Fin 13 THE METROPOLITAN BOROUGH OF FINSBURY. ANNUAL REPORT on the PUBLIC HEALTH OF FINSBURY for the Year 1914 by A. E. THOMAS, M.A., M.D., D.P.H., Medical Oficcer of Health, Barrister-at-Law. London: Printed by Vail & Co., 170, Farringdon Road, E.C. 1915. Public Health Committee, 1914-1915. Chairman. Alderman L. PHILLIPS. Vice-Chairman. Councillor F. T. FOULGER. HIS WORSHIP THE MAYOR. (Councillor W. R. CORKE, J.P.) Alderman W. HOWES. Alderman The Rev. Prebendary G. H. PERRY, M.A. Councillor The Rev. T. C. ELSDON, A.K.C. Councillor Dr. A. F. GALLOWAY. Councillor Dr. W. LAUZUN-BROWN. Councillor Miss F. M. LINDSEY. Councillor G. F. MOBBS. Councillor W. R. PUTTERILL. Councillor O. M. RICHARDS. Councillor ERNEST TROTT. The Public Health Committee meets on the 2nd and 4th Tuesdays of each month at 2.30 p.m. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Finsbury. His Worship the Mayor: Councillor W. R. Corke, J.P. Gentlemen, I have the honour to submit to you the Annual Report on the Public Health and sanitary condition of the Borough of Finsbury for the year 1914. For the sake of uniformity, the method of arrangement adopted in previous reports has, in the main, been adhered to. The present report deals at some length with the subjects of Infant Welfare, Infant Mortality, Tuberculosis and Measles. In presenting this review of last year's work I wish to thank the Council and the Chairman and Members of the Public Health Committee for their ever-willing help, their encouragement and support, and the Officials of the Health Department and of the other Departments for their kind assistance and co-operation. I am, Gentlemen, Your obedient Servant, A. E. THOMAS, Medical Officer of Health. Public Health Department, Town Hall, Rosebery Avenue, E.G. TABLE OF CONTENTS. page Summary 5 Population 6 Census Returns 7 Births 7 Notification of Births 10 Neighbour Nurses 12 Maternity and Child Welfare I6 Health Visitation 19 Weighing Centres 50 Dinner Centres 56 Puerperal Fever 56 Ophthalmia Neonatorum 57 Deaths and Death Rates 57 Inquests 61 Infant Mortality 61 Cancer 70 Alcoholism 71 Tuberculosis.— Phthisis 73 Notifications and Deaths (Table) 73 Finsbury cases 75 Deaths and Death Rates, 1901-1914 89 Death Rates, London Boroughs 91 Tuberculosis—other forms 92 Small-Pox 94 Cerebro-Spinal Meningitis 94 Folio Myelitis 94 Measles 95 Hooping Cough 95 Diphtheria 102 Scarlet Fever 105 Typhoid Fever 107 Infectious Disease, Deaths and Notifications 109 page Disinfection 111 Food Supply 112 Meat and Food Inspection 112 Unsound Food Prosecutions 114 Ox Tongues with Actinomycosis 114 Slaughterhouses 115 Milk Supply 116 Milk Registration 117 Milk Samples in the Metropolitan Boroughs, 1913 118 Milk Samples and Analyses 119 Sale of Food and Drugs Acts 121 Wrapping paper enquiry 122 Milk and Cream Regulations 124 Ice Cream Shops 124 Restaurants 124 Butter Manufacturers 125 Bakehouses 125 Housing 125 Registered Houses 126 Common Lodging Houses 127 House-to-House Inspection 127 Crowding and Overcrowding 129 Inland Revenue Acts 132 Verminous School Children 133 Underground rooms 134 Stable Dwellings 134 Factories and Workshops 135 Canal Boats 144 Black Smoke 145 The Mortuary 145 The Shelter 146 Offensive Trades 146 Staff of Department 146 Work of Inspectors 147 Lady Sanitary Inspector 148 Law Proceedings 149 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1914. VITAL STATISTICS.—A summary of the principal facts of the Vital Statistics for 1914 is given below:— Estimated Population at the middle of 1914 83,212. Finsbury Residents in outlying Institutions 1,462. Birth Rate 30.7 per 1,000 inhabitants. Death Rate 19.6 per 1,000 inhabitants. Infant Mortality 118 per 1,000 births. Phthisis Death Rates Crude 1.81 per 1,000 inhabitants. Corrected 1.78 per 1,000 inhabitants. Death Rates from all forms of Tuberculosis Crude 2.48 per 1,000 inhabitants. Corrected 2-44 pet 1,000 inhabitants. Death Rate from the seven Chief Zymotic Diseases 2.77 per 1,000 inhabitants. In comparison with the returns for 1913, the following matters are of interest:— The number of births and the birth-rate both show a slight increase. 6 The general death rate and the death-rate from Phthisis are both slightly higher in 1914. The death rate from all forms of Tuberculosis is slightly lower. The deaths from Measles and Hooping Cough are more in 1914. The deaths from Diarrhoea and Enteritis are less. The Infant Mortality is much diminished. Scarlet Fever and Diphtheria have been more prevalent. POPULATION.—The population of the Borough at the middle of 1914 was estimated by the Registrar-General to be 83,212, distributed as follows:— Census Population of Borough, April 2nd, 1911, Estimated Population, Middle 1914. Clerkenwell 57,121 54,.0.58 St. Luke 28,976 27,.425 St. Sepulchre 1,826 1,729 The Borough 87,923 83,212 This estimate does not include the Finsbury residents detained in the following outlying institutions: the Holborn Union Institution, 1a, Shepherdess Walk (384), the Holborn Infirmary, Archway Road, Holloway (355), the Holborn Union Institution, Mitcham (488), and the Holborn Schools, Mitcham (235), giving a total of 1,462. Adding these to 83,212, the estimate of the RegistrarGeneral, gives a corrected population of 84,674 for the whole Borough. The day population is estimated to be 180,000. The various rates in the present report are calculated on the estimates of the Registrar-General. 7 CENSUS RETURNS, 1911.—The populations and separate occupiers in the various wards at the time of the census are appended. Ward. Separate Occupiers. Population. Males. Females. Pentonville 3,222 14,479 7,155 7,324 St James' 3,926 16,096 7,761 8,335 St. John's 1,653 7,024 3,432 3,592 St. Mark's 2,231 8,213 4,016 4,197 St. Philip's 2 994 11,309 5,476 5,833 City Road East 2,253 10.021 4,696 5,325 City Road West 1,386 5,368 2,564 2,804 East Finsbury 177 925 461 464 West Finsbury 1,396 5,667 2,759 2,908 Old Street 1,625 6.995 3,435 3,560 St. Sepulchre 376 1,826 900 926 Totals 21,239 87,923 42,655 45,268 The first five wards are in Clerkenwell, the next five in St. Luke. BIRTHS.—During 1914 there were registered 2,558 births of Finsbury residents -equal to a birth-rate of 80.7 per 1,000 inhabitants. The number of births and the birth-rate both show a slight increase this year as compared with 1913. The birth rate for Finsbury still keeps higher than the birthrate for the whole of England and Wales, and does not fall to the same appreciable extent. 8 The corrected rates for the Borough are appended:- CORRECTED BIRTHS AND BIRTH RATES. Year Population in the middle of each year. Corrected Births. Corrected Birth Rates. 1901 101,141 3,254 32.1 1902 99,846 3,191 31.9 1903 98,538 3.162 32.0 1904 97,215 3.095 31.8 1905 95,880 2,886 30.1 1906 94,529 3.012 31.8 1907 93,165 2,884 30.9 1908 91,787 2,916 31.7 1909 90,394 2,857 31.6 1910 88,987 2,833 31.8 1911 87,566 2,676 30.6 1912 86,130 2,579 29.9 1913 84,679 2,494 29.4 1914 83,212 2,558 30.7 The corrected rates for the several sub-registration districts in 1914, were as follows:— Population. Births. Birth-rate. Clerkenwell 54,058 1,659 30.6 St. Luke 27,425 860 31.5 St. Sepulchre 1,729 33 19.0 The Borough 83,212 2,558 30.7 The corresponding birth-rates for the rest of the country for 914 are attached England and Wales 28.8 London 24.8 Finsbury 80.7 97 Great Towns 25.0 145 Small Towns 28.9 Rural Districts 22.2 9 It will be seen that the birth-rate for Finsbury is greater than the rate for the whole of England and Wales, greater than the birth-rate for London, and greater than the rates in the 97 great towns, the 145 smaller towns, and the essentially rural districts. The birth-rate is greatest in St. Luke; least in St. Sepulchre. Of the total number of Finsbury births, 252 occurred in outlying institutions ; 915 births of non-residents took place in the borough. For comparative purposes, the birth-rates of the Metropolitan Boroughs are annexed:— BIRTH RATES, 1914. Borough. Rate. Borough. Rate. Battersea 25.7 Lambeth 23.7 Bermondsey 31.0 Lewisham 19.8 Bethnal Green 29.6 City of London 10.0 Camberwell 25.2 Paddington 20.8 Chelsea 19.2 Poplar 31.4 Deptford 28.6 St. Marylebone 18.7 Finsbury 30.7 St. Pancras 23.9 Fulham 26.4 Shoreditch 32.0 Greenwich 25.1 Southwark 30.0 Hackney 25.7 Stepney 29.2 Hammersmith 23.5 Stoke Newington 20.4 Hampstead 14.7 Wandsworth 20.4 Holborn 16.4 Westminster 14. 1 Islington 25.1 W oolwich 22. 0 Kensington 18.4 County of London 24.3 10 NOTIFICATION OF BIRTHS ACT, 1907.—This Act came into force on the 9th March, 1908, having been adopted by the Borough Council on December 19th, 1907. The effect of its adoption may be seen from the accompanying table. Year 1911 1912 1913 1914 Births notified 3,441 3,401 3,285 3,277 Percentage attended by Doctors 4.5 3.5 4.5 4.1 Percentage attended by Midwives 18.0 18.7 17.0 17.7 Still births notified 92 105 55 72 Births registered 2,676 2,579 2,494 2,558 Notifications were received of 42 sets of twins. The percentage of births notified by parents was 7.8, by medical men 4.1, by midwives 17.7, and by others—chiefly medical students and lady midwifery students—was 70.4 per cent. The mothers in this last group were all attended gratuitously in their confinements. This means that in 1914, 1,800 Finsbury mothers, or 2 out of every 3, were cared for during child-birth, and during the subsequent lying-in period for no charge whatever, chiefly by the medical students of St. Bartholomews' Hospital, University College Hospital, the Royal Free Hospital, and by the midwives and midwifery students from the City of London Lying-in Hospital, the Maternity Nursing Association, and the Royal Maternity Charity. By the provisions of the Notification of Births Act, local Registrars are allowed to inspect the notifications received, and to compare them with their own lists of registered births. By this means it is possible to trace those parents who have not sent information to the Public Health Office. To these a printed form is sent drawing attention to the omission and asking that the notice shall be sent. This has always been effective. 11 In 1914 the number of notices of omission sent to parents was 156. The commonest explanation of the omission is the confusion with the registration which has to be effected with the local Registrar within 6 weeks of the birth of the child. Other explanations which are tendered are the inability to call at the public health office "owing to working early and late," or they " thought the doctor was going to do it." On the whole, there has been an improvement in recent years in the notifications received from parents, though, even now, their letters show occasionally a hazy knowledge of the provisions of the Act, coupled with a serious attempt and an earnest desire to master its simplicity and to observe its conditions. Apparently, many of the letters are dictated by the mother, who is still confined to her bed, and afford evidence of having been drafted by neighbours called together in consultation. Some of the lettersbear no address. Some are in the handwriting of a school child, who has become muddled by the different opinions expressed by the persons present, and hopelessly confounded by the intricacies of converting oratio obliqua into oratio recta. Here is an example:— " Time. " Sex—none. " 19 November. " Premiture child dead who certifys is date Br. Night Date 19th Noverbem female child. Presant at birth mother and the lady what made the tea we dont known her addres. Say father wasnt presant so he dont knows about it so please excuse him but mother knows. It was a stile born and not in the accordnig to the regilatons please to say if it is not I dont think. "Nellie Burton. " Age 10." In administering the Act, the following details are used— 1. A leaflet of instruction giving its chief provisions. 2. A stamped addressed certificate, distributed for use by doctors and midwives. 8. Postcards and sheets for notifications received from hospitals and poor law institutions. 12 4. Sheets for transmitting notices of births of non-residents to the London County Council. 6. Circular letters sent to parents for omitting to notify births in their families. Neighbour Nurses.—It has been already pointed out that a large number of Finsbury mothers are attended in their confinements by students and pay nothing for such treatment. These mothers engage neighbours self-styled "nurses" to help them during the lying-in. Such "nurses" are the modern representatives of Mrs. Gamp. They abound in the Finsbury mean streets. They are engaged without any very clear notion of the duties they may be asked to perform, though some regard their presence at the mother's churching as the most important service they can render. Many are decrepit, shambling, leaden footed, deaf, halting, old cronies, dirty and ignorant. Some receive the Old Age Pension. They are inclined to be "independent." In the words of a mother, "It's hard to get them to come to you, if you are too particular -I am so thankful of her that I couldn't order her about. I am afraid to tell her to wash herself for fear she would leave me and not come back to me again." One such nurse washed the mother once only during her lying-in. They neglect the mothers and their babies. Some admit they do not understand babies. They wash the mother occasionally on request, and then only partly. They do not wash their hands before attending to the mother. They give the mother gruel for the first 8 days of her confinement, alleging that "it is healing to the insides"—they advise that the mother should, during this period, drink gin, because " it keeps the insides sweet." Some neighbour-nurses wash the mother's diapers, others merely throw them under the bed and leave them there until their offensive smell is noticed. 13 Sometimes the nurse may prepare food for the father and elder children—if she does, she expects beer money. Generally the father gets his food outside in a coffee shop—while the children are either fed by the eldest of them, who may be only 12 or even 10 years old, or they are received at meal times at the table of a relative or near neighbour. Some of the more considerate "nurses" scrub the floor, wash the household utensils, come in at 3 p.m. to give the mother a cup of tea, and toast, and at 7 p.m. to give her gruel. They are responsible for many of the foolish practices which obtain in the borough. They are expected to wash the baby, and in so doing wrongly pull away the cord prematurely, leaving an open wound, which they dress improperly with Fuller's earth or with burnt rag. They are eager to give the newly-born baby butter and castor oil, and worry the mother unnecessarily because "its little bowels hasn't acted." They bathe its eyes with stale milk and water, regarding this treatment as a specific for enabling it to "get the sight into its head." They look with indifference upon "thrush." One "nurse" averred that "Thrush was a natural complaint with babies, and showed their stomachs was working all right;" she had had 13 children and they had all had thrush. By the Midwives' Act, 1902, they are forbidden to act as midwives save under circumstances of great emergency, but there is no doubt that many do so act; staying with the mother during her labour until the child is born, and endeavouring to help her during her trial by numerous artifices which are as useless as they are popular. When the child has been born, they send for a student from one of the large general hospitals. In this way the neighbour-nurse is " covered " should any calamity occur. These "nurses" have their obsessions and their old-time beliefs. They assert that— 1. Breast milk and cows' milk will not mix, so that the baby should be fed on one or the other, and not on both. 2. Cow's milk is never twice alike. 14 3. Cow's milk for babies should be from one cow, and there is always one cow for every baby, whose milk alone suits the baby. 4. A baby can't make enough heat to sleep in a cot by itself. 5. It is unlucky to weigh a baby, and dangerous to cut its nails. The nails must be bitten off with the teeth until the child is a year old. 6. A baby must not be put out in the fresh air, or it will get sore eyes. 7. A quick cure for "thrush" is to wipe out the baby's mouth with its wet napkin. 8. If a baby cries without any apparent cause, this is due to some wish of the mother ungratified during her pregnancy. 9. Puerperal Fever is due to the washing of the lying-in mother. 10. Prolonged suckling prevents conception. These and many others are the crude ideas which are kept alive in London slums by " nurses " of the type now under review. It is a pity that the hospitals which now work in the district do not establish an efficient service of maternity nurses to displace some of these noisome and unsavoury " Gamps." Otherwise, the Borough Council might subscribe to the funds of the Royal Maternity Charity or Maternity Nursing Association, on condition that these bodies provided a nurse to attend to Finsbury lying-in mothers on the request of a lady health visitor. It is computed that, one nurse devoting her whole time to this work could attend to 800 mothers during the year. Illustrative Cases. 1. The baby was 8 weeks old, wasting and "covered with sores." During the lying-in, the "nurse" did not wash the mother. She did not put the baby to the mother's breast until it was 3 days old. She wrongly informed the mother that there was no milk in her breasts and immediately began feeding the baby artificially. She advised the mother never to wake the baby to feed it, and not to wash it until it was 6 weeks old. She told the 15 mother not on any account to drink water. "It would cool the insides too suddenly and give her the fever." 2. The baby was 3 months old, and the third child. It was wasting, had thrush, and eczema. The mother had been attended by a "nurse" to whom she paid 8s. per week and 3d. a day beer money. She had washed the mother only on request and the baby " now and then." 3. The mother had a difficult labour and was delivered under chloroform. The "nurse" who looked after her, left her lying in a bed, soaked in urine, for 3 days. The mother was not washed until she got up. 4. A mother complained that the "nurse" who attended her was personally dirty and did not wash or dry the baby properly. She did not wash the baby's napkins but used them over and over again, merely drying them in the interval. She threw the mother's diapers under the bed and left them there until they became very offensive. The mother's bed was not made during the whole of her lying-in. 5. The baby was 2 weeks old, and the second child. The family occupied one room. The mother was attended by a hospital student, and nursed by a neighbour, who said she did not understand babies, but could look after the mother. The mother was washed once only during her lying-in. The baby was washed on its face and hands but not elsewhere. At the first visit of the health visitor, both mother and baby were in a very filthy condition and smelt very offensively. The nurse explained, "It was only top dirt and didn't matter—top dirt didn't cause no fever." 6. The baby was a first child. The mother's milk came on the third day, but the breasts were rather hard, so that the "nurse" rubbed them thoroughly with camphorated oil. When the baby was now put to the breast, it was made very ill by the camphorated oil which it swallowed. Its life was despaired of for many days. The mother in the meantime lost her milk. 7. The "nurse" was lame and deaf and insisted that the baby should be clad in cotton. The mother knew that the child should be clothed in flannel, but was too weak after her confinement to 16 see that her wishes were respected. A compromise was effected by clothing the baby in a cotton shirt next to the skin and a woollen shirt over the cotton one. 8. The "nurse" was an office cleaner. Her hands were very dirty. Her clothing was filthy and smelt very offensively. She was very unreliable and often late in attending to the mother. On thes'i occasions the mother got up from bed, washed herself and the baby, and went back to bed. Subsequently, the mother became ill, and did not get up from her confinement for many weeks. MATERNITY AND CHILD WELFARE. A sum of money has been voted by Parliament in aid of the expenditure of local authorities and voluntary agencies in respect of institutions or other provision lor maternity and child welfare. It is to be noted that:— 1. The grant is not meant to defray the whole expenditure of local authorities: it is only in aid of such expenditure. 2. Local Authorities and Voluntary Agencies both participate in the distribution of the grant. 3. The expenditure is not only in respect of the care of children under one year, but also in respect of the welfare of— Expectant mothers with children yet unborn. Mothers during and after their confinements. Children between the ages of one year and five years. It contemplates the care of the mother during pregnancy, during and after her confinement, and the care of the child before, during, and after its birth until it has reached the age of five years, when it is taken over by the School Authorities under the Scheme for the Medical Inspection of School Children. A fairly complete scheme comprises:— 1. The local supervision of midwives. In London, the Midwives Act, 1902, is administered by the London County Council. 17 2. Arrangements for treating- the mother and baby before the birth of the baby. (a) A consultation centre for expectant mothers, that is, an antenatal clinic, and dealing with the following:— The history of previous confinements, e.g., abortions, miscarriages, syphilis, lead poisoning, deformities, displacements of the womb, and the consequent treatment of these conditions. The treatment of various vaginal and other discharges, and the prevention of ophthalmia neonatorum. The testing of the urine and the prevention of eclampsia. The measurement of ricketty pelves, or other deformities of the pelvic bones, interfering with labour, and the reference of such cases to appropriate institutions. The care of the mother's breasts and the treatment of depressed teats. The treatment of varicose veins, of constipation, and of other minor ailments interfering with pregnancy. (b) The home visitation of expectant mothers.—Arrangements with hospitals and other institutions to supply the Borough Council with the names of residents who apply for maternity help. Preparations for confinements. The cleansing of verminous and dirty tenements. The loan of midwifery bags, blankets, and clothing to poor mothers. The reference of ill-fed and very poor mothers to Dinner Centres. (c) The retention of beds in a lying-in institution to treat complicated cases of pregnancy and of labour. The causes of some of these complications have already been indicated, 18 3. During labour and during the confinement.— The furnishing of skilled and prompt attendance at home —doctors, midwives, or lying-in nurses. The treatment of difficult cases; for example, of mothers with contracted pelves, with diseases of the womb, heart, lungs, or kidneys. If a consultation centre or antenatal clinic were established, these difficulties would have been probably discovered and already referred to a hospital for special treatment. 4. After the birth of the child.— (a) The mother.—The treatment of complications arising during pregnancy—e.g., white leg, or puerperal fever. (b) The home visitation of infants and of children up to five years of age in connection, for instance, with the following matters:— The medical history of such children recorded for the use of educational authorities. The treatment and recognition of the common nonnotifiable infectious diseases, such as measles and hooping cough. The care and feeding of such children and the prevention of diarrhoea and rickets. The recognition and treatment of early unsuspected cases of tuberculosis and arranging for the examination of the contacts. The correction of sanitary defects of environment re-acting adversely upon the health of the children. Dealing with complaints as to neglect, ill-treatment, or exposure, and referring them to the appropriate authorities. (r) A clinic for infants and children up to five years of age, and to which they would be brought for medical examination and treatment. The early correction of defective vision. 19 The prevention and treatment of dental caries and deformities of the dental arch. At this clinic expectant mothers and children will obtain treatment, advice, supervision, and, when necessary, will be referred to special or to general hospitals for consultation or for operative interference. Cases of tuberculosis will be referred to a suitable dispensary. The records obtained at such a clinic will be of very great value to the Hoard of Education. It is to be noted that the scheme is only concerned with nursing mothers, with expectant mothers, and with children under school age. The ccntre is meant to be a maternity centre and a child welfare centre, not a general sick dispensary for the treatment of all and sundry women and children. The foregoing observations on the memorandum of the Local Government Board show what exceedingly important measures are brought within, its scope, and indicate the completion of the public health chain and of the sanitary legislative advance foreshadowed by the Medical Inspection of School Children,, the Public Health (Tuberculosis) Regulations, and the National Insurance Act. The health of the people is now an affair of State from before birth to old age. In the next annual report a full account will be given of the various Finsbury activities which deal with maternity and child welfare and the spheres of their usefulness. HEALTH VISITATION. The duties of the Lady Health Visitors are, briefly:— 1. To visit systematically, and to revisit, all the births in the poorer streets and some of the births in the better class districts. 2. To instruct the mothers, and especially young mothers with first children or twins, in the feeding and proper care of their babies. 3. To watch carefully over the child's health and progress, and to take the necessary steps by advice or by reference to medical or philanthropic agencies to safeguard the child's prospects and the mother's nourishment and circumstances. 20 4. To improve the home conditions of the mothers domestically by help, advice and suggestion, hygienically by referring defects of structure or environment to the Public Health Department. For these purposes, the Borough has been divided into two districts, mapped out as containing those streets in which the largest numbers of infant deaths have occurred in recent years. DISTRICT No. 1. Affleck Street Eagle Dwellings Albert Street East Place Albion Place Easton Place Arlington Street Easton Street Attneave Street Farringdon Road Aylesbury Street Farringdon Road Buildings Bakers Row Fernsbury Street Baron Street Field Place Benjamin Street Fletcher's Row Berkley Street Francis Court Berkley Court Gloucester Street Bowling Green Lane Godson Street Busaco Street Great Bath Street Chapel Row Grimaldi Street Claremont Mews Hallett's Place Clerkenwell Close Hardwick Street Clerkenwell Green Hayward's Place Coldbath Buildings Hermes Hill Coldbath Square Hermes Street Collier Street Howard's Place Corporation Buildings James' Gardens Corporation Row Jay's Buildings Cowcross Street Jerusalem Passage Crawford Passage King's Cross Road Cumming Street Leicester Place Donegal Street Lloyd's Row Donegal Street Buildings Lock's Gardens Douglas Place Margaret Place Dundee Buildings Margaret Street Eagle Court Market Buildings 21 Merlin's Place Muriel Street Myddelton Street New Buildings Noble Street Northampton Buildings Northampton Road Northampton Row Peabody Buildings, Farringdon Road Penton Place Penton Residences Penton Street Pentonville Road Pine Street Pump Court Red Lion Street Richard Street Risinghill Street Robert's Place Rodney Place Rodney Residences Rodney Street Rosomon Mews Rosomon Street Sadler Street St. Helena Street St. James' Street St. James' Walk Salisbury Buildings Scotswood Street Seabrook Place Seymour Place Smithfield Buildings Southampton Street Southern Street Tysoe Street Victoria Dwellings Vineyard Gardens Vineyard Walk Warner Street Warren Street West Place Whiskin Street White Conduit Street White Horse Alley White Lion Street Wilmington Place Wilmington Square Winchester Cottages Winchester Street Wynford Road Yardley Street DISTRICT NO. 2. Allen Street Amias Place Baldwin Street Baltic Street Bartholomew Square Bastwick Street Bath Buildings Brewer Street Brunswick Close Buxton Houses Buxton Street Cavendish Buildings Central Street Church Row Compton Passage Compton Street Coster's Dwellings Cottage Lane 22 Cyrus Street Dingley Road Domingo Street Dufferin Street Elizabeth Place Errol Street Europa Place Frederick Row Galway Street Gastigny Place Gee Street Goswell Terrace Graham Street Great Sutton Street Guest Street Guinness Buildings Hall Street Hatfield Street Helmet Row Henry Street Ironmonger Row Ironmonger Street Langton Avenue Langton Street Leage Street Lever Buildings Lever Street Leverington Street Lewin's Court Little Northampton Street Little Sutton Street Lizard Street Ludlow Street Macclesfield Place Macclesfield Street Malta Street Mason's Place Memel Street Mitchell Street Mitre Court Moreland Street Murton Street Nelson Street New Street Norman Street Norman's Buildings Northampton Street Norway Street Parr's Place Paton Street Peabody Buildings, Dufferin Street Peabody Buildings, Guest Street Peabody Buildings, Roscoe Street Peartree Street Peerless Buildings Peerless Street Percival Street President Street Radnor Street Radsworth Street Rahere Street Rawstorne Street Richmond Street Roscoe Street St. Bartholomew's Buildings St. Clement's Buildings St. John Street Sidney Grove Sidney Place Sidney Street Smith Street Valetta Street Waterloo Street Wharf Road Whitecross Street Wynyatt Street Young's Buildings 23 One district is assigned to each Lady Health Visitor, and in the special streets so named and defined every household in which a birth occurs is visited on or about the eleventh day after the birth if the mother is up, or earlier on request, or if there is reason to believe that the mother is unattended by doctor, midwife or nurse. It is important to notice that, in these streets referred to, every birth is visited, and not merely births in those households where the parents are ostensibly poor or dirty. There are three streets in District 1—Chapel Street, Sekforde Street, and St. John Street, and three streets in District 2—City Road, Goswell Road, and Old Street, where visits arc discretionary and confincd to mothers in poor circumstances, mothers living in attics or in one-roomed or two-roomed tenements in squalid, dirty surroundings. Although many infant deaths have occurred in these six streets, many of their inhabitants aire better-class people and well-to-do tradesmen who do not need the help of the health visitors. In other streets only those births are supervised where the mothers arc very young, careless, negligent, ill-treated, alcoholic, deserted, living in poor and domestically squalid surroundings, or are known to be the chief or sole wage-earners for their families, or where the children are first children, wasting, debilitated, ailing, illegitimate or twins. Other households are visited on request, or on complaint as to ill-treatment, neglect or exposure. While the first visits are made in a general way all over the borough, revisits and supervision of a minute character are chiefly directed to the babies who are not thriving, babies who are debilitated, ill, neglected, dirty, badly fed or clad, "wasters," twins, and others who need careful watching and attention. Very few visits are paid to those mothers who have successfully reared large families and have lost none, or only earlier children. When the desirability of visiting a mother is a matter of doubt, a very good test is to ask her to show for inspection the soap with which she washes the baby. If the mother at once, and 24 without any hesitation, produces soaps of various kinds and qualities—scented, household, and disinfectant soaps—then on this head alone it may be decided that the mother is a clean, careful woman who can very well do without the aid of the health visitor. If, however, the mother does not know where the baby's soap is, if the request leads to a domestic discussion as to who used the soap last, and a reoriminatory dialogue as to where the last user placed it, such a household is at once considered to be one for visiting and for revisiting. In Finsbury, home visitation is considered to be by far the most important work of the Health Visitor. For Finsbury purposes the instruction and attendance at Weighing Centres and Schools for Mothers are, in this connection, deemed to be of third-rate or even of fourth-rate importance. Everything else is subordinated to home visitation, and any part of the work which, in any way, interferes with the efficiency, scope, or extent of home visitation is discarded. As a rule, the health visitors are exceedingly well received and welcomed by parents. It is an extremely rare event for a visit to be resented. On the first occasion, the Health Visitor leaves with the mother a booklet on the care of infants, and a card of information about the Weighing Centres, with an invitation to bring her baby to be weighed. Sometimes it is difficult to sec the mother, because she may have to go out to work at an early hour and may return very late in the day. In such cases a postcard is sent making an appointment for a convenient time, and asking that the mother and baby shall be present when the health visitor calls. When visits cease to the mother of a delicate baby, a stamped postcard, addressed to the health visitor, is left with her. If the mother tills in and sends this postcard by post, she will be revisited Postcards to mothers are sent in plain envelopes so as not to wound their susceptibilities. Letters to these humble households are so few that any contained in official envelopes will rouse the curiosity and adverse criticism of inquisitive reighbours. 25 At the first visit, the following information is obtained (or every birth :— Name. Address- Rent. Birth date; Weight at birth. Age at first visit. Condition at first visit. Method of feeding. The number of the child; the number of infant deaths in the family. The number of rooms occupied in the tenement and their condition. The father's work and its nature; whether casual or regular; in work or out of work; his earnings and when he last worked. The mother's work; its nature; her earnings and when she last worked. The usual support of the household. Some of the above details, such as the earnings of the father and mother, are not made the subjects of enquiry, but are only recorded if they are given voluntarily. At the appropriate times, the health visitors distribute leaflets of information on measles, summer diarrhoea, flies and nuisances associated with the non-removal of house refuse. A visitation register is used to preserve a continuous record of the visits paid and visits due to be paid. A full account of each visit, its reason, the observations made, and the action taken are entered in a daily journal. Books of "reference slips" are used for referring to the medical officer of health matters such as the following :— Homeworkers found at work. Cases of suspected overcrowding. Cases of suspected phthisis, wasting, pleurisy, bloodspitting, long-continued cough, long-continued asthma, or long-continued bronchitis. 26 Mothers or others in their households said to have weak chests or whose chests are "affected." Unnotified cases of ophthalmia neonatorum. Cases of infectious disease, or of suspected infectious disease, discovered in the district and retained at home. Public health nuisances noted during home visitation and attaching to water closets, yard gullies, and the removal of household refuse. Verminous tenements. The chief use of these observations is to secure the abatement of nuisances and the removal of defects of environment which may react adversely upon the progress of the mother or infant. Other obvious results are the provision of medical treatment for both, and the recognition of missed cases of tuberculosis in the household. Correspondence books with counterfoils are used by the health visitors for the following purposes :— To refer mothers, who are very poor or destitute, to the Poor Law relieving officers. To refer ill-fed, thin, and wasting mothers to the dinner centres established at 128 Pentonville Road, 36 King's Square, and 162 Lever Street. To refer cases of cruelty to children or cases coming under Section 12 of the Children Act, 1908, to the Inspector of the National Society for the Prevention of Cruelty to Children. To refer unregistered foster-mothers to the L.C.C. Public Control Department, Avenue House, 21 Northumber land Avenue, London, W.C. To obtain home nursing for lying-in mothers, or mothers with babies, by referring them to the Association for Nursing the Sick Poor, 23 Bloomsbury Square, to district nurses, to the Churches, or to other suitable agencies. The notes sent in these cases are carefully drafted so as to be terse, concise, and free from inquisitorial matter. 27 The foregoing survey indicates briefly the degree of completeness to which the organisation of health visitation in Finsbury has now attained. For the further extension of the work, the details are planned on a sufficiently wide basis to permit of their easy adaptation to fresh measures and to new duties. Birth Visitation.-The number of visits paid by the Health Visitors was as follows .— District. First Births. Total Births. Total Visits. No. 1 79 657 1,709 No. 2 127 919 2,725 Totals 206 1,576 4,434 The numbers for 1913 were 284 first births, 2,082 total births, and 5,964 visits. In 1914 the total number of births in the Borough was 2,558, so that these figures show that during the year over 60 per cent. of all the births that occurred in Finsbury came under the supervision of the Public Health Staff. In the mean streets of the Borough, all the births are visited. The number of twins born and visited was 35 sets, or one set of twins for every 73 births. For the whole country, it is usual to find that twins occur in one out of every 60 to 80 births, and triplets in one out of 6,000 to 7,000 births. Method of Feeding.—Nearly all the Finsbury mothers breast feed their babies, wholly or partially, as long as they possibly can. For this there are many reasons: they have strong maternal instincts, they know that suckling is cheaper than artificial feeding and believe that it hinders or prevents conception. When their babies are a month old, or at most three months old, a large proportion of the mothers have to return to work. Still many try to continue breast-feeding by coming home at meal times or by suckling the baby in the house of a friend, where it has been taken earlier in the day, near the factory or workshop. 28 Overfeeding is almost as common as underfeeding'. Mothers who breast-feed their children, give them boiled bread or cow's milk as well, because the infant "does not seem to be satisfied," or because they think "he does not get enough at one whack." the results to the child are disastrous. His tiny stomach becomes overloaded and distended. He vomits and wastes. The practice of drinking stout "to make milk" is very common A mother stated that to give the baby sufficient nourishment, she should have 2 pints of stout and 2 pints of ale a day. "Stout made the milk, and ale put it in the breast." When a mother really has insufficient breast milk, she endeavours to make up for the deficiency by giving the infant boiled bread or barley water, or both. The use of supplementary feeds of cow's milk is not popular for the alleged reason that "cow's milk and breast milk will not mix." And sometimes when a mother has been induced to give supplementary feeds of cow's milk, a young hospital student with little knowledge and less experience has been known to wrongly advise her to give up breast-feeding entirely and to start artificial feeding. The use of boiled bread, "pobs," or "sop," for infant feeding is extremely common. It is traditional in the borough and is encouraged by obstinate grandmothers who "have brought up and buried more children than their daughters ever had." This feeding with boiled bread is probably responsible for much of the malnutrition observed in the pasty, sallow, pinched, muddycomplexioned, ricketty children of mean streets. Barley water is possibly even more popular than boiled bread and is much ordered by medical men, who probably have never seen the thick grumous mucilage, almost of the consistency of glue, which the mothers make with dirty hands in filthy utensils and which they call barley water. As made in Finsbury, barley water is probably responsible for many infant deaths every year. The mothers make it far too thick; they do not wash their hands before making it. It is made in a dirty glass, cup, or jug which may contain the dregs of a little stout, or may have been fouled by Hies or animals. There are two other very important reasons for condemning the use of barley water. In recent years, barley 29 has been "faced" with talc, steatite, or other noxious mineral matter, and, it is alleged, even with rancid oils. It is quite common also, to find in barley, in rolled oats, and in porridge oats even in some of the best brands, small black pellets which are the excremental droppings of mice. It is possible that the diarrhoea, which sometimes follows the taking of barley water by babies, may really be directly due to the fouling of their drink by this dried faecal matter. The use of barley water is very much discouraged in Finsbury. Artificial feeding is very common after the third month. The tubeless bottle is popular, but the long-tubed bottle is still to be found, chiefly in families where the grandmother's directing influence is paramount. Some mothers there are who assert they have never seen any other kind than the long-tubed bottle. Others appear to be quite dense and crass-headed, and quite unable to understand simple feeding instructions. In these cases it is very helpful to explain matters to the older children of 12 to 14 years, who to a certain extent may be expected to guide and check the mothers. It is astonishing in squalid streets to see the heavy responsibilities that are cast upon young children. When the mother goes out to work, the care of the whole family may be left to a girl of 10 years or even less. Cases have been known where the only occupants of a tenement were a girl of 8 years, who was washing the floor and looking after 3 younger children and the baby. She had been given a halfpenny to get the baby milk—a farthing's worth for dinner and a farthing's worth for tea, and twopence to get herself and the other children fish and chips. In such circumstances, the cleaning of the milk bottle is left to these young children, who do the best they can. One tried to clean the bottle with water and paper pellets made from an old newspaper. Another child of 12 years, a novice at minding baby, was cleaning the milk bottle with paraffin. She observed that "paraffin will clean anything." The milk prepared for the baby by these children foster-mothers is often found to be too hot, so that the infant vomits after taking it. 30 The dummy teat is still extensively used. If it falls on the floor, it is rubbed momentarily on the mother's blouse or apron, lipped by the mother, and replaced in the baby's mouth. This means at least two risks for the infant—contamination from the floor, and infection from the mother's mouth. If the mother suffers from pulmonary tuberculosis, or from pyorrhoea alveolaris, these risks are thereby much increased. It is quite a common occurrence to see the dummy teat being cleaned in soapy water, which has already been used for washing the older children. For in these mean streets the standard of domestic cleanliness and of personal cleanliness is on the whole a low one. It must be admitted, however, that even in the slums may be found rooms exceedingly clean, and very well kept. It is difficult sometimes to rightly appreciate the point of view of the slum-dweller. In a one-roomed tenement dwelt the father, mother, and three children. There was very little furniture. On one occasion at dinner time the father and mother sat at table on the only two chairs they possessed, while the three children and a cat were feeding on fish from one and the same dinner plate placed on an up-ended tub. The cat clawed and mouthed what it could. Sometimes the children gave the cat a part of a tit-bit, and themselves ate the remnants which the cat had declined. When this was pointed out to the mother, she observed, "We consider the cat as one of us. I didn't think the cat would take no harm. I didn't know that cats took the fevers." The use of patent foods is not very common, though some mothers in the very poorest streets buy very expensive foods, even although they may have plenty of breast milk. One mother bought some patent food because "it was such beautiful looking stuff—it looked like silk, 5s. per tin." She thought "it was bound to do baby good because it cost such a lot," and because it had "'Used by Royalty and recommended by doctors,' printed on the label." Such mothers are inclined to believe anything they see in print, and are the prey of unscrupulous manufacturers who advertise their wares extensively and mendaciously. Preserved or dried milks, advertised under trade marks depicting a mare, an ass, or a goat, are taken to be milks actually derived from these animals, and are on that account wrongly considered to be immensely superior to cow's milk. 31 Illustrative Cases. 1. The baby was 3 months old. There had been 11 children, but only 4 now lived. The family occupied one room, only. The mother was a widow who sold flowers in market streets. She had ample breast milk, but gave the baby a bit of eel pic night and morning. She said, "Baby enjoys a bit of eel, it is very good for the chest." 2. The baby was 4 months old. There had been 6 children. Five still lived. They occupied 2 rooms. The father was a costermonger. The mother had very little breast milk. The baby was being fed on biscuits. The mother's method of preparing them was, "Soak a biscuit in hot water, pour the water off, beat up with a pinch of sugar, a pinch of salt, and a knob of butter. Baby looks for it now." 3. The baby was 4 months old, and the sixth child. There were 3 other children. The baby was thin and wasting. Its feet and hands were purple; its face and buttocks were very sore. It was being bottle-fed, but the mother did not know how much water she ought to add to the milk, and she did not know the degree of dilution she was actually using. She just made the mixture "all accordin,'" from which it was inferred that the dilution depended upon the amount of milk available. The amount of liquid in the bottle was said to be always the same. When milk was scanty the deficit was made up with water. The milk bottle was excessively dirty, and the diluted milk actually found in it and which the baby was drinking was sour. On a subsequent visit, the bottle was being washed in a small enamelled bowl, 10 inches in diameter, containing soapy water already used for washing the hands and faces of members of the family. The mother had a wound on her face which had been stitched in four places. She explained that her husband "had been paying her "—he had been "knocking her about." 4. The baby was 9 weeks old and the ninth child. Seven children now lived. The family occupied 2 rooms. The baby was very thin and wasting. It was being fed on oatmeal, sugar, and water. This diet was most unsuitable, and had given the baby 32 severe diarrhoea. This food was being cooked in a can containing the dregs of stale ale. A little cod liver oil and malt were beingadded to the mixture, which when warm was poured into a dirty, offensive-smelling feeding-bottle from which the teat had been lost. The teat was eventually found on the floor. It was being used for play by a kitten. The bottle was kept on a very dirty dresser, and was placed on dirty clothes which awaited washing. The baby was unwashed at 3 p.m. It was clothed in a flannelette vest, a dirty napkin, and enveloped in an old piece of rugging. An older child, years, very poorly clad, slept in a broken perambulator. Four chldren slept on the floor on discarded coats and old sacking. The father and mother slept in the kitchen on the only bed they possessed. The father was a general labourer earning 22s. a week. 5. The baby was four months old, and the fourth child. All the children were living. The family occupied 2 rooms. The baby at the age of four months weighed 1½ 1bs. less than it did on the day it was born. It had been ordered to have 2 pints of milk by the hospital doctor, but the mother stated she could not afford more than half a pint a day. She did not tell the hospital authorities of her poverty. She asserted that "if anything did happen to the baby, she was all light for the certificate from the hospital because she had done her best for it." 6. The baby was 3 weeks old and the sixth child. Only three children now lived. The baby was breast-fed, clean, but wasting and suffering from diarrhoea. The mother used to give it "a few spoonfuls of groats the last thing at night to compose it. It settled the child till the morning." 7. The baby was 4 months old. The mother used to take it to the grandmother's house and leave it with a girl 15 years old. The grandmother and mother went out to work daily. The mother brought a little patent food in paper for the girl-minder to place in a saucepan with boiling water and boil the whole up for the baby's food. She guessed the quantity, and said, "I mixes it as I thinks. I tastes a drop and if it tastes all right, I give it to baby." The food seen was very thick and dirty. 33 8. The baby was 6 months old and had just recovered from pneumonia. It had two teeth, and was trying to eat a "toffee apple" which had become impaled on its teeth. Its mouth was full of green apple pulp. Care and Condition of Baby.—When the babies were first visited by the health visitors, many of them were improperly or irregularly fed, wasting, suffering from exposure or neglect, or insufficiently or improperly clothed. Some babies had no clothes. Just as some babies were under-clothed, so others were overclothed. On a hot summer day, a baby 7 months old was found to be dressed in one woollen vest, one flannel shirt, two flannel frocks, one cotton petticoat, and one woollen dress, The use of flannelette clothes is extremely common—chiefly on Account of the cheapness, and the attractive colour, backed by the protestations of obdurate grandmothers who will have no other. Sometimes a mother explains that she will not give her baby woollen clothes because "once you clothe them in flannel you can never get them to take to flannelette afterwards." Occasionally a slum mother, more intelligent than her neighbours, will develop quite sensible and advanced ideas. Thus a baby was found in its cot, clad only in a coloured coat, active and lively. It was a hot day, and the mother had bought the garment for the baby in order that it might kick freely, and strengthen its muscles in what she called its "sports coat." Babies are put into short clothes at very unsuitable times and in very inclement weather, often, it may be, on the occasion of the birthday of some other member of the family, or at Easter or Christmas. They are taken out to be shown to relatives and friends, clad for the first time in these short clothes, in spite of rain, wind, hail or snow. They catch cold, bronchitis, pneumonia, and a few die. Many children were dirty—very many were verminous. When the mother goes out to work early in the morning the washing of the children is delegated to the eldest, who may be only 8 or 10 years old, or they are left unwashed until the mother returns at night. Some mothers admit that they do not wish to wash their babies, "because the baby flops about so,"— "its bones and joints ain't what you may call set"; others say they do not know how to wash the baby's body, and therefore only 34 wash its face. Some again fear that if they wash the baby "the cold will strike inwardly and set up inflammation of its little insides." In one household where the mother and all the children were found excessively dirty the mother observed, "Dirt didn't matter if the children thrived in it,—it was only top dirt." She washed them " regular at the end of every week." Some mothers wash the baby just a few weeks old with strong unsuitable soaps, so that the skin between the legs becomes very sore and peels in large pieces, leaving raw surfaces. Others, with little knowledge, wash the babies' napkins or clothing in water containing strong soap or washing soda, and in this way give the baby eczema. It is quite common in a household to find that the father is out of work and alleged to be looking for it, and that the mother has regular work and has gone out early in the morning, leaving the care of the home and baby to quite a young child, 8, 10, or 12 years old, who has been given a halfpenny or a penny to get milk for the baby until the mother returns at night, and a penny or twopence to get fish and chipped potatoes or "pieces" for the older children. When the baby becomes ill, the mother takes the advice of a neighbour and uses up the remains of any medicine which the neighbour had "when her own child was took ill in the same manner of speaking." If the illness persists, the mother describes the symptoms to a chemist and "fetches a bottle of medicine" from him. If the child does not improve it is taken in person to see the chemist. After this, if the child still continues ill, the mother seeks medical advice. Discharging eyes are bathed in milk and water. For coughs and colds the chest is rubbed with Russian tallow, camphorated oil, or "nine oils." Diarrhoea, unless it be severe, is considered to be "natural in a baby." When their children become ill, mothers often lessen their chances of recovery by taking them out to a hospital, to a dispensary, or to be christened in rough weather. They say they cannot afford to have a doctor at home. Mothers in mean streets are very fastidious; sometimes they will not use an ointment given to them at the hospital "because it docs not look right," 35 Nearly all the babies slept in bed with their mothers at night, even though they occupied separate cots during the day time. One mother stated that she could not sleep herself if she had not got the baby with her in bed. At the end of 1914 a leaflet of instruction was drafted on the dangers of overlying, and has since been distributed In the borough. For poor people, unable to afford a cot, the use of a banana crate is recommended. It is best sandpapered and pollshed. When padded, these banana crates harbour vermin. The health visitors always endeavour to see the babies. It has been found that the statements of parents and of neighbours as to the condition of the baby cannot always be relied upon. For example, a mother who had to go to work daily had left her baby in the charge of a neighbour, who stated that the child had two good meals a day of "sop" and was as fat "as a little bullock." Difficulties were placed in the way of seeing the child, but it was eventually caught by surprise in the street. It was then found to be pale, flabby, dirty, and emaciated. Mothers appear to be glad when the doctor orders them to give the baby brandy, but they sometimes overdo it. Thus, a doctor had ordered the baby to have 10 drops of brandy three times a day. The mother was actually giving the baby 20 drops of brandy every two hours. Illustrative Cases. 1. The baby was 9 months old and the seventh child. Only four children now lived, three were dead. The family occupied two rooms. The baby had bronchitis and had been placed in an orange box close to the fire. Its head was covered with scabs, which the mother was afraid to touch. Its chest, back, arms and legs were well rubbed with Russian tallow, and it was enveloped, back and front, in thick brown paper soaked in tallow. Over this were placed a cotton-wool jacket, one flannel vest, and two flannelette petticoats. The baby had not had a bath for two months. The mother had bought patent leather shoes to put on the baby when she took it out if the weather became fine. The father was out of work. 2. The baby was 3 months old and the eleventh child. Seven children had died, so that only 4 now lived The family occupied 36 2 rooms. The baby was clothed in a cotton shirt, stiff cotton binder, a dirty foul napkin, and a verminous, roomy, old brown coat discarded by one of the older children. The tenement was visited at 3 p.m. The mother was then dirty, untidy, and unwashed. The older children were said to have been washed, but were "not yet dry." The rooms, the chairs, the table and domestic utensils were filthy. 3. The baby was 6 weeks old and the first child. The family occupied one room. The mother was out at work as a machinist. The father had been out of work for a long time. The mother kept the father and the home. The baby was fat, but small. It was left in charge of the mother's sister, who had had two children and lost both. The mother went to her sister's house at meal times to suckle the baby. 4. The baby was 5 weeks old and the ninth child. Six children had died—only three now lived. The family occupied one room at a weekly rental of 3s. The baby, at birth, weighed 9 lbs.—at five weeks it weighed 8 lbs. 14 ozs. The mother was a jam bottler, earning at most 8s. per week, and left the baby daily with another woman in the same street. It was being fed on condensed milk. The doctor who saw it said it was having insufficient food. The mother was unable to afford more. The father was in prison for ill-treating his wife. 5. The baby was 14 days old and the third child. One child had died. The family occupied one room. The mother was dirty, verminous, and smelt offensively. The mother and grandmother were both drunk. The baby was very dirty and verminous; apparently it had not been washed for many days. The walls oif the tenement, the bedding and the pictures were verminous. The father was a soldier, away from home. 6. The babies were twins, 5 weeks old, and the 10th and 11th children. The parents had only lost one child, and occupied 2 rooms. The father was a labourer out of work. The mother had casual employment, and at the time of the visit was out looking for work. The babies were being bottle-fed by a girl 14 years of 37 age, who had scrubbed the floor and table and was washing the children's clothes and napkins in a small enamelled bowl. The Mothers.—One of the most potent factors in maintaining the infantile mortality of Finsbury at its high level is the employment of the mothers. In the mean streets of the borough, a large number of mothers work cither in their homes as outworkers or in workshops. They resume their employment soon after the confinement, but defer the weaning as long as possible. Some work even during the lying-in, on the third or fourth day after they have just been confined, making wreaths or artificial flowers as they lie in bed. They work chiefly because they are unable to live on their husband's money, because their husbands keep them short, or because their husbands are out of work. A few—very few state that they work in order to get a little extra pocketmoney. Many of them work right up to the day on which they are confined. They work before the confinement in order to pay for the lying-in equipment for themselves and for the clothes for the children about to be born. The difficulties which occur during the confinement are very distressing, especially when the family occupies only one, or at most two, rooms. In such straits the father may go to sleep in a neighbour's tenement, while the children may be taken in by relatives or friends. Often the father may be found sleeping on the common stairs with his head between his hands. These are comparatively easy ways out of trying situations. The deplorable circumstances arise when the family occupies one room and the husband is ill in bed, or when the children cannot be accommodated elsewhere. Thus, in one case the family occupied one room and the father was ill in bed with rheumatic fever. When the mother was confined the father was carefully lifted out of bed and laid on a couch near the side of the bed while the mother was being delivered of her child. It would be a wise provision of the owners of large blocks of tenements if, in such buildings, they were to furnish and equip a special lying-in room for the use of their mothers—a room, cleanly kept and replete with modern conveniences for confinements, which poor mothers cannot afford. 38 Woman's work never ends. In the slums, during the first months of marriage, before the first child is born, the father and mother both work so that they may save as much as they can. Later the husband gradually gives up work, or takes casual employment, often as a "general labourer." Each year many instances are brought to the notice of the public health department where the fathers are anxious for the mothers to go to work and relieve them of the support of the family. When the mothers go to work, some of the younger children are left at home unattended, and may be found running about the room naked or clothed only in a cotton vest. Sometimes they may be found sitting on the doorstep in this condition, or throwing mud or house refuse at one another in the back yard. Sometimes they lie face downwards on the pavement with their heads just over the kerb, handling the filth in the gutter or fashioning it with their hands to the embarrassment of passers-by. Many mothers are ill-treated, insufficiently fed, and insufficiently clothed. Some are disfigured by their husbands. They are then unable to go to a hospital, to a dispensary, or to come to the weighing centre until they have recovered from their maltreatment. Other mothers cease attending because they have no decent clothes, because their clothes have been pawned, or because they have no shoes. However, mothers who are unable or afraid to go out will apparently take all risks and adopt all sorts of devices in order that they may attend the churching. In slum districts the mothers often worsen their prospects by marriage. Before marriage they may earn from twenty to twentyfive shillings per week. After marriage they may have a very hard struggle to keep out of debt. The commonest occupations of the mothers are office-cleaning, machining, bookfolding, charing, street hawking, ironing, working as a laundry hand, or making cardboard boxes, paper bags, or artificial flowers. Some mothers pursue a variety of trades. When one trade fails or becomes slow, they take up another. For example, one mother sold flowers in a market street in the morning, made wreaths in the afternoon, and sold newspapers in the evening. 39 Many mothers were ill, and worn out with child-bearing. Some were consumptive and cowld not or would not recognise the seriousness of their illness. For example, a mother was wasting and had had a persistent cough for two years. After much trouble and hesitation she was persuaded to take medical advice. She was found to have consumption of the lungs. She refused to accept the diagnosis, saying, "I have had this cough for very many years and am now quite used to it. I consider it to be a family complaint." When the mothers get ill they decline to enter a hospital or infirmary until their illness has made considerable progress, because there is no one to look after the children during their absence. Very few of the mothers have good teeth, even though, before marriage, they possessed teeth which were clean and well cared for. In the slums the teeth are washed with ordinary soap. In married women, dental caries is very common, and the need for conservative dental treatment, at a reasonable price, is pressing and urgent. Some of the mothers were personally and domestically dirty. One mother stated that she only washed herself when she went out to visit friends or to do some shopping. During the first few weeks of the war the mothers who were soldiers' wives were in great distress. Later on they were much better off than they had been for years. They received a regular allowance, more than they had previously had from their husbands, and they had less persons to feed because their husbands were away. So much was this betterment appreciated that in mean streets the women became most ardent recruiting agents. They pressed their husbands to enlist because they heard from neighbours how well off those mothers were whose husbands were now soldiers. Mathers, who formerly used to work hard to keep the home, were able to manage without employment when their husbands had enlisted. Some of the occupations and earnings of mothers are appended. The average working day may be taken to be of eight hours' duration, but in many cases this time is much exceeded. Many women consider themselves fairly well paid at the rate of 3d. per hour—many have to be content with 1d., l¼d., or l½d. per hour. 40 Making simple artificial flowers, 3d. per gross. Making artificial wreaths, l½d. each ; the time taken varied from one to one and a half hours. Making soldiers' kit bags, 1s. l½d. per dozen; the home- worker finds her own thread. Capsule packing, 2d. per 1,000 capsules. Washing clothes for laundries and neighbours at home, 4d. per dozen; earnings, 4s. to 5s. per week. Mounting Christmas cards, 1s. 6d. per 1,000. Making petticoats, l½d. each. Cardboard box making, 2¼d. per hour. Envelope folding, 1d. per 1,000 sheets. Bookfolding, 10d. and 1s. per 1,000 sheets. Blouse making, 3s. per dozen blouses. Mantle making, 7d. each. Wire stitching for cardboard boxes, 2d. per 1,000 stitches. Cutting cigarette coupons, 9d. per 1,000. The actual weekly earnings were :— Bottling beer, 11s. Bottling jam, 7s., 8s. Dressmaking, 10s., 12s. Envelope folding, 6s., 7s. 6d., 8s., to 12s. Feather curling, 10s., 12s. French polishing, 5s. to 10s. Laundry hands, 5s., 7s., 9s., 10s. Machining, 6s. to 17s. Making cardboard boxes, 7s. to 10s. Making lancer plumes, 4s. 6d. Making toys, 10s. Office cleaning and charing, 9s., 10s., 12s. Packing cocoa, 10s., 12s. Shirt making, 10s. to 12s. Street hawking, 10s. to 12s. Tailoring, 10s. to 15s. Waitresses in restaurants and coffee houses, 5s., 6s., 7s., 9s., and food. It is usual for the waitress to pay for the washing of her own collars, cuffs, and aprons. 41 Illustrative Cases. 1. An expectant mother was visited one month before her confinement. There were 9 children, all living. The family occupied 2 rooms. The mother had pleurisy and was poulticed by 'he husband when he came home from work. When the pain got less she used to get up and clean the children and the home. She was unable to enter a hospital because there was no one to look after the children in her absence. The father was a costermonger and earned from 12s. to 14s. a week. The mother provided the equipment for her confinement. It consisted of 2 woollen vests, 2 flannel binders, 2 flannel barracoats, 4 second-hand cotton gowns and one shawl. She had not provided any binders for the baby because "she did not hold with them, and knew that babies were better without them." However, the student who attended her in her confinement made her buy some. When she was confined she had on her hands three babies that could not walk. 2. The baby was 3 months old, and the third child. Two lived. The family occupied one room, and was destitute. Everything that could be pawned had been pawned. The mother had no underclothes, no coat, no shoes. The only bedding left was a soiled mattress and a pair of sheets, which could not be pawned because they had been stitched down the middle. The mother got up a few days after her confinement to earn money by taking in washing. Her husband did the wringing. 3. The baby was 10 weeks old, the second child, and the only one living. The family occupied one room. When she was visited by the health visitor the mother was thin, insufficiently fed, and badly clad. She had just "shortened" the baby because it was Easter time. The baby's clothes for this purpose had been borrowed from a neighbour. The only food in the house was bread, butter, and tea dust. The mother had been recommended for free dinners, but she had been unable to attend because her "husband kept on giving her black eyes." 4. The baby was 2 weeks old and the third child. One child had died. The family occupied 2 rooms. The mother sold shell 42 fish at a street stall and went home to breast-feed the baby at meal times, or had the infant brought to her at her stall if trade were busy. The father was a cloth shrinker out of work. 5. The baby was 3 weeks old and the seventh child. Five lived. The family occupied 3 rooms. The baby was breast-fed and in good condition. The home was clean. The mother made cardboard boxes at home, but gave up her work shortly before her confinement. The father had consumption of the lungs and had been away to a sanatorium, but discharged himself prematurely in order that he might proceed home to take care of the children when the mother was confined. The father slept with the mother and the baby, and was said to cough all day and night. One girl slept alone in a small bedroom. Three boys slept in another room. The sleeping accommodation was rearranged by the health visitor. The father now slept by himself in the small room. The eldest girl slept with her mother. The baby slept in a banana crate.. 6. The baby was 12 days old and the second child. One child had died. The family occupied one room. The father was said to "pick up a few pence" labouring in the market as a casual porter. The mother was a french polisher, insufficiently clad. She had no clothes "decent enough to go out in"; she had pawned them. When she went out she borrowed clothes from "the lady upstairs." There was no food in the tenement. The baby was eventually overlain while in bed with its parents. 7. The baby was 2 weeks old. There had been 7 children and 6 still lived. The family occupied one room at a weekly rental of 4s. The baby was clean and well cared for. The room was very dirty. The father was a porter, and when he worked earned 2s. 6d. a day. He said he had "a pain in the back so shocking that one day's work knocked him up for a week." The mother sold lemons and beetroot in market streets and sometimes made a profit of 2s. a day. 43 8. The baby was one month old. There were 2 children, both living. The family occupied one top back room. The only bedclothes were one sheet and a threadbare blanket patched with coatlining and some "oilcloth." The mother was badly clad and insufficiently fed. There was very little furniture. The mother had not bought any equipment for herself or child before her confinement. She was relying upon obtaining a "maternity bag" from the hospital. When this request was not granted she was in great difficulties, because she had nothing ready for the baby when it was born. The family had been sleeping on an empty mattress on the floor. When she. began her labour, her husband went out to buy shavings to pad the mattress. She had borrowed the amount of the Maternity Benefit beforehand from a slum moneylender and was paying 2s. 6d. a week interest, that is at the rate of one penny per week for every shilling lent. The Fathers.—In the slums the fathers are chiefly employed as labourers, carmen, porters, packers, warehousemen, and street hawkers. Many are engaged in casual employment; many are "odd men taken on now and again," or doing "odd jobs." Some are "labourers out of work"; some are work-shy, "do not believe in work," earn an occasional shilling and give their wives a "sixpence now and then." Some fathers give their wives with 4 or 5 children the same wretched pittance as they did when they were first married and had no children to support. Many of the mothers did not know where their husbands worked or what their earnings were. Other mothers wished to conceal the occupations of their husbands. One such had stated that her husband was a carman. Later, they and their baby, 13 months old, were seen in a London square. The mother was soliciting money from passers-by. The father was playing a combination slum orchestra—which included a violin, Pan's pipes, drum, a triangle, and cymbals. Another woman said her husband was a jeweller's traveller. The neighbours said he was a notorious burglar, well known to the police, and had often been in prison. 44 Lowest in the scale are fathers who "work pitches" outside public houses for a living, organ grinders, and those who "go busking" or singing to theatre queues. Those who are attached to public house "pitches" act as messengers, porters, cartminders, or hold horses' heads. They earn from 1s. to 2s. a day, but are often remunerated by having ale given to them instead of money. The takings of organ grinders are said to have materially lessened during the last 5 years. It would appear that 10s. to 15s. is now a fair average weekly amount. Some of the fathers were stated to have given their wives no money since they were married; others kept their families on "starvation money," and were reputed to have "done no regular work for many years," and lav in bed "most days of the week." Some fathers just paid the rent, gave their wives an occasional shilling and took their food out, lest, otherwise, their appetites might render the generosity of their petty gratuities null and void. One mother complained that the bread bill for the family came to 6d. more than the father earned during the week. In another home a father did not think his wife was careful in her housekeeping. He had therefore acted as housekeeper for a short time, spent more than his wife, and found he could not pay his way on the money he had been giving to his wife. Consequently he gave his wife more and paid the rent in addition. These are some of the minor side issues, the delicate problems in housecraft which are referred to the health visitors from time to time for their advice and adjustment. Some of the fathers were consumptive and careless; they spat into kitchen utensils, on the floor and on the fender, and apparently took no precautions to prevent the spread of tuberculosis to the other members of their families. In contrast to the slum fathers who neglected their families, were found others who were most considerate and sympathetic. Thus, a mother was weak after her recent confinement. She was an office-cleaner, but unable to do her work. She used to wait until all the staff had left the office. Her husband then came, scrubbed the floors, and did all the heavy work while she rested. 45 The occupations and actual earnings of fathers are appended. The amounts are the weekly earnings, unless otherwise stated. Barman, 25s. to 27s. Blindmaker, 27s. Carman, 16s., 18s., 19s., 21s., 24s., 25s., 31s. Chimney sweep, 25s. Cloth shrinker, 18s. Collecting and selling old bottles and broken glass, 18s. to 25s. Costermonger, 15s. Fish fryer, 16s. French polisher, 6½d. per hour. Jobbing shoemaker, 16s. to 24s. Labourer, 11s., 15s., 18s., 21s., 23s., 24s. Leather case maker, 38s. Packer, 18s., 19s., 20s., and 5½d. per hour. Porter, 14s., 15s., 18s., 20s., 23s., 26s. Casual porter, 11s. Postman, 30s. Saddler, 30s. Stableman, 19s. to 26s. Street hawker of newspapers, 9s. to 12s. Tarpaulin maker, 19s. Truck hand, 13s. Window cleaner, 25s. Illustrative Examples 1. The baby was 4 months old and the third child. There were 2 other children. The family occupied one room. The mother was a homeworker, making cardboard boxes, clean and industrious. She resumed her work on the eleventh day after her confinement. "The father was now out of work and helped the mother at her box making. When he was in work he earned 15s. per week and was said to spend nearly half of this amount drinking on Saturday night. He had never been able to keep any regular job because he used to lie in bed until 11a.m. or midday. He had latterly taken to selling newspapers in the streets. The family were in arrears with their rent and were eventually ejected from their tenement. 46 2. The baby was 3 months old, and the seventh child. Three children had died. The family occupied 2 rooms. The father had chronic asthma and was only able to work occasionally. He earned about 10s. a week. The mother wished to go to work but was unable to do so because she had to care for the children. The weekly rental was 4s. 6d. The milk for the family cost 2s. 6d. a week. This left 3s. for their food, which was chiefly tea, bread, and margarine. The mother was pale and underfed. 3. The baby was 3 weeks old, puny and hungry. There were 5 other children under 14 years. The mother was haggard and dirty. The father was a general labourer earning 18s. per week. The family occupied 2 rooms at a weekly rental of 5s. Coal and firewood cost 5d. a day. A boy of 3 years was underfed, ricketty and had no shoes or stockings. The father had not had new clothes for many years—he bought second-hand clothes in a market street. The family of eight lived on 10s. a week. 4. The family consisted of the parents, a baby, and an older child, and lived in one room let at a weekly rental of 4s. 6d. The father was a postman earning 30s. a week, but gave his wife only 15s. a week for housekeeping. She was unable to manage on this small amount and worked as a dressmaker, earning 10s. to 12s. a week. In the meantime, because the mother had to work, the children were being neglected and wasting. 5. The baby was 2 weeks old and the sixth child. Three children had died. The family occupied 2 rooms. The father was blind and, led by a neighbour, went at night to sing to theatre queues. The mother worked by day as a street flower seller. During her absence the baby was cared for and fed by its blind father. It was having biscuits and water, prepared by its mother before she went out in the morning. It was having no milk. All the children were very ricketty. Homo Circumstances.—In squalid streets, many of the tenements showed evidence of poverty sometimes approaching to destitution. There was little or no furniture, one or at most two 47 broken chairs, a wooden box turned up on end and used as a table, a ramshackle bedstead with laths broken or absent a bare cupboard, and a few kitchen utensils. Some of the homes had very little food, chiefly scraps of bread, margarine, tea and sugar. Occasional cases were discovered where there was no food at all in the tenement. Some had no coal, no coke, no firewood. The health visitors saw very few fireguards in the homes they visited. Arising out of this poverty is the practice of pawning. There are mothers who regularly throughout the year pawn their own or borrowed goods on Monday and redeem them on Saturday. In many mean streets there are professional pawners—women, well known to the pawnbrokers, who, for small payments, take clothes and household goods to pawn for their neighbours. It is stated that the advantages are twofold. The woman who pawns through a recognised intermediary obtains a larger loan than she would if she herself conducted the transaction. For the pawnbroker, the professional pawner guarantees the good faith of the owner, and will be able to exercise pressure in case of default. As the needs become more urgent, the articles are said to be pawned in the following order—the wedding ring, clock, husband's best suit of clothes (10s.), husband's shirt (1s. 6d.), children's boots, baby's long clothes (2s.), sheets, pillowcases, aprons, petticoats and chemises all in one parcel (3s.), children's frocks or dresses, mother's frocks or dresses, and lastly the wall pictures. Some of the homes were in dark, dilapidated and domestically dirty basements or attics. It is noteworthy that families with numerous children are compelled by house owners in many instances to occupy the basements. Such families are precluded from living in upper rooms because when they occupy the higher storeys the children at play make much noise and interfere with the peaceable enjoyment of their holdings by those who occupy the rooms underneath. One mother observed, "If you have children, you are always pushed to the bottom of the house if you live with respectable people. My children have always been ill since we have had to live in these underground places." Many of the tenements were verminous, many were crowded, a few were overcrowded. 48 Difficulties of crowded and undesirable sleeping arrangements arose which were satisfactorily adjusted after consideration by the staff. The rent paid was very often deemed to be too large, when considered in relation to the amount of the weekly wage or weekly earnings. Many families were being continually ejected for nonpayment of rent, or removed clandestinely to avoid being "sold up." It is curious how the poor cling to a locality. Instances are from time to time brought to the notice of the health visitors where a parent earning twenty shillings a week or less has been known to pay sixpence or eightpence a day in fares rather than move elsewhere. Most tenements had a washhouse or copper in the yard, or some other facilities for washing clothes. When however, the yard was small, cramped, dirty, dusty, or otherwise unsuitable for the baby, the mother was frequently compelled to do her washing in the living room. The mothers, who took in washing, littered the room with dirty clothes and hanged them to dry on lines stretched across the room. In many homes the mothers made cardboard boxes, artificial flowers, wreaths, or worked as dressmakers and tailoresses. In some households the children were ricketty, under-fed, badly clothed, and badly shod. Many parents or other members of the families were ill with tuberculosis or some other communicable affection. When deaths occurred, families who lived in one room were placed in difficult circumstances. In such a home the only furniture consisted of a table, 2 broken chairs, and a bedstead. The coffin was kept on the table until, at the suggestion of a health visitor, the body was removed to the mortuary. Many families spent far too much on life insurance and on death clubs. In these humble households, clubs are an important means of making pro vision for emergencies and for purchasing necessaries. There are loan clubs, sharing-out clubs, boot clubs, hat clubs, feather clubs, and possibly many other clubs. Illustrative Cases 1. The baby was 11 weeks old and the eighth child. Two children had died. The family occupied 2 rooms. The father was at home, out of work. There was no food in the house and 49 no money. While the family were in these straits, "the lady in the room underneath went hopping," and allowed the mother to pawn her husband's 2 best shirts for 4s. 3d. on condition that the mother redeemed them within 4 weeks when the hopping ceased. The mother bought for dinner mutton pieces 2d., potatoes 2d., green peas 2d., to do for the parents and their six children. 2. The baby was 3 months old and clothed in a cotton shirt, a flannel binder, and a cotton frock. There were 2 other children. The family occupied 2 rooms. The mother and the baby were found in the rain wet through. She had been pawning some of the baby's clothes. The tenement was almost bare. One room contained only an old wooden box. The other room had a double bed in which the father, mother, and the children slept. This bed was verminous, dirty, and soaked with urine. The cupboards were empty. This room had a table made up of 2 boxes placed one on top of the other. There were no chairs. 3. The baby was 13 weeks old and the ninth child. All the children were living. The family occupied three very small rooms. The baby was well cared lor, fat and breast-fed. The home was clean but overcrowded. The father, mother, baby and a child 15 months slept in one bed in a very small room. Five girls, the eldest of whom was 15 years, slept in one bed in another small room. Two boys slept in the kitchen. The father was a packer. The mother made watchbags at home. Two girls were working and earned 6s. and 4s. per week respectively. 4. The baby was 6 weeks old and the fifth child. All the children were living. The family occupied two rooms. The baby had bronchitis. The father was a porter earning 18s. a week and gave the mother 16s. The weekly rent was 4s. 6d. The family really lived in what had been one room, but from which ore their arrival a second small room had been partitioned off. This small room was six feet long and six feet broad, and contained a bed in which the three eldest children slept. It had no firepiace and one small window, with a superficial area of one square foot, as the only means of ventilation. 50 5. The baby was 3 weeks old and the eighth child. Two children had died. The family occupied three rooms. The father was a labourer, in casual employment and now out of work. There was very little food in the home. A rabbit was kept in a hutch on the kitchen dresser, and was being fed on vegetable refuse gathered by the children in market streets. It had been purchased to serve eventually for a Christmas dinner, but unfortunately it got voung ones just a few days before Christmas. Weighing Centres.—There are three municipal weighing centres in the Borough, held in the afternoon at 2.30 p.m., at the following times and places. Tuesday: St. Luke's Institute, Radnor Street. Wednesday : The branch Library, 47, Penton Street. Thursday: 268, St. John Street, Clerkenwell. A summary of the meetings held in 1914 is appended:— Centre. No. of Meetings. Attendances. Average Attendance. No. of Children. Penton Street 52 861 17 185 Radnor Street 52 1,425 27 281 St. John Street 52 1,473 38 278 Totals 156 3,759 24 744 Many of the children when first brought to the weighing centres were found to be fed chiefly on patent biscuits, boiled bread, or other unsuitable food. The exclusively breast-fed children were, however, in the majority, and were more than five times as many as the others who were not breast-fed. Eleven per cent, of the whole number of babies were breast-fed and received supplementary feeds of cow's milk. In reoent years the proportion of breast-fed children to the others in the borough has shown a definite increase. On the first visits 66 per cent, of the babies were fat and plump, others, amounting to 31 per cent., were markedly thin. The residue, about 3 per cent, of the whole 51 number, were already markedly wasting'. Eleven per cent. of the babies were under the age of one month at their first visits. By far the larger number of babies, 53 per cent., are brought to the centres between the ages of one and three months. Twelve per cent. were over six months of age. The weights of the children at birth were not always recorded. As far as they were known, they are displayed in the annexed table. Weights at birth. Penton Street. Radnor Street. St. John Street. Totals. Under 4 lbs. 2 0 1 3 4-5 lbs. 5 4 8 17 5-6 lbs. 8 16 9 33 6-7 lbs. 16 33 33 82 7-8 lbs. 35 66 47 148 8-9 lbs. 21 53 46 120 9-10 lbs. 10 29 19 58 10-11 lbs. 2 7 8 17 11-12 lbs. 1 1 2 4 12-13 lbs. 0 1 1 2 Totals 100 210 174 484 The heaviest children weighed 12 lbs. 8 ozs. at birth. The average gain in weight per week for babies in fairly good condition, not wasting, not obviously diseased, and the children of careful mothers, ranged from 3.1 ozs. to 5.2 ozs. The largest average weekly gains were 8.5 ozs. and 10 ozs. The fathers were mainly of the working class, and chiefly carmen, porters, labourers, painters, packers, printers, costermongers, street hawkers, warehousemen, horsekeepers, and taxidrivers. Thirteen per cent. of the fathers were out of work, twenty per cent. were engaged in casual employment. 52 At each meeting of the weighing centres, the babies are weighed and the results entered on cards which are kept by the mothers. The mother's diet, and the child's feeding are inquired into very carefully, and appropriate advice is given. Babies and mothers, who are ill, are referred to various institutions, or out-patient letters are given for dispensary treatment. On each occasion the mothers are encouraged to ask questions, and short lectures of ten minutes duration are given on appropriate subjects. Model clothes suitable for the babies of poor parents are shown to the mothers and their advantages demonstrated. The mothers are shown how to cut out and make the garments and patterns are distributed. Typewritten directions for the knitting of woollen vests are given gratis. The Public Health Department supplies the following details at cost price to mothers, free of cost to poor mothers : Tubeless sanitary feeding-bottles, special rubber teats, weighted cloth covers for milk jugs, cot covers, bristle brushes, drop tubes, woollen vests, pneumonia jackets, and "Finsbury Cream." Disinfectant soap is given on request. The bristle brushes are for cleaning out milk bottles. The drop tubes are for the treatment of eye affections in babies. The "Finsbury Cream" is a special form of fat food for wasting and delicate children. The Council issues leaflets on infant feeding, summer diarrhoea, measles, deaths from overlying, the fly crusade, and a booklet on infant care and management. Thousands of these are given each year to Finsbury mothers. A list of the subjects for lectures at the Weighing Centres is appended. List of Subjects for Lectures. 1. Expectant mothers. The signs of pregnancy. The care of the breasts and of the teats. Vaginal discharges— treatment. Ophthalmia Neonatorum. Miscarriages— treatment and prevention. 2. The last months of pregnancy. The care of the mother's health. Signs and symptoms of disease that may call for medical intervention, 53 3. Minor ailments of pregnancy. 4. Preparation and equipment for the confinement and lyingin Clothing for the baby. Food for the mother. Engagement of a nurse. Home cleanliness and the abolition of vermin. Disinfection of the tenement. Disinfectant soap. 5. Premature birth—its causes and prevention. 6. Breast feeding. Systematic weighing. Test feeds. The care of the mothers' breasts. Supplementary feeds. Scanty milk. Loss of breast milk and how to bring it back. 7. Artificial feeding. Boiled bread. Barley water. Oatmeal. Tops and bottoms. Biscuits. Beer. Ale. Toffee apples. Systematic weighing. A good type of feeding bottle. 8. The dummy or comforter. The bone or ivory ring. The care of the feeding bottle. Feeding bottles suitable and unsuitable. 9. The method and time of weaning. Feeding after weaning. 10. Patent foods. 11. How to undress and bath baby. 12. How to dress baby. Long clothes and short clothes. Binders. Model clothes. The perambulator. Shortening. 13. Sleep and exercise. The cots. The banana crate. Overlying. 14. Baby's toilet and the care of its skin, navel., buttocks, folds and creases. Powders. Olive oil Vaseline. Zinc ointment. Boric ointment. Boracic ointment. Fuller's earth. Puffs. Cotton wool. Napkins. The soft rag. The use and abuse of toilet powders. 15. Teething. "Teething powders." 16. The care of the eyes in babies. Ophthalmia neonatorum. The "blight." 54 17. Milk storage and milk utensils. Condensed milk. 18. Cheap and nutritious foods for nursing mothers and for weaned babies. 19. Foods unsuitable for babies. 20. Thrush—its prevention and treatment. Flowers of sulphur. Vaseline. Soot. Borax and honey. 21. Diarrhoea in babies. Its causes, prevention and treatment. Distribute and explain the appropriate leaflet. 22. Measles and its complications. Distribute and explain the leaflet. 23. Bronchitis and pneumonia. "Influenza colds." Prevention and treatment. 24. Consumption of the lungs. Direct and indirect infection. Direct by coughing, spitting, kissing. Indirect by bedfellow, dried sputum, dust, feeding utensils, dry sweeping, dry dusting, the moistening of dummies and comforters. Preventive measures: Separate room; separate bedroom; separate bed; separate utensils; separate cleansing; fresh air; sunshine; nutritious foods; hot milk; eggs. Distribute and explain the leaflets on "Consumption" and on "Disinfection after Tuberculosis." 25. Rickets—its prevention and treatment. 26. 27. Popular errors—two lectures. 28. Why babies cry. 29. Convulsions and overlying. 30. The feeding of older children. In addition to the lectures, or in place of them, practical demonstrations are given at the Weighing Centres on the following subjects. In this connection, arrangements are made occasionally for mothers to prepare poultices and fomentations and to do elementary bandaging. 56 Practical Demonstrations. 1. How to undress and bath a baby. 2. How to dress a baby. Shortening. Binders. 3. How to prepare baby's food. Milk storage. 4. Feeding bottles—the advantages and disadvantages of certain types. How to clean them, and their care between feeding times. 5. How to make baby's clothes. Model clothes. Patterns. 6. A cheap cot made from a banana crate or orange box. 7. How to make a poultice. 8. Simple bandaging. 9. Pneumonia jackets—how to make them. 10. The treatment of thrush in infants. 11. The treatment of sore, cracked, and depressed teats. 12. How to make whey. 13. How to make a fomentation. 14. Methods of preparing milk. 15. How to prepare meat juice. 16. The treatment of burns and scalds. 17. How to prepare rice water. 18. The care of the buttocks, and the correct way of washing napkins. l9. Soaps. Fatted and super-fatted. Disinfecting soaps. Soaps suitable for babies. Hard and soft water. 20. How to use the "Baby's Book." Distribute copies. 21. The Inspection of the feeding bottles actually used by the mothers, and comments upon their condition. At each meeting, tea and buns are provided at a charge of a penny each to those who can pay—gratis to those who are too poor. 56 Dinner Centres.—There are four dinner centres in the Borough, all conducted by voluntary agencies. The addresses are:— 128, Pentonville Road. 36 King Square. Claremont Mission, Pentonville. 162 Lever Street. At all these centres, nursing mothers may obtain sound nourishing dinners for a penny or twopence. At three of the establishments, necessitous mothers specially recommended may obtain free dinners. PUERPERAL FEVER. This disease is compulsorily notifiable by Section 55 of the Public Health (London) Act, 1891. In 1914, there were 11 notifications and & deaths. The statistics for previous years are appended— Puerperal Fever. Years. 1901-5 1906-10 1911-13 1914 Totals. Nutifications 30 27 29 11 97 Deaths 18 17 12 5 52 The number of notifications, 13, was highest in 1913. The 11 cases in the present year were attended, six by medical students from St. Bartholomew's Hospital, two by midwives, and three by private doctors. The associated causes and conditions were said to be : prolonged labour (3), miscarriage or abortion (3), vaginal douche administered by an untrained nurse (2), unsatisfactory attention during child-birth by untrained nurses or neighbour nurses, 3 cases. In 4 out of 11 cases, the mothers were cared for during child-birth by slatternly neighbour nurses, dirty, untrained women who neither washed themselves properly or the mothers, with nails long and 57 dirt-stained; women who at one and the same visit combined the operations of scrubbing the floor and giving vaginal douches to the mothers. None of them had nailbrushes, none washed the mothers' genitals before, during, or immediately after labour. In two instances these neighbour nurses waited for an hour or more after the babies had been born before obtaining medical assistance. Meantime the children had not yet been separated from their mothers, who were passing motions into the bed, fouling themselves and the infants. Nursing of this deplorable character by these wretched present-day representatives of Mother Gamp should almost be accounted for criminal negligence and treated as such in a Court of law. In Finsbury, every case is investigated by the Lady Sanitary Inspector. The premises are visited, the sanitary defects are ascertained, and made the subject of subsequent notice for amendment. The rooms are disinfected. OPHTHALMIA NEONATORUM. This is the inflammation of the eyes that is apt to occur in the newly-born, and which, when severe and intractable, is nearly always associated with the presence of venereal disease in the parent. Seventeen cases were notified in 1914; but there is reason to believe that many of these were cases of simple conjunctivitis. The children were all visited from the Public Health Department, and the mothers were instructed how to carry out the treatment advised by the doctors. DEATHS AND DEATH RATES. The number of Finsbury residents who died in 1914 was 1,636, equivalent to a crude death rate for the whole Borough of 19.6 per 1,000 inhabitants living. The crude death rate for the whole of London was 14.4 per 1,000, and the corrected death rate 14.4 per 1,000. 58 The Finsbury crude death rates for previous years are given jn the attached table:— CRUDE DEATH RATES, 1901-14. Year. The Borough. Clerkenwell. St. Luke. St. Sepulchre./###] 1901 21.4 20.1 23.5 19.1 1902 22.8 21.8 24.7 21.3 1903 20.2 19.0 22.3 19.7 1904 21.4 20.6 22.8 24.0 1905 19.3 18.1 21.1 26.3 1906 21.4 21.1 21.5 26.1 1907 19.1 17.3 21.8 26.6 1908 19.2 18.7 20.6 11.1 1909 20.1 19.1 21.6 24.0 1910 18.4 17.7 19.6 17.3 1911 19.4 19.3 19.45 11.7 1912 18.5 18.0 19.1 28.3 1913 18.4 18.8 19.0 38.1 1914 19.6 18.7 21.8 16.3 It will be observed that the death rates in St. Luke are generally higher, and in Clerkenwell generally lower than the rates for the whole of the Borough. The factor for age correction derived from the recent census is .9887. This factor enables one district to be compared with another, and smooths down the irregularities which depend upon differences in the ages and sexes of the populations of the different areas. Multiplying this number by 19.6, the crude death rate, gives a corrected death rate of 19.3 per 1,000. There is, however, still another correction to be made in the case of Finsbury due to the number of residents detained in institutions outside the Borough. When these are taken into account the population is 84,674, and the crude death rate becomes 19.3 per 1,000. 59 This, multiplied by the factor .9887 gives a fully corrected death rate of 19.1 per 1,000. The comparison of finsbury with the rest of the country may be seen below :— Corrected Death Rates for 1914. England and Wales 13.7 London 14.4 Finsbury 19.1 97 Great Towns 15.0 145 Smaller Towns 13.1 Rural Districts 12.4 The Finsbury deaths were apportioned as follows:— Clerkenwell, 1,010; St. Luke's, 598 ; St. Sepulchre 28 deaths. The death rates of the Metropolitan Boroughs are subjoined. Death Rates, 1914. Batter sea 13 .2 Kensington 13.4 Bermondsey 17.4 Lewisham 10.7 Bethnal Green 16.0 City of London 13.5 Camberwell 13.6 Paddington 13.3 Chelsea 13.3 Poplar 17.25 Deptford 14.6 St. Marylebone 14.9 Finsbury. 19.1 St. Pancras 15.3 Fulham 13.6 Shoreditch 19.4 Greenwich 14.9 Southwark 18.0 Hackney 13.9 Stepney 16.6 Hammersmith 13.7 Stoke Newington 12.3 Hampstead 10.5 Wandsworth 11.2 Holborn 15.8 Westminster 12.1 Lambeth 14.3 Woolwich 13.2 Islington 15.2 County of London 14.4 60 The deaths of residents in public institutions were:—In general hospitals, 200 (239); in special hospitals, 45 (39); in fever hospitals, 27 (50); in poor law institutions, 590 (492); in asylums, 54 (55); in various hospitals, homes of rest and homes for babies, 19 (27). The figures in brackets are the corresponding numbers for the previous year. It will be noted that 590—that is, 36 per cent.—of the whole number of deaths occurred in poor law workhouses and poor law infirmaries. The following table gives the number of deaths of Finsbury residents that have occurred in public institutions for the last 10 years:— Deaths in Public Institutions Year. Total Deaths. Deaths in Public Institutions of Finsbury Residents. Percentage. 1905 1,855 886 47.8 1906 2,020 1,020 50.5 1907 1,774 911 51.3 1908 1,767 891 50. 4 1909 1,814 988 54.4 1910 1,636 889 54.3 1911 1,697 946 55.7 1912 1,599 873 54.6 1913 1,558 902 57.9 1914 1,636 935 57.1 61 The percentage of deaths occurring in public institutions is slowly, and with slight remissions, continuously increasing. This fact supports the belief that the inhabitants of the district are now generally poorer than they were years ago. The percentage of the total deaths— 36 per cent, of the whole number, which occurred in the workhouse or workhouse infirmary is a fair criterion of the poverty which exists among many inhabitants of the district. No deaths were recorded during the year as having been accelerated by destitution or exposuie. Inquests.—During the past year 182 inquests were held in the Borough, of which 7 were on the bodies of non-residents, who died suddenly in the district. Fifty-seven were on children under 5 years of age, 125 on adults and children over 5 years of age. Amongst the causes of death were the following :—Accidental falls, 17; burns and scalds, 4; run over by taxicabs and motor buses, 8; run over by cabs and horsed vans, 3; overlain in bed by parents, 21 deaths. INFANT MORTALITY. The infant mortality of any district for any stated year means the number of deaths of chddren under one year per 1,000 births. The corrected number of births of Finsbury children for 1914 is 2,558. In the same year 304 children died under one year of age and belonging to the Borough. The infant mortality is obtained by multiplying the number of deaths under one year, 304 by 1,000, and dividing the result by the number of births, 2,558, for that year. The infant mortality of the Borough for 1914 is 118; expressed in popular manner, this means that out of every 1,000 children born during the year 118 died before reaching their first birthday. 62 The corresponding figures for previous years are annexed :— Infant Mortality, 1901-1914. Year. Corrected Births. Corrected Deaths. Infant Mortality. 1901 3,254 533 163 1902 3,191 558 174 1903 3,162 503 159 1904 3,095 522 168 1905 2,886 429 148 1906 3,012 474 157 1907 2,884 368 127 1908 2,916 400 137 1909 2,857 366 128 1910 2,857 342 121 1911 2,676 411 154 1912 2,579 290 112 1913 2,494 348 139 1914 2,558 304 118 The following table compares Finsbury with London and England and Wales generally :— Infant Mortality for 1914. England and Wales 105 Whole of London 104 Finsbury 118 97 Great Towns 114 145 Smaller Towns 104 Essentially Rural Districts 93 63 The infant mortality of Finsbury is 13 per cent. greater than the figure for the whole of London, and 4 per cent. more than the mortality prevailing in the 97 great towns. The rates for the Metropolitan Boroughs are appended below :— Infant Mortality, 1914. Battersea 92 Lambeth 104 Bermondsey 125 Lewisham 74 Bethnal Green 137 City of London 100 Camberwell 99 Paddington 95 Chelsea 67 Poplar 117 Deptford 99 St. Marylebone 98 Finsbury 118 3t. Pancras 92 Fulham 13 Shoreditch 143 Greenwich 98 Southwark 123 Hackney 85 Stepney 125 Hammersmith 94 Stoke Newington 78 Holborn 88 Wandsworth 88 Hampstead 72 Westminster 79 Islington 104 Woolwich 84 Kensington 95 County of London 104 The infant mortality for the Borough for 1914 shows a marked improvement when compared with other London boroughs. In former years Finsbury has had the second or third highest figure. This year it stands sixth, and its infant mortality rate, 118 per 1,000 births, is exceeded by the rates in Shoreditch, 143; Bethnal Green, 187; Stepney, 125; Bermondsey, 125; and Southwark, 123, 64 The deaths of infants allocated to the various diseases are given in the following table, which contains the records for the past four years :— Infant Deaths, 1911-14. Disease. 1911. 1912. 1913. 1914. Totals. Measles 20 29 7 20 76 Diphtheria 1 4 2 2 9 Scarlet Fever - 1 1 - 2 Hooping Cough 10 16 11 13 50 Gastritis 2 — 3 - 5 Diarrhœa and} Enteritis} 115 34 79 73 301 Premature Birth 69 46 58 55 228 Congenital Defects 2 4 4 3 13 Marasmus 43 29 20 9 101 Tuberculous Meningitis 8 4 6 3 21 Other Tuberculous Diseases 2 6 9 5 22 Erysipelas — 1 — — 1 Syphilis 8 10 7 5 30 Convulsions 8 15 3 8 34 Bronchitis 24 16 21 14 75 Pneumonia 38 39 59 46 182 Overlying 15 11 17 21 64 Other Causes 46 25 41 27 139 Totals 411 290 348 304 1,353 During these years the births have numbered 10,307, and the average infant mortality has been 131 per 1,000 births. 65 It will be noted that the largest number of deaths, 342, is attributable to antenatal causes—the group represented by premature birth and its associated conditions, congenital defects, atrophy, debility, and marasmus. The next largest group of deaths, 306 in number, is ascribed to diarrhoea, enteritis, and gastritis, diseases of dirty feeding, of improper feeding, diseases of carelessness and neglect, diseases connected with domestic filth and dirty environment. Next in order of magnitude are the 246 deaths due to bronchitis and pneumonia, diseases of exposure, diseases of insufficient or improper clothing. Most of the deaths due to the three foregoing grouped causes are preventable. That they are not prevented is due to poverty, the employment of the mothers, carelessness, negligence, ignorance, indifference, and, in the first group, probably to wilful design. During the last 4 years, 64 children have been overlain in bed by their parents. These deaths are obviously preventable. Their number showed such a tendency to increase at the end of the year that the Borough Council issued the annexed leaflet. It is given to every Finsbury mother by the health visitor on her first visit to the household. Metropolitan Borough of Finsbury. DEATHS FROM OVERLYING. During the last ten years more than 200 Finsbury babies have been killed by their mothers taking them to bed and suffocating them to death by sleeping over them. What has generally happened is that the mother has been tired or has been drinking at the end of the day's work. She has retired to bed and gone to sleep with the baby at the breast and resting on the mother's arm. During the night the mother has turned on her side and pressed down the baby beneath her breast. The baby has struggled and become convulsed, but its efforts have been too weak to wake the mother. It should be widely known that many babies who are 66 said to have died from "convulsions," have, in reality, been accidently suffocated in bed. Occasionally the mother has been so drunk that she has with difficulty been awakened from her carouse on the following morning. In any case the result to the baby is the same. The baby has been suffocated to death by its own mother. Now every mother thinks that this accident cannot possibly happen to her. And every mother to whom it has happened says she cannot "understand it at all." For many years warnings have been given to Finsbury mothers about these deaths, and yet they still occur at the rate of 20 deaths every year, entirely due to the mother's carelessness or to her drinking habits. All these deaths can be prevented by letting the baby sleep by itself in its own cot at night, and not with the parents or with the other children. A cheap cot can be made by padding a banana crate or orange box or small galvanized bath. Otherwise the baby may be put to sleep in a clothes basket or in one of the wooden drawers pulled out from the chest of drawers and placed on the floor. The baby should in all these cases be carefully wrapped up in warm bedclothes. Put a hot water bottle or a warm brick wrapped in flannel near the baby's feet, but not too close, or the child may be burnt. By Section 13 of the Children Act, 1908. Where it can be proved that the death of a baby was caused by overlying whilst the infant was in bed with some other person (its mother, father, or any other adult) and that such other person was at the time of going to bed under the influence of drink, that other person (the mother, father, or other adult in bed with the baby) shall be liable to prosecution and on conviction to two years' imprisonment with hard labour. To remind you— Never let the baby sleep in the same bed with an adult. Every time a mother and her baby sleep together in the same bed the child's life is risked. Let the baby sleep in its own cot by itself. A. E. THOMAS, Medical Officer of Health. 67 It will be observed that the death rates due to the usual Infectious diseases and to the various forms of tuberculosis are comparatively small. The deaths in 1914 from premature birth were mostly in Lever Street, St. John Street, Rahere Street, Hall Street, Myddelton Street, Pentonville Road, Risinghill Street, Rodney Street, Sekforde Street, White Lion Street, and Wilmington Square. The deaths from bronchitis and pneumonia occurred chiefly in the following streets:—Lever Street, Galway Street, Coldbath Square, Farringdon Road, Lloyd's Row, Nelson Street, Risinghill Street, Warner Street, and Whiskin Street. The deaths from diarrhceal diseases took place mainly in the mean and squalid streets of the borough, and the distribution over the district was fairly uniform. Infant Mortality by districts in previous years.—The infant mortality rates for the period 1908-14 arranged according to districts are given in the annexed table:— Infant Mortality Rates, 1908-14. Year. The Borough Clerkenwell. St. Luke. St. Sepulchre. 1908 137 131 150 34 1909 128 135 130 300 1910 121 122 120 71 1911 154 145 169 181 1912 112 110 111 210 1913 139 135 146 200 1914 118 112 131 121 In 1914 the deaths were—in Clerkenwell 186, in St. Luke 114, and in St. Sepulchre 4 deaths. 68 General Observations.—In discussing the infant mortality in Finsbury, there are certain facts which must be borne in mind. Finsbury is the most crowded borough in London. It lies on the outskirts of the City of London, and its houses are being slowly but surely converted into warehouses and workshops. The changc creates in the vicinity of the demolished sites a zone of crowding and congestion. The hospitals and philanthropic institutions which lie in and near its borders attract into the district the poor, the destitute, the sick and ailing—who are, from a public health standpoint, most undesirable citizens. Finsbury is a happy hunting-ground for the amateur philanthropist. Rents are comparatively high; wages are low. The unskilled labourer and the casual labourer are in much demand. Most of the women, a large proportion of the mothers are wage-earners in factories, workshops, or as out-workers. The deaths that occurred in 1914, and the families affected, were specially investigated Only 37 per cent. of the babies were totally breast-fed; the rest were partially or wholly bottle-fed. Nine per cent. used the condemned bottle with a long tube. Nearly all the infants were using or had used the comforter or dummy teat. Eleven per cent. were insufficiently fed—27 per cent. were being fed at irregular times by young girls and other inexperienced nurses who had been left in charge of the children owing to the mother's absence. In 43 per cent. the infants were weaned during the hot summer months, in spite of persistent teaching to the contrary. Seventy per cent. of the babies slept at night with their parents; 14 per cent. were insufficiently clad. Six per cent. of the mothers had insufficient clothes; 14 per cent. were being inadequately fed. In 20 per cent. of the families the mother was the usual breadwinner and supported the husband and the rest of the family. Thirty-five per cent. of all the mothers under review were engaged in employment during the illnesses which preceded the deaths of their children, chiefly as charwomen, laundresses, machinists, boxmakers, makers of artificial flowers, street hawkers, dressmakers and homeworkers. The mothers stated they worked for various reasons: because they had no other means of support, because their husbands' earnings were small and insufficient, because they were not supported by their husbands, because thic husband's 69 work was casual or irregular, because the husband was ill, crippled, or paralysed, or because the husband was out of work. Eight per cent. of the tenements had dirty walls, dirty bedding, and dirty kitchen utensils. In 23 per cent. of the whole number the families lived and slept each family in one room. In 45 per cent. the tenements contained two rooms. Fourteen per cent. of the tenements were overcrowded. In 62 per cent. the occupants slept in a bed or floor-bed in the kitchen. This use of the kitchen for sleeping purposes may be taken as an index of crowding. Thirty-two per cent. of the households showed marked evidence of poverty. Ten per cent. of the tenements had no cupboards. Twenty-six per cent. had only one cupboard. In these homes it is usual to find the women's hats, clothes, or soap kept in the top compartment; the bread, margarine, sugar and tea-dust in the second; and the wood and coke in the lowest compartment. There were many difficulties of home nursing. The mother was a wageearner, had to go to work, and delegated the treatment to a neighbour or to a careless young girl. The mother had many other young children to look after, and was unable to give proper attentipn to the ailing infant. The mother herself was an epileptic, a cripple, or suffering from illness. The husband worked by night and slept by day, so that the mother attended to the baby only when it cried, so as not to disturb the father's sleep. The mother had excessive homework, had lodgers to care for, and was therefore unable to devote much time to her child. In the one-roomed tenements, there "was hardly space to turn round." Many of the rooms were crowded. The household utensils were dirty and unlit to be used for nursing purposes. Many of the tenements were in dark basements. In the poor homes the baby had no separate cot, there was no hot-water bottle, or even a hot flat iron to be used as its substitute. What more may be done —The following suggestions are advanced:— 1. The establishment of maternity and child-welfare centres in various parts of the borough, for the purposes indicated in np earlier part of this report. 2. The founding of crèches. 3. The institution of dinner centres for nursing mothers. 70 4. The notification of diarrhoea during June, July, and August in children up to 5 years of age. Such notified cases would be visited from the health department and measures taken to see that the medical treatment was carried out in accordance with the doctor's instructions. The home conditions and environment would also be dealt with. At the present time, the earliest information of these cases of diarrhæa is received on the death sheets, and is obviously too late for the purposes of saving life. 5. The drafting and distribution of leaflets on infant management, written in Italian. There is a large colony of Italian inhabitants in the borough whose mothers do not read or understand English. 6. The provision of home nursing for lying-in mothers by subscribing to the funds of one or more of the maternity institutions in Finsbury. 7. The co-ordinating of all the activities—municipal, official and voluntary—which are concerned with infant welfare in the borough. 8. The holding of occasional conferences between official and voluntary bodies for the better correlation of their operations and for the improvement of their efficiency. CANCER. In 1914, death was accredited to Cancer in 103 persons, of whom 49 were males and 54 females. The death rate was 1-237 per 1,000. The deaths in previous years from 1901 upward were 72, 72, 92, 79, 65, 84, 86, 87, 88, 79, 81, 86, and 93 respectively. The following tables show the deaths distributed according to sex and age:— Cancer Deaths, 1901-1914. Ages. Under 10 years. 10- 20- 30- 40- 50- 60- 70- Totals. Males 7 10 12 28 70 153 181 113 574 Females 4 7 7 41 111 156 143 124 593 Totals 11 17 19 69 181 309 324 237 1,167 71 Most of the deaths occur between 50 and 70 years; between 40 and 50 the females exceed the males, between 50 and 60 the sexes are very nearly equal; after 60 the males are more numerous. The parts affected are set out below:— Cancer Deaths, 1901 1914. Sites of the Disease. 1914. 1913. 1912. 1911. 1901-10. Totals. Face, Tongue and Jaw 6 6 6 6 75 99 Throat, Neck and Gullet 9 12 11 9 77 118 Stomach 13 12 14 5 107 151 Intestines 25 17 11 16 154 223 Liver 7 7 14 8 92 128 Pancreas 3 0 2 3 18 26 Breast 8 9 12 11 67 107 Womb 15 12 13 13 116 169 Various 17 18 3 10 98 146 Totals 103 93 86 81 804 1,167 The sites of the disease differ in the two sexes. In man they are chiefly those parts concerned with feeding and the digestion of food, the mouth, tongue, stomach, liver and intestines; in woman they are chiefly those parts concerned with child-bearing and reproduction, the womb and the breast. ALCOHOLISM. Alcoholism and Cirrhosis of the Liver caused 45 deaths in 1914. Cirrhosis of the Liver is the euphemism under which, in deference to the susceptibilities of relatives and friends, alcoholism is masked on death certificates. Latterly, the word "Hepatitis" has been used by medical men, presumably, for the same purpose. It is quite uncommon to find alcoholism entered as a cause of death, except in the case of those who are friendless, homeless, unknown, destitute, or who die in the workhouse or workhouse infirmary. 72 The deaths in previous years are appended:— Deaths from Alcoholism, 1901 1914. Years. Alcoholism and Delirium Tremens. Cirrhosis of the Liver. Total. 1901-10 164 257 421 1911 11 18 29 1912 16 26 42 1913 9 18 27 1914 14 31 45 Totals 1901-14 214 350 564 In addition to the numbers given above there will be other deaths due to alcoholism, but in which it has been omitted as the primary cause from the certificate, and the secondary cause or terminal disease alone inserted. Thus many of the deaths of young adults from pneumonia, many of the cases of Bright's disease of the kidneys, some of the deaths due to bronchitis, alleged "influenza," or neuritis, or to "paralysis," many street and night accidents, and possibly some of the cases of overlying are attributable directly or indirectly to alcohol. The ages at death are shown in the table:— Age. 20— 30- 40- 50- 60- 70- 80- Totals. Males 2 2 9 12 3 2 0 30 Females 0 2 5 2 6 0 0 15 Twenty-five of the cases died in the workhouse and workhouse infirmary. TUBERCULOSIS. Notification.—Finsbury was one of the very first boroughs to adopt the voluntary notification of phthisis and of "open" tuberculosis, that is, tuberculosis associated with discharges. 73 'I his was in 1900, or 14 years ago. From the very first, the cases were visited by the public health staff, suitable enquiries were made into the origin of the disease, the home circumstances and the sanitary condition of the premises. Appropriate advice was given to the patient and to the contacts. A leaflet of instruction was left with the patient, and periodic disinfection of the premises was offered. Now, by the Public Health (Tuberculosis) Regulations. 1912, all forms of tuberculosis are compulsorily notifiable from arid after the 1st February, 1913. TUBERCULOSIS OF THE LUNGS. This disease is also known as pulmonary tuberculosis, phthisis, and, popularly, as consumption of the lungs. The notifications and deaths of Finsbury cases of phthisis since 1901, are appended:— Phthisis Notifications and Deaths, 1901-1914. Total No. of Notifications. No. of Cases notified per 10,000 of inhabitants. Tolal No. of Deaths Death Rate per 1,000. 1901 70 6.9 216 2.13 1902 121 12.1 240 2.40 1903 219 22.2 223 2.26 1904 210 21.6 251 2.57 1905 178 18.5 215 2.24 1906 217 22.9 232 2.45 1907 217 23.2 243 2.60 1908 220 23.9 221 2.40 1909 359 39.7 228 2.52 1910 319 35.8 166 1.86 1911 419 47.8 159 1.81 1912 438 49.6 160 1.85 1913 421 49.7 151 1.78 1914 382 45.9 151 1.81 74 The actual number of notifications received in 1914 was 930, but of these many refer to the same patient. There were 382 primary notifications, of which 118 were from poor law sources, 117 from hospitals and dispensaries, 4 from schools, and 143 from private doctors. In reference to the 118 poor law cases, there were received 666 notifications, re-notifications, and notices of discharge. This means that each poor law case was notified on an average at least five times, and is due to the fact that these pauper cases are restless in institutions, and frequently come out, especially at holiday time, and later seek re-admission. Two hundred and sixty cases gave a Clerkenwell address, 120 lived in St. Luke, 2 in St. Sepulchre. Institutions.—The institutions and the number of notifications from each are appended:— Holborn Union Workhouse and Infirmary, 118; St. Bartholomew's Hospital, 24; the Finsbury Dispensary, Brewer Street North, 23; Royal Chest Hospital, City Road, 18; Brompton Chest Hospital, 8; Downs Sanatorium, Epsom, 7; Long Grove Asylum, 3; Royal General Dispensary, Aldersgate„ E.C., 3; Northern Hospital, Winchmore Hill, 3; Horton Asylum, Epsom, 3; Hospital for Sick Children, Great Ormond Street, W.C., 2; Mount Vernon Hospital, Hampstead, N.W., 2; North-Eastern Fever Hospital, Tottenham, 2; French Hospital, Great St. Andrew Street, W.C., 2; and one from each of the following: Royal National Hospital for Consumption, Ventnor, Isle of Wight; Ewell Epileptic Colony, Surrey; University College Hospital, Gower Street, W.C. ; Central London Throat and Ear Hospital, Gray's Inn Road, W.C. ; Frimley Sanatorium, Surrey; Southwark Infirmary; St. Pancras Infirmary, Dartmouth Park Hill; Military Hospital, Weymouth; Aldershot Camp; Royal Naval Hospital, Chatham; Royal Herbert Hospital, Woolwich; St. Thomas's Hospital; the Chest Hospital, Bonner Road, Victoria Park; and the Homoeopathic Hospital, Queen's Square, W.C. One hundred and one Finsbury patients received institutional treatment in a sanatorium—other than in a poor law infirmary, and chiefly as insured patients under the National Insurance Act. 75 How many of the whole number are Finsbury cases. —A patient is said to belong to Finsbury by residence when he has resided in the Borough for at least live years, or, if not yet five years of age, since his birth. The period five years has been arbitrarily assumed as one of a reasonable duration entitling to a public health settlement, and also because it is generally asserted that the average duration of a case of phthisis from early demonstrable clinical signs to death is about live years. A case is accredited to Finsbury by infection when the presumed duration of the disease, as elicited by enquiry, is less than the length of the patient's residence in the Borough. Adopting these definitions, the cases may be grouped as follows:— 1. Finsbury Cases by residence and infection 239 2. Finsbury Cases by infection 38 3. Finsbury Cases by residence 10 4. Not Finsbury Cases 95 382 The cases which may be definitely associated with the Borough are the first two groups, and amount to 277, that is, to 72 per cent. of the whole number. The remaining 105 cases may be regarded as dumped cases which had contracted the disease elsewhere and had come into Finsbury when they were already stricken with consumption. The Finsbury cases by residence had definite signs of the disease before living in the Borough, but had lived here for five years or more. The cases which were "Not Finsbury" had phthisis when they first came into the Borough but had lived here for less than five years. Fifteen of the cases lived in common lodging houses. The number of patients who give false addresses is still very large. They give false addresses when they enter institutions, and fresh false addresses when they leave. In this way they hope to escape the supervision which naturally follows notification. It is to be 76 noted that most of these false addresses are from poor law infirmaries, hospitals and institutions generally. It is quite rare to receive false addresses on the notifications of private medical men. Patients whose addresses are ascertained to be false while they are still detained in hospitals, discharge themselves precipitately when this fact is communicated to them, and then refuse to give their destinations on leaving. Thus, a patient entered a poor law infirmary with phthisis, and was placed in a ward with other consumptives, some of whose addresses he noted. He had given a false address on admission. When this address was found to be false, he was informed of the fact and was discharged at his own request. He visited the home of one of his fellow-patients, X., in the infirmary, asked for the loan of some money from the wife of X., and arranged that she should receive his letters. He was now notified by a large hospital to have phthisis, and described as living at the address of X. The house was visited by the staff and the true state of affairs discovered and disclosed to the hospital authorities. The patient asked for his discharge and left, refusing his address. He was next notified as an out-patient from the address of Y., another patient whose acquaintance he had made in the infirmary. The investigation of these false addresses leads to much correspondence and much loss of time. The problem of these dumped cases is a very serious one for the Borough. There would appear to be a continuous immigration into Finsbury of consumptives who have developed the disease elsewhere. And unfortunately, from a public health standpoint, once they move into Finsbury, they show no disposition to move out again. So that in the course of time, when these patients die, their deaths are counted by the Registrar-General as Finsbury deaths and tend to attach to the Borough a public health degradation which it does not really deserve. The consumptives who live in common lodging houses are in dire straits. They are ordered by their medical advisers to have eggs and plenty of milk. The systematic drinking of milk, and especially of hot milk, is such a rare phenomenon in these institutions that the patient who attempted it would be marked and his disease would be discovered to his detriment. Such patients must, and do, work until they are 77 forced to give in and seek admission to the poor law infirmary. They must work despite the constant cough and the cutting pain of pleurisy. Their savings are so small that they must work or go under. They may not get the rest, which they desire, because of the noise and traffic in the rooms, the horseplay, and the exigencies of the bye-laws. They conceal their ailments and wander from lodging house to lodging house. They spit broadcast on the walls and on the floors. They use no sputum flasks. To do so would be to invite discovery. They take no preventive measures. They use the common kitchen utensils and the common towels. They are a source of possible danger to the other occupants. One hundred and twenty-three patients were bedridden at the time of notification. These late notifications arc of very little value from a public health standpoint. These cases, where the circumstances are suitable, are urged to enter the Holborn Infirmary, so as to remove, even at this late period, the possibility of their infecting or further infecting the other members of their households. Distribution by streets and blocks of dwellings.— The largest numbers were notified from the following places:— King's Cross Road, 10; Northampton Buildings, 8; Bastwick Street, 8; Rahere Street, 7; Risinghill Street, 7; Guinness's Buildings, 7; White Lion Street, 6; Helmet Row, 6; Gee Street, 6; Cumming Street, 6; St. John Street, 5; Pentonville Road, 5; Donegal Street, 5; Wilmington Square, 4; Whitecross Street, 4; Victoria Dwellings, 4; St. Bartholomew's Buildings, 4; St. James's Street, 4; Northampton Road, 4; Murton Street, 4; Galway Street, 4; Clerkenwell Green, 4; Compton Buildings, 4; Buxton Street, 4; Warden's Place, 3; Winchester Street, 3; St. Helena Street, 3; Rod Lion Street, 3; Old Street, 3; Lloyd's Row, 3; Ironmonger Row, 3; Hermes Street, 3; Hatfield Street, 3; Goswell Road, 3; Great Bath Street, 3; Farringdon Road, 3; Eagle Dwellings, 3; Easton Street, 3; Corporation Row, 3; Bath Buildings, 3; Baldwin Street, 3; Brunswick Close, 3; Baker's Row, 3; Affleck Street, 3. The notifications from the Peabody Buildings were as follows: Roscoe Street, 8; Errol Street, 3; Farringdon Road, 2; Dufferin Street, 2. 78 Sex and Age.—The notified cases, classified according to sex and age are given below:— Years 0- 1 1-2 2-5 5-15 15-25 25-45 45-65 65+ Totals. Males 2 4 4 30 36 88 49 6 219 Females 0 4 5 23 28 68 29 6 163 Totals 2 8 9 53 64 156 78 12 382 Length of residence.—The duration of residence in the Borough and of residence at the notified address were ascertained in many cases, with the following results:— Duration 0-1 week 1 week1 month 1-3 months 3-6 months 6-12 mouths 1-5 years 5 years and over Finsbury Residence 8 6 10 16 13 62 274 Present Address 12 13 28 32 42 120 93 Fifty-six per cent. of the patients had lived less than one year at the addresses given when they were notified. Place of Birth,—This was ascertained in 317 cases as follows: Fins bury, 123; other parts of London, 144; England and Wales, 23; Scotland, 2; Ireland, 7; foreign countries, chiefly Italy and Germany, 18 cases. Eighty-four per cent. were Londoners by birth; 38 per cent. were born in Finsbury. Duration of the Disease.—The presumed duration of the disease when the case was first notified is given in the attached table, which records the results in 322 patients. 0-1 month 1-3 months 3-6 months 6-12 months 1-5 years 5-10 years 10 years and over 9 28 37 47 125 44 32 79 Few cases are recognised in the early and curable stage—62 per cent. had been ill for periods over one year before notification. The corresponding figure in 1913 was 46 per cent. Occupations.—The conditions in life, and occupations of the patients were as fallows :— Males.—Actor, 1; artificial flower seller, 1; asphalter, 1; bacon drier, 1; basket maker, 1; barman, 2; bookbinder, 1; bookkeeper, 1; bootmaker, 3; box maker, 1; brass polisher, 1; butcher, 1 ; cabinet maker, 3; caretaker, 2; carman, 8; carrier's checker, 2; carver and gilder, 1; chef, 2; cigar maker, 1; clerk, 3; coalman, 2; collar cutter, 1; compositor, 3; confectioner, 1; confectioner's assistant, 1; diamond mounter, 1; electrician, 1; electro plater, 2; engineer's fitter, 3; engraver, 1; errand boy, 3; file cutter, 1; footman, 1; french polisher, 2; fruiterer, 1; hawker, 4; horsekeeper, 2; jeweller's assistant, 1; labourer, 6; messenger, 3; metal polisher, 2; milk carrier, 1 ; motor mechanic, 1 ; not known, 3; newspaper seller (street), 2; organ grinder, 1; packer, 4; packing case maker, 2; painter, 3; picture frame maker, 1; pipemounter, 1; porter, 12; portmanteau maker, 1; printer's assistant, 4; publican, 1; scale maker, 1; scene shifter, 1; schoolchild, 24; secretary, 1; sewing machine fitter, 1; shop assistant, 1; signwriter, 1; silversmith, 1; soldier, 2; stoker (R.N.), 1; stonemason, 1; storekeeper, 1; tailor, 1; taxi driver, 1; thermometer maker, 1; traveller, 1; trunk maker, 1; turncock, 1; van washer, 1; walking stick dresser, 2; waiter, 2; warehouseman, 5; watchman, 1; window cleaner, 2; no occupation, 36. Females.—Artificial flower maker, 4; bookfolder, 4; bookstitcher, 1; bottle wrapper, 1; box maker, 1; button maker, 1; charwoman, 1; chocolate packer, 1; cigarette maker, 1; confectioner's assistant, 1; cook, 1; cutter of underclothing, 1; domestic servant, 2; fishmonger, 1; flower seller, 1; french polisher, 1; fur liner, 1; fur stitcher, 1; handstamper, 1; hat maker, 1; housekeeper, 2; housework, 45; jewel case maker, 2; kitchen assistant, 1; machinist, 1; mackintosh maker, 1; milliner, 1; packer, 1; paper bag maker, 1; paper guminer, 1; paper sorter, 1; printer's assistant, 2; restaurant assistant, 1; schoolchild, 18; 80 shirt maker, 1; shopkeeper, 1; showroom assistant, 1; stocking knitter, 2; tobacconist's assistant, 1; umbrella finisher, 1; waistcoat presser, 1; waitress, 2; washerwoman, 4; no occupation, 34. Eighteen patients were homeworkers. National Insurance Act, 1911.—Enquiry was made into the number of patients who were insured under the National Insurance Act. The results are given in the subjoined table:- Total cases. Insured. Dependants. Not Insured. Phthisis 382 167 121 94 Other Tuberculous Diseases 77 18 55 4 Totals 459 185 176 98 Fifty-two patients obtained sanatorium treatment, ten obtained domiciliary treatment at the cost of the London County Insurance Committee. The Homes and Tenements.—Out of the whole number, excluding common lodging houses, 79 were one-roomed tenements, that is to say, in those homes the consumptive patient and the rest of the family lived, took their meals, and slept in one room. The two-roomed tenements numbered 132. The rest had three or more rooms. Twenty-one homes were overcrowded. Eighty-one tenements had only one cupboard each for food, clothes, coke and firewood. Eleven homes had no cupboard accommodation at all. These are very unsatisfactory conditions for a phthisical household. When the patient and his family sleep in one bed, or in different beds in the same room, when the household utensils of the consumptive are kept in the same cupboard as the other household utensils and mixed indiscriminately with them; when his clothes, soiled with sputum, are placed in the common receptacle; when he uses the common towel and washing basin, the common 81 knives, forks, spoons, cups, saucers, and glasses; when the utensils of the household are all washed together in the same bowl and dried with the same cloth, the spread of infection from the patient to his family is greatly favoured. When, in addition to these drawbacks, the tenement is overcrowded and the patient careless, the conditions for promoting the spread of the disease are as pernicious as they possibly can be. Ninety-one tenements were on the list of houses let in lodgings; 29 tenements were in the so-called "model" buildings, which, with their small restricted common landings, and their many points of close contact between the families who occupy them, are only too well adapted for the spread of phthisis. Homework was carried on in eighteen homes. Seven of the houses occupied by the patients were used for the sale or preparation of food products. In 226 instances, or in 66 per cent. of the whole number of cases, the kitchen was being used as a living room and a sleeping room. This is one index of poverty, and shows the difficulties of accommodation and the facilities for infection which accrue in these poor households. Sometimes the patient himself occupies the kitchen by day and night. Many of the kitchens were dirty, verminous, or damp. In seven Houses the kitchen and feeding utensils were extremely dirty. The presence of dirt or vermin may be taken to connote carelessness, and carelessness in the family of a consumptive means increased risk of infection for the rest of the family. A sanitary survey was made of every tenement, and the nuisances found were made the subject of subsequent notice and amendment. The following defects were ascertained: Insufficient head room, 88; dark kitchens, 49; dirty rooms, 27; damp rooms, 6; broken or dilapidated walls or roofs, 12; insufficient ventilation, 9; and verminous rooms, 10 tenements. A Summary of the Difficulties Encountered.- A brief summary of the difficulties encountered in dealing with Finsbury cases of tuberculosis and with home contacts is annexed. 82 1. Many patients give false addresses on notification. They give false addresses when they enter and leave institutions. They wish to evade the supervision which naturally follows notification. 2. Many of the cases are notified for the first time when they are bedridden or otherwise late in the course of the disease—too late for the notification to be of much value from a public health standpoint. The mischief has then been done. 3. The patients arc continually removing from one address to another, and are difficult to follow up. The demand for cheap rooms is often so urgent in the borough that very soon after a room is empty, it is sought by a prospective tenant and occupied before it has been disinfected or cleansed. 4. Most of the patients are very poor—some are destitute. With this poverty go crowding and overcrowding in one- or tworoomed tenements, drink, insufficient food, and insufficient clothing. The home conditions are such that it is extremely difficult to prevent the infection of other members of the family. Cases have occurred where the patient or his family have been too poor to afford even the equipment necessary to proceed to a sanatorium, too poor even to be able to pay the railway fare. In this connection, it is very desirable that sanatoria for the poor should provide clean linen and clean underclothing for the patients rather than that the patients should be asked to provide them. There have been a few instances in Finsbury where the patients were asked before admission to provide, amongst other details, 2 pairs of boots and 2 nightshirts. And these patients had each never possessed more than one pair of boots at a time, had never seen or worn a nightshirt, and were unable to buy them, so that they did not proceed to a sanatorium. The practice of the Public Health Department has been to refer destitute cases to the poor law officers with a view to their admission to the Holborn Infirmary. Insured patients are sent to the London County Insurance Committee. Uninsured patients are referred for sanatorium treatment to the London County Council Public Health Department. 83 5. In some families, the housing conditions are unsatisfactory —the head room, light, and ventilation are insufficient. And the home conditions are such that the provision of a separate room or of a separate bed for the patient is impossible. Some boroughs lend out beds and bedsteads to the poor inhabitants free of charge. 6. Many of the patients have to work hard over long hours, and are quite unable to take the rest in the fresh open air which is now considered to be an important part of the cure. Many are homeworkers. 7. The use of shelters is often rendered difficult because there is no flat roof, because the back yard or forecourt is small, or because these places are much used and frequented by other occupants for various purposes. 8. Many cases live in common lodging houses and are apt to resent instruction or supervision. As soon as enquiries are made after notification, they move elsewhere and are temporarily lost. 9. Cases of tuberculosis occur in those who handle milk, or other foods, and who are on that account possessed of extensive facilities for spreading infection. Cases occur in the inmates of houses used for the sale or preparation of food or food products for human consumption. 10. Many patients are careless and negligent, and take no special precautions to prevent the infection spreading to the rest of the family. Many are apparently indifferent as to whether their wives or children catch the disease or not. 11. Many patients do not know they have consumption even after they have been notified, and their friends and relatives do not wish them to know. There is a conspiracy of silence to keep the patient in an idiotically blissful condition of mischievous ignorance. 12. Some of the patients are illiterate. They cannot read or write. They cannot read the leaflets of instruction left with them. To take an actual example: a woman had been notified to have phthisis on three separate occasions. She had been an in-patient 84 in a poor law infirmary with pulmonary tuberculosis for many months in a ward reserved for "consumptives." She was eventually discharged, and a year later did not know that she had consumption. She could not read or write, but was able to understand the pictorial leaflet issued by the Finsbury Public Health Department. She lived with her illiterate sister, who was also ignorant that the patient had tuberculosis. When the sister realised the true state of affairs, she precipitated the re-admission of the patient to the infirmary because she knew that "consumption was catching," and she "didn't want none of her family to have it." In the search for unrecognised and suspected cases, it is difficult sometimes to arrange for the examination of all the contacts in the house and family. Some of these contacts have to go out to work early in the morning and return late at night. They may be seen at home on Saturday afternoon or on Sunday afternoon, but occasionally they resent examination even then. They do not realise that the examination of contacts is as much for their own benefit as it is for the public health interest. 14. When a room recently occupied by a consumptive is vacated on death or on removal, disinfection is offered in every instance, and a special soap for scrubbing the room is provided free of cost by the Public Health Department. It must be admitted, however, that these facilities for disinfection and for cleansing are not often accepted. The room is occupied by a new tenant sometimes within a few hours of the removal of the last occupant; meanwhile the room has not been disinfected and has not been scoured out. There is no power to enforce compulsory cleansing or disinfection. 15. Patients, who arc discharged from sanatoria, have much trouble in getting suitable employment, or even any employment save unskilled or casual labour. This will be one of the most pressing and urgent problems for the consideration of an "AfterCare Committee." There is much difficulty, too, in following up the educational treatment of the sanatorium—popularly described as "rest, open air, and stuffing," in the dusty, closely-confined, and squalid homes to which they return. 85 16. School children suffering from tuberculosis are excluded from school by the Education Authorities in the hope that the children will be given rest and proper treatment in suitable institutions. These expectations are often not realised. The parents, when the child has been released from school attendance, are inclined to resist the measures which are projected for its betterment. The child discards its splints, or instrument, and is put to run errands, to wash the floor, or to help the parents at a street stall. A consumptive child may be kept at home to mind the younger children. Some further power is desirable to enable local authorities to compel careless parents to do their best for such children, or to deal otherwise with them. Treatment.—Out of 382 patients, 118 had been treated at the Holborn Poor Law Infirmary or Institution. Forty-nine patients received sanatorium teatment in addition to the 52 paid for by the London County Insurance Committee. Each patient notified, when visited, was asked whether he would like to have sanatorium treatment or not—235 stated that they would be very glad to have the opportunity of entering a sanatorium, 68 did not wish to accept. Those who returned home from sanatoria were visited and asked for their comments on the food and treatment. Most patients were very satisfied. Some grumbled. They had expected that when they entered a sanatorium they were to have something far different to what they had been accustomed to have at home. They did not understand the treatment by rest, open air, and graduated exercise. They were surprised that they were given no medicine—" not even cod liver oil or malt." They could not accustom themselves to rooms where there were no fires, and on that account complained that the premises were cold. Some of the comments are given below:— 1. "There were only three meals a day." 2. "The tea in the afternoon was not a proper tea. The cups were so small that they only held a few teaspoonfuls." 3. "Not enough milk." This patient admitted that he had two pints of hot milk daily, and had never asked for more. 86 4. "The bacon was served in lumps, and the kippers were not done." 5. " The clothes were not properly aired." 6. "It wasn't a proper sanatorium because there was no water closet there." This was an institution where the conveniences installed were earth closets. 7. "There were too many restrictions." They had to walk where they were told, not where they liked. They couldn't walk as long as they wished because they had to stop when the doctor told them. These comments obviously refer to the treatment by graduated exercise. 8. "Patients should not be asked to sweep the wards." "We can get enough sweeping at home." 9. "I felt the cold very much. I don't think the air agreed with me." 10. "I had to walk two miles to get stamps." At this institution the matron had ample postage stamps for the use of the patients, but this fact was, owing to some lapse, unknown to them. 11. "Chilblains." This was probably the commonest complaint of all. Many of the patients stated they had chilblains within a few days of their admission, and that the condition persisted for some considerable time. It is very likely that they were attributable to the altered circumstances of rest, food, and Hygiene under which the patients were placed. These comments are of value for two reasons. They show that patients are only too ready to lose sight of the central fact that they are receiving skilled treatment, free of cost, in the best institutions, and are willing to fasten on to petty capricious complaints. They show, too, the necessity of distributing, to prospective patients, leaflets of instruction defining in detail the scope and character of sanatorium treatment, so that they may enter the institutions with knowledge and preparation and leave them with satisfaction. All the cases sent to sanatoria were picked cases. 'Ihey were all examined by experts, previous to their admission, 87 to decide whether they were likely to benefit by sanatorium treatment. The results, on the whole, were very gratifying. Many were discharged, having stayed the allotted periods, with observations of the following character marked on their case sheets: "Fit for ordinary occupation"; "Fit for full work with a steady temperature" Is making satisfactory progress and is now recommended for domiciliary treatment" The lung condition is now fairly quiet and further sanatorium treatment is unnecessary. Recommended for dispensary treatment"; "The disease is now quiescent, discharged to work." A few, who had not completed their cures were discharged at their own request and against medical advice. Some of these shortly afterwards enlisted. Two were discharged for misconduct and for breaches of regulations. Two patients were discharged with progressing illness and as unlikely to benefit by longer stay. What the Borough Council is doing.—The preventive and other measures adopted were fully described in a previous annual report. Briefly they have reference to the following matters :— 1. Visitation and advice to the patient and to the home contacts. The first visits are made by the male staff; the revisits by the Lady Sanitary Inspector. 2. Enquiry for missed cases or suspected cases of tuberculosis. Forty-four suspected cases were discovered in 1914. 3. Suspected cases are put in the way of being medically examined and obtaining treatment. Difficulties are experienced in getting all the home contacts to submit to examination. The majority are not apparently ill; they have no pain or discomfort, and state they have not got time to go and see the doctor." This difficulty will ito longer obtain, once the Finsbury Tuberculosis Dispensary is established and the medical officer is able to examine them in their homes at convenient times. 4. Leaflets of instruction are left at the house—a coloured pictorial leaflet for the very poor and illiterate, a small book for the others. 88 5. The reference to appropriate agencies of cases of poverty or destitution. 6. Advanced cases are advised to enter the Poor Law Infirmary. Insured patients are recommended to apply for sanatorium benefit to the London County Insurance Committee. The London County Council is the authority to provide sanatorium treatment for patients who arc not insured. 7. A sanitary survey of the house and premises with the correction of sanitary defects. 8. Measures in connection with the inspection of meat. 9. General sanitary measures. 10. The free bacteriological examination of sputum. In 1914, the number of specimens examined was 226, of which 51 gave positive results. 11. The offer of free periodic disinfection after notification, and of disinfection after death. In 1914, the rooms, bedding, feeding utensils, towels, handkerchiefs, and linen were disinfected in 113 households. A special leaflet of instruction on disinfection is left in every home where a case or a death occurs and its terms are explained. 12. Sputum flasks are given free to poor patients and sold at cost price to others. A disinfectant soap for cleansing purposes is given gratis to those who would like to scour out their rooms. Schools.—Forty-two of the patients notified were school children. The schools chiefly affected were: Compton Street (6), Rising Hill Street (5), Bath Street (4), St. Peter's, Saffron Hill (2), Hugh Myddelton (2), Ann Street (2), Chequer Street (2), St. John's, Duncan Terrace (2), Richard Street (2), Baltic Street, 2 cases. Deaths —In 1914, the number of Finsbury persons who died of phthisis, or pulmonary tuberculosis, was 151—the same number as in the previous year. In addition to these, 21 died from tuberculous meningitis and 35 from other forms of tuberculosis. The deaths from all forms of tuberculosis were 207. The corresponding number for 1913 was 214. 89 The deaths for previous years are given in the subjoined table : Phthisis Deaths and Death Rates, 1901—1914. Year. Finsbury Deaths from Phthisis. Finsbury Deaths from other forms of Tuberculosis. Phthisis Death Rates per 1,000 inhabitants. Finsbury. England and Wales. 1901 216 30 2.13 1.260 1902 240 23 2.40 1.230 1903 223 39 2.26 1.200 1904 251 67 2.58 1.230 1905 215 52 2.24 1.140 1906 232 48 2.46 1.150 1907 243 42 2.60 1.140 1908 221 39 2.40 1.115 1909 228 31 2.52 1.081 1910 166 31 1.86 1.015 1911 159 45 1.81 1.084 1912 160 44 1.81 1.017 1913 151 63 1.78 1.004 1914 151 56 1.78 — It will be observed that the deaths and death rates are practically the same as they were last year. It is very probable, however, that this list does not contain all the deaths from phthisis which occur in Finsbury. Many are doubtless concealed on the death certificates and wrongly entered as due to pneumonia, bronchitis, chronic bronchitis, pleurisy, asthma or influenza. Enquiry was made into the length of residence of each case in the Borough and as to the presumed duration of the disease. Adopting the classification indicated in an earlier part of this report, the cases were considered to be— 90 Finsbury by residence and infection 106 Fins bury by infection 16 Finsbury by residence 7 Not Finsbury 22 151 Including only the Finsbury cases by infection and by residence and infection, these amount to 122 deaths which may reasonably be associated with the Borough and give a corresponding death rate from phthisis of 1.44 per thousand inhabitants. Allotted to districts, 90 belonged to Clerkenwell, 59 to St. Luke, and 2 to St. Sepulchre. Of the whole number of deaths, 1,636, in Finsbury in 1914, 9.2 per cent, were due to phthisis, as against 9.3 and 9.7 per cent, in 1912, and 1913 respectively. Nearly four-fifths of the total deaths due to phthisis took place between 25 and 65 years. Eighty-four died in poor law institutions. The deaths from phthisis in institutions for previous years are appended :— Phthisis Deaths in Institutions, 1901—1914. Year. Total Number of Phthisis Deaths. Phthisis Deaths in Holborn Union Infirmary. In other Institutions. Total in Institutions. Percentage of Deaths in Institutions. 1901-6 1.377 572 195 767 55 1907 243 108 51 159 65 1908 221 81 50 131 59 1909 218 87 59 146 67 1910 166 63 25 88 53 1911 159 74 M 88 55 1912 160 71 32 103 64 1913 151 60 32 92 62 1914 151 65 40 105 69 91 The method adopted by the Registrar General, of allocating deaths in institutions to the districts in which the patients resided, for however short a period immediately before admission, makes the Finsbury death rate from phthisis higher than it otherwise would be. A patient who sleeps one night in Finsbury and is admitted on the next day to the Holborn Infirmary to die there, is counted as a Finsbury death, even although he may never previously have been in the Borough. The death rates in the metropolitan boroughs are subjoined :— Phthisis Death Rates, London Boroughs, 1914. Borough. Phthisis Death Rate per 1,000. Borough. Phthisis Death Rate per 1,000. Battersea 1.22 Lambeth 1.42 Bermondsey 1. 63 Lewisham 0.75 Bethnal Green 1.64 City of London 1.2 Camberwell 1.43 Paddington 1.06 Chelsea 1.25 Poplar 1.8 Deptford 1 .4 St. Marylebone 1.3 Finsbury 1.78 St, Pancras 1.67 Fulham 1.32 Shoreditch 2.1 Greenwich l.35 Southwark 1.82 Hackney 1.28 Stepney 1.66 Hammersmith 1.4 Stoke Newington 1.1 Hampstead 0.66 Wandsworth 0.93 Holborn 1.97 Westminster 1.38 Islington 1.42 Woolwich 1.27 Kensington 1.10 County of London 1.39 Phthisis Death Rate, 1913 England nd Wales 1004 92 The Finsbury death rate is seen to be the fifth in order of magnitude, and is exceeded by the rates in Shoreditch, Holborn, Southwark, and Poplar. Only 32 per cent, of the Finsbury phthisis patients who died in 1914 were born in the Borough; thirty-three per cent. were born in other metropolitan boroughs and had migrated into Finsbury. Nineteen per cent, of the deceased patients lived an3 slept in one room with the other members of their families ; 38 per cent, occupied two rooms in similar manner. The streets where the largest number of deaths occurred were:— Eight deaths in Lever Street. Six deaths in Donegal Street. Four deaths each in Baldwin Street, Clerkenwel! Green, Galway Street, Rising Hill Street, St. John Street, and White Lion Street. Three deaths each in Compton Street, Easton Street, Helmet Row, Roscoe Street, and Warren Street. Two deaths each in Baron Street, Banner Street, Bowling Green Lane, Gee Street, Little Sutton Street, Myddelton Street, Northampton Road, Northampton Buildings, Margaret Street, Old Street, Penton Street, Radsworth Street, Sadler Street, Sidney Street, St. Helena Street, Victoria Dwellings and Wenlake Buildings. Other Forms of Tuberculosis. - The number of not fications received was 77; of these 2 could not lie traced. The rest—75— were derived, from Clerkenwell 47, St. Luke's 27, and St. Sepulchre 1 case. The parts affected were as follows: Neck glands, 19; axillary glands, 1; mesenteric glands and peritoneum, 12; intestines, 6; bronchial glands, 2; femoral glands, 2; ankle joint, 2; elbow joint, 2; knee joint, 3; hip joint, 9; spine, 3: bones of leg and foot, 1; sternum, 1; skin of faoe and neck (lupus), 2; chest wall and ribs, 1; larynx, 2; meninges of brain, 12; and testicles, one case. Five patients had more than one site affected with the disease. Thirty-five patients were bedridden. Twenty-six were infants under school age, and not attending school. Twenty-two were examples of "open tuberculosis," associated with discharges, and therefore, presumably infectious to those brought into contact 93 with the sufferers. Twenty were school children. The schools chiefly affected were Compton Street (3), Bath Street (3), Rising Hill Street (2), St. Peter's, Saffron Hill (2), and Moreland Street, 2 cases. Age and Sex.—The notified cases, classified according to sex and age are given below :— Years. 0-1 1-2 2-5 5-15 15-25 25-45 45-65 65 + Totals. Males — 7 12 10 2 8 5 2 46 Females 4 6 2 13 3 3 — — 31 Totals 4 13 14 23 5 11 5 2 77 Of the whole number, 42 were considered to be Finsbury cases by residence and infection, 9 Finsbury cases by infection, 2 Finsbury cases by residence, and the rest, 24 in number, were not Finsbury cases. These last were persons who were affected with tuberculosis before coming into the Borough, and had moved into Finsbury so as to be near the hospitals to obtain free treatment. The patients came mostly from the fol'owing streets: Amias Place (2), Baker's Row (2), Central Street (4), Goswell Terrace (2), Ironmonger Street (2), Jerusalem Passage (2), King's Cross Road (2), Lever Street (3), Little Sutton Street (2), Murton Street (2), Pentonville Road (2), and St. John Street, 2 cases. Twelve of the patients lived and slept with their families in one room. Five of the tenements were overcrowded. The close contacts in the same families included 172 adults and children above school age and 208 other children. The kitchen was used for sleeping purposes in 42 instances. Ten families were living under conditions of great poverty. In 11 cases the mother was the chief or only wage earner. The deaths included 21 from Tuberculous Meningitis (Clerkenwell 14, and St. Luke's 7), and 35 from other forms of tuberculosis (Clerkenwell 18, and St. Luke's 17). 94 The Finsbury death rate for all forms of tuberculosis in 1914 was 2.44 per 1,000—the corresponding rate for England and Wales in 1913 was 1.326. The death rate in Finsbury was nearly twice the death rate in the country taken as a whole. SMALL POX. No case of small pox was notified in Finsbury in 1914. The Medical Officer of Health was asked to see in consultation two cases suspected to be small pox. One was a case of chicken pox; the other was a verminous patient, a severe case of the itch that had become infected secondarily by pyogenic organisms. One notice of a small pox contact proceeding into Finsbury was received fiom the medical officer of a port sanitary authority. The address was visited and found to lie incorrect. The contact was not seen. Small pox and other over-sea contacts with cases of plague, yellow fever, or cholera, alleged to be entering the borough are frequenty not interviewed because they give insufficient, inaccurate, or merely accommodation addresses. Sometimes information is refused by the householder at the address indicated. These contacts move rapidly from one place to another—sometimes they merely call at the addresses given to see whether there are letters. The consequence is that these oversea contacts with infectious diseases are for the most part, as far as Finsbury is concerned, not kept under observation or supervision in the borough. This matter has been referred to in previous annual reports. CEREBRO-S PINAL FEVER. POLIO-MYELITIS AND POLIO-ENCEPHALITIS. These diseases are compulsorily notifiable. For notification purposes, posterior basal meningitis is included in the term "cerebro-spinal fever." This term, however, is not to include cases of meningitis due to tuberculosis, syphilis, middle ear disease or injury. 95 Three notifications were received of cerebrospinal meningitis and one of polio-myelitis. The cases and the results of the illnesses are appended. Cerebro Spinal Meningitis, 1914. 1. March 3rd. Male, years. Removed to St. Bartholomew's Hospital. Died. 2. July 24th. Male, 4 years. Removed to North-Eastern Fever Hospital. Recovered. 3. August 3rd. Male, 9 months. Removed to the Cleveland Street Infirmary. Died. The causes of death were given as measles, bronchopneumonia, and cerebro-spinal meningitis. The death was attributed to measles. The cerebro-spinal meningitis was secondary. Polio-Myelitis and Polio-Encephalitis, 1914. 1. October 19th. Female, 5 years. Removed to the Children's Hospital, Great Ormond Street. Recovered. 2. Female, 22 months. Removed to the Royal Free Hospital. Died on April 16th, 1914. This case was not notified. All the cases were investigated Two of the tenements were dirty and verminous ; the others were clean. MEASLES. This disease is not notifiable. In 1914, notices of 849 cases were received from the London County Council Education Department, from head teachers of schools, from school visitors, from doctors, from the medical officers of other borough councils, from relieving officers, from registrars of births and deaths, from sanitary inspectors, superintendents of dwellings, and from parents and guardians. 96 The sections of the Public Health (London) Act, 1891, which refer to the cleansing and disinfection of premises and materials, and to contact with, or exposure of, infected persons and things, have been extended to measles. These are Sections 60-65, 68-70, and 72-74. By the Metropolitan Asylums (Measles) Order, 1911, dated May 30th, 1911, the hospitals of the Metropolitan Asylums Board were made available for the reception of non-pauper cases of measles. The age incidence and the ages at death from 1903 to 1914 are shown in the subjoined table :— Age Incidence of Cases of Measles, 1903-1914. Under i year of age in months. 1- 2- 3- 4- 5-10 10-15 Total 1903-1914. 0-3 3-6 6-9 9-12 5 46 141 197 802 757 941 1,408 2,769 91 7,157 The actual numbers notified year by year were: 577, 802, 561, 1,036, 478, 245, 436, 898, 384, 625, 276, and 849 from 1903 to 1914 respectively. Ages at Death in Cases of Measles 1903-1914. Under 1 year of age in months. 1- 2- 3- 4- 5-10 10-15 Total 1903-1914. 0-3 3-6 6-9 9-12 3 17 64 106 391 125 78 24 20 9 837 The deaths year by year were 69, 60, 31, 115, 43, 38, 86, 73, 85 129, 30, and 78 from 1903 to 1914. The cases were most numerous in 1906, the deaths in 1912. In both these years the disease was very prevalent. 97 The affected households are visited by the Lady Sanitary Inspector, who gives the parents suitable advice as to nursing and feeding the patients. A leaflet of instruction is left at the house, and dispensary tickets given for those children needing treatment. These leaflets are distributed and re-distributed to every tenement in those streets where measles is known to occur. The dirty tenements are disinfected at the end of the case. The rooms were disinfected in 171 tenements. Measles was very prevalent during the year, so that, for three months, the Borough Council engaged the services of a special health visitor to deal with the epidemic. It was found that very few cases were being treated by doctors. The rule is for the patient to be seen by a medical man once only, that is, when the rash is first noticed. After the diagnosis has been made, the mother thinks herself quite competent to treat measles. Further, it is stated that some dispensary doctors wish to revisit only when they are specially sent for. This casts the onus of diagnosing complications unfairly upon the untutored parent. When measles invaded a tenement house, the mothers inhabiting it assumed that all the other diseases, attended with rashes, which occurred amongst the occupants were also measles. This assumption led to cases of scarlet fever being mistaken, for cases of measles. Effective isolation of the patient was often difficult and nearly always impossible. When the parents and 5 or 6 children live and sleep in one room, isolation is clearly impracticable, though even then the mother attempts it by placing the affected child at night to sleep at the foot of the bed while the rest of the family sleep at the top. When the mother goes out to work, the children are left in charge of the eldest child, who is quite unequal to the task of isolation, or under the care of a neighbour who goes in from time to time to see that all is well. When the family occupies 2 or more rooms, the patient may be isolated during the morning and the afternoon, but at meal times the children are allowed to feed and to play together. Some mothers consider it sufficient that they should take the infectec children with them to bed at night. 98 A fresh difficulty occurs when the father works at night and sleeps at home during the day time. Under these circumstanoes, all the children are kept in the living room so that the father may rest. Sometimes the mother will explain that she cannot possibly nurse the ailing child without the help of an older child who is unprotected. ''The children must take their chance." In one family the mother moved all the children who had not had measles into the same room and to sleep in the same bed with the child who had the disease. She explained that, "It was better to let them get measles now, all of them together, and have done with it. Measles was a child's complaint, and the sooner it was over the better." Mothers who go out to work, and put their children into nurseries, still send their infants to a creche, even though they know that others in the family have measles and that possibly the babies may be sickening for the same disease. The home nursing is primitive. It is popularly stated that the rash takes 3 days to come out, stays out for 3 days, and "goes inwardly" for 3 days. At the end of the ninth day the patient is believed to be well and free from infection. Working mothers then place these children, who are wrongly presumed to have recovered, with neighbours to be taken care of. In this way infection was carried into other families. In some of the households affected, nurse children were found to be taken in during the day time for payment. During meal times the children and the patient were usually all found to be feeding together. The patient's utensils were mixed and washed in the common bowl with the utensils of others. Some mothers when their children got measles were afraid to wash or to undress them, and afraid to wash the floor lest the rash should "strike inwardly" and give the patients pneumonia. Many of the children were found up and about on the fourth day of illness or soon after, sometimes clad only in a shirt or jersey, and playing with other children in the passage. 99 It is most difficult to keep the patients in bed. Many mothers stated that the patient should only be kept in bed while the rash was out; others believed that to keep the patient in bed weakened him and rendered the ultimate recovery doubtful and more subject to complications. The mother is advised to keep the patient in bed for one week after the rash has left the legs. This is a practice of perfection, and not often followed in Finsbury. The bed is often moved into the kitchen so that the whole family may be continuously under the supervision of the mother. In one home the kitchen was so small that when the bed was moved in, the door of the food cupboard could not be opened and was removed. The unprotected children are tied in chairs or in mailcarts to keep them from the bed of the child who is ill. Mothers have to be specially warned not to give to the other children the food which has been half-eaten and picked over by the patient. The universal medicine is saffron: "a pennyworth every day for three days and a drink now and then to bring the rash all out." In addition to the saffron, the mother may give the patient brandy, whisky, liquorice powder, cod liver oil, flowers of sulphur, cooling powders, syrup of buckthorn, lemon juice, lung syrup, and "cough mixture from a general shop." One mother gave her child the water that some eels had been in when she bought them "to ease the chest and make the phlegm slippery." The cooked eels were given to another child to prevent him catching measles. Many mothers place a saucer of reputed disinfectant under the patient's bed They imagine that this creates a zone, powerfully inimical to germs, which wards off infection from others who approach the patient. The home treatment for swollen neck glands is to rub them vigorously with camphorated oil. Russian tallow on brown paper is applied to the chest to ease the cough. Illustrative Cases. 1. The family consisted of the parents, 5 boys, one girl, and occupied 2 rooms. The patient, 4 years old, was up and dressed on the eighth day after he sickened. The mother went to work and came home at 1 p.m. and 5 p.m. to cook for the family. The kitchen utensils were all kept together and washed in a common 100 bowl. The father slept out. The eldest boy, 11 years old, had not had measles, and was nursing the patient during the absence of the mother. The mother, a girl 13 years old, and the patient slept in one bed in the kitchen. Four other boys slept in the bedroom. A week later the patient was found playing in the street. He had gone out so that the girl, 13 years, might wash the floor and clean up the home. The result was that all the unprotected children got measles. 2. The parents, 2 boys, and one girl lived and slept in one room. During the day time " isolation " was attempted by keeping the unprotected children at one end of the room, and the baby with measles at the other end near the fire. At night all the family slept in one bed—the parents and baby at the top and the unaffected children at the bottom of the bed. 3. The parents, 3 boys and 2 girls lived in 2 rooms. A boy, 5 years old, had measles. The father was a window cleaner in casual employment, earning 3s. a week. The mother was a charwoman. The boy was taken to a hospital with the measles rash well out, and was detained there for some considerable time awaiting his turn in the midst of many other children. The mother was given some medicine for the child but did not use it. She used instead some "cough mixture" given to her by a neighbour. She gave the unaffected children some of this mixture in order to protect them, as she thought, from the infection, but she took no precautions to clean the spoon which was used and licked in common by all the children. The result was that all the other children took measles. The family were under notice to leave and were threatened with ejectment. They paid no rent. They were rather pleased, therefore, when all the children had the disease. They were all kept in bed for some considerable time. They asserted that their landlord would not have the inhumanity to turn them out of their rooms as long as the children were ill and in bed. 5. The patient was in bed and had nothing on. His mother had just given him for dinner a plateful of boiled potatoes, which she had placed on the bedclothes over his chest as he lay on his 101 back. Some of these he had partially eaten, some he had picked over. The mother thought it was " a pity to throw good food away," so she gave what the patient left to the other children. The rest all caught measles. 6. The family consisted of the parents, one bov, 2 girls, and occupied one room. The boy caught measles and was treated by the mother, who went out to work. During the mother's absence the patient was left in care of his aunt, who came in from time to time to see that all was well. The boy occupied the parents' bed during the day time, but slept on the floor at night. The girls slept with their parents at night, occupying the infected bed. They both got measles. All the patients took saffron and brandy for 3 days and had their chests rubber with camphorated oil. The baby got pneumonia and was being given "lung syrup" obtained by the mother from a grocer's shop. HOOPING COUGH. This is not a notifiable disease. Information of cases is generally reoeived from schools and from the other institutions and persons who send notices of measles. The deaths numbered 43, as against 30 in the previous year. Forty were under 5 years of age; three were over 5 years of age. Disinfection is done on request: it is not done as a routine after recovery. The hospitals of the Metropolitan Asylums Board are now available for the reception of non-pauper cases as well as of pauper cases of hooping cough. Comparative Mortaltiy Table.—In 1914, measles caused 78 deaths and hooping cough 43 deaths. These two diseases are very fatal to children under 5 years. The following table compares the deaths in children under five years from measles and hooping cough with the deaths from other infectious diseases :— 102 Deaths in Children under 5 years, 1901-1914. Year. Measles. Hooping Cough. Small Pox. Scarlet Fever Diphtheria. Enteric Fever. 1901-5 278 211 13 53 80 — 1906-10 347 202 — 39 80 1 1911 82 26 — 4 14 - 1912 124 30 — 4 12 — 1913 30 30 - 4 6 - 1914 75 40 - 5 7 - Totals 936 539 13 109 199 1 From this table it appears that the deaths in 14 years due to scarlet fever, diphtheria, enteric fever, and small pox, all taken together numbered 322, to hooping cough 539, to measles 936. In children under live years, therefore, it is seen that measles kills nearly three times the number of children whose deaths are caused by small pox, scarlet fever, diphtheria, and typhoid all included Hooping cough causes a little more than one-and-a-half times the number of dea ths accredited to the other four named infectious diseases. DIPHTHERIA. The number of cases notified was 140. Of these, six were subsequently sent home as not suffering from diphtheria, leaving 134 true cases. There were 9 deaths, so that 6.7 per cent. of all the patients died. The number of cases is 34 more than last year, the number of deaths remains the same. 103 The particulars of cases in previous years are appended :— Diphtheria, 1901-1914. Year. No. of Cases. No. of Deaths. Case Mortality. No of Deaths per 100 cases notified. No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 1901 289 36 12.5 28.5 3.5 1902 216 37 17.1 21.6 3.7 1903 119 12 10.1 12.0 1.2 1904 123 14 11.4 12.6 1.4 1905 126 11 8.7 13.1 1.1 1906 151 25 16.5 15.9 2.6 1907 127 15 11.8 13.6 1.6 1908 130 16 12.3 14.1 1.7 1909 152 13 8.5 16.8 1.4 1910 126 19 15 1 14.I 2.1 1911 159 17 10.7 l8.l 1.9 1912 148 14 9.4 17.1 1.6 1913 91 9 9.8 10.7 1.06 1914 134 9 6.7 16.1 1.08 All the eases were investigated, and the source, if possible, was ascertained. The premises were inspected and notices served for sanitary defects. The drains were carefully examined, and in nearly every case tested. In only five houses were they found to be defective. Presumed Sources of Infection. In 10 instances the disease was contracted from known, missed, or unrecognised cases in the members of the patient's family. Four patients caught the disease in hospital after they had been admitted suffering from diseases other than diphtheria. These are called cross infections and occur when a patient is being treated in hospital for one disease, say, measles, or pneumonia, and oontracts another disease, e.g., scarlet fever or diphtheria from some other hospital 104 patient. Unfortunately, they occur in most fever hospitals, and point to flaws in their internal administration. Two caught diphtheria on visits to friends or relatives—seven on visits to places of entertainment. Twelve were infected by school fellows or play fellows in the same blocks of model dwellings. Three developed the disease after recent attacks of measles. The association between the two diseases, measles and diphtheria, is often a close one. There were two return cases. Cases discharged cured from Hospitals.—A few days after their arrival home from fever hospitals, all patients are examined very carefully and a record kept of their condition. A leaflet is given to the parents, its terms explained, and precautionary measures are advised. If a child has a discharge from the nose, or if for any other reason the infection is believed to persist,. the mother is advised to take the child to her own doctor, or if poor to bring it to the public health department. The conditions found amongst these convalescent patients after their return home are shown below :— Neck Glands enlarged 20 Nasal Discharge 4 Sore Nostrils 1 Ear Discharge 1 Sores on face or ears 1 Anaemia 12 Sore Throat 2 Squint 2 Difficulty of swallowing 1 Vomiting 3 Weakness of limbs, probably slight paralysis following diphtheria 14 Shortness of breath 7 It is quite possible that some of the cases in the above list were discharged from hospital rather a little too soon. The cases discharged from hospital with nasal discharge or sore throat were, after their return home, examined by the Medical Officer of Health, and swabs taken from the throats and noses. The diphtheria bacillus was not found present in any case. These swabs are examined bacteriologically free of charge for medical men by the Public Health Department. In 1914, 116 specimens were submitted with positive results in 22 instances. A supply of diphtheria antitoxin serum is kept at the public health office, and is available gratis for doctors on request. 165 SCARLET FEVER. There were 438 notifications of scarlet fever, resulting in six deaths. This number of notifications was last exceeded in 1907. The number of deaths in the year still keeps at the comparatively low numerical level which began in 1909. The epidemic which prevailed in 1914 was an exceedingly mild one, and exhibited the same characteristics as the epidemic of the previous year in respect of missed cases, difficulties and errors of diagnosis, and the attendance of unrecognised cases at school. With the exception of 39 cases, all the rest, 399 in number, were between one and fifteen years. The deaths were 1.36 per cent. of the total number of cases, or, roughly, one in every 70 children affected died. Four cases were treated at liome; suitable measures were taken to ensure the isolation of the patient. The rest, 434, were treated in hospital. The particulars with regard to previous years are appended. Scarlet Fever, 1901-1914. Year. Actual No. of cases. No. of Deaths. Case Mortality. No. of Deaths per 100 cases notified. No. of cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 1901 495 19 3.8 48.9 1.8 1902 381 15 3.9 38.1 1.5 1903 283 12 4.2 28.7 1.2 1904 323 17 5.2 33.2 1.7 1905 456 21 4.6 47.5 2.1 1906 422 13 6.1 44.6 1.3 1907 471 l6 3.4 50.5 1.7 1908 387 12 3.1 42.1 1.3 1909 231 9 38.9 25.5 .9 1910 126 4 3.17 14.1 .4 1911 171 6 3.5 19.5 .6 1912 159 5 31.5 18.4 .58 1913 251 5 1. 93 29.6 .59 1914 438 6 1.36 52.6 .72 106 Probable Source.—In 48 cases tlie infection was derived from previous cases in the same families, in another five the disease had been contracted from mild unrecognised cases in the affected households. Thirty-four were examples of school infection, thirty-eight cases were caught from play fellows in the street, six had been infected when visiting or being visited by friends or relatives. Twenty-five cases were not discovered until some weeks after the rashes had appeared. They were then peeling. They were mild missed cases that had apparently only suffered from slight headaches, slight sore throat, or other form of slight malaise which the parents wrongly attributed to "the heat," to "growing pains," or to some other ill-defined and insufficient cause. Eight developed scarlet fever while detained in hospital for some other causes. Thirteen were presumably infected by visiting places of entertainment. Alii the houses where cases occurred were visited and inspected. Nuisances that called for remedy were made the subject of notice and amendment. The rooms, the bedding and clothing, were disinfected. There were 19 return cases. Three "infecting" cases were readmitted to hospital, on the certificates of the Medical Officer of Health after their return home. Cases discharged for Home.-In Finsbury every case discharged from the fever hospital :s visited soon after return home and carefully examined. The possibility of further infection is explained to the mother, suitable measures suggested, and a leaflet of instruction left with her. Special attention is paid to children who develop a discharge from the nose after their return home, to children with adenoids, to children with enlarged neck glands, and to children with sores on their lips, or on their faces. Sixteen such cases were kept under the observation of the Medical Officer for periods varying from one to three months before they were certified as being free from infection and fit to resume school attendance. 107 The cases examined after their return home from fever hospitals had the following complications : Enlarged neck glands 46, general weakness of limbs 32, discharge fro'm nose 41, sores on lips, face, ears, mouth, or nostrils, 9, conjunctivitis 4, peeling on hands or feet 19, sore throat 4, shortness of breath 10, and anaemia 2 cases. ENTERIC FEVER. In 1914, the number of cases notified was 18, with two deaths. The numbers in previous years are given in the accompanying table:— Enteric Fever, 1901-1914. Year. No. of cast s notified. No. of Deaths. Case Mortality. No. of Deaths per 100 cases notified. No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 1901 65 11 16.9 6.4 1.08 1902 77 9 11.7 7.7 0.9 1903 47 11 23.4 4.7 1.1 1904 40 8 20.0 4.1 0.8 1905 42 9 21.4 4.3 0.9 1906 44 14 31.8 4.6 1.4 1907 22 2 21.0 2.3 0.2 1908 41 12 29.2 4.4 1.3 1909 15 3 20.0 1.6 0.3 1910 28 4 14.3 3 .1 0.4 1911 74 9 12.2 8.4 1.02 1912 . 5 1 20'0 0.58 0.11 1913 15 0 0.0 1.7 0.0 1914 15 2 125 1 8 0. 24 Of the 18 cases originally notified, the diagnosis was not sustained in three instances after admission to hospital. 166 Presumed sources of infection.—In 5 cases there was reason to believe that the patients had probably contracted enteric fever by eating fouled shell fish or watercress. Seven patients were infected, directly or indirectly, by one or other members of the same family. The circumstances were as follows: The mother of a family was notified to have enteric fever in November, 1913, and was removed to hospital. The family and the other occupaints of the house were kept under observation. The children were being kept at home. The father was out of work. In a few weeks one of the younger children, five years old, was found to have occasional diarrhœa. The significance of this was pointed out to the father, and he was asked to have the child medically examined by his own doctor or by the medical officer of health. The father declined to assent. Later it was agreed that the child should be examined by a doctor, and the fee was paid iri advance by the Public Health Department. However, at the last minute, the father again refused his consent. Meantime all the children were being kept indoors at home, so that it was felt that there was no safe and sure ground for legal intervention in the absence of positive knowledge. The suspected child got very slowly worse, and was eventually notified to have enteric fever in January, 1914. During the succeeding fortnight, the father and five other children were also notified. With the exception of the baby one year old, the whole family contracted enteric fever—eight cases in all. All cases of typhoid fever on their discharge from hospital are visited and examined. A leaflet of instruction is left with them and specal attention is directed to its more important clauses, which are orally explained at some length. The faeoes and urine are examined baeteriologically only in those patients discharged for home where there is some evidence or suspicion which points to their acting as typhoid carriers. Diagnosis. -Specimens of blood from suspected cases of typhoid fever are examined free of charge for medical men by the Public Health Department. The examinations are conducted at the Bacteriological Laboratory of the Middlesex Hospital. In 1914 eight specimens of blood were received—three gave a positive Widal reaction, the rest were negative. 109 INFECTIOUS DISEASES. General Considerations.—The notifiable diseases named in Section 55 of the Public Health (London) Act, 1891, are small pox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus, enteric, relapsing, continued and puerperal fevers. Cerebro-spinal fever, posterior basal meningitis, polio-myelitis, polio-encephalitis, ophthalmia neonatorum, glanders, anthrax, and hydrophobia in man are likewise notifiable in London by an order of the London County Council, made under Section 55 and 56 of the Public Health (London) Act, 1891. Sections 60-65, 68-70, 72-74 of the same Act, referring to the cleansing and disinfection of premises and materials, and to contact with, or exposure of infected persons and things have been made applicable to measles. Measles and hooping cough are not notifiable. All. cases of tuberculosis have been made notifiable by the Public Health (Tuberculosis) Regulations, 1912, of the Local Government Board. Outbreaks of glanders and anthrax arc notifiable to the Health Authority by the Inspectors appointed under the Diseases of Animals Act, 1894, in pursuance of the provisions of the Anthrax Order, 1899, and of the Glanders and Farcy Order, 1907, of the Board of Agriculture. Cases of anthrax, or poisoning by mercury, arsenic, lead and phosphorus, must be notified to the Chief Inspector of Factories, Whitehall. Notifications.-The notifications of infectious disease received in 1914 were as follows: Small pox none (none), scarlet fever 438 (251), diphthe ria 134 (95), cerebro-spinal fever 3 (5), typhoid fever 15 (15), erysipelas 159 (124), puerperal fever 11 (13), ophthalmia neonatorum 17 (6), and polio-myelitis 1 (3) cases. The figures in brackets refer to the year 1913. 110 The numbers for previous years are appended:— Notifications of Infectious Disease, 1911-1914. Year. Number of Notifications Received. Notifications per 1,000 of the population. Percentage of Cases removed to Hospital. 1911 640 7.3 61 1912 467 5.4 72 1913 511 6.03 74 1914 778 9.3 73 The above table excludes notifications of Chicken-Pox—there were 181 in 1911. The amount paid in fees for notifications of infectious disease was £69 6s. 6d. The lowest was £41 12s. 6d. in 1912, and the highest was £176 16s. in 1902 at the time of the small-pox epidemic. The sum paid for notifications of tuberculosis was £55 2s. 6d. The fees paid under the Diphtheria Antitoxin (London) Order, 1910, amounted to £2 1s. Diagnosis.—In 20 cases out of a total number of 588, the patients after admission to a fever hospital were returned home as not suffering, at the time of admission, from any notifiable infectious disease. Most of these mistakes were made by the house staffs of large general hospitals. The errors were chiefly in connection with scarlet fever. Deaths.—The number of deaths certified in 1914 as due to the infectious diseases named in the accompanying table, was 236. The corresnonding death rate was 2.8 per 1.000 inhabitants. Deaths from Infectious Disease, 1911-1914. Small-Pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Measles. Hooping Cough. Diarrhœa. Total. 1911 — 6 17 9 3 85 27 152 299 1912 — 5 14 1 4 129 31 42 226 1913 — 5 9 - 5 30 30 107 186 1914 — 6 9 2 5 78 43 93 236 The increase this year is associated with the larger number of deaths accredited to measles and hooping cough. 111 DISINFECTION. The Finsbury disinfecting station is at 49, Northampton Road, Clerkenwell. Here provision is made for the housing and accommodation of families during the disinfection of their premises after infectious disease, and for the reception of smallpox contacts during the incubation period. During the year the "Shelter" was thoroughly repaired and equipped anew with bedding, household requisites and feeding utensils. It was used in 1914 by one family from Finsbury (3 persons), and one family from Holborn (3 persons). The Holborn Metropolitan Borough is allowed to use this shelter by an agreement made between the two boroughs, dated October 4th, 1911 and terminable at the pleasure of either Council. The disinfector is a Washington Lyons high-pressure steam apparatus. In 1914, 988 separate rooms were disinfected, of which 171 were for measles, 57 after notification of phthisis, 56 after deaths from phthisis, 44 on account of vermin, and 85 on request. In addition, bedding and mattresses were steam disinfected for the following institutions: The Claremont Hall Crèche, St. Barnabas Home, St. Mark's Hospital, the Remand Home, and St. Luke's Hospital. Altogether 10,989 articles were disinfected in connection with cases of infectious disease, and phthisis; these were chiefly mattresses, pillows, bolsters, sheets, blankets, quilts, cushions, curtains, carpets, table cloths, and bedclothes. Besides these, 18,431 articles of wearing apparel were disinfected for City firms at a price agreed upon, prior to exportation to South Africa, and 1,461 blankets, hammocks, and articles of clothing for the London County Council. The mortuary possesses 18 shells, or empty coffins, for the accommodation of dead bodies. 112 PROTECTION OF FOOD SUPPLY. General Considerations.—Each of the five district inspectors is responsible in his own district for the inspection of foods, of bakehouses, restaurants, of restaurant kitchens, of fried fish shops, of milk shops, ice cream shops, and generally of all places used for the sale or preparation of food for human consumption. The three market streets—Chapel Street, Exmouth Street, and Whitecross Street—are kept under close supervision, and are continuously and specially inspected throughout the year on every Saturday evening and Sunday morning. The latter duty is done by every inspector in turn. Each inspector takes samples under the Sale of Food and Drugs Act in his district. These purchases are nearly always made by deputy. Meat and Food Inspection.—The Borough Council have appointed Mr. Billing as a special meat inspector to inspect systematically butchers' shops, food stuffs, shops for food preparation and cold stores throughout the whole district. In addition he pays special attention to the meat deliveries in the wholesale market in Charterhouse Street, St. John Street, and Cowcross Street, all adjacent to Smithfield Market. Each district inspector holds a certificate of competency in meat inspection. All the unsound, diseased, and decomposed meat is removed under agreement by Messrs. C. and B. Webb, fat melters, 155, Bow Road, London, E. Certification of Meat Food Products.—The Medical Officer of Health, with the consent of the Council, was designated the certifying officer by the Local Government Board, for certification of meat food products for export to the Argentine Confederation, to the United States of America, and to the Phillipine Islands. Seventeen certificates were granted in 1914 to Messrs. Bovril, Ltd., 152 to 166, Old Street, Finsbury, E.C. Diseased and Unsound Meat.—The total amount confiscated in 1914 was just over 191 tons. A full description of the various items is given in the following table:— 113 Summary of Unsound Meat, Offal, and other Food Stuffs confiscated in 1914. Diseased. Sides of Beef 35 Beef Tripes 6 Quarters of Beef 39 ,, Udders 16 Pieces of Beef 13 ,, Kidneys 4 Carcases of Mutton 3 ,, Spleens 6 Carcases of Veal 7 Sheeps' Livers 22,936 Carcase of Pork 1 ,, Lungs 1,856 Beef Livers 5.164 ,, Plucks 241 ,, Lungs 3,220 Pigs' Plucks 146 ,, Heads 150 ,, Mesenteries 4 ,, Tongues 293 Calves'Plucks 22 „ Hearts 35 ,, Livers 128 Tons. Cwts. Qrs. Lbs. Total Weight 82 0 0 4 Decomposed. Quarters of Beef 24 Hampers of Mixed Offal 40 Pieces of Beef 127 Sweet-breads 10 Carcases of Mutton 2 Sheep's Heads 488 Pieces of Mutton 137 ,, Plucks 2098 Carcase of Lamb 1 „ Livers 1565 Pieces of Lamb 23 ,, Kidneys 1272 „ Venison 4 ,. Hearts 750 Carcases of Veal 95 Bags of Sheeps Offal 12 Pieces of Veal 56 Calves' Heads 32 „ Pork 2 ,, Plucks 156 ,, Bacon 162 Pigs' Plucks 878 Beef Lungs 11,377 ,, Livers 84 ,, Livers 1,914 „ Heads 12 „ Hearts 195 Crates of Sheep's Sweet-breads 4 „ Heads 152 „ ,, Kidneys 6l ,, Tongues 73 „ Plucks 13 „ Tails 485 Barrels of Pigs' Kidneys 19 „ Tripes 535 „ ,, Chitterlings 22 „ Kidneys 6,482 Parcels of Game 10 „ Heels 163 ,, Poultry 12 ,, Spleens 6,149 Turkeys 55 „ Skirts 65 Hares 22 Crates of Beef Kidneys 149 Ducks 114 „ Tails 5 Fowls 155 „ ,, Skirts 2 Hazel Hens 46 „ „ Livers 42 Cases of Rabbits 269 ,, „ Brains 15 Eggs 10 „ ,, Tripe 12 Barrels of Apples 17 Bags of Beef 6 Boxes of Skate 11 Tons. Cwts. Qrs. Lbs. Total Weight (Decomposed) 109 7 3 6 Total Weight (Diseased) 82 0 0 4 Grand Total Weight 191 7 3 10 114 Prosecutions.—There were 3 prosecutions in respect of unsound meat in 1914, all at the instance of Mr. Billing, who had seized the meat. 1. Messrs. F. W. Waide. and Co., Ltd., Broad Yard, Turnmill Street, London, E.C., were on May 7th, 1914, fined £50 in respect of a quantity of unsound veal, tongue and bacon, weighing 532 lbs., and being used in the preparation for sale of meat paste for human consumption. 2. Mr. Thomas Henry Mitchell, 67 Hertford Road, Edmonton, was on May 12th, 1914, fined £20 and five guineas costs for depositing for purposes of sale at 93 Charterhouse Street, a beast's head markedly emaciated and taken from a carcase affected with generalised tuberculosis. 3. Mr. John Malpas, 71, Hungerford Road, Holloway, was on May 29th, 1914, fined £30 and five guineas costs for depositing for purposes of sale at 101 Charterhouse Street a large quantity of meat affected with generalised tuberculosis. Foreign Beef Tongues—During the year, 24,644 parcels or crates of frozen Argentine beef tongues were delivered to the cold air stores in Finsbury. From January to June a special examination was made of 11,038 of these tongues, with the result that 142, or 1.28 per cent. of the whole number, were found to be slightly affected with actinomycosis. From July to December 6,813 tongues were examined on the basis of 5 per cent. of the whole number delivered during that period. Of these, only 12, or 0.17 per cent., were found to have small nodules of actinomycosis. The examination was much facilitated by the fact that the lymphatic glands are now, prior to. exportation and under supervision excised from the tongues, opened up, and skewered to the superficial parts. The methods of inspection adopted abroad appear to have been made much more thorough and complete in recent years. Unsound Food submitted for Examination.—Food alleged to be unsound is occasionally brought to the Public Health Department for examination by dissatisfied purchasers and by salesmen who have lost the market. 115 The amount brought in 1914 was less than usual. One instance is worthy of record. A turkey was bought in the Central Meat Market and cooked. When it was being carved, the owner found what he thought was a cancer or other growth in the neck of the turkey. It was brought to the Public Health Department so that the meat might be condemned and its value recovered from the vendor. The "growth" proved to be the crop of the turkey and contained its last meal. In all probability, the crop and the contained meal had not been removed before sale, in order to increase the weight of the bird and thereby raise its price. The crop was full of barley meal. Slaughter houses—In Finsbury there are two slaughter houses; the owners' names and addresses are as follows— Mr. Thus. Webb, 191, Goswell Road. Mr. J. A. Mobbs, 14, Penton Street. The slaughter houses were inspected in 1914 on 109 occasions. No defects were ascertained, and consequently no notices were served. The average number of animals slaughtered is 24 per week—2 heads of cattle and 22 sheep. The quality of the meat is distinctly good. There are no knacker's yards in the borough. Black Puddings—Black puddings or blood sausages are made by boiling farinaceous substances such as oatmeal, rice, or other starchy foods and mixing the mass with warm bullock's blood. This mixture is put into the small intestines of the ox, previously prepared, and small pieces of pork fat, and a little seasoning are added. The filled casings are tied into lengths of 18 inches, so that each length forms a sausage. The ends of the sausages are approximated and tied to form rings. The black puddings are cooked by boiling very slowly for twenty minutes. They are then dyed in a wash of logwood chips. Saveloys.—Saveloys are made by finely mincing meats of various kinds—fresh beef, salt beef, scrap meat, and, generally speaking, any second-rate or inferior meat. Bread, farina (meal), and seasoning are added. The mass thoroughly mixed and minced is put into a sausage filler and therefrom passed into 116 casings made from the prepared small intestines of the ox. The tilled casings are twisted into lengths of about six inches each and are now saveloys. They are cooked by being slowly boiled in water for twenty minutes. They are flavoured by being smoked in a smoke room or by adding " smokine " fluid to the water in which they are boiled. Saveloys and black puddings and the processes of their manufacture are made the subjects of frequent and thorough inspection in Finsbury. They are prepared and sold by the following pork butchers in the borough:— Mr. A. Robinson, 30, Chapel Street. Mr. C. Goebbles, 93, Chapel Street. Messrs. Barnett and Co., 29 Exmouth Street. Mr. C. Smith, 55, Exmouth Street. Mr. G. Sauer, 229, Goswell Road. Messrs. Lemming and Co., 138, St. John Street. Mr. R. Firmin, 141, Whitecross Street. Mr H. C. Trautman, 152, Whitecross Street. Mr. J, Ching, 93, Central Street. Mr. A. Edfe, 28, Bath Street. Mr. G. Goerl, 92, Ironmonger Row. MILK SUPPLY. There are in Finsbury only two sets of premises licensed for cowkeeping. The addresses are annexed. Name of Occupier. Situation of Premises. Actual No. of Cows. Licensed for. Mr. Harry Eade 40, Rawstorne Street 15 15 Mr. J. H. Jenkins 230, St John Street 30 30 The premises were inspected by the district inspectors on 3 occasions. They are also periodically inspected by the London County Council staff and their veterinary inspector. One notice for cleansing was served in 1914. 117 Dairies and Milkshops.—The number of persons registered during the year as purveyors of milk was 23. Of these 4 were new applications, 19 were on the transfer of the business. The number left on the register was 257, and includes 184 owners of milkshops as distinguished from dairies and restaurants, selling milk in driblets, for a farthing or a halfpenny at a time, in this way disposing of three or four quarts a day. These milkshops, which are also small general or grocery shops, were inspected on 189 occasions, and 22 notices were served for various sanitary defects. The procedure, the limitations, and conditions precedent to registration have been fully described in previous reports. Each applicant fills in a form dealing with the following matters:— 1. Name and private address of the applicant. 2. The address of the milk shop. 3. The names and addresses of the wholesale firms who supply the applicant with milk. 4. The place of storage for the milk, the kind of vessel used, and the kind of cover. 5. Any other trade conducted on the premises. 6. A list of any offensive materials sold or stored on the premises. 7. The average amount of milk sold or to be sold per day. Each applicant is supplied with printed copies of the regulations made by the London County Council as to Dairies, Cowsheds and Milkshops; the Milk and Sale of Eood Clauses, Sections 5, and 8 of the London County Council (General Powers) Act, 1908; and Extracts from the Dairies, Cowsheds and Milkshops Orders of 1885, 1886, and 1899 referring to the milk from diseased cows. It is found that most of the small shops, in addition to selling milk also sell commodities which are liable to contaminate the milk or are relatively offensive, such as oil, matches, soap, bath brick, coal, coke, candles, pickles, fish, furniture polish, vinegar, firewood, or boot blacking. A few shops sell paraffin. It is, however, not allowed to be sold from the same counter or from the same room as that from which the milk is sold. It must not be sold from any plaoe in or near that in which the milk is stored. 118 The sale of paraffin oil or other material from the premises is not objected to provided the oil is stored and sold outside the shop. Thirty per cent. of the applicants were illiterate. The following table compares the milk vigilance of Finsbury with that of the other London boroughs:— MILK SAMPLES, 1913. Borough No. of Samples. No. Adulterated. Percentage. Battersea 637 40 6.2 Bermondsey 629 67 10.6 Bethnal Green 505 54 10.6 Camberwell 445 23 5.1 Chelsea 163 9 5.5 Deptford 304 17 5.5 Finsbury 360 26 7.2 Fulham 435 21 4.6 Greenwich 176 11 6.2 Hackney 547 50 9.1 Hammersmith 311 25 8.0 Hampstead 256 13 5.0 Holborn 225 14 6.2 Islington 600 45 7.5 Kensington 269 6 2.2 Lambeth 492 50 10.0 Lewisham 329 28 8.5 London (City of) 398 13 3.2 Paddington 259 30 11.5 Poplar 188 25 13.2 St. Marylebone 536 37 6.9 St. Pancras 396 45 11.8 Shoreditch 500 114 22.8 Southwark 668 57 8.5 Stepney 998 122 12.2 Stoke Newington 65 3 4.6 Wandsworth 795 76 9.5 Westminster (City of) 922 81 8.7 Woolwich 313 24 7.6 Whole of London 12,720 1,128 8.8 119 It will be noticed thai with regard to the percentage of adulteration estimated on the whole number of milk samples in each borough, Finsbury is seventeenth on the list. The boroughs which precede it and their corresponding adulteration percentages are : Shoreditch (22.8), Poplar (13.2), Stepney (12.2), Paddington (11.5), St. Pancras (11.3), Bermondsey (10.6), Bethnal Green (10.6), Lambeth (10.0), Wandsworth (9.5), Hackney (9.1), Westminster (8.7), Lewisham (8.5), Southwark (8.5), Hammersmith (8.0), Woolwich (7.6), and Islington (7.5). The percentage in Finsbury was 7.2. Milk Samples and Analyses.—The total number of milk samples taken in 1914 was 344, of which 29 or 8.4 per cent. were found to be adulterated on the standard adopted by the Board of Agriculture—that is not less than 8.5 per cent. of non-fatty solids, and not less than 3 per cent. of fat. No preservatives were found in any of the samples. 120 The following table gives the statistics for the last 10 years:- ANALYSES OF MILK SAMPLES, 1905-1914. No. of Samples Analysed. No. of Samples Adulterated. Percentage of Adulterated Samples. Added Water. Percentage of Watered Milks in Samples Analysed. Removal of Fat. Percentage of Milks with fat removed on Samples Analysed. Under 5% 5% or over. 10% or over. 15% or over. 20% or over. Under 5% 5% or over. 10% or over. 15% or over. 20% or over. 1905 849 38* 10.9 16 I 1 — 1 5.4 7 8 1 1 1 5.1 1906 377 51* 13.5 10 n 1 2 — 6.3 9 8 1 — 1 5.0 1907 329 38* 11.5 7 4 4 — — 4.5 5 9 4 — 2 6.0 1908 365 32 8.7 11 2 1 1 1 3.6 7 5 2 1 1 4.3 1909 365 33 9.0 6 2 2 — — 2.7 7 8 1 2 3 5.7 1910 362 38 10.8 5 3 4 1 — 3.7 2 16 5 1 1 7.1 1911 373 43 11.5 4 12 - 1 - 4.6 8 7 7 2 2 6.9 1912 370 28* 7.5 2 3 1 — - 1.6 8 5 7 — 1 5.6 1913 360 26 7.2 6 3 2 2 0 3.6 7 3 0 1 2 3.6 1914 344 29 8.4 3 - 2 — - 1.4 9 5 5 5 — 6.9 *These figures include samples of milk which were adulterated with preservatives. 121 Sale of Food and Drugs Acts —In Finsbury 500 food samples are taken for analysis each year, and, in addition, 100 samples of milk are taken in the evening-, or on Sundays at irregular and unusual hours. A rota is arranged at the beginning of the year, but each inspector may also take samples at his own discretion. All the shops in the Borough are sampled from time to time—no exception is made. In 1914, 596 samples were taken under the Sale of Food and Drugs Acts, two samples under the Milk and Cream Regulations, and two informal samples. The tables given below show the number and nature of the samples collected and the number adulterated in each case. Substance. Samples taken. Adulterated. Substance. Samples taken. Adulterated. Milk 344 29 Pepper 7 0 Butter 124 3 Flour 6 0 Cocoa 19 1 Tea 5 0 Vinegar 19 0 Lard 4 0 Coffee 12 0 Cheese 3 0 Sugar 12 0 Rice 2 0 Margarine 10 0 Dripping 1 0 Bread 10 0 Olive Oil 1 0 Jam 9 0 Mustard 8 0 Total 596 33 122 The statistics for previous years are subjoined:— Year. Total Examined. Genuine. Adulterated. Percentage of adulterated samples. Percentage of adulterated samples for tin whole of London. 1901 501 413 88 17.56 II.4 1902 556 475 81 14.56 11.9 1903 610 524 86 14.10 10.8 1904 610 537 73 11.96 10.2 1905 620 547 73 11.77 10.2 1906 602 527 75 12.42 12.1 1907 603 551 52 8.62 10.0 1908 601 547 54 8.94 9 .9 1909 600 553 47 7.83 7.8 1910 600 541 59 9.83 8.5 1911 600 549 51 8.50 9.3 1912 601 567 34 5.65 8.8 1913 601 570 31 5.1 9.1 1914 596 563 33 55 — Two informal samples of butter were taken not under the Sale of Food and Drugs Acts. They were both genuine. Wrapping Paper Enquiry.- In 1914, an enquiry was made into the source, condition, and cleanliness of the paper used for wrapping around articles of food sold for immediate consumption, or for consumption without prior cooking or washing. The investigation was made in shops in the slums, and in street stalls in Clerkenwell and St. Luke's. The shops and stalls at which enquiries were made included the following: general shops, fried fish shops, chemists' shops, ham and beef shops, dairies, bakers' shops, dining rooms, grocers' shops, and shops and stalls for the sale of salt or sweets. The articles bought were cake, bread, sweets, fried fish, chip potatoes, table salt, vaseline, saveloys, ham, beef, meat pies, pastries, cheese, biscuits, hot fruit and meat 123 puddings, bread and butter and peas pudding. The paper for wrapping was found to consist of newspapers, newspaper posters, pages from magazines and periodicals, advertisement handbills, old time-tables, and old directories. In a few instances the paper was found to be faded, fly-marked, greasy, or dirty. In dining rooms it is common to use the daily newspapers which are brought in to read by customers and afterwards discarded. In very few cases, the paper in bulk was found to be dusty and much worn. In one shop the outer sheets of the bundles were much mudstained. The paper was usually stored under the shop counter, occasionally in the living room, on a shelf in the kitchen, in a cupboard under the stairs, or on a landing which in one house adjoined an open W.C. door. In one shop the paper was kept on the floor under the counter and was weighted down by old mildpwed boots. In a few shops the storage place was very dusty, in two shops dirty. In market streets the paper may be stored in boxes under the stalls. These boxes were usually clean. The paper was obtained or purchased from private houses, printing establishments, office cleaners, proprietors of patent medicines, coffee shops, public houses, auction rooms, newspaper shops, or was left in dining rooms by customers. The newspapers used were some of them 11 years old—the majority were a few months old. The proprietors of fried fish shops buy their paper from a special dealer well known to the trade. For the sale of sweets, small paper bags are in general use: they are very cheap and cost 4d. or 6d. per 1,000. In ham and beef shops the meat was placed in grease-proof paper prior to enclosing it in an outer wrapping. One shopkeeper advertised his shortage of paper in the shop window and was thus able to renew his supply by buying from neighbouring householders. It was found, however, that enquiries are not usually made by such buyers as to the existence of illness in the houses from which paper is obtained, though it was sometimes stated that the proprietors of the shops had a personal knowledge of the households concerned, and it was not considered necessary to make such enquiries. 124 Three shopkeepers stated that they had refused to buy paper because the material offered was fouled. Generally, the paper actually in use was found to be clean, so that the result of the enquiry, on the whole, was satisfactory. Milk and Cream Regulation.—Two samples of cream were submitted to the Public Analyst under the Milk and Cream Regulations with the following results:— 1. Preserved cream.—Fat, 47 per cent. Boric acid, 0.149 per cent. 2. Fresh cream.—Fat, 43 per cent. No preservative. No preservatives were found in the 344 samples of milk. Ice Cream Shops.—These are all periodically inspected. At the end of 1914, there were on the register the names and addresses of the proprietors of 100 shops in the borough. They were inspected on 120 occasions, and as a result 36 notices were served for sanitary and other defects. There were no prosecutions. The itinerant ice-cream vendors are probably the filthiest tradesmen in London. Their ice cream is, or may be, made in the gutter, and the stain of its place of origin adheres to it throughout its existence. The use of the small conical glasses which are mouthed and sucked by children is most undesirable. For cleaning, they are dipped into dirty water which contains the mouth secretions of previous buyers, swabbed with a small wet offensive duster and upended on a soiled barrow-top. One itinerant attempted to improve upon this method by immersing his right thumb into the same nauseous water and rubbing it vigorously on the inside of the glass : he used no duster. Another was giving the final polish to his glasses by rubbing them inside and outside with his handkerchief into which he blew his nose. Still another cleaned out the form in which he made icecream sandwiches by licking it with his tongue. Restaurants.—There are 202 restaurants in the borough. They are regularly inspected. In 1914 the number of notices served was 61, the number of inspections 226. These premises are not included in the sum total of workplaces given on another page. 125 Wholesale Margarine Dealers and Butter facturers.—At the end of the year there were on the register 21 wholesale dealers in margarine and 4 butter manufacturers. One hundred and twenty-four samples of butter were taken for analysis and three were found to be adulterated. Ten samples of margarine were obtained, all genuine. Bakehouses.-The total number of bakehouses in actual use in the borough is 57—of which 23 are above ground, and 34 below ground. All the bakehouses are periodically inspected. In 1914, the number of visits paid was 138. Notices for cleansing and dilapidations were issued in 27 instances. These were all complied with. HOUSING. The number of habitable houses in the borough on March 31st, 1914, was 7,545. Of this number, 1,667 were let in two or more habitable hereditaments. The number of small separate occupations was 10,315. In this calculation are included 51 blocks of artisans' dwellings, containing 4,424 separate occupations. Each block is regarded as one house. The houses of gross annual value of £40 or under numbered 4,369. The lettings in tenement houses are not separately rateable. It may be taken that the whole of the separate occupations given above, 10,315, are under £40 gross annual value. Mitre Court.—In 1914, the four houses—1, 2, 3, 4, Mitre Court—were separately represented by the Medical Officer of Health as being unfit for human habitation. The Borough Council made closing orders in respect of these houses on April 2nd, 1914. They were subsequently demolished. The Medical Officer of Health issued a report on the property to the Council, which dealt with the following matters:— 1. The site and location. 2. A general description of the property, of its approach, and of the surrounding premises. 3. The families and occupants of each house. The number of adults and children. 126 4 The freeholders and leaseholders. 5. The notifications of infectious disease during the ceding five years. 6. The deaths and general death rates for five years. 7 The phthisis notifications and deaths for five years. 8. The infant mortality rates for five years. 9. The sanitary notices issued in respect of the property for five years. 10. The drainage and water closet accommodation. 11. The water supply. 12. The disposal of house refuse. 13. The provision of washhouses. 14. The houses as obstructed and obstructing dwellings. The absence of through ventilation. 15. The eaves, gutters, down spouts, and roofs. 16. The walls and woodwork. 17. The basements. 18. A fully detailed report upon each house, room by room. The houses were condemned chiefly for the following reasons— The houses were obstructed in respect of light and ventilation. There was an absence of through ventilation. The rooms were low or dark. There were no washhouses. There were no separate cupboards for food storage. Some of the rooms had insufficient window area. The approach to the court was by means of a narrow passage 30 yards long, whose width ranged from 3 ft. 10 ins. to 4 ft. 8 ins. There were four houses containing 15 rooms, occupied by 14 families, consisting of 34 adults and children over 10 years, and 9 children under 10 years. The average death rate for the preceding five years had been 31 per 1,000. Registered Houses let in Lodgings.-No fresh houses were placed on the register in 1914. The number on the register at the end of the year was 1,164. 127 From time to time registered houses are converted into factories, workshops, warehouses, or offices; some are demolished, rebuilt, and used for purposes of storage. For these and for many other reasons, such registered houses, being no longer occupied as dwelling houses are temporarily, at all events, no longer subject to the operation of the bye-laws. For the purpose of cleansing, 895 intimation notices and 487 statutory notices were served. For overcrowding there were 38 notices. The number of visits paid was 8,802. There were three prosecutions for failing to cleanse within a reasonable period after notice served. Common Lodging Houses—The common lodging houses in the Borough are given in the following table:— Address. Registered Owner Registered Number of Occupants. Average Attendance. Banner Street, 6 Rev. Preb. Carlile 140 105 Clerkenwell Green, 35 Mrs. J. M. Claytor 73 34 Mary Curzon Hostel, 164-170, King's Cross Road Duchess of Marlborough 56 45 Old Street, 97 Mr. W. H. Hatch 80 62 Pentonville Road, 19-23 Mrs. Shuttleworth 93 55 White Lion Street, 57 Mr. Shuttleworth 98 70 Totals 540 371 The Mary Curzon Hostel is for the reception of women only, and was opened on October 6th, 1913. The common lodging houses in the metropolis are administered by the London County Council, and are licensed annually at a special meeting held in June of each year. Systematic House to House Inspection.—The details of the work done under the Housing (Inspection of District) Regulations, 1910, are indicated briefly in the subjoined table:— 128 SYSTEMATIC HOUSE TO HOUSE INSPECTION, 1914. Street, Place, or Buildings. No. of houses inspected. No. of houses in which defects were found. Percentage of houses with defects to houses inspected. Families occupying. Number of rooms. Total. Occupied. Empty. Overcrowded. Allen Street 6 4 66.6 12 31 31 0 C Baker's Row 29 14 48.2 80 149 137 12 0 Bath Court 3 1 33.3 5 12 12 0 0 Benjamin Street 9 2 22.2 44 71 71 0 0 Berkley Street 9 1 11.1 36 68 57 11 0 Brewer's Buildings 44 1 2.2 44 120 120 0 0 Brunswick Close 25 3 I2.0 41 118 118 0 0 Caroline Place 3 0 .0 3 6 6 0 0 Central Street 11 5 45.4 14 39 39 0 0 Chapel Street 97 41 42.2 116 505 429 76 0 Clerkenwell Close 5 5 100.0 14 40 28 12 0 City Mansions 5 1 20.0 5 20 20 0 0 Compton Passage 4 1 25.0 4 17 15 2 0 Compton Street 18 9 50.0 39 97 88 9 1 Corporation Row 8 6 75.0 8 24 24 0 0 Crawford Passage 4 4 100. 0 12 22 20 2 0 Dingley Road I 0 .0 3 4 4 0 0 Donegal Street 29 20 68.9 92 214 189 25 3 Dundee Buildings . 19 2 10.5 20 40 40 0 0 Eagle Court 7 3 42.8 9 30 23 7 0 Eagle Dwellings 10 1 10.0 10 33 33 0 0 East Place 10 8 80 .0 16 46 46 0 0 Exmouth Street 43 15 34.8 58 248 235 13 0 Frederick's Row 4 4 100.0 6 16 16 0 0 Glasshouse Chambers 10 0 .0 10 33 33 0 0 Godson Street 13 3 23.0 49 114 101 13 0 Hallett's Place 11 4 36.3 17 44 44 0 1 Howard Buildings 1 1 100.0 1 2 2 0 0 Kemp Place 4 0 .0 4 8 8 0 0 Lewin's Court 7 4 57.1 15 31 31 0 0 Leicester Place 1 1 100.0 5 12 12 0 0 Little Sutton Street Bldgs. 18 3 16.6 18 34 34 0 0 Macclesfield Place 9 3 33.3 9 26 26 0 0 Market Buildings 15 0 .0 13 16 14 2 0 Mason's Place 19 11 57.8 19 38 38 0 0 Merlin's Place 19 5 26.3 35 93 85 8 0 Mitchell Street 19 4 21.0 63 127 127 0 0 Murton Street 10 3 30.0 32 75 74 1 0 Northampton Street 36 5 138 93 236 218 18 0 Old Street 49 21 42.8 69 274 270 4 0 Paton Street 9 4 44.4 21 44 44 0 0 Peel Court 2 0 .0 2 4 4 0 0 Pickard Street 14 9 64.2 44 112 102 10 0 Rahere Street 59 25 42.3 171 408 396 12 0 129 Systematic House to House Inspection—continued. Street, Place, or Buildings. No. of houses inspected. No. of houses in which defects were found. Percentage of houses with defects to houses inspected Families occupying. Number of rooms. Total. Occupied. Empty. Over crowded. Rawstorne Street 42 7 16.6 103 281 272 9 0 Red Lion Street 18 13 72.2 76 171 146 25 0 St. James Street 11 6 54.5 45 85 85 0 1 St. John Street 40 12 30.0 69 238 226 12 0 Smithfield Buildings 15 0 .0 15 30 30 0 0 Spa Cottages 9 2 22.2 13 36 36 0 0 Stewart's Place 4 2 50.0 10 14 14 0 0 Union Pl., Clerkenwell CI. 2 0 .0 2 6 6 0 0 Valetta Street 12 2 16 .6 l6 49 49 0 0 Warden's Place 5 2 40.0 18 42 40 2 0 Warner Street 5 3 60.0 13 29 29 0 0 Waterloo Street 26 23 88.4 58 129 126 3 0 West Place 7 3 42. 8 17 31 25 6 0 White Conduit Street 19 10 52.6 32 110 99 11 0 Whitecross Street 70 24 34.2 89 381 373 8 0 Wynyatt Street 58 15 25.8 135 380 372 8 3 Totals 1,071 381 35.6 2,092 5,713 5,402 311 9 The numbers of houses inspected similarly in previous years were 1,476, 1,501, 1,447, 1,548, 2,250, 1,341, 806, 534, 789, 1,355, 888, 1,336, and 971 from 1901 to 1913 respectively. Crowding and Overcrowding.—During the year, 103 cases of overcrowding were discovered and abated—38 of these were in registered houses. Nine were detected as the result of systematic house-to-house inspection. The largest number of overcrowded tenements were in Risinghill Street (5), Goswell Road (4), Vineyard Walk (4), Albert Street (3), Donegal Street (3), Southampton Street (3), Mitre Court (3), Northampton Road (3), James Gardens (2), Winchester Cottages (2), Lever Street (2), Amias Place (2), Gee Street (2), Hatfield Street (2), Peerless Street (2), Great Bath Street (2), Easton Street (2), Easton Place (2), Margaret Street (2), Sadler Street (2), and Baker's Row (2). In the area covered by systematic 130 house-to-house inspection 2,092 families occupied 5,402 rooms, or 2.57 rooms per family. Of the total number of rooms inspected 5.4 per cent. were empty. This shows that the crowding is not due to lack of available accommodation. It is difficult sometimes to appreciate the stress on room accommodation that is experienced in the poorer quarters of the borough. By way of illustration, the rooms, occupants, cubic space, and disposition for sleeping purposes are given below in a house in St. Luke's. Some sociological details are added by way of general interest. The house has three floors—ground floor, first and second floors, and accommodated two families on each floor, 30 occupants. Each family occupied a set of two rooms back and front, placed on the right and left of the common staircase. The combined rents amounted to 35s. per week. Ground Floor Right—Back and Front Rooms.—Occupied by the father, mother, boy 6, and girls 4 and 2 years. The family all slept in two beds in the back room. The weekly rent was 5s. 6d. The father was a carman earning 25s. a week and a reservist. He rejoined his regiment on the outbreak of war. Ground Floor Left—Back and Front Rooms.—Occupied by the father, mother, boy 6, girls 5 and 2 years. All slept in one bed in the back room. The weekly rent was 6s. The father worked for a gas company and earned 30s. a week. He enlisted at the commencement of the war. First Floor Right—Back and Front Rooms.—Occupied by the father, mother, daughter 40 years, and son 25 years. The weekly rent was 6s. The mother and daughter slept in the front room; the father and son slept in the back room. The father was a road sweeper earning 28s. a week. The son was an odd man who swept the roads occasionally. The daughter was a cardboard box maker earning 12s. a week. 131 First Floor Left—Back and Front Rooms.—Occupied by the father, mother, sons 24, 20, 18, 14, and daughters 12 and 9 years. The weekly rent was 6s. The front room was used as a living room for all the family and was occupied at night by the parents and the two girls. There were two beds—one was made up on the floor. The room contained 1,092 cubic feet and was overcrowded. The back room contained one double bed occupied by the four sons for sleeping purposes. Its cubic capacity was only 704 cubic feet, so that it was overcrowded. The father was an "odd man," but had not done any work for nine months. The mother was an office cleaner at 3s. a week. The three elder sons were porters earning from 12s. to 20s. a week, and all enlisted. The youngest son was an errand boy at 5s. a week. It will be noted that although both the rooms were overcrowded, the family could well afford to take extra accommodation. It is not an uncommon experience to find that cases of overcrowding may be associated with a comparatively high total family income. Second Floor Right—Front and Back Rooms.-Occupied by the father, mother, boys 10, 9, 1, and girls 7 and 4 years. The weekly rent was 5s. 6d. but had not been paid for four months. The front room, containing 617 cubic feet, was used as a living room for the whole family, and was occupied at night by the father, mother and baby. It was overcrowded. The back room contained one bed occupied at night by the boys 10, 9, and the girls 7 and 4 years. The father was a loafer, and was said "to do odd jobs when it suited him." The mother sold matches and begged in the streets, taking the youngest child out with her. To these practices the other tenants strenuously objected, alleging that they brought discredit upon the fair name of the house, and with such effect that the father, thoroughly ashamed of himself, enlisted, and the mother moved elsewhere. Second Floor Left.—Both rooms were occupied by one male adult. The weekly rent was 6s. It is worthy of comment that from this one house, six persons enlisted during the early months of the war. 132 From time to time, cases of indecent occupation or of sex promiscuity are brought to the notice of the department. The following are examples :— 1. The family consisted of the parents, girls 19 and 9, boys 6, 5 years and the baby 9 months. They all occupied one room for living and sleeping. 2. The family consisted of the parents, sons 19, 10, and daughters 18, 15, 12, 7 and 5 years. They rented two rooms. In the front room, cubic capacity 1,086 cubic feet, slept the parents and the three younger girls in one double bed. In the back room, cubic capacity 613 cubic feet, the sons 19 and 10 years, slept in a single bed, while the daughters, 18 and 15 years, slept on the floor. 3. The family consisted of the father and his 2 daughters, aged 23 and 15 years. They occupied one basement room only. There was a bedstead, but it had no laths or bedclothes. The three were said to sleep on the floor on coats and discarded clothing. 4. The family consisted of the parents, sons 24, 20, 18, 12, and daughters 22 and 14 years. They occupied two rooms each containing one bed. The parents slept in a bed in one room, while the daughters slept in the same room on the floor. The sons slept in the other room. These cases of sex promiscuity are generally reported as cases of alleged overcrowding. As a rule, very little difficulty is experienced in effecting arrangements which make for decency and propriety, sometimes by a readjustment of the family for sleeping purposes, sometimes by the family renting an extra room elsewhere. Customs and Inland Revenue Acts, 1890 and 1903 — An application was received in respect of two contiguous dwelling houses, owned in common, and containing six tenements. The houses were carefully inspected, but no certificates were granted. The houses bad been brought down almost to ground level in 133 1913, and had been reconstructed in that and the following year. In three of the tenements the bedrooms had no fireplaces and were each ventilated by a small perforated grid, 9 inches by 6 inches, placed in a corner near the ceiling. One of these bedrooms is described below. It had no fireplace and no cupboard. Its length and breadth were 9 ft. 6 ins., and 7 ft. 6 ins. Its height was 8 ft. 9 ins. It contained a double bed, a baby's cot, one chair, and one small round table 2 ft. 6 ins. in diameter. The only loose space "in which they could turn round" was 4 ft. 3 ins. by 3 ft. The clothes of the mother and baby were placed at night on the table. The father hanged some of his clothes on the gas bracket, and put the rest on the bed. The washing basin was kept at night on the floor and was placed on the bed when the occupants desired to wash. The baby's clean clothes were hung from nails in the wall. The room was "ventilated" by a small grid, placed high up in a corner and communicated with the open air. The mother, who occupied the tenement, stated she had recently been confined, and complained that she had been unable to have a fire in her bedroom which was exceedingly stuffy and offensive a,t night time—so much so that she had to keep the bedroom door continuously open. It is astonishing that such houses may be constructed in Central London in these days, and still more surprising to find that they may be made the subjects of applications for exemption from inhabited house duty. For such applications have to be accompanied by certificates signed by the medical officer of health that the houses to which they refer are so constructed as to afford suitable accommodation for each of the families or persons dwelling therein, and that due provision is made for their sanitary requirements. The conditions attaching to the issue of these certificates have been set out at length in a former annual report. Vepminous Houses —When school children are found to be verminous in school by the London County Council medical officers in the course of their official inspections, the names and addresses of such children are sent to the Public Health Department. 134 Their homes are then visited by the sanitary inspectors, and notices for cleansing are served on the occupiers where the premises are dirty and verminous. The parents are offered steam disinfection for the verminous bedding and clothing, and sulphur fumigation for the rooms. The number of children notified in 1914 was 944. The number of homes found clean on the first visit was 87 per cent. This confirms the view that, while the presence of head lice or body lice discovered in school children may suggest the presence of bugs in the home, the association is not a close one. Of the rest, 106 tenements were dirty or verminous. Ninety of the addresses were inaccurate. In 44 cases the tenements were disinfected by the Borough Council. Of the 106 dirty or verminous homes, the walls and ceilings of all were dirty and verminous. The bedding in 85 homes was very much fouled, the bedding in 71 was very verminous. In 31 instances the bugs had invaded the wall picture frames. Underground Rooms.—In six instances underground rooms were found to be separately occupied in contravention of the provisions of the Public Health (London) Act, 1891, Section 96. Notices were served and the illegal occupations were discontinued. Stable Dwellings—The stable dwellings remaining in the Borough are given in the following list. They are all frequently inspected. 135 Premises. No. of Occupancies No. of Persons. Adults. Children. Total. 82, Bath Street 1 1 0 1 23A, Charterhouse Street 1 2 1 3 Claremont Mews 7 13 9 22 14, Clerkenwell Close 1 2 0 2 Davis'Yard 1 2 0 2 Garnault Mews 1 1 0 1 Holford Mews 3 8 1 9 Holford Yard 3 8 4 12 Jay's Buildings ...... 8 45 27 72 119, Lever Street .... 1 2 3 5 1, New Court, Peter's Lane 1 2 4 6 FACTORIES AND WORKSHOPS. The number of workshops and workplaces on the Register at the end of 1914 was 2,018 compared with 1,984 at the end of 1913. During the year under review 35 entries were removed from the register owing to the closing of premises, the conversion of workshops into factories, by the introduction of some formi of mechanical power or to the removal of the occupiers to other places of business. The number of workshops and workplaces newly registered was 69. The factories on the register at the end of 1914 numbered 1,072, compared with 1,064 at the end of 1913. During the year nine factories were removed from the register, 17 were added. There were still seven tenement factories on the register at the close of the year. The list included seven tenement factories in which there were separate occupiers carrying on different trades or processes and supplied with mechanical power by the owners of the premises. 136 The following paragraphs indicate the workshops, workplaces, and factories on the registers, and show the large variety of manufacturing processes which are carried on in Finsbury. Workshops and Workplaces.—Clocks and watches, 135; jewellery, 109; tailoring and clothing, 84; cabinet and furniture making and polishing, 74; engraving, embossing and chasing, 56; leather, leather goods and trunks, 55; furriers and skin dressers, 54; stabling, 52; provisions, bacon, grocery and food preparation, 46; forwarding goods, 46; building trades, 41; gold and silver workers and refiners, 40; boots and shoes, 38; mantles and costumes, 37; fancy goods and toys, 36; hats and caps, 36; cycles and motors, 32; drugs, chemicals, perfumery, and sundries, 32; underclothing, shirts, skirts, blouses and aprons, 31; picture frames, mouldings, and mounts, 30; millinery, 29; feather work, 28; iron and metal work, 27; marine store, rag, and paper waste, 24; firewood and coal dealers, 23; glasswork and glassware, 23; engineers and machinists, 23; laundries, 23; paper and cardboard, 22 ; boxmaking, 21; stick mounting and making, 21; gilding and plating, 21; barometers and thermometer, 20; basket, cane, bamboo and wickerwork, 20; farriers and smiths, 19; stationery and sundries, 19; ties and neckwear, 19; packing cases, 18; jewel and instrument cases, 18; artificial flowers, 18; ironmongery and hardware, 17; rubber and waterproof goods, 17; shopfitting and show cases, 17; woollen, linen and cotton goods, 16; book and card edge gilding, 15; upholstery, 14; brasswork, 14; optical goods, 13; ink, paint, oil, gum, colours and dyes, 13; timber, 11; coachbuilding and wheelwrights, 11; Christmas cards, postcards, and fine art publishers, 11; phonographs and automatic machines, 11; wirework, 11; brushes, 10; pianos, organs and musical instruments, 10; books and book material, 10; sports outfitters, 10; harness and saddling, 9 ; stamp die-cutting and sinking, 9; confectionery, 9; wines, spirits, and cordials, 9; wood, ivory, and bone carving and turning, 9; capper work, 8; tinplate work, 8; embroidery, lace and fancy needlework, 8; surgical instruments and goods, 7; electrical goods, 7; tailors' and drapers' dummies, 7; photographic goods, 7; signwriting and ticket writing, 6; lapidary work, 6; trucks and barrows, 6; enamelling and japanning, 6; scientific instruments, 6; pattern cards, 6; wood carving 137 and gilding, 6; umbrellas, 6; lamps, lanterns and stoves, 5; clothtrimming and sorting, 5; lithography and stereotyping, 5; cork goods, 5; scales and balances, 5; locksmiths, 5; bottle washing and stoppering, 5; gold blocking, 5; sign, facia, and letter makers, 5; agricultural and horticultural goods, 4; bedding and bedsteads, 4; asbestos work, 4; stone yards, 4; pipe making and mounting, 3; gloves, 3; glazier's diamonds, 3; saws, 3; machine ruling, 3; domestic machinery, 3; hair goods, 3; sponges, 3; undertakers, 3; linen collars and cuffs, 2: china and earthenware, 2; buttons, 2; knife-cleaning goods, 2; window cleaning, 2; carpet planning, 2; combs, 2; heelball making and wax refining, 2; bookbinding, 2; Plaster casts, 2; oil stoves, 2; fern drying and preserving, 2; tarpaulins and weather goods, 2; powder-puff making, 2; horse dealer, 2; milk utensil making, 2; and others, giving a total of 2,018. The summarised "other" workshops include the following manufactures, trades or occupations: children's underclothing, clean towel supply, wax figures, tobacco, typewriters, disinfectant manufacture, mosaic work, naturalist, ice-cream freezers, Christmas cracker maker, incubators, rope and twine, caterers, pipe importers, photo printing, artificial stone goods, pattern making (general), pipe case making, boot and shoe polish making, rule making, heraldic painting, envelope addressing and clerical work, lithographic stone merchant, wood paving, tile making, soap merchant, general machine dealer, electric wire maker, publishing, lever pallett making. Factories —Printing and stationery, 143; engineering and machinery, 88; shirts, skirts, blouses, ties and underclothing, 71; gilding, plating, and polishing, 50; jewellery and gold and silver work, 49; bookbinding, 38; box making and paper bag making, 32; stick making and mounting, 30; brass and copper work, 31; provisions, grocery, bacon, and food preparation, 25; glass and china work, 19; engraving and die-sinking, 18; ivory, wood, and bone turning, 16; ink, paint, gum, soap, polish, and varnish, 15; leather goods and bags, 15; iron and metal work, 14; pipe making and mounting, 14; brushes, 12; mantle making, 12; scientific and surgical instruments, 11; cabinet making, 11; clock, jewel, and instrument cases, 11; foundries, 11; lithography and stereotyping, 138 11; picture frames and mounting, 11; paper and cardboard, 10; cycles and motors, 10; shop fitting, 10; cigars, cigarettes and tobacco, 10; optical goods, 10; surgical goods, 9; vanwork and wheelwrights, 9; drugs and drysalting. 9; art publishing and Christmas cards, 8; beer and spirits, 8; packing cases, 8; clocks and watches, 8; confectionery and cocoa, 8; joinery and saw mills, 8; cutlery, 7; wirework, 6; sports goods, 6; cold storage, 6; rubber goods, 6; boots and shoes, 6; art needlework and embroidery, 5; infants' clothing, 5; laundries, 5; linen collars, 5; buttons and studs, 4; mineral waters, 4; glaziers' diamonds, 4; barometers and hydrometers, 4; cloth shrinker and waterproofer, 4; artificial flowers, 3; builders and the supply of builders' sundries, 3; phonographs and records, 3; pattern cards, 3; upholstery, 3; lamps, 3; clock cases, 3; silk work, 3; gold blocking, 3; saw making, and piercing, 2; horse hair, 2; feathers and bedding, 2; cork goods, 2; vulcanised fibre, 2; electrotyping, umbrellas, 2; smiths and farriers, 2; tea packing, 2; scale making, 2; electrical goods, 2; dairy utensils, 2; spice grinding, 2; piano and organ key making, 2; model and pattern maker, 2; forage stores, 2; waste paper sorting and rag sorting, 2; combs, 2; woodwork, 2; and 47 other trades, making a total of 1,072. The "other'' trades in the above summary include the following: whips, contractors, pianos and musical instruments, marble work, furniture, electricity generating station; fur and skin dyeing, bamboo work, murac, flooring, carpet planning, petrol purification, shipping agents, dyers, clean towel supply, fountain pen making, tar felting, screen and panel painting, silica manufacture, pearl and tortoise shell work, hydraulic pumping station, bakery, tailors' and drapers' models, horn workers, easel making, woollen clothing, tape making, spring making, saw sharpening, draughtsman, rouge manufacture, galvanizers, machine ruling, metal mills, photographic goods, tailor, office machinery, domestic machinery, pen and pencil making, the making of bottle stoppers, suspenders and hair pins, fibre trunks, patent signs, wood and hardware, ferns and flowers, and furriers. The persons employed in the factories in Finsbury are approximately: males, 21,190; females, 18,121; in the workshops: males, 12,187; and females, 7,619. These numbers exclude the office hands and clerical staff. 139 During the year 179 first visits and 374 revisits were made by the Council's Inspector to Factories, and 383 first visits and 634 revisits to workshops and workplaces. A summary of the defects found is appended :— Summary of Defects and Defaults in Factories, Work shops and Workplaces for which Notices were servec during 1914. Factories Work. shops. Work. places. Totals. Dirty workshops and workplaces ... 69 6 75 Damp and dilapidated premises 1 10 1 12 Dirty passages and staircases 4 13 ... 17 Overcrowding of workshops ... 2 ... 2 Insufficient ventilation 1 11 ... 12 Water supply leaking or inadequate 2 6 1 9 Sanitary conveniences, dirty 66 71 13 150 Sanitary conveniences, defective 38 41 13 92 Insufficient sanitary conveniences 3 ... ... 3 Improper use of sanitary conveniences by both sexes 3 5 4 12 Yards dirty, and paving worn 7 18 2 26 Storage cisterns dirty or defective 6 11 ... 17 Accumulations of refuse 7 11 2 20 Dustbins, defective or absent 15 20 2 37 Drainage defective or choked 10 9 2 21 Rain-water pipes choked or broken 5 9 1 15 Absence of guttering or guttering choked 3 7 ... 10 Waste pipes defective 1 3 1 5 Roofs leaking 12 20 1 33 Urinals defective or dirty 7 5 2 14 Sinks defective or choked 7 1 ... 8 Non-removal of manure ... ... ... 1 Floors broken or dirty 4 9 ... 13 Nuisances from the emission of black smoke 5 1 ... 6 Totals 207 352 50 609 In connection with these defects 427 intimation notices and 44 statutory notices were served. 140 Infectious Disease —Notices were received of the occurrence of 23 cases of infectious disease in the homes of workers in Finsbury and resident in other districts. These cases were enquired into and suitable precautions taken. The Home Office—Seventy-six notices of occupation were received from the Home Office during the year, and 37 notices of complaint relating to the following matters: sanitary conveniences, 17; dirty premises, 16; insufficient ventilation, 1. The notices sent to the Home Office were as follows: Abstract of the Factory and Workshops Act not affixed, 15; the workshop abstract exhibited in a factory, or the factory abstract exhibited in a workshop, 3; insufficient means of heating, 1; dirty walls, 8; insufficient ventilation, 3; want of proper drainage to factory floor, one notice. One notice was sent to the London County Council referring to inadequate means of escape from fire in a factory. Prosecutions—There was one prosecution: for emitting black smoke from a factory boiler shaft. The defendants were fined £2 and 2s. costs. 141 The following matters are presented in the form required by the Home Office:— Inspection of Factories, Workshops and Workplaces. Premises. Inspections. Written Notices. Prosecutions Factories (Including Factory Laundries.) 604 104 None. Workshops (Including Workshop Laundries ) 910 180 Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 220 31 Total 1,734 315 Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects. Number of Prosecutions. Found Remedied Referred to H.M. Inspector. Nuisances under the Public Health Acts.— Want of cleanliness 146 146 .. None. Want of ventilation 15 15 .. Overcrowding 2 2 .. Want of drainage of floors 1 1 .. Other nuisances 189 185 .. Sanitary accommodation} Insufficient. 1 1 .. Unsuitable or defective 184 184 .. Not separate for sexes 30 30 .. Offences under the Factory and Workshop Acts— Illegal occupation of underground bakehouse (S. 101) •• • • •• Breach of special sanitary requirements for bakehouses (SS. 97 to 100) .. .. • • Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) 14 .. 14 Total 582 564 14 142 143 HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists, Outworkers. Lists. Outworkers. Contractors Workmen. Contractors Workmen. Wearing Apparel— Circular letters and forms are sent to all employers twice yearly when the lists are nearly due. None. None. None. None. None. None. None. (1) making, &c. 180 192 3040 24 9 314 2 (2) cleaning and washing .. .. .. .. .. .. 3 Household linen .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. Curtains & furniture hangings .. .. .. .. .. .. .. Furniture and upholstery .. .. .. .. .. .. 1 Electro-plate 6 3 21 1 1 .. .. File making .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. Fur pulling .. .. .. .. .. .. .. Cables and chains .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. Umbrellas, &c. 4 .. 31 1 .. 4 1 Artificial flowers 2 .. 22 3 2 19 2 Nets, other than wire nets .. .. .. .. .. .. .. Tents .. .. .. .. .. .. .. Sacks .. .. .. .. .. .. .. Racquet and tennis balls .. .. .. .. .. .. .. Paper, etc., boxes, paper bags 24 .. 334 4 .. 56 2 Brush making 10 2 95 1 .. 1 .. Pea picking .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. Stuffed toys .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. Chocolates and sweetmeats .. .. .. .. .. .. .. Cosaques, Christmas crackers, .. .. .. .. .. .. .. Christmas stockings, &c. .. .. .. .. .. .. .. Textile weaving .. .. .. .. .. .. .. Total 226 197 3543 34 12 394 .. .. .. .. .. .. 11 .. .. 144 OTHER MATTERS. Matters notified to H. M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 17 Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H. M. Inspector 36 Reports (of action taken) sent to H. M. Inspector 36 Other 15 Underground Bakehouses (s. 101):— In use at the end of the year 34 Canal Boats Acts, 1877 to 1884.—During the year the total number of boats inspected was 111, of which 7 were carrying offensive cargoes. The Acts and Regulations were contravened in three instances, and for these Complaint Notes were sent to the owners requiring abatement within a specified time. The infringements were in respect of the followng matters :— 1. Absence of Certificate. 2. Cleanliness, dilapidations, painting and absence of ficate. 3. Dilapidations. These were remedied, and it was not found necessary to take legal proceedings. The following table gives statistics relating to the inspection of boats for the past 5 years :— Year. Boats inspected. Persons found on Boats. Totals. Registered for. Men. Women. Children. 1910 112 299 29 36 364 413 1911 106 270 39 50 359 377 1912 100 249 28 41 318 363 1913 119 284 35 42 361 436 I914 111 259 29 53 341 395 145 Of the 111 boats inspected 81 were occupied by men only, 7 by men and women, and 23 by men, women and children. The children accompanying their parents on the boats appeared to be well cared for. No case of infectious disease was notified or discovered in the canal boats, therefore isolation of patients and detention of boats have not been necessary. The inspection of canal boats is part of the duty of the sanitary inspector whose district includes that portion of the borough in which the canal is situated. This year the duties were carried out by Inspector Norman. There is no separate remuneration for this work. Black Smoke.—During the year 192 black smoke observations were made by the district and workshop inspectors. In 18 cases the black smoke was emitted for three minutes or longer, and, in respect of these, cautionary letters and notices calling upon the occupiers to prevent the recurrence of the black smoke were issued. Summary proceedings for the abatement are taken under Section 24 of the Public Health (London) Act, 1891. Where the black smoke lasted less than three minutes no action was taken. There was one prosecution. The defendants were fined £2 and 2s. costs. The Mortuary —The municipal mortuary is at 47, Northampton Road, Clerken.well. There are on the same premises a disinfecting station and a coroner's court. The returns for the year were: inquest cases, 103; bodies of persons removed after death from infectious diseases, 8; bodies deposited in the mortuary from one-roomed or two-roomed tenements owing to insufficient accommodation at home for the retention of the bodies 3; bodies brought to the mortuary for the convenience of relatives, 244. The number of post-mortem examinations was 81. The Shelter—The Council's shelter is situated at 47, Northampton Road, Clerkenwell, in connection with the Disinfecting 146 Station. In 1914, 2 families, 6 persons in all, availed themselves of its accommodation while their rooms were being disinfected after the occurrence of infectious disease. Offensive Trades—In Finsburv there is only one registered offensive trade—Mr. Joseph L. Henson, Tripe Dresser, 137, Whitecross Street. This was inspected on 10 occasions in 1914. It was not found necessary to serve any notice for sanitary defects. Fat melting is apparently becoming more prevalent in Finsbury. Nearly all the butchers melt small quantities. Two butchers are believed to melt large quantities. On one occasion, 2 cwts. of recently-melted fat were seen on the premises of one of these tradesmen, and the workman engaged stated that his employer melted about one ton of fat each week. In 1914, a petition was received in respect of the offensive trades of gut sorting, gut testing, and the trimming of fat from bladders "in the rough," conducted in a shop in a main street of the borough. The smell was exceedingly offensive and was much objected to by tradesmen and residents in the neighbourhood of the premises. After negotiation, the business was eventually transferred elsewhere. During the year, byelaws were issued by the London County Council in respect of the business of a vendor of fried fish and the trade of fish curing. Staff of the Public Health Department.—The Staff consists of :— A Chief Sanitary Inspector, five District Sanitary Inspectors, a special Meat Inspector, a special Factory and Workshop Inspector, one Lady Sanitary Inspector, two Lady Health Visitors, one Chief Clerk, and two Clerks. In addition there are two Disinfectors, one Van Driver, who may assist with disinfection, and a Keeper of the Mortuary and Coroner's Court. The Mortuary Keeper works the steam disinfector, and his wife attends to those who are temporarily housed in the Council's shelter. The following table summarises the work done during 1914 by the Sanitary Inspectors:- 147 WORK OF THE SANITARY INSPECTORS, 1914. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Thick. Inspector Morgan. Totals. Houses damp, dirty or dilapidated remedied 251 166 161 41 236 855 Doors, windows, floors, walls, ceilings, sash cords repaired 154 111 58 96 67 486 Overcrowding cases abated in other than Registered Houses 17 3 7 7 31 65 Illegal occupation of underground rooms 3 3 0 0 0 6 Water closet defects remedied 337 205 249 215 269 1275 Water closets erected 15 19 103 20 5 162 Urinal defects remedied 3 3 21 1 3 31 Urinals erected 0 1 13 0 0 14 Soii pipe and ventilating shaft defects remedied 11 1 20 3 2 37 Soil pipe and ventilating shafts erected 7 5 23 5 1 41 Yard defects remedied 117 99 74 64 55 409 Waste pipe defects remedied 34 15 26 5 21 101 Waste pipes erected 8 7 41 4 0 60 Water cistern defects remedied 34 19 21 9 43 126 Accumulations of rubbish or manure removed 33 19 10 32 39 133 Dung or Dust receptacles repaired or renewed 78 40 40 54 101 313 Drains relaid or amended 59 20 40 13 12 144 Drains cleared 60 60 73 3° 142 365 Rain water pipes cleared, repaired, or renewed 17 13 34 17 17 98 Water supply to houses re-instated 1 0 0 1 16 18 Roofs and Gutters repaired 65 87 81 43 28 304 Area defects remedied 6 14 9 9 8 46 Washhouse defects remedied 81 62 50 37 28 258 Animal Nuisances abated 7 1 1 2 4 15 Floor space unventilated 1 3 0 0 0 4 Stables cleansed or repaired 1 0 2 0 0 3 Smoke observations 5 13 32 11 30 91 Water Supply laid on to upper storeys of house 0 8 2 1 0 11 Miscellaneous Nuisances abated 26 33 7 25 55 146 Drains tested 191 135 116 38 65 545 Bakehouses—inspections 28 59 24 9 18 138 Bakehouses cleansed or repaired 6 6 7 7 1 27 Restaurants-No. of inspections 26 50 93 32 25 226 Restaurants cleansed or repaired 7 8 29 10 7 61 Milkshops—No. of inspections 40 43 55 23 28 189 Milkshops cleansed or repaired 3 6 8 1 4 22 Public Houses cleansed or repaired 3 4 15 1 0 23 Ice Cream Premises—No. of inspections 18 29 35 22 16 120 Ice Cream Manufactories cleansed or repaired 4 2 8 18 4 36 Butchers' shops cleansed or repaired 5 0 6 0 0 11 Fish Purveyors' Shops cleansed or repaired 3 0 4 0 0 7 Registered Houses—visits of inspection 1711 2147 1588 1054 2302 8802 148 Work of the Sanitary Inspectors, 1914—continued. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Thick. Inspector Morgan. Total. Registered Houses — Overcrowding cases abated 10 11 8 3 6 38 Registered Houses—cleansed 207 159 140 133 248 887 Registered Houses — Intimation (Cleansing) Notices served 207 173 134 133 248 895 Registered Houses — Statutory (Cleansing) Notices served 115 87 81 0 204 487 First visits (complaints, casual visits) 1674 1434 1623 1060 1345 7136 Revisits 2966 3137 3210 1595 3011 13919 Intimation Notices served 664 455 486 436 838 2879 Statutory Notices served 117 101 83 110 232 643 Infectious disease investigations 313 201 188 168 507 1377 House inspections 583 422 312 239 520 2076 House to house inspections 175 158 167 315 256 1071 Canal Boats inspected 0 0 111 0 0 111 Cowsheds —No of inspections 0 0 0 1 2 3 Slaughterhouses—No. of inspections 3 0 0 0 2 5 Slaughterhouses—No. of notices served 0 0 0 0 0 0 Verminous tenements—No. of inspections 206 421 348 62 84 1121 Verminous tenements cleansed by Borough Council 15 6 1 2 20 44 Work of Mrs. Greenwood, Lady Sanitary Inspector, 1914. First Visits. Phthisis 84 Infant Deaths 303 Homeworkers 354 Factories & Workshops 56 Births 93 Complaints 90 Sundries 406 Re-visits. Phthisis 78 Infant Deaths 236 Homeworkers 143 Factories & Workshops 28 Complaints 123 Number of Notices served 82 Dirty rooms and tenements 14 W.C's. dirty or defective 33 Unsuitable sanitary accommodation 1 Yard paving defective or walls dirty 7 Wash-house walls dirty or paving defective 7 Rooms overcrowded 19 Floors and bedding dirty 15 Accumulations of refuse 4 Underground rooms illegally occupied 10 Workshops dirty 2 Dustbins dilapidated or absent 5 Roofs leaky 3 Sink waste pipes defective 3 Other nuisances 2 Nuisances referred to District Ispectors 14 Attendances at weighing centres 147 149 LEGAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Date, 1914. Name and Address of Defendant. Offence. Result. May 7th F. W. Waide & Co. Ltd., 67, Turnmill Street, E.C. For the preparation of meat intended for the food of man which was unfit fur the food of man. Fined £50. „ 12th Thomas Henry Mitchell, 67, Hertford Road, Lower Edmonton. For depositing for the purpose of sale and intended for the food of man meat which was unfit for the food of man. Fined £20 and £5 5s. costs. ,, 12th Ernest Knifton, Hope Yard, Longhedge Lane, Lower Edmonton. For depositing for the purpose of sale and intended for the food of man meat which was unfit for the food of man. Dismissed. Evidence of ownership insufficient. „ 29th John Malpas, 71, Hungerford Road, Holloway, N. For depositing for the purpose of sale and intended for the food of man meat which was unfit for the food of man. Fined £30 and £5 5s. costs. June 25th H. Brickell, Fife Road Beckton Road, Plaistow, E. Failing to cleanse the registered house at 4, Hatfield Street. Fined £1 and £1 3s. costs. „ 25th H. Brickell, Fife Road, Beckton Road, Plaistow, E. Failing to cleanse the registered house at 5, Hatfield Street. Fined £1. 25th H. Brickell, Fife Road, Beckton Road, Plaistow, E. Failing to cleanse the registered house at 25, Baltic Street. Fined £1. „ 26th Herbert Grimstone, 323, Ivydale Road, Nunhead. Failing to unstop a choked water closet at Arthur Buildings, Peter's Lane. Fined £4. 150 SALE OF FOOD AND DRUGS ACTS. Date, 1914. Name and Address of Defendant. Offence. Result. Jan. 16th William Jones, 13. Percival Street For selling milk containing 13.3 per cent. of added water Fined £5 and 12s 6d. costs „ 16 th Thomas James Evans, 47, Mydde ton Street For exposing margarine for sale by retail without having it labelled Pined £5 and 12s. 6d costs ,, 21st Rachael Mary Evans, 214, City Road For selling butter adulterated with 40 per cent. of foreign fat. Fined £2 and £1 3s. costs Feb 20th Timothy Cæsar Morgan, 182, Milkwood Road, Heme Hill For selling butter adulterated with 80 per cent. of foreign fat Fined £18 and 12s. 6d. costs „ 20th Evan Timothy, 1, Whiskin Street For selling butler adulterated with 82 per cent. of foreign fat Fined £7 and 12s. 6d. costs Apl. 9th Albert Bucsanszky, 12, Richmond Street For exposing margarine for sale by retail without having it labelled Fined 12s. 6d. and 12s.6d. costs „ 9th Charles Rich, 37, Chiswell Street For selling butter containing 2.25 per cent. of added water Fined 12s. 6d. and 12s 6d.costs „ 29th Mary Ann Brown, 11, White Lion Street For selling milk from which 15 per cent. of its fat had been abstracted Ordered to pay 12s. 6d. costs May 20th Louisa Shakshaft, 162, King's Cross Road For selling milk from which 10.3 per cent. of its fat had been abstracted Fined £2 and 2s. costs June 25th Elizabeth Askew, 44, Radnor Street For selling milk from which 8.6 per cent. of its fat had been abstracted Fined 10s. and 12s. 6d. costs „ 25th Elizabeth Davies and Nancy Evans, trading as D Hughes at 39, Baldwin Street For selling milk from which 17 per cent. of its fat had been abstracted Fined £2 and £1 3s. costs „26 th Rebecca Patrick, 3, Penton Street For selling milk from which 18.3 per cent. of its fat had been abstracted Ordered to pay 12s. 6d. costs „ 26th Misses A. & C Haggis, 39, Amwell Street For selling raspberry jam adulterated with 20 per cent. of apple pulp Fined 5s. and 12s. 6d. costs July 23rd Alice Pritchard, 12, Penton Street For selling milk from which 12.6 per cent. of its fat had been abstracted Fined 1s. and 12s. 6d. costs „ 23rd Alfred James Clarke, 28, Rosoman Street For selling milk from which 9 per cent. of its fat had been abstracted Fined 1s. and 12s. 6d. costs „ 23rd William Jones, 2a, King's Cross Road For selling milk from which 16.6 per cent. of its fat had been abstracted Ordered to pay 12s. 6d. costs. AWarranty was produced 151 Sai.e of Food and Drugs Acts—continued. Date, 1914. Name and Address of Defendant. Offence Result. July 23rd Annette Dibsdale, 21, Easlon Street For selling milk containing 14.1 per cent. of added water Ordered to pay 12s. 6d. costs ,, 23rd Eliza Davis, 17, Pine Street For selling milk from which 14.0 per cent. of its fat had been abstracted Dismissed. A Warranty was proved „ 23rd Evan Timothy, 1, Whiskin Street For selling milk from which l0.5 per cent. of its fat had been abstracted Dismissed. A Warranty was proved ,, 23rd Albert Woods, 26, Clerkenwell Close For selling milk from which 12.3 per cent. of its fat had been abstracted Ordered to pay 12s. 6d. costs „ 30th Richard Richards, 22, Luke Street For selling milk from which 10 per cent. of its fat had been abstracted Dismissed. A Warranty was proved Aug. 19th Charles Smith, 69, Moreland Street For selling milk from which 19.6 per cent. of its fat had been abstracted Fined £1 and £1 3s. costs Sept. 17th John Herbert Jenkins, 230, St. John Street For selling milk from which 6 per cent. of its fat had been abstracted Ordered to pay £1 3s. costs. Oct. 15th Alphonso Bonito, 81, Whitecross Street For selling milk from which 7 per cent. of its fat had been abstracted Fined 10s. and 12s. 6d. costs ,, 23rd Anna Lloyd, 231, Goswell Road For selling cocoa adulterated with 15 per cent. of sugar and 15 per cent. of foreign starch Fined £2 and 12s. 6d. costs Nov. 5th John Herbert Jenkins, 230, St. John Street For selling milk from which 5 per cent. of its fat bad been abstracted Fined £2 and 12s. 6d. costs 152 TABLE I. Vital Statistics of Whole District during 1914 and previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. T hansferable Deaths. Nett Deaths belonging to the District. Un corrected Number. Nett. Number Rate. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1.000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1909 90,394 3,427 2,857 31 6 882 9.7 56 988 366 128 1,814 20.1 1910 88,987 3,566 2,833 31.8 819 9.2 69 886 342 121 1,636 18.4 1911 87,566 3,441 2,676 30.6 839 9.6 67 935 411 154 1,697 19.4 1912 86,130 3,138 2,579 29.9 790 9.1 69 878 290 112 1,599 18.5 1913 84,679 3,053 2,494 29.4 737 8.7 92 913 348 139 1,558 18.4 1914 83,212 3,221 2,558 30.7 774 9.3 103 965 304 118 1,636 19.6 Area of District in acres} (exclusive of area} 586.6 covered by water.} Total population at all ages 87,976 Total families or separate occupiers, 21,278 Average number of persons per occupancy, 4.13. At Census of 1911. 153 TABLE II. Cases of Infectious Disease notified during the Year 1914. Number of cases notified. Total cases notified in each locality. Notifiable Disease. At Ages—Years. 1 2 3 Total cases removed to Hospital. At all Ages. Under 1 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 yeais 45 and under 65 years 65 and upwards. Clerkenwell St. Luke. St. Sepulchre. Small Pox — — — — — — — — — — — — Cholera (C) Plague (P) — — — — — — — — Diphtheria (including Membranous croup) 134 5 45 67 14 2 1 — 76 55 3 133 Erysipelas 159 8 11 13 16 49 47 15 109 50 13 Scarlet Fever 438 8 116 275 27 12 — — 314 123 1 434 Typhus Fever — — — — — — — — — — — Enteric Fever 15 — 1 7 2 5 — — 12 3 — 15 Relapsing Fever (R) Continued Fever (C) — — — — — — — — — — — Puerperal Fever 11 — — — 2 9 — — 9 2 7 Cerebro Spinal Meningitis . 3 1 2 — — — — — 1 2 — 2 Poliomyelitis 1 — — 1 — — — — — 1 1 Ophthalmia Neonatorum 17 17 — — — — — — 10 7 — 2 Pulmonary Tuberculosis 382 2 17 53 64 156 78 12 260 120 2 203 Other forms of Tuberculosis 77 5 30 21 2 12 5 2 48 28 1 48 T otals 1237 46 222 437 12/ 245 131 29 839 391 7 858 ] 54 TABLE III. Causes of, and Ages at, Death during Year 1914. Causes of Death. Nett Deaths at the subjoined ages ot " Residents" whether occurring in or without the District. Total Deaths, whether of " Residents " or " Non-Residents" in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and upwards Enteric Fever 2 — — — — 1 1 — — — Small-pox — — Measles 78 20 39 16 1 2 — Scarlet fever 6 — 2 3 1 — — — — — Whooping-cough 43 13 18 9 3 — — — — — Diphtheria and Croup 9 2 3 2 2 — — — — — Influenza 7 — — — 1 1 4 1 Erysipelas 3 — — — — — — 2 1 — Phthisis (Pulmonary Tuberculosis) 151 — 3 2 3 17 78 40 8 1 Tuberculous Meningitis 21 3 5 6 5 1 1 — — — Other tuberculous diseases 35 5 3 12 5 6 1 3 — Cancer, malignant disease 103 — — 2 1 16 33 51 10 Rheumatic Fever 5 — — 2 1 1 1 — — Meningitis 10 3 3 4 — — — — — Organic Heart Disease 158 3 — 3 5 9 25 68 45 — Bronchitis 165 14 4 1 1 — 7 46 92 1 Pneumonia (all forms) 157 46 25 18 5 2 19 29 13 3 Other diseases of Respiratory organs 9 1 2 — — — 2 1 3 1 Diarrhoea and Enteritis 93 73 15 1 — — — 3 1 1 Appendiciiis and Typhlitis 4 — — — 1 3 — — — — Cirrhosis of liver 31 — — — — — 5 21 5 Alcoholism 14 — 1 7 6 Nephritis and Bright's Disease. 117 — — — — 1 13 46 57 — Puerperal Fever 5 — — — 5 — Other accidents and diseases of Pregnancy and Parturition 5 — — — — 1 4 — — 3 Congenital Debility and Malformation, including Premature Birth 67 65 2 — — — — — — 30 Violent Deaths, excluding Suicide 59 24 2 6 3 6 7 11 1 Suicide 11 5 4 2 1 Other Defined Diseases 184 12 5 5 8 7 22 40 85 13 Diseases ill-defined or unknown 84 20 6 I 2 2 4 9 40 10 1636 304 132 86 55 59 222 363 415 75 155 TABLE IV. Infant Mortality, 1914. CAUSES OF DEATH. 1 Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and underfi mnnt.hH 6 months and under 9 months. 9 months and under 12 mos. Total deaths under 1 year. All causes Certified .. .. .. .. .. .. .. .. .. .. Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 2 8 10 20 Scarlet fever .. .. .. .. .. .. .. .. .. .. Whooping cough .. .. .. .. .. 1 4 2 6 13 Diphtheria and Croup .. .. .. .. .. .. .. .. 2 2 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. 3 3 Abdominal Tuberculosis .. .. .. .. .. .. .. 2 .. 2 Other Tuberculous Diseases .. .. .. .. .. .. .. 2 1 3 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 2 .. 3 Convulsions .. .. 3 .. 3 3 .. 1 1 8 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 1 1 .. 3 3 5 1 2 14 Pneumonia (all forms) .. .. 2 .. 2 7 10 14 13 46 Diarrhoea |Enteritis .. 1 1 2 4 17 23 16 13 73 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. 1 1 1 3 2 .. .. .. 5 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 2 1 3 .. 6 9 5 1 .. 21 Injury at birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 3 .. .. .. 3 1 .. .. .. 4 Congenital Malformations 1 .. .. .. 1 1 .. 1 .. 3 Premature birth 43 4 1 1 49 4 2 .. .. 55 Atrophy, Debility and Marasmus .. .. 3 .. 3 5 .. 1 .. 9 Other causes 4 1 2 .. 7 5 1 4 3 19 Totals 55 9 17 4 85 58 53 55 53 304 Nett Births legitimate 2498 Nett Deaths legitimate infants 284 in the year illegitimate 60 in the year of illegitimate infants 20