THE METROPOLITAN BOROUGH OF FINSBURY. ANNUAL REPORT ON THE Public Health of Finsbury for the Year 1927 BY A. E. THOMAS, M.A., M.D., D.P.H., Medical Officer of Health. Barrister-at-Law. London: Printed by Waterlow & Sons Ltd., London, Dunstable and Watford. 1928. Public Health Committee, 1927-8. Chairman : Councillor E. TROTT, J.P. Vice-Chairman : Councillor S. G. NUNN. HIS WORSHIP THE MAYOR. (Councillor C. J. SABOURIN, J.P.) Alderman Wm. HOWES, J.P. Alderman W. R. PUTTERILL. Councillor Mrs. A. CHAPMAN, J.P. Councillor H. G. DAINTY. Councillor F. T. FOULGER. Councillor Mrs. M. F. GAIGER. Councillor F. HAYES. Councillor T. A. HUTCHINSON. Councillor Mrs. E. J. L. LORD. Councillor A. G. WEBB. Maternity and Child Welfare Committee, 1927-8. Chairman : Councillor Mrs. A. CHAPMAN, J.P. Vice-Chairman : Councillor F. T. FOULGER. HIS WORSHIP THE MAYOR. (Councillor C. J. SABOURIN, J.P.) Alderman W. R. PUTTERILL. Councillor H. G. DAINTY. Councillor Mrs. M. F. GAIGER. Councillor E. TROTT, J. P. Co-opted Members : Lady BARTON. Miss E. F. BOLTON. Mrs. M. G. SABOURIN. Miss M. WILMSHURST. 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. PAGE Statistics 5 Population 6 Births and Birth Rates 8 Maternity and Child Welfare 10 Health Visitation 23 Weighing Centres 23 Grants to Mothers and Children 24 Hospital Treatment 26 Puerperal Fever 27 Maternal Mortality 27 Ophthalmia Neonatorum 28 Deaths and Death Rates 28 Inquests 29 Infant Mortality 30 Tuberculosis 33 Phthisis Notifications and Deaths 34 Other Forms of Tuberculosis 41 Tuberculosis Dispensary 41 Infectious Disease 42 Housing 67 Housing on L.C.C. Estates 68 Disinfection 73 Food Inspection 74 Slaughter Houses 75 Milk Shops 75 Samples for Analysis 76 Offensive Trades 78 Factories and Workshops 78 Homework 84 Rats and Mice (Destruction) Act, 1919 85 Common Lodging Houses 85 Canal Boats 85 Mortuary 86 Staff 86 Work of the Staff 88 Legal Proceedings 91 Statistical Tables 92-94 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1927. STATISTICS.— A summary of the principal facts of the statistics for 1927 is given below : — Area (acres) 587 Estimated civilian population at the middle of 1927 75,500 Finsbury residents in outlying institutions at the end of June, 1927 993 Number of inhabited houses (structurally separate dwellings), Census, 1921 10,889 Number of families or separate occupiers (Census, 1921) 20,005 Rateable value £1,242,657 Sum represented by a penny rate £5,042 Birth rate, Finsbury 19.2 per 1,000 inhabitants. Birth rate, London 16.1 per 1,000 inhabitants. Birth rate, England and Wales 16.7 per 1,000 inhabitants. Death rate, Finsbury 13.4 per 1,000 inhabitants. Death rate, London 11.9 per 1,000 inhabitants. Death rate, England and Wales 12.3 per 1,000 inhabitants. Infant mortality, Finsbury 50.3 per 1,000 births. Infant mortality, London 59.0 per 1,000 births. Infant mortality, England & Wales 69.0 per 1,000 births. Phthisis death rate, Finsbury 1.34 per 1,000 inhabitants. Finsbury death rate from all forms of tuberculosis 1.58 per 1,000 inhabitants. In comparison with the results for 1926, the following matters are of interest :— The number of births and the birth rate are less in 1927. The general death rate is higher in 1927. The death rates for consumption of the lungs and for all forms of tuberculosis are both mure in 1927. The infant mortality is very much lower in 1927. The deaths from cancer, whooping cough, influenza and tuberculosis are more in 1927. The deaths from measles, diarrhoea, premature birth, and heart disease are less in 1927. Diphtheria has been more prevalent than in 1926. Measles has been much less prevalent in 1927. POPULATION. At the Decennial Census made on the 19th-20th June, 1921, the population of Finsbury was given as 75,995. The Registrar- General, 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 1927 was estimated by the Registrar-General to be 75,500, which is the figure used in compiling this report. Estimate of Population 1927. Estimated population 1927. Census population 1921. Census population 1911. Clerkenwell 49,994 50,322 57,121 St. Luke 24,432 24,592 28,976 St. Sepulchre 1,074 1,081 1,826 Totals 75,500 87,923 75,995 The estimate does not include the Finsbury residents detained in the following institutions : —The Holborn Union Institution, la, Shepherdess Walk, (593); the Holborn and Finsbury Hospital, Archway Road, Holloway (227); and the Holborn Schools, Mitcham (173); giving a total of 993. Adding this number to the Registrar- General's estimate 75,500, we get a corrected population of 76,493 for Finsbury in the middle of the current year. 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 1927. 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 16.1 11.9 59 Paddington 15.5 13.5 79 Kensington 15.0 13.8 66 Hammersmith 15.6 13.0 61 Fulham 15.1 66 11.3 Chelsea 13.4 14.1 76 City of Westminster 10.0 12.3 68.6 St. Marylebone 13.2 11.3 59 Hampstead 11.9 12.2 51 St. Pancras 15.5 12.3 62 Islington 18.3 12.3 53 Stoke Newington 14.0 12.2 66 Hackney 15.7 11.6 64 Holborn 11.96 12.5 38 Finsbury 19.2 13.4 50.3 City of London 8.7 11.5 105 Shoreditch 20.6 12.6 74 Bethnal Green 19.6 11.1 57.7 Stepney 18.1 11.6 68 Poplar 19.8 11.8 66 Southwark 19.0 13.4 61 Bermondsey 18.5 12.9 67 Lambeth 16.2 12.4 50.5 Battersea 16.6 12.2 53.5 Wandsworth 13.53 11.3 51 Camberwell 15.6 11.4 52 Depttord 16.8 11.5 58 Greenwich 16.2 10.8 53 Lewisham 15.1 11.0 46 Woolwich 15.9 10.6 42 England and Wales 16.7 12.3 69 BIRTHS AND BIRTH RATES. These are given in the annexed table:— Population in the middle of each year. Corrected Birth Rates. Year. Corrected Births. 1910 88,987 2,833 31.8 87,566 30.6 1911 2,676 1912 86,130 2,579 29.9 84,679 2,494 29.4 1913 1914 83,212 2,558 30.7 76,915 2,192 28.5 1915 1916 80,764 1,926 23.8 1917 75,813 1,572 20.7 1918 74,502 1,275 17.1 1919 78,431 1,582 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 23.9 1924 77,180 1,662 21.5 1925 77,560 1,754 22.6 1926 77,550 1,659 21.4 1927 75,500 1,449 19.2 The rates for the various districts were as follows:- Population. Births. Birth rate. Clerkenwell 49,994 905 18.1 24,432 St.Luke 532 21.7 St. Sepulchre 1,074 12 11.1 The whole Borough 75,500 1,449 19.2 The corresponding birth rates for the rest of the country are attached :— England and Wales 16.7 London 16.1 Finsbury 19.2 107 great towns 17.1 155 smaller towns 16.4 The number of Finsbury births reported as illegitimate was 58. The number of deaths in illegitimate children under one year was two. NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. The statistics for the last five years are given in the accompanying table. Year 1922 1923 1924 1925 1926 1927 Total Birthsnotified 3,510 3,421 3,167 3,362 3,169 2,955 Percentage attended by Doctors 2.4 2.4 3.8 3.5 2.5 2.2 Percentage attended by Midwives 28.4 27.5 29.0 31.2 25.2 28.1 Finsbury Still Births notified 59 51 42 41 47 31 Finsbury Birth registered 1,934 1,844 1,662 1,754 1,659 1,449 The number of Finsbury births notified in 1927 was 1,484. Notifications were received of 15 sets of twins. The percentage of births notified by parents was 8.0, by medical men 2.2, by midwives 28.1, by hospitals, infirmaries and nursing homes 21.8, and by others, chiefly medical students and midwifery students was 39.9 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 1927 the number of instances in which parents omitted to notify was 81. To these a printed form was sent drawing attention to the omission. Pine Street Maternity and Child Welfare Centre. The Pine Street Maternity and Child Welfare Centre was opened by the Marquess and Marchioness of Northampton, April 4th, 1927, and the opening ceremony marked the consummation of a desire, long entertained by the Finsbury Borough Council, to provide the Borough with a new Maternity and Child Welfare Centre embodying in an attractive building the best accommodation and equipment that architectural knowledge and administrative experience can suggest. Historically, it is the culmination of the gradual progression and development of a work initiated by the Borough Council some quarter of a century ago, having for its object the amelioration of the conditions of motherhood and the care and nurture of infant life. How small was the beginning, and how surely and deliberately the work has year by year expanded, may be gathered from the brief chronological narrative which follows. The first modest step was taken in the year 1903, when the Borough Council, impressed with the high infantile death rate of that period, made arrangements for the giving of lectures on infant feeding and domestic hygiene. In 1904 the Council co-operated in the establishment of a milk depot in the Borough, to be managed by a voluntary Committee of medical men, for the sale of specially prepared milk for infants. In 1906 this depot was taken over by the Borough Council as a municipal undertaking. At this period attention was further directed to the educational side of the question. The female Sanitary Inspectors were instructed to visit mothers in their homes and advise them in matters of personal hygiene and the welfare of their babies. A school for mothers, established by a voluntary body, was used as a centre for lectures by, and consultations with, the Council's medical and sanitary officers. The material side was also enlarged by the adoption of special arrangements for the free or cheap supply of dried milk. These provisions remained in force until 1910, when the Council adopted a policy based upon a wider application of educational methods. Two lady Health Visitors were appointed under new legislative authority, with the specific duties of home-visiting, the giving of advice on the proper nurture, care and management of young children and questions of health and hygiene, and enquiring into the causes of infantile mortality. The nuclei of the Maternity Clinics were then formed by the provision of Consultation and Infant Weighing Centres in various parts of the Borough. Then followed official recognition of certain voluntary centres established for the purpose of supplying suitable meals for expectant and nursing mothers. In 1914 came recognition by Parliament of the work of local authorities in this connection by the voting of a money grant towards the cost of that work. In 1915 a further advance was made by the Borough Council in taking over the activities of a branch of the Invalid Kitchens Association established at 162, Lever Street. The operations at this institution were already becoming blended with maternity work, and the Council at once adopted and enlarged this work, particularly on the medical and educational side. Thus was founded the East Finsbury Maternity and Child Welfare Centre, which has remained housed at 162, Lever Street up to the present time. The Council's next scheme will have relation to the provision of a new building for this centre. In 1918, an important step was taken by Parliament in the passing of the Maternity and Child Welfare Act, which required the appointment by a local authority of a Special Committee to deal with motherhood and infancy. One of the first things done by the Committee in Finsbury was to review the needs of the western portion of the Borough, with the result that a municipal centre was established for the Clerkenwell area, at Newcastle Place, Clerkenwell Close. At this period, the work received a further impetus in the decision of the Council to appoint an assistant Medical Officer of Health, whose chief duty was to be the supervision and direction of the Council's Maternity and Child Welfare activities. In 1922, the Clerkenwell Centre was removed from Newcastle Place to a temporary home at the old Sessions House, Clerkenwell Green. The transfer was intended only as a preliminary measure to a larger scheme, which was rendered feasible by the kindness of the Marquess of Northampton, who came forward with an offer of a site as a free gift to the Borough. The site is that upon which this useful building has been erected, and this opportunity is taken by the Borough Council to record their appreciation of His Lordship's generosity. The cost is £7,500, towards which the Ministry of Health has contributed £2,500. When to this actual outlay is added the value of the site, it will be seen that the whole constitutes an important property ; and it may be said that the Council regard it with feelings of gratification as the climax of their work in this area, and with the hope that their effort will prove of lasting and ever-growing benefit to the mothers and infants of the Borough. A word as to the "infantile mortality rate" for the Borough of Finsbury, or, in other words, the death rate amongst infants under 1 year of age. In 1902, this stood, for the Borough, at 154 deaths per 1,000 infants. For the Clerkenwell area, which this new Centre will serve, the average rate at that period was 180 per 1,000. In the year 1927 the rate for Finsbury was 50.3 and for the Clerkenwell area 50.8 per 1,000. The infant mortality for 1927 is exceedingly low, and is a most critical index of the sanitary administration and the public health welfare of the community. The excellence of this result speaks most highly of the care, energy and engaging interest taken in Child Welfare by the Council, the Public Health and Child Welfare Committees. Description of the Building The new building has a frontage of 50 feet to Pine Street and 130 feet to Vineyard Walk, both of which roads will be widened to 40 feet under the re-planning scheme for this area. Spa Playing Fields form the North-eastern boundary, so that the new centre is well placed for light and air. The entrance, facing South-west, is from Pine Street. An entrance corridor 22 feet by 6 feet leads into a large Waiting Hall 40 feet long by 20 feet wide with accommodation for 80 seats. It is lighted by French windows on the South-east side, and by high Clerestory windows along the whole length of the North-west and South-east walls. The French windows open on to a covered verandah where perambulators may be left under the eye of those in the Hall. The Maternity Superintendent lias a room 14 feet 6 inches by 12 feet immediately on the left-hand side of the entrance corridor at the Western corner of the building. Here she can keep an eye on all who come in and out; and she has a large lock-up Store Cupboard opening out of her room. For Mothers who have to leave their babies while being examined, there is a large Nursery 20 feet by 14 ft. 6 ins. at the Southern angle of the building, with three windows facing Southeast and two facing South-west, so that the children get all the sunshine possible. This room, like the Corridor and Hall, has a white tiled dado, which can easily be cleaned down. Off the Nursery is a small sink-room and W.C. for infants. Along the North-west side of the Hall are a series of consulting Rooms —a Receiving Room 12 feet by 12 feet with a Clothes fumigating cupboard, and a bathroom opening out; from this room a door leads to the Weighing Room 13 feet by 12 feet, which again communicates with a Consulting Room 15 feet by 12 feet. All these rooms are top-lighted in addition to windows, so that however much the site is built in on the North, these rooms will always be well lighted. There is a small Laboratory 12 ft. 4 ins. by 9 ft. 9 ins. opening off the Consulting Room, for research work. A wicket window in the Consulting Room allows the doctor to pass prescriptions into a small Dispensary at the North-east end of the Hall; patients return to that end of the Hall and wait their turn at another Dispensary wicket for their medicines, and so pass out at the Eastern end. At the Eastern angle of the building is a Kitchen, where cooking lessons will be given, and where light refreshments will be sold to patients while awaiting their turn. There is a patients' lavatory at the Eastern end of the Hall, and staff lavatories on the Southern side. A staircase at the Eastern end leads down to the Boiler Room and Coal Store, and up to a Caretaker's flat, which consists of Living Room 12 ft. 4 ins. by 11 ft.9 ins.; Scullery, two bedrooms, and a bathroom and lavatory. The Maternity Centre is very solidly built of brick and faced with Crowborough bricks externally, and roofed with "Roman" tiles. The flat roofs and floor of the Caretaker's flat are of fireresisting material. All the doors leading from the Hall are of teak, so as to minimise the cost of upkeep in painting and to withstand the hardest wear. The floors generally are of an asbestic material called "Decolite," but the entrance corridor, bathroom and lavatories, and the kitchen, are tiled. In addition to central heating and hot water boilers in the basement, all rooms have gas fires so that they can be warmed easily during cold spells in the summer months when the heating boiler is not working. At the back of the building is a tar paved playground 50 feet by 40 feet. The Contractors were Messrs. Chessums, Limited, of Imperial Works, Portland Road, Tottenham, N.15, and the Architect was Mr. E. Stanley Hall, M.A., F.R.I.B.A., F.R.San.I., of 54, Bedford Square, W.C.I. The East Finsbury Maternity and Child Welfare Centre, 162, Lever Street.— The work and classes at the Maternity and Child Welfare Centre, 162, Lever Street, in 1927, were as follows: — Monday Sale of Dried Milk 9 a.m. to 10 a.m. Dental Clinic 2 p.m. alternate weeks. Children's Clinic and weighing, 2 p.m. Tuesday Sewing Class, 2, p.m. Wednesday Sale of Dried Milk 9 a.m. to 10 a.m. Children's Clinic and Weighing Centre, 2 p.m. Clothing Club and Mothers' Holiday Fund, 3 p.m. Thursday Dental Gas Clinic, 11 a.m., arranged when necessa ry. Friday Sale of Dried Milk, 9 a.m. to 10 a.m. Children's Clinic and Weighing Centre, 2 p.m. Clothing Club, 3 p.m. Saturday sale of Dried Milk, 9 a.m. to 12 noon Number of individual mothers, children and infants who have attended clinics and classes: — Mothers, Nursing 114 „ Expectant 28 „ of children 1-5 years 34 Children,1—5 years 275 Infants under 1 year 352 Total 803 Children's Clinic.—In 1927 the number of meetings was 103. The patients who attended were :— Children 1—5 years, 275 ; infants under 1 year— 352; the attendances were: children, 1 —5 years 2,206; infants 2,679. Average attendances per clinic : —Children 21, infants 26. Mothers' Clinic.—In 1027 the number of meetings was 48 ; the patients were: —Nursing mothers 114, expectant mothers 28. The attendances were:—Nursing mothers 180, expectant mothers 34. Average attendance:— Nursing mother! 3, expectant mothers 0.7. Dental Clinic.—The number of clinics was 29. The patients were: — Nursing mothers 40, expectant mothers 4, mothers of children under 5 years 34, children to 5 years 22. The attendances were:—Nursing mothers 107, expectant mothers 8, mothers of children under 5 years 103, children 27. Average attendance at a clinic 84. Seven mothers were fitted with dentures from this clinic. These were referred to the Charity Organisation Society, who arranged with the mothers for the reduced cost of the dentures and for weekly instalments to be paid. 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 Pine Street Centre on alternate weeks. Patients were allowed to attend at either Centre. Home visits were paid by the Superintendent:—General visits 177 ; expectant mothers 167. Sale of Dried Mi1k.—1,407 one-pound packets were sold in 1927 at cost price. The number of packets given free by order of the Maternity Committee was 471, at part cost 28. Sewing Class.— In this class mothers were taught to knit or to sew garments for themselves or their children out of their own material or material bought through the Centre at cost price. The number of sewing classes was 50, attendances 576. Average attendance 11. During the class, children and babies were looked after in the nursery. Attendances of children 591. Clothing Club.—This club was held to sell woollen and other garments at cost 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 voluntary helpers, particularly those of the League of Remembrance, that the club continued to be self-supporting. In addition, there were eight other ladies, voluntary helpers, whose assistance extended the work of the Centre. Advice and treatment were given at the clinics held at 162, Lever Street for the following conditions :— Mothers— Post-Natal. General Advice 17, Debility 14, Constipation 11, Dental Caries 10, Cough 9, Anaemia 4, Dyspepsia 4, Headache 2, Heart Disease 2, Subinvolution 2, Mammary Abscess 1, Incomplete Abortion 1, Adenitis 1, Cough 1, Nasal Catarrh 1, Raynaud's Disease 1, Diphtheria 1, Mastitis 1, Tonsillitis 1, Arthritis 1. The following cases were referred to a Hospital or to a private doctor:—Mammary Abscess, Incomplete Abortion, Nasal Catarrh, Dyspepsia, Raynaud's Disease, Diphtheria. The cases of Dental Caries were referred to the Dental Clinic. The case of Diphtheria was notified to the Medical Officer of Health. Mothers Ante-Natal. General Advice 14, Constipation 5, Cough 3, Examination 3, Menorrhagia 1. B Children, 1-5 years. General Advice 300, Cough 112, Malnutrition 51, General Inspection 28, Diarrhoea 27, Impetigo 20, Constipation 19, Bronchitis 13, Rickets 12, Debility 11, Dermatitis 11, Worms 11, Enlarged Tonsils 7, Dental Caries 7, Anaemia 6, Rash 5, Adenitis 5, Blepharitis 4, Coryza 4, Squint 4, Tonsillitis 4, Nasal Catarrh 4, Injury 4, Herpes 3, Marasmus 3, Whooping Cough 3, Hernia 3, Otorrhoea 3, Eczema 3, Phimosis 3, Urticaria 3, Digestive Disturbance 2, Stomatitis 2, Worms 2, Cyst 2, Abscess 2, Chicken Pox 2. Thrush 2, Snuffles 2, Sleeplessness 2, Influenza 1, Adenoids 1, Pemphigus 1, Furuncle 1, Haematoma 1, Vomiting 1, Tongue Tie 1, Teething 1, Jaundice 1, Ophthalmia 1, Exostosis 1, Cold 1, Cardiac Disease 1. The following cases were referred to Hospital:— Enlarged Tonsils, Rickets, Whooping Cough, Squint, Adenitis, Adenoids, Cyst, Otorrhoea, Malnutrition, Abscess, Chicken Pox, Hernia, Worms, Injury, Exostosis, Tonsillitis, Cardiac Disease, Bronchitis. Infants up to one year. General Advice 380, Cough 124, General Inspection 102, Constipation 32, Diarrhoea 29, Digestive Disturbance 13, Malnutrition 13, Impetigo 13, Dermatitis 11, Phimosis 11, Thrush 9, Urticaria 7, Otorrhoea 7, Worms 7, Rickets 0, Marasmus 5, Anaemia 4, Pemphigus 4, Tonsillitis 4, Rash 3, Naevus 3, Debility 3, Coryza 3, Conjunctivitis 3, Pyrexia 3, Bronchitis 3, Indigestion 3, Eczema 2, Abscess 2, Blepharitis 2, Furuncle 2, Hernia 2, Hare Lip 1, Chicken Pox 1, Enuresis 1, Broncho-Pneumonia 1, Intertrigo 1, Whooping Cough 1, Herpes 1, Stye 1, Prolapsus Recti 1, Pavor Nocte 1, Petit Mal 1, Stomatitis 1, Pleurisy 1, Tongue Tie 1, Ophthalmia 1, Sore Throat 1, Nasal Catarrh 1, Sleeplessness 1, Injury 1. The following cases were referred to Hospital:— Abscess, Rickets, Chicken Pox, Naevus, Phimosis, Broncho- Pneumonia, Otorrhoea, Furuncle, Worms, Whooping Cough, Malnutrition, Diarrhoea, Hernia. South Clerkenwell Centre, Pine Street, Clerkenwell, E.C.— The work and classes held at this Centre during 1927 were as follows:— Monday Sale of Dried Milk, 9 a.m. to 10 a.m. Dental Clinic, 2 p.m. to 3 p.m., in alternate weeks. Tuesday Weighing of Children, 10 a.m. Mothers and Children's Clinic, 2 p.m. Clothing Club, 3 p.m. Wednesday Sewing Class, 2 p.m. Thursday Dental Gas Clinic, 11.30 a.m., when necessary. Children's Clinic and Weighing of Children 2 p.m. Clothing Club and Mother's Holiday Fund, 3 p.m. Friday Sale of Dried Milk, 9 a.m. to 10 a.m. Saturday Sale of Dried Milk, 9 a.m. to 12 noon Numbers of Individual mothers,Children and Infants who have attended clinics and classes:— Mothers, nursing 67 „ expectant 10 „ of children, 1-5 years 39 Children, 1-5 years 216 Infants 579 911 Children's Clinic.—In 1927 the number of meetings was 101. The patients who attended were :—Children 1—5 years, 216 infants under 1 year 579. The average attendances per clinic:— children 17, infants 24. B 2 Mothers' Clinic.—In 1927 the number of clinics held was 47. The number of patients was 77 —post natal 67, expectant mothers 10. Attendances at these clinics numbered 155 post-natal, expectant 30. Dental Clinic.—The number of clinics was 41. The patients were : — Nursing mothers 29, expectant mothers 5, mothers of children 1—5 years 39, children 20. Average attendance at a clinic 6. Nine mothers were fitted with dentures at the clinic; six by their own efforts, and with help granted by their approved societies, were provided with dentures; three were referred to the Charity Organisation Society, who in each case arranged with the mother for the payment of part cost of the dentures. 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 162, Lever Street on alternate weeks. Patients were allowed to attend at either Centre. Home visits were paid by the Superintendent. General visits 96, expectant mothers 72. In connection with the dental clinic, 8 visits. Dinners were served to 52 mothers, who made a total of 659 attendances. Sale of Dried Mi1k.— 1,079 one pound packets were sold in 1927 at cost price. The number of packets given free by order of the Maternity and Child Welfare Committee was 643. Five were supplied at part cost. Sewing Class.—Mothers were taught at the sewing class to knit and to make garments for themselves, their husbands, or their children, and special instructions were given as to outfits for expectant mothers. Some provided their own material and to others material was supplied at cost price through the Centres. Forty-seven classes were held, and these were attended by 133 mothers; these made in all 437 attendances. The attendances of children in the nursery on these occasions numbered 455. 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. Advice and treatment were given at the Pine Street Centre, Clerkenwell, for the following conditions: — Babies under one year of age. General Advice 378, General Inspection 134, Cough 57, Constipation 42, Diarrhoea 16, Digestive Disturbance 14, Malnutrition 12, Coryza 12, Hernia 11, Naevus 8, Thrush 8, Dermatitis 7, Marasmus 5, Otorrhoea 4, Rash 4, Urticaria 4, Phimosis 4, Bronchitis 4, Rickets 3, Blepharitis 3, Intertrigo 2, Debility 2, Conjunctivitis 2, Impetigo 2, Eczema 1, Anaemia 1, Pemphigus 1, Abscess 1, Herpes 1, Hydrocephalus 1, Undescended Testicle 1, Caries 1, Ophthalmia 1, Sore Throat 1, Sleeplessness 1, Nasal Obstruction 1. The following recommendations to Hospital were made:— Otorrhoea, Naevus, Abscess, Conjunctivitis, Hydrocephalus, Injury, Nasal Obstruction. Children 1 —5 years. General Advice 209. Cough 86, Rickets 61, Malnutrition 30, General Inspection 19, Sore Throat 15, Debility 12, Constipation 9. Dermatitis 8, Digestive Disturbance 6, Caries 6, Anaemia 5, Impetigo 4, Diarrhoea 4, Worms 4, Coryza 3, Hernia 3, Urticaria 3, Injury 3, Enuresis 3, Adenitis 2, Nervous child 2, Otorrhoea 1, Rash 1, Marasmus 1, Thrush 1, Conjunctivitis 1, Blepharitis 1, Herpes 1, Phimosis 1, Chicken Pox 1, Strabismus 1, Cyst 1, Stye 1, Dentition 1, Anorexia 1, Bronchitis 1, Talipes 1, Diphtheria 1, Septic Finger 1. The following recommendations to Hospital were made: — Rickets, Enlarged Tonsils, Tonsillitis, Phimosis, Blepharitis, Septic Finger, Chicken Pox, Malnutrition, Squint, Abscess, Hernia, Marasmus, Otorrhoea, Strabismus, Cyst, Adenitis, Talipes, Diphtheria, Nervous Child. The case of Diphtheria was notified to the Medical Officer of Health. Mothers, ante-natal. Cough 3, Varicose Veins 2, Constipation 2, Debility 1, Dyspepsia 1. Mothers, Post Natal. General Advice 18, Debility 17, Constipation 9, Cough 4, Headache 3, Dental Caries 2, Menorrhagia 2, Anaemia 2, Diarrhoea 2, Dyspepsia 4, Constipation 2, Sacralgia 1, Varicose Veins 1, Blepharitis 1, Anaemia 1, Deafness 1, Furunculosis 1, Myocarditis 1, Prolapse 1, Dyspepsia 1, Tonsillitis 1, Agalactia 1, Mastitis, 1, Failure of Lactation 1, Urticaria 1, Cold 1, Cervicitis 1, Neuritis 1, Sore Throat 1. The following cases were referred to Hospital:— Heart Disease, Menorrhagia, Deafness, Prolapse. The cases of Dental Caries were referred to the Dental Clinic. During the year the Assistant Medical Officer of Health administered gas at the Centre for extraction of teeth. 11 such gas-dental clinics were held, and gas was administered 97 times, making an average attendance of 8 at these clinics. Lectures on Clothing suitable for infants and toddlers. Infant feeding, Expectant mothers, "The Dummy," and Measles were given to the mothers attending the Sewing Class. Health Visitation. The number of visits paid by the Health Visitors in 1927 was as follows:— Total Visits to Children under 1 year. District. First Births. Total Births. No. 1 139 570 3,471 No. 2 116 408 2,695 No. 3 84 437 3,437 Totals 339 1,415 9,603 The numbers for 1926 were 339 first births, 1,415 total births, and 11,756 visits. In 1927 the total number of Finsbury births notified was 1,484, so that the figures in the preceding table show that during 1927 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 13 sets, or one set of twins for every 114 births notified. 4,285 Visits were paid to Children between 1 and 5 years of age. Weighing Centres : There are two municipal weighing centres in Finsbury, held at the following places:— 162, Lever Street.—Wednesday, at 2 p.m.; Friday, at 2 p.m. Pine Street. —Tuesday, at 10 a.m. and 2 p.m.; Thursday, at 2 p.m. A summary of the meetings held in 1927 is appended:— Attendances. No. of Babies and Children up to 5 years. No. of Meetings. Average Attendance. Centre. Lever Street 103 4,985 48 599 Pine Street 101 4,094 40 579 44 Total 204 9,079 1.178 The number of new babies brought during the year was 549. Of these 438 were solely breast fed, 28 were bottle fed, and 74 breast fed and bottle fed, when they were brought to the Centres. The average gain in weight per week while under observation was 4.4 ounces. The highest weekly average gain was 6.3 ounces. On their first visits 470 babies were fat and plump, 62 were thin, while 9 were wasting. Only 16 per cent. were brought while they were still under the age of 1 month. 33 per cent, attended under three months. The number of premature babies kept under supervision was 10, twins 7 sets. The weights of the children at birth are not always known or 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. 2 Under 4 lbs. 0 2 4 4—5 lbs. 5 2 7 14 5—6 lbs. 27 32 18 77 6—7 lbs. 73 74 63 210 7—8 lbs. 151 137 115 403 8—9 lbs. 140 126 127 393 9—10 lbs. 55 55 64 174 14 18 24 56 10—11 lbs. 11—12 lbs. 5 7 3 16 2 2 Over 12 lbs. 1 5 Totals 471 455 425 1,351 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 for 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. 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 Sub-Committee. 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 milk 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 hour 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 1927, 1,316 applications were received, an average of 110 per month; 355 families received grants in respect of these applications; the largest proportion of applications was made during the March quarter, 1027. Many applications related to both mother and child, and in respect of 1,316 applications 1,447 grants were made. 15 applications were refused for various reasons, for example:—lncome beyond scale approved by the Council; mother not expectant within the prescribed period of three months ; child over five years of age. The grants comprised milk, 29,466 pints, dinners 6,393, and dried milk 1,111 pounds. The majority of grants were free of cost to the applicant. In some cases the applicants paid half the cost of the grant. The net cost to the Council for the grants of milk, dinners and dried milk was £676 18s. 2d. The Ministry of Health refunds one-half of the approved net expenditure in this connection. Of the 355 families who received grants, 96 were in receipt of unemployment benefit ; 93 were in receipt of poor-law relief; 238 of the applicants were Ex-Service men. 26 of the fathers were stated to be " chronic out-of-works " In 42 cases " large families " were reported, that is, families with six or more children. 63 of the applicants were regularly employed and 259 irregularly employed. 5 applicants were in the employ (casual) of the Finsbury Borough Council. Grants were made in respect of 14 illegitimate children. In 9 cases the man and wife were living apart. 6 widows applied for, and received, grants. Of the total 355 families dealt with, 173 lived in one-roomed tenements, 153 lived in two-roomed tenements, and 29 in threeroomed tenements. The rents for unfurnished rooms were as follows : —For one room from 2s. 6d. to 7s. weekly. For two rooms from 3s. to 10s. 6d. weekly. For three rooms from 7s. 0d. to 12s. 6d. weekly. The rents for furnished rooms were :—For one room from 12s. to 14s. weekly. For two rooms from 14s. to 16s. weekly. For three rooms from 14s. to £1 weekly. Hospital Treatment. —The Borough Council renewed their agreement with the governing body of the Infants' Hospital, Vincent Square, Westminster, S.W.I, from 1st October, 1925, for the retention of three 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 £75 per annum retaining fee, and £2 per week per cot when occupied by cases sent in under the agreement. The new agreement terminates on the 1st October, 1928. The cots have been occupied in 1927 by 22 ailing babies. Puerperal Fever. —In 1927 there were 3 notifications, with 1 death. The statistics for previous years are appended:— 1912-21 1922 1926 Years. 1923 1924 1925 1927 Total. Notifications 71 7 13 7 11 3 6 118 Deaths 33 4 1 1 1 1 1 42 The cases of puerperal fever are investigated by the Assistant Medical Officer of Health. The premises are visited, the sanitary defects ascertained, and made the subject of notice for amendment. If the patient is admitted to hospital, the rooms are disinfected immediately after the patient's admission. Maternal Mortality. This measures the death rate of mothers due to and associated with child-bearing. It is expressed as a number per 1,000 births, because it is assumed that each time a birth occurs the mother's life may theoretically be presumed to be in peril. The recent rates for Finsbury are given below: — Finsbury Maternal Deaths. Maternal Mortality Rate. Finsbury Births. Year. 1920 2, 540 3.15 8 1921 1,973 4 2.03 1,934 3.10 1922 6 1923 1,844 6 3.25 1924 1,662 1 .60 1925 1,754 5 2.85 1926 1,659 5 3.01 1927 1,449 4 2.76 The comparison with London and with England and Wales as a whole may be made by means of the attached table : — Maternal Mortalities, 1920-1927, England and Wales. Finsbury. London. Year. 1920 3.15 3.39 4.33 1921 2.03 2.98 3.91 1922 3.10 2.84 3.81 1923 3.25 2.89 3.81 1924 .60 3.08 3.90 2.85 8.19 4.08 1925 1926 3.01 3.35 4.12 1927 2.76 2.91 4.11 It will be noted that in recent years the Finsbury death rates are less than those prevailing in London and England and Wales. This result is probably due to the excellent way in which the Borough is served by the General and Maternity Hospitals, in and near the Borough and by the Maternity Nursing Association. The Council pays for the use of beds for special or necessitous cases of mothers who are confined in the City of London Maternity Hospital. In addition, the Council has an arrangement with the Metropolitan District Nursing Association, 31, Bedford Place, W.C.I, for the nursing of poor lying-in mothers in their homes and of special cases of mothers suffering from the diseases or accidents of pregnancy. Ophthalmia Neonatorum. —Thirty-one cases were notified in 1927. 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. Eight of the patients were sent into hospital; thirteen attended Moorfields Eye Hospital, one attended University College Hospital and one attended St. Bartholomew's Hospital as out-patients. Seven cases were attended at home by private doctors or doctors from institutions. One case was reported from an institution in the Borough. In no case was impairment of vision reported. DEATHS AND DEATH RATES. The number of Finsbury residents who died in 1927 was 1,010 ; equivalent to a death rate for the whole Borough of 13.4 per 1,000 inhabitants living. The death rate for the whole of London was 11.9 per 1,000. The death rates for previous years are given in the attached table. Death Rates, 1912-1927. 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 24.3 22.9 17.4 1918 23.7 1919 15.4 15.8 15.2 9.0 9.2 1920 14.7 14.5 15.4 1921 14.7 14.4 15.4 10.6 1922 16.3 15.9 16.6 23.7 1923 13.0 13.1 12.9 12.7 1924 14.1 14.3 13.6 19.1 1925 13.6 13.3 14.1 16.3 1926 12.9 12.3 13.9 15.4 1927 13.4 13.3 13.1 19.5 The Finsbury deaths were apportioned as follows:—Clerkenwell 667, St. Luke's 322, St. Sepulchre 21 deaths. The comparison of Finsbury with the rest of the country may be seen below :— Death Rates for 1927. England and Wales 12.3 London 11.9 Finsbury 13.4 107 great towns 12.2 155 smaller towns 11.3 Inquests.—During the past year 69 inquests were held in the Borough of which 1 was on the body of a non-resident who died suddenly in the district. Ten were on children under 5 years of age, and 59 on adults and children over 5 years of age. Amongst the causes of death were the following :— Accidental burns 1, accidental scalds 3, accidental drowning 4, accidental falls 9, knocked down by tricycle 1, by motor vehicles 7, by train 1, and by tram 1, suffocated by smoke in room 1, collision of vehicles 1, accidental fracture of leg 1, deaths while under anaesthetic 2, suicide 6. INFANT MORTALITY. The infant mortality of the Borough for 1927 is 50.3. Expressed in popular manner, this means that out of every 1,000 children born during the year, 50 died before reaching their first birthday. The corresponding figures for previous years are annexed: — Corrected Births. Corrected Deaths. Infant Mortality. Year. 1901 3,254 533 163 1902 3,191 558 174 1903 3,162 503 159 1904 3,095 522 168 1905 2,886 148 429 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 1,582 140 89 1920 2,540 188 74 1921 1,973 181 92 1922 1,934 158 82 1923 1,844 112 60.7 1924 1,662 125 75 105 1925 1,754 59.8 1926 1,659 109 66 1927 1,449 73 50.3 The following table compares Einsbury with London and England and Wales generally: — England and Wales 69 Whole of London 59 Finsbury 50 Great towns 71 Smaller towns 68 Amongst the 29 Metropolitan cities and boroughs 3 have an infant mortality lower than Finsbury ; those with lower rates of infant mortality were Holborn, Lewisham and Woolwich. The deaths of infants allocated to the various diseases are given in the following table, which contains the records for previous years : — Infant Deaths, 1911-27. 1911-20 1921-25 Total. Disease. 1926 1927 Measles 137 17 4 0 158 Diphtheria 14 9 0 0 23 Scarlet Fever 3 1 1 1 6 Whooping Cough 87 28 1 3 119 Diarrhoea and Enteritis 469 94 15 13 591 Premature Birth 446 166 33 12 657 Congenital Defects 20 23 1 3 47 Marasmus 170 27 5 2 204 Tuberculous Meningitis 40 2 0 1 43 Other Tuberculous Diseases 38 6 2 2 48 Erysipelas 4 1 1 0 6 Syphilis 63 9 0 0 62 Convulsions 14 5 0 90 71 Bronchitis 146 35 6 2 189 Pneumonia 394 147 19 14 574 Overlying 103 11 0 0 114 Other Causes 335 91 16 20 462 3,393 Totals 2,530 681 73 109 During the same period the births have numbered 33,669 and the resulting average infant mortality for the last 17 years has been 101 per 1,000 births. The infant deaths in 1927 were chiefly in the following streets : Bastwick Street (2), Busaco Street (2), Crawford Passage (2), Farringdon Road (2), Gee Street (2), King's Cross Road (2), Leage Street (2), Risinghill Street (2), Lever Street (2), Seward Street (2), Warren Street (2), Wynford Road (2), Donegal Street (3), Little Sutton Street (4), Macclesfield Street (4), Southampton Street (2). In 1927 the infant deaths were in Clerkenwell 46, in St. Luke's 27, and in St. Sepulchre, 0 deaths. Infant Mortality by Districts. —The infant mortality rates for the period 1909 —1927, arranged according to districts, are given in the subjoined table. Infant Mortality, 1909-27. The Borough. Clerkenwell. St. Luke's. St. Sepulchre. Year. 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 118 112 131 121 128 119 144 111 1915 1916 124 127 120 61 118 116 138 0 1917 1918 110 119 95 111 166 1919 89 90 84 1920 74 70 82 105 1921 92 93 90 83 1922 82 85 75 154 1923 61 58 66 0 1924 75 72 79 153 1925 5908 55.2 66.6 105.3 1926 66 69 62 0 1927 50.3 50.8 50.7 0 TUBERCULOSIS (All Forms). 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 to 1924 1925 1926 1927 Number of deaths from Tuberculosis 596 126 99 114 Number of cases notified only at death 44a 6c 3d 5g Number of cases dying non-notified 120b 14f 17e 22h Number of cases notified within a month of death 50 14 13 11 Number of cases notified within 1 to 3 months of death 55 12 15 16 Number of cases notified within 3 to 6 months of death 4 53 12 11 Of the numbers given above, those deaths which occurred in poor law institutions are as follows : —a, 32 ; 6, 65 ; c, 5 ; d, 2 ; e, 12 ; f, 9 ; g 4 ; h6. C Tuberculosis of the Lungs.— The notification and deaths of Finsbury cases of Phthisis since 1901, are appended:— Phthisis Notifications and Deaths, 1901-1927. No. of Cases notified per 10,000 of inhabitants. Total No. of Primary Notifications. 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 22.9 232 2.45 1907 217 23.2 243 2.60 1908 220 23.9 221 2.40 1909 359 39.7 228 2.52 1910 319 35.8 166 1.86 1911 419 47.8 159 1.81 1912 438 49.6 160 1.81 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 1.35 1921 213 27.7 116 1.51 1922 140 18.2 102 1.33 1923 150 19.4 90 1.16 1924 144 18.6 95 1.23 1925 202 26.0 111 1.43 1926 160 20.6 1.13 88 1927 154 20.4 101 1.34 The actual number of notifications received in 1927, was 551, but of these many refer to the same patient. There were 269 total primary notifications, but of these 115 were duplicates, leaving 153 true cases ; of these 37 were from poor law sources, 82 from hospitals and dispensaries, 30 from private doctors, and 4 from sundry sources. In reference to the poor law cases there were also received 112 notices of admission and discharge relating to patients previously notified ; 172 such notices were also received in respect of tuberculous persons entering and leaving institutions other than poor law. 87 gave a Clerkenwell address, 65 lived in St. Luke's, and one lived in St. Sepulchre. How many of the whole number are Finsbury Cases — 1. Finsbury cases by residence and infection 103 2. Finsbury cases by infection 15 3. Finsbury cases by residence only 2 4. Not Finsbury cases 20 5. Not ascertainable 13 153 The cases which may be definitely associated with the borough are the first two groups, and amount to 118, that is 77 per cent. of the whole number. Distribution by Streets and Blocks of Dwellings.—The largest numbers were notified from the following places:—Central Street 4, Pentonville Road 4, Gee Street 3, Ironmonger Street 3, Macclesfield Street 3, Medcalf Place 3, Mitchell Street 3, Peerless Street 3, Wharton Street 3, Affleck Street 2, Clerkenwell Road 2, Coldbath Square 2, Granville Square 2, Myddelton Square 2, Northampton Road 2, Old Street 2, Percy Circus 2, Pickard Street 2, President Street 2, Radnor Street 2, Rahere Street 2, Risinghill Street 2, Sekford Street, 2, Sidney Street 2, Southampton Street, 2, White Lion Street 2. The notifications from the various grouped buildings and dwellings were :—St. Bartholomew Buildings 4, Compton Buildings 3, Victoria Buildings 3, Coldbath Buildings 2, Northampton Buildings 2. The Homes and Tenements of the Patients. —Out of the whole number, excluding lodging houses, 33 were one-roomed tenements, that is to say, in these tenements the patient and family lived c 2 and slept in one room only. 56 were two-roomed tenements, 51 had three to six rooms, 3 were notified from institutions, and their families had left the addresses given, one requested that he should not be visited, 5 were not traceable and 10 were inmates of common lodging houses. Nine of the tenements were overcrowded. Three tenements had only one cupboard for food and coal. Six 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 familes, the abatement of overcrowding is insisted upon forthwith. Twenty-six tenements were on the list of houses let in lodgings, 25 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. Homework was not carried on in the home of any case notified. Of the houses occupied by the patients, three were used for the sale or preparation of food products. 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. The only statutory power for preventing consumptives handling food for human consumption is given by the Public Health (Prevention of Tuberculosis) Regulations, 1925 : "No person who is aware that he is suffering from tuberculosis of the respiratory tract shall enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk; further, if a local authority on the report of their Medical Officer of Health are satisfied that any person engaged in the milk trade as above is suffering from tuberculosis of the respiratory tract and is in an infectious state they may by notice require such person to discontinue his employment. Certain provisions of the Public Health Acts relating to compensation for damages sustained by reason of the exercise of these powers apply to any person so affected, where he is not himself in default." 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 and dilapidated 6, water closet out of order 1, dirty yard and area walls 1, water-closet dilapidated 1, water closet pan leaky 1, sash cords broken 3, broken area and yard paving 2, dustbin absent 1, water cistern foul 1, rain-water pipe broken 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. Persons. Families. Persons. Families. 1 45 1 1 2 41 2 8 3 9 3 14 4 0 4 15 5 0 5 1 6 0 6 1 7 0 7 0 One bedroom contained three beds, and five persons regularly used the beds, one bedroom had four beds, used by four persons. Ten patients gave common lodging house addresses. Only 45 patients out of 136 living in private houses were able to have a bed and bedroom all to themselves. In 50 other households, where only one bed was available, 59 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 91 persons who occupied the same bedroom as a phthisical patient, and in some instances the same bed. Eleven bedrooms were dark, or had insufficient light. The ventilation was insufficient in 7 other bedrooms, and 4 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 save one. 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. Two bedrooms were dirty; one was verminous. In 26 instances the patients were said to be of careless habits. The Kitchen. —In 76 instances or 50 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. One of the kitchens was dirty. 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 1927 the number of specimens examined was 231, of which 25 gave positive results. Free systematic and periodic disinfection is offered after the notification of patients. In 1927 the rooms, bedding, feeding utensils, towels, handkerchiefs and linen were disinfected in 59 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 445. 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 930. Deaths. —In 1927 the number of Finsbury persons who died of phthisis or pulmonary tuberculosis was 101. In addition to these, 12 died from tuberculous meningitis, and 6 from other forms of tuberculosis. The deaths from all forms of tuberculosis were 119. The deaths for previous years are given in the subjoined table:— Phthisis Deaths and Death Rates, 1901-1927. Finsbury Deaths from other forms of Tuberculosis. Phthisis Death Rates per 1,000 inhabitants Finsbury Deaths from Phthisis. Year. England and Wales. Finsbury. 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 44 1912 160 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 1.259 165 1917 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 1.51 .854 1922 102 19 1.33 .889 1923 90 13 1.16 .836 1924 95 11 1.23 .841 1925 111 15 1.43 .833 1926 88 12 1.13 .771 1927 101 18 1.34 .791 The Phthisis Death Rate for 1,000 inhabitants in London during 1927 was -91. 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: 75 deaths from phthisis belonged to Clerkenwell, 26 to St. Luke's, and 0 to St. Sepulchre. Of the whole of the 1,010 deaths in Finsbury in 1927, 10.0 per cent. were due to phthisis, as against 8.8 for 1926, 10.52 for 1925, 8.7 for 1924, and 8.9 per cent, for 1923. Sixty-nine 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 36, derived from Clerkenwell 27, St. Luke's 9, and St. Sepulchre 0 cases. The parts chiefly affected were the peritoneum (2), spine (4), glands (13), meninges (6), ankles (2), arm (2), hip (2) cases. Fourteen patients were bedridden at the time of notification. In these, notification was a very late incident in the disease. 8 cases were infants under school age. 7 were examples of " open tuberculosis " associated with external discharges, and therefore presumably infectious to those brought into contact with the sufferers. 16 were school children. Of the whole number, 21 were considered to be Finsbury cases by residence and infection, 9 Finsbury cases by infection, 4 were not Finsbury cases, and 2 were doubtful. Two of the tenements were overcrowded. The close contacts in the same families included 89 adults and children over school age, and 72 other children. The kitchen was used for sleeping purposes in 20 instances. In 2 cases the mother and children respectively were the chief or only wage earners. The deaths included 12 from tuberculos meningitis (Clerkenwell 7, St. Luke's 4, St. Sepulchre 1) and 6 (Clerkenwell 3, St. Luke's 3, St. Sepulchre 0) from forms of tuberculosis other than tuberculous meningitis and phthisis. Altogether 47 primary notifications were received, but 11 of these were duplicates. The Finsbury death rate from all forms of tuberculosis in 1927 was 1.34 per 1,000 ; the corresponding rate for England and Wales in 1927 was .972, and for London in 1927, was 1.05. Tuberculosis Dispensary.—A Tuberculosis Dispensary for Finsbury residents was established at the Royal Chest Hospital, City Road, on December 1st, 1916. During 1927 new patients numbering 420 were examined ; of these, 163 were under 15 years of age, the rest above that age. Those suffering from tuberculosis were 86 (48 insured and 38 not insured). The suspects were 9 (6 insured and 3 not insured). The total number of patients, new and old, who attended during the year was 938. The total attendances were 4,207. The visits to the homes of the patients were 3,194. These visits were nearly all made by the nurse attached to the dispensary. 145 persons were recommended by the Tuberculosis Officer for sanatorium or hospital treatment. In the great majority of these cases institutional treatment was given. The total number of close contacts examined at the Tuberculosis Dispensary was 200, out of a possible 445. The number of " X "- ray examinations was 23. The number of sputum specimens examined by the hospital pathologist was 455. The Tuberculosis Officer made 417 visits to the homes of the patients. Under the scheme formulated by the Ministry of Health in Memorandum 30/T the Tuberculosis Officer furnished 286 reports to the Ministry of Pensions in respect of the examination of exservice men during 1927. The fees paid for this work are handed over by the Borough Council to the Tuberculosis Officer. INFECTIOUS DISEASE. Small Pox. —No case was notified during 1927. Cases were notified in other London boroughs, and the names and addresses of many persons living in Finsbury, who had been in contact with persons suffering from small pox, were notified to me. Each contact was kept under observation during the incubation period. Free supplies of calf lymph were maintained for use in emergency, and were distributed free to medical practitioners in Finsbury upon request, for use in the cases of persons who had been in close contact with small pox and persons closely associated with close contacts. Typhus Fever. —No case was notified in 1927. Cerebro Spinal Fever. —Two cases were notified in 1927. There were no deaths. Anthrax, Glanders and Hydrophobia. —No cases were notified during 1927. Encephalitis Lethargica. —Five cases were notified during 1927. One death was reported. Poliomyelitis and Polio Encephalitis. —One case of acute poliomyelitis was notified in 1927. There were no deaths. Measles. —435 cases of measles and german measles were notified during 1927. Measles and german measles have been 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. 185 cases were removed to hospital. In these cases disinfection was carried out immediately after the patient's removal, excepting where there was another case remaining in the same room. Comparative Table. —In 1927 measles caused 3 deaths (all of these were under 5 years) and whooping cough 5 deaths. These two diseases are extremely fatal to children under 5 years. Deaths in Children under S years, 1901-1927. Whooping Cough. Scarlet Fever. Typhoid Fever. Period. Measles. Small Pox. Diphtheria. 278 211 53 80 1901-5 13 1906-10 347 202 39 80 1 27 1911-15 366 169 48 1916 36 12 1 11 117 2 1917 10 7 1918 51 54 3 9 1919 - - 11 1920 10 12 4 27 1921 3 13 6 22 1922 29 22 2 20 2 1923 10 7 8 1924 44 25 2 14 1926 12 15 4 1926 21 5 - 2 5 1927 3 17 1 3 Totals 1,336 774 13 144 340 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - From this table it appears that the deaths in 27 years due to scarlet fever, diphtheria, typhoid fever and small-pox, all taken together, numbered 507, to whooping cough 774, and measles 1,336. In children under 5 years therefore, it is seen that measles kills nearly three times the number of children whose deaths are caused by small-pox, scarlet fever, diphtheria and typhoid fever all combined. Whooping cough alone causes many more than the number of deaths accredited to the other four named infectious diseases. Diphtheria.—The number of cases notified was 208, all except 4 of which were admitted to isolation hospital. Of these, 19 were subsequently sent home as not suffering from diphtheria, 12 cases proved to be tonsilitis, 2 cases were diagnosed as laryngitis, 1 mumps, and 4 were described as " not diphtheria," leaving 189 true cases of diphtheria. There were 4 deaths, so that 2.1 per cent. of all the patients died. The number of cases was 26 more than last year ; the number of deaths is 1 less than in 1926. The 4 cases treated at home were kept under observation; suitable measures were adopted to secure isolation, and the premises were disinfected upon the recovery of the patients. The particulars of cases in previous years are appended : — 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. No. of Cases. No. of Deaths. Year. 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 116 11 9.5 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 3.07 33.6 1.03 1923 260 8 1924 163 14 8.6 21.1 1.81 1926 201 6 2.9 25.9 .77 1926 163 5 3.1 21.0 .64 1927 189 4 2.1 25.0 .53 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. 5 of the cases were contracted in hospital after the patients had been admitted suffering from diseases other than diphtheria. There was 1 " return " case. Some interesting points in connexion with cases are as follows:— 1. A patient admitted to hospital suffering from anaemia; whilst still in hospital he was notified as suffering from diphtheria. 2. A patient admitted to a general hospital suffering from concussion and shock ; removed 13 days later to isolation hospital suffering from diphtheria. 3. Swabs taken from nose and throat yielded negative results but the patient was notified to be suffering from diphtheria and was removed to isolation hospital. 4. One Finsbury patient admitted to general hospital suffering from " pneumonia " was found to have diphtheria. 5. In the case of a patient taken to a hospital clinic for general advice, a white patch was observed on the throat whilst the doctor was examining the teeth ; this patient was found to have diphtheria. 6. A patient was discharged from Isolation hospital after diphtheria ; the patient was taken later to a general hospital with convulsions and was certified again to be suffering from diphtheria, and was returned to isolation hospital. 7. A patient who had been under treatment at a special children's hospital for pneumonia, was said by the parents to have had a nasal discharge ever since he left that hospital up to his removal 15 days later to isolation hospital suffering from diphtheria. Notifications. The number of actual cases of diphtheria notified each year from 1920-1927, arranged according to the ages of the patients, is given in the attached table : — Diphtheria Notifications, 1920 -1927. Total Notifications. At Ages—Years Year 0-1 1-2 2-5 5-15 15-25 25-45 45-65 65+ 1920 11 8 56 113 19 7 1 215 1921 5 29 84 189 37 14 5 363 37 1922 19 36 91 176 13 2 1 375 1923 9 21 83 148 30 19 4 314 1924 6 24 66 75 15 8 194 5 14 96 106 21 8 3 252 1925 1926 5 10 64 85 15 7 186 1927 2 11 56 92 19 9 189 Total 8 years 62 153 595 984 193 85 15 1 2,088 Annual averages 19 74 123 24 10 8 - 261 0.1 2 - - - - - - - - - From the table it will be seen that in recent years, since 1924, the prevalence of the disease has shown a tendency to diminish. The stress of the disease is chiefly during the school years— from 5 to 15 years of age. Under one year of age, and beyond 45 years of age, the numbers of patients affected is small. During the same period 1920-1927, the deaths from diphtheria amongst Finsbury patients have been as follows: — Diphtheria Deaths, 1920 - 1927. At Ages—Years Total Deaths. Year 0-1 1-2 2-5 5-15 15-25 25-45 45-65 65 + 1920 2 3 12 10 87 1921 2 5 15 13 1 36 1922 3 3 14 9 1 1 31 1923 2 2 4 8 1924 1 4 9 14 1925 1 1 2 2 6 1926 1 2 2 5 1927 1 2 1 4 Total 8 years 11 20 60 37 2 1 131 Annual averages 1 2.5 7.5 4.6 0.2 16 0.1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - The largest number of deaths has occurred between 2 and 5 years, the next largest number between 5 and 15 years. If we re-arrange these tables thus:- Total cases notified, 1920-1927 Total deaths 1920-1927 Case mortality per cent. Year. 0—1 62 11 18 1—2 153 20 13 2—5 595 60 11 5—15 984 37 4 15—25 193 2 1 25—45 85 45—65 15 65+ 1 1 100 Totals 2,088 131 6 It will be noted that, discarding the one case over 65 years, the highest death rates amongst the patients affected are in babies under one year, and the subsequent death rates show a diminution as the children get older and are able to speak and draw intelligent attention to the condition of the throat. For babies, of course, this is impossible, and unless the diphtheria is suspected—for example, by the baby showing signs of difficulty in swallowing, recognised by a careful mother—the disease may advance unrecognised until it is too late and end in death. The prevalence of the disease per 1,000 population, the death rates per 1,000 population, and the case mortality per 100 cases, - - - - are compared in the following tables with the corresponding figures for London and England and Wales. Notifications per 1,000 Population. England and Wales. Year. Finsbury. London 1920 2.74 3.05 1.86 1.76 1921 4.22 3.62 1922 4.58 3.38 1.37 1.05 1923 3.36 2.36 1924 2.11 2.30 1.07 1.23 1925 2.59 2.72 1926 2.10 2.95 1.31 1927 2.50 2.71 1.33 The number of notifications per 1,000 population has, since 1924, been less in Finsbury than in London as a whole, but is still much higher than in England and Wales as a whole. Deaths per 10,000 Population. England and Wales. Year. Finsbury. London. 1920 3.45 2.3 1.51 1921 4.69 2.5 1.26 1922 4.03 2.5 1.07 1923 1.03 1.3 .71 1924 1.81 1.2 .65 1925 .77 1.1 .72 1926 .6 1.2 .77 1927 .5 9 .7 D The death rates in Finsbury in 1923, 1925, 1926, 1927, have been less than those prevailing over London as a whole. As a rule, with the exception of 1926 and 1927, the death rates per 1,000 population in Finsbury have been larger than those over the whole of England and Wales. Case Mortality per 100 Cases. England and Wales. Year. Finsbury. London 1920 12.5 7.7 8.1 1921 11.1 6.9 7.2 1922 8.8 7.4 7.8 1923 3.07 5.7 6.7 1924 8.6 6.2 6.0 1926 2.9 4.1 5.9 1926 3.1 4.1 5.9 1927 2.1 3.23 5.25 A low case mortality depends upon the early recognition and its early treatment by diphtheria antitoxin serum in sufficiently large doses. Cases of diphtheria which are treated by the appropriate antitoxin serum before the fifth day of the disease, almost always recover; after the fifth day the recovery is doubtful, and the longer the serum treatment is deferred the less hopeful becomes the outlook. From all these tables, it would appear that in the last few years there has been much improvement in the borough, in the diminution of the prevalence of diphtheria, in the diminution of its death rate, and in its diminished case mortality. Further, in the matter of diminished death rate and diminished case mortality, Finsbury compares most favourably with London and England and Wales as a whole. Measures already taken.—In Finsbury, nearly every case of diphtheria is removed to the infectious disease hospitals of the Metropolitan Asylums Board at the earliest opportunity. Very few cases are treated at home. Facilities for early diagnosis are afforded to doctors practising in the borough. The Medical Officer of Health is always ready and willing to see suspected cases with the doctors in attendance. Swabs from the nose and throat of suspected cases are examined at the Royal Institute of Public Health at the expense of the Borough Council. Outfits are supplied, too, for this purpose to the local doctors. In 1927, 755 specimens were submitted, with positive results in 87 instances. Diphtheria antitoxin serum is kept at the Public Health Department, and is available gratis for doctors on request for the treatment of Finsbury patients, at the earliest possible opportunity, even before removal to hospital, and for those occasional patients who are too ill to be removed and are treated at home. Fees are paid to medical men for administering the serum. Cases of diphtheria discharged from hospital as cured are examined very carefully shortly after their return home, and a record kept of their condition. If necessary swabs are taken from the nose and throat for bacteriological examination. Any cases suspected of harbouring the diphtheria bacillus in nose or throat are kept under the personal supervision of the Medical Officer of Health, treated and kept away from school until found to be free of the bacillus by bacteriological examination. Leaflets of instruction are given to the parents of the patients at the removal of the patient, and at his discharge from hospital. Cases Discharged cured 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 D 2 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. 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. Three such cases occurred in 1927. 25 patients upon discharge had enlarged neck glands. Three patients had sores on the nostrils. Outbreaks of Diphtheria at the Claremont Day Nursery, White Lion Street, Pentonville, Finsbury. Cl0aremont Day Nursery, a part of the Claremont Mission, situated in White Lion Street, Pentonville, N.1, is in two portions —a toddlers' room on the ground floor, attached to which is a room containing 10 cots, a reception room, a bathroom, and a disinfecting cupboard, and a creche on the first floor containing 15 cots, used for babies under 15 months, leading from which is a room for the preparation of feeds. Other rooms in the building are used for the staff quarters. On the ground floor are a kitchen used entirely for the creche, a shed for perambulators, and a lavatory in which a few perambulators are kept owing to lack of other accommodation. There is no outdoor accommodation for the children. The toddlers' room has no windows; it is lighted from the roof, which is covered by a lantern light. The ventilation is secured by pivoted windows in the lantern light, which are always kept open on account of the poor ventilation. There is an open fireplace, and a door leading to the yard, which assist the ventilation. The nursery is a minor portion of a large building devoted to many other purposes, such as a men's club, a women's club, girl guides, public baths, and mission activities. The nursery is therefore in constant contact with the general public mainly on the ground floor. It is interesting to note that six of the seven recent cases of diphtheria have occurred amongst the toddlers, whose room is on the ground floor. The other case was a nurse on the staff who was found to be a carrier of the diphtheria bacillus. The premises have been inspected by a sanitary inspector of the Finsburv Borough Council, and with the exception of one small rainwater pipe defect, were found in good repair. The equipment of the nursery was found to be adequate, consisting of stretcher beds, cots, blankets, mackintoshes, sheets, towels, face flannels, combs, tooth-brushes, sponges, mugs, plates, chairs, tables, ear syringes, wool, boracic powder, zinc ointment, boracic ointment and white precipitate ointment, syrup of figs, castor oil, clinical thermometers, lysol, carbolic acid, and dried milks. The daily routine commences at 7 a.m., when the nursery is aired, prepared and warmed. At 8 a.m. children commence to arrive. Their own clothes are removed and put in numbered pigeon-holes. The children are given a warm bath and put into creche clothes. In the case of babies the same routine applies, but in addition, their eyes and noses are bathed with boracic lotion, and their heads are combed. The babies' bottles are got ready, and they are fed at 8.45 a.m. The toddlers are given hot milk at 9.15 a.m., and dinner at 11.30 a.m. At 12.30 p.m. they are put to bed on cots and stretcher beds in the toddlers' room to sleep until 2.30 p.m. They play games until 3.30 p.m., when they have tea. At 4 p.m. they are changed back into their own clothes and are taken home between 5 p.m. and 6 p.m. The rooms are thoroughly cleansed and left in order for the next day. The same routine applies to the babies, except that the feeds are at 12.15 p.m. and 3.30 p.m. and the babies are allowed to sleep between feeds. Children are only accepted from mothers at work at a charge of 9d. per day for one child and 1s. per day for two children. In the event of a child's illness, the mother is sent for at her working address, and asked to take the child to its own doctor or to a hospital. The children are weighed —toddlers once a fortnight, babies once a week. When it is possible for mothers to come in at midday, it is arranged for them to breast-feed their own babies. There are a number of visitors to the creche, including seven voluntary workers, one of whom attends every morning at the babies' nursery. In the toddlers' room there is a different voluntary worker each day of the week. The casual visitors include the Pastor of the Mission, the Rev. F. W. Newland, Mrs. Newland, the Medical Officer, two typists at the mission, three sisters attached to the mission, and other occasional callers. The records kept at the nursery are a rough notebook for entering names and addresses of parents on first attending the nursery. Should the child stay a week, a card is made out giving the following particulars Date of admission, occupation of father, address of mother's employer, reasons for admission, feeding before admission, vaccination, past illnesses, abnormalities, present condition, and medical officer's notes. Overleaf are spaces for entering dates and the appropriate weights of the child. The routine adopted with a newcomer is for the mother to be interviewed by the Matron, and the employer's address taken. No enquiries appear to be made regarding contact with cases of infectious disease. There is no detailed medical examination, and no certificate of freedom from disease is required. The children are taken into the reception room, stripped, bathed, and dressed in creche clothes. Their own clothes are put into the disinfecting cupboard and disinfected twice a week, but not on arrival as a newcomer, unless the disinfecting cupboard is working on that date. The Medical Officer visits once a week. He has no definite time or day specified for his visits. His visit consists of a round of the babies' nursery, and usually the toddlers' room. The detailed minute medical examination of the children and attendant records are not apparently a routine measure. Children are examined at the request of the Matron. Prior to May, 1927, there have been no known cases of diphtheria at the nursery for at least four years; no record of any case prior to that has been found. The outbreak under consideration commenced on the 11th May, 1927. At the date of this report there have been seven cases on the 11th, 15th 16th May, 1927 ; 18th, 21st July, 1927 ; 27th, 30th August, 1927. There have been no deaths. The first case, J. W. of Islington, aged 3 years 10 months, appeared to be unwell and languid on the 11th May, 1927. The Matron advised the mother to take the child to hospital. This was done, and a swab of the throat taken ; it was found to be positive, and the child removed to an infectious disease hospital next day. The second case was P. D. of Islington, aged 3 years 10 months. She attended the nursery on the 15th May, 1927, and was found to be unwell. She was sent to St. Bartholomew's Hospital, where a diagnosis of Heavy cold was made. As she was worse next day she was sent again, and a swab of the throat taken. This was found to be positive, and the child was removed to an infectious disease hospital. On the 15th May, 1927, the throats of the Matron, nurses, and the children were all swabbed for bacteriological examination. One positive swab was found, and this child was the third case — P. E. of Islington, aged 1 year 8 months. She was stated to be suffering from a " cold " and had a nasal discharge, but did not appear ill. She was sent to an infectious disease hospital on the 16th May, 1927. No more cases occurred until the 18th July, 1927, when the fourth case occurred. F. H. of Islington, aged 3 years 2 months, was drowsy and cold during the evening of the 18th July, 1927 ; she was taken to the Royal Free Hospital, where a swab was taken and found positive. She was removed to an infectious disease hospital. Further swabbing gave a positive result in the case of one nurse. She was not ill, so the swab was repeated on the 21st July, 1927. The nasal swab was found to be negative, but the throat positive. The fifth case was therefore N. W. of Ashford, Kent, aged 17 years, and she was removed to an isolation hospital as a carrier of the diphtheria bacillus. On the 27th August, 1927, the sixth case was discovered. The nursery had been closed from the 22nd July, 1927, until the 22nd August, 1927, for the summer holidays, and on the 26th August, 1927, nine children were swabbed prior to going to a holiday home. One of these swabs was positive. D. T. of Finsbury, aged 3 years, had a cough, and owing to a positive swab was removed to an infectious disease hospital. The seventh case was E. F. of Islington, aged 4 years 6 months. This child had a cold and seemed ill on the 29th August, 1927. A swab was taken and found positive. She was removed to an infectious disease hospital. This case had been swabbed on the 26th August, 1927, with the other holiday children and found negative. Certain difficulties have been encountered during this outbreak, the constant contact with the public who use the mission, and the influx of new children to the nursery, who have not been swabbed. No further clinical cases have occurred since August 27th, 1927, but under the conditions noted one is compelled to feel a certain uneasiness regarding the occurrence of new cases in the future. The Claremont Creche has been under continuous supervision by the Finsbury Public Health Department since May, 1927, following the occurrence of the three first cases in the toddlers' room. These three cases were all removed to a fever hospital. The swabs taken in July and August with their results have already been enumerated. On September 19th, 20th, 22nd, 1927, swabs were taken from the noses and throats of all the toddlers, babies, matron, sister, probationers, cook and washerwoman. This was done with the concurrence of the medical officer of the creche. On September 23rd, 1927, swabs were taken from the noses and throats of two probationers, who had previously given positive results, and of two voluntary workers. On September 27th, 1927, swabs were taken from the noses and throats of 3 new children, who sought admission to the creche. In all 98 swabs were taken with the following results:— Nose —Positive, 8 cases. Throat —Positive, 1 case. Three of the children had enlarged tonsils and adenoids, but none of the patients had any signs of membrane in nose or throat. They were all cases of " bacteriological " diphtheria. The results were communicated by telephone immediately to the medical officer of health of boroughs concerned, and the affected children and adults were excluded from attendance at the creche. The facts disclosed do not warrant any cause for serious anxiety. It has long been recognised that many members of the general public harbour the diphtheria germ in nose or throat, or both. In various researches the numbers have been put at percentages ranging from 15 to 30 per cent. In the present enquiry, out of 46 persons examined 9 were diphtheria carriers, equivalent to 19 per cent. None of the babies were found to be carriers. The carriers were 5 toddlers, 2 probationers, and 2 voluntary workers. To complete the investigation, virulence tests were made in respect of the Finsbury residents. These were all returned as nonvirulent. With reference to the Islington children, 2 virulence tests were obtained by the Medical Officer of Health for Islington. One gave a negative result, one a positive result. One child was taken by his parents to a private medical practitioner, who considered that there was no need to notify him as a case of diphtheria, but who promised to take a swab to be tested for pathogenicity. The present position, then, is that the recent careful and thorough investigation revealed that at the creche there are a certain number of diphtheria carriers among the voluntary helpers, the staff, and the toddlers, well within the limits of the carrier percentage of the general population. There has been no recent outbreak of true clinical diphtheria, diphtheria with membrane possibly to be followed by paralysis. However, these carriers are a possible standing menace to the babies and toddlers of the creche, and it is within the bounds of probability that these diphtheria bacilli, harboured in the noses and throats of the carriers, often of a non-virulent type, may occasionally become virulent to their hosts or others. But it must be confessed that the factors which determine the lighting up of this virulence are at present unknown. Now the babies and toddlers, if they are affected with diphtheria, have very little means of actively and intelligently directing the attention of the nurses to their condition and to the sites of the infection. Cases have occurred where little children have had diphtheria for many days before the disease was even suspected, and delay in treating diphtheria means a high mortality. It becomes necessary, therefore, to pay great attention to babies and toddlers and to make special and frequent medical examination of the noses and fauces. It is proposed, in order to safeguard the children, to give the toddlers toxoid antitoxin immunity, subject to the consent of the parents. The staff will be offered the Schick Test, and those that react will be given toxoid antitoxin immunity. The Claremont Creche is attended by babies and toddlers from Islington, Finsbury, and St. Pancras. It is an institution carefully conducted and very well administered. There is a towel, face flannel, comb and tooth brush, marked separately and reserved for each child. The knives, forks, spoons, cups and plates are boiled after every meal. The beds and bedding are marked for each child. No handkerchiefs are used. Bits of clean rag are provided instead and are burnt immediately after use. A separate case card is provided for each child. On one side are spaces for the dates and appropriate weights of the children. On the other side are the following items:— Date of admission. Occupation of father. Address of mother's employer. Reasons for admission. Legimitate. Weight on admission. Feeding before admission. Vaccination. Past illnesses. Abnormalities. Present condition. Medical Officer's notes. Although the item of legitimacy is dealt with, it is not made a test for admission. It would appear desirable that this enquiry should be deleted; it may hinder a mother of an illegitimate child from placing the child in Claremont, and it is well known that these illegitimate children, with their excessively high mortality, are those for whom the help of a creche is specially required. It is very necessary that each new child should be seen by a doctor before or soon after admission, and a fairly full note taken. There is kept a daily register of all the attendances. The register has spaces for the child's name, the address at which the mother works, the amount of the daily payments and the total weekly payments. Usually the weekly payments lie between £4 and £5, but have occasionally amounted to nearly £5 15s. 0d. During the investigation it was ascertained that the staff did not have fire drill or fire practice, nor apparently had any welldefined fire routine or fire stations been adopted and circulated amongst the staff. A fire chute runs from the creche to the street, and is said to have been tested six times during the last four years " to see that it worked properly." No member of the staff is on the State Register of Nurses. No member of the staff has had fever hospital or general hospital experience. Two members of the staff have certificates. One has a certificate from St. Christopher's Nursery Training College, Tunbridge Wells, granted after examination in 1913. The other has a certificate from the National Society of Day Nurseries, granted after examination in 1919. The Matron, Sister, and Probationers are extremely solicitous about the welfare of their infants, and look after their charges exceedingly well. They are very well spoken of by the mothers. Recommendations (1) The adult staff will be offered the Schick test, and those who re-act will be advised to accept toxoid antitoxin immunity. (2) The toddlers will be given toxoid antitoxin immunity, subject to the consent of the parents. (3) The probationers should be offered the opportunity of having a course of lectures on the commoner infectious diseases. The London Fever Hospital, Liverpool Road, is quite handy and convenient for this purpose. (4) Occasional fire practice should be given to the staff. Written notes should be circulated as to the exact duty to be performed by each member and the station allotted to her. The Daily Register of the patients should always be on the table, and it should be the duty of some definite member of the staff to secure its safety so that the register may be called quickly after an alarm. (5) Steps should be taken to improve the lighting and ventilation of the toddlers' room. A copy of this report was sent to the Ministry of Health. Diphtheria:—The Schick Reaction—Toxiod Antitoxin Immunity. The Schick Test or Schick Reaction is a method of testing whether a patient is susceptible to diphtheria, or, in other words, whether a person exposed to the risk of catching diphtheria is likely to contract the disease. The test is performed by injecting into the skin of the left forearm a very minute measured quantity of diluted diphtheria toxin or poison. If the person injected is susceptible to diphtheria then within 24 to 48 hours of the injection there appears at the place of injection a red inflamed swollen area one half of an inch to one inch across. If the patient is not susceptible to diphtheria, then no such swollen area appears. The test, therefore, is one which is now used to distinguish between those persons who are liable to catch diphtheria and those who will definitely not catch it; in other words, to separate the susceptible persons from the immune persons. The test was discovered in 1913 by Professor Schick, of Vienna, and its use, though delayed by the Great War, is now gradually extending. It has been used in New York City ever since its introduction in increasing numbers year by year. It has been practised in the elementary schools of Edinburgh, Aberdeen, Birmingham, Cardiff and Dundee for the last three or four years. The tests have been made at the Infant Welfare Centres of Holborn (1922), Westminster (1926), and Camberwell (1926), and schemes have been authorised for Deptford, Battersea and Hackney. In New York, since the commencement of the test, an enormous number of tests have been made without the slightest distress or ill effects. Toxoid Antitoxin Immunity.—This is the name of a method used for the purpose of conferring immunity to diphtheria upon those susceptible to the disease. In other words, it renders those who are likely to catch diphtheria immune and therefore free from attack, even if exposed to the disease. It is the complementary sequel to the Schick reaction. The Schick test points or marks out those who are liable to contract diphtheria. The Toxoid Antitoxin immunity removes this liability and makes them safe, even if in the closest contact with the disease. The immunity is conferred by injecting into the shoulder muscles of the patient a carefully standardised and measured amount of a mixture of diphtheria toxin or poison and diphtheria antitoxin or the antidote to the poison. As a result of the injection there is gradually established in the patient an immunity which lasts at least 10 years. Complete immunity does not develop immediately; it takes from 3 to 6 months. The injections are given once a week for 3 weeks and then a further series, if necessary, at the end of 3 months. Although over two million injections have been given in New York without any harm, yet there are on record three instances where, owing to faulty technique and faulty preparation of a toxin antitoxin mixture, serious results followed, leading to the deaths of 11 children. The toxoid antitoxin mixture used in London is of the highest standard of excellence. No harmful effects have been observed in the use of the mixture at the London centres. The method has been found to be of inestimable value in protecting nurses who work in the diphtheria wards of fever hospitals. Incidence of Diphtheria.—The notifications of diphtheria and the deaths from the disease in Finsbury for the last eight years, 1920-1927, are given in this present report. The large number of notifications from 1 to 5 years and from 5 to 15 years will be noted, showing the increased prevalence of the disease before school age and during school age. The high case mortality is specially marked under one year and from 1 to 15 years. These conditions and inferences apply almost exactly in like manner to the rest of the country, and show the desirability of employing the Schick Test and conferring toxoid-antitoxin immunity both before and during school age. What is London Doing?— Work of the nature described has been carried out in Holborn since 1922, in Camberwell and Westminster since 1926. Schemes have been authorised by the Ministry of Health for Battersea, Deptford and Hackney. The statutory authority for the venture is derived from Sec. 77 of the Public Health (London) Act, 1891. Before the scheme is definitely started, it has generally been found desirable to advertise its advantages by— (1) Posters on the notice boards and sand-bins of the local authority. (2) Leaflets distributed by the — Health visitors to mothers. Sanitary inspectors visiting notified cases of diphtheria. Head Teachers of elementary schools to their scholars for taking home. (3) Talks at the Infant Welfare Centres by the Assistant Medical Officer of Health. It must be emphasised that before any injection is made the consent of the mother or guardian must be obtained, preferably in writing. A printed form is used for the purpose, which only needs the written signature of a parent. If this signature is not obtained the injections are not given. Recommendations. It is recommended that a scheme be adopted in Finsburv— (a) For conferring immunity against diphtheria upon children from 1 to 5 years without a previous Schick test. (b) That for children of school age a preliminary Schick test be made and that toxoid antitoxin immunity be conferred upon the susceptibles thus indicated. It is estimated that if the scheme be adopted the cost for the first year will probably be from £60 to £100 —a small sum in comparison with the number of lives which would be undoubtedly saved. This recommendation was accepted by the Finsbury Borough Council. A further report will be issued in 1928. Scarlet Fever. —There were 242 notifications of scarlet fever in 1927. Of these, 13 were subsequently sent home as not suffering from scarlet fever, leaving 229 true cases.* There were 2 deaths. All the patients were treated in hospital. The cases treated at home were kept under observation, suitable measures were adopted to secure isolation and the premises were disinfected upon the recovery of the patient. *The cases stated not to be suffering from Scarlet Fever were reported to be suffering from: —Chicken pox I, diphtheria 2, erysipelas, measles and diphtheria I, erythema I, erythema and enteritis I, measles I, tonsilitis 3, and " not scarlet fever " 3. The particulars of previous years are subjoined:- No. of cases per 10,000 of Population. No of Deaths per 10,000 of Population. Cases Mortality No. of Deaths pel 100 cases. No. of cases. No. of Deaths. Year. 1911 171 6 3.5 19.5 .6 1912 159 5 3.15 18.4 .58 1913 251 5 1.93 29.6 .59 191 438 6 36 52.6 .72 1918 390 10 2.56 50.7 1.30 1916 178 2 .26 1.12 23.9 1917 99 2 2.02 14.9 .29 1918 3 2.02 22.2 .45 148 1919 235 0 0.00 31.2 .00 1920 418 4 0.96 53.4 0.51 1921 586 6 1.02 76.4 .78 1922 335 4 1.19 43.6 .52 1923 165 2 1.1 21.3 .25 1924 189 2 1.05 24.4 .24 1925 261 0 .00 33.6 .00 1926 231 2 .86 29.7 .26 1927 229 2 .86 30.3 .26 Four patients developed scarlet fever while they were detained in hospital for other causes, There were five " return " cases. Sixteen cases were not discovered until some days after the rash had appeared. 2 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 ami 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 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. Five such cases were kept under the observation of the Medical Officer for periods varying from one to five weeks before they were certified as being free from infection and fit to resume school attendance. Enteric Fever.-In 1927 no cases of enteric fever were notified. There were no deaths, The numbers in previous years are given in the accompanying table: — No.of cases per 10,000 of Population. No. of cases per 10,000 of Population. No. of cases notified. Cases Mortality. No. of Deaths, per 100 cases. No. of Deaths. Year. 1911 74 9 12.2 8.4 1.02 1912 5 1 20.0 .58 .11 1913 15 0 0 1.7 .00 1914 15 2 12.5 1.8 .24 1915 3 1 33.3 .13 .39 1916 4 0 .0 .53 .00 1917 2 1 50.0 .29 .14 1918 2 0 .0 .30 .00 1919 7 0 .0 .93 .00 1920 5 0 0 .64 .00 1921 5 0 0 .65 .00 1922 4 1 25.0 .52 .13 1923 2 0 .0 .26 .00 1924 5 0 .0 .64 .00 1925 7 3 42.8 .90 .39 1926 2 0 .0 .26 .00 1927 0 0 .0 .00 .00 E 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, 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 0766." In 1927, 2 specimens of blood were received for diagnosis; they were both negative. Trench Fever, Dysentery, Malaria. —No cases were notified during 1927. Infectious Disease —Exclusion from School.—The London County Council has recently altered its rules for the exclusion from school of contacts with cases of scarlet fever, measles and German measles. The following regulations now obtain: — Scarlet Fever.—School children living in houses in which cases of scarlet fever have occurred are to be excluded from school for 7 days from the date of the disinfection of the premises. Measles and German Measles. —School children suffering from measles are to be excluded from school for 3 weeks from the date of the appearance of the rash. HOUSING. Number of new houses erected during the year:— (a) Total 55 (b) With State assistance undei the Housing Acts: (i) By the Local Authority (ii) By other bodies or persons 0 1. Unfit dwelling-houses:- Inspection (1) Total number oi dwelling houses inspected for housing defects (under Public Health or Housing Acts) 94 (2) Number of dwelling-houses which were inspected and recorded under the Housing (inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 94 (3) Number of dwelling-houses found in be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling-houses(execlusive of of those ref erred to under the preceding sub heading) found not to be in all respect reasonably fit for human habitation 3 2. Remedy of defects without Service of Formal Notices: Number of defective dwelling-houses rendered lit in consequence of informal action by the Local Authority or their officers 0 3.Action under Stat utory Powers: (a) Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 E 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (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 2064 (2) Number of dwelling-houses in which defects were remedied:— (a) By Owners 2064 (b) By Local Authority in default of Owners 0 (c) Proceedings under sections 11, 14 and 15 of the Housing Act, 1925: — (1) Number of representations made with a view to the making of closing orders 1 (2) Number of dwelling-houses in respect of which closing orders were made 1 (3) Number of dwelling-houses in respect of which closing orders were determined, the dwellinghouses 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 (6) Number of dwelling-houses demolished voluntarily upon the making of closing orders 0 London County Council Houses. —Particulars of the housing scheme whereby applicants for housing accommodation on the estates of the London County Council may be recommended for priority consideration were given in my Report for 1925. To the estates on which accommodation was available in 1925 and 1926, i.e. Becontree, Essex, and Downham, Kent, was added the Watling Estate, Hendon, The Watling Estate is situated off the main road to Edgware, and is in the vicinity of Edgware, Hendon and Mill Hill. It can be reached by train from the Bank and Charing Cross by Under- Electric trams pass the Estate, which can also be reached by Bus Services, Nos. 60 and 16, from Victoria, Oxford Street, Hyde Park, Trafalgar Square and Kilburn, passengers changing at Cricklewood to Bus Service 142B. Accommodation, consisting of cottages containing 3, 4 and 5 rooms, and flats containing 2, 3 and 4 rooms, with scullery, bathroom and garden, is provided on this Estate for British subjects residing in the Administrative County of London. Approximate rents, including rates and water charges, payable weekly in advance, are as follows: — s. d. 2-room flats 13 6 a week. 3 14 6 „ 4 „ „ 17 0 3 „ cottages 16 0 4 „ „ (non-parlour) 17 0 4 „ „ (parlour type) 19 0 5 „ „ 20 6 „ As a general rule, all applications are dealt with in order of receipt, and applicants can only be allowed to take the minimum accommodation that is considered sufficient for their needs. Sub-letting is not permitted. Sites have been allocated for the erection of churches and schools. In 1927, applications were received from 130 families for preferential consideration in the allocation of housing accommodation on L.C.C. Estates, on account of special alleged housing hardships. Of these 14 withdrew their applications before enquiry being deterred from proceeding further on account of the additional expense of travelling to and from their work. 21 families were not recommended for various reasons, e.g., insufficient means or distance from place of employment. 10 applications were deferred for further consideration. 85 families were considered suitable for recommendation to the London County Council for preferential consideration but of these abandoned their applications. 71 families were offered accommodation by the London County Council, 54 of these being recommended by the Medical Officer of Health, 6 families failed to take advantage of the offer. During the year 1927, notifications were received that 9 families who had been recommended for preferential treatment had been rejected by the London County Council; in the cases of 19 applicants recommended, no information had been received at the end of 1927. The total applications made to the Public Health Department, 1924-1927, were 446. The number of applicants recommended for priority treatment was 236. The families accommodated by the London County Council were 146, as follows: —Becontree 68, Downham 46, Watling 29, Tottenham 3 families. In addition, a large number of Finsbury families obtained houses by direct,application to the London County Council. Many of the unsuccessful applicants found they could not afford the increased rent and added railway fares. There is one other item of expense which, in the experience of the L.C.C. officers, is often forgotten. The town children, transferred to the healthy tonic environment of the country, develop enormous appetites and seriously increase the food bills of their parents. Visit to the London County Council Wormholt Estate. The London County Council in 1927 offered to the Finsbury Borough Council a number of houses, not exceeding 100, on the L.C.C. Wormholt Estate. These houses may be occupied by tenants nominated by the Finsbury Borough Council; the tenant will pay the usual rents prevailing on the estate, while the Finsbury Borough Council pays an annual charge, estimated at £610s. per annum on each house for a defined number of years. Such an accommodation would be extremely useful to this borough council if Finsbury ever undertook another clearance scheme similar to the White Horse Alley Reconstruction Scheme. The Wormholt Estate lies half-way between Shepherds Bush and Acton, and is well served by four railway stations Wood Lane, East Acton, Wormwood Scrubbs and Shepherds Bush. There arc many workmen's trains at reasonable fares. The estate is well laid out on broad commodious expansive lines. It lias an open-air swimming bath and ample playing ground. There are gardens, some of them quite large gardens, attached to each house. Many of the houses have gardens at the back and front. The houses are being completed at the rate of 40 to 50 per month. There arc 600 houses now in process of construction, and eventually the estate will have 710 L.C.C. houses. A few tenement houses containing flats (60) will also be built. It is believed that all the houses and flats will be completed by July, 1928. Houses have already been retained by the following boroughs—Kensington, St. Marylebone, Hammersmith, Hampstead, Paddington and Westminster. The estate was visited in September, 1927, on behalf of the Council, by Alderman W. Howes, Chairman of the Public Health Committee, the Town Clerk, and the Medical Officer of Health, and a thorough inspection made of houses already built and others in process of construction. The houses will be of various types, and will contain 3 rooms, 4 rooms, and 5 rooms. The rents will range from 12s. to 15s. 6d. per week, exclusive of rates and water charges. The houses contain at least 2 bedrooms ; the 5-room houses and some of the 4-room houses have 3 bedrooms each. In every house there is a well-ventilated larder, food cupboards and shelves, a kitchen dresser, a portable copper, a coal bunker, one or more wardrobe cupboards, a bath, a separate water closet, and provision for a hot-water supply. Electric light is installed everywhere on the shilling-in-the-slot system. In each house there is one gas point and one gas fire in a bedroom. Each house has an inter-oven and in some of the better types there are double folding doors between the living-room and parlour. The windows are glazed in special metal frames which allow of the windows being cleaned from the inside of the rooms. Provision is made for drying clothes in the garden. Each house has a tiled sink with draining board, and a gas cooker. There are hooks for hanging up clothes. The houses are well ventilated throughout. The attic is ventilated by elevating one end of the trap-door so as to allow of the sides of the trap-door giving a clear open interval of 1 inch width, connecting the top landing with the attic. The floor boards are of wood laid directly on to concrete. The walls are distempered. The wood work is finished in dark oak colour. The net cost per house is said to range from £500 to £600. The offer of the London County Council was accepted by the Finsbury Borough Council at the Council's meeting on December 1st, 1927. 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 small pox contacts, and of suspected cases of small pox during the incubation period. The " shelter " was used on two occasions only in 1927, by one family from Holborn, and by one Finsbury family. 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 Holborn Borough Council pays £37 10s. per annum for this accommodation. The disinfector is a Washington-Lyons high-pressure steam apparatus. In 1927, 916 premises, comprising 1,283 separate rooms were disinfected, of which 176 were for measles, 63 after notification of phthisis, 11 after deaths from phthisis, 234 after scarlet fever, 193 after diphtheria, 55 on account of vermin, and 184 premises were disinfected for miscellaneous reasons. In addition, bedding and mattresses were steam disinfected for the following institutions: Claremont Hall Creche, St. Barnabas' Home, St. Mark's Hospital Women's League of Service. Altogether, 9,986 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, 151,044 articles of partly worn wearing apparel and 1 ton of horsehair (265 separate charges of the disinfecting apparatus) were disinfected for exporting firms at the price agreed upon, prior to exportation to South Africa and other foreign parts. Cleansing of Persons. —In 1927, 19 adults and 5 children were cleansed at the St. Pancras Cleansing Station by arrangement with that Borough. The cleansing in every case was for body vermin. INCREASE OF RENT & MORTGAGE INTEREST (RESTRICTION) ACT, 1920. Three applications for certificates were received under Section 2 of this Act. The premises were inspected by the Medical Officer of Health. One certificate was granted, one was refused, and one application was withdrawn. FOOD INSPECTION. Certification of Meat Food Products. —The Medical Officer of Health, with the consent of the Council, was designated the certifying officer by the Local Government Board for certification of meat food products for export to Canada, to the United States of America, to Australia, to the West Indies, and to the Philippine Islands. 388 certificates were issued in 1927. Meat and Food Inspection.—In March, 1924, the Borough Council appointed Mr. T. Penman as a special meat inspector to inspect systematically butchers' shops, food stuffs, shops for food preparation and cold stores throughout the whole district. In addition, he pays special attention to the meat deliveries in the wholesale market in Charterhouse Street, St. John Street and Cowcross Street, all adjacent to Smithfield Market. All the unsound, diseased and decomposed meat is removed under agreement by Messrs. C. & B. Webb, fat melters, 155, Bow Road, London, E. Unsound Russian Pork In August, 1927, there were deposited for sale on the premises of a Finsbury firm three large casks of pork pieces in brine. They had been shipped here on behalf of Messrs. Arcos, Ltd., Moorgate, E.C., by way of Hull, from the Kurgen factory in Russia. The contents of the casks consisted of a large number of nondescript cuts of aged pork, so trimmed as not to permit of satisfactory examination. One large piece of this pork was markedly tuberculous. The consignment was surrendered to the Finsbury Meat Inspector and subsequently destroyed as unfit for human consumption. Diseased and Unsound Meat.—The total amount confiscated in 1927, was over 142 tons, as follows:— tons. cwts. qrs. lbs. Diseased meat 22 19 0 0 Diseased offals 31 8 1 17 7 1 17 54 Decomposed meat 40 0 1 16 Decomposed offals and other goods 48 2 24 5 6 88 0 12 Total for 1927 142 tons. 13 cwts. 2 qrs. 11 lbs. Unsound Bacon for Soap.—During 1927, 66 tons, 15 cwts., 2 qrs., 19 lbs. of unsound bacon was sold by firms in the Borough under the supervision of the Meat Inspector to reputable concerns engaged in the soap-making trades. Prosecutions. —For particulars of prosecutions, see page 91 of this report. Slaughter Houses. —In Finsbury there is now only one slaughter house, viz.:—that of Mr. J. A. Mobbs, 14, Penton Street. This slaughter house was inspected in 1927 on 75 occasions. No defects were ascertained and consequently no notices were served. Only a few small animals were slaughtered each week in the slaughter house during the year. There are no knackers' yards in the Borough. MILK SHOPS. At the end of 1927, there were on the register 155 milk shops. These were inspected on 177 occasions. 33 notices were served for the abatement of various nuisances. There were no prosecutions. SALE OF FOOD AND DRUGS ACTS. The number of samples taken in 1927, was 602. The results are given in the table below:— Total No. of Samples. Total No of Samples Samples Adulterated. Samples Adulterated. Articles. Articles. Almonds (ground) 1 0 Ginger (Ground) 3 0 Butter 116 0 Lard 46 0 Cheese 7 0 Lemonade Powder 2 0 Cheese (Cream) 1 0 Margarine 25 0 Cinnamon (Ground) 5 0 Milk 249 18 Cocoa 25 0 Mincemeat 2 0 Coffee 9 0 Mustard 6 0 Cream 1 2 2 Oatmeal 0 Cream (Preserved) 5 0 Pepper 3 0 Curry Powder 4 0 Rice 16 0 Custard Powder 10 0 Roast Fat 1 0 Dripping 5 0 Sausages 22 6 Fish Paste 5 0 Suet (Shredded) 4 0 Flour 2 0 Tea 11 0 602 Flour (Self-Raising) 13 0 Total 25 PUBLIC HEALTH (PRESERVATIVES &c, IN FOOD) REGULATIONS 1925. Several samples of food were purchased and were examined for preservatives in 1927. In two cases only (sausages) were preservatives reported present, and in both the preservatives complied with the regulations in character and amount. In neither case, however, were labels exhibited giving notice that preservatives were present, and legal proceedings were taken resulting in the infliction of 10/6 costs in each case. The statistics for previous years are sub-joined: — Adulterated. Percentage of adulterated samples. Total examined. Year. Genuine. 1910 600 541 59 9.83 1911 51 600 549 8.50 1912 601 667 34 6.65 1913 601 570 31 5.1 1914 596 563 83 5.5 1915 600 566 34 5.6 1916 600 565 30 5.8 1917 601 544 87 9.5 600 553 47 7.8 1918 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 1.5 600 590 10 1.7 1924 1925 600 589 11 1.8 11 1926 600 589 1.8 1927 102 577 25 4.1 In respect of the milk supplied in 1927, there were six prosecutions. To the vendors of the remaining adulterated samples, cautionary letters were sent. The Milk (Special Designations) Order, 1923.— Six applications under the order were received during 1927, five for a dealer's licence to use the designation " Certified," and one to use the designation " Grade A." The applications were granted. OFFENSIVE TRADES. At present there are the following offensive trades established in Finsbury : — Tripe Dresser Messrs. Henson, 137, Whitecross Street Fur Skin Dresser H. P. Millicent & Co., 8, Mallow Street Fur Skin Dresser L. Decent, 31 and 32, Sidney Grove. Regular inspections are carried out at these premises; the conduct of the business in each case is subject to special By-laws made by the London County Council. Public Health (Milk and Cream) Regulations, 1912 and 1917. — Action taken in Finsbury during 1927 under the above-mentioned regulations is shown by the following table: — No. of samples containing above prescribed limit of preservative. No. of samples examined. Nature of Sample. Cream 7 1 Milk 248 0 FACTORIES AND WORKSHOPS. The number of workshops and workplaces on the register at the end of 1927, was 2,441, compared with 2,493 at the end of 1926. During the year under review, 52 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 212. The factories on the register at the end of 1927 numbered 1,896, compared with 1,860 at the end of 1926. The list included 14 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. 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 43, instrument, jewellery, etc., box making 16, packing case making 30, brushes and combs 9, house repairs and decorating 5, patent flooring 1, tarred felt making 1, clock and watch case making 11, watch making and repairing 19, cloth shrinking 3, pleating 7, disinfectants and soaps manufacturing 4, drug grinding 1, druggists sundries 17, making and repairing addressing machines 1, making and repairing motors and cycles 18, making and repairing domestic machinery 6, making and repairing springs 1, making and repairing typewriting machinery 2, model and pattern making 8, smithing and wheelwrights' work 8, making and repairing sewing machines 9, making and repairing electrical goods and machinery 18, general engineering 121, wireless components 9, artificial flower making 15, embroidery 13, making and importing fancy goods 20, ivory and tortoise-shell working 6, leather goods 52, pipe making and mounting 24, toy making 6, walking sticks and umbrellas 38, trouser presses 2, sports goods 13, cleaning feathers 3, dyeing and curling feathers 7, horsehair cleaning 2, cabinet making 24, carpet planning 1, picture-frame making 10, shop fitting 20, upholstery 8, cold storage 6, confectionery 10, drysalting 1, food preparing 19, mineral waters 3, cordial and spirit colouring 1, glass stopper making 3, glass working 21, sand blasting 2, jewellery making and repairing 34, gold and silver refining 4, rouge manufacturing 1, silversmiths 28, jewellery repairs 6, steam laundries 4, diamond cutting and polishing 4, glaziers' diamond making 3, brass workers 16, coppersmiths 10, engraving and die sinking 25, foundry 8, gilding, plating and polishing 81, general metal-working 29, type-founding 6, wire-working 12, sheet-metal working 10, aerography 2, paint, enamel and varnish making 5, panel and screen painting 2, musical instrument making and repairing 20, scientific instrument making 33, electrical instrument making 7, optical instrument making 26, photographic instrument making 1, surgical instrument making 11, weighing and scales instruments making 9, art publishing 23, envelope and paper bag making 6, gold blocking 4, ink and gum making 8, machine ruling 17, pattern cards 10, printing 152, showcards 3, manufacturing stationers 30, stencil cutting 1, waste paper sorting 1, bookbinding 34, fountain pens 2, rubber works 4, rubber stamp making 4, waterproofing 1, stone and marble working 2, statuary 1. Making wearing apparel as follows: —Aprons 5, blouses 42, boots and shoes 11, boot socks and laces 1, children's clothing 21, fur garments 22, glove making 3, haberdashery 6, hat making 41, linen collars 6, neckties 12, shirt and pyjama making 28, mantle making 86, tailoring 49, skirt making 14, underclothing 29, button making 8. Beer bottling 1, distilling 0, dealing in wines, spirits and tobacco 3, tobacco, cigarettes and cigar making 12, general woodwork 19, hardwood turning 19, saw milling 5, wood cutting 2, electricity generating station 1, hydraulic power station 1, forage cutting 5, packing and fowarding goods 4, vulcanite and fibre manufacturers 8, cork cutting 2, cutlery grinding 6, van building 4, dyeing 1, fur skin dressing 2, saw making 1. Total 1,896. Workshops.-Cardboard box making 22, instrument, jewellery, etc., box making 30, packing case making 17, making brushes and combs 11, house repairs and decoration 46, making clock and watch cases 20, dial painting 14, making and repairing clocks and watches 121, shrinking cloth 2, cutting and sorting cloth 10, accordion pleating 2, chemical research work 1, drug and chemical making 8, druggists sundries 31, disinfectants 2, agricultural engineering 5, cycle and motor repairing 25, electrical workers 32, fitter's work 5, locksmiths 7, machinists 10, pattern making 1, sewing machines 8, smiths and wheelwrights 8, general engineering 37, wireless components 11, artificial flower making 14, artists' materials 2, art needlework and embroidery 13, basket making 15, leather goods 74, fancy goods making and importing 22, shoe trimmings 4, sports goods 7, ivory working 7, pipe making 6, taxidermy 1, toy making and importing 28, walking sticks and umbrellas 25, wig and costume making 1, soap and perfumery 3, general fancy goods 27,. photography 2, curling and dyeing feathers 12, blind making 4, cabinet making 57, French polishing 22, making and repairing furniture 20, shop fitting 33, upholstery 19, undertakers 7, picture framing 17, carpet planning 1, confectionery 18, storage and preparation of food stuffs 69, glass working 32, bottle washing 4, china and glass merchants 3, instrument making —musical 27, optical 9, photographic 9, scientific 30, surgical 13; weighing machines 3, gold beating 4, gold and silver refining 12, gold and silver smiths 42, enamelling 4, repairing and making jewellery 91, wholesale and retail jewellers 33, laundries 8, laundry receiving and sorting 19, diamond cutting and polishing 10, general lapidary 3, metal burnishing 5, coppersmiths 9, engraving and die sinking 64, gilding and plating 8, farriers' and smiths' work 17, sheet metal working 20, wire working 14, general metal work 42, oil and colour manufacturing 7, sign writing 14, ink, gum and varnish making 6, blacking and polish making 5, japanning 3. Bookselling and publishing 21, card and book edge gilding 16, envelope and paper bag making 6, machine ruling 4, paper storage 16, wholesale stationers 28, waste paper sorting 12, card mount cutting 6, relief stamping 11, lithographers 3, rubber goods making 10, ebonite workers 2, stone and marble working 4, statuary 7, blouse making 17, boot and shoe repairing 35, boot and shoe warehouse 7, button making 1, children's clothing 5, corset making 3, furriering 127, glove making 1, hat making 45, mantle making 36, millinery 40, necktie making 5, shirt and collar making 2, tailoring 74, underclothing 11, woollen goods 6, haberdashery 7, cigar making 2, wine, spirit and tobacco storage cellars 7. Firewood chopping 17, timber yards 11, wood turning 7, van building 7, wood carving 7, wood working 15, hat block making 3, harness making and repairing 7, mat making 1, celluloid workers 1, forwarding agents 30, hardware manufacturers 28, miscellaneous merchants 44, stabling and garage 37, stores 40, towel supplying 4, cork cutting and working 5, window cleaning 3, rope and twine making 4, ammunition storage 1, dyeing and cleaning 4. Total 2,411. The persons employed in the factories in Finsbury are approximately: Males 38,426, females 32,276. In the workshops and workplaces: Males 12,122, females 8,764; these numbers exclude the office "hands" and clerical staffs. During the year 2,115 first visits and 1,105 revisits were made by the Council's inspectors to factories, and 2,508 first visits and 967 revisits to workshops and workplaces. F 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 1927. Factories. Workshops. Workplaces. Total. Absence of water supply 2 4 6 Cisterns dirty or covers broken 3 - 3 1 5 2 Dampness in walls 8 5 11 Drains choked 4 2 Drains leaky 3 3 Dustbins broken or absent 16 30 7 53 Floors insufficiently drained 1 3 4 Guttering or rainwater piping broken, leaking or inadequate 5 9 2 16 Manhole covers broken 1 1 2 Open drain inlets 1 1 Overcrowding of workrooms 6 4 10 Refuse accumulations 11 14 5 30 Roofs leaky 3 1 1 5 Floors broken 2 2 Ceilings broken 9 2 15 4 Sanitary conveniences not separate for the sexes 14 15 1 30 Sanitary conveniences defective 90 32 2 124 Sanitary conveniences dirty 126 140 10 2 275 Sanitary conveniences insufficient 12 1 23 Sanitary conveniences unsuitable 21 15 1 37 Soil-pipes leaky 2 1 3 Staircases and landings dirty 7 17 2 26 Urinals foul 8 4 1 13 Ventilation of workrooms inadequate or insufficient means of 9 2 11 Waste material improperly stored 4 1 Waste pipes choked or leaky 11 1 12 Water closets choked 10 9 1 20 Water fittings leaky 16 13 2 31 Workshops or workplaces dirty - 42 11 53 Yard paving broken Yard walls dirty 1 1 - 389 389 61 839 Total In connection with these matters 438 intimation notices and 13 statutory notices were served. 6 1 5 - - - - - - - - - - - - - - - - - The Home Office. — 21 notices of occupation were received from the Home Office during the year, and 37 notices of complaint relating to the following matters: — Premises dirty 6 Sanitary conveniences insanitary 24 Absence of separate accommodation for the sexes 2 Water closet accommodation insufficient 5 The notices sent to the Home Office were as follows:— Abstract of the Factory and Workshop Act not affixed, or wrongly affixed 24 New occupation 30 The following matters are presented in the form required by the Home Office. Inspection of Factories, Workshops and Workplaces. Written Notices. Prosecutions. Premises. Inspections. Factories (including Factory Laundries) 3,220 220 Nil Workshops (including Workshop Laundries) 2,773 186 Nil Workplaces (other than Outworkers premises) 702 35 Nil 6,695 Nil 441 F2 Defects found in Factories, Workshops and Workplaces. Referred t. H.M. Inspector No. of Prosecutions. Remedied. Particulars. Found. Nuisances under the Public Health Acts — Want of Cleanliness 182 180 4 Want of Ventilation 11 11 Over-crowding 10 9 - Want of drainage of floors 4 4 Other nuisances 418 415 Insufficent Unsuitable Sanitary accommodation - Defective Not separate for the sexes 83 23 - 37 37 124 121 30 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) 4 Total 830 829 Nil There were 10 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 24 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act, 1901 (S. 5):- Notified by H.M. Inspector 37 Reports (of action taken) sent to H.M. Inspector 37 Underground bakehouses (S. 101) in use at the end of the year 26 Home Work, 1927. In no instance during 1927 was homework found to be carried on in unwholesome premises. - - - - - - - - - - - - - - - - - - - - - - - - - - - RATS AND MICE (DESTRUCTION) ACT, 1919. The methods indicated in my Report in 1921 have been maintained in 1927. COMMON LODGING HOUSES. In 1927, two common lodging houses were licensed in Finsbury as follows:— 57, White I.ion Street, James Shuttleworth —98 men. 88, Old Street, Salvation Army—372 men. CANAL BOATS ACTS, 1877 TO 1884. During the year 1927, the total number of Canal Boats inspected was 96. None carried offensive cargo. The Acts and Regulations were contravened in one instance — the deck lead of an after cabin being leaky ; this was remedied by the owner after service of a notice. The following table gives statistics relating to the inspection of Canal Boats for the past 5 years:— Persons found on boats. Year. Boats Inspected. Registered for. Totals. Women. Men. Children. Totals. 77 171 28 43 242 279 336 321 336 323 1924 94 163 56 64 283 1925 93 151 54 80 285 1926 97 166 57 53 275 1927 96 163 47 41 251 Of the 96 Canal boats inspected, 56 were occupied by men only; 18 by men and women only ; 22 by men, women and children. The number of children on the boats was 41 of which 24 were of school age and 17 under school age. The children accompanying their parents on the boats appeared to be well cared for. No cases of Infectious disease were notified or discovered on the canal boats, therefore isolation of patients and detention of boats have not been necessary. The inspection of canal boats is part of the duty of the Sanitary Inspector whose district includes that part of the Borough in which the canal is situated. This year the duties were carried out by Inspector Newdick. THE MORTUARY. In 1927, the number of post-mortem examinations was 40, the number of bodies brought to the mortuary for the convenience of relatives of the deceased was 156. The number of inquests held in the Borough was 11. One body was received into the mortuary on account of death after infectious disease. STAFF OF THE PUBLIC HEALTH DEPARTMENT. The 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 —T. Penman. Sanitary Inspectors—G. E. J. Davis, C. M. Longden, E. A. Norman, H. Newdick. Workshops Inspectors—R. A. Puckle, H. Clinton. Woman Inspector—Miss F. Hall. Clerical Chief Clerk —E. Q. Bilham. First Assistant Clerk —N. C. Turrell. Second Assistant Clerk—L. T. H. Mussett. Junior Clerk—J. Hurren. Office Youth—J. Barry. Mortuary and Disinfecting. Mortuary Keeper and Disinfector —J. Campbell. Disinfector —F. Readstone. Motor Driver Disinfectors —F. W. Battle and J. Luke. Maternity and Child Welfare. Superintendent, 162, Lever Street—Miss M. I. Batty. Superintendent, Pine Street Centre—Miss E. J. Smith. Clerk—G. A. Webber. Dispenser (part-time)— Miss A. Preece. Health Visitors—Misses G. M. Bolton, M. Williams, D. E. Leggatt. Cleaner at 162, Lever Street—Mrs. Purcell. Caretaker at Pine Street Centre —Mrs. Haynes. Dentist (part-time, for Maternity and Child Welfare) — Mrs. Marie Verheyden, L.D.S. Assistant Medical Officer of Health -W. G. Booth, M.B., B.S., D.P.H. WORK OF THE STAFF. The work of the staff is presented below in tabular form:— Work of the Sanitary Inspectors, 1927. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Newdick. Totals Houses damp, dirty or dilapidated, remedied 90 116 138 104 448 Doors, windows, floors, walls, ceilings, sashcords repaired 196 153 213 136 698 Overcrowding cases abated in Other than Registered Houses 0 1 4 4 9 Illegal occupation of underground rooms. 1 0 3 0 4 Water closet defects remedied 160 139 164 86 549 Water closets erected 66 15 68 106 284 2 Urinal defects remedied 2 0 0 13 Urinals erected 4 0 3 4 11 Soil pipe and ventilating shaft defects remedied 4 7 20 3 34 Soil pipe and ventilating shafts erected 20 9 42 26 97 Yard defects remedied 32 50 112 61 255 13 Waste pipe defects remedied 20 16 14 63 12 40 Waste pipes erected 17 31 100 Water cistern defects remedied 2 12 4 3 21 Accumulations of rvibbish or manure removed 27 6 14 7 54 Dung or dust receptacles repaired or renewed 42 34 43 46 165 27 23 148 Drains relaid or amended 48 50 Drains cleared 21 28 23 116 44 Rain water pipes cleared, repaired or renewed 13 16 47 10 86 Water supply to houses reinstated 4 0 0 5 Roofs and gutters repaired Area defects remedied 103 92 41 377 22 13 11 73 27 141 1 Work of the Sanitary Inspectors, 1927 —continued. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Newdick. Totals. Washhouse defects remedied 41 58 72 33 204 1 Animal nuisances abated 1 1 0 3 0 4 0 4 Floor space unventilated 0 Smoke observations 9 4 4 35 52 Water supply laid on to upper storeys of house 3 0 1 0 4 112 48 53 260 Miscellaneous nuisances abated 97 145 237 145 68 595 Drains tested Bakehouses, inspections 16 26 24 24 90 6 Bakehouses cleansed or repaired 4 12 14 36 32 68 234 Restaurants, No. of inspections 61 73 11 3 34 14 62 Restaurants cleansed or repaired Milkshops, No. of inspections 42 42 58 178 36 Milkshops cleansed or repaired 2 5 11 17 35 Public-houses cleansed or repaired 2 0 9 0 11 Ice Cream Premises —No. of inspections 48 15 28 31 122 7 Ice Cream Manufactories cleansed or repaired 7 4 14 32 Registered Houses visits of inspection 1431 996 1308 648 4382 Registered Houses—Overcrowding cases abated 0 14 0 14 0 221 180 188 0 589 Registered Houses —cleansed Registered Houses—lntimation (Cleansing) Notices served 92 221 199 188 700 Registered Houses —Statutory (Cleansing) Notices served 96 53 4 226 104 First visits (complaints, casual visits) 1769 1493 1656 1977 6895 2065 2496 1484 Re-visits 2099 8144 325 431 1364 Intimation Notices served 383 225 65 77 55 8 205 Statutory Notices served Infectious disease investigations House inspections 141 210 183 142 676 311 274 358 335 1278 43 64 111 210 House to house inspections 39 0 0 96 96 Canal Boats inspected 0 REPORT ON THE WORK OF THE LADY SANITARY INSPECTOR FOR 1927. The following is a summary of the work of the Lady Sanitary Inspector during 1927: — Visits and re-visits :— Factories (other than outworkers' premises) 383 Workshops (other than outworkers' premises) 267 Outworkers' premises 1,471 Complaints of verminous conditions 765 2,886 Intimation Notices served 239 Statutory Notices served 3 242 Summary of matters for which Notices were served: — Dirty and dilapidated premises 141 Leaky roofs 15 Sanitary conveniences dilapidated, dirty, insufficient, not separate for sexes 121 Drains choked, leaky 1 Waste-pipes, rain-water pipes and gutters choked, leaky 4 Damp walls 3 Dustbins absent, broken 14 Other nuisances 17 LEGAL PROCEEDINGS. Name and address of Defendant. Offence. Result. PUBLIC HEALTH (LONDON A CT, 1891):— Emily Marlow (Mrs.), 28, Aylesbury St., E.C.I. John Butler, High Street, Burford, Oxon. Bennett, Son & Co., Ltd., 41, Chapel St., N. Failing to provide sufficient water supply to 28, Aylesbury St., E.C.I. Depositing in premises at Charterhouse Street for the purpose of sale four quarters of beef, diseased, and unfit for the food of man. Exposing for sale unsound tripe and cowheel. Ordered to abate the nuisance forthwith. Dismissed. Ordered to pay £5 5s. costs. SALE OF FOOD AND DRUGS ACTS, 1875 to 1909:— W. J. Braid, 171, Pentonville Rd., N.I. Selling milk 20% deficient in fat. Ordered to pay £1 1s. costs. Ordered to pay £1 Is. costs. Jessie Connock, 26, Clerkenwell Close, E.C.I. Selling milk deficient in fat Amelia Stacey, 23, Leage St., E.C.I. Selling milk 14% deficient in fat. Fined £2. Colthorpe & Gosling, 47, Myddelton St. Selling milk 25% deficient in fat. Ordered to pay £5 5s. costs. P. Flin, 18, Wynford Rd., N.I. Selling milk 5% deficient in fat. Fined £2 and £2 2s. costs. Ordered to pay £4 4s. costs. Knebworth White Cross Milk Ltd., 332 a, Goswell Rd., E.C.I. Selling milk 10% deficient in fat. SALE OF FOOD ORDER, 1921: — Lewis Taylor, 39, Exmouth St., E.C. Failing to so label imported eggs. Fined £5. PUBLIC HEALTH (PRESERVA TIVES IN FOOD) REGULATIONS, 192 5 Francis Russell, 213, Goswell Rd., E.C.I. Lewis Taylor, 37/41, ExmouthSt., E.C. John Henry Whiting, 2, Lower Charles St., E.C.I. Selling sausages containing preservative without giving notice. Selling sausages containing preservative without giving notice. Wholesale supplier of the above mentioned sausages to Lewis Taylor. Ordered to pay 10s. 6d. costs. Ordered to pay £2 2s. costs. Ordered to pay £1 1s. costs. CASES OF DISEASE NOTIFIED DURING THE YEAR 1027. Total cases notified in each locality Number of cases notified Total cases removed to Hospital St. Sepulchre Notifiable Disease At Ages—Years Clerkenwell St. Lukes At all Under 1 year 1 and under 5 year 5 and under 15 year 15 and under 25 years under 45 years 45 and under 35 years 65 and upwards Diphtheria (including Mem. Croup) 208 4 71 99 23 10 1 159 46 3 204 - 147 - Scarlet Fever 242 3 70 18 3 1 161 80 1 243 - 2 4 2 Puerperal Fever 6 - - - 1 5 - - Puerperal Pyrexia 16 7 8 9 6 - - - - - - 4 Ophthalmia Neonatorum 111 31 23 8 7 - - - - - - - Pulmonary Tuberculosis 154 2 2 42 70 32 6 85 68 1 - - 1 111 Other forms of Tuberculosis 36 7 7 8 2 25 11 - - - Acute Primary Pneumonia 62 9 6 18 56 - 7 8 14 7 - 31 Acute Influenzal Pneumonia 24 1 4 5 5 5 4 4 18 8 1 - 8 Erysipelas 44 15 16 2 4 35 9 7 - - 4 - Encephalitis Lethargica 5 1 1 1 3 2 3 - - - - 1 1 Acute Poliomyelitis 1 - - - - - - 1 - - - - Cerebro Spinal Meningitis 2 1 2 - - 1 1 - - - - - - Measles and German Measles 435 32 3 286 116 301 134 185 - - - - Zymotic Enteritis 5 1 1 4 - - - - - 120 76 391 125 Totals 1,270 451 70 28 881 384 5 694 INFANT MORTALITY, 1927 Under 1 week 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 mths. Total deaths under 1 year Total under 4 weels 1-2 weeks 2— 3 weeks 3-4 weeks CAUSE OF DEATH Small-pox Chicken-pox Measles Scarlet Fever 1 1 Whooping cough 1 2 3 Diphtheria and Croup Erysipelas Tuberculous Meningitis 1 1 Abdominal Tuberculosis - Other Tuberculous Diseases 1 1 2 Meningitis(not Tuberculous) 1 1 3 5 Convulsions Laryngitis. - 1 1 1 Bronchitis. 2 Pneumonia 2 1 1 4 1 2 1 6 14 Diarrhoea 2 11 Enteritis 1 1 1 5 1 3 11 Gastritis Syphilis Rickets Suffocation (overlying) Injury at Birth - Atelectasis 1 1 - 1 Congenital Malformation 1 1 2 1 3 4 Heart Disease 1 1 6 6 Premature Birth 9 1 10 2 12 Atrophy, Debility and Marasmus 1 1 2 Other causes 5 1 1 7 1 8 Totals 3 3 20 6 32 6 16 - - - - - - - - - - - - - - - - - - - - - - - - - - 73 9 11 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1927 Total Deaths whether of " Residents " or "Non-Residents" in Institutions. Net deaths at the subjoined ages of "Residents" whether occurring within or without the district Clerkenwell. St. Luke's. Cause of Death 1 and under 2 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards 2 and under 5 years 5 and under 15 year All ages Under 1 year Enteric Fever - - - - - - - - - - - - Small Pox - - - - - - - - - - - - Measles 3 - - 3 - - - - - - 2 - Scarlet Fever 1 1 2 1 1 - - - - - - - 11 6 Wnooping Cough 17 3 6 8 - - - - - - 4 - 1 2 1 - - - - - 4 - Diphtheria Influenza 38 - 1 1 1 3 9 13 10 - 28 10 Erysipelas - - - - - - - - - - - - Cerebro Spinal Fever - - - - - - - - - - - - Phthisis 101 1 - 2 1 20 30 40 7 - 75 26 5 Tuberculous Meningitis 12 1 3 2 1 - - - - 7 4 1 - 3 Other Tuberculous Diseases 6 1 1 1 - 2 1 - - 3 Rheumatic Fever 3 1 4 1 1 - 2 1 - - - - - Cancer 111 - - - 1 12 53 45 12 71 38 - 23 38 Bronchitis 104 2 - 1 1 2 75 - 66 - 19 Pneumonia, all forms 97 14 13 14 2 2 10 23 3 68 30 2 1 - 3 2 Other Respiratory Diseases 5 - 1 - 1 - - Diarrhœea 2 - - - 2 - - - - - - - 6 Enteritis 11 11 - - - 5 - - - - - Appendicitis 1 3 - - 1 1 1 2 11 - - - 2 1 Alcoholism 3 - - - 2 1 - - - - 4 Cirrhosis of Liver 8 6 1 - 4 1 - - - - - Bright's Disease and Cerebral Hæmorrhage 82 - - - - 2 6 35 39 3 57 24 - - - 1 - - - - 1 - Puerperal Fever 1 - Other Diseases and Accidents of Pregnancy and Parturition 3 3 - - 1 1 2 - - - - - - - 1 - - - Congenital Malformation 4 3 - 3 11 - 12 12 5 7 5 Premature Birth - - - - - - - 2 2 2 - Marasmus - - - - - - - - Want of Breast Milk - - - - - - - - - - - - Convulsions - - - - - - - - - - - - 10 5 16 - Violence 34 2 3 1 1 2 10 3 - - 3 2 Suicide 1 1 3 5 - - - - - - 8 11 Old Age 21 - - - 21 - - - 90 Other Defined Diseases 170 2 2 3 4 6 14 49 8 117 45 5 - - 1 3 2 11 6 I11-Defined Diseases 17 2 8 4 37 2 42 59 1 79 Heart Disease 119 6 - - 3 7 8 5 2 1 - - - - - - 5 3 Meningitis 1 Encephalitis Lethargica - - - - 1 - - 1 - - - Totals 322 1010 385 667 73 34 43 22 47 103 303 37 9 18 Broncho Pneumonia 54 13 12 11 1 2 6 3 35 - 43 1 1 3 1 8 13 14 - 30 12 Other Pneumonias 2 * These figures are included in the above table.