actual progress. My report upon a proposed reorganisation of the staff of Sanitary Inspectors was duly considered and the formation of a Food Section was agreed to by Council and was sanctioned by the Minister of Health. Unfortunately unforeseen circumstances prevented this section from starting its activities until January 1st, 1935. Certain other reorganisation in the staff of the department was alsofound to be necessary and this will be considered by Council early in the New Year. The new Tuberculosis Dispensary did not materialise, as I had hoped, but this should now be a fait accompli in 1935 and before that year is out the Tuberculosis Service in Stepney will be placed upon a more efficient basis. Slum Clearance did not progress as rapidly as I hoped and I was able to represent only one Clearance Area—the Beccles Street area— during the year. The Minister of Health confirmed the Council's Compulsory Purchase Order on 28th September. The bathing facilities for the treatment of Scabies, other than in school children, are very inadequate and consideration is being given to the necessary alterations at the Council's Disinfecting Station. In the meantime arrangements were made with Bethnal Green for the bathing of adults and with the London County Council for the bathing of children under school age. 5 The problem of the eradication and prevention of the Bed-bug occupied my attention during the later part of the year, and as a preliminary step Miss Whitty was appointed a Sanitary Inspector, her chief duties being to keep the Council's flats under regular supervision and to inculcate a spirit of "bug-mindedness" in the tenants. At the time of writing consideration is being given to my report upon a comprehensive scheme including the disinfestation of the furniture of all tenants entering Council's property. In order to relieve Miss Whitty of her Infant Life Protection duties, each Health Visitor was appointed to act as Infant Protection Visitor in her own district. Owing to the poor arrangements for the care of fosterchildren in the Borough, it was thought advisable to work out an ideal scheme in conjunction with the Ministry of Health and the London County Council and to retain Miss Whitty's services in the meantime. To arrange an ideal service of foster-parents in a locality most unsuitable for the purpose is a very difficult problem and so far the ideal has not been achieved. In conjunction with the Medical Superintendents of the three London County Council General Hospitals I arranged a system of co-operation between the Public Assistance Committee and the Tuberculosis Dispensaries in respect of Tuberculous persons who are in receipt of public assistance. By a system of simple forms there is now intimate liaison between the District Medical Officers on the one hand and the Tuberculosis Officers on the other; the District Medical Officers can now quickly obtain the expert opinion of tha Tuberculosis Officers upon the fitness for work of, and the appropriate treatment for, the patients under their care ; the Tuberculosis Officers can now refer to the District Medical Officers all those patients who in their opinion require extra nourishment through the Public Assistance Committee and in this way there is a minimum amount of delay in the receipt by those patients of such nourishment. Dental treatment for expectant and nursing mothers and for patients suffering from tuberculosis is now a service provided directly by the Council instead of being, as hitherto, a service provided as a result of a contract with the British Dental Hospital. During the year Mr. F. F. Sharles, F.S.A.A., who was appointed by the Council to investigate the financial and other detailed arrangements of administration in the different departments, made his investigations into those arrangements in the Public Health Department. I welcomed this 6 investigation, coming as it did in the early days of my service as Medical Officer of Health, for it brought to my notice imperfections, here and there, of which I might never have become aware or of which it might have taken me years to become so. His report was issued on 17th September and with very few exceptions his recommendations were adopted by the Council on 24th October. The chief improvements were in respect of the system of timekeeping and booking at the Disinfecting Station, the financial arrangements at the Council's Infant Welfare Centres and the Council's Milk Scheme. It is satisfactory to know that these matters are now on an improved basis. The main features of the year, so far as the vital statistics and the incidence of disease are concerned, were as follows:- The number of births further decreased by 20 (legitimate 25 less, illegitimate 5 more). Owing to the estimated decrease in population the birth-rate rose to 15.3 as compared with 15.1 last year. The crude death-rate decreased from 12.9 last year to 12.3 this year, there being 171 fewer deaths. The Registrar-General has produced a Comparability Factor for adjusting the local crude Death Rates for 1931 and subsequent years. In order to make a strict comparison of Stepney's death-rate with that of the country as a whole, it is necessary to multiply the crude death-rate by 1.17. Stepney's Comparable Death Rate for 1934 is therefore 14.3. It is naturally rather perturbing to have to report an increase in the Maternal and Infantile Mortality and in the deaths as a result of Measles. I report at length on these matters elsewhere in this report, but I want to say a few more words here about Maternal Mortality. Quite rightly this subject is causing a good deal of attention at the present time, but I do want to emphasise a word of warning against pushing the propaganda too far. By all means let us consider the matter very seriously, both from an administrative and from a technical point of view, and let us do all in our power to improve our Maternity Services, but I do deprecate the impression which is being broadcast that child-bearing is dangerous. If the dangers of child-birth continue to be exaggerated, women will either take good care that they have no children or will resort to means of ridding themselves of the so-called danger at the earliest possible moment, only to place themselves for the first time in real definite danger. 7 I am glad to be able to report a decrease of 20 deaths from Pulmonary Tuberculosis and of 11 from Non-Pulmonary Tuberculosis; better still there were 64 fewer notifications during the year. These statistics show that the slight setback experienced last year has been more than overtaken, especially in the matter of notifications (12 more last year, 64 less this). Influenza was almost negligible, there being only 13 deaths, all in elderly persons. There was a great decrease in the amount of Scarlet Fever, but Diphtheria remained about the same. I report especially on Diphtheria on page 107. Smallpox (Variola minor) has now disappeared from this country and it is to be hoped that it will be many years before there is another visitation. As I mention elsewhere, although it is a mild disease, public opinion is such, owing to the name Smallpox, that all the measures applicable to the severe type, Variola major, have to be taken. Careful watch must be kept however against the possible occurrence of imported cases of the severe type. There were 11 fewer cases of Spotted Fever (cerebro spinal meningitis) and the results of treatment were much better, the case mortality being 31% as compared with 46% last year. Cancer showed a further decrease, the death-rate being 1.4 as compared with 1.5 last year. There were 28 fewer deaths. I wish to express my warm appreciation of all the help and all the kindness I have received throughout the year from members of the Council in general and from the Chairmen and members of the Public Health and Maternity and Child Welfare Committees in particular. I wish also to express my gratitude to Dr. O'Shiel, Deputy Medical Officer of Health, for the unfailing support which he has given me during this his first year of office. The difficulties in the way of a newcomer to Stepney are well known, and the intricacies of the various Maternity and Child Welfare Services in the Borough are out of the ordinary. His work, therefore, has been all the more praiseworthy. 8 Finally I wish to pay a special tribute to the members of my staff, including Mr. Lellow, the Chief Clerk. 1934, especially during the last few months, was a year of much upset, mainly through illness, and I am particularly grateful for the splendid way in which the whole staff carried on in the face of those difficulties. I have the honour to be, Your Worship, Ladies and Gentlemen, Your obedient servant, A. Ferguson, Medical Officer of Health. 9 SUMMARY OF STATISTICS, 1934. Area of Borough (in acres) 1902 766 Population (1934) (Registrar-General's estimate) 214,990 Number of inhabited houses (end of 1934) according to Rate Books 37,757 Rateable value £1,737,350 Sum represented by a penny rate £6,914 Total. Male. Female. Live Births Legitimate 3,174 1,610 1,564 1 Birth rate Illegitimate 125 64 61 15.3 Still Births 111 61 50 Rate per 1,000 total births 33.6 Deaths 2,657 1,419 1,238 Death rate 12.3 Number of women dying in, or in consequence of childbirth: From sepsis 6 From other causes 12 The death rate was 545 per 1,000 births Death rate of Infants under one year of age per 1,000 live births: Legitimate ... 86'9 Illegitimate ... 96'0 Total death-rate ... 87.2 Deaths from Measles (all ages) 88 „ „ Whooping Cough (all ages) 20 „ „ Diarrhoea (under 2 years of age) 69 ,, „ Respiratory Tuberculosis 183 „ „ Other Tuberculosis Diseases 21 „ „ Cancer 321 „ „ Heart Disease 633 „ „ Zymotic diseases 204 1.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. The estimate of the Register-General to the mid-year 1934 is 214,990. The total number of births of Stepney residents during the year was 3,299 —1,674 males and 1,625 females—or 20 less than in the previous year. The birth-rate was 15.3 per 1,000 of the population. Population. Births, 10 Births in Public Institutions in the Borough. 4,218 births occurred in Public Institutions in the Borough, of which '2,068 belonged to Stepney and 2,150 belonged to other Boroughs. 1,548 births occurred in the East End Maternity Hospital:— 466 belonged to Stepney, and 1082 to outlying Districts. 796 births occurred in the London Hospital:— 357 belonged to Stepney, and 439 to outlying Districts. 280 births occurred in the St. George-in-the-East Hospital:— 261 belonged to Stepney, and 19 to outlying Districts. 630 births occurred in the Mile End Hospital:— 535 belonged to Stepney, and 95 to outlying Districts. 156 births occurred in the St. Peter's Hospital:— 135 belonged to Stepney, and 21 to outlying Districts. 807 births occurred at 24, Underwood Street:— 314 belonged to Stepney, and 493 to outlying Districts. 1 birth occurred in the London Jewish Hospital, Stepney Green, which belonged to an outlying District. Births in Outlying Districts. 182 births occurred outside the Borough, the parents being residents of Stepney. Twins. 40 sets of twins and 1 set of triplets were 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 net number of births notified under the Act was as follows:— Live Still Births Births. (a) In Institutions 2289 77 (b) At home:— Notified by doctors 116 3 ,, private midwives 194 4 ,, doctors and midwives from Institutions 716 13 3,315 97 Marriages The total number of marriages which took place during the year was 2,174, or 70 more than in the previous year. The proportion of persons married was 21.1 per 1,000 ot the population. 11 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 2,657—1,419 males and 1,238 females—or 177 less than in the previous year. Deaths. The death-rate for the whole Borough was 12"3 per 1,000 of the population. Deaths in Public Institutions in the Borough. 2,168 deaths occurred in Public Institutions in the Borough, of which 1,406 belonged to Stepney and 762 belonged to other Boroughs. Belonging to Stepney. Belonging to other Boroughs. East End Maternity Hospital, Commercial Road 18 19 Princess Elizabeth of York Hospital for Children Shadwell 22 47 London Hospital, Whitechapel Road 153 531 London Jewish Hospital, Stepney Green 48 41 Mile End Hospital, Bancroft Road 482 29 St. George's Hospital, Raine Street 316 23 St. Peter's Hospital, Vallance Road 266 48 Sick Room Help Society, 24, Underwood Street 3 11 Stepney Institution, South Grove 98 13 Deaths in Outlying Districts, There were 505 deaths of persons belonging to the Borough in various Institutions outside the Borough:— Mental Hospitals 86 Hospitals for Infectious Diseases 104 Hospitals and Institutions 315 In addition there were 27 deaths of Stepney residents in private houses outside the Borough. Social Conditions. The approximate number of registered unemployed on the 24th December, 1934, was 10,800 males and 3,250 females, and on the 18th December, 1933, was 8,293 males and 1,337 females. The following particulars relate to Stepney residents in receipt of domiciliary relief during the weeks ended 6th January, and 29th December, 1934: 1934. Men. Women Children. Total. 6th January 1,704 2,666 3,018 7,388 29th December 2,159 3,027 3,481 8.667 Changes in Staff. II.—GENERAL PROVISION OF HEALTH SERVICES. There have been several changes in the personel of the Public Health Department during the year. Dr. F. R. O'Shiel, the Deputy Medical Officer of Health, commenced duty on the 22nd January and Dr. W. J. C. Auld, who was a temporary Tuberculosis Officer, ceased duty on the 20th January. 12 Miss Whitty, formerly a Health Visitor in this Department, was appointed as Sanitary Inspector. She commenced her new duties on the 1st December. Miss W. E. Paice, a Health Visitor, resigned on the 31st July, owing to marriage, and Miss D. E. Blackmore, one of the Tuberculosis Visitors, was transferred to the vacancy thus caused on the 1st August. Miss E. Wilton was engaged as a temporary Tuberculosis Visitor on the 25th July to take the place of Miss Blackmore. Mrs. A. Aylward, a clerk, left on the 23rd June and Miss M. Fitzgerald, a temporary Clerk, was placed on the permanent staff on the 30th May. It was found necessary to appoint another clerk in the maternity section and Miss P. Romaine was appointed on the 19th December. Mr. R. Roper, a temporary Sanitary Inspector, was placed on the permanent staff of District Sanitary Inspectors on the 25th July, and Mr. W. H. Haworth was appointed a District Sanitary Inspector on the same date. Mr. S. Lowther, a Clerk, was promoted to the position of Clerk and reserve Sanitary Inspector on the 25th July. Dr. G. C. Davison, part-time Medical Officer for Maternity and Child Welfare, left on the 31st May and Dr. M. Ward was appointed part-time Medical Officer for one of the Council's Maternity and Child Welfare Centres on the 25th July. Mr. F. R. Payne was appointed part-time Dental Surgeon at the Council's Dental Clinic on the 25th July and Dr. J. P. Reidy was appointed part-time anaesthetist at the same clinic on the same date. A list of the staff of the Public Health Department and their qualifications is given on page 3. Nursing in the home. 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 Coundil pay this Society Is. 3d. per visit to such cases and 2,185 visits were made by them during the year, i.e., 2,089 Measles, 85 Ophthalmia Neonatorum and 11 Pemphigus Neonatorum. Midwives. There are 8 Midwives practising in the Borough, and in addition there are 22 employed by the voluntary associations. The midwives are under the supervision of the London County Council. 13 The number of bacteriological examinations made at the Mile End Hospital Laboratory Facilities on behalf of the Public Health Department during the year was 2,898. These consisted of:— No. No. Positive. Negative. Totals Swabs (for Diphtheria bacilli) 311 2,582 2,893 Blood (for Typhoid bacilli) 4 1 5 There were 284 specimens of sputa examined at our Tuberculosis Dispensaries for general practitioners. 37 of these were found to be positive. Hospital facilities. The following is a list of the hospital facilities in the Borough, 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 362 14,358 106,737 General. Voluntary. Female 397 Cots 84 Other 32 Mile End Hospital, Bancroft Road. Male 152 6,121 8,360 General. L.C.C. Female 253 Children 135 St. George-in-the-East Hospital, Raine Street. Male 202 4,272 12,159 General. L.C.C. Female 152 Children 52 Sick staff 4 St. Peter's Hospital, Vallance Road. Male 221 3,670 8,532 General. L.C.C. Female 183 Children 57 Isolation 5 South Grove Institution, South Grove. Male 441 580 — General. L.C.C. Female 237 London Jewish Hospital, Stepney Green. Male 41 1,511 16,377 General. Voluntary. Female 51 Children 12 Other 5 Princess Elizabeth of York Hospital for Children, Glamis Road. Children 135 1,567 15.176 General. Voluntary. East End Maternity Hospital, Commercial Road. 56 1,574 377 Maternity. Voluntary. Jewish Maternity Hospital, Underwood Street. 34 798 midwifery 3 gynaecological 48 maternity & 320 general Maternity. Voluntary. 14 Memo. 37/T (Revised). Ministry of Health Form T. 145. A. Return showing the work of the Dispensaries for the year 1934:— 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 170 85 12 8 12 7 13 13 182 92 25 21 722 *(b) Diagnosis not completed . — — — — — — — — 22 21 19 17 (c) Non-tuberculous — — — — — — — — 99 123 52 49 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 2 — 2 — — — — 1 2 — 2 580 *(b) Diagnosis not completed .. — — — — — — — — 10 5 5 6 (c) Non-tuberculous - - - - - - - - 104 123 157 165 C.—Cases written off the Dispensary Register as:— (a) Recovered 15 25 5 5 2 - 2 4 17 25 7 9 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 218 288 224 228 1,016 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 765 526 94 78 68 66 118 99 833 592 212 177 1,952 (6) Diagnosis not completed - - - - - - - - 36 27 41 34 1. Number of cases on Dispensary Register on January 1st 1,911 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 76 2. Number of cases transferred to other areas. cases not desiring further assislance under the scheme, and cases "lost sight of" 149 4. Cases written off during the year as Dead (all causes) 172 5. Number of attendances at the Dispensary (including Contacts) 6.738 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 57] 7. Number of consultations with medical practitioners:— (a) Personal 46 (b) Other 270 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 193 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 6,026 10. Number of (а) Specimens of sputum, etc., examined 726 (b) X-ray examinations made in connection with Dispensary work 222 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 2 12. Number of "T.B. plus' cases on Dispensary Register on December 31st 827 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 *i.e., remaining undiagnosed on 3lst December. 15 Form T145a. (a) PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 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. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 1929 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 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) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 15 19 15 — 34 3 2 1 — 3 4 3 2 — 5 9 4 2 — 6 14 5 4 — 9 F. 11 15 9 — 24 2 4 3 — 7 2 3 2 — 5 3 5 4 — 9 13 10 1 — 11 Children 7 1 - - 1 2 — — — — 4 — — — — 8 3 — — 3 11 - 1 — 1 Disease not Arrested Adults M. 9 17 14 2 33 1 1 3 1 5 2 4 1 — 5 3 1 5 — 6 7 8 13 1 22 F. 7 12 14 1 27 1 — 4 - 4 2 2 5 — 7 2 3 2 — 5 2 2 3 — 5 Children — 2 — — 2 1 — — - — 1 3 — — 3 — — — — — 2 - 1 — 1 Condition not ascertained during the year 13 25 15 — 40 3 3 2 - 5 4 4 5 — 9 10 3 4 — 7 18 7 4 — 11 Total on Dispensary Register at 31st December 62 91 67 3 161 13 10 13 1 24 19 19 15 — 34 35 19 17 — 36 67 32 27 1 60 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 19 6 6 — 12 7 5 — - 5 9 2 — — 2 8 1 2 — 3 2 1 1 — 2 F. 17 16 2 — 18 3 4 — — 4 11 3 — — 3 5 5 — — 5 7 1 1 — 2 Children 6 2 — — 2 4 — — — — 6 2 — — 2 5 5 — — 5 — — — — Lost sight of, or otherwise removed from Dispensary Register 68 30 26 1 57 6 7 7 - 14 12 6 11 1 18 9 12 8 2 22 14 6 9 1 16 Dead. Adults M. 9 2 18 7 27 5 4 4 1 9 6 3 8 2 13 4 2 7 3 12 9 3 7 2 12 F. 9 4 10 1 15 - - 2 3 5 2 3 2 — 5 4 3 2 1 6 3 4 7 2 13 Children - - - - - - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register. 128 60 62 9 131 26 20 13 4 37 46 19 21 3 43 35 28 19 6 53 35 15 25 5 45 Grand Totals 190 151 129 12 292 39 30 26 5 61 65 38 36 3 77 70 47 36 6 89 102 47 52 6 105 16 PULMONARY TUBERCULOSIS—continued. Condition at the time of the last record made during the year to which the return relates 1930 1931 1932 1933 1934 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 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) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 11 8 3 — 11 11 1 1 - 2 8 - - - - - - - - - - - - - F. 7 11 2 — 13 9 10 3 — 13 5 — 1 — 1 — — — — — — - — — Children 10 2 — — 2 14 2 — — 2 15 — — — - - — — — — — - — — Disease not Arrested. Adults M. 3 8 13 3 24 12 10 23 1 34 21 27 38 4 69 42 26 32 4 62 56 39 34 5 78 F. 5 7 6 — 13 12 5 14 2 21 14 22 15 1 38 28 14 21 3 38 33 14 20 2 36 Children 4 1 — — 1 5 1 — — 1 12 1 — — 1 18 1 2 — 3 18 2 3 — 5 Condition not ascertained during the year 12 4 3 — 7 18 6 5 1 12 19 2 11 — 13 18 9 2 1 12 — — — — — Total on Dispensary Register at 31st December 52 41 27 3 71 81 35 46 4 85 94 52 65 5 122 106 50 57 8 115 107 55 57 7 119 (6) 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 15 9 16 3 28 21 18 23 — 41 16 7 15 1 23 12 10 13 1 24 5 2 4 1 7 Dead Adults M 4 6 10 4 20 3 1 12 9 22 5 7 14 10 31 4 9 19 16 44 — 3 6 23 32 F. 5 2 5 5 12 3 7 8 3 18 2 4 4 6 14 - 2 6 10 18 — 1 7 6 14 Children 1 2 - — 2 — — — — — 1 1 - — 1 1 — — 2 2 1 — 1 — 1 Total written off Dispensary Register 25 19 31 12 62 27 26 43 12 81 24 19 33 17 69 17 21 38 29 88 6 6 18 30 54 Grand Totals 77 60 58 15 133 108 61 89 16 166 118 71 98 22 191 123 71 95 37 203 113 61 75 37 173 17 Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates. Previous to 1926 1926 1927 1928 1929 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 Bones and Joints Abdominal Other Organs peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 1 — — 2 3 2 — — 1 3 2 — 1 3 4 1 - - 5 2 1 — 2 5 F. 1 — — — 1 1 — — 1 2 - - 1 — 1 1 — - 1 2 — - - - - Children 12 — — — 12 2 1 — 1 4 1 2 — 3 6 6 1 1 5 13 5 3 4 5 17 Disease not Arrested Adults M. - - - - - - - - - - - - - - - - - - - - - - - 1 1 F. — — 1 — 1 — — 1 — 1 1 — — 1 2 1 — — — 1 — — — - — Children 2 — 1 1 4 — — — 1 1 2 — — — 2 — — 2 1 3 4 — — 1 5 Condition not ascertained during the year 3 — 3 2 8 — 1 — 2 3 1 1 1 4 7 1 — 2 2 6 4 — 2 2 8 Total on Dispensary Register at 31st December 19 — 5 5 29 5 2 1 6 14 7 3 2 9 21 13 2 5 9 29 15 4 6 11 36 Transferred to Pulmonary - - - - - - - - - - - - - 1 1 - - - - - - - - 1 1 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — 1 2 3 — 1 - 1 2 1 — - — 1 — — — 2 2 - - — - — F. - — — 1 1 — — 1 — 1 — — - 1 1 — — — — — — — 1 2 3 Children 3 1 1 5 10 2 1 — 3 6 1 1 — 2 4 1 — — 11 12 2 - — 4 6 Lost sight of, or otherwise removed from Dispensary Register 7 3 4 14 28 2 2 — 2 6 2 1 1 3 7 1 — 2 1 4 3 2 1 2 8 Dead Adults M. - - - - - - - - - - - - - - - - - - - - - - 1 - 1 F. - - - - - - - - - - - - - - - - - - - - - - - - - Children — — - 3 3 — — — 1 1 1 — — 1 2 — — — 3 3 — - — — — Total written off Dispensary Register 10 4 6 26 46 4 4 3 7 18 6 2 1 7 16 2 — 2 17 21 5 9 3 8 18 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 29 4 11 31 75 9 6 4 13 32 13 5 3 16 37 15 2 7 26 50 20 6 9 19 54 18 NON-PULMONARY TUBERCULOSIS—continued. Condition at the time of the last record made during the year to which the return relates. 1930 1931 1932 1933 1934 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 J 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 — — 1 3 2 1 — 3 6 — 1 1 — 2 1 — 2 i 4 1 — 1 — 2 F. 2 — 1 3 6 2 — 1 — 3 — 1 — 1 2 — — 1 i 2 — — — — — Children 1 2 4 11 18 5 2 3 12 22 2 1 — 4 7 — — — 4 4 — 2 2 — 4 Disease not Arrested Adults M. 1 - - - 1 - - - - - - - 1 - 1 - 1 2 2 5 4 — 1 3 8 F. - - - - - 1 - - - 1 1 1 1 2 5 1 1 — 2 4 — 2 — 3 5 Children 4 1 — 3 8 1 1 — — 2 5 1 2 9 17 5 2 2 10 19 3 1 3 13 20 Condition not ascertained during the year 4 1 3 3 11 1 3 3 4 11 2 — 1 4 7 2 — 2 8 12 — — - — — Total on Dispensary Register at 31st December 14 4 8 21 47 12 7 7 19 45 10 5 6 20 41 9 4 9 28 50 8 5 7 19 39 Transferred to Pulmonary - - - - - - - - - - - - - - - - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — 1 1 - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - Children 1 - - - 1 - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register — 2 2 4 8 4 —• 4 4 12 6 2 — 7 15 1 — 1 5 7 — — — — — Dead Adults M. — — 1 1 2 — 1 1 — 2 — — — — — — — 1 1 2 1 1 1 — 3 F. - - - - - - - - - - - - - - - - - - - - - - - - - Children - — — 1 1 — — — 1 1 1 — 3 1 5 — — — 1 1 1 1 1 — 3 Total written off Dispensary Register 1 2 3 7 13 4 1 5 5 15 7 2 3 8 20 1 — 2 7 10 2 2 2 — 6 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 15 6 11 28 60 16 8 12 24 60 17 7 9 28 61 10 4 11 35 60 10 7 9 19 45 19 Tuberculosis Dispensaries. There are three Municipal Tuberculosis Dispensaries in the Borough. 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. 27 Children who Were contacts of infectious cases of pulmonary tuberculosis were boarded out during the year. After Care During the year the Tuberculosis Care Committee held 28 meetings, 27 of which were meetings of the sub-Committees and one a full meeting of the Committee held at the Public Health Offices. Two meetings of the Standing Conference of Metropolitan Borough Tuberculosis Care Committees were also held at the County Hall, Westminster. They were attended by six delegates and the secretary from Stepney, and matters likely to be of help to tuberculous patients were discussed, and recommended to the London County Council for consideration. 20 598 cases were brought before the Care Committee for consideration, advice, and help, this number being nearly 100 in excess of last year. 452 were persons admitted or re-admitted to sanatorium or hospital for residential treatment, and 146 were cases reported on as needing various kinds of assistance. The latter figure is exactly twice that of last year, owing to the fact that now all cases of tuberculosis, including homeless and destitute patients, are brought to the notice of the Care Committee. In August the London County Council decided to provide free residential treatment for all cases of tuberculosis, so after this date the Committee's duty of making an assessment towards the cost of treatment was changed to that of considering the financial and home conditions of patients recommended for sanatorium treatment, and deciding, not how much patients or their families should pay, but what, if any, help were needed, and if so, how to provide that help. A great deal of this assistance is obtained through the Public Assistance Committee and the voluntary charitable societies. Forty-two necessitous patients in sanatorium or hospital were provided with clothing by the Public Assistance Committee, and in several cases letters from the Tuberculosis Officers or the Secretary resulted in increased relief being allowed to families on the grounds of tuberculosis. The Charity Organisation Society gave clothes to several patients, they paid for the parents to visit a child at Margate, and sent one woman for a badly needed holiday. The Jewish Board of Guardians again helped practically all the cases recommended to them by the Care Committee, and the Red Cross Society, the United Services Fund, and the Invalid Kitchens have given valuable help from time to time. Eleven patients returning from sanatorium have been lent single beds and bedding by the Borough Council in order that they could sleep alone and lessen the risk of infection to others. In spite of the assistance given from outside charities, the secretary, after ten years experience, feels strongly that there should be an emergency fund to relieve urgent cases of distress which are brought to her notice from time to time. One of the great difficulties about being obliged to refer all cases needing assistance to outside bodies is that some time must necessarily elapse before the help can be given. Each Society has its own enquiries to make and Committees to consult before anything can be done, and apart from 21 this delay, there is the natural reluctance of the patient or his family, who having given all details of his circumstances to the Care Committee secretary, must be sent to another office to repeat them before his case can be investigated. Towards the end of the year, with the sanction of the Committee, the secretary raised by private subscription a small fund with which she has been able to provide pocket money for three penniless patients in sanatorium and to pay 12/- railway fare for the parents of a child whom the London County Council urgently wished them to visit. But many cases badly needing help often have to be refused, and a small fund, officially administered by the Care Committee, would be of the greatest use. One of the men provided with pocket money who is still at sanatorium, writes appreciative letters saying what a difference it is making to his stay there. He discharged himself after being away for a short time earlier in the year because he could not endure being with other men and not having anything at all with which to pay his share of the little extras which must always be bought. It is only necessary to imagine oneself in his place to understand this. Handicraft Class The Handicraft Class has had another successful year and the attendance of patients has much improved. 46 classes were again held, with an average attendance of 16. The class participated in the Exhibition and Sale held at the Carpenter's Hall in October, and £17 of goods were sold, comparing quite favourably with classes from other and wealthier districts. The work of the ex-Service men was sent to the Imperial Institute Armistice Week Exhibition, and most of it was disposed of. The valuable effect of the class on patients who have attended for a time is very noticeable. They become much more cheerful, extremely interested in the work, and find in the class a social centre which makes a very welcome change from the long hours they must spend at home. One man who moved to the L.C.C. Estate at St. Helier last May still comes up from time to time, as he misses the class so much. The class is held at St. George-in-the-East Dispensary from 2.30 to 4.30 on Thursday afternoons (except during August). Visitors are always welcome, and the patients very much appreciate any interest that is taken in them. 22 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 8 112 Pneumo-Thorax Refills at Brompton ,, 3 30 „ ,, „ Victoria Park ,, 25 298 ,, „ „ Colindale „ 7 60 „ ,, ,, Grove Park „ 1 16 „ „ „ Margaret Street,, 1 15 ,, ,, ,, St. George-in-the-East Hospital 10 52 Sanocrysin treatment at Victoria Park Hospital 1 6 Supply of Extra Nourishment. Grants to Tuberculous patients were made on the recommendation of the Tuberculosis Officers for a period of 28 days in the first instance. 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 396 grants were made to 128 persons, the total cost being £372 17s. 5½d. Dental Clinic. In January the Council considered my report on the suggested tion of the Dental Clinic at 35, Stepney Green. Previously there was an agreement between the Council and the British Dental Hospital. The Council decided to give notice of the termination of this agreement and to take the necessary steps to make the Dental Clinic entirely a Council concern. The agreement terminated on 24th June, 1934, the equipment was purchased from the British Dental Hospital and Mr. F. R. Payne, L.D.S., was appointed to the part-time post of Dental Surgeon to the Council. The clinic will be run at a slight saving of expenditure and is now under the complete control of the Council. 23 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 95 4 — 9 — 4 26 117 6 6 — 5 1 23 35 16 Children - - - - - - - - - - - - - - - - Men 71 3 - 2 1 - 14 74 6 5 - 3 - 14 40 8 Total 166 7 - 11 1 4 40 191 12 11 - 8 1 37 75 24 No. of Ordinary sessions held 12 No. of Gas „ „ 12 (b) MATERNITY. Women 607 46 - 53 1 9 158 827 40 35 - 13 7 110 264 75 Children 68 - - - - - 36 97 - - - - - 32 - 28 Total 675 46 - 53 1 9 194 924 40 35 - 13 7 142 264 103 No. of Ordinary sessions held 26 No. of gas ,, „ 26 24 (Form m.C.w. 96 revised) Maternity and Child Welfare. Maternity and Child Welfare Services. 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 1934. 1.—Population of the area served by the Council :—219,100. 2.—Number of births notified in that area during the year under the Notification of Births Act, 1907, as adjusted by any transferred notifications : (a) Live births, 3,315. (b) Still births, 97. (c) Total, 3,412. (d) By midwives, 2,848. (e) By doctors and parents, 564. 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, 1,021. Total visits, 2,765. (b) to children under 1 year of age :—First visits, 3,086. Total visits, 20,138. (c) to children between the ages of 1 and 5 years Total visits, 41,071. 4.—Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council, 7. (b) Number of Centres provided and maintained by Voluntary tions, 9. (c) Total number of attendances at all Centres during the year :— (i) by children under 1 year of age, 29,867. (ii) by children between the ages of 1 and 5 years, 23,133. (d) Total number of children who attended at the Centres for the first time during the year and who, on the date of their first attendance, Were : (i) under 1 year of age, 2,665. (ii) between the ages of 1 and 5 years, 461. (e) Total number of children who were in attendance at the Centres during the year and who, at the end of the year, were : (i) under 1 year of age, 2,284. (ii) between the ages of 1 and 5 years, 4,349. 25 (f) Percentage of notified live births represented by the number in (d) (i), 80.39. 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 tions, 3. (c) Total number of attendances by expectant mothers at all Clinics during the year, 19,803. (d) Total number of expectant mothers who attended at the Clinics during the year, 5,515*. (e) Percentage of total notified births (live and still) represented by the number in (d), —. * These figures include non-residents. 6.—Supply of Milk and Food. Terms of Supply. Milk Other Food. Expectant mothers. Nursing mothers. Children under 5 years of age. Expectant mothers. Nursing mothers. Children under 5 years of age. Free, or at less than cost price, in necessitous cases. Yes Yes Yes Yes Yes Yes At cost price in other cases (e.g. sale of dried milk at Centres) Yes Yes Yes Yes Yes Yes 7.—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 for one bed. Number of matornity beds (exclusive of isolation and labour beds) nil nil Total number of beds 55 Subsidised by the Council 1 Total number of women admitted to these beds during the year nil nil Total admissions 1,574 Admission to Council's bed 20 II. Number of women (if any) sent by the Council during the year to other Maternity Institutions, nil. 8.—Homes and Hospitals for Sick or Ailing Children under 5 years of age. 26 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, 1. 9.—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, 115. (d) Total number of such cases sent by the Council during the year to other convalescent institutions, 158 (233 were sent by voluntary associations). 10.—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) Number of:— (i) maternity beds (exclusive of isolation and labour beds) included under (b) (i) or (ii) above nil (ii) women admitted to these maternity beds during the year nil (d) Total number of cases admitted to these homes during the year (i) expectant mothers nil (ii) mothers and babies nil (iii) babies nil 27 (e) Total number of such cases sent by the Council during the year to other homes for mothers and babies nil 11.—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 197 (c) Total number of attendances of children at these nurseries during the year, 31,702. 12.—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 *13 13 5 6 (2) Pemphigus Neonatorum — 1 1 — (3) Puerperal fever 5 5 — 4 (4) Puerperal pyrexia 38 38 — 35 (5) Measles and German measles (in children under 5 years of age) - 2,683 128 807 (6) Whooping Cough (do.) — — — 107 (7) Epidemic Diarrhoea (do.) — — — — (8) Poliomyelitis (do.) 3 3 3 *Number of cases in which vision was unimpaired 13, impaired —, or lost — „ „ ,, the patient died —, removed from district —, or was still under treatment at the end of the year — ,, ,, any other category —. 13.—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 2 (b) Total number of cases attended during the year by these nurses, 717. 28 14.—Midwives. I. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year 8 (b) Number (i) employed by the Council nil (ii) directly subsidised by the Council nil (iii) employed by Voluntary Associations 22 (c) Number of cases during the year in which the Council paid or contributed to the fee of a midwife nil 15.—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 6 (all cases of abortion) (ii) from other causes 12 (one abortion from drugs) (b) Number of these cases which died:— (i) at home nil (ii) in institutions 18 16.—Administration of Part I. of the Children Act, 1908, as amended by Part V. of the Children and Young Persons Act, 1932. (a) Number of persons on the Register who were receiving children for reward at the end of the year 18 (b) Number of children on the Register:— (i) at the end of the year 19 (ii) who died during the year nil (iii) on whom inquests were held during the year nil (c) Number of Infant Protection Visitors at the end of the year who were:— (i) Health Visitors 1 (ii) Female, other than Health Visitors nil (iii) Male nil (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or societies authorised to visit under the proviso to Section 2 (2) of the Act of 1908 nil. 29 (e) Proceedings taken during the year:— No. of cases. Act and Section under which proceedings were taken. Nil. — (f) Number of cases in which the local authority has given a sanction during the year:— (i) under (a) of Section 3 of the Act of 1908 nil (ii) „ (b) „ „ „ nil (iii) „ (c) „ „ „ nil (g) Number of orders obtained during the year under Section 67 of the Act of 1932:— (i) from a court of summary jurisdiction nil (ii) from a single Justice 3 Feeding of Infants. Breast fed 2,916 Artificially fed 170 No. of infants dead before the visit of Health Visitor 64 removed before the visit of the Health Visitor 100 untraced 6 Maternity Outfits. Sterilized maternity outfits are supplied at cost price through the Municipal Ante-natal Clinic. During the year two sets were supplied. 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 31 and 32. Prevention of Deafness. The arrangements were continued with the London County Council for the treatment of children under school age, suffering from ear defects, referred by our Maternity and Child Welfare centres. The charge is 7/- per case. Six cases received treatment during the year. 30 Convalescent Treatment During the year, mothers and children were sent away to the homes mentioned below:- Home. Mothers. Children. Invalid Children's Aid Association, Beaconsfield — 3 „ „ „ „ Tunbridge Wells — 1 St. Mary's, Dover 39 44 All Saints' Convalescent Home, Eastbourne 4 41 Littlestone-on-Sea 10 16 53 105 Provision of Milk and Meals to Expectant and Nursing Mothers and to Children. The following table shows the approximate quantity and cost of milk etc., distributed during the year:— No. of Applications. No. of Grants. Quantity. Cost. Cows' Milk— £ s. d. Free 6,726 8,354 29,237¼ gals. 3,067 0 4¼ Half-Price 84 110 383¼ „ 20 5 10¼ Dried— Free 2,680 3,150 13,016 packets. 1,075 19 11 Half-Price 39 47 194 „ 8 2 8 Virol, etc.— Free 2,437 2,795 2,557¼ lbs. 168 7 10 Half-Price 39 47 45½ „ 1 11 10 Total 12,005 14,503 29,620½ gals. £4,341 8 5¾ 13,210 packets 2,602¾ lbs. The number of dinners supplied by the Stepney Invalid Kitchen, White Horse Street, on the grounds of health, to expectant and nursing mothers who are in necessitous circumstances was 2,115, at a cost to the Council of £52 17s. 6d. 31 HEALTH VISITORS' REPORT. DISTRICT Ratcliffe, Shad well, St. George's, pt. Mile End N. Mile End, S.W. pt. Whitechapel Limehouse, pt. North and pt. South St. George's, North Mile End. S.E Mile End, N.E. Mile End, C. Limehouse, W. Whitechapel and SpitalfieMs Mile End, N. Limehouse, pt. North and South Wapping NAME Miss Railey Miss Blackmore (5 months) Miss Brazier Miss Carty Miss Clements Miss Cordwell Miss Foucar Miss Gibbs Miss Michell Miss Paice (7 months) Miss Styles Miss Whitty (11 months) Total Visits:— Primary 408 137 447 171 230 199 216 248 423 108 355 144 3,086 Revisits:— To infants under 1 year 254 223 519 425 371 568 409 623 479 124 488 417 4,900 To children between 1-5 years 917 486 807 1,066 1,209 982 1 067 1,118 593 436 1 341 803 10 825 Ante-natal:— Primary 24 47 59 8 36 10 3 17 68 5 7 30 362 Subsequent 3 - - - - 13 - - 67 - - 5 83 Ophthalmia Neonatorum 1 - 1 3 - - - - 3 3 2 - 13 Puerperal Fever 1 - 1 1 - - 1 - - - - 1 5 „ Pyrexia 5 3 4 - 2 - - 5 4 1 4 4 38 Measles 337 5 278 283 279 302 243 120 400 247 345 267 3 106 ,, Revisits 2 - 29 47 6 55 19 27 136 19 38 70 448 Miscellaneous 431 338 898 470 622 425 444 323 441 316 203 671 5 582 Infant Life Protection - - - - - - 10 - - - - 240 250 Women's Common Lodging Houses - - - - - - - - - - - 32 32 Totals 2,383 1,239 3,043 2,474 2,755 2,554 2,418 2,481 2,614 1,307 2,783 2,684 28,735 CENTRES ATTENDED:— Municipal 194 71 97 174 199 86 132 21 109 5 1 1 70 143 1 447 Voluntary 1 1 4 - - - 102 124 - - - - 232 Totals 195 72 101 174 199 86 234 145 109 51 170 143 1,679 Visits by Health Visitors. 32 Municipal Centres. Details of the work at the Municipal Centres will be seen in the following 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) 49 51 — 62 61 50 50 60 52 51 48 51 665 „ Attendances of Infants 1,590 1,301 — 1,249 1,755 1,355 1,127 496 1,403 1,122 115 975 12,487 „ „ Children 1 to 5 909 889 - 1,504 853 1,442 1,165 459 954 990 117 882 10,164 „ Infants on Registers at end of the year 1117 — 511 755 1179 850 635 443 6,490 „ Children on Registers at end of the year 2146 — 1,122 689 2251 1288 921 838 9,265 „ Ante-Natal Sessions — — 61 — — — — — — — — 61 „ „ New Cases — — 121 — — - — — — — — — 121 „ „ Subsequent Attendances - - 320 - - - - - - - - - 320 „ Doctors' Consultations 49 51 51 52 51 60 50 - 62 51 - 61 508 33 Maternal Mortality. The Registrar-General allocates 15 cases to deaths from puerperal causes, 5 of which were due to puerperal sepsis and 10 to other puerperal causes. The maternal mortality on this basis would be 4.54 per 1,000 births. The Registrar's figures, however, are based upon strict allocation according to rule and, as "Maternal Mortality" is taken to indicate deaths as a result of child-birth or associated with child-birth, there are 3 other cases which I must add to the list. One of these was a death from septicaemia as a result of an induced abortion—an inquest was held on this case and an open verdict was returned. One was a death on the certificate of which there was no mention of pregnancy—the mother died in premature child-birth probably as a result of drugs taken to procure abortion. One was a death from Hyperthroidism which would not have taken place if the mother had not been pregnant. It is only because of local investigation that the last 2 cases could be considered as maternal deaths and, having been investigated, they must be added to the list. There were therefore 18 deaths—a rate of 5.45 per 1,000 births. In 1933 there were 12 deaths—a rate of 3.61 per 1,000 births. Analysis of deaths. I. Due to sepsis—6 deaths (3 in 1933). All these were in cases of abortion in the early months of pregnancy. II. Due to other causes—12 deaths (9 in 1933). Drug abortion lease. Ruptured Ectopic Gestation 2 cases. Pulmonary embolism after Caesarian Section lease. Placenta Praevia 1 „ Ruptured Uterus 1 „ Post-partum Haemorrhage 1 „ Toxaemias of pregnancy 2 cases. Inter-current disease 3 „ A rate of 5.45 per 1,000 births is naturally staggering, to say the least of it, but we must not allow ourselves to become hysterical. We should calmly and dispassionately analyse the cases and should carefully investigate the cause of each of the 18 deaths. In this way we can see in which way, if any, our Maternity Services have failed in 1934. It is always possible that a large death-rate in any one year may be due to the coincidence that many 34 deaths happened to take place in that year. It should be remembered also that as the birth-rate decreases so will each death have a greater purely mathematical result upon the death-rate. It is no part of the duty of a Medical Officer of Health to whitewash the Maternity Services, but it is his duty to endeavour to ascertain in which direction they are failing and in which direction they can be improved.Consequently I have very carefully considered the circumstances of each death and the following is my considered analysis. In my opinion 9 of the 18 deaths were probably preventable and 9 were probably unpreventable. Probably preventable cases. A. 7 cases of abortion. 6 cases as a result of sepsis. I case due to action of drugs on the kidney. 3 cases were definitely suspicious of artificial means. 1 case was almost certainly accidental. All 7 cases were probably preventable by the intelligent co-operation of the mother by:— (1) refraining from interfering with nature; or (2) seeking medical advice immediately after abortion or by more intelligent co-operation between the mother and the family doctor. B. 2 cases were admitted to hospital as emergency cases. 1 at no time attended an ante-natal clinic. 1 attended the ante-natal clinic but failed to seek immediate medical advice on the sudden occurrence of persistent vomiting, the cause of which had been unforeseen, her pregnancy having been perfectly normal until then. These 2 deaths might have been prevented by early treatment such as could have been brought about by more intelligent co-operation of the mother during the ante-natal period. Probably unpreventable deaths. 6 deaths were definitely non-preventable. With wisdom after the event there is a faint possibility that 3 deaths might have been prevented:— 35 1 by early induction of labour. 1 by the provision of a home help during the ante-natal period to help with the house work. 1 by the provision of a home help together with a liberal supply of extra nourishment. In the case of these 9 non-preventable deaths it would have been wiser if 4 of the mothers had not become pregnant—2 of these were primiparae and 2 were multiparae (one of whom had 16 children in 22 years). I would like to mention at this stage that all the deaths took place in hospital and I know that these unfortunate mothers all received the most expert treatment possible. I can lay no blame on the hospitals. So far as ante-natal care is concerned I cannot trace any inefficiency on the part of staff in any case in which the mother actually started to attend an ante-natal clinic. 9 of these expectant mothers had booked their confinement with a hospital or otherwise and had received proper ante-natal care; of these 7 are included in the 9 probably unpreventable deaths and 2 in the 9 probably preventable deaths. 9 of these expectant mothers had not booked their confinement and had not received ante-natal care—some died before it is generally considered time to think of the matter and some probably had no intention of considering it; of these, 7 are included in the 9 probably preventable deaths and 2 in the probably unpreventable deaths. I can trace only one death in a general practitioner or private midwife case, and this case received her ante-natal care from the Council's own antenatal clinic. Albumenuria was discovered and she was referred for treatment to a hospital, but she had already damaged her kidneys beyond repair. This is the case I referred to earlier as a drug abortion. No ante-natal care can hope to be successful in the face of persistent and secret use of means to terminate pregnancies. With one possible exception I cannot definitely attribute any of these deaths to malnutrition. I can attribute one death partly to Obesity. It is reasonable to think that the more properly nourished an expectant mother may be the stronger she will be to withstand an abnormal confinement, 36 the healthier her baby will be, and the quicker will she recover from her confinement. I am not convinced, however, that malnutrition has any real connection with maternal mortality. Correct nutrition of the expectant mother must be an important consideration, and I am glad to say that it is a point to which all medical officers in Stepney give special attention. After April 1st, 1935, expectant mothers will be able to receive extra nourishment through the Council's scheme from the beginning of the 4th month of pregnancy instead of, as now, only from the beginning of the 7th. I do not wish it to be thought that I am minimising the seriousness of the situation, but it would appear that the actual maternity services in Stepney are adequate and efficient ; that however does not mean that further improvements should not be made. There is one point which my analysis brings to light very definitely. I refer to the apparent lack of intelligent co-operation on the part of so many expectant mothers, and this is apparent more in multiparae than in primiparae. I suppose that a mother having been piloted successfully through her first confinement thinks she can pilot herself through the others. Until all expectant mothers realise the wisdom of seeking the early help of a pilot on every occasion, the maternal mortality will never sink as low as we would all like to see it. Again, and I do not want to be misunderstood, I have often wondered if the much improved Maternity Schemes have been as futile as they are made out to be. Have deaths as a result of early abortion always been included as Maternal Mortality and are such abortions not on the increase ? It has come to the pitch now that Local Authorities are judged by the Maternal Mortality rate in their district, and it is very unfair that these deaths should be allowed to swell the total upon which they will be judged. Women who wish to procure an abortion will hide the fact that they are pregnant and will certainly not attend an Ante-Natal Clinic. Deaths from abortion might be considered to point to foolishness on the part of certain mothers in the district, but should not be counted as a black mark against the maternity services of the Local Authority. They should certainly be noted as a separate item, but should not be included in the list of deaths which are due to child-birth. 37 The deaths from stated causes at various ages under one year of age are shown in the table below:— Cause ok 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 35 6 2 3 46 20 42 31 35 174 L 25 1 1 3 30 22 21 16 25 114 Small-pox m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Chicken-pox m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 2 Measles m. ... ... ... ... ... ... 2 3 9 14 F. ... ... ... ... ... ... 2 2 8 12 3 Scarlet Fever m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 4 Whooping Cough m. ... ... ... ... ... ... 1 2 2 5 F. ... ... ... ... ... ... 1 2 2 5 5 Diphtheria and Croup m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 10 Tuberculous Meningitis M. ... ... ... ... ... ... ... ... ... ... L ... ... ... ... ... ... ... ... ... ... 10 Abdominal Tuberculosis (b) m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 10 Other Tuberculous Diseases m. ... ... ... ... ... ... ... ... 1 1 F. ... ... ... ... ... ... ... ... ... 11 Syphilis m. ... ... ... ... ... ... ... ... 1 1 F. ... ... ... ... ... ... ... ... ... ... 19 Bronchitis m. ... ... ... ... ... 1 2 ... 1 4 F. ... ... ... ... ... 1 2 ... ... 3 20 Pneumonia (all forms) m. ... ... 1 2 3 7 14 15 13 52 L. 1 ... ... ... 1 8 3 6 3 21 23 Diarrhoea m. ... ... ... ... ... 4 14 6 4 28 F. ... ... 1 ... 1 4 4 6 4 19 23 Enteritis m. ... ... ... ... ... ... 3 ... 2 5 f. ... ... ... ... ... ... 3 ... 5 8 27 Gastritis m. ... ... ... ... ... ... ... 1 ... 1 f. ... ... ... 1 1 ... ... ... ... 1 31 Congenital Malformations m. 6 2 ... ... 8 2 1 ... ... 11 F. 1 ... ... ... 1 2 ... ... 1 4 31 Premature Birth m. 19 1 1 ... 21 1 ... ... ... 22 F. 16 ... ... 2 18 3 1 ... ... 22 31 Atrophy, Debility & Marasmus m. ... 3 ... ... 3 1 1 ... ... 5 f. 2 ... ... ... 2 2 4 ... ... 8 31 Atelectasis m. 4 ... ... ... 5 ... ... ... ... 5 f. 2 ... ... ... 2 ... ... ... ... 2 31 Injury at Birth m. 4 ... ... ... 4 1 ... ... ... 5 F. 1 ... ... ... 1 ... ... ... ... 1 31 Convulsions m. ... ... ... ... ... ... ... ... ... ... f. ... ... ... ... ... ... ... ... ... ... 34 Suffocation, overlying m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 35 Rickets (a) m. ... ... ... ... ... ... ... ... ... ... f. ... ... ... ... ... ... ... ... ... ... 35 Meningitis (not tuberculous) m. ... ... ... ... ... 2 1 1 ... 4 F. ... ... ... ... 1 ... ... ... ... 1 35 Laryngitis M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 35 Erysipelas M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... 1 ... ... ... 1 35 Other causes M. 2 ... ... ... 2 1 2 3 2 10 F. 2 ... ... ... 2 1 1 ... 2 6 36 Ill defined M. ... ... ... ... ... ... 1 ... ... 1 f. ... ... ... ... ... ... ... ... ... ... Totals ... 60 7 3 6 76 42 63 47 60 288 38 Infantile Mortality 288 infants died under one year of age 01 71 more than in the previous year. The Infant Mortality rate for the Borough was 87.2 per 1,000 births. Just as in the case of the Maternal Mortality it is necessary to consider carefully this sudden increase in Infant Mortality, so that steps may be taken to save more infants in the future. It should be remembered that the Infant Mortality rate may so easily fluctuate from year to year. This is shown very vividly in the following particulars of Infant mortality in Stepney since 1920. 1920. 90 per 1,000 births. 1925. 73 per 1,000 births. 1930. 76 per 1,000 births. 1921. 89 „ „ 1926. 65 „ „ 1931. 78 1922. 79 „ „ 1927. 68 „ „ 1932. 61.6 „ 1923. 62 „ „ 1928. 71 „ „ 1933. 65.3 „ 1924. 74 „ „ 1929. 88 „ „ 1934. 87.2 „ There are many reasons for the deaths of infants under one year of age, some epidemiological in origin-—such epidemics being far from constant from year to year—some embryological. Epidemiological Reasons. Measles. There were 26 more deaths in 1934 than in 1933. There were 110 deaths in 1933, and it will be remembered that I expressed the fear that the 1934 epidemic might turn out to be a severe one. Pneumonia. There were 37 more deaths in 1934 than in 1933, and I cannot help feeling that, although Measles was not mentioned in connection with these deaths, it showed its effect in this increased number of deaths. Diarrhoea. There were 6 more deaths in 1934 than in 1933. Unfortunately a dry, hot year—much welcomed by the hiker, camper and holiday maker—does take its toll amongst the infants. Special weather conditions. The worst month for Infant Mortality was February, there being during that month 10 deaths from Diarrhoea and 26 from Pneumonia. This was easily the worst month for Pneumonia, and it equalled August in the number of deaths from Diarrhoea. February was a particularly rainless 39 month with mild days and cold and frosty nights. It is probable that these conditions, together with the presence of a severe Measles epidemic, were sufficient to account for this increase in infantile deaths in February. It is significant that in March the infantile deaths from Pneumonia and Diarrhoea dropped suddenly to 9. In March the rainfall was above the average and the weather was unsettled and cold. Compared with the 36 deaths in February, 1934, there were 5 deaths in February, 1933 (6 in February, 1935). Embryological Reasons. These reasons are Congenital malformations and Premature Births. In 1934 there were 22 more deaths than in 1933. It would appear therefore that in comparing the number of deaths in 1933 and 1934 an increase of 79 deaths can be attributed to Measles, to Pneumonia and Diarrhoea in February, and to embryological reasons. In order to show how easily the Infant Mortality rate can fluctuate and how easily it has been affected in 1934, I calculate that, if it had not been for the above three reasons, the rate would have been 66.3 per 1,000 births —a rate which corresponds very favourably with that of 1933. What are the lessons to be learned from 1934 ? So far as Measles is concerned it must be remembered that 1934 was the year for the regular biennial epidemic in London. I have suggested elsewhere the preparations that should be made for the next epidemic in 1935-36. So far as the embryological reasons are concerned, these are intimately wrapped up with the prevention of Maternal Mortality. The schemes for improving the Ante-natal care and the health of the expectant mother will have a corresponding effect on the embryo, especially so far as prematurity is concerned, and therefore on the health of the infant in the first few weeks of life. So far as Diarrhoea is concerned this is primarily a matter of better education of the parents and I deal with this aspect later in this report. There is a need, however, for investigation into the reason why infants develop typical "Summer" Diarrhoea in the winter months. Schemes Generally for the Prevention of Maternal and Infantile Mortality. The Maternity and Infant Welfare services in Stepney have always been considered to be reasonably efficient. Certain improvements and amendments were necessary, however, and at the time of writing this report the Council 40 have sanctioned certain schemes for such improvement. They should not rightly be included in this report for 1934, but they will be included in my report for 1935. I do, however, want to emphasize an opinion which 1 have formed during my investigation into these matters during the past year or more. A local authority may establish the finest Maternity service and the finest Infant Welfare service in the kingdom, but there will be little improvement in these mortality rates unless the mothers are taught to appreciate these services and to avail themselves of them in an intelligent manner. Education of the mother is therefore of the first importance. This education is a terribly depressing matter. One can imagine the despair of a doctor or a health visitor who has spent several periods of ten to fifteen valuable minutes, or even longer, giving advice to a Mother, to find later on that she has not taken in one single word of that advice and has not carried out one single instruction. There is far too much of the idea of "what was good enough for my mother and her children is quite good enough for me and mine." It appears to me that we must train a new type of mother—a mother who will forget her mother's training (or rather will realise her mother's lack of training) and who will become more naturally scientifically minded. Then we will have women who, immediately they become pregnant, will be industrious in their attendance for ante-natal care, and who, immediately they become mothers, will carry out all the instructions given to them at Infant Welfare centres or elsewhere. Then, and not until then, can any schemes for the prevention of Maternal and Infantile Mortality hope to be completely successful. How is this universal new type of mother to be obtained? It appears to me that the training should start in early life. Why not start the lesson in the nursery through the medium of the ubiquitous doll? This can be done easily in the Day Nurseries and in the Nursery Schools and in the Infant Classes, and it should be possible to teach the correct playing with dolls on the lines of real infant care. The most receptive age, however, in my opinion, is from 13 to 16, or even earlier, and here is the finest opportunity for instilling the lessons of motherhood into the future generation of mothers. During the last 2 years of school life and during the first 2 years of club life all girls should be taught what motherhood means (and incidentally during the latter part of that period the meaning of sex). 41 They should be taught that child birth is a perfectly safe and natural process; that nature rebels against being interfered with, generally with disastrous results; that complications do occur occasionally, but that these complications can be cured when discovered early ; that early discovery of complications depends upon keeping under the necessary medical supervision from the time that pregnancy starts until the baby is born ; that the growth and well-being of the baby also is a natural process provided it is fed according to nature; that nature requires clean and regular feeding and plenty of sunlight and fresh air; that the best advice can be obtained from the doctors and the health visitors at the local Infant Welfare Centres. The lesson should emphasize that all processes are natural and safe, for I am afraid that if the publicity of the dangers of child-bearing remains in its present intensity it will defeat its object. The future mother must look forward to child bearing with confidence, otherwise abortions will become more frequent or marriages will become more childless still. Let us instill this confidence and this knowledge into the child of to-day—she will then be the perfect mother of to-morrow. infant Life Protectlon. Towards the end of the year the Maternity and Child Welfare Committee expressed dissatisfaction with the conditions under which some of the foster children were cared for in the Borough and I was asked to prepare a scheme which would ensure good conditions for every child. I reported that, although the present conditions could not be considered ideal, the results on the whole had been reasonably satisfactory. The aim of the Act is to maintain the "health and well-being" of the children and with very few exceptions this aim has been achieved. The main difficulty is in respect of the infants of single women, many of whom are mere girls who have come to London as domestic servants, who have lost their places through childbirth or illness and who have drifted to the common lodging houses. Poor as some of the conditions are at present, these infants are under the close supervision of the Infant Protection Visitor and strict legal action in respect of these infants would result in the placing of future infants in unknown and probably poorer, conditions, and there would be no such supervision. It is useless to tackle this problem without first gaining the confidence of these young unmarried mothers and this has been my policy up to date. Until a more ideal scheme can be formulated, 1 maintain that in the interests of the children it is the best policy. 42 Action under Section 67 of the Children and Young Persons Act, 1032, means the removal of the children to a " place of safety," and in Stepney this means removal to a Public Assistance Institution. (Such action was taken in three cases in l!)34.) So far as 1 can make out, there is nothing to prevent the parents from removing their children from that Institution the next day. Ideally, the " place of safety " should be another foster-home at which the average mother would be only too willing to allow her child to remain. This, however, entails the payment of an adequate reward to the good foster-mothers—a reward which many of these young unmarried mothers cannot afford. The year ended with preparations, at the suggestion of the Minister of Health, for a conference with the officials of the London County Council. 43 LIST OF MATERNITY AND CHILD WELFARE CENTRES, ETC., N THE BOROUGH. centres. monday. tuesday. wednesday. thursday. friday. REMARKS: morning. afternoon. morning. afternoon. morning. afternoon. morning. afternoon. morning. afternoon. (a) Municipal: Advice to mothers, health talks and knitting classes are held in connection with these Centres. Limehouse Town Hall, Commercial Road 2 to 5* 2 to 5* St. George's Town Hall, Cable Street 10 to 12 2 to 5* 2 to 5* Riverside Mansions, New Gravel Lane 10 to 12 2 to 5* 10 to 12 Hughes Mansions, Vallance Road 2 to 5 2 to 5* Congregational Buildings, Burdett Road 2 to 5* St. Phillips Institute, Newark Street 2 to 5* 401, Mile End Road 2 to 5* (b) Voluntary: Mission Hall, Carr Street 2 to 5* (also sewing) • Stepney Infant Welfare Centre and Babies Home, 587, Commercial Road 10.80 (sunlight) 2* 10.30* (sunlight) 2.15 to 4.15 (sewing) 10.30 (dental) 2.30 (lectures on home nursing and infant care) 10.30 (sunlight) 2* Memorial Hall, High Street, Shadwell 2 to 4* 2 to 4* 2.30 to 4 (sewing) The Superintendent is available at her flat nearby for consultation any day from 8 a.m. to 10 p.tn. Dame Colet House— 29, Duckett Street & 9.15 to 11 (minor dressings) 2* 9.15 to 11 (minor dressings) 2* 9.15 to 11 (minor dressings) 2.30 (sewing and health talk) 9.15 to 11 (minor dressings) 9.15 to 11 (minor dressings) 10, Duckett Street 3 (sunlight) 2.30 (sunlight) 2.30 (sunlight) Sunlight with the doctor by arrangement. 12, St. Clare Street, Minories 2 to 4* 2.30 to 4 (knitting and lecture) 2.30 to 4 (sewing and lectures) 2 to 4* Toddlers' dinners daily, 12.30. Mothers dinners daily, 2. Jewish Infant Welfare Centre, Bernard Baron Settlement, Berner Street 2 to 5* 2 to 4 (sewing) 2 to 5* Jewish Mothers Welcome, Bernard Baron Settlement, Berner Street 9 to 11 (advice to mothers and minor ailments) 2 to 4 (sewing) 9 to 11 (advice to mothers and minor ailments) 1.45 to 4* 9 to 11 (advice to mothers and minor ailments) 9 to 11 (advice to mothers and minor ailments) 1.45 to 4* 9 to 11 (advice to mothers and minor ailments) Toddlers first Tuesday in each month, 11 to 12.30. 17, Iceman Street 1.30 to 2.30 (dental) 44 LIST OF MATERNITY AND CHILD WELFARE CENTRES, ETC., IN THE BOROUGH-,continued. CENTRES. MONDAY. TUESDAY. WEDNESDAY. THURSDAY. FRIDAY. REMARKS: morning. afternoon. morning. afternoon. morning. afternoon. morning. afternoon. morning. afternoon. Jewish Maternity Hospital, 24, Underwood Street 9.30 to 12 (dental) 2.30 to 6.30 (sewing) 2 to 4* 2 to 4* 2.30 to 5.30 (sewing) East Stepney Jewish Centre, Beaumont Hall, Beaumont Square 10 to 12.30 2 to 4* 10 to 12.30 ANTE-NATAI. CLINICS, (a) Municipal: Limehouse Town Hall, Commercial Road 10 to 1* (b) London County Council: Mile End Hospital, Bancroft Road 2 2 St. George's Hospital, Raine Street 2 Also Saturdays, 11.30. St. Peter's Hospital, Vallance Road 2 (c) Voluntary: East End Maternity Hospital, 396, Commercial Road 9 2 2* 9 9 Jewish Maternity Hospital, 24, Underwood Street 10 to 12* 10 to 12* London Hospital, Whitechapel Road 9* 9* CRECHES. Voluntary : Day Nursery, Memorial Hall, High Street, Shad well This is an open air one and it is open from May to October. Jewish Day Nursery, 23, New Road Port of Loudon Day Nursery, 5, Pier Head, Wapping Marie Hilton Creche, Stepney Causeway : St. Paul's Day Nursery, Wellclose Square BABIES' NURSING HOME. 587, Commercial Road Residential treatment. DAY NURSERY SCHOOL—L.C.C. Old Church Road Open Monday to Friday. *Denotes that there is a doctor in attendance. 45 III.—SANITARY CIRCUMSTANCES OF THE AREA. The Public Cleansing Officer has kindly supplied me with particulars of scavenging the salient alterations in the activities of the Public Cleansing Department during the year:— (a) Street Cleansing.—-The whole of the street cleansing service was reorganised to commence on the 3rd March, 1934. Revision was made in the working hours of the employees so that cleansing operations were carried out from 6 a.m. to 10 p.m. in two shifts each day (Monday to Saturday inclusive). Night work, on which approximately 120 employees were previously employed, was abolished, with the exception of a skeleton staff of 20 men, and mechanical sweeping, watering and gully emptying. The displaced employees from night work were transferred to the day shifts. As a result of this reorganisation, all streets are swept at least once daily, some twice a day, and many thoroughfares receive constant attention, during working hours. Before the reorganisation the streets were swept by men in gangs, the refuse being swept into heaps, which were subsequently loaded into a horse vehicle, but under the new system the employees work on the "beat" system, i.e., men, working with orderly trucks, are responsible for cleansing a specified area, and the sweepings are picked up immediately and placed in their orderly truck, to await collection by motor vehicle which takes the refuse to the disposal centre. (Motor vehicles have replaced horse vehicles in furtherance of the scheme.) The results have fully justified the extensive changes made and the efficiency of the service has been considerably increased, whilst the unsightly heaps of sweepings awaiting removal, have been obviated, undoubtedly in the public interest, both from health and aesthetic points of view. Three new petrol gully emptiers have been purchased (and the use of steam vehicles on this work discontinued,) the new vehicles giving a very improved service in gully cleansing. One new sweeping and swilling machine was also purchased during the year under review. All these new machines are engaged both day and night. 46 (b) Collection of House and Trade Refuse.—The Committee purchased six new metal moving floor refuse collection vehicles, enabling one section of the eastern half of the borough to be reorganised whereby refuse is now collected from the premises in this area at least twice weekly, which system is functioning satisfactorily. (c) Horse Transport.—The purchase from time to time of new mechanical vehicles has resulted in the disposal of the remainder of the Council's horses during 1934. (d) Disposal of Refuse.—Following widespread investigation, the Council entered into a new contract, with the existing contractor, for the removal of refuse by barge, the main feature of the revised contract being the disposal of all refuse by "controlled" tipping, in accordance with the suggestions issued by the Minister of Health. 47 The following tables show the work of the Sanitary Inspectors:— REPORT OF INSPECTIONS, Etc. BY THE SANITARY INSPECTORS-1934. 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. W. H. Haworth (4 months) J. G. McCarthy. R. Roper. W. Shepherd. R. Simpson. W. F. Smith. S. H. V. Trimming W. T. Twynham. S. Vogler. R. H. Waterman. Miss H. A. Whitty. Totals Bakehouses — 25 60 42 14 31 7 13 31 21 19 23 11 — 15 39 15 27 26 16 — 435 Butter and Margarine Premises — — — — — — — — — — — — — — — 5 — — 1 — — 6 Butchers' Shops 87 182 39 71 41 52 24 36 174 35 — 164 63 — 38 82 17 25 88 16 — 1,247 Butchers' Stalls — 158 — 20 — — — 15 157 — 13 164 38 — — 40 3 2 — — — 610 Common Lodging Houses — 59 — 44 — — — 80 — — — — 40 — — 6 — 65 50 10 32 386 Complaints — 82 856 818 218 641 320 924 341 411 166 915 609 7 387 338 425 751 1,042 56 — 9,307 Cowsheds — — 4 17 2 4 — 6 — 6 2 22 — — — 12 — 10 40 9 — 134 Factories — 94 21 94 9 32 58 129 85 74 2 3 34 — 17 84 12 230 207 74 — 1,259 Houses let in Lodgings — 219 110 328 132 193 78 166 372 4 — 117 50 — — — 2 240 236 80 2,327 House to House — 139 80 224 212 246 292 47 265 271 34 42 558 — 426 125 173 161 136 249 — 3,680 Ice Cream — 18 47 45 18 46 16 44 29 26 2 14 63 — 19 24 10 25 45 31 — 522 Infectious Disease — 130 139 98 101 195 99 88 84 80 41 201 76 — 177 110 106 74 96 124 — 2,025 Milkshops — 82 173 J 27 45 32 42 62 133 52 7 102 54 1 26 78 23 35 151 104 — 1.329 Offensive Trades — 8 34 53 2 22 9 15 2 6 16 19 — 2 2 83 1 22 54 7 — 357 Outworkers — 42 46 70 60 55 45 102 212 — 11 5 — — 43 107 6 139 331 1 — 1,276 Restaurants and Eating Houses — 81 21 21 107 34 15 83 11 29 10 10 56 — 13 26 13 58 80 85 — 753 Markets (week-end) — 3 3 3 1 3 1 3 3 3 2 3 3 — 3 3 — 3 3 3 — 46 Sanitary Inspection. 48 REPORT OF INSPECTIONS, ETC. BY THE SANITARY INSPECTORS—1934—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. W. H. Haworth (4 months) J. G. McCarthy. R. Roper W. Shepherd. R. Simpson. W. F. Smith. S. H. V. Trimming. W. T. Twynham. S. Vogler R. H. Waterman. Miss H. A. Whitty. Totals. Seamen's Lodging Houses — — — — — — — — — — — — — — — — — — — — — 366 Wharves 1,260 10 — — — — — — — — — — — — — — — — — — — 1,345 Workplaces — 25 35 4 72 12 ii 21 9 11 — 1 120 4 18 47 7 42 171 — — 610 Workshops — 95 90 153 96 43 74 109 151 88 5 28 164 10 133 217 15 151 242 90 — 1,951 Bishopsgate Station — — — — 108 — — — — — — — — 2 — — — 1 — — — 111 Miscellaneous — 2,119 1,271 2,015 713 1,221 752 935 1,518 963 422 1,565 1,937 77 1,415 1,507 468 2,107 1,615 1,870 — 24,490 Observations re Smoke Nuisance — 103 5 20 4 36 10 2 — 1 19 — — — 16 19 3 — 6 85 — 329 Re-Visits — 1,682 1,079 1,620 1,412 1,494 1,175 2,292 1,679 1,674 699 1,285 1,275 17 3,733 1,203 1,576 2,474 2,093 1,580 — 30,042 Intimations served — 648 770 796 510 831 731 815 606 616 332 814 487 18 1,218 587 460 1,005 860 703 — 12,807 Statutory Notices served — 108 329 259 174 300 408 316 241 208 109 86 135 10 764 212 195 323 421 130 — 4,728 Summonses taken out under Public Health (London) Act 1891. L.C.C. (General Powers) Acts, Byelaws, etc. 1 — 6 — — 2 27 16 2 6 — — 2 — 2 1 2 3 11 4 — 85 Food & Drugs (Adulteration) Act. No. of samples taken — 90 181 126 96 124 60 104 91 91 — 92 1 — 90 92 36 91 129 90 — 1,584 Food & Drugs (Adulteration) Act. No. of Summonses taken — — 19 — — 1 2 1 1 — — 3 — — — 2 o 3 2 1 —- 37 49 RETURN OF SANITARY WORK, 1934 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. W H. Haworth (4 months) J. G. McCarthy. R. Roper. 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 3 5 1 — 1 3 1 1 — — — — — 2 — 1 5 3 — 26 Bakehouses: No. of cleansings of 20 24 26 6 31 4 19 15 7 6 20 4 — 14 35 22 14 — 10 277 Cisterns cleansed, covered and repaired — — — 2 — 4 10 3 — — — 18 — 2 5 — 2 — 7 53 Dampness in premises remedied 43 121 63 59 190 110 171 61 120 68 64 189 2 51 169 167 111 108 65 1,932 Drains—Cleansed or repaired 71 80 97 31 66 21 67 44 64 9 87 64 3 151 11 51 122 79 66 1,184 Constructed or reconstructed 26 17 18 6 16 10 15 13 43 5 7 22 — 28 37 11 9 6 28 317 Dust receptacles provided 83 157 86 113 198 108 107 108 88 80 285 164 6 372 83 125 143 131 116 2,533 Number of dwelling rooms cleansed 474 224 483 328 680 545 656 506 492 130 627 473 6 671 451 305 458 518 699 8,726 Houses ventilated beneath the lower floor 2 3 1 5 — 2 4 2 — 6 2 2 — 3 23 17 — 8 5 85 Improved light and ventilation provided to rooms 2 8 4 2 — 3 7 3 19 5 — — — — 2 17 4 3 115 194 Manure receptacles provided or reconstructed — — 3 — — — — — — 2 — 2 — — — — 1 — — 8 Offensive accumulations removed 6 38 31 28 33 8 81 1 21 3 5 43 9 8 19 86 52 16 488 Overcrowding in dwellings abated 5 1 3 9 — 3 11 1 1 — — — 5 6 1 9 2 5 62 Sanitary work. 50 RETURN OF SANITARY WORK, 1934—Continued. 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. W. H. Ha worth (4 months) J. G. McCarthy. R. Roper W. Shepherd. R. Simpson. W. F. Smith. S. H. V. Trimming. W. T. Twynham. S. Vogler R. H. Waterman. Totals. No. of gutters and rain-water pipes fixed or repaired 57 47 42 33 97 97 102 51 24 86 66 76 — 202 275 75 99 47 57 1,533 No. of repairs to roofs 146 111 152 68 149 126 121 77 57 71 195 237 — 134 219 165 123 114 224 2,489 Sink, bath and lavatory pipes fixed or repaired 28 28 26 34 48 8 52 15 44 14 10 211 — 53 174 33 112 27 94 1,011 Smoke nuisances abated 13 — — 2 — 2 5 1 — 1 — — — 2 1 3 — — 25 55 Underground rooms—illegal occupation discontinued 2 2 24 1 — 5 10 — 30 1 — — — — 7 — 4 — — 86 Urinals fixed or repaired 3 — 1 5 — 1 3 1 — — — — — 4 — — 5 — 2 25 Verminous rooms cleansed 19 39 28 22 16 78 27 31 12 26 1 54 — 7 86 40 31 26 17 560 Waterclosets—Cleansed or repaired 63 98 — 88 115 45 183 91 128 18 60 115 2 108 49 151 331 128 144 1,995 „ Light and ventilation provided — — 1 6 6 3 3 1 — — — 4 — — — 10 18 — 42 94 ,, Pans and traps fixed 42 46 70 38 83 36 24 44 22 17 15 78 — 88 19 42 41 28 98 831 „ Provision or repair of flushing apparatus 39 31 26 43 49 42 52 27 64 17 63 97 2 109 27 31 83 69 131 1,002 Water supply to houses reinstated or repaired 8 — — — 13 6 18 — 2 2 3 4 — 5 14 1 3 1 25 105 Yards, areas and forecourts cleansed, paved, or paving repaired 27 76 63 49 76 98 53 32 46 6 30 35 1 162 31 66 117 64 52 1,084 Floors, windows, staircases, fireplaces and coppers repaired 251 247 315 167 406 256 190 163 109 107 436 532 5 458 361 525 497 440 155 5,620 Miscellaneous 95 84 102 32 78 433 99 54 33 74 183 210 3 54 323 264 465 183 130 2,899 51 Date. Matter of information or complaint. Result. 1934. Public Health (London) Act, 1891. 5th Jan. Failing to remedy the defective sink-waste pipe, window-frame and firestove at 38, Spital Street, E. Ordered to do the work within 14 days and pay £1 1s. od. costs. 5th Jan. Failing to remedy the damp walls of the ground floor back-addition room at 81, Underwood Street. Ordered to do the work within 14 days and pay £1 1s. 0d. costs. 23rd Jan. Failing to remedy the defective roof, stove, sashes and frames of windows at 11, Doveton Street. Ordered to do the work within 14 days and pay £1 1s. 0d. costs. 23rd Jan. Failing to remedy the defective eaves gutters and rain-water pipe and the damp walls of the front room ground floor at 13, Doveton Street. Ordered to do the work within 14 days and pay £1 1s. 0d. costs. 23rd Jan. Failing to repair the defective drain at 19, Ropery Street. Ordered to do the work within 21 days and pay £1 1s. 0d. costs. 23rd Jan. Failing to provide temporary protecting walls when removing the front of house for reconstruction under a dangerous structure notice at 68, Coutts Road. Ordered to do the work within 24 hours. 23rd Jan. Failing to remedy the defective foul sinkwaste pipe and roof of back-addition at 98, Newark Street. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 26th Jan. Failing to remedy defective roof; walls and ceilings of house dirty and dilapidated and kitchen floor infested with rats at 29, White Horse Street. Ordered to do the work within 7 days and pay £1 0s. 0d. costs. 19th Feb. Failing to abate a nuisance caused by a choked drain at 20, Synagogue Place. The work having been completed at the time of the hearing, the summons was withdrawn on payment of £1 1s. 0d. costs. 19th Feb. Failing to abate a nuisance caused by defective drain at 21, Synagogue Place. The work having been completed at the time of the hearing, the summons was withdrawn on payment of £1 1s. 0d. costs. 19th Feb. Failing to reconstruct defective drains at 4, 5, 6, Barnardo Street. The defendant's Solicitor having given an undertaking to do the work, the cases were adjourned sine die. £2 2s. 0d. costs. 23rd Feb. Failing to abate a nuisance caused by stove and flue smoking into living room, and roof of house defective at 16, Gray Street. Ordered to do the work within 14 days and pay £1 1s. 0d. costs. 9th Mar. Failing to abate a nuisance arising from defective roof and damp walls at 30, Hungerford Street. The work having been done at the time of the hearing, the summons was withdrawn on payment of £1 1s. 0d. costs. Legal Proceedings. 52 Date Matter of information or complaint. Result. 9th Mar. Failing to remedy defective and dirty walls and ceilings, damp walls, defective flooring and windows, etc., at 7, Canal Road. Ordered to do the work within 7 days and pay £1 Is. Od. costs. 26th Mar. Failing to abate nuisances arising from defective sink-waste pipe, damp walls and defective roof, at 26, Frederick Place. Ordered to do the work within 7 days and pay £1 Is. Od. costs. 26th Mar. No water supply to house—broken water pipe flooding kitchen. Defective walls of kitchen ground floor. Roof of house defective. Walls and ceiling of front room second floor dirty and damp, at 72, Bedford Street. Ordered to do the work within 14 days. The water supply was reinstated at the time of the hearing of the summons. 26th March Broken dangerous ceiling of back-addition first floor. Defective roof of scullery, at 85, Oxford Street. Ordered to do the work within 5 days. 26th March Failing to remedy damp, dirty and dilapidated walls, etc., at 28, Cadiz Street. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 26th March Failing to abate the nuisance caused by the defective flushing apparatus and insufficient flush to water-closet at 1, Pelham House. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 16th April Failing to abate a nuisance arising from defective yard paving, water-closet putty joint, etc., at 38, Mulberry Street. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 20th April Failing to abate a nuisance arising from defective flue, damp walls, dirty walls and ceilings, etc., at 8, Tredegar Square. Ordered to do the work within 14 days and pay £1 1s. 0d. costs. 20th April Failing to abate a nuisance arising from defective sashes, sink, roof, dirty walls, etc., at 13, Tredegar Square. Ordered to do the work within 14 days and pay £1 1s. 0d. costs. 4th May Failing to abate a nuisance arising from defective roof, yard paving, etc., at 81, Lower Chapman Street. Work done at time of hearing. Fined 10s. Od. with £1 1s. Od. costs, or 7 days' imprisonment. 4th May Failing to abate a nuisance arising from defective roof at 3, Canal Road. Ordered to do the work within 7 days. 6th May Failing to abate nuisances arising from damp, dirty and defective walls and ceilings and defective flooring at 117, Bridge Street. Ordered to do the work within 7 days and pay £1 l1s. 6d. costs. This case had been adjourned on the 20th April, 5 th May Failing to abate nuisances arising from defective roof, damp walls and dirty walls and ceilings at 18, Frederick Place. Ordered to do the work within 7 days and pay £1 1s. Od. costs. 24th May Failing to abate nuisances arising from defective roof, flooring, stove, stairtreads, dirty and defective walls and ceilings at 628, Mile End Road. Ordered to do the work within 7 days and pay £l ls. Od. costs. 53 Date. Matter of information or complaint. Result. 7th June Failing to abate nuisances arising from defective flooring, paving; dirty and defective walls and ceilings at 53, Eric Street. Ordered to do the work within 14 days and pay £2 1s. 0d. costs. 5th June Failing to abate a nuisance arising from defective sink-waste, etc., at 57, Plumbers Row. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 5th June Failing to abate a nuisance arising from defective flush to water-closet, etc., at 59, Plumbers Row. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 28th June Failing to abate a nuisance arising from defective flushing apparatus at 7, Lytton House, Pelham Street. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 28th June Failing to abate a nuisance arising from defective flushing apparatus at 5, Pelham House, Pelham Street. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 28th June Failing to abate a nuisance arising from damp walls, stopped drain, defective eaves gutters and dirty walls and ceilings at 28, Cottage Grove. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 28th June Failing to abate nuisances arising from dirty walls and ceilings, defective flooring and stove at 9, Tredegar Square. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 28th June Failing to abate nuisances arising from defective paving, flooring, damp walls, defective windows, dirty walls and ceilings at 9, Canal Road. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 29th June Failing to abate nuisances arising from defective roof, ceiling, etc., at 3, Canal Road. Ordered to do the work within 7 days and pay £1 1s. 0d. costs. 2nd August Failing to abate nuisances arising from defective roof and damp walls at 437, Mile End Road. Ordered to pay £2 5s. 0d. costs. 17th August Failing to remove an accumulation of rubbish and cleanse the basement at 129, New Road. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 17th August Failing to remove an accumulation of rubbish from 19, Fleur-de-Lis Buildings. Ordered to do the work within 7 days and pay £2 8s 0d. costs. 27th August Failing to abate a nuisance arising from defective soil pipe at 28, Nelson Street. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 26th September Depositing for sale at 167, Cannon Street Road, on 1st August, 173 tins of condensed milk which was unsound and unfit for human food. Fined £40 0s. Od. and pay £5 5s. 0d. costs. 4th Oct. Failing to abate nuisances arising from dilapidated walls and ceilings, defective flooring and stairs at 160, Commercial Road. Adjourned from 1st October. | Ordered to do the work within 14 days and pay £2 8s. 0d. costs. 54 Date. Matter of Information of Complaint. • Result. 5th Oct. .... Failing to abate nuisances arising from insufficient receptacle for house refuse, sink waste pipe defective, accumulation of refuse, eaves gutters and rain-water pipe, treads and risers to stairs defective at 2/2a, Fashion Street. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 15th Oct. Failing to abate a nuisance arising from accumulation of refuse at 19, Fleur de Lis Buildings. Prohibition Order granted; defendant to pay £2 8s. 0d. costs. 25th Oct. Failing to abate nuisances arising from defective yard paving, no dust bin, damp walls, defective roof, flooring, etc., at 55, Grove Road. Ordered to do the work within 7 days and pay £2 5s. 0d. costs. 25th Oct. Failing to abate nuisances arising from defective roofs, gutters, damp walls, etc., at 60, Clinton Road. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 26th Oct. Failing to remove an accumulation of rubbish from 125, New Road. The work having been completed at the time of hearing, the summons was withdrawn on payment of £2 5s. 0d. costs. 26th Oct. Failing to abate nuisances arising from defective roof and dirty and defective walls and ceilings at 37, Tredegar Square. Ordered to do the work within 7 days and pay £2 8s. 0d. costs, 26th Oct. Failing to abate nuisances arising from dirty and defective walls and ceilings, defective pa ving, no dust bin, etc., at 10, Edwards Road. The work having been completed at the time of hearing, the summons was withdrawn on payment of £2 5s. 0d. costs. 26th Oct. Failing to abate nuisances arising from defective walls and ceilings, no dust bin, defective paving and sink-waste pipes at 52, Burdett Road. The work having been completed at the time of hearing, the summons was withdrawn on payment of £2 5s. 0d. costs. 26th Oct. Failing to abate nuisances arising from defective roof, dirty walls and ceilings at 14, Frederick Place. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 26th Oct. Failing to abate nuisances arising from damp walls, defective roof, sashlines, etc., at 19, Cottage Grove. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 13th Nov. Failing to abate a nuisance arising from dirty water-closet pans at 103/7, New Road. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 16th Nov. Failing to abate nuisances arising from foul state of basement with accumulation, foul sink in scullery, and defective roof of house at 86, Rutland Street. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 20th Nov. Failing to repair the yard paving at 9, Vine Court. The work havingbeencompleted at the time of the hearing, the summons was withdrawn on payment of £2 4s.0d. costs. 55 Date. Matter of information or complaint. Result. 21st Nov. Failing to abate a nuisance arising from dirty rooms and furniture at 23, Scarborough Street. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 21st Nov. Failing to repair defective soil-pipe and yard drain at 41, Brick Lane. The work having been completed at the time of the hearing, the summons was withdrawn on payment of £2 5s.0d.costs. 22nd Nov. Failing to abate nuisances arising from defective water-closets on first floor and choked sink-waste pipe at Paragon Mansions, Stepney Green. The work having been completed at the time of the hearing, the summons was withdrawn on payment of £2 5s. 0d. costs. 23rd Nov. Failing to abate nuisances arising from defective flooring, sashlines and dirty walls and ceilings at 5, Murdock Cottages. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 23rd Nov. Failing to abate nuisances arising from defective roof, sashlines, defective and dirty walls and ceilings at 6, Murdock Cottages. The work having been completed at the time of the hearing, the summons was withdrawn on payment of £2 5s.0d.costs. 23rd Nov. Failing to abate nuisances arising from dirty and defective walls and ceilings and damp walls at 54, Grove Road. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 26th Nov. Failing to abate nuisances arising from damp walls, defective paving, roof, tap and stair-treads at 26, Frederick Place. Ordered to do the work within 7 days and pay £2 8s. Od. costs 3rd Dec. Failing to abate nuisances arising from defective roof, stove, mantelpiece and dirty and defective ceiling at 16, Tredegar Square. Ordered to do the work within 7 days and pay £6 8s. 0d costs 3id Dec. Fading to abate nuisances arising from defective roof, stair-treads, sashlines. water pipe, damp walls and dirty walls and ceilings, at 18, Cottage Grove. Ordered to do the work within 14 days and pay £2 8s. 0d costs. 3rd Dec. Failing to abate nuisances arising from the damp wall and defective stove at 4, Buttress Street. Ordered to do the work within 7 days and pay £2 8s. 0d. costs. 31st Dec. Depositing for preparation for sale on 30th October, at 88, Stepney Green a quantity of liquid egg which was intended for the food of man and which was unsound and unfit for human consumption. Fined £10 0s. 0d. London County Council Byelaws. 23rd Feb. Failing to deposit plans for the erection of a urinal at 13, Vallance Road. Fined 10s. 23rd Feb. For erecting a urinal in the basement of 13, Vallance Road, in contravention of the requirements of the Bye-laws. Fined 10s. and £2 2s. 0d. costs. 56 Date Matter of information or complaint. Result. 23rd Feb. Failing to notify the alteration of the drain at 13, Vallance Road. Fined 10s. 23rd Feb. Keeping animals (to wit, dogs) other than poultry on the premises where poultry is slaughtered, at 56, Weaver Street. Fined 10s. 23rd Feb. For failing to provide properly covered vessels for the keeping of manure at the poultry slaughter-house at 56, Weaver Street. Fined £2 0s. 0d. and pay £2 2s. 0d. costs. 13th Apl. Failing to cleanse his premises—fried fish shop, between 1st and 10th day of March. Defendant was discharged under the Probation of Offenders Act on payment of 10s. 6d. costs. 16th Apl. Erecting a sink contrary to the Bye-laws at 47, Gt. Prescot Street. Fined £2 0s. 0d. on the first summons, the two remaining not being dealt with on the Magistrate's suggestion. 16th Apl. Failing to deposit drawings of drainage executed at 47, Gt. Prescot Street. 16th Apl. Failing to give notice of work executed at 47, Gt. Prescot Street. London County Council (General Powers) Act, 1908. 12th Nov. For failing to keep the bakehouse at 54, Whitechapel High Street, in a cleanly condition. Fined £1 0s 0d. with £2 2s. 0d. costs. 31st Dec. For not observing due cleanliness upon premises where food is prepared for sale for human consumption on 26th October, at 88, Stepney Green. Fined £1 0s. Od. with £3 0s. 0d. costs. Milk and Dairies (Consolidation) Act, 1915. 28th May Selling milk on 14th February, without having his name and address inscribed on the vehicle or receptacle. Fined Is. Od. with £2 2s. 0d. costs. Milk and Dairies Order, 1926. 9th Mar. For filling a bottle with milk, not on registered premises. Defendant was discharged under the Probation of Offenders Act, on payment of 5s. costs. 4th June Filling two bottles with milk in the street. (Not on registered premises.) Fined £1 0s. 0d. 10th Aug. For filling bottles with milk and sealing them otherwise than on registered premises on 29th June. Fined £1 0s. 0d. and pay £1 Is. 0d. costs. 22nd Nov. For selling milk without being registered. Fined £2 0s. 0d. with £1 1s. 0d. costs. 31st Dec. For causing to be filled and sealed one bottle of milk otherwise than on registered premises on 30th November. Fined £2 0s. Od. with £2 2s. 0d. costs. 57 Date. Matter of information or complaint. Result. Food and Drugs (Adulteration) Act, 1928. 12th Mar. For selling milk 17.7 per cent. deficient in fat. (B.9.) Pleaded guilty. Defendant discharged under Probation of Offenders Act on payment of 5s. costs. 12th Mar. For selling milk 17.3 per cent. deficient in fat. (B.10.) do. 29th Mar. For selling milk containing 6.7 per cent. added water. (J.12.) Defendant was discharged under the Probation of Offenders Act, on payment of £3 3s. 0d. costs. 29th Mar. For selling milk containing 12.2 per cent. added water. (K.20.) 29th Mar. For selling separated milk from a receptacle which was not labelled "Separated Milk." (K.9.) Defendant was discharged under the Probation of Offenders Act, on payment of £1 1s. 0d. costs. 4th June For selling milk containing 4.6 per cent. added water. (N.6). Case withdrawn on payment of £2 2s. 0d. costs. 4th J une For selling milk containing 5.3 per cent. added water. (X.141.) Dismissed under Probation of Offenders Act, and to pay £2 2s. 0d. costs. 4th June For selling minced meat containing 1,570 parts per million of sulphur dioxide on 24th April. (N.16.) Fined £1 0s. 0d. 26th June For selling sterilised milk on 16th May, containing 10.6 per cent. added water, and 3.3 percent. fat deficiency. (D.73.) Fined 10s. with £3 3s. 0d. costs. 26th June For selling minced meat containing 780 parts per million of sulphur dioxide on 11th May. (D.59)., Fined £2 0s. 0d. with £2 2s. 0d. costs. 16th July For selling milk containing 5.2 per cent. added water on 27th March. (X.l 13). (This case was adjourned from 14th May, so that the third portion could be submitted to the Government Analyst.) Fined £1 0s. 0d. and pay £2 2s. 0d. costs. 16th July For selling milk 5 per cent. deficient in fat on 7th June. (P.51.) Fined £1 0s. 0d. and pay £2 2s. 0d. costs. 16th July For selling milk 15.7 per cent. deficient in fat on 28th May. (B.39.) Fined £1 0s. 0d. and pay £1 1s. 0d. costs. 24th July For selling milk 17 per cent deficient in fat on 15th June. (H.74.) The summons dismissed under the Probation of Offenders Act. Order to pay £2 2s. 0d. costs. 24th July For selling minced meat containing 30 parts sulphur dioxide per million on 25th June. (M.60.) Fined £2 0s. 0d. and pay £1 1s. 0d. costs. 24th July For selling minced meat containing 1,290 parts sulphur dioxide per million on 25th June. (M.61.) Fined £2 0s. 0d. and pay £1 1s. 0d. costs. 58 Date. Matter of information or complaint. Result. 24th July For selling minced meat containing 330 parts of sulphur dioxide per million on 25th June. (M.62.) Fined £1 0s. 0d. and pay 10s. 6d. costs. 10th Aug. For selling minced meat containing 510 parts sulphur dioxide per million on the 8th July. (X.152.) Fined £2 0s. 0d. and pay £1 1s. 0d. costs. 10th Aug. For selling minced meat containing 3,760 parts sulphur dioxide per million on 27th June. (L.46.) Fined £5 0s. 0d. and pay £2 2s. 0d. costs. 10th Aug. For selling minced meat containing 30 parts sulphur dioxide per million on 27th June. (L.46.) Fined £2 0s. 0d. and pay £2 2s. 0d. costs. 3rd Sept. For selling minced meat containing 370 parts sulphur dioxide per million on 20th July. (X.184.) Fined £2 0s. 0d. and pay £2 2s. 0d. costs. 3rd Sept. For selling minced meat containing 30 parts sulphur dioxide per million on 19th July. (X.180.) Fined £1 0s. 0d. and pay £1 1s. 0d. costs. 3rd Sept. For selling minced meat containing 550 parts sulphur dioxide per million on 16th July. (X.154.) Fined £2 0s. 0d. and pay £2 2s. 0d. costs. 3rd Sept. For selling minced meat containing 1,380 parts sulphur dioxide per million on 18th July. (X.171.) Fined £3 0s. 0d. and pay £2 2s. 0d. costs. 3rd Sept. For selling minced meat containing 170 parts sulphur dioxide per million on 18th July. (X.172.) Summons dismissed under the Probation of Offenders Act. Ordered to pay £2 2s. 0d. costs. 3rd Sept. For selling minced meat containing 30 parts sulphur dioxide per million on 20th July. (X.183.) Fined £1 0s. 0d. and pay £1 1s. 0d. costs. 3rd Sept. For selling minced meat containing 2,180 parts sulphur dioxide per million on 16th July. (X.153.) Fined £3 0s. 0d. and pay £2 2s. 0d. costs. 14 th Sept. For selling milk 3.3 per cent. deficient in fat and 4.7 per cent. solids not fat on 30th July. The sample was taken in course of delivery. (X.14.) Fined £2 0s. 0d. and pay £3 3s. 0d. costs. 14th Sept. For selling milk 8.2 per cent. deficient in solids not fat on 30th July. (X.12). The sample was taken in course of delivery. Fined £2 0s. 0d. and pay £3 3s. 0d. costs. 17th Sept. For selling minced meat containing 170 parts sulphur dioxide per million on 20th July. (X.186.) Fined £1 0s. 0d. and pay £1 1s. 0d. costs. 17th Sept. For refusing to sell ½-lb. minced meat to the Sampling Officer on 19th July. Fined £10 0s. 0d. and pay £5 5s. 0d. costs. 18th Sept. For selling whiskey which had been reduced to 36.6 under proof (representing the presence of 2.5 per cent excess water). (X.30.) Summons dismissed under the Probation of Offenders Act. Ordered to pay £5 5s. Od. costs. 59 Date. Matter of information or complaint. Result. 28th Sept. For selling milk 5 per cent. deficient in fat and 2.5 per cent, deficient in solids not fat on 3rd August. (X.37.) Fined £1 0s. 0d. and pay £2 5s. 0d. costs. 9th Nov. For selling milk containing 3.3 per cent. added wateron 26th September. (X.42.) The summons was dismissed underthe Probation of Offenders Act. Ordered to pay £3 3s. 0d. costs. 9th Nov. For selling milk containing 3.3 per cent. added water on 26th September. (X.43.) The summons was dismissed under the Probation of Offenders Act. Ordered to pay £3 3s. 0d. costs. 9th Nov. For selling milk containing 3.2 per cent. added wateron 26th September. (X.44.) The summons was dismissed under the Probation of Offen ders Act. Ordered to pay £3 3s. 0d. costs. 31st Dec. For selling milk containing 8.9 per cent. added water on 1st December, (C.88.) Dismissed on payment of £4 4s. 0d. costs. No. of Summonses Fines. Costs £ s. d. £ s. d. Food and Drugs (Adulteration) Act, 192B 37 48 10 0 75 14 6 London County Council Bye-laws 9 6 0 0 4 14 6 London County Council (General Powers) Act, 1908 2 2 0 0 5 2 0 Milk and Dairies Order, 1926 5 6 0 0 4 9 0 Public Health (London) Act, 1891 68 50 10 0 107 4 6 Milk and Dairies (Consolidation) Act,1915 1 o 1 0 2 2 0 Total 122 113 1 0 199 6 6 Total Fines and Costs. 329 observations were made by the Sanitary Inspectors for the detection of nuisances from smoke, which necessitated the serving of 50 Intimation notices for the abatement of the nuisance. Smoke Nuisances 2,910 written complaints were made to me during the year, which were duly investigated. Of these 102 were from H.M. Inspector of Factories relating to workshops, 85 from the London County Council respecting verminous school children, and 2,723 related to the condition of houses, etc. In addition 6,397 inspections were made as a result of complaints made to the Sanitary Inspectors. Complaints 60 Drainage. The Sanitary Inspectors supervise all drainage work. Full particulars as to the work done by them are given on pages 49 and 50. 6,124 drains Were tested during the year. Of these, 612 were found to be defective. Rats and Mice. During the year 804 complaints were received as to nuisances from rats or mice. As a consequence 833 drains were tested and in 143 instances they were found to be defective. 661 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 work carried out during the year by his department. Record of Rat Destruction carried out by the Council's Ratcatchers from Is/ January to 31st December. No. of premises visited 1,150 „ „ visits 17,411 „ „ rats found dead 131 * „ „ rats caught in our traps 2,246 „ „ premises cleared of rats as reported by the Occupiers 758 „ ,, new rat complaints during this period 701 *1,294 of these Were actually brought into the Depot and destroyed. The poisons used were as follows:— Rodine 49,610 cubes Barium carbonate 32,088 „ Phosphor paste 37,630 „ Extract of Squills 19,136 portions In co-operation with adjoining Boroughs poisoned bait was laid down in various sewer manholes and side entrances of the boundary roads during the following quarterly Rat weeks:— 1934. Manholes. Side entrances. Baits laid. Totals. Eaten. Not touched. 5th to 10th Feb. 347 34 2,971 498 3,469 7 th to 12th May. 335 38 2,570 827 3,397 30th July to 4th Aug. 233 23 1,871 344 2,215 61 National Rat Week—-5th to 10th November. The Council adopted a similar procedure as in previous years. Notices, drawing the attention of the public to the matter, were inserted in four local newspapers. Communications were sent to 14 local cinemas, requesting that notices be displayed on the screen, drawing attention to National Rat Week. 74 chemists and oilmen within the Borough were supplied with copies of the Ministry of Agriculture's form No. 618/T.R., bulletin No. 30 the official pictorial bills and 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 rodine, were placed in the sewer manholes and side entrances at 211 different positions throughout the Borough. A total of 1,887 portions of bait were laid, of which number 1,730 were eaten. The Council employ three men as ratcatchers, who give their whole time to rat destruction. 42 applications were received during the year for Certificates that certain houses were not in a reasonable state of repair. 34 were granted, 5 were refused and 3 were withdrawn by the applicants. In addition, 4 applications were received for Reports that the work mentioned on the Certificates had been satisfactorily executed. All were granted. Increase of Rent and Mortgage Interest Restrictions Acts. 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 5 houses and 176 tenements. Water Certificates, Annual certificates are granted respecting Hairdressers' Shops in the Borough, which come up to a certain standard of cleanliness. Two certificates were granted during the year. Hairdressers' Shops. 62 Report required by L.C.C. Premises. No. in Borough on 31st Dec. 1934 No. of Inspections No. of Prosecutions Common lodging houses 17 386 — Seamen's lodging houses 12 366 — Cowsheds (licensed) 19 134 — Slaughterhouses (licensed) — — — Other offensive trades 53 357 1 Milkshops 341 1,329 — Ice Cream premises 311 522 1 Restaurants and Eating houses 355 753 — Registered Foster mothers 18 223 — Nurse children kept 19 — — Smoke nuisances. (1) No. of observations 329 (2) No. of intimations served 50 (3) No. of complaints received 50 (4) No. of Statutory notices served 6 (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 214 No. of children cleansed 6 No. of premises cleansed— (a) after infectious diseases 1,759 (b) for vermin 768 (c) after Tuberculosis 204 Water Supply to Tenement Houses. No. of premises supplied 13 No. of prosecutions — Sanitary Officers. No. of Sanitary inspectors (whole time)— Male 20 Female 1 No. of Sanitary inspectors (part time)— Male — Female — No. of health visitors (whole time) 10 (part time) — 63 Total No. of houses in the borough 37,757 No. of houses occupied by the working classes 31,708 No. of houses inspected— (a) On account of complaints or illness (P.H. Act) 2,910 (b) „ „ Infectious disease 2,025 (c) Housing Consolidated Regulations, 1925 698 No. of notices served— (a) Under P.H. Act:— (i) Intimation 12,807 (ii) Statutory 4,728 (b) Under Housing Act 13 No. of houses repaired or nuisances remedied under P.H. Act, 1891 11,164 No. of houses repaired under Sec. 17 of Housing Act, 1930— (a) By owners 2 (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 128 (Of this number 79 were erected by the local authority.) (b) In course of erection 101 (Of this number 98 are being erected by the local authority.) No. of representations by Medical Officer or other person 17 No. of houses included in such representations 68 No. of Closing Orders made 2 No. of Closing Orders determined (i.e., Houses made fit) — No. of Demolition Orders 4 No. of houses demolished— (a) In pursuance of orders 4 (b) Voluntarily — 64 Underground Rooms— No. illegally occupied 698 No. closed or illegal occupation discontinued 86 Overcrowding—- No. of cases of overcrowding found 74 No. remedied 62 No. of prosecutions — Houses let in lodgings. No. in the borough 2,770 No. of inspections 2,327 No. of prosecutions 4 Canal Boats Acts 1877 and 1884. Pursuant to the Third Section of the Canal Boats Act, 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 1934 to give effect to the provisions of the said Acts and Regulations, viz.:— (1) Canal Boats coming within the district are inspected by a Sanitary Inspector, who receives a sum of ,£10 per annum for the performance of this duty. His inspection is irrespective of the examination of Boats made by the Examining Officer prior to their registration. (2) The number of boats inspected was 18. No children were found on the boats. There were no contraventions of the Acts and Regulations. No boats were registered during the year. Factories, Workshops and Workplaces [Home Office Form 572] I.—Inspections. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 1,376 266 — Workshops (Including Workshop Laundries) 2,355 4L3 — Workplaces (Other than Outworkers' premises) 438 65 1 Totals 4,169 744 1 65 2.—Defects found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts.— Want of cleanliness 329 329 — — Want of ventilation 45 45 — — Overcrowding 4 4 — — Want of drainage of floors — — — — Other nuisances 311 311 — — Sanitary Accommodation insufficient 26 26 — — unsuitable or defective 252 252 — — not separate for sexes 30 30 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) Other offences 2 2 — — (Excluding offences relating to outwork which are included in Part 3 of this report.) Totals 999 999 — — 3 —Registered Workshops. Workshops on the Register (s. 131) at the end of the year 1934. Number. Bakehouses 133 Boot, Shoe and Slipper Making 103 Cabinet Making 83 Furriers 107 Hat and Cap Manufacturers 43 Laundries 5 Rag Sorting, etc. 52 Wearing Apparel (Tailors, Milliners, Dressmakers, etc., etc.) 1,672 Miscellaneous 362 Total 2,560 66 4.-Other Mailers. Class. Number. matters notofied to H.M. Inspector of Factories:- Failure to affix Abstract of the Factory and Work-shop Act(s.133), 1901 22 Action taken in matters referred by H.M. Inspector as remediable under the Public Heath 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. Inspector 102 102 other 1 Underground Bakehouses (s. 101):- Certificates granted during the year - In use at the end of the year 6 Out workers. The net number of outworker in the Borough engaged in the various trades is as follows:- Making, cleaning, etc., of wearing apparel 2,267 Furriers 55 Umbrellas 17 Boots and shoes 46 Paper bags and cardboard boxes 20 Brushes 3 Flag making 4 Feather bedding 2 Christmas cards 1 Carnival bats 22 Artificial flowers 3 Braces 1 Handbags 2 Cigarette making 1 Pot scourers 9 Fancy jewellery 2 Bristles 1 2,486 The number of inspections made to outworkers' premises was 1,270, and the number of premises where sanitary defects were found to exist was 387 Notifiable infectious disease occurred in 95 outworkers' premises. There are 103 firms in the Borough employing outworkers, and of these linns 93 sent in list twice in the year and 12 once. These related to a net number of 1,116 outworkers, of which 714 were resident in the Borough and 402 were transferred to other Districts. 67 In addition, 641 list relating to a net number of 1,742 outworkers were received from other Boroughs during the year. Outworkers' premises whore sanitary defects were found to exist:- Nature of work. Instances. Notices served. Wearing Apparel Making, etc. 335 301 Cleaning and washing 4 3 Household linen 2 2 Curtains and furniture hangings l 2 Furniture and upholstery 4 6 Fur pulling 3 — Umbrellas, etc. 5 5 Paper, etc., boxes, paper bags 6 6 Stuffed toys 2 2 Cosaques, Christmas crackers, Christmas stockings, etc. 1 1 Hoots and shoes 24 22 Total 387 350 The number of bodies deposited in the Mortuary during the year was 306. Mortuary mill Shelter. 52 Jewish bodies were officially "watched." 174 inquests were held in the Coroner's Court, and 207 post mortem examinations were made. The shelter is used for the accommodation of contacts of infectious disease while their homes arc being disinfected. During the year there were 8 persons admitted to the shelter; 5 adults and 3 children. 9 inspections were made during the year to premises subject to the provisions of the Kag block Acts. One informal sample of rag flock was examined and found to be satisfactory. Rag Flock Acts. There are 19 cowsheds in the Borough licensed to accommodate a total of 493 cows. During the year 134 inspections were made to the cowsheds, but it was only found necessary to serve notices for defects or nuisances under the Public Health Act. Cowsheds. 357 inspections were made during the year to the 53 offensive businesses (including 42 poultry slaughter houses) carried on in the borough. 22 notices were served for minor matters and it was found necessary to take legal proceedings in one instance. Offensive Businesses. The Slaughter of Animals Act, 1933, came into operation on the 1st January. 10 persons were duly licensed as Slaughtermen at a knackers yard in the Borough. 68 Lodging Houses. There are 17 common lodging houses. 386 inspections were carried out during the year. 11 notices were served for various defects found to exist. The usual annual census of persons in Common Lodging Houses was taken on the night of the 16/17th February. Of the 2,140 licensed beds for men 1,502 were occupied. ,, 551 ,, ,, women 308 were occupied. ,, 48 ,, ,, married couples 23 were occupied. In addition to the above there are 12 Seamen's lodging houses to accommodate a total of 757 lodgers. 366 inspections were made during the year, and 5 notices were served for minor nuisances. Statistics. IV.—HOUSING. 1.—Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 26,671 (b) Number of inspections made for the purpose 32,747 (2) (a) Number of dwelling houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 698 (b) Number of inspections made for the purpose 793 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 105 (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 11,895 2.—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 7,878 3.—Action under Statutory Powers during the Year:— (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— 69 (1) Number of dwelling houses in respect of which notices were served requiring repairs 2 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 2 (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 4,017 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 4,017 (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 4 (2) Number of dwelling houses demolished in pursuance of Demolition Order 4 (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 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil There were 5 underground rooms in respect of which undertakings have been accepted pursuant to Section 19 (2) of the Housing Act, 1930. 423 families in the Borough took accommodation on the London County Council's housing estates as follows:— Estate. Number of families. Estate. Number of families. Ann Street 2 Hughes Fields 1 Becontree 287 Kingshold 1 Birchfield Street 3 Northwold 3 Brook Street 3 Oliver Goldsmith 2 Boundary Street 12 Prestons Road 7 Bow Bridge 29 Prevost Street 2 Bourne 1 Rudstone Houses 1 Brightlingsea Buildings 2 Streatham Hill 1 Bewley Buildings 1 St. Helier 17 Collingwood 7 Stamford Hill 7 Clapham Park 1 Totterdown Fields 1 Chancery Buildings 2 Watling 4 Downham 4 White Hart Lane 1 East Dulwich 1 Wapping 6 Glebe 2 Welling 1 Honor Oak 1 Whitmore 6 Holland 4 Housing Accomodation provided. 70 Overcrowding. 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, 74 fresh cases of overcrowding were found, which involved the serving of 74 intimation notices. 62 cases of overcrowding were abated. House to House Inspections. List of streets in which all the houses have been inspected as a result of House to House inspection during the year 1934. (a) Limehouse. Mr. Bottomley. Beccles Street. Gill Place. Bungay Street. Tenbury Place. Mr. McCarthy. Hope Place. Reform Place. Raby Street. Taylors Place. Mr. Waterman. Bower Street. Ronald Street. Drew's Buildings. Sage Street. Havering Street. Solander Street. Medland Street. Steel's Lane Mercer Street. Warton Place. Prittlewell Place. (b) Mile End. Mr. Brown. Bromhead Road. Vine Cottages. Hawkin's Street Buildings. Winwood Street Buildings Hewitt's Court. Mr. Edwards. Commodore Street. Stepney Green Dwellings. Monsey Street. Victoria Buildings. Mr. Flint. Cordelia Street. Morgan Street. Edwards Road Murdock Cottages. Eric Street. Salmen Street Maplin Place. Whitman Road Mr. Harris. Bedford Street. Myrdle Street. Charles Martin Mansions. Newark Street. Fulcher's Buildings. Rutland Street. Mr. Haworth. Maplin Street. Rhodeswell Road. 71 Mr. Simpson. Cambridge Mansions. Grebe Court. Doveton Street. James Street. Entick Street. Key Street. Essex Street. Mile End Buildings. Faith Street. Sceptre Street. Ferriers Court. Wickford Street. Mr. Trimming. Clemence Street. Maritime Street. Locksley Street. (c) St. George's. Mr. Day. Betts Street. North East Passage. Denmark Street. Phoenix Court. Harad's Place. Rogers Court. Kinder Street. Russell Court. Lawrence Buildings. Upper Chapman Street. Little Turner Street. Walburgh Street. Mr. Dee. Cinnamon Street. Royal Jubilee Buildings. Hilliards Court. St. George Street. Johnson's Buildings. Seven Star Alley. Lavender Place. Star and Garter Yard. Pearl Street. Starch Yard. Penang Street. Whitethorn Court. Plough Alley. Whitethorn Place. Mr. Guy. Cable Street. Planet Street. Fenton Street. Sheridan Street. Hardinge Street. Sutton Street. Mason's Flats. Mr. Smith. Challis Court. Wellington Buildings. Ellen Place. Wicker Street. Globe Court. Wicker Terrace. Golding Terrace. (d) Whitechapel. Mr. Green. Brownson's Court. Lambeth Street. Christopher Court. Sugar Loaf Court. Great Alie Street, Synagogue Place. Grigg's Court. 72 ('d) St. George's— cont. Mr. Roper. Black Eagle Street. Pools Square. Duval Street. Pope's Head Court. Frying Pan Alley. Quaker Street. Harrisons Court. Quaker Square. Little Pearl Street. Shepherd Street Buildings. Mr. Twynham. Easington Buildings. Pelham Street. Flower and Dean Street. Perry's Avenue. Mason's Court. Ramar Place. Montague Houses. Sir George's Residences. Montague Place. Mr. Vogler. Augustine House. Osborn House. Bulwer House. Pelham House. Clinton House. Regal Place. Lytton House. Selby Street. Nelson Place. Victoria Cottages. Overcrowding. This is a heartbreaking problem at the present time—heartbreaking for the overcrowded families, heartbreaking for the officials and voluntary workers who discover the cases of overcrowding and still more heartbreaking for the Medical Officer of Health to whom such cases are referred. What is the solution? The Housing Bill, 1935, in itself is not a solution, except that there will be a subsidy for the rehousing of overcrowded families. Now that a standard of overcrowding will be fixed, a more accurate knowledge of the amount of overcrowding will be possible, and therefore an accurate knowledge of the amount of rehousing accommodation required to abate that overcrowding will be obtained. That, however, will not produce the houses by which overcrowding will be abolished. Taking the Census of 1931 as a basis, it is estimated that additional accommodation for at least 14,128 persons will be required. Where can this extra accommodation be obtained? It is obvious that a large proportion of these persons must be rehoused outside the Borough, but it is also obvious that few of them can afford to live as far out as Becontree. It is obvious that some accommodation outside the Borough must be found and that the accommodation must be within reasonable distance of Stepney. In this the Council are helpless, so does it not mean that the London County Council must produce the necessary accommodation? Without it a solution of the overcrowding problem in Stepney is impossible. 73 A very disturbing feature in the Borough is the conversion of a room or of rooms in dwelling houses into workshops or workplaces, in some cases the whole dwelling house having been so converted. In view of the overcrowding and of the shortage of housing accommodation this is becoming a very serious matter and it is hoped that legislation will be forthcoming shortly by which this practice can be brought to an end. At the end of the year there were 85 dwelling-houses used entirely as workshops and 1,466 in which at least one room was used for such purpose. Workshops in Dwelling houses. There is no question that workshops and dwelling-houses should be entirely separate; Town Planning will ensure this separation in time to come. Ideally there should be a zone for residential purposes and a zone for industrial. Powers to acquire property for reconditioning and for conversion should enable the Council to reconvert into dwelling-houses all converted workshops in residential areas; then workshops to take their place can be constructed in the appropriate neighbourhood. During the year a survey was made of the 9,594 underground rooms in the Borough. Underground rooms. The following is the result of that survey:- (a) Number which do not comply with the Regulations— (1) Used for sleeping purposes 698 (2) Used for living purposes 5,461 (3) Empty or used as workshops, stores, etc. 2,260 (b) Number which do comply with the Regulations— (1) Used for sleeping purposes 316 (2) Used for living purposes 838 (3) Empty or used as workshops, stores, etc. 21 The Regulations are those made by the Council pursuant to Section 18 (1) of the Housing Act, 1925. At the present time the Council are concerned with underground rooms under the Housing Act only with a view to closing for sleeping purposes those rooms which do not comply with the above Regulations. The Council have no power to deal with any other underground rooms and must therefore limit their attention to the above 698 rooms which, though not complying with the Regulations, are used for sleeping purposes. With regard to this closure for sleeping purposes, it will be realised that unless the room is habitually used for sleeping the Council cannot deal with it under the Housing Acts. This gives rise to difficulties because, if the 74 tenants vacated the room before the closing order was made the room could be relet and the procedure for the closing of that room would have to be started anew. Again, there is nothing to prevent the letting of a room for sleeping purposes which is used at the present time as a living room or which is empty, or which is used as a store. It would be of great help if it could be enacted that all underground rooms which do not comply with the Regulations, could be closed for sleeping purposes whether occupied or not at the time for such purposes. The Council could then close for sleeping purposes all underground rooms which do not comply with the Regulations. It will be seen from the survey figures that there are 8,419 underground rooms in Stepney which do not comply with those Regulations; of these, 7,721 are not used for sleeping. Under this suggested enactment the Council could at once proceed to close for sleeping purposes all these 7,721 rooms and by that action could ensure that they will never be used for, or converted into, sleeping quarters. With regard to the 698 rooms which are at present used for sleeping, the Council will steadily take the necessary action as and when alternative re-housing accommodation becomes available. Unless there is legislation on the lines suggested, it would appear that there are no powers to prevent any of the above 7,721 rooms being let for sleeping purposes, and unless the above 698 rooms are occupied for sleeping at the time the closing order is made, no legal action can be taken. It will be generally agreed that rooms which are unfit to sleep in should be considered to be unfit to live in. If it is unhealthy to live in these rooms at night, it is equally unhealthy to live in them during the day, especially for those who spend most of their day in these rooms. Could it not be argued, therefore, that no underground room should be used for living or sleeping purposes, if it does not comply with the Regulations? In a Borough like Stepney, with its housing difficulties, such enactment would give rise to a serious problem for it would entail the additional closing of 5,461 rooms (at present used for living purposes), together with the closing for living purposes of the above 698 rooms which should be closed for sleeping purposes. This would entail the necessity of rehousing the families which would be displaced as a result of closing these 6,159 rooms. Taking, as an average, an occupation of two underground rooms per family, it might entail the rehousing of anything up to 3,000 families. It would be impossible to consider this problem as a separate entity at the present moment. Luckily there is no necessity to consider it as a separate entity, for the great majority of such underground rooms will be dealt with under Slum Clearance Schemes. 75 It is hardly possible to imagine a Borough more beset with difficulties— difficulties which have to be overcome before Slum Clearance activities can actually start and difficulties which arise during the redevelopment of cleared sites. The housing problem in Stepney. As can readily be understood, ready-made building sites in Stepney are few and far between and all initial sites have to be obtained as a result of much careful thought and negotiation. Without these initial sites Slum Clearance cannot begin. For the purpose of continuity in Slum Clearance the sites of Limehouse Fields and of Market Buildings are quite useless—they are serving very useful purposes, however, in allowing of rebuilding in order to rehouse people living in slums on those sites. Southern British Ropes and Branch Road sites, however, will be excellent rehousing sites and already the former is earmarked for the inhabitants of the Beccles Street area, upon which the Council made a Compulsory Purchase Order during the year. The Branch Road flats will become available for the inhabitants of areas to be represented in 1935. A real start has been made, and with careful arrangement these two sites will lead to a continuous programme of Slum Clearance by the Council. There are still, however, grave difficulties ahead. To rehouse slum dwellers in modern flats and to make no provision for good air space around those flats and for proper and adequate open spaces is merely to perpetuate slum conditions. There must, therefore, be proper planning in the redevelopment of slum areas. I am of the opinion that Town Planning should actually precede Slum Clearance, or, at the very least, that these two activities should proceed hand-in-hand. If blocks of flats are not erected according to an already prepared layout plan there will be chaos. There are large areas in Stepney which are crying out to be completely reconstructed and unless plans are developed on those lines the Borough will never be improved from a healthy residential point of view. The London County Council have decided to Town Plan those Boroughs which were not previously subject to Town Planning, so the opportunity has now arrived for real constructive work in Stepney. Slum clearance must therefore work hand-in-hand with reconstruction on proper Town Planning lines and those lines must give to Stepney some large open spaces which are so urgently necessary. As in the case of the abatement of overcrowding, so in the case of reconstruction after Slum Clearance—many persons displaced from slum areas must be rehoused outside the Borough. It is possible, however, when that 76 reconstruction is complete and when Stepney is replanned, that there will be accommodation left over to allow some of the above persons to return. This is possible because there are certain areas in which so much space is taken up by an excessive number of short and narrow useless streets which will disappear in the work of reconstruction. It is possible also because there are many empty industrial buildings in residential areas, which will allow of space for housing purposes. The clearance of the slums in Stepney and the proper redevelopment of the Borough must of necessity be a slow process, for there is so much spadework to be completed. Milk Supply. v.—INSPECTION AND SUPERVISION OF FOOD. There are 341 dairy premises on the register and 1,329 inspections were made to them during the year. It was found necessary to serve 31 notices for minor matters. In addition there are registered in the Borough 304 purveyors who sell milk in sealed bottles, 75 dairymen who have premises outside the Borough, and 19 cowsheds. Milk (Special Designations) Order, 1923. 65 licences under this Order were issued during the year, being 4 more:han the previous year. The descriptions of the licences are as follows:— Dealers Licences. Dealers Supplementary Licences. "Certified Milk" 3 1 "Grade A. (T.T.)" Milk 19 6 "Grade A." Milk Pasteurised 1 — "Grade A." Milk 5 — "Pasteurised" Milk 20 10 Butchers' Shops and Stalls. 1,247 inspections were made to butchers' shops and 610 to butchers' stalls in the Borough. 25 notices were served for minor infringements of the Meat Regulations. Ice Cream Premises. 53 premises were registered whereon Ice Cream is manufactured, stored or sold, and 11 premises were removed from the register. 522 inspections were made and 24 notices were served. 77 There are 7 Butter and Margarine factories and 46 premises used by Wholesale Dealers in Margarine on the Register. 6 inspections were carried out during the year. 435 inspections were made to the bakehouses in the Borough, and 277 cleansings were carried out. Butter Factories, Wholesale Dealers in Margarine, etc. Bakehouses. 24 certificates have been issued respecting the export of consignments of food products prepared within the Borough:— 4 to Italy. 3 to Egypt. 2 to Syria. 2 to Argentine. 12 to the United States of America. 1 to Honolulu. Certification of Food Products for Export. 1,345 inspections were made at the various wharves in the Borough. 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. Food Inspection. Fresh Meat. Tons. cwts. qrs. lbs. 1 carcase Australian Mutton — — 1 18 4 carcases New Zealand Mutton - 2 0 18 1 pair hind quarters of Mutton — — — 13 Preserved Meat. 1,460 tins of Beef 3 8 3 24 144 „ Ox Tongue — 7 2 24 62 „ Rabbits — — 3 20 2,540 „ Tongues 1 2 2 22 Fresh Fruit and Vegetables. 11 crates of Apricots — 1 0 20 214 „ Bananas 7 7 3 0 2 baskets of „ — — 1 4 13 bunches of „ — 7 3 0 1 basket of Beans — — 1 4 27 bags of Dates 2 3 3 10 34 boxes „ Dates (in bulk) 5 10 0 0 2 barrels of Grapes — 1 0 8 1 package of „ — — 1 8 1 basket of marrows — — 1 12 78  Tons. cwts. qrs. lbs. 10,865 bags of Onions 543 5 0 0 17 bundles of Peas — 4 1 0 14 crates of Plums — 1 2 0 380 bags of Potatoes 19 0 0 0 1,362 baskets of Tomatoes 17 13 0 6 8 cases of Shelled Walnuts — 2 3 12 Preserved Fruit and Vegetables 84 tins of Assorted Fruits — 1 3 14 45 „ Cherries — — 3 15 11,924 „ Oranges 4 10 3 13 1,058 „ Peaches — 13 0 0 3,607 „ Pears — 16 0 12 181 „ Pineapples — 4 1 2 2 boxes of Sultanas — — 2 0 1,577 tins of Tomatoes 2 1 2 0 Preserved Fish 28,548 tins of Crab 7 7 3 7 2,525 „ Crayfish 1 2 0 0 12,348 „ Pilchards 5 10 2 0 3,639 „ Salmon 1 12 1 25 Sundries. 40,123 tins of Assorted Canned Goods 27 10 2 1 239 „ Canned Foodstuffs — 4 3 9 139 „ Canned Fruit — 3 2 14 1 bag of Cocoa beans — 1 2 15 Cocoa bags (in bulk) — — — 17 173 tins of Condensed Milk — 1 2 5 4 cases of Dried Turtle — 6 0 0 62 bags of Groats 3 17 2 0 287 bottles of Mayonaisse — 1 1 4 28 bags of Rice 2 5 0 0 4 cases of Sultana Cakes — 4 0 0 1,372 tins of Tomato Paste 5 6 3 0 Total 665 6 3 12 79 Caseous Lymphadenitis— There were 1,979 carcases of imported mutton examined by the cutting of lymphatic glands. Of these, 5 were found diseased. This is a marked reduction of the percentage of diseased carcases. This shows 25 per cent. against .52 per cent. in 1933. This is undoubtedly brought about by the more careful examination at the time of slaughter. 163 Detention notices and 233 Release notices were issued during the year, in respect to the undermentioned foodstuffs:- Article. Detention Notices. Release Notices. Quantity. No. of notices. Weight. Quantity. No. of Notices. Weight. T. c. q. lbs. T. c. q lbs. Tallow 4,884 casks. 72 1,953 12 0 0 6,047 casks. 160 2,448 16 0 0 Mutton 33.822 carcases. 66 — 32,819 carcases. 66 — Oranges 761 cases 4 — 298 cases 2 — 40 tins. 84 tins. Crab 368 cases. 2 — 252 cases. 1 — Salmon 5,666 cases. 3 — 7,691 cases. 2 — Sultanas 200 boxes. 1 — 200 boxes. 1 — Ox tongues 15 cases 5 — 5 0 6 — — — 13 tins. Miscellaneous Canned Pork 1 case 1 — — — — 10 tins Crayfish 18 cases 1 — — — — Tomatoes 25 cases 1 — — — — Pears 50 cases 1 — — — — 7 tins Sardines — — — 20 cases. 1 — Tongues 51 cases 1 — — — — 54 tins Onions 342 bags 2 17 2 0 0 — — — do. 8,864 bags 1 - — — — Rice 28 bags 1 2 5 0 0 — — — Cocoa beans 1 bag 1 1 2 15 — — — 80 Zeebrugge-Harwich and Calais-Harwich Train Ferries. 108 special midnight and early morning visits were made by the Sanitary Inspectors. In addition, 3 inspections were made by day. At Bishopsgate Station. The total weight of fresh fruit and vegetables examined was 7,856 tons. This consisted of:— Belgian Pears, Beans, Cauliflowers, Carrots and Potatoes. Bulgarian Grapes. Dutch Gooseberries. French Peas. Hungarian Apricots, Grapes, Greengages, Gooseberries, Melons, Peaches and Plums. Italian Apples, Cherries, Chestnuts, Grapes, Lemons, Peaches, Pears, Plums, Strawberries, Beans and Peas. Spanish Apricots, Oranges, Plums and Potatoes. Austrian, Belgian and Jugo-Slavian Bacon, German, Hungarian, Italian, Jugo-Slavian and Roumanian Poultry and Italian Cheese were also examined. On 11th August a truck containing 50 cases of Belgian shrimps arrived in transit for Paris. Owing to some difficulty with the French authorities this remained at Bishopsgate Station until the 14th August, when it was returned to Zeebrugge. On 23rd August a consignment of Jugo-Slavian bacon was examined. Two sides of bacon were found to be incomplete by reason of the removal of gammon and hock respectively. This had been done in a very unskilful manner and was probably due to pilfering. As the sides were otherwise quite normal, they were not detained. Hungarian live carp were sent approximately each fortnight, and consignments of Belgian fresh fish and cooked shrimps occasionally arrived. The following foodstuffs were found to be unsound and were destroyed:— (a) ex Zeebrugge-Harwich Train Ferry. Tons. cwts. qrs. lbs. 640 Packages Apricots 3 7 0 6 4 Crates of Cauliflowers — 1 1 12 1 Basket of Cherries — — — 7 165 Bags of Chestnuts 3 10 0 0 2 Bags of Gooseberries — — 1 8 81  Tons. cwts. qrs. lbs. 313 Packages of Greengages 1 8 0 24 1 Package of Grapes — — — 21 647 Melons 1 0 3 6 1,746 Packages of Peaches 11 2 2 9 24 Packages of Pears — — — 24 133 Packages of Plums — 16 3 22 21 7 2 27 (b) ex Danish Steamer via Harwich. 50 Bags of Cabbages 1 15 0 0 Total 23 2 2 27 20 tons 7 cwt. 16 lbs. of maize were received into the Borough for conversion to cattle food. This was carried out under our supervision. 30 cases of sardines were detained at a Railway Depot in the Borough and reshipped to Genoa. 32 tons 16 cwt. 1 qr. 23 lbs. of tea sweepings were removed from a warehouse and released for chemical purposes. I had reason to investigate a case of gastro intestinal disturbance in a child which was alleged to be due to eating tomato puree from a tin purchased in the Borough. 7 samples of the same brand of tomato puree, which was of foreign origin, were examined and found to contain varying amounts of tin ranging from 2.3 to 5.2 grains per lb. and 0.15 to 0.25 grains of copper per lb. As this amount of tin is considered to be potentially deleterious to health I allowed the consignments to be surrendered. In all, 1,122 tins were surrendered from two shops in the Borough and the importers withdrew this particular consignment from the market. In July it was discovered that many vendors in the Borough were in the habit of adding sulphur dioxide as a preservative to minced meat, as much as 3,760 parts per million being found in one sample. This is, of course, a definite infringement of the Public Health (Preservatives, etc., in Food) Regulations. Apart from this, it is a practice to be condemned in that it tends to mask putrefaction and leads to a false sense of security. There were 16 prosecutions in a few weeks. All vendors of minced meat were circularised. Preservative in Minced Meat. 82 Unsound food seized by, or surrendered to, the District Sanitary Inspectors:— Fish. Tons. cwts. qrs. lbs. Bloaters — — — 10 Cod — 2 0 0 Cod Fillets — 2 0 0 Crayfish Tails 1 10 0 0 Dabs — 2 0 0 Eels — 1 2 0 Fish (assorted) — — 2 12 Haddock — — — 5 Plaice — 1 1 0 „ (frozen) 3 10 0 0 Salmon 1 10 0 0 „ (frozen) — 2 0 0 „ (smoked) — — — 10½ „ (tinned) — — 2 6 Salmon Tails (smoked) — — — 24½ Soles (Dover) — — — 7 „ (Lemon) 2 2 0 0 „ (Lemon—frozen) — 13 0 0 Meat. Bacon — 3 0 17 Beef (corned) — 19 0 14 „ (tinned) — 6 3 22 Chickens — — 2 10 Ham — — — 19½ „ (cooked) — 1 3 19 „ (tinned) — 3 3 20½ „ (tinned, cooked) — — 2 22 „ (spiced) — — 1 20 Mutton — — — 14 Tongue (tinned) — — — 6 Veal — — — 9 83 Fruit. Tons. cwts. qrs. lbs. Apples 1 16 2 24 Bananas — 5 2 0 Chestnuts 5 11 2 0 Grape Fruit 7 8 0 2 Grapes — 15 0 0 Melons 1 18 1 12 Mixed Fruit — — — 20 Oranges — 3 0 0 Peanuts — 1 0 0 Pears 9 11 1 7 Pineapples — 12 0 0 Plums — — 2 4 Raspberries 1 0 0 0 Strawberries 15 10 0 0 Tomatoes — 4 3 5 Miscellaneous. Cereals — 14 0 0 Condensed Milk — — 3 17 Dried Pears — 10 0 4 Fruit, Meat and Fish (Mixed) — 7 3 19 Gherkins - 3 0 0 Lemon Cheese — — — 22 Macaroni — — 3 6 Rice — 7 1 0 Rolled Oats — 3 1 15 Tinned Cucumbers - 17 2 12 Tinned Tomatoes — 10 2 0 Tomato Puree — 11 0 0 Vermicelli — — — 3½ Total 60 19 0 17½ 85 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to submit to you my eleventh Annual Report, dealing with the work carried out in the Borough Laboratory during the year 1934. During the year 1,725 samples were submitted to me for examination; these samples were made up as under:— Foods 1,521 1,614 Drugs 93 Public Health Department 93 Borough Engineer 11 Public Cleansing Officer 5 Private 2 1,725 The 1,614 samples of foods and drugs were purchased or taken by Inspectors under the Food and Drugs (Adulteration) Act, and consisted of:— Formal Samples 1,046 Informal Samples 568 1,614 Out of 1,046 formal samples 66 or 6.3 per cent. were adulterated and of 568 informal samples 8 or 1.4 per cent. were adulterated, making a total of 1,614 samples out of which 74 samples or 4.6 per cent. were adulterated. 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. 86 Table A. Nature. Number of Samples. Number Genuine. Number Adulterated Percentage Adulterated Preservative Found. Ammoniated Tincture of Quinine 7 6 1 1.4 — Arrowroot 6 6 — — None Boracic Powder 6 6 — — — Borax 6 6 — — — Boric Ointment 3 3 — — — Butter 143 143 — — None Cake 3 3 — — None Camphorated Oil 6 6 — — — Castor Oil 6 6 — — — Cheese 3 3 — — None Citric Acid 6 6 — — — Cocoa 3 3 — — — Coffee 9 9 — — — Condensed Milk 3 3 — — None Corn Flour 3 3 — — None Cream 12 12 — — None Cream of Tartar 6 6 — — — Dried Fruit 18 18 — — 10 Dried Milk 3 3 — — None Epsom Salts 6 6 — — — Flour 9 9 — — None Glauber's Salt 3 3 — — — Glycerine 9 9 — — — Ground Ginger 10 10 — — None Honey 4 4 — — None Horse Radish and Beetroot 1 1 — — None Jam 3 3 — — None Jelly 3 3 — — 3 Lard 9 9 — — None Margarine 147 147 — — None Milk 1,005 959 46 4.6 None Milk Sugar 6 6 — — — Minced Meat 35 19 16 45.7 16 Olive Oil 6 6 — — — Pearl Barley 10 8 2 20.0 2 Pepper 16 14 2 12.5 None Rice 6 6 — — None Sal Volatile 3 3 — — — Sausage 12 11 1 8.3 1 Separated Milk 5 5 - - None 87 Table A— Continued. Nature. Number of Samples. Number Genuine. Number Adulterated Percentage Adulterated Preservative Found Sodium Bicarbonate 6 6 - - - Spirits 13 12 1 7.7 - Sugar 3 3 - — None Sweets 7 7 - — 1 Sweet Spirit of Nitre 5 2 3 60.0 — Tea 6 6 — — — Vinegar 11 9 2 18.2 None Zinc Ointment 3 3 - - - 1,614 1,540 74 4.6 33 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. Examinations Miscellaneous Samples Total Samples 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 1933 1,513 37 2.4 20 112 1,645 1934 1,614 74 4.6 — 111 1,725 It will be seen that there has been a considerable increase in the percentage of adulteration. Offences were committed in 100 cases. These were dealt with as shown below:— Adulterated. Other offences. Total. Formal Proceedings 37 8 45 Caution 26 3 29 No action 3 - 3 Informal 8 10 18 74 21 95 Legal Proceedings 88 In addition to the above, 5 samples of milk failed to comply with the requirements of the L.C.C. contract; these cases were referred to the L.C.C. Milk. Fines and costs totalled £143 0s. 6d. 1,005 samples of milk were analysed. Of these 46 or 4.6 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. 1925. 1926. 1927. 1928. 1929. 1930. 1931 1932. 1933. 1934. Number of samples. 825 809 854 923 923 900 881 974 928 1005 Percentage of adulteration. 2.9 1.6 1.4 4.1 3.9 2.2 3.0 2.6 2.2 4.6 Table D shows the extent of the adulteration and the action taken in each case. Table D. Number. Deficient in Fat per cent. Deficient in Solids-notfat per cent. Minimum added water per cent. Hortvet. Action: Result of Proceedings. B 8 6.3 - - Vendor cautioned. B 9 17.7 — — Dismissed on payment of 5s. costs. B 10 17.3 — - Dismissed on payment of 5s. costs. H 15 14.7 — — Vendor cautioned. H 16 7.0 — — Vendor cautioned. J 12 - 6.7 4.9 Discharged under the Probation of Offenders Act. Vendor paid £3 3s. costs. K 20 - 12.2 - Discharged under the Probation of Offenders Act. Same vendor as J 12. X 113 — 5.2 — Vendor fined £1 with £2 2s. costs. X134 — 6.4 — No action taken. L 30 12.3 — — Vendor cautioned. C 25 3.0 — — Vendor cautioned. N 6 — 4.6 4.9 Withdrawn on payment of £2 2s. costs. 89 Table D— continued. Number. Deficient in Fat per cent. Deficient in Solids-not fat per cent. Minimum added water per cent. Hortvet. Action: Result of Proceedings. X 141 - 5.3 4.9 Discharged under the Probation of Offenders Act. Vendor paid £2 2s. costs. D 65 — 8.6 10.6 No action. F 33 18.0 — — Vendor cautioned. D 73 3.3 10.5 12.6 Vendor fined 10s. with £3 3s. costs. F 51 4.7 — — Vendor cautioned. B 39 15.7 — — Vendor fined £1 with £1 1s. costs. B 41 6.0 — — Vendor cautioned. B 46 9.3 — - Vendor cautioned. P 51 5.0 — — Vendor fined £1 with £2 2s. costs. H 57 4.0 — — Vendor cautioned. H 74 17.0 - - Discharged under the Probation of Offenders Act. Vendor paid £2 2s. costs. L 60 6.0 — - Vendor cautioned. X 4 10.0 — — Vendor cautioned. X 12 — 8.2 7.0 Vendor fined £2 with £3 3s. costs. X 14 3.3 4.7 4.2 Vendor fined £2 with £3 3s. costs. H 3 5.0 - - Vendor cautioned. H 5 8.3 — — Vendor cautioned. H 7 6.7 2.6 — Vendor cautioned. X 37 5.0 2.5 1.7 Vendor fined £1 with £2 5s. costs. X 40 4.7 — — Vendor cautioned. D 5 — 8.6 — Sample purchased informally. D 2 4.7 — — Vendor cautioned. X 42 - 3.3 2.8 Discharged under the Probation of Offenders Act. Vendor paid £3 3s. costs. X 43 - 3.3 2.8 Discharged under the Probation of Offenders Act. Vendor paid £3 3s. 0d. costs. X 44 - 3.2 2.8 Discharged under the Probation of Offenders Act. Vendor paid £3 3s. costs. H 37 4.0 — - Vendor cautioned. J 83 6.0 — — Vendor cautioned. T 32 4.0 — — Vendor cautioned. X 46 86.7 — — No action. L 84 — 7.5 9.8 Vendor cautioned. C 88 — 6.9 8.9 Dismissed on payment of £4 4s. costs. X 66 — 6.2 8.3 Vendor fined £2 with £2 2s. costs. E 83 - 6.6 9.2 Discharged under the Probation of Offenders Act. Vendor paid £2 2s. costs. D 31 10.0 - — Vendor cautioned. 90 The Value of the Hortvet Determination. The Sale of Milk Regulations presume that when the percentage of solidsnot-fat in a milk is less than 8.5 the sample contains added water and the defendant is required to prove the contrary in order to avoid conviction. According to this standard 8.5 parts of solids-not-fat represent 100 parts of milk. If a sample contained half the quantity, that is, 4.25 parts of solidsnot-fat, that would represent half the sample, or 50 parts of milk, the remaining 50 parts being added water. On this principle by means of a simple formula the content of added water is calculated. The same figure represents the deficiency in solids-not-fat. Prior to the introduction of the Hortvet such a sample would have been reported as 50 per cent. deficient in solids-not-fat, representing the presence of at least 50 per cent. of added water. Milk may, for various reasons, be naturally deficient in solids-not-fat, so that it is necessary for the analyst to be able to differentiate between naturally abnormal milk and milk to which water has been added. The milk of a single cow and occasionally the mixed milk of a herd may fall below the standard. In Stepney the great proportion of the milk sold is previously bulked and pasteurised, so that it is extremely unlikely that the composition of the milk would be below the minimum owing to natural causes. A very usual defence in the past has been the production of figures showing or purporting to show considerable deficiencies in solids-not-fat in the milk of herds of cows under natural conditions. There was then only one method which was really helpful in confirming the presence of added water as suspected by the deficiency of solids-not-fat. This method depends on the fact that the constituents of the milk solids, lactose, proteins and ash (mineral compounds after ignition) are present in certain proportions in normal milk. It was found that in the case of milk naturally deficient in solids-not-fat the ratio did not hold good owing usually to a deficiency of lactose, but in watered milk the constituents remained in the usual proportions. This method was used here in addition to the ordinary analysis in cases where the deficiencies of solidsnot-fat were small. The introduction of the freezing point method has cleared the position considerably. The method is based on the fact that genuine milk from healthy cows, whatever its chemical composition, freezes at a point which is within a known range. The freezing point of milk which is naturally deficient in solids-not-fat will come within this range so that it is 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 if it is outside the freezing point range. 91 The apparatus now in general use by many public analysts is the Hortvet Cryoscope. The Council of the Society of Public Analysts has approved the freezing point determination as a means of detecting and determining added water in milk and has stated that for administrative purposes the freezing point should be determined by the Hortvet apparatus. With this instrument the freezing point of milk varies between -0.530° C. and -0.565° C. A depression of the freezing point less than 0.53° C. shows the presence of added water, and calculation on this basis figure gives the minimum amount of added water present. It does not of necessity show the whole of the added water as milk with a freezing point of -0.565° C. can be watered down to -0.530° C. without detection. On an average the minimum added water figure is two to three per cent. below the truth. Generally the freezing point gives a more accurate basis of calculation than that based on the solids-not-fat, as its range of variation from the average is less than the range of variation from the average in the case of solids-not-fat. In the latter case the range of variation from a basis figure of 8.5 per cent. (which is well below the average) is greatly to the advantage of the dishonest milkman. In Stepney the solids-not-fat range from 9.1 per cent. at the most to the legal minimum of 8.5 per cent., so that a sample of milk containing 9.1 per cent. of solids-not-fat could be watered down to 8.5 per cent. and would satisfy the legal minimum; a sample so treated would contain 6.6 per cent. of added water. Similarly in the case of the freezing-point a sample diluted from -0.565° C. to -0.530° C. would contain 6.2 per cent. added water, so that it would at first appear that both methods give similar results for Stepney milk. This is not entirely so, however, as there is no relation between the solids-not-fat and the freezing-point. It would in fact be possible to obtain the following conditions, which will show that it is to some extent a matter of chance as to whether either method will indicate the presence of appreciable amounts of added water. In order to show the significance of the Hortvet figure, combinations of the extreme variations of the solids-not-fat in Stepney milk have been related to the extreme variations of the freezing-point. Table G. Original Milk. After dilution. Solids-not- fat per cent. Freezing Point. Solids-not- fat per cent. Minimum added water per cent. Freezing Point Minimum added water per cent. Actual water content per cent. 1 8.50 -0.565°C. 7.97 6.2 -0.530°C. None 6.2 2 8.50 -0.530°C. 7.97 6.2 -0.497°C. 6.2 6.2 3 9.10 -0.565°C. 8.54 None. -0.530°C. None. 6.2 4 9.10 -0.530°C. 8.50 None. -0.495°C. 6.6 6.6 92 In the first case the solids-not-fat shows the presence of at least 6.2 per cent. added water, while the freezing point shows none and points to the possibility of the deficiency being due to natural causes. In the second case the maximum of added water is obtained in both methods of calculation. In the third case no added water is indicated by either test, although 6.2 per cent. is actually present. In the fourth case the solids-not-fat figure satisfies the Regulations though 6.6 per cent. of added water is shown to be present by the freezing point. The last example shows the necessity of carrying out freezing point determinations although the sample is apparently satisfactory from the chemical analysis. Recently convictions have been obtained on the freezing point only, and this figure is being accepted at the Thames Police Court. There is one difficulty, however. In the case of any dispute as to the figure, the third part of the sample could not be examined as the freezing point determination is only correct when carried out on fresh milk. The above figures show that the detection of about 5 per cent. of added water may be a matter of chance. At any rate, the full amount present would rarely be detected, and, in my opinion, in those cases where added water is definitely detected the amount should be calculated from an average and not from a minimum figure. The figures also show why the calculation of added water by both methods is seldom likely to give the same figure. Although wide variations are shown in the above hypothetical figures, on an average the disagreement is not great. Out of 20 adulterated and poor quality samples examined during the year, 11 samples gave by the Hortvet calculation from 0.3 to 2.6 per cent. higher, and 9 samples from 0.1 to 1.8 per cent. lower than the figure calculated from the 8.5 basis. The latter samples were mainly obtained in those months in which the solids-not-fat is low, that is, nearer to the minimum of 8.5 per cent. Both methods of calculation, of course, give only the least amount of added water present, the Hortvet method having the great advantage of proving that the milk is definitely adulterated and not naturally deficient in solids-not-fat. Notes on Table D. In the case of sample X 113, which contained 5.2 per cent. of added water, the defence produced a certificate of analysis showing a figure of 8.4 per cent. for the solids-not-fat and stating that the sample was "of poor quality and doubtful purity." 93 The "third part" was therefore sent to the Government Chemist, who certified the sample to contain 7 per cent. of added water. 55 samples were taken on delivery from farmers supplying a wholesaler. Out of these, 6 samples were adulterated and 6 were poor quality samples slightly deficient in solids-not-fat. The 6 adulterated samples are numbers X 4, X 12, X 14, H 3, H 5 and H 7 in the table. In the case of X 12 and X 14 the Hortvet determination proved that this farm milk had been watered and was not naturally deficient in solids-not-fat; the other sample, H 7, was too sour for the determination to be made. Adulterated samples X 113 (referred to above) andX 134 were taken from the same retailer. X 113 consisted of loose milk and proceedings were taken. X 134 consisted of sterilised bottled milk so no action was taken against the retailer, but a further sample, X 141, was taken on delivery from the wholesaler. This sample was adulterated and proceedings were taken, the defendant paying costs. A further sample of sterilised bottled milk, D 65, taken from the same retailer was again adulterated; no action was taken, this sample being followed up by sample D 73, taken on delivery from the same wholesaler. This sample was also adulterated and a conviction was obtained. The defence put forward was that steam condensed in some of the bottles during the preliminary sterilisation, and it was stated that in future the bottles would be sterilised with the open end downwards. Later an informal sample of sterilised bottled milk, D 5, supplied by the same vendor was found to be adulterated, and three formal samples, X 42, X 43 and X 44 were obtained from three shops supplied by him, one of these samples being taken on delivery. The samples were all adulterated. Proceedings were taken and the vendor paid costs in each case. The business has now been given up. 94 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 81 3.51 8.77 12.28 February 81 3.51 8.76 12.27 March 73 3.60 8.74 12.34 April 68 3.66 8.70 12.36 May 85 3.52 8.76 12.28 June 70 3.52 8.77 12.29 July 148 3.50 8.68 12.18 August 68 3.65 8.67 12.32 September 81 3.76 8.69 12.45 October 92 3.76 8.78 12.54 November 70 3.82 8.83 12.65 December 88 3.66 8.77 12.43 Whole Year 1 005 3. 61 8.74 12.35 Legal Minimum - 3.00 8.50 - The best quality milk has been supplied in November as is usual in Stepney. During the last eleven years the supply has been the best nine times in November and twice in October. This year the lowest figures for solidsnot-fat were obtained in July and August, July having the lowest percentage of total solids; this may have been due to the extremely dry summer. Usually the quality of the milk supply in Stepney is poorest in the late spring months. The yearly averages are given in the following table:— Table F. Year. Fat per cent. Solids-not-fat per cent. Total Solids per cent. 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 3.62 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 1933 3.63 8.74 12.37 1934 3.61 8.74 12.35 95 The average composition of the milk supply remains much the same, and there is room for improvement in the quality. Samples of milk which are slightly below the legal standard of composition are reported as " Genuine, poor quality, slightly deficient in solids-not-fat." During the year 17 samples having a percentage of solids-not-fat varying between 8.25 per cent, and 8.40 per cent. have been classified as "Poor Quality." Poor Quality Milk Samples In all cases where a determination of the freezing point could be made the samples were found to be adulterated. 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. The presumptive standard requires a minimum of 8.5 per cent. of solidsnot-fat. A sample of milk below this standard is not necessarily adulterated and milk above the standard is not necessarily genuine. At the completion of this year it is intended to return all samples of milk as adulterated whether containing slightly less than or more than the standard of 8.5 per cent. solids-not-fat where the determination of the freezing point has shown that the sample definitely contains added water. This will have the effect of increasing the percentage of adulteration and diminishing the number of poor quality samples. As has been explained earlier, the freezing point determination may not always detect added water, even when there is a deficiency of solids-not-fat, caused bv added water. 39 samples of milk were taken on delivery for chemical examination from six institutions in the Borough. One sample, D 2, was 4.7 per cent. deficient in fat and the contractor was cautioned. The average composition of the milk was : Fat, 3.77 per cent., and solids-not-fat, 8.80 per cent. This is good quality milk and considerably better than the average Stepney supply. Hospital, etc.. Samples. Of the above, two samples, B 54 and B 55, satisfied the requirements of the Sale of Milk Regulations but failed to comply with the conditions of the L.C.C. contract, which states that the milk must contain 3.25 per cent. of milk fat, except in the month of March, when this figure is lowered to 3.0 per cent. According to these conditions the samples B 54 and B 55 were both 4.6 per cent. deficient in fat. 96 School Samples. 61 samples of milk were taken on delivery at 49 schools in the Borough. All the samples were genuine. The average composition of the samples was: Fat, 3.43 per cent., and solids-not-fat, 8.70 per cent. These figures are lower than the average figures obtained for the Borough supply. Three samples, P 57, H 52 and H 54, were 3.1, 3.1 and 4.6 per cent, deficient in fat respectively according to the conditions of the L.C.C. contract. The Chemical Treatment of Food. Out of 1,521 samples taken under the Act, 1,490 were examined for preservatives and 33 samples were found to contain sulphur dioxide. Out of 38 miscellaneous samples examined, 20 contained sulphur dioxide and one sample contained hydrogen peroxide. Boron compounds, so prevalent in the past in butter and cream, and salicylic acid in jam and fruit wines have disappeared; formalin is still occasionally detected in milk. The Regulations allow no other preservatives than prescribed amounts of sulphur dioxide or benzoic acid to be present in certain foods. In the main, the foods in which preservative is allowed are fruit pulp, jam, sugar, etc., where without preservative at the worst fermentation or mould growth could take place, but in meat, where decomposition or putrefaction could take place, sulphur dioxide is prohibited. Details of a large number of cases in which sulphur dioxide was detected in minced meat are given in this report. The sulphur dioxide in itself is not harmful, as when the meat is cooked practically all the preservative is driven off; the danger is that the preservative, which is sprinkled in powder form over the meat, is added to mask evidence of decomposition and to keep the meat longer than it should be kept, in order to be sold. The powder does not come in contact with all of the meat which is in a state of incipient decomposition. Some of the samples of minced meat examined were almost black and obviously old meat; generally the amount of preservative found in these samples was small, as the preservative gradually disappears. The amount found, therefore, may only represent a small part of the quantity originally added. In Germany the following preservatives will shortly be allowed in use : Ethyl and propyl esters of p-hydroxybenzoic acid, including their sodium compounds and mixtures, hexamethylene-tetramine (hexamine), hydrogen peroxide, benzoic acid, boric acid, formic acid and sulphur dioxide. Packed preserved food must, however, be labelled "chemically preserved." Apart from the preservation of food, the great excuse for the chemical treatment of food is that the public demands a white product and in order to fulfil this demand bleaching agents, etc., must be used. Sulphur dioxide and hydrogen peroxide have the dual quality of preserving and bleaching, the golden 97 colour of preserved sultanas is due to the bleaching action of sulphur dioxide; herring and tripe are bleached with hydrogen peroxide; sulphur dioxide has been used to bleach ground ginger, pepper, pearl barley and starch. It might seem that in order to get a white product it would be better to bleach pepper,flour, etc., rather than grind a great deal of the goodness out of it, but there is always the possible action of the bleaching agent on the vitamins and other constituents to be considered. The present tendency appears to be to use the bleaching agent and then to get rid of the excess before the product is marketed. (See Pepper and Herrings in this Report.) Flour is either bleached or "improved" by the use of such chemicals as nitrogen peroxide, chlorine, nitrogen trichloride, benzoyl peroxide and potassium persulphate. Apart from extraneous dirt, etc., the colour of flour is due to the presence of the vital food factor carotene, which is yellow in colour, and the object of the bleaching is to convert the yellow carotene into a colourless compound. The "polishing" of rice removed the outer layer containing the vitamins from the grain and caused disease in those countries where rice is the main food. Polished rice is rarely met with, but pearl barley is still "faced" with talc in order to improve its appearance. Foods are often treated with fumigants of a noxious character. Recently, unripe fruit has been exposed to certain gases in order to change the colour of the skin from green to yellow and give the impression that the fruit is ripe. The yellow colour of butter is an index of its vitamin content but this colour can be imitated by the use of dyes. 143 samples of butter were examined. All the samples were genuine and free from preservatives and prohibited dyes; 24 samples contained a slight amount of artificial colouring matter. Butter. Two samples of condensed milk and one sample of dried milk were genuine and free from preservative. 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. One sample of machine-skimmed condensed milk was slightly deficient in total milk solids and the tin contained slightly less condensed milk than that required to be equivalent to the number of ounces of standard skimmed milk declared on the label. Condensed and Dried Milk. 98 Two samples of milk food contained less than 70 per cent. of dried milk and therefore did not come within the scope of the Dried Milk Regulations. Cream. 12 samples of cream were genuine and free from preservative and thickering substances. The percentage of milk fat in 11 of the samples varied from 45.1 to 54.4, with an average of 50.9 per cent. The remaining sample described as Coffee Cream, contained 26.7 per cent. of fat and is cpmparable with the Single Cream grade containing 25 per cent. of milk fat suggested by the Reorganisation Commission for Milk, 1933. The average fat content of all samples was 48.9 per cent. Dried Fruit. 18 samples of dried fruit examined were genuine. 10 of the samples contained preservative in amount less than that permitted by the Preservative Regulations. 5 samples of sultanas contained 333, 288, 170, 122 and 227 parts sulphur dioxide per million respectively. 3 samples of dried apricots contained 992, 896 and 456 parts sulphur dioxide per million respectively. 1 sample of raisins contained 256 parts sulphur dioxide per million, and 1 sample of mixed peel contained 102 parts sulphur dioxide per million. 3 samples of prunes, 2 samples of raisins, 2 samples of mixed peel, and 1 sample of sultanas were free from preservative. Margarine. 147 samples examined were genuine and free from preservative and prohibited colouring matter. 130 of the samples were artificially coloured. Offences with regard to labelling were committed in 11 cases. Minced Meat. 35 samples were examined. of these 16 contained preservative. Sulphur dioxide is prohibited in meat. N 16. Contained 1,570 parts sulphur dioxide per million. Vendor fined £l. D 59. Contained 780 parts sulphur dioxide per million. Vendor fined £2 with £2 2s. 0d. costs. M 60. Contained 30 parts sulphur dioxide per million. Vendor fined £2 with £1 Is. Od. costs. M 61. Contained 1,290 parts sulphur dioxide per million. Vendor fined £2 with £1 Is. 0d. costs. 99 M 62. Contained 330 parts sulphur dioxide per million. Vendor fined £1 with 10s. 6d. costs. X 152. Contained 510 parts sulphur dioxide per million. Vendor fined £2 with £1 Is. 0d. costs. X 153. Contained 2,180 parts sulphur dioxide per million. Vendor fined £3 with £2 2s. 0d. costs. X 154. Contained 550 parts sulphur dioxide per million. Vendor fined £2 with £2 2s. 0d. costs. X 171. Contained 1,380 parts sulphur dioxide per million. Vendor fined £3 with £2 2s. 0d. costs. X 172. Contained 173 parts sulphur dioxide per million. Dismissed under the Probation of Offenders Act. Vendor paid £2 2s. Od. costs. X 180. Contained 30 parts sulphur dioxide per million. Vendor fined £1 with £l Is. 0d. costs. X 183. Contained 30 parts sulphur dioxide per million. Vendor fined £1 with £1 Is. 0d. costs. X 184. Contained 370 parts sulphur dioxide per million. Vendor fined £2 with £2 2s. 0d. costs. X 186. Contained 170 parts sulphur dioxide per million. Vendor fined £l with £1 Is.0d. costs. L 45. Contained 30 parts sulphur dioxide per million. Vendor fined £2 with £2 2s. 0d. costs. L 46. Contained 3,760 parts sulphur dioxide per million. Vendor fined £5 with £2 2s. 0d. costs. In the case of the last sample the vendor stated that it was sausage meat and that it was not for sale. According to the Preservative Regulations "Sausages and sausage meat containing raw meat, cereals and condiments" may contain 450 parts sulphur dioxide per million if the presence of the preservative be declared by notice or label. The sample, however, consisted of ordinary minced meat. 10 samples of pearl barley were examined. Of these, 2 samples were found to be adulterated. M 91 (Informal). Contained 14 parts sulphur dioxide per million and 0.3 per cent. of talc. M 92. Same vendor as M 91. Contained 12 parts sulphur dioxide per million and 0.3 per cent. of talc. Pearl Barley. 100 Barley water is used extensively for invalids and children. In addition to being an adulterant, the presence of talc (mineral "facing"), which is used to procure an artificial whiteness, is unnecessary and objectionable. Pepper. Out of 16 samples of pepper examined, 2 were found to be adulterated, both samples containing foreign starch. Owing to information from other parts of the country that pepper which had been found to contain sulphur dioxide originated from a Stepney factory, samples were taken from this firm but no sulphur dioxide was found. It was admitted, however, that sulphur dioxide was used but that it was removed before the pepper was sent out; one consignment had, however, been despatched before the treatment had been carried out. H 49 (Informal). Contained 40 per cent. potato starch. D 17 (Same vendor as H 49). Contained 40 per cent. potato starch. Vendor cautioned. X 138, X 139, X 140 (Formal factory samples). Sulphur dioxide absent. Flour. 9 samples of flour examined were genuine and free from preservative. 6 of the samples contained traces of potassium persulphate. Sausage. 12 samples of sausage were analysed. Of these, 1 sample was found to be adulterated. The water content varied between 52.2 per cent, to 60.5 per cent, with an average of 55.1 per cent. H 26 (Informal). Contained 136 parts sulphur dioxide per million without notice or label. Sausage may contain not more than 450 parts sulphur dioxide per million if the presence of this preservative be declared by notice or label. No further formal sample was taken in the above case as a notice was afterwards shown. Spirits. 9 samples of whisky, 3 samples of rum and 1 sample of brandy were examined. Of these, 1 sample of whisky was adulterated. X 30. Contained 2.5 per cent. excess water. Dismissed under the Probation of Offenders Act. Vendor paid £5 5s. 0d. costs. Whisky, brandy, rum or gin must not be reduced to more than 35 degrees under proof, i.e., 65 per cent. proof spirit or 37.2 per cent.alcohol by volume. 101 It was stated that the sample was a proprietary brand whisky which was always sent out at a higher strength than the Government limit so that more water than that shown above had actually been added. 11 samples were analysed and 2 of these were adulterated. All the samples were bought as vinegar; 9 consisted of artificial vinegar, that is, dilute acetic acid coloured with caramel and 2 consisted of fermented vinegar. The 2 fermented vinegars contained 45 parts and 30 parts sulphur dioxide per million respectively. Although vinegar is not included in the list of foods in which stated amounts of sulphur dioxide are permitted, the Regulations state that a food may contain any preservative necessarily introduced by the use of any of these foods, with a reservation as to the amount allowed in the final product. Malt, glucose, starch, finings, etc., may be used in the manufacture of vinegar, and some of these are included in the list of foods containing a permitted amount of preservative. D 92 (Informal). 7 per cent.deficient in acetic acid. D 7 (Same vendor as D 92). 7 per cent. deficient in acetic acid. Vendor cautioned. There is no legal standard for vinegar. The Local Government Board in 1911 suggested definitions for vinegar, malt vinegar and artificial vinegar and convictions have been obtained in cases where samples did not comply with these definitions. Recently the Society of Public Analysts and the Malt Vinegar Brewers' Federation have agreed on standards on similar lines to those suggested by the Local Government Board. In addition, the agreement stipulates that artificial or imitation vinegar shall be labelled as such, and that when a purchaser demands vinegar he shall be supplied with malt vinegar unless notified otherwise. Vinegar. Of 93 drugs examined, 4, or 4.3 per cent., failed to comply with the requirements of the British Pharmacopoeia and were returned as adulterated. Ammoniated Tincture of Quinine. M 81 (Informal). 20 per cent, deficient in ammonia. A further formal sample from the same vendor was satisfactory. Sweet Spirit of Nitre. H 46 (Informal). 20 per cent. deficient in ethyl nitrite. H 47 (Informal). 44.8 per cent. deficient in ethyl nitrite. H 61 (Same vendor as H 47). 63.2 per cent. deficient in ethyl nitrite. The vendor was specially cautioned. Drugs. 102 A formal sample obtained from the vendor of H 46 was satisfactory. None of the above samples of sweet spirit of nitre complied with the limit of acidity. Poor Quality Samples. These include samples of inferior grade or of a doubtful character and are 42 in number. 17 of these consisted of milk. Other poor quality samples were: 9 flour (contained persulphates), 5 margarine and 3 butter (contained a slight excess of water), 2 rice (contained 0.24 and 0.16 per cent, talc respectively), 1 condensed milk (slightly deficient in total milk solids), 1 glycerine (contained excess of iron), 1 glycerine (slightly deficient in glycerine), 1 camphorated oil (4.6 per cent, deficient in camphor), 1 ammoniated tincture of quinine (4.4 per cent, deficient in ammonia), and 1 sale volatile (9.5 per cent, deficient in ammonia and 7.5 per cent, deficient in carbon dioxide). Offences other than Adulteration Margarine.—In 11 cases the vendor had not complied with the requirements of the Act with regard to labelling. In 2 of these cases the vendor was cautioned, in the remaining cases the sample had been purchased informally. Milk.—In 4 cases for bottling milk other than on registered premises the defendants paid a fine of £1 with £l Is.0d. costs, a fine of £1, a fine of £2 with £2 2s. 0d. costs and 5s. costs respectively. In 1 case the vendor, who was not registered, was fined £2 with £1 Is. Od. costs. In 1 case for selling separated milk without labelling the churn the vendor paid £1 Is. Od. costs. In 1 case for omitting the name and address on the vehicle and receptacle the defendant was fined Is. with £2 2s. 0d. costs. In 1 case for supplying pasteurised milk (hospital contract) in unlabelled churns the vendor was cautioned. Minced Meat.-—For refusing to sell minced meat a fine of £10 with £5 5s. 0d. costs was imposed. Horse Radish Sauce.—The sauce was observed to be highly coloured. It was stated by the manufacturers that the sauce contained three parts of beetroot to one part of horse radish and they agreed to label the product "Horse Radish and Beetroot Sauce." When a sample was later submitted 103 for analysis it was found that the sauce contained less than 10 per cent, of beetroot, the whole being dyed the requisite colour. (Horse radish contains much starch, beetroot is free from starch.) Public Health Department.—92 samples submitted by the Public Health Department comprised the following:— Preservatives— 33 samples were examined for the presence of preservative. Of these, 32 samples either contained less preservative than the amount permitted by the Regulations or were free from preservative. These satisfactory samples consisted of: Sultanas (23), raisins (7), and tinned apricots (2). One sample of sultanas containing 768 parts sulphur dioxide per million was unsatisfactory. 3 samples of pickling liquid and 2 samples of "rollmops" (bottled herring) were examined for hydrogen peroxide; hydrogen peroxide was present in 1 sample of pickling liquid. The examination of these samples followed a complaint from a packer that he could not sell his " rollmops " as his competitors had a whiter product which he said was artificially produced. The sliced herrings are dipped in a pickling liquid containing hydrogen peroxide and when sufficiently bleached, drained, and bottled in a liquid free from hydrogen peroxide. The bleaching agent could not therefore be detected in the finished product. (In a recent report from Western Australia it was stated that tripe had been examined which had been bleached and " plumpsd " with sodium peroxide solution forming a whiter product and increasing the weight so that 20 lbs. of tripe produced at least 25 lbs. after treatment.) Fit for Food— 21 samples examined with regard to their fitness for human consumption were:— Unsatisfactory Samples: Machine Skimmed Condensed Milk (6), Evaporated Milk (3), Rolled Oats (foreign origin), and Sage. Satisfactory Samples: Seedless Raisins (2 , Macaroni Sticks (2), Rolled Oats (2), Macaroni Shapes, Evaporated Milk, Greek Olives and Tea. The sample of tea referred to was analysed owing to a complaint that the tea contained glass and dust. The label stated "This tea is not dust but a small-leaf tea out of the best teas and specially blended for Miscellaneous Samples 104 quick brewing." There was no firm's name on the packet. No glass was present; the foreign particles amounted to 0.2 per cent., some of these particles consisting of vitreous pieces of resin. The tea also contained numerous small brown balls made up of tea hairs, "flower of tea," which consists of tea hairs from the leaf buds. This kind of tea is rarely seen to-day. Export— 10 samples for export were satisfactory. These Were: Olive Oil (9), and Meat Extract. Metals—- 13 samples of tinned foods were examined for metallic contamination. Unsatisfactory samples were: 7 samples of Tinned Tomato Puree (foreign origin) containing 5.2, 3.1, 2.4, 2.3, 2.9, 2.4 and 2.5 grains tin per pound respectively, and 0.25, 0.25, 0.21, 0.25, 0.18. 0.18 and 0.15 grain copper per pound respectively. There is no legal limit for tin so that samples are judged on the L.G.B. Report No. 7, 1908, which states that "the presence of tin in quantities approaching 2 grains to the pound may be taken to signify that the food has become potentially deleterious to health." Copper is prohibited when present as a colouring matter, but in any other form presumably 0.5 grain per pound, as suggested by a Departmental Committee in 1903, may be allowed; traces of copper are present naturally in certain vegetables. Satisfactory samples comprised: Tinned Sardines (3), examined for lead, Tinned Sardines (2), examined for tin and lead, and Tinned Tomatoes, examined for tin. Appreciable quantities of lead have recently been found in tinned sardines and the source of contamination has been traced to the grills on which the fish are cooked, the metal used in tinning the grills containing a considerable amount of lead. There is no legal limit for lead in food, though the British Pharmacopoeia requires drugs to comply with limits of lead ranging from 0.3 to 25 parts per million. Water—- 4 samples of Water were examined. Of these, 2 samples examined for purity Were satisfactory and 2 samples of drainage water were free from sewage. Formalin-— 3 samples of Formalin complied with the requirements of the specification. 105 Cause of Illness— 1 sample of Pickles, said to have caused illness, was free from deleterious ingredients or impurities. Other Samples— 1 sample of Surgical Spirit consisted of methylated spirit (92 per cent, alcohol by volume) containing 5 per cent. of castor oil. Half a pint of the spirit contained a medicinal dose of castor oil. There has been much drinking of this spirit by certain enthusiasts. The methylated spirit is purer than the dyed variety and the castor oil may be separated roughly by adding water or milk and skimming off the oil. 1 sample of "Sylvite" consisted of a mixture of yellow mercuric oxide in excess to which weak nitric acid solution had been added. The two-ounce bottle contained 24 grains of mercuric nitrate in solution; the liquid was therefore highly poisonous. The bottle was not labelled. Mercuric nitrate is not included in the list of scheduled poisons under the old Act. This list is now in process of revision under the new Pharmacy and Poisons Act, 1933. 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 was satisfactory the chlorine content being less than 5 parts per 100,000. Borough Engineer.—-11 samples comprised: Carbolic Powder (4), Cold Bitumen (4), and Bathing Pool Water (3). Public Cleansing Officer.—2 samples of Carbolic Powder examined were unsatisfactory; a further 3 samples of Carbolic Powder under a new contract were satisfactory. Private Samples.—1 sample of Sterilised Milk (contained a small quantity of paraffin) and 1 sample of Aluminium Sulphate were analysed for private purchasers. I desire again 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. April, 1935. 107 VI.—PREVALENCE OF, AND CONTROL OVER, DISEASE. A—Notifiable Diseases. 1,750 notifications (other than of tuberculosis) were received, or 687 less than in the previous year. This is good news, but it is very disappointing to note that Diphtheria did not share in this decrease. The notification rate for the whole Borough was 8.1 per 1,000 of the population. Notifications. 814 cases were notified during the year, or 569 less than in the previous year. 808 of these cases were removed to hospital. There is little to report; the disease showed its usual mild form. The death rate for the whole Borough was .01 per 1,000 of the population. 45 cases were wrongly diagnosed; there were 4 deaths, all in children under 5 years of age; the case mortality was .52 per cent. Scarlet Fever. 666 cases were notified during the year, or only 2 less than in the previous year. 663 of these cases were removed to hospital. The death rate for the whole Borough was .1 per 1,000 of the population. 88 cases were wrongly diagnosed; there were 22 deaths of which 13 were in children from 1 to 5 years of age, and 9 in children between the ages of 5 and 14; the case mortality was 3.8 per cent. Last year the case mortality was 2.2 per cent. During the year a new agreement was drawn up with the London County Council with regard to the arrangement whereby bacteriological specimens are examined at the Mile End Laboratory. This new agreement arranged for the transmission by post to the general practitioners of new swabbing outfits in exchange for those swabs sent for examination. In this way it is certain that every general practitioner is kept supplied with outfits. At the same time the requisition form, which each doctor completes on sending a swab for examination, was simplified and was amended to include the examination of swabs for the purpose of discovering carriers of virulent bacilli. In order that too much encouragement should not be given to the diagnosis of diphtheria on swab results, the following is printed on the reverse side of the amended requisition form:— " One or more negative swabs do not necessarily exclude the possibility of diphtheria, and therefore " (1) Anti-toxin should be given at once to all cases which are clinically suspicious without waiting for the bacteriological report; " (2) Cases which are clinically definite should not be kept at home until the result of the bacteriological examination is reported but should be certified and removed to hospital in the usual way." Diphtheria. 108 A circular letter was sent to all the doctors practising in the Borough calling their attention to all these amendments. It is hoped that these hints will lead to the immediate treatment of all cases of diphtheria and so will give them the best chance of complete and uncomplicated recovery. This is especially necessary in view of the increased case mortality. Mechanical aids to diagnosis are very useful but there is a tendency on the part of most of us to rely upon them too much to the exclusion of our own clinical findings. In the report for 1935 I expect to be able to report upon the early days of Diphtheria Immunisation in Stepney. Anti- Diphtheritic Serum. This serum is supplied on request to the general practitioners of the Borough. During the year 46 tubes, each containing 4,000 units, were issued from the Public Health Office. Typhoid fevers. There were 4 cases notified during the year, 1 of which was paratyphoid. All were removed to hospital. There was one death. No definite source of infection could be traced in any of these cases. The death rate for the whole Borough was .004 per 1,000 of the population. Small Pox. There were 9 cases of Variola Minor notified during the year, or 14 less than in the previous year. The last case occurred on 17th March, 1934. Stepney, London, and indeed the British Isles, are now quite free. The epidemic started in Stepney in January, 1929, so that by extreme concentrated effort the disease was eradicated in just over 5 years. During that time there were 1,848 cases with 7 deaths. It is to be hoped that it will be many years before it appears again, if at all, for although generally it is a mild disease the efforts for its control are rather inclined to upset the routine work of the Public Health Department. 109 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. RETURN RESPECTING THE VACCINATION OF CHILDREN WHOSE BIRTHS WERE REGISTERED IN STEPNEY FROM JANUARY 1st TO DECEMBER 31st, 1933 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, 1933. Col. I. Successfully Vaccinated. Number of these Births duly entered by 31st January, 1935, 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. Insusceptible of Vaccination. Had Small Pox. (1) (2) (3) (4) (5) (6) (7) Limehouse 1,712 408 — — 922 40 St. Georges, East 581 188 — — 223 35 Total 2,293* 596 — — 1,145 75 Whitechapel 1,670 876 — — 420 91 Mile End 1,001 260 1 — 516 70 Total 2,671* 1,136 1 — 936 161 * These do not include 25 re-registered births 2 in Limehouse, 12 in St. Georges, and 1 inadvertently registered in St. Georges. 8 in Whitechapel and 2 in Mile End. M l—l o Registration Sub-Districts comprised in the Vaccination Officer's District. Number of these Births which on 31st January, 1935, remained unentered in the " Vaccination Register " on account (as shown by " Report Book") of Number of these Births remaining on 31st Jan., 1935, 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 1934. 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 1934. 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) Limehouse — 230 33 79 694 1,054 St. Georges, East - 13 17 105 348 219 Total — 243 50 184 1,042 1,273 Whitechapel 4 225 15 39 1,054 491 Mile End 6 56 20 72 400 531 Total 10 281 35 111 1,454 1,022 Limehouse and St. Georges. Whitechapel and Mile End Number of children successfully vaccinated after declaration of conscientious objection had been made. These numbers are included in Column 6 12 2 Total number of certificates for the year 1934 sent to other Vaccination Officers 240 160 Ill SUMMARY OF PRIMARY VACCINATIONS DURING THE YEAR JANUARY TO DECEMBER, 1934 (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 Health of child. Condition of house. Prevalence of infectious disease. Parents removed out of district. Otherwise not found. Whitechapel 1,837 1,054 198 - - 491 4 970 20 395 Mile End 955 400 89 - - 531 1 224 16 375 Other vaccinations 25 — — — — — — — — Limehouse 1,908 568 32 — — 1,053 1 834 41 263 St. Georges 540 350 20 — — 219 - 25 33 367 Other Vaccinations - - — — — - — — — Total 5,240 2,397 339 — — 2,294 6 2,053 110 1,400 14 re-registered births, 5 in Limehouse and 9 in St. Georges are not included in the above. 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, 1934. 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. Under one year of age. One year and upwards. Total. Whitechapel District Dr. D. F, Kennard 393 69 462 25 Shadwell do. Dr E. Lipman... 121 27 148 17 Mile End do. Dr. S. Mikhail 238 59 297 10 Limehouse do. Dr. T. O'Keefe... 108 49 157 16 St. George-in-the-East District Dr. B. R. Rygate 260 54 314 28 St. George-in-the East Hospital Dr. A. C. Gairdner — — - 21 Mile End Hospital Dr. A. Randle 20 18 38 18 Totals 1140 276 1416 135 112 113 3 cases of acute poliomyelitis and 1 of polio-encephalitis were notified during the year. The case of polio-encephalitis died. One case of acute poliomyelitis made a complete recovery; the other two recovered but show slight wasting' of the affected limb Acute Poliomyelitis Polioencephalitis 4 cases occurred during the year, and there were 3 deaths. The death rate for the whole Borough was .01 per 1,000 of the population. Encephalitis Lethargica. 13 cases were notified during the year, and there were 4 deaths. The death rate for the whole Borough was .01 per 1,000 of the population. Of the 9 cases which recovered, 6 made a complete recovery, 2 show slight paralysis, and 1 has left the district and cannot be traced. With one exception, all these 13 cases received serum treatment. Cerebrospinal Meningitis. Again there has been a decrease in the number of notified cases, there being 13 cases as against 32 in the previous year. 6 cases were removed to hospital. There were no untoward results. Ophthalmia Neonatorum. 5 cases of puerperal fever and 38 cases of puerperal pyrexia were notified during the year, there being 7 less cases than in the previous year. All these cases were duly investigated and all made complete recovery. 39 cases were removed to hospital. Puerperal Fever and Puerperal Pyrexia. 315 cases of Pneumonia and 1 of Dysentery were notified under these Regulations during the year. There were 235 deaths from Pneumonia, or 33 less than in the previous year. 119 of these were in persons over 45 years of age. It is obvious that many cases of Pneumonia are never notified. Pneumonia Malaria and Dysentery Regulations. 133 cases of infectious diseases removed to hospital were found not to be suffering from the disease stated on the certificate. Of these cases, 45 were cases of scarlet fever and 88 of Diphtheria; 38 were cases notified by private practitioners and 95 were from public institutions. This sending to fever hospitals of cases with a wrong though conscientious diagnosis is not to be condemned, especially in the case of diphtheria. It is a matter of erring in the right direction for it is better to send away a case of diphtheria before being quite certain than to keep it at home until a clinically swab-proof diagnosis is made. The fever hospitals are much too careful to allow of anv ill-effects. Wrong Diagnosis. 15 cases were notified during the year. On investigation not one of these cases was proved to be a genuine case of food poisoning, all being cases of dietetic errors. Food poisoning. 114 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR, 1934. Disease. Total Cases Notified. In Age Groups. Cases admitted to Hospital Total Deaths. Under 1 year. l— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65 and over Total Smallpox - - - - - - - 5 1 — 2 1 9 9 — Scarlet Fever 3 37 79 84 98 271 138 40 60 4 — — 814 808 4 Diphtheria 15 37 55 84 83 236 74 30 49 1 2 — 666 663 22 Enteric Fever — — — 1 — — — 1 1 — 1 — 4 4 — Puerperal Fever — — — — — — _ 3 2 — — 5 4 — Puerperal Pyrexia - - - - - - - 2 33 3 — — 38 35 — Erysipelas 3 1 2 2 — 3 8 9 25 23 64 25 165 102 3 Encephalitis Lethargica — — — — — — — 1 - — 3 — 4 4 2 Cerebro-spinal Fever 4 — 2 2 — 1 1 2 1 — — — 13 13 3 Ophthalmia Neonatorum 13 - - - - - - - - - - - 13 6 — Food Poisoning - - - - - 1 — 2 5 2 4 1 15 3 — Polio-myelitis — 2 1 - - - - - - - - - 3 3 — Polio-encephalitis - - - - - 1 - - - - - - 1 1 — Totals 38 77 139 173 181 513 221 92 178 35 76 27 1,750 1,655 34 115 349 cases of Pulmonary Tuberculosis were notified during the year, or 39 less than in the previous year. Of these, 231 were males, a decrease of 23. 118 were females, a decrease of 16. 71 cases of Non-pulmonary Tuberculosis were notified during the year, or 25 less than in the previous year. There were 204 deaths from Tuberculosis, or 31 less than in the previous year. Of these: 120 males and 63 females died from Pulmonary Tuberculosis. 13 males and 8 females died from Non-pulmonary Tuberculosis. The death rate for the whole Borough was .94 per 1,000 of the population. Ministry of Health. Form T.137 1934. PART I —Summary of Notifications during the period from the 1st January, 1934 to the 31st December, 1934, in the area of the Metropolitan Borough of STEPNEY. Tuberculosis. Public Health Tuberculosis) Regulations, 1930. Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis Age periods 0— 1— 5— 10— 15— 20— 25- 35— 45— 55— 65— Total (all ages) Total Notifications. Pulmonary Males 1 3 9 u 32 42 35 53 29 9 231 247 „ Females — 1 3 4 20 32 32 6 9 7 4 118 124 Non-pulmonary Males ... — 7 7 5 4 4 4 5 — 4 — 40 40 „ „ Females 6 5 6 4 1 5 2 1 1 31 33 SUPPLEMENTAL RETURN. PART II.—New cases of Tuberculosis coming to the linowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age periods 0— 1 1— 5— io—lie— 20— 25— 35— 45— 55— 65— Total Pulmonary Males 3 7 5 3 3 21 Females 1 l 3 3 1 3 1 2 15 Non-pulmonary Males ... ?, i 1 1 3 1 9 .. „ Females — 1 — 1 — 3 — — — 5 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 9 3 \ transferable deaths from Registrar General 8 2 Posthumous notifications . Transfers " from other areas (other than transferable deaths) 19 9 Other Sources — — 116 PART III. NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining at the 31st December, 1934, on the Registers of Notifications kept by the Medical Officer of Health. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total 1165 583 1748 376 380 756 2,504 Number of cases removed from the Register(s) during the year by reason 1. Withdrawal of notification 6 7 13 2 2 15 2. Recovery from disease 12 18 30 2 4 6 36 3. Deaths 124 65 189 18 13 31 220* New Cases of Tuberculosis and Mortality. 16 of these refer to old cases, ascertained during the revision of the Register. Particulars of new cases of tuberculosis and of all deaths from the disease in Stepney during 1934. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. 0 - - - - - - 1 - 1 1 1 7 6 1 — 4 3 5 3 3 7 5 1 — — 2 10 9 4 5 6 — 1 1 — 15 18 20 4 4 4 10 3 1 20 32 32 4 1 16 12 1 — 25 42 32 4 5 21 17 1 1 35 35 6 5 2 17 6 — — 45 53 9 — 1 30 8 1 — 55 29 7 4 1 21 7 1 1 65 and upwards 9 4 — 10 2 — — Totals 231 118 40 31 120 63 13 8 Public Health (Prevention of Tuberculosis) Regulations, 1925. These regulations provide that persons suffering from Tuberculosis of the Respiratory tract shall not be employed in the handling of milk or milk receptacles. 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. 117 Incidence of Tuberculosis in various occupations, Occupation. New Cases Notified. Deaths. Occupation. New Cases Notified. Deaths . Bakers 1 2 Motor Fitters — 1 Bath Attendants 1 —. Newsvendors — 1 Book Keepers 1 1 No Occupations 38 22 Book Makers — 1 Nurses 1 — Boot Makers — 2 Old Age Pensioners 1 — Bottle Washers — 1 Packers 3 1 Box Makers 1 2 Painters — 2 Brewers' Bottlers — 1 Paper Sorters 1 — Bricklayers 1 1 Paviors — 1 Brush Makers — 1 Pedlars 1 4 Biscuit Packers — 1 Plasterers 1 1 Butchers 4 1 Porters 2 — Cabinet Makers 8 4 Postmen 1 1 Canvassers 1 — Pressers 7 3 Cap Makers 1 — Printers 4 — Caretakers — 1 Rag Sorters — 1 Carmen 4 8 Railway Messengers 1 1 Carpenters 3 — Rent Collectors 1 — Caterers 1 1 Restaurant Keepers — 1 Charwomen 3 1 Ropemakers 1 — Checkers — 1 Salesmen 2 1 Chemists 1 — Scavengers 2 — Christmas Card Sorters — 1 Scholars 43 1 Cigarette Makers — 2 Seamen 20 5 Cinema Operators 1 1 Second-hand Clothiers — 1 Clerks 5 6 Servants (Domestic) — 2 Coal Porters 2 2 Sheet Metal Workers — 1 Commercial Traveller — 1 Shop Assistants 1 — Compositors 1 1 Shop Boys 1 - Cooks 1 1 Signwriters — 1 Cowmen 1 1 Skin Dressers - 1 Dispensers - 1 Stationer's Cutters 1 — Dressmakers 5 1 Stevedores 3 11 Electricians - 1 Stewards 1 — Embroiderers 1 1 Stick Makers 1 1 Engineers — 1 Stokers 2 2 Factory Hands 1 — Street Traders 1 3 Factory Supervisors 1 — Tailors 22 13 Fine Art Publishers 1 - Taxi Drivers 1 — Fish Porters 1 1 Tea Packers 1 — French Polishers 2 1 Telephone Operators — 1 Fruit Porters — 1 Tin Polishers 1 1 Fruit Salesmen 1 — Tinsmiths — 1 Furriers 3 2 Timber Porters 1 1 Greengrocers 1 — Tobacco Workers 3 — Hairdressers 2 1 Tool Makers 1 — Handymen — 1 Transport Workers 1 — Hawkers 6 — Trimmers 1 - Housekeepers 6 — Turncocks 1 — Housewives 48 31 Typists 2 — J ewellers — 1 Umbrella Makers — 1 Job Buyers — 1 Unknown Occupations 54 — Jute Spinners — 1 Upholsterers 1 1 Labourers 24 12 Van Boys 1 — Laundry Hands 3 — Van Guards 1 — Librarians 1 — Victuallers 1 — Lightermen 1 1 Waiters 5 — Machinists 10 2 Warehousemen 3 — Mat Makers 1 1 Waterside Horse Drivers 1 — Match Sellers 1 Wharf Foremen — 1 Messengers — 1 Under 5 years 9 3 Metalworkers 2 — Milliners 1 — 420 204 Motor Drivers 3 2 118 Measles. The following are the statistics referring to the epidemic:— Ages Under 1 1-2 2-3 3-4 4-5 5-14 14 and over Total. No. of Cases 211 435 492 717 826 1179 59 3919 No. admitted to Hospital. 92 220 179 161 157 201 21 1031 No. of Deaths 24 41 14 3 2 5 0 89 No. dying in Hospital. 17 33 11 3 2 4 0 70 No. dying at Home 7 8 3 0 0 1 0 19 It will be seen from the above figures— (f) That of the deaths 27% were in children under I year of age; 46% „ ,, between 1 and 2 years of age; 16% ,, ,, ,, 2 and 3 (2) That of the cases under the age of 1 year, 11% died; between the ages of 1-2 years, 9% died; ,, ,, 2-3 ,, 3% ,, (3) That of the cases under the age of 1 year, 44% were admitted to hospital; between the ages of 1-2 years, 50% ,, ,, ,, ,, 2-3 36% ,, ,, B—Other Diseases. 1933-34 was responsible for the usual biennial epidemic in London. The epidemic started early in November, 1933, reached its peak during March and had died out in August. It is not easy to say definitely that the epidemic was more severe than usual but it certainly appeared so. In spite of a very keen co-operation with the schools, and in spite of a determined effort in visitation, there were 89 deaths, which is the highest number recorded in Stepney since the year 1928 when it was 92. In this connection it should be realised that the lowered birth-rate means a smaller amount of soil for the Measles seed, so this large number of deaths is significant. On the other hand, the fact that there was only one death in 1933 probably meant that the available soil in 1933 was not completely used up in that year and remained available for sowing in 1934. 119 It will be seen how dangerous the disease is in children under 5 years of age and especially in children under 3 years. It will be seen what a high proportion of these very young children were admitted to hospital and yet the mortality was so high. It is obvious that these children were admitted to hospital too late to save them, and before the next biennial epidemic steps must be arranged whereby these very young children will be discovered in the earliest possible stage of the disease. There must be increased propaganda in the Infant Welfare Centres and elsewhere as to the danger of measles to the children under 5 years of age. The advisability of the compulsory notification of Measles in children under 5 years of age must be considered. The number of deaths was 20, or 11 less than in the previous year. Of Whooping Cough. these, 19 occurred in children under 5 years of age (10 of them under 1 year). A system of notification by the schools has been arranged; warning notices and handbills are posted at or issued by the Infant Welfare Centres; it is hoped that all cases will now be brought to notice in the early stage of the disease so that they—and especially those under 1 year of age—will receive prompt treatment. The death rate in 1934 was .09 per 1,000 of the population. There were 69 deaths, the same as in the previous year. 62 of these Diarrhoea, deaths, or 89 per cent., were in children under 1 year of age. The death rate was .32 per 1,000 of the population. The total deaths from diseases of a Zymotic character was 204, or 77 more Zymotic than in the previous year. They include all deaths from Small Pox, Scarlet Diseases. Fever, Diphtheria, Typhoid Fever, Measles, Whooping Cough and Diarrhoea. The increase was entirely due to Measles. The death rate was .948 per 1,000 of the population. The number of deaths was 13, or 104 less than in the previous year. As influenza, usual these occurred in elderly persons. The death-rate for the whole Borough was .06 per 1000 of the population. The number of deaths from cancer was 321, or 28 less than in the previous Cancer. year. The death-rate for the whole Borough was 1.4 per 1,000 of the population. 30 were under 45 years of age—11 males and 19 females. 142 were between 45 and 65 years of age—62 males and 80 females. 110 were between 65 and 75 years of age—64 males and 46 females. 39 were 75 years of age and over—17 males and 22 females. 120 The organs and parts of the body affected were as follows :— Male. Female. Mouth, Throat and alimentary canal 87 81 Other abdominal organs 17 16 Generative organs 7 24 Breast — 30 Skin 3 3 Lung and Pleura 27 6 Bones 9 3 Other specified Organs 1 4 Other undefined 3 — Totals 154 167 Heart Disease. Diseases of the Respiratory Organs. Scabies. Cleansing and Disinfection. There were 633 deaths from Heart disease (299 males and 334 females) or 61 less than in the previous year. The death-rate for the whole Borough was 2.9 per 1,000 of the population. The number of deaths from diseases of the Respiratory Organs (excluding Tuberculosis) was 338 or 53 less than in the previous year. The death-rate for the whole Borough was 1.5 per 1,000 of the population. During the year it became increasingly obvious that persons suffering from Scabies were at a disadvantage in Stepney because of lack of bathing accommodation. There is only one bath at the Council's Disinfecting Station in Branch Road and this is almost fully occupied in the cleansing of verminous persons and it was decided that new bathing arrangements would have to be made for Scabies. Children of school age have always been well treated at the London County Council bathing stations and it was necessary to make arrangements for the treatment of adults and of children under school age. An arrangement was made with Bethnal Green for the former and one with the London County Council for the latter. These arrangements were purely of a temporary nature until such time as the Council could reorganise the Disinfecting Station to include proper bathing facilities. I am of opinion that adult scabies is very prevalent, and I have every hope that these facilities will be available during 1935. 220 persons were cleansed during the year and had their clothing disinfected—214 adults and 6 children. 209 were cleansed because of vermin and 11 because of infectious disease. 121 2,731 rooms were fumigated and the bedding, etc., removed and disinfected by steam. Of these, 1,759 rooms were fumigated because of infectious disease, 204 as a result of pulmonary tuberculosis, and 768 because they were verminous. In addition to these, scabies occurred in 497 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 this year reached 110,640. The total number of articles disinfected for all purposes was 145,085. During the year it also became increasingly obvious that some form of Bug eradication special measures for the eradication of the bed-bug was imperative. This was especially obvious in connection with Council property and on 24th October Miss Whitty was appointed a Sanitary Inspector, her chief duties being to keep all the Council flats under constant supervision. This was only a preliminary to a comprehensive scheme for bug eradication generally, and the Council in 1935 are already considering such a scheme with special reference to the disinfestation of the furniture of all tenants on their transfer to the flats. 122 VII.—STATISTICS PROVIDED BY THE REGISTRAR- GENERAL. Memo. 1, 1931, 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 4 and Appendix II of Circular 1417 dated the 25th October, 1934, addressed to Medical Officers of Health from the Ministry of Health. (1) Numbers of stillbirths registered in Stepney during the calendar year, 1934:— Stillbirths registered. Inward Transfers. Outward Transfers. Stillbirths allocated to the Borough. Total (Legitimate and Illegitimate) Males 99 5 43 61 Females 77 3 30 50 Illegitimate Males 2 — — 2 Females 1 1 — 2 (2) Numbers of cases of infectious diseases notified in Stepney during the 52 weeks ended 29th December, 1934. Smallpox 9 Puerperal Fever 6 Scarlet Fever 858 Puerperal Pyrexia 38 Diphtheria 762 Erysipelas 165 Enteric Fever 5 Pneumonia 313 The case rates of these diseases for England and Wales per 1,000 population are respectively as follows:— Smallpox 0.004, Scarlet Fever 3'76, Diphtheria 170, Enteric Fever 0-03, Puerperal Fever 0.06, Puerperal Pyrexia 0.15, Erysipelas 0.51, Pneumonia 1.27. 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 4 0 and Puerperal Pyrexia 9.6 per 1,000 total births (i.e. live and stillbirths) registered during the year. Memorandum S.D. 52. 1935. (3) Metropolitan Borough of Stepney. Live Births 1934, Live Births registered (excluding reregistrations). Inward Transfers. Outward Transfers, Live births allocated to the Borough. Total Live Births (Legitimate and Illegitimate) Males 2,700 86 1,110 1,676 Females 2,564 96 1,034 1,626 Illegitimate Live Births Males 62 14 12 64 Females 60 20 11 61 Memo, S.D./E.P. (4) Metropolitan Borough of Stepney. Estimate of Resident Population mid-year 1934, 214,990. Deaths under 1 year of age: Legitimate Illegitimate M. 160 8 F. 109 4 (5) CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF STEPNEY. 1934. S.D.24 CAUSES OF DEATH. Sex. All 0— 1— 2— 5— 15- 25— 35— 45— 55— 65— 75— Ages. ALL CAUSES M. 1,419 168 51 38 38 61 58 70 156 271 310 198 F. 1,238 113 41 34 34 44 51 53 110 222 274 262 1. Typhoid and paratyphoid fevers M. ... ... ... ... ... ... F. 1 ... ... ... ... ... ... ... ... ... 1 ... 2. Measles M. 46 11 25 8 2 ...... ... ... ... ... ... ... F. 42 12 17 11 2 ... ... ... ... ... ... ... 3. Scarlet Fever M. 3 1 2 ... ... ... ... ... ... ... ... F. 1 ... 1 ... ... ... ... ... ... ... ... ... 4. Whooping cough M. 6 5 ... 1 ... ... ... ... ... ... ... ... F. 14 5 3 5 l ... ... ... ... ... ... ... 5. Diphtheria M. 15 ... 2 8 5 ... ... ... ... ... ... ... F. 7 ... 1 2 4 ... ... ... ... ... ... ... 6. Influenza M. 3 ... ... ... ... ... ... ... ... 1 l ... F. 10 ... ... ... ... ... ... ... ... 3 2 2 7. Encephalitis lethargica M. ... ... ... ... ... ... ... ... ... ... ... ... F. 3 ... ... ... ... ... ... ... ... 3 ... ... 8. Cerebro-spinal fever M. 3 2 ... 1 ... ... ... ... ... ... ... ... F. 1 ... ... l ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system. M. 123 ... 1 1 ... 20 22 17 33 3 20 7 1 F. 63 ... ... ... 3 21 16 6 7 ... 2 10. Other tuberculous diseases M. 13 ... 2 1 2 3 2 1 1 1 ... ... F. 9 ... 2 2 1 1 1 ... ... 1 1 ... 11. Syphilis M. 8 ... ... ... ... ... ... ... 4 2 1 ... F 3 ... ... ... ... ... ... ... ... ... ... 12. General paralysis of the insane, tabes dorsalis. M. 5 ... ... ... ... ... ... ... 2 1 1 1 F. 3 ... ... ... ... ... ... 1 ... 2 ... ... 13. Cancer, malignant disease M. 154 ... ... ... ... 1 1 9 25 37 64 17 F 167 ... ... ... ... 3 4 12 32 48 46 22 14. Diabetes M. 13 ... ... ... ... ... 1 ... 2 4 6 ... F. 35 ... ... ... ... ... ... ... 7 15 9 4 15. Cerebral haemorrhage, etc. M. 33 ... ... ... ... ... ... 1 ... 7 14 11 F. 35 ... ... ... ... ... ... ... 5 8 18 4 16. Heart disease M. 299 ... ... ... 3 6 8 7 31 68 94 82 F. 334 ... ... ... 6 4 9 9 17 61 103 125 17. Aneurysm M. 9 ... ... ... ... ... ... 1 3 5 ... ... i O O F. 5 ... ... ... ... ... ... 1 2 ... 2 ... 18 Other circulatory diseases M. 51 ... ... ... ... ... 1 1 4 12 17 16 F. 61 ... ... ... ... ... ... ... 5 13 17 21 19. Bronchitis M. 50 4 ... ... ... ... ... 1 5 13 14 12 F. 29 2 ... ... ... ... ... 2 1 4 8 12 123 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. 148 45 12 5 2 5 3 7 13 24 ... 19 13 F. 87 18 8 4 2 2 2 1 9 12 16 13 21. Other respiratory diseases M. 14 1 ... 1 1 1 1 2 1 3 1 2 F. 10 1 ... 1 ... ... ... ... 2 3 1 2 22. Peptic ulcer M. 17 ... ... ... ... ... ... 4 ... 8 4 1 F. 4 ... ... ... ... ... ... ... ... 1 ... ... 23. Diarrhoea, etc. M. 38 35 2 1 ... ... ... ... ... ... ... 1 F. 31 27 2 ... ... 1 ... ... ... ... 1 ... 24. Appendicitis M. 7 ... ... ... ... 2 1 2 1 ... ... ... F 4 ... ... ... 1 ... 1 1 ... 1 ... ... 25. Cirrhosis of liver M. 3 ... ... ... ... ... ... 2 ... ... 1 ... F. 1 ... ... ... ... ... 1 ... ... ... ... ... 26. Other diseases of liver, etc. M. 6 ... ... ... ... ... ... ... 2 2 1 1 F 6 ... ... ... ... ... l ... 3 2 ... ... ,27. Other digestive diseases M. 26 ... ... 1 1 3 2 2 5 1 7 3 F. 27 ... ... 1 2 3 2 ... 3 9 4 28. Acute and chronic nephritis M. 66 ... ... ... ... 1 2 4 7 18 13 21 F. 61 ... ... ... 1 2 3 1 5 12 19 18 29. Puerperal sepsis F. 5 ... ... ... ... ... 2 3 ... ... ... ... 30. Other puerperal causes F. 10 ... ... ... ... 1 3 6 ... ... ... ... 31. Congenital debility, premature birth, malformations, etc. M. 49 47 ... ... ... ... ... ... 1 ... ... ... F. 34 34 ... ... ... ... ... ... ... ... 1 2 32. Senility M. 3 ... ... ... ... ... ... ... ... ... ... 14 F. 15 ... ... ... ... ... ... ... ... 1 ... ... 33. Suicide M. 18 ... ... ... ... 1 ... 1 5 5 6 ... F. 2 ... ... ... ... ... 2 ... ... ... ... ••• 34. Other violence M. 62 1 3 4 5 9 4 3 8 11 9 5 F. 33 ... 2 5 2 2 1 1 3 5 2 10 35. Other defined diseases M. 128 11 2 3 17 9 10 7 3 27 28 11 F. 83 14 2 2 9 2 3 7 10 16 11 7 36. Causes ill-defined, or unknown M. ... ... ... ... ... ... ... ... ... ... ... ... F. 2 ... 2 ... ... ... ... • • • ... ... ... ... 124 (6) BIRTH-RATES, DEATH-RATES, AND ANALYSIS OF MORTALITY IN THE YEAR 1934. (Provisional figures.) Rate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate Per 1,000 Live Births. Percentage 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). Total Deaths under one year. Certified by Registered Medical Practitioners. Inqu st cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England and Wales 14.8 0.62 11.8 0.00 0.00 0.09 0.02 0.05 0.10 0.14 0.54 5.5 59 90.4 6.5 2.1 1.0 121 County Boroughs and Great Towns, including London 14.7 0.66 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 90.5 6.1 2.9 0.5 135 Smaller Towns Estimated Resident Populations, 25,000-50,000 at Census 1931 15.0 0.67 11.3 0.00 - 0.07 0.02 0.04 0.09 0.14 0.42 3.6 53 91.2 6.1 1.6 1.1 London 13.2 0.50 11.9 0.00 0.00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 87.7 6.3 6.0 0.0 Puerperal Sepsis. Others. Total, The maternal mortality rates for England and wales are as follows{per 1,000 Live Births 2.03 2.57 4.60 „ „ Total Births 1.95 2.46 4.41 125 1 127 INDEX. PAGE. I. Statistics and Social Conditions of the Area 9 II. General Provision of Health Services 11 III. Sanitary Circumstances of the Area 45 IV. Housing 68 V. Inspection and Supervision of Food 76 VI. Prevalence of, and Control over Infectious and other Diseases 107 VII. Statistics provided by the Registrar-General 122 After care, Tuberculosis 19 Analyst's Report 85-105 Ante-Natal Clinics 25, 44 Area of Borough 9 Bacteriological Examinations 13 Bakehouses77 Beccles Street Area 4 Births 9, 10 Births Act, Notification of 10 Bishopsgate Goods Station 80 Bug Eradication 121 Butcher Shops and Stalls 76 Butter Factories 77 Canal Boats Acts 64 Cancer 119 Cerebro-Spinal Fever 113 Cleansing of persons 62, 121 Committees, List of Members 2 Complaints of nuisances 59 Convalescent Treatment 26, 30 Cowsheds62, 67 Creches, List of 44 Dairies and Milkshops 76 Day Nurseries 27, 44 Deafness, prevention of 29 Deaths 11 Dental Clinic 22, 23 Diarrhoea 119 Diphtheria 107 Diphtheritic Serum 108 Disinfection 62, 121 Drainage 60 128 PAGE. Dysentery 113 Eating Houses 62 Encephalitis Lethargica 113 Enteric Fever 108 Extra Nourishment, Supply of 22 Factory and Workshops 64-66 Fines and Costs 59 Finsen Light 22 Food and Drugs Acts 85-105 „ Inspection 70-83 „ Poisoning 113 „ Products, Certification of 77 „ Regulations (Imported) 77-80 „ Zeebrugge-Harwich Ferry - 80 „ Calais-Harwich Ferry 80 Foster Mothers 62 Hairdressers' Shops 61 Handicraft Class 21 Health Visitors, work of 24, 29, 31, 32 Heart Disease 1, 20 Home nursing 27 Hcme Office, report to 64-67 Hospital facilities 13 Houses let in Lodgings 64 House to House Inspection 70-72 Housing:—Statistics 68-69 „ Accommodation 69 Housing:—Problem in Stepney 75 Ice Cream Premises 62,76 Infant Life Protection 28, 41 Infant Welfare Centres, List of 43 Infantile Mortality 37-41 Infants, Feeding of 29 Infectious Diseases 107-114 „ ,, Summary of, 114 Influenza 119 Laboratory facilities 13 Legal Proceedings 51-59 Lodging houses, Common and Seamen's 62, 68 London County Council, Report to 62-64 Malaria 113 Marriages 10 129 PAGE. Margarine premises 77 Maternal Mortality 28, 33-36, 39 Maternity and Child Welfare Centres, etc. 43, 44 „ „ „ Services 24-29 „ Centres, Work at 24, 32 „ Outfits 29 Measles 118 Midwives 12, 28 Milk—(Special Designations) Order 76 „ Analysis of 88 Milk and Dairies Order 56 „ and Meals, Provision of 25, 30 Milkshops 62, 76 Minced Meat, Preservatives in 57, 58, 81, 98 Ministry of Health, Returns to 14-18, 24-29, 64-67, 109-112, 115-116 Mortuary 67 Notifiable diseases 114 Nursing in the Home 12 Offensive Businesses 62,67 Ophthalmia Neonatorum 113 Outworkers 66, 67 Overcrowding 64, 70, 72 Pneumo-Thorax refills 22 Pneumonia 113 Polio-Myelitis 113 Population 9 Public Cleansing 45 Puerperal Fever and Pyrexia 113 Rag Flock Acts 67 Rats and Mice Destruction 60,61 Rent and Mortgage Interest, etc., Act 61 Respiratory Diseases 120 Restaurants and Eating Houses 62 Sanitary Inspectors:—Inspections 47, 48 „ „ Notices served 48,63 „ „ Return of sanitary work 49, 50 ,, „ Samples taken 48, 86 Sanocr^pin Treatment 22 Scabies 120 Scarlet Fever 107 Scavenging 45 Shelter 67 130 PAGE. Slaughter of Animals Act, 1933 67 Slaughterhouses, Poultry 62, 67 Small-pox 108 Smoke Nuisances 59, 62 Social Conditions 11 Special Treatment (Tuberculosis) 22 Staff 3, 11, 12 Statistics, Summary of 9 Tuberculosis: Dental clinic 23 „ Dispensaries, List of 19 „ „ Return of work (Forms T 145 & T 145a) 14-18 „ Incidence of and Mortality from occupations 117 „ Notifications, Summary of (Form T137 Rev.) 115 „ Regulations, 1930 115 1925 116 „ Deaths 115 Twins 10 Underground Rooms 64, 69, 73, 74 Unsound Food 77-83 Vaccination 109-113 „ by Public Vaccinators 112 „ Officers, Returns by 109-111 Verminous persons and premises 62, 121 Water Certificates 61 Whooping Cough 119 Workshops and Workplaces 64-66 Workshops in Dwelling Houses 73 Wrong Diagnosis of Infectious Diseases 113 Zymotic Diseases 119