FIN 14 \ THE METROPOLITAN BOROUGH OF FINSBURY. ANNUAL REPORT on the Public Health of Finsbury for the Year 1923 by A. E. THOMAS, M.A., M.D., D.P.H., Medical Officer of Health, Barrister-at-Law. London: Printed by Vail & Co., 170, Farringdon Road, E.C, 1924. Public health Committee, 1923-24. Chairman : Alderman L. PHILLIPS. Vice-Chairman : Councillor 1-'. T. FOULGER. HIS WORSHIP THE MAYOR. (O. W. NICHOLSON, Esq., M.P., L.C.C.) Alderman W. HOWES. Alderman The Rev. Prebendary G. H. PERRY, M.A. Alderman W, R. PUTTERILL. Councillor Mrs. A. CHAPMAN. Councillor H. G. DAINTY. Councillor Mrs. J. L. DICKER. Councillor Dr. A F. GALLOWAY. Councillor Mrs. E. J. L. LORD. Councillor S NUNN. Councillor E. TROTT. Maternity and Child Welfare Committee, 1923-24. Chairman : Councillor F. T. FOULGER. Vice Chairman : Lady BARTON. HIS WORSHIP THE MAYOR. (O. W. NICHOLSON, Esq., M.P., L.C.C.) Alderman W. HOWES, J. P. Alderman W. R. PUTTERILL. Councillor Mrs. A. CHAPMAN. Councillor Mrs. J. L. DICKER. Councillor Dr. A. F. GALLOWAY. Councillor Mrs. E. J. L. LORD. Councillor E. TROTT. Co-opted Members: Lady BARTON. Miss B. BLUNT. Miss E. F. BOLTON. Mrs. HOWELL. The Public Health Committee meets on Tuesdays, when necessary, at 2.30 p.m., and the Maternity and Child Welfare Committee meets on Tuesdays after the Public Health Committee. TABLE OF CONTENTS Statistics 5 Population 6 Births and Birth Rates 8 Maternity and Child Welfare 9 Health Visitation 20 Weighing Centres 21 Grants to Mothers and Children 22 Hospital Treatment 28 Rest Homes 28 Puerperal Fever 28 Ophthalmia Neonatorum 29 Deaths and Death Rates 29 Inquests 30 Infant Mortality 30 Tuberculosis 84 Phthisis Death Rates 41 Tuberculosis Dispensary 43 Infectious Disease 43 Housing 50 Disinfection 67 Food Inspection 68 Slaughter Houses 70 Milk Shops 71 Samples for Analysis 72 Factories and Workshops 73 Homework 80 Bakehouses 82 Rats and Mice (Destruction) Act, 1919 83 Common Lodging Houses 83 Canal Boats 83 Mortuary 84 Staff 85 Work of the Staff 86 Legal Proceedings 89 Statistical Tables 90 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1923. STATISTICS.—A summary of the principal facts of the statistics for 1923 is given below :— Area (acres) 587 Estimated civilian population at the middle of 1923 77,230 Finsbury residents in outlying institutions at the end of June, 1923 1,082 Number of inhabited houses (structurally separate dwellings), Census, 1921 10,889 Number of families or separate occupiers (Census, 1921) 20,005 Rateable value £1,094,253 Sum represented by a penny rate £4,415 Birth rate. Finsbury 23.9 per 1,000 inhabitants. Birth rate, London 20.2 per 1,000 inhabitants. Birth rate, England and Wales 19.7 per 1,000 inhabitants. Death rate, Finsbury 13.0 per 1,000 inhabitants. Death rate, London 11.2 per 1,000 inhabitants. Death rate, England and Wales 11.6 per 1,000 inhabitants. Infant mortality, Finsbury 60.7 per 1,000 births. Infant mortality, London 60.0 per 1,000 births. Infant mortality, England & Wales 69.0 per 1,000 births. Phthisis death rate, Finsbury 1.16 per 1,000 inhabitants. Finsbury death rate from all forms of tuoerculosis 1.33 per 1,000 inhabitants. In comparision with the results for 1922, the following matters are of interest— The number of births and the birth rate are less in 1923. The general death rate is much lower in 1923. The death rate for consumption of the lungs and from all forms of tuberculosis are both lower in 1923. The infant mortality is much lower in 1923. 6 The deaths from measles, scarlet fever, whooping cough, diphtheria, influenza, phthisis and tuberculous diseases other than tuberculous meningitis), bronchitis, pneumonia, puerperal fever, violence and suicide, are less in 1923. The deaths from erysipelas, tuberculous meningitis, cancer, diarrhoea, and diseases and accidents of pregnancy and parturition, are more in 1923. Scarlet fever and diphtheria have been much less prevalent than in 1922. POPULATION. At the Decennial Census made on the 19th-20th June, 1921, the population of Finsbury was given as 75,995. The RegistrarGeneral, however, in view of information obtained by him as to the movements of population, considered the population to be 76,019, in the middle of 1921. The population of Finsbury at the middle of 1923 was estimated by the Registrar-General to be 77,230, which is the figure used in compiling this report. Estimate of Population 1923. E-timated population 1923. Census population 1921. Census population 1911. Clerkenwell 51,140 50,322 57,121 St. Luke.. 24,991 24,592 28,976 St. Sepulchre 1,099 1,081 1,826 Totals 77,230 75,995 87,923 The estimate does not include the Finsbury residents detained in the following institutions :—The Holborn Union Institution, la, Shepherdess Walk (620) ; the Holborn and Finsbury Hospital, Archway Road, Holloway (257), and the Holborn Schools, Mitcham (205), giving a total of 1,082. Adding this number to the Registrar-General's estimate 77,230, we get a corrected population ot 78,312 for Finsbury in the middle of the current year. 7 The following table shows the general birth and death rates and infant mortality in each of the Metropolitan Boroughs and in London, and in England and Wales during 1923. Births annual rate per 1,000 persons living. Death Rate per 1,000 living. Deaths of Infants under 1 year, to 1.000 births. LONDON 20.2 11.2 60 Paddington 17.9 11.7 69 Kensington 17.5 12.3 70 Hammersmith 20.2 110 64 Fulham 18.4 10 5 64 Chelsea 15.1 12.2 58 City of Westminster 12.5 10 6 46.6 St. Marylebone 15.8 11.7 66 Hampstaad 14.3 10.3 42 St. Pancras 20.3 12 1 63 Islington 21.1 11.6 66 Stoke Newington 18.2 10 2 46 Hackney 19.6 10.6 53 Holborn 13.7 12.1 79 Finsbury 23.9 13.0 60.7 City ot London 8.2 11.2 60 Shoreditch 26 9 13.0 82 Bethnal Green 24.2 11.3 68.7 Stepney 22.8 11.0 62 Poplar 25 6 11.3 60 Southwark 24.3 12.8 68 Bermondsey 24.0 12.2 76 Lambeth 27.0 11.2 42.7 Battersea 20.1 10.8 49.5 Wandsworth 16.3 10.1 52.5 Camberwell 20.7 11.0 56.7 Deptford 21.1 11.1 59 Greenwich 20.5 10.95 60 Lewisham 18.1 10.1 43 Woolwich 20.5 9.9 43 England and Wales 19.7 11 6 69 8 BIRTHS AND BIRTH RATES- These are given in the annexed table :— Year. Population in the middle of each year. Corrected Births. Corrected Birth Rates. 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 1915 76,915 2,192 28.5 1916 80,764 1,926 23.8 1917 75,813 1,572 20.7 1918 74,502 1,275 17.1 1919 78,431 1,532 20.2 1920 78,423 2,540 32.4 1921 76,690 1,973 25.7 1922 76,840 1,934 25'2 1923 77,230 1,844 233 The rates for the various districts were as follows :— Population. Births. Death.rate. Clerkenwell 51,140 1,169 22.8 St. Luke 24,991 662 26.5 St. Sepulchre 1,099 13 11.8 The whole Borough 77,230 1,844 23.9 The corresponding birth rates for the rest of the country are attached :— England and Wales 19.7 London 20.2 Finsbury 23.9 105 great towns 20.4 157 smaller towns 19.8 9 The number of Finsbury births reported as illegitimate was 60. The number of deaths in illegitimate children under one year was four. NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. The statistics for the last five years are given in the accompanying table. Year 1919 1920 1921 1922 1923 Total Births notified .. 3,297 4,200 3,694 3,510 3,421 Percentage attended by Doctors 1.5 3.5 2.6 2.4 2.4 Percentage attended by Midwives 27.0 31.3 43.4 28.4 27.5 Still Births notified 24 70 55 59 51 Births registered 1,582 2,540 1.973 1,934 1,844 The number of Finsbury births notified in 1923 was 1,845. Notifications were received of 26 sets of twins and one set of triplets. The percentage of births notified by parents was 5.9, by medical men 2.4, by midwives 27.5, by hospitals, infirmaries and nursing homes 17.3, and by others, chiefly medical students and midwifery students was 46.9 per cent. The mothers of this last group were all attended gratuitously in their confinements by medical students and student midwives from various hospitals and institutions. In 1923 the number of instances in which parents omitted to notify was 88. To these a printed form was sent drawing attention to the omission. The East Finsbury Maternity and Infant Welfare Centre, 162, Lever Street.— The work and classes at the Maternity and Child Welfare Centre, 162, Lever Street, in 1923, were as follows :— Monday Mothers' clinic, 10.30 a.m. to 12.30 p.m. Dental clinic, 2.30 p.m. to 3.30 p.m.. alternate weeks. 10 Tuesday ... Talks to Mothers, 3 p.m. to 3.30 p.m. Sewing Class, 2.30 p.m. to 5 p.m. Wednesday... Post-Natal clinic and Weighing Centre, 10.30 a.m. to 12.30 p.m. ; and 2 p.m. to 5 p.m. Clothing Club, 2.30 p.m. Friday post Natal clinic and Weighing Centre, 10.30 a.m. to 12.30 p.m. ; and 2 p.m. to 5 p.m. Clothing Club 2.30 p.m. Numbers of individual mothers, children and infants who have attended clinics and classes :— Mothers, nursing 266 expectant 80 of children 1—5 years 46 Children 1—5 years 421 Infants under 1 year 454 Total number 1,267 Post-Natal Clinic.—In 1923 the number of meetings was 176. The patients who attended were:—Children, 1—5 years, 396; infants under 1 year, 454; the attendances were, children 1—5 years, 2,454; infants, 3,397. Average attendances per clinic:—Children 14, infants 19. Mothers Clinic.—In 1923 the number of meetings was 35; the patients were :—Nursing mothers 180, expectant mothers 74. The attendances were :—Nursing mothers 397, expectant m'others 169. Average attendances :—Nursing mothers 11, expectant mothers 5. Dental Clinic.—The number of clinics was 32. The patients were :—Nursing mothers 51, expectant mothers 6, mothers of children under 5 years 26, children 1 to 5 years 25. The attendances were :—Nursing mothers 156, expectant mothers 15, mothers of children under 5 years 70, children 30. Average attendance at a clinic 8. 11 Eighteen mothers were fitted with dentures from this clinic. These were referred to the Charity Organisation Society, who arranged with the mother for the reduced cost of the dentures and for a weekly instalment to be paid. Grants were in some cases obtained from the Hospital Sunday Fund. Nitrous oxide gas, with or without oxygen, was given by the Assistant Medical Officer of Health to those requiring an anaesthetic for extractions. Fortnightly dental clinics were continued, the clinic being held at the Old Sessions House Centre on alternate weeks. Patients were allowed to attend at either Centre. Weighing Centre.—The number of weighing days was 197. The number of individual babies weighed was 454, the weighings 3,397. Average 17 per session. The number of individual children weighed was 396, the weighings 2,454. Average 12 per session. Home visits were paid by the Superintendent :—General visits 191, ophthalmia neonatorum 3, expectant mothers 213, puerperal fever 10. Sale of Dried Milk.—3,004 one-pound packets were sold in 1923 at cost price. Number of packets given free by order of the Maternity Committee 278, at half-cost 8. Talks to Mothers.—The Assistant Medical Officer of Health gave "Talks to Mothers." The number of lectures given was 9, attendances 95. The subjects taken included breast and bottle feeding, diarrhoea, measles, rickets, baby hygiene, and sick-room cookery. Sewing Class.—In this class mothers were taught to make garments for themselves or their children out of their own materials or materials bought at the Centre. An experienced voluntary helper, Miss Scarle, gave two or three hours every week to help and advise the mothers. The number of classes was 41, attendances 428. Average attendance 10. During the class, children and babies were looked after in the nursery. Attendances of children 474. 12 Clothing Club.—This club was held to sell woollen and other garments at a reduced price for the children of those mothers who attended the Centre. Mrs. Mason, the voluntary helper in charge of the club, attended the Centre twice a week, and it was through her efforts and the work of other helpers, particularly those of the League of Remembrance, that the club continued to be self-supporting. Other voluntary helpers whose assistance extended the work of the Centre were Mrs. Sparrow, Mrs. French, Mrs. Clarke and Miss Pettiward. Advice and treatment were given at the clinics held at 162, Lever Street for the following conditions :— Mothers, Nursing : Abscess of arm 1, anaemia 38, bronchial catarrh 4, breast abscess 1, bronchitis 1, constipation 77, conjunctivitis 2, cough 6, dyspepsia 13, debility 129, eczema 1, general advice 18, hernia 1, inflamed breast 11, lymphangitis 1, menorrhagia 7, neuralgia 5, pleurisy 1, phlebitis 1, rheumatism 1, prolapsus uteri 1, tonsillitis 2. The following cases were referred to hospital :— Inflamed breast, eczema, pleurisy, phlebitis, breast abscess, abscess of arm, hernia, lymphangitis, menorrhagia. Cases of cystitis and tonsillitis were referred to the patient's own doctors. Mothers, expectant : Anaemia 11, bronchial catarrh 2, cough 12, cystitis 1, constipation 39, cracked nipples 2, debility 5, general advice 51, gumboil 1, menorrhagia 1, pleurisy 1, varicose veins 9. Children 1 to 5 years : Adenitis 1, bronchial catarrh 31, bronchitis 4, boils 6, burn 1, cough 117, constipation 19, conjunctivitis 15, dyspepsia 43, diarrhoea 45, debility 36, diphtheria 3, dental disorders 8, enlarged tonsils 2, eczema 1, general supervision 613, enlarged gland 1, 13 gumboils 3, hip joint disease 1, impetigo 20, jaundice 1, laryngitis 1, meningitis 1, anaemia 1, malnutrition 32, measles 2, mumps 1, neuralgia 1, otorrhoea 4, otitis media 1, parasites 1, pleurisy 1, pertussis 1, rickets 50, rhinitis 1, scald on face 1, sore throat 2, scabies 6, stomatitis 8, strabismus 1, thrush 1, tonsillitis 2, worms 2, wasting 1, rheumatism 1, rash 2, cervical adenitis 1. Cases of the following diseases were referred to a doct'or :— Pertussis, mumps, tonsillitis. The dental cases were referred to a dentist. Cases of the following diseases were referred to a hospital:— Meningitis, hip-joint disease, cervical adenitis, laryngitis, otitis media, adenitis, rickets, boils, rheumatism, enlarged tonsils, mumps, strabismus, bronchitis, eczema, rickets diarrhoea. One case of diphtheria was discovered and was notified immediately to the Medical Officer of Health. Infants up to 1 year : Bronchial catarrh 36, boils 2, bronchitis 1, constipation 55, cough 134, conjunctivitis 5, cervical adenitis 2, convulsions 1, dyspepsia 49, diarrhoea 30, dentition disorders 6, eczema 2, general supervision 925, hernia 1, infective enteritis 1, intertrigo 1, jaundice 1, malnutrition 48, naevus 1, omphalitis 3, otorrhoei 6, pertussis 4, prematurity 1, rickets 6, ringworm 1, stomatitis 1, scabies 1, thrush 26, umbilical hernia 2, ulcerated buttocks 1, vomiting 12, varicella 2, wasting 1, abscess of neck 1, bronchopneumonia 1. Cases of the following diseases were referred to a doctor :— Varicella, diarrhoea, pertussis, bronchitis. Cases of the following diseases were referred to a hospital: Cervical adenitis, ringworm, convulsions, enteritis, vomiting, broncho-pneumonia, malnutrition, pertussis, jaundice, hernia, wasting, conjunctivitis, abscess of neck, 14 South Clerkenwell Centre, Old Seaaiona House. Clerkenwell Green. The work and classes held at this Centre during 1923 were as follows :— Monday Post-Natal Clinic and Weighing- Centre, 2 p.m. to 5 p.m. Dental Clinic, 2.30 p.m. to 3.30 p.m., in alternate weeks. Tuesday Mothers' Clinic, 10.30 a.m. Wednesday Sewing Class, 2.30 p.m. to 5 p.m. Thursday Post-Natal Clinic, 10 a.m. to 12.30 p.m., and 2 p.m. to 5 p.m. Weighing Centre, 2 p.m. to 5 p.m. Clothing Club, 2 p.m. Numbers of individual mothers, children and infants who have attended clinics and classes :— Mothers, nursing 120 expectant 38 of children 1—6 years 10 Children 1—5 years 233 Infants 242 Total number 643 Post Natal Clinic.—In 1023 the number of meetings was 80. The patients who attended were :—Nursing mothers 92, children 1—5 years 219, infants under 1 year 242. The attendances were :—Nursing mothers 212, children 1 to 5 years 1,392, infants under 1 year 2,183. Average attendances per clinic:—Nursing mothers 2, children 7, infants 17. Mothers' Clinic.—In 1923 the number of clinics held was 38. The number of patients was 27 ; attendances at these clinics have been included in those numbers mentioned in the post-natal clinics. Dental Clinic.—The number of clinics was 32. The patients were :—Nursing mothers 15, expectant mothers 6, mothers of children 1—5 years 13, children from 1 to 5 years 14. The 15 attendances were:— Nursing mothers 55, expectant mothers 17, mothers of children 1 to 5 years 47, children 22. Average attendance at a clinic 6. Nine mothers were fitted with dentures at the clinic. These were referred to the Charity Organisation Society, who arranged with the mothers for the payment in whole or part by the mothers. Nitrous oxide gas, with 'or without oxygen, was given by the Assistant Medical Officer of Health to those requiring an anaesthetic for extractions. The dental clinic was held fortnightly. The clinic was held at 1G2, Lever Street on alternate weeks. Patients were allowed to attend at either centre. Weighing Centre.—The number of weighing days was 102. The number of individual babies weighed 228, the weighings 2,151. Average weighings per session 21. The number of individual children 1—5 years weighed was 251, the weighings 1,355. Average weighings per session 13. Home visits were paid by the Superintendent:—General visits 278, ophthalmia neonatorum 40, puerperal fever 31, expectant mothers 149. Sale of Dried Milk.—2,433 one-pound packets were sold in 1923 at cost price. The number of packets given free by order of the Maternity Committee was 536. Sewing Class.—Mothers were taught at the sewing class to make garments for themselves or their children. Some provided their own material and to others material was supplied at cost price through the Centre. 44 Classes were held, and these were attended by 20 nursing and 5 expectant mothers; these made in all 454 attendances. The attendances of children in the nursery on these occasions numbered 490. Clothing Club.—This club was held to sell woollen and other garments at a reduced cost for the babies and children of those mothers who attended the Centre. 16 Advice and treatment wore given at the clinics held at the Old Sessions House, Clerkenwell Green, for the following1 conditions :— Mothers, expectant : General advice '23, vomiting 2, debility 2, constipation 18, cough 2, varicose veins 2, menorrhagia 1, anaemia 9. Mothers, nursing : General advice 4, dyspepsia 19, constipation 42, cough 5, scalded leg 3, neuralgia 2, anaemia 1 fl, debility 70, inflammation of breast 2, menorrhagia 1, bronchial catarrh 1, pleurisy 1, varicose veins 3, hernia 2, prolapsus uteri 2. Patients referred to a private doctor or to hospital for further treatment included the following conditions :—Menorrhagia 2, pleurisy 1, and to the Metropolitan Nursing Association for nursing :—Scalded leg 1. Children 1—5 years : General supervision 301, abscess of neck 1, anaemia 1, bronchial catarrh 3, burnt fobt 1, constipation 13, cough 53, dentition disorders 5, dyspepsia 20, diarrhoea 10, enlarged tonsils 7, general debility 30, herpes 2, impetigo (!, malnutrition 13, otorrhoea 3, pertussis 1, rickets 31, ringworm 1, scabies 2, stomatitis 1, vomiting 1. Of these cases the following were referred tb hospital or to a private doctor:—Pertussis 1, burnt foot 1, abscess of neck 1, enlarged tonsils 7, and ringworm 1 case. Infants up to 1 year : General supervision 451, boils 1, bronchial catarrh 3, bronchitis 5, conjunctivitis 6,' constipation 59, cbugh 52, diarrhoea 24, dentition disorders 10, dyspepsia 26, enlarged tonsils 1, general debility 7, herpes 3, impetigo 3, malnutrition 30, pertussis 1, prematurity 2, rhinorrhoca 3, rickets 11, scabies 2, stomatitis 3, thrush 11, vomiting 18. • 17 Two cases of diphtheria were discovered amongst the children who attended for advice, these were immediately notified to the Medical Officer of Health and were removed to the M.A.B. Hospital; the following cases were referred to hospital or to private doctor: Bronchitis 5, pertussis 1, and boils 1. Proposed Now Maternity Centre or Contres. The Maternity and Child Welfare Committee has had under con' sideration the provision of new, up-to-date and well equipped centres—one to he placed in South Clerkenwell, the other in East Finsbury. It is considered desirable that, if possible, such a centre should consist of :— 1. A covered room or enclosure for perambulators. 2. A kitchen, scullery and coal shed. 3. One large room to be used as a waiting room and receiving room for mothers, and also as a lecture room. 4. Private rooms for the doctor and maternity intendent. 5. Consultation room for the doctor and dentist. 6. A dispensary. 7. A general store room. 8. A room for undressing patients and weighing the babies. 9. A fairly large room to be used as a nursery for those children detained while their mothers are at the sewing class. 10. A bathroom. 11. A small laboratory to be used for the chemical and bacteriological investigation of children's diseases and for the manufacture of vaccines. 12. A room for observation purposes or for the short porary isolation of children while awaiting removwi to hospital. 13. A caretaker's room if the caretaker is resident. 18 If this accommodation is not entirely available, it will be quite easy, by omitting some of the foregoing proposals, or by arranging that one room shall serve two or more purposes, to secure a centre still capable of good thorough useful work. Staff of The Maternity Centres Duties of Assistant Medioal Officer At each centre, there is a superintendent and a charwoman. The same dispenser attends at both centres. The centres are under the control of the Medical Officer of Health, and the Assistant Medical Officer of Health. The Assistant Medical Officer of Health is appointed for Maternity and Child Welfare purposes and his duties include the following :— 1. To work under the supervision and control of the nity and Child Welfare Committee and of the Medical Officer of Health. 2. To supervise the work of the three health visitors and two Maternity superintendents, and in this connection to visit "special babies" either independently, or at the request of the Medical Officer of Health, the health visitors or maternity superintendents. "Special" babies include those who are premature, illegitimate, twins, wasting, difficult to feed, babies whose mothers are widows, ill, dead, or at work, babies in chargc of foster mothers, babies who are below the usual standards of weight for age, and babies who require visiting for any other reason. Nursing help may be obtained for such babies at the expense of the Borough Council. 3. Attendance at the various clinics—ante-natal and natal. 4. The administration of anaesthetics when required. 5. To visit cases of measles, diarrhoea, pneumonia and whooping cough notified to the Borough Council. To suggest treatment in suitable cases when no doctor is in attendance, and to issue requisitions for nursing 19 help. In this connection, the Ministry of Health, in a special memorandum, point out that it is very undesirable that the staff of the centres should be on holiday when epidemic diarrhoea is likely to be prevalent, that is during July, August or September. Their holidays should be taken at some other time. 0. The investigation of disease in children under 5 years of age. 7. The investigation of cases of Ophthalmia Neonatorum and of Puerperal Fever. 8. The investigation of the causes of infant deaths and the conditions associated therewith. !). The supervision and, where necessary, the treatment of cases of absence of breast milk (Agalactia), or of insufficient breast milk in nursing mothers. 10. Lectures to mothers on subjects which touch their daily life closely and practically from a health standpoint. 11. The issue of medical certificates when required for the purpose of grants for milk and/or dinners. 12. The recommendation to the Medical Officer of Health of cases for admission to the Infants' Hospital, Vincent Square, and when necessary the supervision and treatment of these cases after discharge from hospital. For some of these children it may be expedient to draw up special diet lists for use after their return home. 13. The supervision of the work of the dispenser. The formulation of a pharmacopoeia with stock mixtures and elegant, cheap, palatable preparations for dispensing based upon the use of harmless drugs only. It is considered desirable that all poisonous drugs should be excluded from municipal medical practice amongst mothers, children and infants. 20 14. The compilation of various reports, annual, monthly and special. The special reports include those referring to the work of the various child welfare organisations working' in the district which receive grants from the Borough Council. 15. To arrange for the work of voluntary helpers. 16. The development and extension in the Borough of ventive measures as applied to maternity and child welfare. 17. Generally to perform such other duties, relating to the appointment as may reasonably be required by the Maternity and Child Welfare Committee or by the executive officer of the Committee. HEALTH VISITATION. The number of visits paid by the Health Visitors in 1923 was as follows :— District. First Births. Total Births. Total Visits. No. 1 131 687 3,801 No. 2 115 602 2,714 No. 3 101 570 3.660 Toials 347 1,859 10,175 The numbers for 1922 were 354 first births, 1,993 total births, and 10,069 visits. In 1923 the total number of Finsbury births notified was 1,845, so that the figures in the preceding table show that during 1923 practically every birth that occurred in the Borough came under the supervision of the Public Health Staff. The number of twins born and visited was 26 sets, or one set of twins for every 71 births notified ; one set of triplets was also born and visited, 21 Weighing Centres : There are two municipal weighing centres in Finsbury, held at the following places :— 162, Lever Street.—Wednesday, at 10.30 a.m. ; Friday, at 2 p.m. Old Sessions House, Clerkenwell Green.—Monday, at 2 p.m. ; Thursday, at 2 p.m. A summary of the meetings held in 1923 is appended :— Centre. No. of Meetings. Attendances Average Attendance. No. of Babies. Lever Street 197 3,397 17 454 Old Sessions House 102 3,507 34 228 Total 299 6,904 51 682 The number of new babies brought during the year was 459. Of these, 360 were solely breast fed, 54 were bottle fed, and 45 breast fed and bottle fed, when they were brought to the Centres. The average gain in weight per week while under observation was 4 ounces. The highest weekly average gain was 7 ounces. On their first visits 372 babies were fat and plump, 80 were thin, while 7 were wasting. Only 37 per cent. were brought while they were still under the age of 1 month. 89 per cent. attended under three months. The number of premature babies kept under supervision was 27. 22 The weights of the children at birth are not always known ov recorded by the parents. As far as they are known they are given in the following table :— Weights at Birth. District No. 1. District No. 2. District No. 3. Totals. Under 4 lbs. 1 0 5 6 4-5 lbs. 4 8 4 16 5-6 lbs. 19 15 8 42 6—7 lbs. 61 10 45 116 7—8 lbs. 163 36 290 489 8—9 lbs. 182 62 215 459 9-10 lbs. 62 80 38 180 10—11 lbs 17 60 0 77 11—12 lbs 4 32 0 36 Over 12 lbs. 1 14 0 15 Totals 514 317 605 1,436 The fathers were mainly of the working class, and chiefly labourers, porters, carmen, printers, packers, fitters, street hawkers, motor drivers, newsvendors, warehousemen and postal employees. Milk and/or Dinners fop Mothers and Milk for Children— The Council makes grants of milk and/or dinners to nursing and expectant mothers, and grants of milk to babies under 1 year and children from 1 to 5 years of age. The grants are given free or at a reduced cost in conformity with a scale of income agreed to by the Borough Council and approved by the Ministry of Health already reported. 23 The Borough Council reserves the right in particular circumstances to vary this scale in favour of the applicant, subject to every case of alteration being specially sanctioned by the SubCommittee. Each applicant for a grant has to fill up and sign a printed form of application. The family is then visited by the Health Visitor or Maternity Superintendent, who, after full consideration of the home circumstances and condition of the mother and children, recommends a grant of milk and/or dinners. Thereafter the Medical Officer of Health immediately reviews the whole case, increases the grant recommended, if need be, and an order is forthwith sent to the milkman or dinner centre, and information of the grant is sent to the applicant. Urgent cases are dealt with at once before enquiries are completed, and the grants are re-adjusted later when full information has been received. All grants are periodically reviewed by a Sub-Committee of the Borough Council, which sits for about one-and-a-half to two hours every alternate Monday afternoon. In this connection it is pleasing to record that a grant has never been refused to any necessitous mother or child. Generally speaking, grants to children between 1 and 5 years are only made in cases of illness, where a medical certificate is furnished. During the year 1923, 1,589 applications for grants were received, an average of 132 per month; the largest proportion of applications was made during the December quarter, 1923. 2,069 grants were made, comprising 1,575 cases; in 14 cases no grants were made owing principally to the income of the applicants being in excess of the scale approved by the Ministry of Health. The grants comprised fresh milk in 1,391 cases, dinners in 522, and dried milk for weaned babies in 156 cases. 24 The majority of grants were free of cost to the applicant. In some cases the applicants paid amounts varying from onefourth to three-fourths of the cost, according to their means. The net cost to the Council of the grants of milk, dinners and dried milk, was £886. The Ministry of Health refunds onehalf of the approved net expenditure in this connection. These grants have been of inestimable value to the recipients. The Council, acting through the Maternity and Child Welfare Committee, has taken a liberal, broad-minded, generous view of the applications presented to it, and it is safe to say that all the cases have been dealt with as expeditiously as possible, with every consideration for the prejudices and social amenities of the families concerned. On the whole, the statements of the applicants have been honest and straightforward, and have stood the test of enquiry. Occasionally the circumstances of a family have been bettered, and the father or responsible parent has at once informed the Medical Officer of Health of his changed circumstances, and has asked that the grant be discontinued. These grants have constituted one of the most important measures framed for the reduction of infant mortality. Parents just above or just below the poverty line, parents who have refused to accept poor law relief, mothers with ailing husbands, widows, mothers with illegitimate children, families living under distressing home circumstances, all these have been enabled to get food for themselves and for their babies, and so achieve the resistance which good nourishment gives to fend off disease and its complications. The Borough Council has done the right thing and the best thing yet devised for the benefit of the babies. A few instances are appended, chosen at random, to show the sorts of cases that have actually been helped by the Council's grants. 1. The first applicant for a grant was in March, 1921. The tather was a wood chopper, and latterly a labourer. In 1921, 25 the family consisted of the parents and 8 children, of ages ranging from 15 months to 15 years. By the end of 1923, two more children had been born. The father was out of work. The total income of the family was 28s. per week, earned by the two eldest sons, 17 years and 16 years—the former a street newsvendor, the latter a messenger. They occupied two rooms, for which they paid 8s. 7d. weekly rent. The family was given grants more or less continuously from 1921 to the end of 1923, by which time the Maternity Sub-Committee felt that the family could not apparently be re-established on a self-supporting basis. They were then referred for relief to the Guardians of the Poor Law. It will be noted that although the family was in serious difficulties in 1921, although they had only two rooms to accommodate themselves and 8 children, yet into this extremely limited accommodation two more children were born by the end of 1923. The Council's free grant consisted of daily dinners for the mother, and two pints of milk daily for the babies. 2. The first application for a grant was in April, 1923. The father was a "dealer," who had been in prison. He disappeared, leaving no trace, shortly after the baby was born. The child was 1 year 10 months old, illegitimate, and suffered from diarrhoea. Six weeks after the birth of the child, the mother was turned adrift by her parents. She became a casual charwoman, and did occasional scrubbing work in various institutions. Her earnings were about 5s. per week. She shared a room with a girl friend, for which she paid 3s. weekly rent. She lived principally on "tea." She was not eligible for National Health or Unemployment Insurance benefits. The Council's grant consisted of one pint of milk free daily for the baby and was continued through the whole of 1923. 3. The mother was a charwoman and single. The father was an engine attendant at a "roundabout," making a circuit of country fairs, and could not be traced. The first application for a grant was made in April, 1922. The mother was then expectant, and had no income. She was stated to be friendless. Her parents were dead. She was attended in her confinement by a medical student from St. Bartholomew's Hospital. She had 26 in her charge her younger brother, aged 10 years, who had been left on her hands. At first she received the Council's grant of free dinners. After the child's birth, an additional grant of milk was made for the baby. Until she received help from the Council she stated that she was living on one meal a day—consisting of tea and bread and butter. In March, 1923, she obtained work as a charwoman for two days a week at 3s. a day and her food. The Council's free grants were made from April, 1922, to October, 1923. 4. The mother was a factory hand out of work, and living with her parents. Her first application was in February, 1923. Her baby was then 4 months old and illegitimate. The father paid 10s. a week towards the support of the child. The mother eventually became a coft'ee shop worker, and was stated to work 8 hours daily for 5 days a week for 6s. per week and her food. The Council made a free grant of 1½ lbs. of dried milk each week from February 1923, to the end of the year. 5. The family consisted of the father, mother and 8 children, with ages ranging from 3 months to 18 years. They occupied two rooms, for which they paid 9s. 9d. weekly rent. The father was a street hawker, earning from 30s. to 35s. per week. The total income of the family was 45s. per week. There had originally been 15 children, but 7 of these had died. The Council made free grants of milk and dinners from January, 1921, to the end of 1923. 6. The family consisted of the parents and 8 children, whose ages ranged from one week to 17 years. I heir first application for a grant was in February, 1920. They occupied 4 rooms, for which they paid 15s. 5d. weekly rent. The total income of the family never exceeded £3 per week. They paid 4s. per week to a boot club, and an equal amount to a clothing club. The father was a man who did "odd jobs." The mother was ill, and tottering, almost worn out with child bearing. One child had tonsillitis, two children were wasting, one child was convalescent from diphtheria, and another child had scarlet fever. The remaining 3 children were recovering from measles. 1 he family appeared 27 to be an unfortunate one. The mother said she always had "her hands full." The father and mother appeared to be steady and respectable folk. The Council made a free grant of 2 pints of milk daily for nearly 2 years. 7. The family consisted in 1922 of the parents and 6 children, with ages ranging from 5 weeks to 8 years. The first application for a grant was made in February, 1922. They occupied 2 rooms at 10s. weekly rent. The father was a bottle washer, earning 55s. per week. One of the children had appendicitis. The mother had been ill for 2 months, and later was compelled to enter the Poor Law Infirmary. About this time the father fell out of work. Another child was born in May, 1923. The father then obtained work as a labourer. The Council made a grant of 1 pint of milk free daily for the baby, and free dinners for the mother for 2 years. 8. The family consisted of the parents and 8 children, with ages ranging from 10 weeks to 12 years. The first application for a grant was made in March, 1922. The father was a labourer, earning, when in work, £3 16s. per week. They occupied 2 rooms, at 7s. 6d. weekly rent. The father had been "gassed" during the war, and was often laid up ill. The mother had been confined in hospital, and was extremely ill for 3 months. The Council made a free grant of 1 pint of milk daily for 14 months. 9. The family consisted of the parents and 2 children, aged 18 months and 4 weeks respectively. The first application for a grant was made in March, 1923. They occupied 3 rooms, at 9s. 3d. weekly rent. The sole income was 21s. per week unemployment benefit. Later the father obtained casual work as a labourer, but never for long. The baby died in August, 1923. Another child was born 5 months later. The mother was always ill. She said she had always had bronchitis—"in fact, she was born with it." The Council made a free grant of 1 pint of milk daily during the lifetime of the baby, and free dinners for the mother for over a year. 28 The foregoing examples show that the Council's grants, made after careful Consideration by the Maternity Sub-Committee, have been wisely given to the babies and mothers of families, usually in very straitened circumstances. Certain it is, that these grants of the Borough Council have been of the greatest possible value to Finsbury mothers, and have saved many infant lives. Hospital Treatment.—The Borough Council entered into an agreement with the governing body of the Infants' Hospital, Vincent Square, Westminster, S.W.1, for the retention of two cots for use when required for the reception and treatment of ailing Finsbury children up to the age of 5 years. The Borough Council pays £50 per annum retaining fee, and £2 per week per cot when occupied, by cases sent in under the agreement. The agreement came into force on the 1st October, 1923, since which date the cots have been more or less continuously filled by ailing Finsbury babies—chiefly premature or wasting children. This accommodation has proved to be of very great value to the Borough. Rest Homes for Mothers.—The work carried on by Miss Pettiward, a voluntary worker, at 162, Lever Street, is specially in connection with the sending away of suitable women through voluntary organisations which provide holidays for convalescent and overworked mothers. The number dealt with during 1923 was 24 in connection with the Lever Street Centre, and 3 who attended the Old Sessions House Centre. Puerperal Fever.—In 1923 there were 13 notifications, with 1 death. The statistics for previous years are appended :— Years. 1912-17 1918 1919 1920 1921 1922 1923 Totals Notifications 53 1 6 5 6 7 13 91 Deaths 24 0 3 5 1 4 1 38 29 The cases of puerperal fever are investigated by the Maternity Superintendents. The premises are visited, the sanitary defects ascertained, and made the subject of notice for amendment. The rooms are disinfected. Ophthalmia Neonatorum—Eight cases were notified in 1923. The children were all visited from the Public Health Department, and the mothers were shown how to carry out the treatment advised by the doctors. None of the patients were sent into hospital, but 7 attended Moorfields Eye Hospital as outpatients. In no case was impairment of vision reported. DEATHS AND DEATH RATES. The number of Finsbury residents who died in 1923 was 1,006, equivalent to a death rate for the whole Borough of 13 per 1,000 inhabitants living. The death rate for the whole of London was 11.2 per 1,000. The death rates for previous years are given in the attached table. Death Rates, 1912-1923. Year. The Borough Clerkenwell. St. Luke's. St. Sepulchre. 1912 18.5 18.0 19.1 28.3 1913 18.4 18.0 19.0 38.1 1914 19.6 18.7 21.8 16.3 1915 21.5 20.7 25.5 16.3 1916 19.3 19.2 20.3 8.4 1917 20.4 20.0 21.9 10.6 1918 23.7 24.3 22.9 17.4 1919 15.4 15.8 15.2 9.0 1920 14.7 14.5 15.4 9.2 1921 14.7 14.4 15.4 10.6 1922 16.3 15.9 16.6 23.7 1923 13.0 13.06 12.9 12.7 30 The Finsbury deaths were apportioned as follows:—Clerkenwell 668, St. Luke's 324, St. Sepulchre 14 deaths. The comparison of Finsbury with the rest of the country may be seen below:— Death Rates for 1923. England and Wales 11.6 London 11.2 Finsbury 13.0 105 great towns 11.6 155 smaller towns 10.6 Inquests.—During the past year 99 inquests were held in the Borough of which 8 were on the bodies of non-residents who died suddenly in the district. Ten were on children under 5 years of age, and 89 on adults and children over 5 years of age. Amongst the causes of death were the following:— Accidental falls 9, suicides 11, accidental suffocation 1, burns and scalds 4, run over by motor vehicle 9, knocked down by train 1, drowning 3, morphia poisoning(misadventure) 1, knocked down in street at play 1, chronic lead poisoning 1, accidental poisoning by coal gas 1, knocked down by truss of hay 1. Two deaths took place under anaesthetics administered for necessary operations. INFANT MORTALITY. The infant mortality of the Borough for 1923 is 60.7. Expressed in popular manner, this means that out of every 1,000 children born during the year 60.7 died before reaching their first birthday. The corresponding figures for previous years are annexed:— 31 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 2,837 366 128 1910 2,813 342 121 1911 2,676 411 154 1912 2,579 290 112 1913 2,494 348 139 1914 2,558 304 118 1915 2,192 281 128 1916 1,926 240 124 1917 1,572 187 118 1918 1,275 141 110 1919 1,275 190 89 1920 2,540 188 74 1921 1,973 181 92 1922 1,934 158 82 1923 1,844 112 60.7 32 The following table compares Finsbury with London and England and Wales generally:— Infant Mortality for 1923. England and Wales 69 Whole of London 60 Finsbury 60.7 Great towns 72 Smaller towns 69 Amongst London Boroughs Finsbury stood fourteenth, its infant mortality was 60.7. The deaths of infants allocated to the various diseases are given in the following table, which contains the records for previous years:— Infant Deaths, 1911-1923. Disease. 1911-16 1917 1918 1919 1920 1921 1922 1923 Total Measles 102 19 12 2 2 1 1 — 139 Diphtheria 11 0 0 1 2 2 3 2 21 Scarlet Fever 2 1 0 0 0 1 0 — 4 Whooping Cough 68 3 11 0 5 6 7 3 103 Gastritis 7 0 0 0 0 0 0 0 7 Diarrhæa and Enteritis 393 22 12 25 17 34 5 23 531 Premature Birth 300 25 28 44 49 44 50 28 568 Congenital Defects 13 4 0 1 2 13 7 1 41 Marasmus 135 19 7 4 5 5 10 2 187 Tuberculous Meningitis 31 3 5 0 1 0 2 — 42 Other Tuberculous Diseases 29 3 5 1 0 2 1 1 42 Erysipelas 3 1 0 0 0 0 0 1 5 Syphilis 45 6 2 0 0 2 4 — 59 Convulsions 54 5 3 6 3 3 5 1 80 Bronchitis 109 13 8 6 10 6 8 6 166 Pneumonia 258 34 31 26 45 35 36 25 490 Overlying 88 10 3 2 0 4 3 — 110 Other Causes 226 19 14 22 47 23 16 19 386 Totals 1,874 187 141 140 188 181 158 112 2,981 33 During the same period the births have numbered 26,838, and the resulting average infant mortality for the last 13 years has been 111.1 per 1,000 births. The infant deaths in 1923 were chiefly in the following streets:—Lever Street (9), Gee Street (7), Northampton Street (4), Cumming Street (3), Moreland Street (3), Richard Street (3), Southampton Street (3), Affleck Street (2), Busaco Street (2), Goswell Road (2), Galway Street (2), Hermes Street (2), Henry Street (2), Myddelton Street (2), Penton Street (2), President Street (2), Risinghill Street (2), Seward Street (2), Winchester Street (2), Wynyatt Street (2). Infant Mortality by Districts.—The infant mortality rates for the period 1909—1923 arranged according to districts are given in the subjoined table. Infant Mortality, 1909-23. Year. The Borough Clerkenwell St. Lukes. St. Sepulchre 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 1915 128 119 144 111 1916 124 127 120 62 1917 118 116 138 0 1918 110 119 95 111 1919 89 90 84 166 1920 74 70 82 105 1921 92 93 90 83 1922 82 85 75 154 1923 61 37 23 0 34 In 1923 the infant deaths were in Clerkenwell 68, in St. Luke's 44, and in St. Sepulchre 0 deaths. TUBERCULOSIS. Tuberculosis.-The voluntary notification of Pulmonary Tuberculosis and of Tuberculosis of other parts of the body associated with discharges was adopted by the Finsbury Borough Council in 1900. Now by the Public Health(Tuberculosis) Regulations, 1912, all forms of Tuberculosis are compulsorily notifiable from and after the 1st February, 1913. The following information is of interest as throwing some light on the approximate duration of cases of Tuberculosis after notification:— 1920. 1921. 1922. 1923. Number of deaths from Tuberculosis 132 134 121 103 Number of cases notified only a death 39 40 11 3 Number of cases notified within a month of death 12 7 13 11 Number of cases notified within 1 to 3 months of death 12 15 5 11 Number of cases notified within 3 to 6 months of death 8 21 12 6 35 Tuberculosis of the Lungs.—The notifications and deaths of Finsbury cases of Phthisis since 1901 are appended:— Phthisis Notifications and Deaths, 1901-1923. Total No. of Primary Notifications. No. of Cases notified per 10,000 of inhabitants. Total 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 2.22 1904 210 21.6 251 2.54 1905 178 18.5 215 2.24 1906 217 229 232 2.45 1907 217 232 243 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 438 496 160 1.81 1913 421 49.7 151 1.78 1914 382 45.9 151 1.78 1915 315 40.9 153 1.95 1916 272 33.6 150 2.02 1917 306 44.9 165 2.42 1918 257 38.6 152 2.28 1919 265 33.8 114 1.51 1920 201 25.6 106 1.33 1921 213 27.7 1l6 1.51 1922 14O 18.2 102 1.33 1923 150 19.4 90 1.16 36 The actual number of notifications received in 1923 was 536, but of these many refer to the same patient. There were 150 primary notifications, of which 25 were from Poor Law sources, 79 from hospitals and dispensaries, and 46 from private doctors. In reference to the 25 Poor Law cases there were also received 43 re-notifications and notices of admission and discharge. This means that many of the Poor Law cases were notified on an average twice, 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. Ninety-five gave a Clerkenwell address, 52 lived in St. Luke's, and 3 in St. Sepulchre. How many of the whole number are Finsbury Cases— Adopting the definitions given in previous reports, the cases may be grouped as follows:— 1. Finsbury cases by residence and infection 110 2. Finsbury cases by infection 20 3. Finsbury cases by residence only 5 4. Not Finsbury cases 15 150 The cases which may be definitely associated with the Borough are the first two groups, and amount to 130, that is 86 per cent. of the whole number. Distribution by Streets and blocks of dwellings.— The largest numbers were notified from the following places:— Gee Street 5, Southampton Street 5, Ironmonger Street 4, Pentonville Road 4, Risinghill Street 4, Lower Charles Street 3, Lever Street 3, Mitchell Street 3, Northampton Road 3, Richmond Street 3, Warren Street 3, Wynford Road 3, Albert Street 2, Affleck Street, 2, Baldwin Street 2, Bastwick Street 2, Cyrus Street 2, Coldbath Square 2, Donegal Street 2, Margaret Street 2, President Street 2, Penton Street 2, Rahere Street 2, St. John Street 2, Wharton Street 2, White Lion Street 2 cases. 37 The notifications from the various grouped buildings and dwellings were:—Northampton Buildings 3, Norman Buildings 3, Cavendish Dwellings, 2, Winton Houses 2, Compton Buildings 1, Corporation Buildings 1, Farringdon Road Buildings 1, Guinness Buildings 1, Peerless Buildings 1, Pollard Houses 1, and in the Peabody Buildings as follows:—Farringdon Street 3, Dufferin Street 2, Errol Street 1, Guest Street 1, Roscoe Street 1. The Homes and Tenements of the Patients.-Out of the whole number, excluding lodging houses, 28 were one-roomed tenements, that is to say, in these tenements the patient and family lived and slept in one room only. Fifty-eight were tworoomed tenements, the rest had three to six rooms. Three of the tenements were overcrowded. Twenty-five tenements had only one cupboard each for food. Nine had no cupboard accommodation at all. These are very unsatisfactory conditions for a phthisical household. When the household utensils of the patient are kept in the same cupboard as the other household utensils; when his clothes are hung on the common peg; when he uses the common towel and washing basin, the common knives, forks, spoons, cups, saucers and glasses, when the utensils of the household are all washed together indiscriminately, the spread of infection from the patient to his family is greatly favoured. When in addition to these, the tenement is overcrowded, the conditions for promoting the disease are as pernicious as they possibly can be. It is difficult to conceive a condition which favours the spread of the infection more than overcrowding. In phthisical families, the abatement of overcrowding is insisted upon forthwith. Twenty-two tenements were on the list of houses let in lodgings, 22 tenements were in the so-called "model" buildings, which, with their common landings and their many points of contact between the families who occupy them, are only too well adapted for the spread of phthisis. 38 Homework was not carried on in the home of any case notified. Of the houses occupied by the patients, five were used for the sale or preparation of food products, one was also a milk shop. It is very unfortunate and most undesirable that these consumptive patients should have to do with the handling or manufacture of articles for human consumption. There is not, however, at present, any practical method of preventing or otherwise satisfactorily dealing with their employment in such occupations. 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:—Rooms dirty 17, water closet choked 3, manhole cover broken 2, roof leaky 3, dustbin absent 2, sink waste pipe broken 1, washhouse dirty 1, flooring broken 3, yard paving broken 2, water closet flush pipe broken 1, water closet with insufficient flush 1. The patient's bedroom.—The number of beds in the patient's bedroom, the number of persons occupying the patient's bedroom, and the number of families affected are given in the attached table:— Persons and Beds in the Patients' Bedrooms. One Bed. Two Beds. Th'ee Beds Persons. Families. Persons. Families. Persons. Families. 1 44 1 0 1 0 2 54 2 6 2 0 3 12 3 9 3 0 4 2 4 16 4 0 6 0 5 3 5 1 6 0 6 1 6 0 7 0 7 0 7 0 39 One patient gave a common lodging house address, but he could not be traced there. Only 44 patients out of 150 were able to have a bed and bedroom all to themselves. In the 68 other households, where only one bed was available, 84 persons slept in the same bed with the consumptives, and were consequently exposed to infection. This number refers to those families which only possessed one bed. In addition to these, there were 88 persons who occupied the same bedroom as a phthisical patient, and in some instances the same bed. Twelve bedrooms were dark, or had insufficient light. The ventilation was insufficient in one other bedroom, and six bedrooms were stuffy. The defective ventilation and absence of ventilation greatly facilitates the spread of the disease. It is difficult sometimes to suggest means by which it may be overcome—occasionally owners have been induced to place gratings in the walls. Unfortunately, even when they have been provided, the occupants have been known to stuff the aperture with rags, and thus render these gratings useless. All the bedrooms occupied by consumptives had fireplaces. It is extremely important that every room used for human habitation should have a fireplace or means of communication with the outer air in addition to the window frame. Four bedrooms had dirty walls and ceilings; of these, one was also verminous. In 14 instances the patients were said to be of careless habit. In one room the bedding was fouled by the patient's sputum. The Kitchen.—In 78 instances or 52 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. Six of the kitchens were dirty and one was also verminous. 40 The presence of dirt and 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. Other Measures.-Enquiry is made in every infected household for missed or suspected cases of tuberculosis. Cases so found are urged to seek medical advice and treatment, and are informed where and how to obtain them. The free bacteriological examination of sputum is offered to all medical men who practise in the Borough. In 1923 the number of specimens examined was 120, of which 30 gave positive results. Free systematic and periodic disinfection is offered after the notification of patients. In 1923 the rooms, bedding, feeding utensils, towels, handkerchiefs and linen were disinfected in 66 households. A special leaflet of instruction in disinfection is left in every home where a case of phthisis occurs and also after a death from phthisis, and its terms are explained. 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. Contacts.—The number of close contacts, that is, the number of persons of the same households as the consumptive patients was 517. The number of remote contacts, that is, the number of persons living in the same houses as the consumptive patients, but not being members of the consumptives' families, was 1,107. Deaths.-In 1923 the number of Finsbury persons who died of phthisis or pulmonary tuberculosis was 90. In addition to these, 9 died from tuberculous meningitis, and 4 from other forms of tuberculosis. The deaths from all forms of tuberculosis were 103. The deaths for previous years are given in the subjoined table:— 41 Phthisis Deaths and Death Rates, 1901—1923. 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 2.45 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 1.81 1.016 1915 153 63 1.95 1.185 1916 150 33 2.02 1.259 1917 165 40 2.42 1.406 1918 152 40 2.25 1.543 1919 114 15 1.51 996 1920 106 26 1.35 887 1921 116 18 151 .854 1922 102 19 1.33 .889 1923 90 13 1.16 .836 The Phthisis Death Rate for 1,000 inhabitants in London during 1923 was .97. 42 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. Allotted to districts:—59 deaths from phthisis belonged to Clerkenwell, 30 to St. Luke's, and one to St. Sepulchre. Of the whole of the 1,006 deaths in Finsbury in 1923, 8.9 per cent. were due to phthisis, as against 10.3 per cent. in each of the years 1922 and 1921 respectively. Seventy-four per cent. of the total deaths due to phthisis took place between 25 and 65 years. Other Forms of Tuberculosis.—The number of new cases notified was 45, derived from Clerkenwell 27, St. Luke's 17, and St. Sepulchre 1 case. The parts chiefly affected were the hip 3, neck glands 8, knee joint 2, ankle 4, peritoneum 2, wrist joint 2, pleura 4, Fallopian tubes 2, meninges 2, and spine 7 cases. Twenty-five patients were bedridden at the time of notification; in these, notification was a very late incident in the disease. Nine were infants under school age. Five were examples of "open tuberculosis" associated with external discharges, and therefore presumably infectious to those brought into contact with the sufferers. Fourteen were school children. Of the whole number, 30 were considered to be Finsbury cases by residence and infection, 8 Finsbury cases by infection, and the rest, 7 in number, were not Finsbury cases. Nine of the patients lived and slept with their families in one room. One of the tenements was overcrowded. The close contacts in the same families included 102 adults and children over school age, and 74 other children. The kitchen was used for sleeping purposes in 28 instances. In 8 cases the mother was the chief or only wage earner. The deaths included 9 from tuberculous meningitis (Clerkenwell 6, St. Luke's 3, St. Sepulchre 0), and 4(Clerkenwell 3, St. Luke's 1, St. Sepulchre 0) from forms of tuberculosis other than phthisis. The Finsbury Death Rate from all forms of tuberculosis in 1923 was 1.33 per 1,000; the corresponding rate for England and Wales in 1923 was 1.121, and for London in 1923 was 1.16. 43 Tuberculosis Dispensary.—A Tuberculosis Dispensary for Finsbury residents was established at the Royal Chest Hospital, City Road, on December 1st, 1916. During 1923 new patients numbering 429 were examined; of these, 154 were under 15 years of age, the rest above that age. Those suffering from tuberculosis were 99(63 insured and 36 not insured). The suspects were 16(10 insured and 6 not insured). The total number of patients, new and old, who attended during the year was 816. The total attendances were 3,920. The visits to the homes of the patients were 3,234. These visits were nearly all made by the nurse attached to the dispensary. 128 persons were recommended by the Tuberculosis Officer for sanatorium or h'ospital treatment. In the great majority of these cases institutional treatment was given. The total number of contacts examined at the Tuberculosis Dispensary was 223. The number of "X"-ray examinations was 6. The number of sputum specimens examined by the hospital pathologist was 438. The Tuberculosis Officer made 285 visits to the homes of the patients. Under the scheme formulated by the Ministry of Health in Memorandum 30/T the Tuberculosis Officer undertakes, for the Ministry of Pensions, the examination of ex-Service men. The number of reports furnished to the Ministry of Pensions in respect of such examinations during 1923 was 310. The fees paid for this work are handed over by the Borough Council to the Tuberculosis Officer. INFECTIOUS DISEASE. Small Pox—One case was notified during 1923. The patient was removed to the isolation hospital and duly recovered. Cases were notified in adjacent boroughs, and the names and addresses of many persons living in Finsbury, and who had been in contact with persons suffering from smallpox, were notified to me. Each contact was kept under observation during the incubation period. All necessary precautions were taken, disinfection of 44 premises was carried out; free supplies of calf lymph were maintained for use in emergency, and were distributed free to medical practitioners in Finsbury upon request. Typhus Fever.— No case was notified in 1923. Cerebro Spinal Fever.—There were three notifications, with two deaths. The homes of all the patients were visited, and a sanitary survey made of the premises. Notices were served where necesary, and patients' rooms, personal clothing and bedclothes disinfected. The contacts were examined bacteriologically by an expert appointed by the London County Council. The results were all negative. Anthrax, Glanders and Hydrophobia.--No cases were notified during 1928. Encephalitis Lethargica.—Two cases were notified during 1923. One death was reported. Polio Myelitis and Polio Encephalitis.—One case of Acute Poliomyelitis was notified in 1923. Measlas.—357 cases of measles were notified during 1923. Measles was compulsorily notifiable in Finsbury from 8th January, 1923(except cases occurring within two months of any notified case in the same household) by Order made by the Ministry of Health at the suggestion of the Borough Council. Comparative Table.—In 1928 measles caused 10 deaths(all of these were under 5 years), and whooping cough 7 deaths. These two diseases are extremely fatal to children under 5 years. 45 Deaths in Children under 5 years, 1901-1923. Period. Measles. Whooping Cough. Small Pox. Scarlet Fever. Diphtheria. Typhoid Fever. 1901-5 278 211 13 53 80 — 1906-10 347 202 — 39 80 1 1911-15 366 169 — 27 48 — 1916 36 12 — 1 11 — 1917 117 10 — 2 7 — 1918 51 54 3 9 1919 9 — — — 11 — 1920 10 12 — 4 27 — 1921 3 13 — 6 22 — 1922 29 22 — 2 20 — 1923 10 7 — 2 8 — Totals 1,256 712 13 139 323 1 From this table it appears that the deaths in 23 years due to scarlet fever, diphtheria, enteric fever and smallpox, all taken together, numbered 476, to whooping cough 712, and measles 1,256. In children under five years, therefore, it is seen that measles kills over two-and-a-half times the number of children whose deaths are caused by smallpox, scarlet fever, diphtheria, and typhoid all included. Whooping cough causes one-and-a-half times the number of deaths accredited to the other four named infectious diseases. Diphtheria-The number of cases notified was 814, all of which were admitted to isolation hospital. Of these, 31 were subsequently sent home as not suffering from diphtheria, one case proved to be scarlet fever, and 22 other cases were diagnosed as tonsillitis, leaving 260 true cases of diphtheria. There were 8 deaths, so that 2.5 per cent. of all the patients died. The number of cases is 92 less than last year; the number of deaths is 23 less than in 1922. 46 The particulars of cases in previous years are appended:— 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. 1911 159 17 10.7 18.1 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 1915 116 9 7.7 15.0 1.17 1916 162 14 8.6 21.8 1.88 1917 144 8 5.5 21.1 1.17 1918 110 10 9.1 16.5 1.50 1919 1l6 11 7.9 15.4 1.46 1920 215 27 12.5 27.4 3.45 1921 324 36 11.1 42.2 4.69 1922 352 31 8.8 45.8 4.03 1923 263 8 3.07 33.6 1.03 All the cases were investigated, and the source, if possible, was ascertained. The premises were inspected, and notices were served for sanitary defects. The drains were carefully examined, and in nearly every case tested. Three of the cases were contracted in hospital after the patients had been admitted suffering from diseases other than diphtheria. There were nine "return" cases. Cases Discharged oured from Hospitals.-A few days after their return home from fever hospitals, all patients are examined very carefully, and a record kept of their condition. A leaflet is given to the patients, 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. 47 The cases discharged from hospital with nasal discharge, ear discharge or sore throat were, after their return home, examined by the Medical Officer of Health, and swabs taken from the throats and noses. Five such cases occurred in 1923. Thirtyfive patients upon discharge had enlarged neck glands. Two patients had sores on the lips and face. Swabs are examined bacteriologically free of charge for medical men by the Public Health Department. In 1923, 464 specimens were submitted, with positive results in 82 instances. A supply of diphtheria anti-toxin serum is kept at the Public Health Office, and is available gratis for doctors on request, for the treatment of Finsbury patients prior to removal to hospital or for patients treated at home. A fee of 2s. 6d. is paid for each case where the serum is injected between 9 a.m. and 9 p.m. A fee of 5s. per case is paid where the serum is injected after 9 p.m. and before 9 a.m. Scarlet Fever.—There were 183 notifications of scarlet fever. Of these 18 were subsequently sent home as not suffering from scarlet fever, leaving 165 true cases. There were 2 deaths. Two cases were treated at home; suitable measures were taken to ensure the isolation of the patients. The rest, 163 in number, were treated in hospital. 48 The particulars of previous years are subjoined:— Year. No. of cases. No. of Deaths. Case Mortality. No. of Deaths per 100 cases No. of cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 1911 171 6 3.5 19.5 .6 1912 159 5 3.15 18.4 .58 1913 251 5 1.93 29.6 .59 1914 438 6 1.36 52.6 .72 1915 390 10 2.56 50.7 1.30 1916 178 2 1.12 23.9 .26 1917 99 2 2.02 14.9 .29 1918 I48 3 2.02 22.2 .45 1919 235 0 0.00 31.2 0.00 1920 418 4 0.96 53.4 .51 1921 586 6 I .02 76.4 .78 1922 335 4 1.19 43.6 .52 1923 165 2 1.21 21.3 .25 Nine patients developed scarlet fever while they were detained in hospital for other causes. There was 1 "return" case Two cases were not discovered until some days after the rash had appeared. They were then peeling. All 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. Cases discharged for Home.—In Finsbury every case discharged from the fever hospital is 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 49 to children who develop a discharge from the nose or ears after their return home, to children with adenoids, to children with enlarged neck glands, and to children with sores on their lips, ears, or on their faces. Twenty-eight such cases were kept under the observation of the Medical Officer for periods varying from one to four weeks before they were certified as being free from infection and fit to resume school attendance. One patient, upon discharge from hospital, had a " rash." Enteric Fewer—In 1923 the number of cases notified was 2, with no deaths. The numbers in previous years are given in the accompanying table :— Enteric Fever, 1911-1923. Year. No. of cases notified. No. of Deaths. Case Mortality No. of Deaths, per 100 cases No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 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 O.O 1914 15 2 12.5 1.8 O.24 1915 3 1 33.3 0.39 O.13 1916 4 0 0.0 0.53 O.O 1917 2 1 50.0 0.9 0.14 1918 2 0 o.o 0.30 O.OO 1919 7 0 O.O 0.93 0.00 1920 5 0 00 0.64 0.00 1921 5 0 0.0 0 .65 O.OO 1922 4 1 250 0.52 0.13 1923 2 0 0.0 0.26 O.O Cases of typhoid fever, on their discharge from hospital, are visited and examined. A leaflet of instruction is left with them, and special attention is directed to its more important clauses, 50 which are orally explained at some length. The faeces and urine are examined bacteriologically 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 Royal Institute of Public Health, 37, Russell Square, London, W.C. Telephone address "Museum 766." In 1923 three specimens of blood were received for diagnosis; all gave negative results. Trench Fever, Dysentery, Malaria.—No cases were notified during 1923. HOUSING. Number of new houses erected during the year: — (a) Total nil (b) As part of the Municipal Housing Scheme nil 1. Unfit dwelling houses:— Inspection (1) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 212 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 0 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 51 (4) Number of dwelling-houses (exelusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 0 2. Remedy of defects without Service of Formal Notices Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 6 3. Action under Statutory Powers : (a) Proceedings under Section 28 of the Housing Town Planning &c. Act, 1909. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit:— (a) By Owners 0 (b) By Local Authority in default of Owners 0 (3) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declaration by owners of intention to close 0 (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1721 (2) Number of dwelling-houses in which defects were remedied:— (a) By Owners 1721 (b) By Local Authority in default of Owners 0 (c) Proceedings under sections 17 and 18 of the Housing Town Planning, &c. Act, 1909: 52 (1) Number of representations made with a view to the making of closing orders 0 (2) Number of dwelling-houses in respect of which closing orders were made 0 (3) Number of dwelling-houses in respect of which closing orders were determined, the dwelling-houses having been rendered fit 0 (4) Number of dwelling-houses in respect of which demolition orders were made 0 (5) Number of dwelling-houses demolished in pursuance of demolition orders ... 0 Basement Dwellings.—A special investigation was made to determine approximately the number of basements, i.e., "underground rooms" in Finsbury used for dwelling purposes. The following is a numerical summary of the results of the investigation :— (a) Number of basements in the borough used for dwelling purposes 2,670 (b) Number of basement dwellings in the borough with ceilings at or below street level 642 (c) Number of basement dwellings in which the width of area in street does not exceed 3 feet 824 (d) Number of basement dwellings in which the width of area in street does not exceed 4 feet but does exceed 3 feet 653 Overcrowding.—In view of the popular misconception current as to the meaning of the term "overcrowding," the following is of interest:— There are three definitions of overcrowding:— 1. The definition of the Registrar-General, which regards a house or tenement as overcrowded if, on an average, there are more than two persons per room. Thus, if a tenement contains Ihree. rooms and is occupied by seven persons, then the occupancy 53 is one of 2.3 persons per room, and is an overcrowded one by the terms of this definition. This definition takes no account of the size of the rooms and has no validity in law. 2. Houses let in lodgings.—For houses let in lodgings, and entered, as such by act of the Borough Council in the official Register of Houses let in Lodgings, the standard of overcrowding is a numerical one, and depends upon the available cubic capacity and use of the inhabited room or rooms. In registered houses let in lodgings, if a room is used for living or sleeping only, it must provide at least 300 cubic feet of free air space for each adult occupying it. If used for living and sleeping, there must be provided at least 400 cubic feet of free air space for each adult. Children ten years of age and under must have half these amounts of free air space in each case. It must be noted that these standards do not apply to every house in Finsbury which is occupied by members of more than one family. They apply exclusively to those houses let in lodgings which are on the official register—to these and to these only. 3. Ordinary dwelling houses, not registered as "Houses let in lodgings," and occupied by one family or by many families. In order to sustain successfully in law a case of overcrowding in these houses it is necessary to prove that the overcrowding is injurious or dangerous to the health of the inmates. As a general rule this is a very difficult thing to do—often it is impossble. The courses then open are:— (a) To ask the magistrate in assessing the overcrowding to apply to the house or tenement the numerical standards given above in (2). Magistrates are very reluctant to take this course—a course which will certainly render the judgment null on appeal. (b) For the Borough Council to register the impugned house as a house let in lodgings, provided it is occupied by two or more families. 54 HOUSING IN FINSBURY. In a return made to the Ministry of Health in 1919, many streets and areas were mentioned as districts which in normal times would receive attention from a housing standpoint, and made the subject of representation, but in respect of which action was then being postponed in view of the difficulty of re-housing the tenants who would be consequently displaced. These streets and areas were the following:— Amias Place, Bakers' Row, Baltic Street, Bastwick Street, Bath Court, Berkley Court, Berkley Street, Busaco Street, Caroline Place, Chapel Place, Chapel Row, Charlotte Place, Church Row, Claremont Mews, Coleman's Buildings, Compton Passage, Crawford Passage, Dingley Road, Douglas Place, East Place, Easton Place, Easton Street, Elizabeth Place, Emmen's Buildings, Europa Place, Eaulkner's Alley, Field Place, Fletcher's Row, Francis Court, Frye's Buildings, Gee Street, Great Bath Street, Hatfield Street, Holford Mews, Hallett's Place, James' Gardens, Jay's Buildings, Kemp Place, Eambs' Buildings, Leicester Place, Lewin's Court, Ludlow Street, Macclesfield Place, Margaret Street, Mason's Place, Medcalf Place, Memel Street, Merlin's Place, Mount Zion, Mulberry Place, Murton Street, Parr's Place, Prospect Row, Pump Court, Richmond Street, Rodney Place, Rosoman Mews, St. Helena Street, Seabrook Place, Shrewsbury Court, Sidcup Place, Sidney Grove, Sidney Place, Sidney Street, Stewart's Place, Thornhill Cottages, Union Place (Clerkenwell Close), Union Place (Glasshouse Yard), Wardens Place, Warner Street, West Place, Whitehorse Alley, Winchester Cottages, Wither's Place, Young's Buildings. This list is not exhaustive. It contains the places which five years ago were considered to be amongst the worst. Since then, however, the Finsburv housing problem has become more acute than ever. There are two considerations involved. On the one hand there are in the borough a large number of poor people, some living almost from hand to mouth, who apparently cannot possibly pay an economic rent for houses, or tenements in houses erected at the present day. 55 Above this stratum of the submerged, there is a class of tenant who could pay an economic rent with difficulty, and by stinting himself and family of food or clothing-. From this standpoint the Finsbury housing problem is the problem of poverty and its alleviation or prevention. On the other hand, land in the borough is so dear that when the Council propounded a housing scheme in 1919, it was rejected by the Ministry of Health on this head alone, apart from other considerations. Further, the trend of circumstances seems to move to make Finsbury into a place of warehouses and workshops. Gradually, but surely, dwelling houses are being emptied and being turned into factories and business premises. This gradual de-population of the borough is borne out by the records of the last three censuses. The populations of Finsbury at the various censuses were as follows:— Census Year .Population of Finsbury. 1901 101,463 1911 87,923 1921 75,995 The tendency of these conversions of dwelling houses is to create in the immediate neighbourhood a zone of reactionary crowding or overcrowding. The same result has been observed to take place when a piece-meal attempt is made to deal with housing by erecting model dwellings or "buildings" in paracentral London. The hard-working labourer, the honest workman, are joined by the ne'er-do-well and the indigent, and they all move to the favoured district to "squat" under uncomfortable conditions, waiting for a vacancy and for the earliest opportunity to apply for it "on the spot. It is quite obvious that the best solution will be for the Metropolitan boroughs and the London County Council in conference to tackle the housing problem as a whole. For one borough to deal with its own inhabitants has doubtless its 56 accredited sphere of usefulness, and such action is much to be commended; but in the long run it is a palliative, which deals only with the pressing and urgent needs of the moment. It does not take the long view. Finsbury pays its proportion of the housing rate made by the London County Council, but apparently very few of its inhabitants have been taken into the houses erected by the London County Council in "outer" London, possibly because they cannot afford to pay the rents demanded. In the meantime the housing shortage in Finsbury is poignant, distressing and insistent. The massed grouped "model'' dwellings appear to be the only type which, if erected in the borough, offer the prospect of an economic return on the money expended. And if the Council erected such dwellings, then by gradually housing and accommodating the displaced tenants by a series of grading or zoning operations done in stages, the improvement effected might eventually, to a slight extent, even reach and touch the poorest resident. One index that the housing problem is now more acute in the borough consists in the relatively large number of letters and personal applications now received by the* Public Health Department, asking for help in finding rooms or to be referred to suitable housing agencies with vacant tenements. Ten or twelve years ago these applications were quite rare; now they are very common. And they sometimes disclose an amount of discomfort, and of distress which seriously indict the housing policy of the nation; and of fortitude under suffering, which do honour to the name of Briton. Here are extracts from two letters:— "I am writing on behalf of the shorted of houses. I have a wife and 8 children in two very small rooms measuring 12 feet by 10, owing to the lack of spase 4 of my children sleep in one bed 4 in the other. 1 have been within 20 miles of London to seek for a place. I have got my name on the 57 L.C.C. books for this last 12 months. I have not heard from them. I am willing- to pay any reasonable rent and I am in very good work and wages. I have been at my place seven years. I have try every Borough and Town Hall in London were they are Building but they tell me that they cannot except anybody from other Boroughs. I have had half my furniture in the back garden untill neighbours have been kind enough to take it in. I myself work night work. I start at 12 o'clock at night. I have to get up at 7 o'clock to let my children go to bed. They are boys and girls ages from 12 years to 17 have to sleep together together in one bed. I myself have to sleep in a arm chair when I do not have to go to work and my wife and children are getting in ill health through overcrowded. Sir, I hope you could help me out of this very bad circumstances as I am at present for the Childrens sake." The above facts were confirmed when the occupant was visited by the Public Health Staff. Eventually the Public Health Department was able to find accommodation for the family in a house at Ilford. Pardon me, I ask if it is possible for you to inform me how I should enquire to register, to obtain a L.C.C. house or flat. At present 1 only rent one room which has to suit all my requirements i.e., six of us sleeping and eating in the same room. It comes very hard on me as I am unable to get my proper rest during the day, whilst I am night work. In the fine weather I do not mind as my children can play outside the street door, but in wet and cold weather the poor little souls must play in the room. I have searched all over London for rooms and have failed. In the house where I am residing for the present, there as been four cases of measles within the last 6 weeks and one of my youngsters is still suffering from the effects. My eldest girl won a junior County Scholarship last year and it seems a pity to think that when she comes from school of an evening, that she cannot sit down in quietness to do her 58 homework. I am all out to see my children get on in this world, but whilst I am confincd in this room it means that things will not go along as smooth as if I had 3 rooms. My work is regular I being a Police Officer and if you can help me in any way of obtaining rooms I would be extremely obliged to you." Here are two examples which illustrate the breaking up of corporate family life: — 1.—A family consisted of the parents, boys 21 years, 18 years, and a girl 15 years. They occupied one back room of 723 cubic feet capacity. It was much overcrowded. There was one double bed. The father was in permanent employment and had been in the same situation for 29 years. All the family took their meals here together, but separated at night. The girl went to sleep with her sister-in-law in Hackney. One boy slept at Rowton House. The eldest boy slept at a fruiterer's in Hoxton. When the boys fell out of work they slept on the floor in the tenement occupied by their parents. 2.—A family was ejected from a house where they occupied 3 rooms because, so it was alleged, the landlord wanted the tenement for his own son. The family consisted of the parents, 1 adult boy, 2 adult girls, one child of school age, and one child 3 years old. After ejection the family took their meals "where they could." The parents and youngest child slept at night in a room occupied during the day by an old lady who went elsewhere to sleep a sort of Box and Cox arrangement. One girl slept in another room at the top of the same house. The two boys slept elsewhere at two distinct and separate addresses. There is nowhere in Finsbury to which people without a habitation can turn so as to get reasonable and comfortable accommodation at short notice for a moderate rent. 59 Another feature of the housing stress in the borough consists in the use of basements for dwelling1 purposes. There are in Finsbury 2,670 basements used to this end. Of these 042 have their ceilings at or below the level of the adjoining street. In 824 basements the width of the area in the street is 3 feet or less. In 653 basements the width of the area lies between 3 and 4 feet. At the 1921 census, there were in Finsbury 4,917 families, out of a total number of 20,005 families, occupying one room each per family. These 4,917 families comprised 9,296 persons. Amongst them were :— 39 families of 6 persons each; 8 families of 7 persons each; 1 family of 8 persons; 2 families of 9 persons ; 1 family of 11 persons; all occupying one room per family. There were 7,253 families (26,332 persons) occupying each 2 rooms per family. On the statistical basis of the number of rooms per person, Shorcditch was the worst in London, followed closely by Finsbury. The numbers were: Shorcditch .65 rooms per person, Finsbury .67 rooms per person, Southwark .73 rooms per person, Bermondsey .75 rooms per person, and Poplar .76 rooms per person. In the whole of London, taken by wards, there were 4 wards where these factors were less than .60 per person. One of these was in Stepney, three in Finsbury. On the Registrar-General's standards, the percentage deficiency of rooms was greatest in Finsbury. Overcrowding is defined by the Registrar-General as including only those houses or tenements where there is on an average more than 2 persons per room. In this connection the following figures have been extracted from the Census Report for 1921 (County of London, Text page 12). 60 Population living more than 2 persons to a room given as the percentage of the total private family population. Percentages 1921 1911 Finsbury 34 39.8 Shoreditch 32 36.6 Stepney 29 34.9 Bethnal Green ... 27.8 33.2 South wark 23.5 25.8 Bermondsey 23.2 23.4 St. Pancras 22.4 25.5 Poplar 21.2 20.6 Holborn 19.8 25.6 Islington 19.4 20.0 St. Marylebone 17.9 20.7 Kensington 16.7 17.1 Paddington 15.4 16.2 Hammersmith 13.8 14.2 Greenwich 13.8 12.1 Chelsea 13.7 14.9 Fulham 13.1 14.6 Deptford 12.8 12.2 Camberwell 12.8 13.5 Lambeth 12.7 13.6 Battersea 12.4 13.3 Hackney 11.5 12.4 Westminster 10.1 12.9 Stoke Newington 8.1 8.8 Woolwich 7.8 6.3 Wandsworth 6.8 6.3 City of London 6.6 12.3 Hampstead 6.5 7.1 Lewisham 4.7 3.9 61 The question is often asked what constitutes a reasonable and comfortable standard of housing. We are living in a democratic and progressive age in the midst of intense industrial and agricultural unrest. The workers, the populace, assert their claims for better and for decent housing. And all right-thinking municipal councils agree that the claim is a just one, to be met by the provision of dwellings which promise health, comfort, privacy, security, and due consideration for morality. These matters have been much discussed in municipal and public health circles and the following suggestions are advanced as tentative reasonable minimum standards in this connection. A house or tenement should: For Security: Be damp proof, rain proof and wind proof. Have locks or bolts on every door. Have facilities for fire escape or (and) fire prevention. For Privacy and Morality: Have every bedroom self-contained—that is, no bedroom is to be approached through another bedroom. Have a sufficiency of bedrooms to prevent culpable sex promiscuity. Permit of home isolation—that is, the tenement as a home should be sufficiently secluded from other tenements to allow the discussion of family affairs in privacy. Have sufficient accommodation so that the mother's confinement should not take place in the living room required for the use of other members of the family. For Health and Comfort: Have hot water provided for domestic purposes. Have a scullery with a sink waste. Have facilities for cooking. Have a larder. Have accommodation for illness. 62 Be so constructed as to hinder the lodgment of vermin, prevent the accumulation of dust, and facilitate domestic cleansing. Have a clear space at the back and front of the house. Have the forecourt and backyard properly paved. Have means of access for coal carts, dustcarts and trademen's carts. Have an open space available for children's play. Have facilities for chopping domestic firewood. Have a place for storing perambulators, bicycles, gardening tools and other household accessories. Have at least three rooms. Meanwhile, the housing problem in Finsbury awaits a fair, just and equitable solution. The foregoing pages have been written with a view to bringing to the knowledge of the Council some of the considerations and some of the facts which affect it. But the problem still remains and probably will remain for many years. The commendable course would appear to be for the Borough Council to take action to meet any very urgent and pressing needs while the larger issue was left to the County Council and to the Metropolitan Boroughs in conference and association. Houses Let in Lodgings.—These are houses let out in tenements or occupied by members of more than one family. Many of these houses, though not all, are subject to special byelaws and are entered on the Council's register of houses let in lodgings. The bye-laws, which apply solely to the registered houses let in lodgings, often called "registered houses" for short, provide for: 1. The prevention of overcrowding and the provision of adequate air space in each room, whether the room be used solely for living purposes, for sleeping purposes, or for both living and sleeping. Definite standards apply in each of these three cases. 2. The prevention of sex promiscuity. 63 3. The imposition of an annual cleansing throughout the whole house in the early months of each year. It is not all the houses let in lodgings that are placed on the Council's register, but only those that are considered to require special supervision and regulation. Thus, houses are registered for the following reasons: — (a) The low general character of their environment—the surroundings are of the slum type and coloured with the characteristics of the slums. (b) The nature and age of the property and the large number of sanitary notices attaching to it. (c) The dirty, slatternly character of the occupiers. (d) The difficulty of fixing the responsibility for sanitary defects and nuisances disclosed at frequent inspections. (e) The difficulty or delay frequently experienced by ihe sanitary officers in getting nuisances abated or remedied—the taint of the "tardy landlord" and "hospital job" type of repairs. (f) The frequency with which the tenements are found overcrowded or crowded just below the limit. (g) The prevalence of sex promiscuity. (h) The frequency with which the houses are found, on inspection, to be dirty. (i) The prevalence of tuberculosis in several of the occupants, or for any other suitable reason which marks the houses as calling for special supervision. The houses let in lodgings, at present on the Council's recfister, are as follows:— Albert Street: 9, 11, 13, 14, 18, 19, 21, 22, 23, 24. Albion Place: 12. Aylesbury Street: 18, 19, 25. Baldwin Street: 2, 4, 6, 7, 10, 11, 15, 16, 17, 18, 21, 23, 25, 26, 28, 30, 38, 53, 55, 56, 57, 58, 59, 60. Baltic Street: 16, 18, 20, 22. Baron Street: 6, 17. Baker's Row: 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19. Bartholomew Square: 16. 64 Bastwick Street: 13, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77. Hath Court: 1, 2, 3, 4. Benjamin Street: 12, 13, 14. Berkley Court: 3, 4, 5, 9, 12, 13, 14, 15. Berkley Street: 5, 7, 13b. Bowling Green Lane: 13, 14, 31, 32. Busaco Street: 35, 36, 37, 38, 39, 40, 41, 42. Castle Street: 3. Central Street: 126, 129, 130, 131, 132, 133, 134, 135, 136, 137, 139, 141, 144, 145, 150, 157, 158, 159, 163, 166, 168, 170, 171, 172, 174, 176, 178. Chapel Row: 15. Chapel Street: 17, 18. City Road : 328, 336. Clerkenwell Close: 4, 11, 12, 13, 25, 26, 43, 54. Clerkenwell Green: 4. Coldbath Square: la, 2, 3, 4, 5, 6, 7, 8, 9, 10. Collier Street: 3, 5, 9, 11, 14, 16, 18, 55, 57, 59. Compton Street: 11, 12, 16, 21, 22, 55. Corporaton Row: 35. Crawford Passage: 8, 9, 10, 11, 12, 13, 19. Cumming Street: 7, 9, 11, 13, 14, 15, 18. Cyrus Street: 4, 6, 20, 30. Dingley Place: 9. Dingley Road: 27. Domingo Street: 3. Donegal Street: 21, 23, 25, 27, 29, 31, 33, 35, 42, 44, 46, 50, 52. Douglas Place: 4, 5, 6, 7, 8, 9. Easton Place: 1, 2, 5, 7, 8, 9. Easton Street: 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 37. Europa Place: 1, 2. Farringdon Road: 164, 167. Featherstone Street: 17, 19. Fletchers Row: 1, 2, 3, 5. Francis Court: 2, 3, 4, 5. Gal way Street: 3, 15, 17, 26, 47, 53, 55, 57, 59, 61, 63, 65, 67, 69, 71. Gee Street: 1, 3, 5, 7, 9, 15, 17, 21, 23, 25, 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 53, 55, 57, 63, 65, 67, 69, 71; 6, 28, 34, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68. Gloucester Street: 11, 30. Godson Street: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. Golden Lane: 58. Goswell Road: 176. Great Bath Street: 4, 6, 10, 11, 12, 14, 17, 18, 19, 20, 21, 22, 25, 26, 28, 29, 30, 31, 32. Halletts Place: 6½, 7, 10, Hatfield Street: 24, 26, 28, 30. Hermes Street: 10, 11, 12, 13, 14, 15, 28, 29, 31. 65 Ironmonger Row: 36, 38, 88. Ironmonger Street: 3, 4, 9. James Gardens: 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 14, 15. Jerusalem Passage: 10. King's Cross Road: 112, 114, 116, 118, 120, 122, 124, 126. Lamb's Buildings, Bunhill Row: 1, 2. Leicester Place: 2, 4. Lever Street: 21, 23, 25, 27, 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 55, 57, 59, 61, 65, 69, 71, 73, 79, 161. . Leverington Street: 5. Little Northampton Street: 11, 12, 13, 14, 15, 16, 17. Little Sutton Street: 5, 19, 21, 23 , 25 , 27, 29, 31, 33 , 35, 37. Lizard Street: 17, 21. Lloyds Row: 2, 3, 6, 21, 26, 27, 28, 29, 32, 33, 34, 35. Locks Gardens : 17. Lorenzo Street: 3, 4, 5. Macclesfield Street: 31, 43, 49, 51, 53, 55, 57. Malta Street: 5, 9, 16, 20. Margaret Street: 3, 4, 5, 85. Memel Street: 10, 11, 12, 17, 18, 19. Merlins Place: 2, 3, 5, 6, 7. Mitchell Street: 31, 33, 35, 37, 44. Moreland Street: 67. Myddelton Street: 73. Murton Street: 1, 3, 5, 7, 9, 11, 13, 15, 17, Northampton Road: 5, 7, 9, 11, 13, 15, 17, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 51, 53, 55, 57, 59, 61, 63, 65; 2, 4, 8, 16, 18, 20, 22, 24, 26, 28, 32, 34, 36, 38, 40, 42. Northampton Row: 7, 9, 11, 12, 13, 14. Northampton Street: 21, 52. Norway Street: 2, 3, 10. Peerless Street: 4, 6, 12, 16, 18, 20, 22, 34, 36, 38, 40, 46, 48, 52, 54, 56. Penton Grove: 18, 19. Pentonville Road: 122, 158, 160, 162, 175, 181, 183, 185, 189, 191, 193, 195, 197, 199, 201, 207, 209, 211, 213, 215, 217, 219, 221, 223, 225. Penton Street: 36, 62. Percival Street: 48. Playhouse Yard: 8, 10, 12, 14, 18, 20. President Street: 28, 34. Pine Street: 2, 4, 6, 9, 11, 13, 14, 18, 21, 22, 26, 32. Radsworth Street: 14, 16. Radnor Street: 3, 4, 5, 8, 44, 50. Rahere Street: 14, 24, 27, 28, 38, 39, 40, 41, 43, 44, 46, 47, 48, 50, 54, 58, 60, 62, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75. Red Lion Street: 46, 54. Richmond Street: 27, 28. 66 Rising-Hill Street: 1, 3, 5, 7, 11, 13, 15, 17, 23, 25, 27, 43, 45, 47, 49, 51, 53, 55, 57, 2, 4, 6, 8, 10, 12, 14, 18, 20, 22, 22a, 22b, 22c, 36, 38, 40, 42, 44. Rodney Street: 3, 5, 7, 9, 11, 13, 17, 19, 25, 27, 29, 31, 33, 35, 37, 28, 30. Rosoman Street: 15, 17, 21, 25, 27, 41, 100, 104, 107, 109, 111, 117, 119. Sadler Street: 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 5, 7, 9. Shrewsbury Court: 13. St. Helena Street: 4, 6, 37, 41, 45, 47, 51, 53, 55, 67. St. James' Street: 2, 3, 4, 5, 9, 12, 13, 14, 15, 16, 17. St James' Walk: 5, 15, 17, 21, 25. St. John's Lane: 6. St. John's Square: 53, 54. St. John Street: 128, 130, 140, 228, 181, 263. Sans Walk: 10. Sekforde Street: 24. Sidney Street: 4, 5, 6, 8. Skinner Street: 11. Smith Street: 7, 28, 32. Southampton Street: 36, 44, 46, 48, 50, 52, 54, 76, 78, 80, 92, 104, 106. Stewarts Place: 2, 3, 4, 5. Union Place, Glasshouse Yard: 2, 3, 8, 12. Vineyard Walk : 2, 3, 9, 14, 15. Vineyard Gardens : 9, 14, 15. Wardens Place : 2, 3, 4. Warner Street: 27, 29, 31, 39, 43, 45, 47. Warren Street: 1, 2, 3, 4, 5, 6, 12, 43, 44, 50, 51, 52, 53, 54. West Place : 3, 4, 5, 6, 7. White Conduit Street: 2, 15, 16, 19, 20. Whitecross Street: 100, 102, 113, 132, 164, 163, 165. Whitehorse Alley: 7, 8, 9, 11, 12, 13, 14, 15. White Lion Street: 13, 14, 22, 23, 30, 31, 34, 35, 36, 38, 39, 41, 77, 78, 79, 82, 92. Wilmington Square: 24. Wilmington Street: 2, 4, 5, 6. Winchester Street: 58. Woodbridge Street: 4, 6. Wynford Road: 74, 100. Yardley Street: 17. Youngs Buildings, Old Street: 2, 3, 4, 5. 67 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, and of suspected cases of smallpox during the incubation period. The "shelter" was used on three occasions only in 1923, by two families from Finsbury, and one family from Holborn. The Holborn Metropolitan Borough is allowed to use this shelter by an agreement made between the two Boroughs, dated 4th October, 1911, and terminable at the pleasure of either Council. The payment by the Holborn Borough Council was increased from £10 per annum to £37 10s. per annum as from 1st August, 1922. The disinfector is a Washington-Lyons high-pressure steam apparatus. In 1923, 860 separate rooms were disinfected, of which 118 were for measles, 44 after notification of phthisis, 20 after deaths from phthisis, 2 after enteric fever, 169 after scarlet fever, 328 after diphtheria, 25 after other diseases, 135 on account of vermin, and 19 on request. In addition, bedding and mattresses were steam disinfected for the following institutions:—The Claremont Hall Creche, St. Barnabas Home, and St. Mark's Hospital. Altogether 11,473 articles were disinfected in connection with cases of infectious disease and phthisis; these were chiefly mattresses, pillows, bolsters, sheets, blankets, quilts, and wearing apparel. Besides these, 315,643 articles of wearing apparel were disinfected for City firms at the price agreed upon, prior to exportation to South Africa. The conversion in 1922 of the disinfecting apparatus from the direct-fired type to a separately steamed apparatus, with upright boiler, has proved to be very satisfactory. The Ford ton chassis, fitted with two interchangeable bodies for the conveyance of articles before and after disinfection, has continued to be of great advantage in the speedy handling of clothing and bedding. 68 FOOD INSPECTION. Certification of Moat 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 Canada, to the United States of America, and to the rtiillippine Islands. Twenty-four certificates were issued in 1923. Meat and Food Inspection.—The Borough Council 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 paid special attention to the meat deliveries in the wholesale market in Charterhouse Street, St. John Street and Cowcross Street, all adjacent to Smithfield Market. All the unsound, diseased, and decomposed meat is removed under agreement by Messrs. C. and B. Webb, fat melters, 155, Bow Road, London, E. Diseased and Unsound Meat.—The total amount confiscated in 1923 was over 73 tons. A full description of the various items is given in the following table:— 69 Summary of Unsound Meat, Offal, and other Food Stuffs confiscated in 1923. Diseased. Sides of Beef 2 Sheep's Livers 10,650 Quarters of Beef 70 ,, Lungs 499 Pieces of Beef 2 ,, Plucks 17 Carcases of Veal 1 Pigs Heads 2 Sides of Veal 4 ,, Plucks 3 Beef Heads 119 ,, Livers 53 ,, Tongues 152 Boars Heads 1 ,, Livers 1,040 Carcases of Goats 1 „ Lungs 368 Turkeys 4 ,, Hearts 7 Sides of Bacon 1 Carcases of Mutton 1 Tons. Cwts. Qrs. Lbs. Total Weight 21 14 0 9 Decomposed. Quarters of Beef 19 Beef Kidneys stone 56 Sides of Beef 2 ,, Milts 563 Pieces of Beef 429 Pigs Heads 2 Carcases ot Mutton 89 ,, Plucks 768 Pieces of Mutton 1 ,, Livers 1,471 Carcases of Lamb 77 ,, Lungs 7 Sides of Lamb 1 Calves Livers 114 Piects of Lamb 6 Barrels of Pigs Plucks 1 Pieces of Veal 1 ,, Sausage Casings . 45 Quarters of Veal 3 Hampers of Calves Plucks . 1 Carcases of Pork 2 Offal 6 Sides of Pork 2 Bags of Sheeps Hearts 2 Sides of Bacon 2 ,, ,, Plucks 6 Pieces of Bacon 429 ,, Beef Livers 10 Hams 16 ,, „ Skirt 14 Beef, Lungs 496 ,, ,, Sweetbreads . 5 ,, Livers 332 ,, Pigs Plucks. 29 ,, Hearts 385 ,, Sheeps Brains 2 ,, Heads 49 ,, Beef Loins 1 „ Tongues 160 Crates of Rabbits 288 ,, Tails 272 ,, Geese 3 ,, Tripes 1,063 ,, Fowls 51 „ Kidneys 173 ,, Calves Plucks 5 ,, Skirts 56 Tripe stone 107 „ Feet 4 Bags of Tripe 3 „ Brains, Sets 150 Boxes of Weasand Meat 3 B xes of Beef Kidneys 12 Partridges 7 ,, ,, Tails 21 Pheasants 11 ,, ,, Livers 12 Turkeys 3 ,, ,, Skirts 2 Guinea Fowls 5 Tongues 1 Wood Pigeons 17 Boxes of Sheeps Kidneys 47 Cases of Cheese 10½ ,, Pigs Kidneys 27 Gouda Chees's 26 ,, Beef 3 Cases of Apples 1 Sheeps Heads.. 276 Baskets of Pears 69 ,, Hearts 672 Barrels of Apriects 16 ,, Plucks 725 Potatoes cwt. 16 ,, Lungs 250 Tins of Corned Beef 3 ,, Livers 2,364 Trunks of Haddock 1 „ Tongues 12 Tons. Cwts. Qrs. lbs. Total Weight (Decomposed) 52 3 1 1 Total Weight (Diseased) 21 14 0 9 Grand Total Weight 73 17 1 10 70 Prosecutions.—There were no prosecutions in respect of unsound meat in 1923. Foreign Beef Tongues.—During the year, 21,805 parcels of frozen Argentine beef tongues were delivered to the cold-air stores in Finsbury. A special examination was made of 10,950 of these tongues, with the result that 54 or .49 per cent, were found to be slightly affected with actinomycosis. Slaughter Houses.—In Finsbury there are two slaughter houses. The owners' name and addresses are as follows:—Mr. Thomas Webb, 191, Goswell Road. Mr. J. A. Mobbs, 14, Penton Street. The slaughter houses were inspected in 1923 on 65 occasions. No defects were ascertained and consequently no notices were served. There are no knacker's yards in the Borough. Slaughter of Poultry By-Laws.—By-Laws made by the London County Council for regulating the business of a siaughterer of poultry came into force during 1923. The Inspectors, however, reported that there were no premises in the Borough to the occupier of which the by-laws applied. Food Storage.—The storage places of food stuffs sold by street traders in the Borough of Finsbury are frequently visited and the goods therein are inspected by the Sanitary inspectors and also by the Meat Inspector. As a rule very small stocks are kept. It is the practice, as far as possible, to sell off all goods daily, principally to save depreciation in value. Many of the stall-keepers have suitable places for storing their goods; some, however, have no stores or have unsuitable storage accommodation. 71 Much has been done during the past year to effect improvement in this respect. It is hoped that, as a result of the recommendations of the Departmental Committee on Meat Inspection, additional powers will soon be given to sanitary authorities for dealing with the storage and sale of all food-stuffs, intended for human consumption. The Sanitary Inspectors state that the food-stuffs sold by street traders and others in the Borough are stored in many cases in dwelling-houses in rooms specially set apart for this purpose, and also in sheds in the yards of dwelling-houses. These may be looked upon more or less as suitable places of storage. However, fruit and vegetables have occasionally been found in a few cases in places used as common stabling for a pony. And sometimes vegetables have been found thrown loose in the yards and washhouses of dwelling-houses. The appropriate administrative action has been taken in such cases. Generally speaking, on the whole the storage places have been found to be clean. If registration were provided, as recommended by the Departmental Committee appointed by the Minister of Health in June, 1920, in its report of April, 1921 (as applied to butchers' meat for the food of man) and were extended so as to include all food-stuffs, the control of the premises or places used for the storage of fruit and vegetables from a sanitary point of view would be comparatively easy. MILK SHOPS. At the end of 1923 there were on the register 151 milk shops. These were inspected on 177 occasions. 45 notices were served for the abatement of various nuisances. There were no prosecutions. 72 SALE OF FOOD AND DRUGS ACT. The number of samples taken in 1923 was 602. The results are given in the table below:— Articles. Total No. of Samples. Samples Adulterated. Articles. Total No of Samples. Samples Adulterated. Milk 257 9 Cornflour 1 0 Butter 125 0 Sugar 2 0 Cocoa 54 0 Tea 5 0 Coffee 26 0 Ground Ginger 2 0 Coffee and Chicory 5 0 Lard 28 0 Pepper 6 0 Margarine 21 0 S. R. Flour 14 0 Custard Powder 6 0 Mustard 5 0 Beef Suet 1 0 Rice 32 0 Jam 1 0 Oatmeal 9 0 Lemonade Crystals 1 0 Tapioca 1 0 | Total 502 9 The statistics for previous years are sub-joined: Year. Total examined. Genuine. Adulter, ated. Percentage of adulterated samples. 1910 600 541 59 9.83 1911 600 549 51 8.50 1912 601 567 34 5.65 1913 601 570 31 5.1 1914 596 563 33 5.5 1915 600 566 34 5.6 1916 600 565 35 5.8 1917 601 544 67 9.5 1918 600 553 47 7.8 1919 591 569 22 3.7 1920 603 587 16 2.6 1921 602 588 14 2.3 1922 602 590 12 2.0 1923 602 593 9 1.5 73 In respect of the milk supplied in 1923 there were four prosecutions. To the vendors of the remaining 5 adulterated samples, cautionary letters were sent. In each of these latter cases the milk was only slightly deficient in the non-fatty solids. The Milk (Special Designations) Order, 1923.—One application under the order was received during 1923 for a dealers licence to use the designation "Certified." The application was granted. Public Health (Milk and Cream) Regulations. 1912.— Action taken in Finsbury during 1923 under the above-mentioned regulations is shown by the following tabic:— Nature of Sample No. of samples examined No. of samples containing above prescribed limit of preservative Cream 0 0 Milk 257 0 FACTORIES AND WORKSHOPS. The number of workshops and workplaces on the register at the end of 1923 was 2,221, compared with 2,146 at the end of 1922. During the year under review, 140 entries were removed from the register owing to the closing of premises, the conversion of workshops into factories by the introduction of some form of mechanical power, or to the removal of the occupiers to other places of business. The number of workshops and workplaces newly registered was 215. The factories on the register at the end of 1923 numbered 1,618, compared with 1,491 at the end of 1922. The list included 10 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. 74 The following lists indicate the workshops, workplaces and factories on the registers and show the large variety of manufacturing processes which are carried on in Finsbury:— Factories. — Cardboard box making 42, instrument, jewellery, etc., box making 15, packing case making 24, brushes and combs 8, repairs and decorating 6, patent flooring 1, tarred felt making 1, clocks and watches case making 13, making and repairing 8, cloth shrinking 4, disinfectants and soaps manufacturing 5, drug grinding 1, druggists sundries 12, making and repairing addressing machines 1, making and repairing motors and cycles 18, making and repairing domestic machinery 4, making and repairing springs 1, making and repairing typewriting machinery 2, making and repairing models and patterns 7, smithing and wheelwrights' work 12, making and repairing sewing machines 4, making and repairing electrical goods and machinery 13, general engineering 102, artificial flower making 13, embroidery 13, making and importing fancy goods 11, ivory and tortoise-shell working 5, leather goods 37, pipe making and mounting 25, toy making 3, walking sticks and umbrellas 40, whip making 1, trouser presses 1, sports goods 11, cleaning feathers 4, dyeing and curling feathers 10, horsehair cleaning 2, cabinet making 24, carpet planning 1, picture-frame making 10, shop fitting 14, upholstery 6, cold storage 7, confectionery 8, drysalting 1, food preparing 28, mineral waters 3, cordial and spirit colouring 1, glass stoppers making 2, glass working 21, sand blasting 2, jewellery making 36, gold and silver refining 2, rouge manufacturing 1, silversmiths 26, steam laundries 4, diamond cutting and polishing 4, glaziers diamonds making 3, brass work 13, coppersmiths 10, engraving and die sinking 22, foundry 9, gilding, plating and polishing 75, general metal-working 21, typefounding 6, wire-working 12, sheet-metal working 13, aerography 1, paint, enamel and varnish making 3, panel and screen painting 2, musical instrument making and repairing 16, scientific instrument making 33, electrical instrument making 4, optical instrument making 17, photographic instrument making 1, surgical instrument making 13, weighing and scales instruments making 8, art publishing 24, envelope and paper bag making 6, gold 75 blocking 4, ink and gum making 8, machine ruling 8, pattern cards 10, printing 134, showcards 2, manufacturing stationers 31, stencil cutting 1, waste paper sorting 1, bookbinding 29, fountain pens 2, making rubber 5, rubber stamp making 3, waterproofing 1, stone and marble working 3, statuary 1. Making wearing apparel as follows:—aprons 4, blouses 46, boots and shoes 11, boot socks and laces 2, children's clothing 17, fur garments 9, glove making 3, haberdashery 4, hat making 28, linen collars 6, neck ties 13, shirt and pyjama making 20, mantle making 41, tailoring 47, skirt making 14, underclothing 24, button making 8. Beer bottling 1, distilling 6, dealing in wines, spirits and tobacco 3, tobacco, cigarettes and cigar making 13, general woodwork 17, hardwood turning 20, saw milling 5, wood cutting 2, electricity generating station 1, hydraulic power station 1, forage cutting 5, packing and forwarding of goods 3, vulcanite and fibre manufacturers 5, cork cutting 2, cutlery grinding 6, van building 3, total 1,618. Workshops-—Cardboard box making 24, instrument, jewellery, etc., box making 29, packing case making 14, making brushes and combs 9, repairs and decoration 46, making clocks and watches cases 20, dial painting 15, making and repairing clocks and watches 114, shrinking cloth 3, cutting and sorting cloth 9, accordian pleating 5, chemical research work 2, disinfectants making 0, drug and chemical making 6, sundries 27, agricultural, 5, cycle and motor repairing 29, electrical 18, fitters' work 2, locksmiths 7, machinists 7, pattern making 1, sewing machines 4, smiths and wheelwrights 3, general 29, artificial flowers making 15, artists' materials 1, art needlework and embroidery 10, basket making 14, leather goods 80, making and importing 22, miniature painting 1, shoe trimmings 3, sports goods 7, ivory working 7, pipe making 3, taxidermy 1, toy making and importing 32, walking sticks and umbrellas 18, wig and costume making 1, soap and perfumery 3, general 22, curling and dyeing feathers 12, blind making 3, cabinet making 59, french polishing 21, making and repairing furniture 20, shop fitting 27, upholstery 15, undertakers 7, picture framing 16. confectionery 11, storage and preparation of food stuffs 55. 76 glass working 27, bottle washing 4, china and glass merchants 3, musical instruments 17, optical instruments 8, photographic 8, scientific 23, surgical 12, weighing machines 3, gold beating 4, gold and silver refining, gold and silver smiths 33, enamelling 3, repairing and making jewellery 88, wholesale and retail jewellers 16, laundries 11, laundry receiving and sorting 17, diamond cutting and polishing 9, general lapidary 3, metal burnishing 6, coppersmiths 9, engraving and die sinking 55, gilding and plating 14, farriers and smiths work 18, sheet metal working 22, wire working 14, general metal work 51. Oil and colour manufacturing 6, sign writing 11, ink, gum and varnish making 8, blacking and polish making 5, japanning 5. Bookselling and publishing 21, card and book edge gilding 12, envelope and paper bag making 6, machine ruling 3, paper storage 14, wholesale stationers 31, waste paper sorting 12, card mount cutting 2, relief stamping 9, rubber goods making 10, stone and marble working 7, statuary 1, blouse making 18, boot and shoe repairing 35, boot and shoe warehouse 8, button making 1, children's clothing 6, corset making 2, furriering 99, glove making 1, hat making 48, mantle making 36, millinery 42, necktie making 6, shirt and collar making 4, tailoring 76, underclothing 12, woollen goods 8, haberdashery 5, cigar making 1, <vine, spirit and tobacrx> storage cellars 8. Firewood chopping 24, timber yards 8, wood turning 7, van building 10, wood carving 6, wood working 16. Hat block making 2, harness making and repairing 7, mat making 1, celluloid 1, forwarding agents 44, hardware manufacturers 23, merchants 67, stabling and garage 57, stores 49, towel supplying 3, cork cutting and working 6, window cleaning 4, rope and twine making 4, ammunition storage 1, dyeing and cleaning 3. Total 2,221. The persons employed in the Factories in Finsbury are approximately males 35,976, females 30,104. In the workshops and workplaces!—males 10,970, females 8,411. These numbers exclude the office "hands" and clerical staffs. During the year, 1846 first visits and 827 re-visits were made by the Council's inspectors to factories and 2,528 first visits and 1,285 re-visits to workshops and workplaces. 77 A summary of the defects or insanitary conditions found is appended:— Summary of Defects and Defaults in Factories, Workshops and Workplaces, for which Notices were served in 1923. Factories Workshops Workplaces Total Animals improperly kept .. 1 .. 1 Absence of water supply .. 5 .. 5 Dampness in walls .. 4 3 7 Drains choked 1 1 .. 2 Drains leaky .. .. 4 4 Dustbins broken or absent .. 10 4 14 Floors insufficiently drained .. 3 2 5 Guttering or rainwater piping broken, leaking or inadequate .. 5 3 8 Manhole covers broken .. .. 1 1 Overcrowding of workrooms .. 1 .. 1 Refuse accumulations 4 14 2 20 Roofs leaky .. 5 2 7 Floors broken .. .. 1 1 Ceilings broken .. 3 •• 3 Sanitary conveniences not separate for the sexes 2 2 .. 4 Sanitary conveniences defective 14 16 8 38 Sanitary conveniences dirty 93 34 9 136 Sanitary conveniences insufficient 1 13 . . 14 Sanitary conveniences unsuitable 29 11 8 48 Soil-pipes leaky .. .. 1 1 Staircases and landings dirty .. 3 2 5 Urinals foul 4 2 1 7 Ventilation of workrooms inadequate or insufficient means of .. 3 .. 3 Waste material improperly stored .. 1 . . 1 Waste pipes choked or leaky 3 4 5 12 Water closets choked 6 10 3 19 Water fittings leaky .. 5 3 8 Workshops or workplaces dirty .. 42 32 74 Yard paving broken .. 1 1 2 Yard walls dirty .. 1 •• 1 Total 157 200 95 452 In connection with these matters 326 intimation notices and 15 statutory notices were served. 78 The Home Office.—Seventy-six notices of occupation were received from the Home Office during the year, and 43 notices of complaint relating to the following matters:— Premises dirty 5 Sanitary conveniences insanitary 26 Absence of separate accommodation for the sexes 2 Water closet accommodation insufficient 5 Water closet accommodation not provided 1 Yard surfaces insufficiently drained 1 Absence of proper water-closet door fastenings 3 The notices sent to the Home Office were as follows:— Abstract of the Factory and Workshop Act not affixed, or wrongly affixed 64 New occupation 53 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) 2,673 145 — Workshops (Including Workshop Laundries) 2,960 151 — Workplaces (other than Outworkers premises included in Part 3 of this Report) 853 45 — Total 6,486 341 — 79 Defects found in Factories, Workshops and Workplaces. Particulars. Found Remedied Referred to H.M. Inspector. No. of Prosecutions Nuisances under the Public Health Acts— Want of Cleanliness 269 255 Want of Ventilation 6 6 Over-crowding 1 1 Want of drainage of floors 5 5 — — Other nuisances 132 132 Sanitary accommodation Insufficient Unsuitable or 39 37 — — Defective 477 472 — — Not separate for the sexes. 29 29 - - Offences under the Factory and Workshop Acts— - - - - Illegal occupation of underground bakehouse (S. 101.) - - - - Breach of special sanitary requirements for Bakehouses (S.S. 97 to 100). - - - - Other offences (excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 958 937 — — There were 21 outstanding matters at the close of the year. OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix abstract of the Factory and Workshop Act (S. 133, 1901) 64 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 43 Reports (of action taken) sent to H.M. spector 43 Other 0 Underground bakehouses (S. 101) in use at the end of the year 27 80 81 HOME WORK, 1923. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107 Prosecutions 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. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecu. tions. 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 I50 245 1248 41 14 172 Boxes, paper 22 0 291 1 0 5 Artificial flowers 14 0 156 6 1 39 Christmas crackers 4 0 128 0 0 0 Sports requisites 2 0 83 0 0 0 None. None. None. None. None None. None. None. None. Brushes 2 0 4 0 0 0 Fancy goods 10 0 58 3 0 4 2 i 4 0 0 0 Feather sorting 2 0 5 3 0 62 Total 208 246 1977 54 15 282 - - - - - - - - - 81 WORK, 1923. Prosecutions OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Failing to keep or permit inspection of Lists. Failing to send Lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecu. tions. None. None. None. None None. None. None. None. — — — — — — - — 82 BAKEHOUSES IN FINSBURY. At the passing of the Factory and Workshop Act, 1901, which introduced new legislation with regard to bakehouses, there were in the Borough forty-six "underground" bakehouses, and twenty-three "above-ground" bakehouses. The definition of an "underground" bakehouse is any bakehouse where the surface of the floor is more than three feet below the surface of the footway of the adjoining street or of the ground adjoining or nearest to the room. Among the new requirements of the Act was that no underground bakehouse could be used unless it was so used on the 17th August, 1901, and that after the 1st January, 1904, it would not be lawful to use any underground bakehouse whenever established, unless the Council was satisfied that it was suitable for the purpose and had given a certificate to that effect. As the result of the additional requirements referred to, and of the enforcement of the regulations made by the Council under the Act to apply to underground bakehouses, two aboveground and six underground bakehouses were closed at that time. Since then further thirteen underground and seven above-ground bakehouses have been closed, whilst five above-ground bakehouses have been opened. The number of bakehouses at present in use in the Borough is:— Underground bakehouses 27 Above-ground bakehouses 19 All the bakehouses in the Borough are periodically inspected by the Public Health Staff and notices served for the nuisances discovered. At premises in Myddelton Street it was proposed by the occupier to establish an underground bakehouse, but the project was abandoned by the occupier after his attention had been directed to the prohibition upon the establishment anew of an underground bakehouse. 83 The bakehouses at present on the register are as follows: Above ground: Clerkenwell Green, 6. Central Street, 89. Chapel Street, 65. Field Place, 13. Helmet Row, 2. Leverington Street, 2. Whitecross Street, 162, 97. Compton Street, 60. Collier Street, 2. Exmouth Street, 32. Goswell Road, 207, 94, 202, 164 Liverpool Road, 7, 43. Penton Street, 18. Wynford Road, 22. Under ground: Amwell Street, 53. Central Street, 29, 124. Chapel Street, 2. Exmouth Street, 17. Goswell Road, 5, 236, 272. King's Cross Road, 92. Northampton Street, 32. Rosoman Street, 51. St. John Street, 56, 365. Tysoe Street, 2 & 4. White Lion Street, 72. Bath Street, 66, 42. Barnsbury Road, 6. Donegal Street, 16. Farringdon Road, 88. Ironmonger Row, 58. Moreland Street, 3 Penton Street, 30. Red Lion Street, 40. Southampton Street, 42. Whitecross Street, 148, 61. RATS AND MICE (DESTRUCTION) ACT, 1919. The methods indicated in my Report in 1921 have been maintained in 1923. COMMON LODGING HOUSES. In 1923 only one common lodging house was licensed in Finsbury as follows:— 57, White Lion Street, James Shuttleworth—98 men. CANAL BOATS ACTS, 1877 TO 1884. During the year 1923 the total number of canal boats inspected was 77. None carried offensive cargoes. 84 The Acts and Regulations were complied with in each instance. The following table gives statistics relating to the inspection of canal boats for the last 5 years. Year. Boats Inspected Persons found on boats. Totals. Registered for Men. Women. Children. 1919 56 92 39 60 191 213 1920 90 165 48 79 292 351 1921 82 137 57 75 269 317 1922 68 117 45 44 206 251 1923 77 171 28 43 242 279 Of the 77 boats inspected 53 were occupied by men only, 6 by men and women, and 18 by men, women and children. The number of children on the boats was 43, of which 22 were of school age and 21 under school age. These children appeared to be well cared for. No cases of infectious disease were notified or discovered in the canal boats, therefore isolation of patients and detention of boats have not been necessary. The men working the canal boats were on strike for 14 weeks during 1923—from May to September. The inspection of Canal Boats is part of the duty of the Sanitary Inspector whose district includes that part of the Borough in which the canal is situated. This year the duties were carried out by Inspector Newdick. There is no separate remuneration for this work. THE MORTUARY. In 1923 the number of post-mortem examinations was 54, the number of bodies brought to the mortuary for the convenience of relatives of the deceased was 145. The number of inquests held in the Borough was 69. The number of bodies received into the mortuary on account of death after infectious disease numbered 4. 85 STAFF OF THE PUBLIC HEALTH DEPARTMENT. I he names and appointments of the various members of the staff are here inserted in accordance with the instructions of the Ministry of Health. Inspectorial. Meat Inspector—G. T. Billing (died 29th December, 1923). Sanitary Inspectors—G. E. J. Davis, C. M. Longden, E. A. Norman, H. Newdick. Workshops Inspectors—R. A. Puckle, H. Clinton. Woman Inspector—Miss M. E. Davies. Clerical. Chief Clerk—E. Q. Bilham. First Assistant Clerk—H. Dewhurst. Second Assistant Clerk—N. C. Turrell. Junior Clerk—G. A. Webber. Office Youth—G. Miller. Mortuary and Disinfecting. Mortuary Keeper and Disinfector—W. Oliver. Disinfectors—J. Campbell, F. Readstone. Motor Driver Disinfector—J. J. Sweet. Maternity and Child Welfare. Superintendent, Maternity Centres—Miss W. C. Chapman. Assistant Maternity Superintendent—Miss S. W. Foucar. Clerk-—L. T. H. Mussett. Dispenser (part time)—Miss K. E. Seabrook. Health Visitors—Misses L. M. Jefferys, E. J. Smith, G. M. Bolton. Centre Cleaners—Mrs. Cunningham, Mrs. Purcell. Dentist (part time, for Maternity and Child Welfare)— Mrs. Marie Verheyden, L.D.S. 86 Assistant Medical Officer of Health (Maternity and Child Welfare)—Miss Isobel M. MacLullich, M.D. (to 30th September 1923). Inspector Billing died at the end of 1923 of pneumonia, following influenza. He had long been ill with diabetes but with careful dieting had been able to perform his duties for the Borough. In Mr. Billing the Council lost a most zealous official and reliable officer, honoured alike by the staff and by the meat traders for his high conception of his duty and responsibility, and for the precision and extent of his knowledge of meat inspection and of the meat trade. WORK OF THE STAFF. The work of the staff is presented below in tabular form:Work of the Sanitary Inspectors. 1923. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Newdick. Totals Houses damp, dirty or dilapidated, remedied 168 120 131 147 566 Doors, windows, floors, walls, ceilings, sashcords repaired 221 154 122 124 621 Overcrowding cases abated in other than Registered Houses 1 .. 3 .. 4 Illegal occupation of underground rooms .. .. 2 .. 2 Water closet defects remedied 172 133 204 161 670 Water closets erected 75 11 53 108 247 Urinal defects remedied .. .. 11 7 18 Urinals erected 5 3 11 16 35 Soil pipe and ventilating shafts erected 26 8 38 34 106 Soil pipe and ventilating shaft delects remedied 2 7 31 3 43 Yard defects remedied 76 49 122 106 353 Waste pipe defects remedied 2 19 20 24 65 Waste pipes erected 31 6 47 35 119 Water cistern defects remedied 13 14 8 10 45 Accumulations of rubbish or manure removed 19 !3 20 7 59 Dung or dust receptacles repaired or renewed 37 42 54 54 187 Drains relaid or amended 58 27 35 42 162 Drains cleared 18 61 40 16 135 Rain water pipes cleared, repaired or renewed 23 14 46 38 121 Water supply to houses reinstated 5 2 1 1 9 Roofs and gutters repaired 125 87 108 62 382 Area defects remedied 4 14 31 8 57 87 Work of the Sanitary Inspectors, 1923—continued. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Newdick. Totals. Washhouse defects remedied 72 60 78 69 279 Animal nuisances abated .. 6 .. .. 6 Floor space unventilated 1 1 .. .. 2 Stables cleansed or repaired .. .. 2 .. 2 Smoke observations 1 .. 10 21 32 Water supply laid on to upper storeys of house 1 1 .. .. 2 Miscellaneous nuisances abated 91 53 20 62 226 Drains tested 78 100 118 46 342 Bakehouses, inspections 16 30 28 32 106 Bakehouses cleansed or repaired 2 7 13 6 28 Restaurants, No. of inspections 50 17 67 69 203 Restaurants cleansed or repaired 7 3 22 13 45 Milkshops, No. of inspections 42 33 43 59 177 Milkshops cleansed or repaired 2 9 12 22 45 Public-houses cleansed or repaired .. .. 5 .. 5 Ice Cream Premises—No. of inspections 58 14 32 20 124 Ice Cream Manufactories cleansed or repaired 4 6 11 5 26 Butchers' shops cleansed or repaired 1 1 1 .. 3 Fish Purveyors' Shops cleansed or repaired 3 .. .. .. 3 Registered Houses—visits of inspection 1103 1123 1516 623 4365 Registered Houses — Overcrowding cases abated 1 .. 4 .. 5 Registered Houses—cleansed 220 180 168 90 658 Registered Houses—Intimation (Cleansing) Notices served 220 187 168 80 655 Registered Houses—Statutory (Cleansing) Notices served 48 28 35 6 117 First visits (complaints, casual visits) 1427 1547 1184 1511 5669 Re-visits 2574 2262 3169 1407 9412 Intimation Notices served 584 5rI 579 397 2071 Statutory Notices served 72 60 84 17 233 Infectious disease investigations 203 250 216 159 828 House inspections 368 347 297 381 1393 House to house inspections 74 75 62 17 228 Canal Boats inspected .. .. .. 77 77 Cowsheds—No. of inspections .. .. .. .. .. Slaughterhouses—No. of inspections .. 32 .. .. 32 Slaughterhouses — No. of notices served .. .. .. .. .. Verminous tenements—No. of Inspections .. .. .. .. .. Verminous tenements cleansed by Borough Council .. • • .. .. • • 88 Work of the Lady Sanitary Inspector, 1923. Visits and re-visits as follows:— Homeworkers 467 Infectious disease investigations 373 Workshops and factories 1,359 Scabies and other skin diseases 356 Other visits 27 Number of notices served 234 Rooms and tenements dirt 69 W.C.'s dirty or defective 97 Yard walls dirty or paving broken 12 Flooring ana sashcords broken 5 Workshops dirty or overcrowded 49 Dustbins dilapidated or absent 3 Roofs leaky 2 Pipes leaky 8 Pipes choked 3 Accumulations of refuse 3 Gully grid absent 2 Rooms verminous 12 Lavatory basins and sinks foul 14 W.C. accommodation unsuitable 7 No intervening ventilating space between W.C's and workroom 8 Matters reported to H.M. Inspector of Factories— No abstract affixed 2 New occupation of premises 2 89 LEGAL PROCEEDINGS UNDER THE SALE OF FOOD AND DRUGS ACTS, 1875 to 1909. Date, 1923. Name and Address of Defendant. Offence. Result. May 10th Richard Haly, 328, Goswell Road For selling milk containing 118 per cent, of added water Fined £2 and 10s. 6d. costs June 5th James Osborne. 8, Bemerton Street, Islington For selling milk 13.3 per cent, deficient in fat Fined £50 and and £5 5s. costs „ 5th Richard Lloyd Lewis, 169, Lever Street For selling milk 12 per cent, deficient in fat Dismissed on payment of £3 3s. costs Mar. 28th Dorothy Edwards, 1, Great Sutton Street For selling milk containing colouring matter Fined 8s. and £1 13s. 6d. costs LEGAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Date 1923. Name and Address of Defendant. Offence. Result. Nov. 6th W. Palmer, 286, Goswell Road Failing to comply with notice requiring abatement of nuisance at 280, Goswell Road Order made for abatement of nuisance with in 21 days and payment of £2 2s. costs Nov. 6th W. J Nicholls, 17, Minard Road, Hither Green, S.E. Failing to comply with notice requiring abatement of nuisance at 59, Bastwick Street Fined 1s. and £2 2s. costs. Nov. 6th W. J. Nicholls, 17, Minard Road, Hither Green, S.E. Failing to comply with notice requiring abatement of nuisance at 61, Bastwick Street Work completed. Summons withdrawn LEGAL PROCEEDINGS UNDER THE HOUSING, TOWN PLANNING, Etc., ACT, 1909. Date, 1923. Name and Address of Defendant. Offence. Result. Jan. 30th Alfred McDonald, 6, Union Place Failing to vacate 6, Union Place, after notice of a Closing Order had been served upon him Warrant of ejectment granted 90 Cases of Infectious Diseasb Notified during the Year 1923. Notifiable Disease. Number of cases notified. Total cases notified in each locality. Total cases removed to Hospital At all Ages At Ages—Years. Clerkenwell Luke St. Sepulchre Under 1 year 1 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 Small Pox 1 — — — — — 1 — — 1 - 1 Cholera, Plague — — — — — — — — — — - — Diphtheria (including Membranous Croup) 311 9 104 148 30 19 4 — 216 95 3 314 Scarlet Fever 183 4 74 88 11 5 1 — 129 52 2 181 Typhus Fever — — — — — — - — - - - - Enteric Fever 2 — — — — — 2 — 2 - - 2 Relapsing Fever, Continued Fever - - - - - - - - - - - - Puerperal Fever 13 — — — 4 9 — — 8 5 - - Cerebro Spinal Meningitis — — — — — — — - - - - - Acute Poliomyelitis 1 — — 1 — — — — 1 - - 1 Ophthalmia Neonatorum 8 8 — — — — - - 7 1 - - Pulmonary tuberculosis 150 1 — 9 40 60 35 5 95 52 3 93 Other forms of tuberculosis 45 — 10 15 12 7 1 — 27 17 1 22 Anthrax — — — — - — — — — - — Glanders — — — — — - — — - - - - Malaria — — — — — - — — — - - - Trench Fever - - - - - - - - - - - - Dysentery — — — — — — — — — - - - Acute Primary Pneumonia 50 — 11 5 9 10 12 3 33 17 - - Acute Influenzal Pneumonia 14 — — — 1 5 7 1 7 7 - - Erysipelas 138 — 7 7 33 54 28 9 109 29 - - Encephalitis lethargica 2 — 1 — — — 1 - 1 1 - - Acute polioencephalitis — — — — — - - - - - - - Hydrophobia — — — — — - - - - - - - •Diarrhoea 139 38 67 7 3 10 5 9 112 27 - - ‡Measles 357 25 224 103 4 1 — — 217 135 5 60 Totals 1,417 85 498 383 147 180 97 27 964 439 14 674 * Notifiable from 2nd July, 1923. ‡ Notifiable from 8th January, 1923. 91 Causes of, and Ages at, Death during the Year 1923. Cause of Death. Net Deaths at the subjoined ages of "Residents" whethar occurring within or without the District. Total Deaths whether of "Residents" or "Non-Residentsp" in the 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 - - - - - - - - - - Small Pox - - - - - - - - - - Measles 10 - 6 4 - - - - - - Scarlet Fever 2 - 2 - - - - - - - Whooping Cough 7 3 4 - - - - - - - Diphtheria and Croup 8 2 2 4 - - - - - - Influenza 14 — — 2 1 1 1 4 5 - Erysipelas 2 1 — — — — — — 1 — Phthisis (Pulmonary Tuberculosis) 90 1 - - 3 16 39 28 3 - Tuberculous Meningitis 9 — 3 2 3 1 — — — — Other tuberculous diseases 4 — 2 — — 1 1 — — — Cancer, malignant disease 116 1 1 — 1 2 11 61 39 — Rheumatic Fever 7 — — 1 4 1 1 — - — Meningitis 4 2 1 1 — — — — — 1 Organic heart disease 117 5 — — 3 4 8 44 53 4 Bronchitis 108 6 1 1 — — 3 38 59 — Pneumonia (all forms) 96 25 16 8 2 2 5 23 15 8 Other diseases of respiratory Organs 8 - - - 1 - 1 4 2 - Diarrhœa and Enteritis 32 23 6 1 — — — 1 1 — Appendicitis and Typhlitis 11 — — 1 3 3 1 3 — — Cirrhosis of liver 5 - - - - - - 3 2 — Alcoholism — — — — — — — — — — Nephritis and Bright's Disease 86 - - 1 3 2 4 31 45 1 Puerperal Fever 1 — — — — — 1 — — — Other diseases and accidents of Pregnancy and Parturition 5 - - - - 1 4 - - 6 Congenital Debility and Malformation, including Premature Birth 29 29 - - - - - - - 24 Violent Deaths, excluding Suicide 31 4 1 2 5 3 3 7 6 11 Suicide 7 — - — - - 2 2 3 - Other Defined Diseases 182 8 6 1 4 7 18 33 105 - Diseases ill-defined or unknown 15 2 2 — 1 — 1 2 7 - Totals 1006 112 53 29 34 44 104 284 346 55 *Cerebro-Spinal Meningitis 2 - 1 1 - - - - - - *Broncho-Pneumonia 57 24 12 6 1 — 2 6 6 7 *Other Pneumonias 39 1 4 2 1 2 3 17 9 1 *These deaths are included in the table above. 92 Infant Mortality, 1928. cause of death 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 under 6 months 6 months and under 9 months 9 months and under 12 mos Total deaths under 1 year Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 .. 1 1 3 Diphtheria and Croup .. .. .. .. .. .. 2 .. .. 2 Erysipelas .. .. .. .. .. .. 1 .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. .. .. 1 .. 1 .. 2 Convulsions .. .. .. .. .. .. .. 1 .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 1 1 3 1 2 .. .. 6 Pneumonia 2 2 .. 1 5 5 5 5 5 25 Diarrhœa .. .. .. .. .. 2 2 1 1 6 Enteritis .. .. .. .. .. 2 6 5 4 17 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis .. .. .. .. .. .. .. .. .. .. Congenital Malformations .. 1 .. .. 1 .. .. .. .. 1 Heart Disease 4 .. 1 .. 5 .. .. .. .. 5 Premature Birth 16 2 3 .. 21 6 1 .. .. 28 Atrophy, Debility and Marasmus .. .. .. .. .. 1 1 .. .. 2 Other causes 2 .. .. .. 2 1 3 2 2 10 Totals 26 6 5 2 39 20 23 16 14 112 Nett Births in the year Legitimate 1,818 Illegitimate 26 Nett Deaths in the year Legitimate Infants 108 Illegitimate Infants 4