ISL 1 1893, THIRTY-EIGHTH ANNUAL REPORT ON THE Health and Sanitary Condition OF THE Parish of St. Mary, Islington. ALFRED EDWIN HARRIS. MEDICAL OFFICER OF HEALTH. London: Chas. Straker & Sons, Ltd., “Avenue Works,” Bishopsgate Avenue, E.C. 1894. With the Medical THIRTY-EIGHTH ANNUAL REPORT ON THE Health and Sanitary Condition OF THE Parish of St. Mary, Islington. ALFRED EDWIN HARRIS. MEDICAL OFFICER OF HEALTH. London: Chas. Straker & Sons, Ltd., “Avenue Works,” Brshopsgate Avenue, E.C. 1894. With the Medical officer of Healths Compliments. THIRTY-EIGHTH ANNUAL REPORT ON THE Health and Sanitary Condition of the Parish of St. Mary, Islington. ALFRED EDWIN HARRIS. MEDICAL OFFICER OF HEALTH. London: Chas. Straker & Sons, Ltd., “Avenue Works,” Bishopsgate Avenue, E.C. 1894. m INDEX. Page. Adulteration of Food 125 Births 18 Cancer 57 Cholera 108 Clerical Staff 115 Cow Houses 124 Deaths 21 ,,at different ago periods 21 ,,in the Quarters 30 „ in the Sub-Districts 29 ,, from Zymotic Diseases 31,32 Diarrhœa 51 Diphtheria 39, 101 „ and Defective Drains 40 „ Fatality of 77 ,, Notification of 74 „ and Yerbury Road Board School 41 Disinfecting Station 113 Enteric Fever 50 „ Fatality of 80 „ Notification of 79 Erysipelas, Fatality of 83 ,, Notification of 82 Food, Adulteration of 125 „ Unsound 127 Hanovor Street Board School 92 Hospital Accommodation 69 ,, Correspondence with Metropolitan Asylums Board 71 ,, Statistics 83 Houses, Disinfection of 92 Infantile Mortality 84 Infectious Diseases Notified 73 ,, ,, Precautions Against 103 Influenza 53 Marriages 18 Measles 35 Membranous Croup 78 Notification of Infectious Diseases 58, 73 „ „ ,, „ in the Sanitary Districts 61 ,, „ „ ,, in the Wards 60 „ „ Scarlet Fever 64 ,, „ Small Fox 62 Overcrowding 9,10 ,, in Tenements 12 Office Accommodation 116 Persons to an Acre 6 Page. Population, Ages of, at Census 5 „ Age Distribution 15 ,, Density of 6 ,, Dwelling in Tenements 7 ,, Estimated in 1893 17 ,, Sex Distribution 15 „ in Sub-Districts 17 Precautions against Infectious Diseases 103 „ ,, Cholera 109 Proceedings, Legal 123 Public Disinfection 122 Puerperal Fever 54 „ ,, Notification of 80 ,, ,, Fatality of 81 Regent's Canal 108 Sale of Food and Drugs Acts 125 Sanitary Inspectors 26, 93 Scarlet Fever 37, 64 ,, ,, Fatality from 72 Simple Continued Fever 51 Slaughter Houses 124 Small Pox 35, 62 Superintendent of Public Health Department 103 Tabes Mesenterica 57 Tenements 7 ,, Family groups in 8 „ Occupiers of 7 ,, Overcrowding in 10,12,13 „ per-centage of Population in 9 Enteric or Typhoid Fever 50 Typhus Fever 49 Unsound Food 127 Water Supply 119 ,, „ Bacterioscopic examination of 120 ,, ,, Analysis (Chemical) 148 Whooping Cough 48 Yerbury Road Board School 41, 86 Zymotic Diseases 33 APPENDIX. Tables Population, Inhabited Houses, Marriages, Births, and Deaths A Annual Birth and Death-rates, and Death-rates of Children B Deaths registered from all causes during the year C Deaths registered from all causes in each District D Deaths registered from all causes in each Quarter E Deaths since 1882, from specified diseases F Deaths of Residents in Public Institutions outside the Parish G Deaths classified according to Diseases, Ages, and Localities H Population, Births and casos of Infectious Sickness I Summary of Sanitary Work in eight Districts J Summary of Sanitary Work in fourteen Districts K Summary of Applications for Removal of Dust L Water Analysis M&N ANNUAL REPORT. To the Chairman and Members of the Vestry of St. Mary, Islington. Gentlemen, In order rightly to understand the vital statistics of this, or any other report dealing with them, it is absolutely essential that their basis—which is the number of the population and its distribution— should be clearly understood. At the recent census the population of Islington was found to amount 319,143 persons, of whom 150,760 were males, and 168,383 females. The ages of these persons were as given in Table I. Table I. Ages. Males. Females. Persons. Under 1 year. 4,025 4,100 8,125 0—5 18,820 18,944 37,764 5—15 32,608 32,995 65,603 15—25 29,553 34,349 63,902 25—35 26,075 28,832 54,907 35—45 18,815 20,967 39,782 45—55 12,866 14,929 27,795 55—65 7,270 9,527 16,797 65—75 3,632 5,573 9,205 75 and upwards 1,121 2,267 3,388 All Ages 150,760 168,383 319,143 Large though this number is, yet it fell considerably short of the estimated population, and even short of the excess of Births and 6 Deaths in the decade 1881-90, in which period it was found that the former exceeded the latter by 41,828, whereas the enumerated increase amounted to only 36,278, or 12.8 per cent. on the preceeding census. In this connection it is interesting to note the manner in which the population of Islington multiplied during the two preceding decades. From 1861 to 1870, it increased 37.6 per cent.; from 1871 to 1880, 32.3 per cent.; and from 1881 to 1890 only, 12.8 per cent The Parish is now nearly built over, and consequently in the future such large increases as just mentioned cannot recur. Space for the inhabitants has become less and less during the last half century, for whereas in 1841-50, there was available 0.041 acre for each person, now there is only 0.010. The following table shows the acres to a person available in each decade since 1841. Table II. 1841-50. 1851-60. 1861-70. 1871-80. 1881-90. 0.041 0.025 0.017 0.013 0.010 The entire extent of the Parish is 3,107 acres, on each of which 102 persons live, which must be considered a very great crowding together of the people. The inhabitants now dwell in 37,875 houses, compared with 34,046 houses in 1881, and there are, therefore, now 8.42 persons to each house compared with 8.31 in 1881. In this period, too, there were 563 houses in course of erection, while in 1891 there were only 237 building; so that while the population was still increasing, not nearly so many new buildings were in course of erection. It is true that at the time the census was taken building operations in London generally were much below their usual average, so that it would be unfair to say that they are not intended to be carried on as extensively as in past years, until all the available sites are built on. 7 Still one cannot close his eyes to this fact, that the older parts of this Parish which, a comparatively few years ago, were inhabited by the wealthier classes, are now occupied by persons in inferior positions in life, and even by the poorer classes—by the masses. These houses, formerly occupied by single families, are now for the most part tenanted by two or more families, and are, therefore, more crowded and less salubrious. The last census, for the first time, gave the public an insight into the manner in which Islingtonians are lodged in tenements, but unfortunately it did not give particulars respecting the sub-districts— a defect which is to be regretted, as the information would be invaluable to this Authority. From the returns I have extracted the following table, a study of which will well repay those persons who take an interest in the housing of the working classes and in the health of the community. Table III. Showing the total tenements, and tenements with less than five rooms, distinguishing those occupied by various numbers of persons. 2,652 Rooms in Tenements. No. of Tenements with less than 5 rooms. Number of Occupants of Tenements. 1 2 3 4 5 6 7 8 9 10 11 12 Total Tenements Column 1 2 3 4 5 6 7 8 9 10 11 12 13 1 12,856 4,559 4,240 2,137 1,194 497 159 51 10 4 4 1 - 2 16,716 1,293 4,097 3,656 2,915 2,135 1,304 753 379 133 39 9 8 3 11,806 392 2,339 2,406 2,035 1,700 1,182 862 491 266 87 36 10 4 8,015 100 831 1,152 1,301 1,285 1,118 883 602 412 205 82 44 Totals 49,393 6,344 11,507 9,351 7,445 5,617 3,763 2,549 1,482 815 335 128 57 Definition of In the instructions to the enumerators issued by the “house.” Registrar-General, “all the space within the external and party walls of a building was to be considered a separate house, by 8 however many families, living in distinct tenements or apartments, it Definition of might be occupied. By a tenment was to be understood tenement." any house or part of a house separately occupied either by the owner or by a tenant; and a separate schedule was to be given to the occupier of each such tenement." These definitions, which were plain enough, were, it is stated by the Registrar General, misunderstood in many instances by the enumerators, and consequently errors arose, which, wherever they were detected, were rectified. From Table III. (Registrar-General's) I have constructed the following table which gives the actual number of persons living in similar tenements, and shows the aggregation of the people in family groups consisting of 1 to 12 persons in each group. Table IV. Giving the number of persons in 1 to 4 room tenements, and showing the crowding in family groups consisting of 1 to 12 persons in each. Rooms in Tenements. Number of Occupants in Groups from 1 to 12. 1 2 3 4 5 6 7 8 9 10 11 12 Totals Column. 1 2 3 4 5 6 7 8 9 10 11 12 13 1 4,559 8,480 6,411 4,776 2,485 954 357 80 36 40 11 — 28,189 2 1,293 8,194 10,968 11,660 10,675 7,824 5,271 3,032 1,197 390 99 36 60,639 3 392 4,678 7,218 8,140 7,500 7,092 6,034 3,928 2,394 870 396 120 48,762 4 100 1,662 3,456 5,204 6,425 6,708 6,181 4,816 3,708 2,050 902 528 41,740 Totals 6,344 23,014 28,053 29,780 27,085 22,578 17,843 11,856 7,335 3,350 1,408 684 179,330 9 From this table I have constructed Table V., which gives the number per 100 of the population in similar family groups living in tenements, containing one to four rooms each. Table V. Showing the number of persons per 100 of the population in family groups of 1 to 12 persons living in tenements of 1 to 4 rooms. Rooms in Tenements. No. Per Centum of Population in Family Groups of 1 to 12 Persons. Per 100 persons in each part of Tenements. 1 2 3 4 5 6 7 8 9 10 11 12 Column 1 2 3 4 5 6 7 8 9 10 11 12 13 1 1.43 2.66 2.01 1.50 0.78 0.30 0.12 0.02 0.01 0.01 0.00 0.00 8.83 2 0.41 2.57 3.43 3.65 3.35 2.45 1.65 0.95 0.38 0.12 0.03 0.01 19.00 3 0.12 1.46 2.26 2.55 2.35 2.22 1.89 1.23 0.75 0.27 0.12 0.03 15.28 4 0.03 0.52 1.08 1.63 2.01 2.10 1.93 1.50 1.16 0.64 0.28 0.16 12.92 Totals.. 1.98. 7.21 8.79 9.33 8.48 7.07 5.59 3.71 2.29 1.04 0.44 0.21 56.20 From Table III. and IV. it is ascertained that as many as 28,189 persons live in 12,856 tenements of one room in each. That 60,639 persons occupy 16,716 tenements with two rooms, that 48,762 persons live in 11,806 tenements with three rooms, and that 41,740 persons dwell in 8,015 tenements with four rooms in each. And finally, that 179,330 persons are housed in 49,393 tenements with less than five rooms in each tenement. The construction of these tables would be mere waste of time if nothing respecting the overcrowding of the district could be ascertained from them. But it is naturally asked, What is the definition of “overcrowding?” I am of opinion that it is not always the mere allowance of cubic feet per every individual who occupies each room which should be the determining quantity, but that consideration should be given 10 to several other important factors, such as (a) the occupation of the room as a sleeping-room and as a living-room; (6) the surroundings or situation of the house or room; (c) the work or employment of the occupier at his home; and (d) the ventilation, light, and sanitary circumstances generally. Bat these matters are not frequently enough considered, and a ready general rule of allowing from 250 to 400 is adopted; but these limits very often vary in different districts. This statement is proved by the fact that in the regulations of various Sanitary Authorities for the management and control of common lodging-houses the limit of space varies considerably. In the General Report of the Census, Dr. Ogle discusses the term “overcrowding,” and, perhaps, it would be as well to adopt his definition for the purposes of this portion of tbe report. It is as follows: “It is plain the number of rooms and occupants is not in itself an absolutely sure guide, because rooms differ largely from each other in size. Still we may be tolerably certain that the rooms in tenements with less than five rooms will not, in any but exceptional cases, be of large size, and that ordinary tenements which have more than two occupants per room, bed-rooms and sitting-rooms included, may safely be considered as unduly overcrowded.” Taking this, then, as the definition, it is found that, excluding all one-roomed tenements with not more than two occupants, all tworoomed tenements with not more than four occupants, all three-roomed tenements with not more than six occupants, and all four-roomed tenements with not more than eight occupants, there are left 12,949 tenements of less than five rooms, in each of which there are more than two occupants per room. These 12,949 tenements, which are overcrowded, are made up in the following manner:- One-roomed tenements 4,077 or 31.71 per cent. Two-roomed „ 6,377 „ 38.15 „ Three-roomed „ 1,752 „ 14.84 „ Four-roomed „ 743 „ 9.27 „ One, two, three, and four12,949„26.21 „ roomed tenements 11 From Table IV. I extract the information that these 12,949 overcrowded tenements, containing 64,604 persons, lodge 20.24 per cent. of the total population of the Parish, who I farther find were distributed as follows:— In one-roomed tenements... 15,150 or 4.75 per cent. of the population. „two-roomed„ 23,524 „ 8.94„ „ „three-roomed„ 13,742 „ 4.30,, „ „four-roomed„ 7,188 „ 2.25„ „ In all overcrowded tenements 64,604 „ 20.24„ „ From these figures and from Table V. (column 13) I find that out of 8.83 per cent. of the population living in one-roomed tenements, 4.75 per cent. are overcrowded; of the 19.00 per cent. living in tworoomed tenements, 8.94 per cent. are overcrowded; of the 15.28 per cent. living in three-roomed tenements, 4.30 are overcrowded; and of the 12.92 per cent. living in four-roomed tenements, 2.25 are overcrowded. It is found, too, that of those persons who live in tenements consisting of not more than five rooms, the largest proportion dwell in those composed of two and three rooms (Table V., column 13), and also that the greatest overcrowding occurs in the same class of tenements. Upon analysing still further the figures already given, I find that the 12,949 overcrowded tenements are occupied on an average by 4.94 persons per tenement, and that they contain 25,059 rooms, which are occupied on an average by 2.57 persons per room. This overcrowding is greatest in the single tenements, where it is 3.71 persons per room; next greatest in the three-roomed tenements, where the figure is 2.61; then in the four-roomed tenements, where there are 2.41 persons; and least in the two-roomed tenements, where there are 2.23 per room. Perhaps, however, the latter figure is not altogether so small relatively as it appears, for it must not be forgotten that in many cases the occupants will use one room for a living-room or kitchen, and will crowd themselves together at night in the other room, which they will use solely as a bed-room. If this overcrowding be bad, and it is undoubtedly 12 so, it follows as a matter of course that the overcrowding in the oneroomed tenements is a still greater evil for here the occupants cook, work, dress, and sleep—in fact, live, move, and have their being. Having these facts in view, the following table is of great interest:- Table VI. Showing the overcrowded tenements and how they are occupied. Rooms in Tenements. No. of over-crowded Tenements. Occupants. No. of Rooms. Occupants. Per Tenement. Per Room. 1 4,077 15,150 4,077 3.71 3.71 2 6,377 28,524 12,754 4.47 2.23 3 1,752 13,742 5,256 7.85 2.61 4 743 7,188 2,972 9.67 2.41 Total 12,949 64,604 25,059 4.94 2.57 I have dealt solely with tenements containing less than five rooms only because there are no other particulars furnished by the Census Returns. It is not, however, to be understood that there is no overcrowding in those of larger size. It is more than probable that there is; but, not having the figures, I am not in a position to make a positive statement. A discussion of the figures given in the preceding pages would not be valuable unless there were some facts with which they could be contrasted. Fortunately, in the Census General Report a table is given which shows the overcrowding in the rural and urban districts of England and Wales, and I have constructed other tables for London, from which I have obtained corresponding information for it. Consequently, I have been able to contrast three other groups of places; and I print a table which gives important particulars as to the housing of the population in tenements in Islington, London, and in the urban and rural districts. 13 In examining Table VII. it will at once strike even the casual observer that not only Islington, but London, compare very unfavourably with the Urban and Rural Districts in the proportionate number of large tenements; for whereas in the Rural Districts 51.34 per cent., and in the Urban Districts 46.27 per cent. of the tenements contain five or more rooms, in Islington it reaches only 32.10 per cent., and in London 32.74 per cent. Table VII. Showing the relative proportion per cent. of Tenements of 1, 2, 3 and 4 rooms to the total number of tenements. No. of Rooms in Tenements. 1 3 3 4 5 or more Rooms. Islington 17.69 23.01 16.25 11.05 32.10 London 18.40 20.23 16.34 12.29 32.74 Urban Districts 6.16 12.59 12.60 22.38 46.27 Rural Districts 0.96 8.30 11.70 27.70 51.34 Table VIII. Showing the average number of persons living in overcrowded tenements (under five rooms) per tenement and per room. Districts. l-roomed Tenements. 2-roomed Tenements. 3-roomed Tenements. 4-roomed Tenements. Per Tenement. Per Room. PerTenement. Per Room. PerTenement. Per Room. PerTenement. Per Room. Islington 3.71 3.71 4.47 2.23 7.85 2.61 9.67 2.41 London 3.79 3.79 6.01 3.00 7.85 2.61 9.69 2.42 Urban 3.85 3.85 6.08 3.04 7.92 2.64 9.68 2.42 Rural 4.36 4.36 6.16 3.08 7.95 2.65 9.67 2.42 14 Table IX. Giving the percentages of the population living in overcrowded tenements of 1 to 4 rooms each in Islington and London, and in the Urban and Rural Districts. Districts. Tenements consisting of Totals. 1 room. 2 rooms. 3 rooms. 4 rooms. Islington 4.75 8.94 4.30 2.25 20.24 London 5.07 7.80 4.55 2.17 19.59 Urban 1.62 4.42 3.46 2.82 12.31 Rural 0.25 2.48 2.83 2.90 8.46 In Islington and London as a whole the tenements consisting of one and two rooms are most numerous. They form I7.69 and 23.01 per cent. of the total tenements in the Parish, and 18.40 and 20.23 per cent. in the Metropolis. These percentages are in marked contrast to the low percentages of the Urban and Rural Districts, in which the combined percentages for the single and two-roomed tenements are less than the percentage of the two-roomed tenements in Islington and also in London. Now, in Table VIII., it is observed that where overcrowding occurs in the single and double tenements of the Urban and Rural Districts it is greater than either in Islington or in London. But fortunately for these places, as I have shown, they have comparatively few tenements of these classes, while, on the contrary, Islington and London possess an abnormal number. This is most unfortunate, for as I have already stated overcrowding in one and two rooms is the very worst description of it. If the premises be granted—which my personal observation has long since taught me to be sound—that people, as a rule, endeavour to keep one room solely as a “living”-room, wherein they perform all the ordinary household duties and dwell during the day, but do not sleep during the night, then the matter is capable of proof. 15 Thus, if I take a number of tenements with an average of three persons per room, I find that to- 6 persons in 2 rooms is generally 6 persons in one room at night. 9 ,, 3 ,, 3.5 „ ,, 12 ,, 4 „ 4 ,, „ 15 ,, 5 ,, 3.75 „ ,, Islington, therefore, stands in a distinctly unfavourable position as regards overcrowding. In Table IX. I have calculated the percentage proportion of the population that dwell in the overcrowded tenements of the several districts which I have taken for comparative purposes. From this table I find that nearly nine per cent. (8.94) of our Parishioners are housed in two-roomed tenements, compared with 4.42 per cent. in the Urban and 2.48 in the Rural Districts. I notice, too, that the percentage is 1.14 higher than the London rate. Taken altogether, the facts exhibited in Table IX. are unsatisfactory, for in its last column is disclosed the fact that as much as 20.24 per cent. of the local population dwell in overcrowded tenements (1-4 rooms). This is 7.93 per cent. higher than the Urban Districts' percentage (12.31), and 11.78 higher than that (8.46) of the Rural. It was also 0.65 higher than the percentage (19.59) of London. These are not all the facts to be brought out by a study of these statistics as to overcrowding, and I therefore recommend their study to every person who is interested in the housing of the people. Personally I did not expect when I commenced a study of the census returns to find that Islington compared so unfavourably with other places in the lodgment of its inhabitants. The light now thrown on this question naturally brings with it new responsibilities in seeing that the large overcrowded population is adequately cared for, and placed under the best possible Sanitary conditions. AGE AND SEX DISTRIBUTION OF THE POPULATION. In the estimation of the value of death-rates, the age, and to a lesser extent the sex, distribution of the population is of value, as will be seen when I come to discuss the mortality of the Parish. 16 From Table I. I have calculated that every 1,000 of the population is composed as shown in- Table X. Showing the Age and Sex Distribution for every 1,000 persons of all ages. Ages. Males. Females. Persons. 0—5 57 61 118 5—15 102 104 206 15—25 93 107 200 25—35 82 90 172 35—45 59 65 124 45—55 40 47 87 55—65 23 31 54 65—75 11 17 28 And upwards 4 7 11 All Ages 471 529 1,000 This table may be read in the following manner:-Out of every 1,000 persons in the population, 118 are under five years, of whom 57 are males, and 61 females. I have prepared another Table (XI.), which shows the age distribution of the population in several districts as well as in England and Wales, from which it will he seen that places differ very materially in this resnect. Table XI. Showing the age distribution in several districts and in England and Wales. Ages. Under 5 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 & upwards. Islington 118 206 200 172 124 87 54 28 11 London 119 207 201 170 123 87 53 29 11 Urban Districts 123 225 199 157 118 85 53 30 10 Rural Districts 123 237 178 134 107 88 67 46 20 England & Wales 123 228 193 151 115 86 57 34 13 17 Table XII. Giving the estimated population in the middle of 1893, at nine age periods, and showing the estimated number of males and females living at the several age periods. Ages. Males. Females. Totals. 0—5 19,364 19,488 38,740 5—15 33,551 33,949 67,631 15—25 30,410 35,310 65,659 25—35 26,824 29,655 56,468 35—45 19,355 21,583 40,709 46—55 13,245 15,339 28,561 55—65 7,485 9,795 17,732 65—75 3,737 5,728 9,192 75 and upwards 1,153 2,332 3,611 All ages 155,124 173,179 328,303 This and the following table contain the figures on which all the birth and mortality statistics in this report are based. Table XIII. Showing the estimated populations in the four sub-registration districts of Islington. Districts. Populations. Upper Holloway 95,694 South-west Islington 106,614 South-east Islington 64,996 Highbury 60,999 Islington 328,303 18 MARRIAGES. There were 5,306 persons married which represents half that number of marriages. The Annual rate of persons married was 16.16 per 1,000 of the population. In 1892 the rate was 17.14 per 1,000, consequently the present rate is 0.98 lower than the preceding year. Table XIV. Showing the marriages and marriage rates in each quarter, together with the marriages in 1892. Period. Marriages. Persons married. Persons married, rate per 1,000 population. 1892. Marriages. First Quarter 439 878 10.79 464 Second 705 1,410 17.34 736 Third 819 1,638 20.14 831 Fourth 690 1,380 16.97 752 Year 2,653 5,306 16.16 2,783 BIRTHS. There were 9,749 births registered in the Parish. Of these 5,032 were males, and 4,717 females, and the proportion of the latter to the former was as 93.7 is to 100. This proportion of females to males is less than in any year since 1881, when it was 92.6. The 9,749 births were equal to a birth rate of 29.69 per 1,000 of the population. This rate is only 0.25 higher than in the preceding year, which was the lowest previously recorded in Islington. It is a noticeable fact that ever since 1879 the birth rate of the district has been steadily declining, and it is since then also that Islington has ceased to augment its population by leaps and bounds. Growing communities and nations are always remarkable for high birth rates—just as those that are standing still are noted for low rates. It is to be noticed, also, that the natural increase of the district has been only once in twenty-two years so small as in 1893, the excess of births over deaths amounting to 3,358, namely in 1871 when it was 3,026. 19 Table XV. Showing the births of males and females in each quarter in the several sub-registration districts. Upper Holloway. Islington South-west. Islington South-east. Highbury. Whole Parish. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st. Qr. 343 342 685 467 432 899 269 233 502 223 183 406 1,302 1,190 2,492 2nd” 374 361 735 426 440 866 247 232 479 223 206 429 1,270 1,239 2,509 3rd” 347 341 688 398 402 800 266 241 507 197 202 399 1,208 1,186 2,394 4th„ 332 328 660 433 388 821 280 226 506 207 160 367 1,252 1,102 2,354 Total. 1,396 1,372 2,768 1,724 1,662 3,386 1,062 932 1,994 850 751 1,601 5,032 4,717 9,749 The following table has been prepared for the purpose of enabling a comparison to be made between the Islington Birth-rates and those of other large communities. Table XVI. Showing the Birth-rates in each quarter and for the year in Islington, in London and in the 33 large Towns. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Upper Holloway 28.70 30.79 28.82 27.65 28.92 Islington, South-West 33.80 32.56 30.08 30.86 31.75 Islington, South-East 30.98 29.55 31.28 31.22 30.67 Highbury 26.71 28.22 26.25 24.14 26.24 The Parish 30.40 30.60 29.20 28.71 29.69 London 32.7 30.7 30.6 29.7 31.0 33 Large Towns 33.2 32.2 31.5 30.5 31.9 The low birth-rate of the district is curious because the number of persons living at that period of life, namely, between twenty-five and forty-fire years of age, is proportionately greater than in any of the districts specified in Table XI. b 2 20 Table XVII. Showing Births, Birth-rates, &c., in Islington, for the past 22 years. Year. Total Births. Birth Rate* per 1,000 of the Population. Males. Females. Proportion of Females born to every 100 Males. Excess of Registered Births over Registered Deaths 1871 7,655 35.6 3,824 3,831 100.2 3,026 1872 8,000 36.1 4,051 3,949 97.5 3.970 1873 8,522 37.4 4,364 4,158 95.3 4,129 1874 8,669 37.0 4,316 4,353 100.9 3,989 1875 9,032 37.5 4,657 4,375 93.9 4,376 1876 9,186 37.1 4,735 4,451 94.0 4,397 1877 9,310 36.6 4,807 4,503 93.7 4,472 1878 9,456 36.1 4,736 4,720 99.7 4,298 1879 9,917 36.8 4,965 4,952 99.7 4,596 1880 9,846 35.5 5,155 4,693 91.1 4,560 1881 9,968 35.1 5,176 4,792 92.6 4,852 1882 10,051 34.9 5,178 4,873 94.8 4,787 1883 9,888 34.0 5,075 4,813 94.8 4,748 1884 10,011 34.0 5,131 4,880 95.1 4,782 1885 9,643 32.3 4,987 4,656 93.3 4.320 1886 9,814 32.5 4,937 4,877 98.8 4,653 1887 9,726 32.2 4,929 4,797 97.3 4,326 1888 9,568 30.9 4,906 4,662 95.0 4,704 1889 9,559 30.5 4,869 4,690 96.3 4,807 1890 9,419 29.7 4,790 4,620 96.4 3,701 1891 9,797 30.8 4,891 4,906 100.3 3,940 1892 9,552 29.4 4,904 4,648 94.7 3,867 1893 9,749 29.69 5,032 4,717 93.7 3,358 *In this table the rates have been re-calculated on the basis of the census figures of 1881 and 1891. 21 DEATHS.* There were 6,391 deaths registered in London of persons who were parishioners of Islington. Of these 5,859 were registered in the Parish, and 532 in other parts of London whither they had gone for treatment in Public Institutions. The deaths comprised 3,201 males and 3,190 females. The death-rate was 19.45 per 1,000 of the Eestimated population, and it exceeded that of the preceding year, when it was 17.52, by 1.93. The following table gives the number of males, females and persons who died at nine different age periods, together with the estimated number of persons living at those ages, and the death-rates. Table XVIII. Showing the population, deaths and death-rates from all causes at nine age periods of Males, Females and Persons. Ages. Males. Females. persons. Population Deaths. Death Rates. Population. Deaths. Death Rates. Population Deaths. Death Rates. 0—5 19,364 1,376 71.05 19,488 1,122 57.57 38,740 2,498 64.48 5—15 33,551 134 3.99 33,949 167 4.92 67,631 301 4.45 15—25 30,410 128 4.20 35,310 120 3.40 65,659 218 3.77 25—35 26,824 192 7.15 29,655 218 7.35 56,468 410 7.26 35—45 19,355 286 14.77 21,583 251 11.62 40,709 537 13.19 45—55 13,245 310 23.41 15,339 277 18.05 28,561 587 20.15 55—65 7,485 304 40.61 9,795 292 29.81 17,732 596 33.61 65—75 3,737 272 72.79 5,728 392 68.44 9,192 664 72.21 75 and upwards 1,153 199 172.60 2,332 351 150.50 3,611 550 152.33 All ages 155,124 3,201 20.63 173,179 3,190 18.41 328,303 6,391 19.45 *The deaths of 468 persons who had come from other districts of London for treatment in the Public Institutions of Islington are excluded from these returns. 22 In a preceding table (XI.) I gave the age distribution of the population, and I compared it with the age distribution of other districts. Now age distribution has a considerable effect on the death rate of a community, and it is consequently impossible to compare the death rate of one place with that of another unless allowance be made for it. One population may be cast in such a manner that it has an undue proportion of young lives, another of the middle ages, and yet another of old persons. Before then one can say whether the death rate of Islington is good, bad or indifferent, it should be compared with other districts. I have accordingly prepared Table XIX. in which I give the deaths that would have occurred at the several age periods (the death rates being the same) in Islington if the population had been cast (1) as in England and Wales, (2) as in the Urban Districts, and (3) as in the Rural Districts. Table XIX. Showing the deaths that would have occurred in Islington if the ages of the population had been distributed as in the undermentioned places, cols. 4, 5, 6. Ages. Islington. Deaths and Death Rates that would have occurred if the ages of the population had been distributed as in Death Rates. 1893. Deaths in 1893. England and Wales. The Urban Districts. The Rural Districts. 1 2 3 4 5 6 0—5 64. 48 2,498 2,603 2,603 2,603 5—15 4.45 301 333 328 346 15—25 3.77 248 239 246 221 25—35 7 26 410 360 374 319 35—45 13.19 537 498 511 463 45—55 20.15 587 580 573 593 55—65 33.61 596 629 585 739 65—75 72.24 664 806 711 1,091 75 and upwards 152.33 550 650 500 1,000 Totals. 6,391 6,698 6,431 7,375 Death Rates. 19.46 - 20.40 19.58 22.46 23 Here it is seen that the mortality in Islington, with its population distributed as it is, is less than if it were distributed in either of the three other ways that are mentioned, for it is found that if it were cast as that of England and Wales it would have resulted in 6,698 deaths, as that of the Urban Districts in 6,431 deaths, and as that of the Rural Districts in 7,375 deaths, instead of those which have resulted, namely 6,391 deaths. The net gain in lives to Islington in 1893 was 307 when compared with England and Wales, 40 with the Urban Districts, and 984 with the Rural Districts, as the respective standards. The fact is that the population is least, relatively to the districts under comparison, at those ages when the death rates (vide Table XVIII., column 10) are highest, and greatest when the death rates are least. Our population is so distributed that it contains a greater proportion of persons at those age periods when life is most valuable, when men and women, having been educated, are learning some trade, business, or profession, or, having learned them, have fully entered on the battle of life, become parents, and also attained to their fullest development, physically and intellectually, and to their greatest value commercially. The next question is, is the mortality at the different age periods, or at any age period, excessive? In order that this query may be answered I have prepared another Table (XX.) which is of very considerable interest, and well worth careful study. In this Table I give in columns 3, 5 and 7, the death rates for Islington at the several age periods in 1893, the death rates of Dr. Farr's Healthy Districts and the death rates in England and Wales in the decade 1871-80*, while in columns 4, 6 and 8, I give the number of deaths that were registered in the Parish in 1893, and those that would have resulted in it if the death rates had been the same as in the healthy districts and as in England and Wales. It should be stated that in Dr. Farr's group of 53 healthy districts the mean mortality was 16 94 per 1,000, and that it. consisted of all those districts whose annual death rate had not reached 17.0. Of these districts he writes that they "have a salubrious soil, and supply the inhabitants with waters generally free from organic impurities. The people are by no means wealthy; the great mass of them are labourers and work people on low wages whose families get few luxuries and very rarely taste animal food. Their cottages are clean, but are sometimes *Those for 1881-90 have not been yet published by the Registrar-General. 24 crowded, and impurities abound; the sanitary shortcomings are palpable." Such a state of healthiness would be difficult to attain in a district like Islington, completely built over as it is, and with surroundings very different from the Healthy Districts, which were for the most part rural or semi-rural. I have added them to the Table to show that, favourably circumstanced as they were by nature, they were not at certain age periods so healthy as Islington. It is sometimes good to know our strong as well as our weak points. The following is the Table:— Table XX. Showing the deaths and death-rates at different age periods in Islington in 1893, and the deaths that would have occurred if the death-rates had been the same as those in the Healthy Districts, and in England and Wales (1871—80), together with the death-rates of these districts. Ages. Estimated Population in 1893. Annual Death Rates. Deaths in 1893. Annual Mortality Rates in the Healthy Districts. Deaths which would have occurred in Islington if the death rates had been the same as in Healthy Districts. Death Rates in England in 1871-80. Deaths which would have occurred in Islington if the death rates had been the same as in England. 1 2 3 4 5 6 7 8 0—5 38,740 64.48 2,498 40.34 1,562 63.12 2,444 5—15 67,631 4.45 301 5.60 378 5.06 342 15—25 65,659 3.77 248 7.28 478 6.18 405 25—35 56,468 7.26 410 8.56 483 8.93 504 35- 45 40,709 13.19 537 9.63 392 12.62 513 45—55 28,561 20.55 587 12.32 351 17.72 506 55—65 17,732 33.61 596 22.28 395 31.49 558 65—75 9,192 72.24 664 52.39 481 64.85 596 75 and upwards. 3,611 152.33 550 145.32 524 161.59 583 328,303 19.45 6,391 16.75 5,044 21.27 6,451 15.36* 19.64* *The death rates that would have prevailed in these districts at all ages if the distribution of the ages had been the same as in Islington in 1893. The rate would also be slightly different if sex distribution had been taken into consideration, viz.: 19·39. Note.—When the above table was compiled the death-rate for England during the dicennial period had not been published, and therefore I had to fall back on that of the preceding decade. The death-rate 1881—90 was 19·15. 25 Here it is seen that the death rates in Islington are in excess of the Healthy Districts in the age periods 0-5, 35—45, 45—55, 55—65, 65—75, and 75 upwards, and below them in the age periods 5—15, 15—25, and 25—35. In the age periods 0—5, 35—45, 45—55, 55—65, and 65—75, they are above those of England and Wales, and below them in the others. This is just what might be expected at the earlier period (0—5) of life when the peculiar conditions, under which the population is housed in tenements, with so many of them overcrowded, are considered, for it is under such conditions that juvenile life suffers most. But one would hardly expect that at the next period (5—15) the vitality of the population would have been so good. Indeed, the low death-rate of 4•45 is not easily explained, and more particularly the difference of 1•15 between it and that of the healthy districts. No surprise need, however, occur that the death-rate of the age period 15—25 is so very good, being as it is, nearly 50 per cent. below that of the healthy districts, and 40 per cent. below that of England and Wales, for just at this period, and the next, there is an immigration into the Metropolis of some of the best lives of the country, of which Islington gets its due share, for the purpose of entering on commercial life. Towards the latter part of the age period (25—35) the good character of the rate is not maintained, for then the wear and tear, bodily and mental, begin to tell, with the result that at the next period (35—45) their effects are very apparent, and the death-rate is found to exceed the healthy district rate by 3•56, and the English rate by 0'57. This difference is even more accentuated at the next period of life (45—55), for it is found that the death-rate is 8•23 per 1,000 persons living at that age in excess of the healthy districts' rate, and 2•83 above that of England and Wales. The fact is that the worries, cares, anxieties and hard work, mental and physical, and dissipation have told their tale, and demanded their victims, as an analysis of the death returns conclusively prove. It need cause no wonder then to find that when men have reached the age of 55 the death toll is still very heavy, and that as they have 26 grown old before they reach 65 years, an undue proportion of them die, or are left so decrepit that when they have reached the latter age they are unable in even larger proportions to struggle on to 75. The death-rate of 72•24 as compared with 52•39 of the healthy districts, and 64•85 of the country as a whole speaks for itself. The mortality being so heavy at this period, it is only natural to expect, when very old age is reached, that the high death-rate should continue, and it is not surprising to find it very much above that of the other death-rates I have selected for comparative purposes. Still, it is gratifying to find in adolesence and in early and matured manhood that the vitality of our inhabitants is so good. Considering the conditions under which the population lives as to business and occupation, the hurrying to and fro, and the restless activity of commercial life, it becomes all the more necessary that the homes of these people should be made as healthy as possible. Nothing can be more regrettable than to see an undue proportion of our people dropping off when they have only reached the prime of life, at which period their minds should have reached their highest degree of excellence, and when they should have commenced to amass, if they have not already done so, wealth sufficient to support themselves and their families in their declining days. It is difficult to assess at a money value the loss of such lives to the commonweal, but it must be very great, and, therefore, it behoves those who have the sanitary charge of their surroundings to see that nothing is left undone to preserve such valuable lives. Our laws for the protection of health are far better than those of other countries, but it is no matter how good they may be if there be not a sufficient staff of capable sanitary experts to enforce them. There has been of late years a great advance in the class of men who act as Sanitary Inspectors, but great as the improvement has been, I have no hesitation in saying that there is room yet for even greater improvement, and I trust that the strong efforts that are now being made to raise their educational status and their emoluments will be entirely successful. It is only by doing so that the best men will be attracted to the Sanitary 27 service. Great responsibilities rest on them, much is required of them, and they are expected to act with independence and impartiality. Sanitary Science has advanced with great strides during the last two decades, so that to-day the Inspector of twenty years ago, with occasional exceptions, is out of date. The Inspector of these days must not only be able to advise as to Sanitary work, and as to the best sanitary appliances to be used, but he must know something of the physical laws and agencies which are at work to the detriment of the human race, to combat which these appliances were invented. It is folly to think because a man is a good mechanic, whether he be a plumber, a mason or a carpenter, that he must, therefore, be a good Sanitary Inspector. It seems to me that education comes first, and everything else afterwards; and that the educated men can only be procured by offering sufficient salaries, by raising the dignity of the office, and by making their positions secure. I write thus because I know from long experience that many persons in the public boards all over the country, and Islington is no exception, are of opinion that the work of these men can be done by anyone. This is absolutely erroneous, and I trust that before long it will have disappeared. And I also sincerely hope that the Vestry of this great Parish will be one of the first to recognise these facts, and offer to their future Inspectors such inducements as will attract the best men, and when they have attracted them, incite them to remain. By these remarks I do not mean to cast the slightest reflection on the Sanitary Staff of the Parish, for as a body they are undoubtedly the most capable men in such positions it has been my lot to meet with; and, indeed, some of them will compare favourably with any men in similar positions. It is not satisfactory to me, however, to find that these men are constantly applying for more lucrative positions, because I do not wish to lose them. Good men are not so easily obtained, and men with experience are not to be had at the salary offered; Islington is a good training school, and the Inspectors who have done a few years' service here are certain to obtain better paid appointments. To train men in special work and then to lose them is a great misfortune, for it must not be forgotten that good Sanitary Inspectors are not made in less than three or four years. 28 I have preferred to make these remarks in an Annual Report rather than in a mere ephemeral paper, because the reader will have brought before him all the facts of which the mortality is made up, and will be able to learn from them, even apart from any observations that I may deem necessary to make about them, the diseases that are more or less amenable to sanitary control by the adoption of efficient hygienic measures, and are, therefore, so much to be considered preventable, and being preventable, they will, I feel certain, come to the conclusion that it would be the greatest wisdom to spend money for their prevention. And in this connection I would remind the Vestry that the amount spent in Islington on the Health Department for the preservation of the Public Health only amounts to ½d in the £. This is truly an insignificant sum compared with the large amounts that are spent by the public in the cure of preventable diseases, and on the education of the people. If we educate our children, and then let them die, the money spent on them has been fruitlessly spent. Better far to educate and keep them healthy, so that by their labour they may help to swell the wealth of the community, or by their genius render benefits to humanity. But to return to Tables XIX. and XX. From these Tables two facts are deducible (1) that the age distribution of the Parish is favourable to a low death-rate which is proved by columns 4, 5 and 6 of Table XX., and also by Table XX., columns 5, 6, 7 and 8, which show that the death-rate in the healthy districts would have been only 15•36 instead of 16•75, and in England and Wales only 19•64 instead of 21•27 if similarly favoured; and (2) that the death-rates at the several ages, while not so good as those of the healthy districts, are better than those of England and Wales (Table XXI., columns 6 and 8). In these it is seen that the aggregate deaths would have been 5,044 if the death-rates had been the same as in the former district, and 6,451 as in the latter. I have already given a Table, which shows the rates for males and females at the different groups of ages, to enable any one taking an interest in these matters to follow up this subject more minutely, and to make comparisons for the distribution of the sexes. Infectious Disease Notification. CHARTS. Showing the rise and fall of Infectious Diseases each week during 1893. 29 Let me say that on applying the English mortality rates for males and females to the Islington population to each group of ages the results gave 3,179 deaths for males, and 3,188 for females, or 6,367 persons. These deaths are equal to a death-rate of 19•39, which is the Standard Death-rate of Islington, and the death-rate by which the condition of the health of the Parish should be gauged when compared with the rest of the country. Judging then the Death-rate of Islington (which was, as already stated, 19•45 per 1,000) by this standard death-rate it must be considered satisfactory, for it is only 0•06 above it, and more especially so when the conditions of the population as to lodging and housing are taken into consideration, as well as the large aggregation of persons on a limited area. It must be recollected that while in Islington there is only 0•009 acre allotted to each person living in it, the country, as a whole, affords 1•53 acres. Putting it differently, on each acre of Islington there dwell 105 persons, while on each acre of the country there are only 1•25. MORTALITY IN THE SUB-REGISTRATION DISTRICTS. The following Table gives the number of persons, males and females, distributed to the several Sub-registration Districts in which they had lived. Table XXI. Registration Sub-Districts. Males. Females. Persons. Death Rates. Upper Holloway 845 857 1,702 17.78 Islington, S.w. 1,163 1,140 2,303 21.60 Islington, S.e. 691 687 1,378 21.20 Highbury 502 506 1,008 16.52 The Parish 3,201 3,190 6,391 19.45 The Age Distribution in the several Sub-registration Districts are not known, and therefore it is not possible to say positively which, if any, of the death-rates is excessive. Apparently they are what one might 30 reasonably expect, if the character, mode of life, and housing of their populations is considered; for the death-rate is found to be least in those districts which are least overcrowded, and greatest where they are most dense. Judging them then by what is known of the districts, I am of opinion that these death-rates are not unreasonable, and are not excessive. Indeed they are the very opposite if judged by the rates in the worst districts of very many of the large towns, or even of the Metropolis. SEASONAL MORTALITY. Table XXII. The deaths in the Four Quarters. Classified Causes of Death. Quarters. Year. 1st. 2nd. 3rd. 4th. 1. Specific Or Febrile Causes 181 275 356 267 1,079 1. Miasmatic Diseases 153 202 184 221 760 2. Diarrhœal 12 54 154 17 237 3. Malarial ,, .. .. .. .. .. 4. Zoögenous ,, .. .. .. .. .. 5. Venereal ,, 7 5 9 4 25 6. Septic ,, 9 14 9 25 57 II. Parasitic Diseases 1 .. .. 1 2 III. Distic ,, 9 14 9 12 44 IV. Constitutional Diseases ,, 229 255 314 295 1,093 V. Developmental ,, 136 123 106 161 526 VI. Local ,, 909 685 588 857 3,039 1. Diseases of Nervous System 172 180 152 144 648 2. ,, Organs of Special Sense 4 5 2 3 14 3. „ Circulatory System 98 93 92 111 394 4. ,, Respiratory ,, 476 255 152 430 1,313 5. „ Digestive ,, 82 78 130 89 379 6. ,, Lymphatic ,, 1 1 4 2 8 7. ,, Glandlike Organs of uncertain use .. .. 2 .. 2 8. „ Urinary System 44 41 34 38 157 9. ,, Reproductive System 8 21 9 14 52 10. ,, Bones and Joints 6 5 4 5 20 11. ,, Integumentary 18 6 7 21 52 VII. Violence 51 48 51 56 206 1. Accident or Negligence 44 43 37 45 169 2. Homicide .. .. .. 3 3 3. Suicide 7 5 14 8 34 VIII. Ill-defined Causes 81 85 134 102 402 All causes 1,597 1,485 1,558 1,751 6,391 31 Table XXIII. Deaths and Death-rates from all causes in the Four Quarters for the Sub-districts, together with the death-rates in London and the 33 great Towns. Sub-Districts. 1st. 2nd. 3rd. 4th. Year. Deaths. Deathrate. Deaths. Deathrate. Deaths. Deathrate. Deaths Deathrate. Deaths. Deathrate. Upper Holloway 433 18.14 373 15.62 431 18.05 465 19.48 1,702 17.78 Islington, S.-West 552 20.75 567 21.31 564 21.20 620 22.31 2,303 21.60 Islington, S.-East 345 21.28 314 19.37 333 20.54 386 23.81 1,378 21.20 Highbury 267 17.56 231 15.19 230 15.13 280 18.42 1,008 18.42 The Parish 1,597 19.48 1,485 18.11 1,558 19.00 1,751 21.36 6,391 19.45 London — 22.1 — 19.5 — 20.5 — 23.1 — 21.3 33 Large Towns — 22.0 — 19.8 — 21.8 — 22.5 — 21.6 Table XXIV. Deaths from the principal Zymotic Diseases in the Four Quarters. seasons. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric (Typhoid Fever) Diarrhœa. TOTALS. First Quarter .. 25 24 32 32 .. 9 12 134 Second „ .. 52 20 42 55 .. 8 54 231 Third „ 2 31 23 52 53 .. 13 154 328 Fourth „ •• 11 27 63 41 1 18 17 178 Year 2 119 94 189 181 1 48 237 871 1892 2 169 52 130 149 .. 38 158 698 32 Table XXV. Death rates from the principal Zymotic Diseases for the Four Quarters. SEASONS. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric (Typhoid Fever) Diarrhœa. Total Death Rate. First Quarter .. 0.30 0.29 0.39 0.39 .. 0.70 0.14 1.63 Second Quarter .. 0.63 0.24 0.51 0.67 .. 0.09 0.65 2.81 Third Quarter 0.02 0.37 0.28 0.63 0.64 .. 0.15 1.87 2.23 Fourth Quarter •• 0.13 0.32 0.76 0.50 0.01 0.21 0.20 2.17 Year 0.00 0.36 0.28 0.57 0.55 0.00 0.14 0.72 2.65 1st Quarter.—From the preceding Tables it is gathered that Developmental and Respiratory Diseases, together with diseases of the urinary organs, showed their most fatal record in the first quarter. 2nd Quarter.—Miasmatic (which includes the principal fevers) and Septic diseases, and diseases of the nervous and reproductive systems were responsible for their highest mortality in the second quarter. 3rd Quarter.—Diarrhœal and Constitutional Diseases, and diseases of the digestive system reached their greatest mortality in the third quarter; and in the 4th Quarter diseases of the circulatory and integumentary systems, together with deaths from Violence, whether caused through accident or negligence, or wilfully, were accredited with their highest record. ZYMOTIC DISEASES. The returns show that the deaths (871) from the principal zymotic diseases were 173 above the number registered in 1892. These 871 deaths were also 37 above the corrected average (that is, the deaths corrected for increased population) of the decennial period 1881-90. 33 The zymotic death-rate consequently rose from 2•32 in the preceding year to 2•65, which is almost the same rate as that recorded in the 10 years 1881 to 1890. If to this death-rate be added, as it ought, the death-rate from membranous croup, which almost to a certainty was diphtheria, it becomes 2•68. The zymotic death-rate in London was 3•04, so that the local death-rate from these diseases in the Parish was 0•37 below that of the metropolis. The death-rate throughout the London districts ranged from 5•58 in St. Luke's to 1•32 in Hampstead, which also enjoyed the lowest death-rate (12•9) from all causes. Table XXVI. Deaths from the principal Zymotic Diseases, inclusive of the deaths of Parish Patients in Hospitals outside the District. districts. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric (Typhoid Fever) Diarrhœa. S. Upper Holloway 2 24 19 54 50 1 17 79 246 South West .. 56 40 68 73 .. 14 89 340 South East .. 24 14 48 30 .. 8 47 171 Highbury .. 15 21 19 28 • • 9 22 114 Totals 2 119 94 189 181 1 48 237 871 Table XXVII. Death rates from the principal Zymotic Diseases, inclusive of the deaths of Parish Patients in Hospitals outside the District. districts. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric (Typhoid Fever) Diarrhœa. total death rate. Upper Holloway .. 0.25 0.19 0.56 0.52 0.01 0.17 0.82 2.57 South West .. 0.52 0.37 0.63 0.68 .. 0.13 0.83 3.18 South East .. 0.36 0.21 0.73 0.46 .. 0.12 0.72 2.63 Highbury •• 0.24 0.34 0.31 0.45 •• 0.14 0.36 1.86 Death-rates •• 0.36 0.28 0.57 0.55 0.00 0.14 0.72 2.65 34 Table XXVIII. Showing the Deaths from the principal zymotic Diseases in 1893, and for the past twelve years. Estimated Population in the Middle of the Year. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric (Typhoid Fever). Diarrhœa. Total. Death-Rate per 1,000 Population. 1881 283,721 66 161 116 42 172 ... 79 216 852 3.0 1882 287,191 11 153 142 54 299 ... 77 149 885 3.0 1883 290,711 1 165 95 70 119 ... 86 162 698 2.4 1884 294,267 36 125 57 114 268 ... 83 266 949 3.2 1885 297,867 38 289 29 138 200 ... 55 191 940 3.1 1886 301,512 ... 64 25 54 205 ... 48 307 703 2.3 1887 305,112 2 331 50 27 238 ... 39 291 978 3.2 1888 308,936 ... 151 50 35 230 ... 49 146 661 2.1 1889 312,713 ... 180 32 44 112 ... 56 170 595 1.9 1890 316,543 ... 185 29 47 200 ... 35 169 665 2.1 Average for 10 yrs. 300,132 15 180 62 62 204 ... 61 207 793 2.64 1891 320,418 ... 205 28 94 235 ... 25 146 733 2.28 1892 324,339 2* 169 52* 130* 149 ... 38* 158 698 2.32 1893 328,303 2* 119 94 189 181 1 48 237 871 2.65 * These figures in 1892 and 1893 include the deaths in the M. A. B.'s Hospitals. 35 SMALL POX. The deaths from Small Pox were two in number, and occurred in the Metropolitan Asylums' Board Small Pox Hospitals, whither the patients had been removed from Upper Holloway. Each death was registered in the third quarter. The number of deaths was exactly the same as in the preceding year. It is satisfactory to find that since 1885 the disease has not assumed a fatal form in the Parish. The death-rate amounted to only 0•006 per 1,000 per annum of the population. MEASLES. Measles, the notification of which is not compulsory, caused 119 deaths, or 50 less than in 1892, and produced an annual death-rate of 0•36 per 1,000 inhabitants. It was most fatal in the second quarter of the year, when 52 deaths were registered and the death-rate rose as high as 0•63. The mortality was greatest in Islington South West, where the deaths numbered 56, and the death-rate was 0•52; then, in order of greatest fatality, came Islington South East, with 24 deaths and a death-rate of 0•36; Upper Holloway, with 24 deaths and a deathrate of 0•25; and Highbury, 15 deaths and a death-rate of 0•24. In the Districts the mortality was not, however, greatest in the same seasons of the year, for while the curve attained its highest point in Upper Holloway and Islington South West in the second quarter, it did not reach it in Islington South East until the third, and in Highbury until the fourth quarter. In the fourth quarter there was no death from the disease in the large district of Upper Holloway. The rate (0•36) registered in the Parish is 0•29 below the average death-rate of London from Measles during the decade 1881—90, and very considerably less than the record of the years 1840—80; so that in this light it cannot be said to have been unduly fatal in 1893. Compared with the deaths in the Parish itself, they were not excessive, for it will be noticed in the Table (XXVIII.) that only once in c2 36 the preceding eight years has the mortality been less, namely, in 1886, when only 64 deaths were registered. The death-rate from 1871 to 1880 had been 0•52, while from 1885 to 1892 it was 0•63. It will be noticed that as in previous years, so now, the mortality was greatest in those districts of the Parish in which the people are poorest and most crowded together. This is just what might be expected, for Measles is a highly infectious disease, which is generally spread by the inhalation of the disease germs that are given off in the breath or the exhalations of the persons attacked. It is unfortunately highly infectious in the stage preceding the eruption, when, as a rule, it is not recognised by the guardians of the patients, who, in consequence, are not prevented from mixing with other children. In Measles it is well to isolate patients for a month; but, as a matter of fact, this course is rarely, or never, adopted, for somehow it has got to be looked on as a mild disease, which very seldom kills; and, indeed, patients are frequently sent to school in a few days after convalescence. This is a terribly dangerous practice, and is undoubtedly the means of unduly spreading the infection. It is not safe for children to return to school under one month, a fact which, if widely known, would lead to their detention at home, and would considerably lessen the number of cases and deaths, for then much avoidable disease would be prevented. Table XXIX. Giving the Deaths in the Sub-Districts for the Quarters. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 10 12 2 .. 24 Islington, South West 10 27 14 5 56 Islington, South East 2 9 12 1 24 Highbury 3 4 3 5 15 The Parish 25 52 31 11 119 37 Table XXX. Giving the Death-rates of the Sub-Districts for the Quarters. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0•41 0•50 0•08 .. 0•25 Islington, South West 0•37 1•01 0•52 0•18 0•52 Islington, South East 0•12 0•55 0•74 0•06 0•36 Highbury 0•19 0•26 0•19 0•32 0•24 The Parish 0•30 0•63 0•37 0•13 0•36 SCARLET FEVER. Scarlet Fever raged as an epidemic disease during the whole year, and caused 94 deaths. This number was 42 more than those registered in 1892, and 57 more than the average (37) of the preceding eight years. The death-rate was equal to 0•28 per 1,000 per annum of the estimated population, and—notwithstanding the extraordinary number of cases notified—compares favourably with the mean-rate recorded during the decade 1871—80, in which it was 0•68, but unfavourably with the rate during the eight years 1885—92, when it was only 0•11. The death-rate for the year was, however, lower than that for the Metropolis, wherein it was 0•37 for the same period, and also lower than its (London's) mean annual mortality of 0•33 in the decennial period 1881—90. In Islington its most fatal effects were felt in the sub-registration district of Islington South-West, in which the deaths were 40 and the death-rate 0•37. Highbury followed closely on this rate with one of 0•34 and with 21 deaths. In Upper Holloway, with 19 deaths, the death-rate was 0•19; while in Islington South-East 14 deaths produced a deathrate of 0•21. 38 In Upper Hollow-ay it was most fatal in the third quarter, when the death-rate was 033 per 1,000 (8 deaths). In Islington SouthWest the mortality rate was greatest in the fourth quarter, when it was 0.48 (13 deaths). In Islington South-East it had two maxima, one in the second quarter and one in the fourth quarter, when the rates were 0.24 (4 deaths). The highest rate in Highbury occurred in the fourth quarter, when it was 0.46 (7 deaths). The highest rate in the Parish, as a whole, was recorded in the fourth quarter, when it was 0.32 (27 deaths). The following Tables (XXXI. and XXXII.) give the deaths and death-rates in the several sub-districts and in the Parish:— Table XXXI. Showing the deaths in the Sub-districts for each quarter:— Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 6 2 8 3 19 Islington, South West 9 11 7 13 40 Islington, South East 3 4 3 4 14 Highbury 6 3 5 7 21 The Parish 24 20 23 27 94 Table XXXII. Showing the death-rates of the Sub-districts for each quarter:— Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year Upper Holloway 0•25 0•08 0•33 0•12 0•19 Islington, South West 0•33 0•41 0•26 0•48 0•37 Islington, South East 0•18 0•24 0•18 0•24 0•21 Highbury 0•39 0•19 0•32 0•46 0•34 The Parish 0•29 0•24 0•28 0•32 0•28 39 DIPHTHERIA. The returns of the deaths from Diphtheria are very disheartening, for they show not only a substantial increase on the returns for the year 1892, but an increase of over 100 per cent. on those of 1891. I find on looking up the Islington Bills of Mortality that the deaths since 1860 have increased to an alarming extent. During the decade 1861—1870 the registered deaths numbered only 347, which represents an annual average of nearly 35. In the succeeding decade, 1871—80, the returns showed only 327 deaths, or a yearly average of nearly 33. In the next decade, 1881—90, the returns showed 625 deaths, or an average of 62 per annum. The death-rates in the several decades since 1861 were— 1861—70 0•18 per 1,000 1871—80 0•13 „ 1881—90 0•20 „ During the last three years the rates were— 1891 0•29 per 1,000 1892 0•40 „ 1893 0•57 „ The largest number of deaths registered in any one year previous to 1893, was 138 in 1885, which followed another high return—114 deaths in 1884. From 1886 to 1890, inclusive, the greatest mortality was 54 in 1886. In 1887 the number of deaths were as few as 27, but since then they have steadily increased, being 35, 44, 47, 94, 130, until now they are 189. It looks, too, as if the year recently entered on was not going to show a decline, for there has been a continued increase in deaths from this cause. The unfavourable returns in Islington are not exceptional, for the 40 Metropolis, as well as the country at large, shows an increased mortality, as the following figures, which give the death-rates, show:— Mortality. Periods. England. London. 1861—70 0•19 0•18 1871—80 0•12 0•12 1881—90 0•16 0•26 1891 0•17 0•34 1892 0•22 0•46 1893 — 0•74 This steady growth of Diphtheria is a most serious matter, and demands the closest investigation. Many sanitarians have given it most anxious consideration, and many reasons accounting for the increase have been adduced, one being that the malady is better diagnosed, and that consequently sore throats, which had been referred to other species of disease, are now classed under their correct heading, and are accordingly entered in the returns as Diphtheria. This solution is not, to my mind, nearly sufficient, for it will not by any means explain the great increase, especially in London, of the disease. Diphtheria is a disease that, to a large extent, has been spread, like other diseases, by the ordinary means of infection, such as personal contact, fomities, and infected milk. There are, however, other means by which it is propagated, and these are school influences, defective sanitary fittings, and damp. In my opinion these are the three great factors in its causation. I have convinced myself that this is so by an examination into the circumstances of 1,300 cases that were reported in Islington under the Notification Act, from December 1892 to the present date. These are no new theories; they have been discussed in the medical press time after time, and therefore I do not intend to continue to discuss them here; but I would say one or two words respecting the possibility of contracting Diphtheria from sewer air, admitted into houses through defective drains and other sanitary fittings. The possibility of the disease being contracted in this manner has been altogether denied by some writers. In the light, however, of personal investigation, I have no hesitation in saying that even they would be convinced if they could see the records I have collected. In case after case I find a 41 ending recurrence of untrapped waste pipes to sinks; sinks connected directly to the drains; small defective drains under the houses; gullies in cellars; gullies in the cellars, til ted with bell-traps; defective connections between the w e.'s and the soil pipe; w.e.'s without water supply, etc., etc.; and so the defects go on with weary iteration. But persons will say, "These facts prove nothing; a similar state of affairs has been found in houses in which you have had typhoid fever, scarlet fever, or whooping cough." I know it is so; but I answer by saying that if, when the drainage has been put right, there have been no new cases of sickness in the houses, although children lived in them, who by reason of their age were likely to be attacked, it is only reasonable to conclude that the defective drains were the most probable origin of the disease, especially when no other circumstances could explain it. But I have even a better case than that afforded by the absence of the disease in ordinary houses, which will go far to prove my contention that Diphtheria is undoubtedly spread by sewer air. For several years cases of Diphtheria had been constantly recurring in the Yerbury Road Board School, and apparently without any cause, so that at last I determined that the drainage system of the school should be thoroughly examined. This was done, with the result that very serious defects were discovered, through which it was possible for sewer air to enter the school. The School Board were then required by the Vestry to execute certain works, so that the drainage might be made perfect. They demurred to some of the demands, so that finally the case came into Court. Several times during its hearing it was suggested that there was no proof that the conditions which were discovered had been the cause of the disease, and the Vestry and myself personally were challenged to prove it. The challenge was not accepted, but on the contrary the Vestry counsel, knowing the difficulty of such proof, and that medical authorities differed on the subject, stated again and again that the Vestry did not allege that the Diphtheria had been due to the school drains. This was 15 months ago; but to-day I stand on different ground, and I have no hesitation in affirming now that the school drains had been the cause of the constantly recurring cases, because from the date 42 of the completion of the work the disease ceased to recur, and the school, which had the worst health record in Islington, may now lay claim to the best. The Yerbury Road Board School, from the sewer air theory point of view, holds a unique position, for undoubtedly it proves, albeit negatively, that sewer gas can, and does, convey the germs of Diphtheria into the interior of our dwellings through defective sanitary appliances, and that these are consequently a real, and not an imaginary, danger to the persons living therein, more especially to those who, in consequence of their youth, are most susceptible to this very terrible and fatal disease. The poison of Diphtheria is, unfortunately, one that is not easily destroyed, and it is therefore essential that houses in which the disease has appeared should be thoroughly disinfected, but above all that the walls of the rooms in which the patients have lain should be stripped and washed with disinfectants, while at the same time the ceilings should be scraped and limewashed. In schools the spread of the disease is very much favoured by the adherence to the walls and ceilings of the exhalation of the scholars, and it is, therefore, of the utmost importance, when the disease is prevalent in a district, that the schoolrooms should be systematically cleansed and disinfected. This should be effected at least once a week, when in addition to washing the floors and the school furniture with disinfectants, the class-rooms themselves should be fumigated with sulphurous acid or chlorine gases. There is no great trouble and very little expense attached to these precautions and there is, therefore, no excuse for their neglect, more especially in schools supported by local rates or public money. Let it not be forgotten that the mere closure of schools for a short or a long period its good only in so far that it prevents children, in whose homes disease exists, or who themselves are suffering from suspicious sore throats, from mixing with each other; but that it does not destroy the infective germs which have already found their way into the rooms, and which are possibly lodged on the walls, ceilings, wood-work or school furniture. 43 I am sorry to have to say that the importance of these precautions is not very well understood, and that they are infrequently carried out. School teachers and school managers have a great responsibility resting on their shoulders; and it is to be hoped that they will, at all events in Islington, adopt, and systematically effect, these very necessary measures for the prevention of sickness, and possibly death, amongst their scholars. The total deaths in Islington numbered 189, and produced a deathrate which was equal to 0•57 per 1,000 of the population per annum. The deaths and death-rates in the several Sub-Districts were as follows:— Deaths. Death Rate. Upper Holloway 54 0.56 South West Islington 68 0.63 South East Islington 48 0.73 Highbury 19 0.31 Parish 189 0.57 From this table it is seen that in proportion to its population the Sub-District of South East Islington, suffered most severely, while next in order came South West Islington, Upper Holloway, and Highbury. The disease in the first quarter showed only a death-rate of 0•39, but as each quarter succeeded the other it rose higher and higher, until in the fourth it was as high as 0•76. And here it will be well to compare the incidence of the disease in Islington with that in the Metropolis, and in the 33 great cities of England. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. London 0•60 0•63 0•80 1•01 33 Large Towns 0•36 0•37 0•44 0•54 Islington 0•39 0•51 0•63 0•76 This return shows that while in each period the local rate was not nearly so good as in the great towns, yet it was not so high as that of the Metropolis. 44 All these rates are excessive, and cannot be easily accounted for, and only teach us that where all are bad Islington is less bad than the one and not so good as the other. London as a whole, and Islington as a considerable district of it, are, as I have pointed out in the earlier part of this report, unfavourably circumstanced, owing to their overcrowded habitations, in defending themselves against this disease, which, once it has gained admission into them, spreads rapidly from person to person, especially when they live in such close proximity to each other. Another reason is, and I speak now for Islington only, although the defect is, I believe, common to London, that the house drains are generally in a defective condition, badly jointed, if jointed at all, and leaking to a considerable extent, thereby causing pollution of the sub-soil. It is no uncommon occurrence to find houses with old worn-out, or rotten drains, which cross under several or through individual houses, or run from back to front. The plans of many of these drains do not exist, for plans were not insisted on when they were laid, and each builder did just what he liked, and, therefore, contented himself with getting an outlet for the sewerage where he could. Naturally, the drain of the house next door was his easiest and least costly outlet, and having in all probability built that house too, he joined the new drain to that previously laid, viâ the shortest route, and quite indifferent to the fact that it passed under the house, the garden or the yard. The connections of the soil pipes, sinks or other drains were then made in the cheapest and most expeditious manner, and so long as these auxilliary pipes pierced the main drain of the house, thereby ensuring the discharge of their contents into it, nothing further was considered necessary; and as a result to-day sewer gas finds an easy entrance into our houses by many vents. But comparatively modern drains, nay, even some drains laid within five years have been found imperfect. The fact,is, that supervision was generally lax, and builders were allowed too free a hand. I do not say or imply that those men who were appointed by the Vestries or 45 other Boards to superintend works, omitted to do so, but I do say that they were far too few in number to properly superintend the drainage works that were laid down in such profusion in all parts of their districts. London has grown in leaps and bounds in the present century, and has extended itself with marvellous rapidity, and public bodies did not keep corresponding pace with its needs. Perhaps too much blame should not be attached to them for this, because after all the sanitary requirements of communities were not so well understood a few years ago as they are now. Nevertheless, this fact remains that not a few of the London districts lag a long distance behind many of the large provincial towns in matters of sanitation. But since the passing of the Public Health (London) Act, 1891, there has been a steady forward movement in the Metropolis, and possibly nowhere more than in Islington, where sanitation is so active, that one now constantly hears of the persecution of the ״poor property owner." That owner who for long years had everything his own way, and who did as little as he could to make things healthy for his tenants, knowing well that there were plenty of persons ready to occupy any or every house. Property has rights, but so has flesh and blood; and if it be right that property should be protected from unnecessary exactions, it is surely righteous that the health and lives of human beings should be safe-guarded in every way. Insanitary property owners have had their day. But a new régime is in power now, and, as a consequence, we find speculating builders and interested parties banding themselves together, and even forcing one Local Authority to actually appeal to the Local Government Board to rescind one of the most important by-laws* ever framed for the purpose of preventing the entrance of sewer gas into houses. And this same Board even endeavour to make their Medical Adviser eat his own words because he condemns their action in a report, which fortunately has found its way into the higher official world, and into the hands of the public. And why was this done? Solely because it was stated that the additional cost could not be borne by the property owner. The * Respecting the construction of intercepting traps. 46 contention is ridiculous and frivolous. I would not, however, have mentioned this matter, but that I have noticed a similar disposition amongst a few Islingtonians and Vestrymen, and, therefore, I venture to remind them that there exists such a dreadful disease as Diphtheria, which in the first quarter of last year, in one district, destroyed nearly one out of every two (42.1 per cent.) persons whom it attacked; and also to inform them that sewer gas, apart altogether from the debateable question of its being able to convey the germ of the disease into a house, renders human beings, chiefly children, by lowering their vitality, by debilitating their constitutions, and by producing a morbid condition of the throat, especially liable to fall a victim to the disease, if by chance they are brought into contact with it. It is, therefore, no wonder, living, as Londoners do, in houses which are indifferently drained, into which sewer gas obtains an entrance, that when the disease gains an admittance it spreads rapidly and results fatally to so many. While such a disease as this is possible in Islington, I much mistake the feelings of the Vestry whom I serve, or of the Public Health Committee to whom is delegated the responsibility of administering the Public Health Acts, if they will abate any of their demands on propertyowners to put t heir houses in a thoroughly sanitary condition, or if they will at all slacken their efforts, now that they have taken up sanitation in an earnest spirit, not only to keep the district in its general healthy condition, but also to make it more salubrious, if that be possible —and it is—in so large a community. Table XXXIII. Showing the Deaths for each Quarter in the Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 8 12 6 28 54 Islington, South West 16 12 26 14 68 Islington, South East 5 11 17 15 48 Highbury 3 7 3 6 19 The Parish 32 42 52 63 189 47 Table XXXIV. Showing the Death-rates for each Quarter in the Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0.33 0.50 0.25 1.17 0.56 Islington, South West 0.60 0.45 0.97 1.52 0.63 Islington, South East 0.30 0.67 1.04 0.92 0.73 Highbury 0.19 0.46 0.19 0.39 0.31 The Parish 0.39 0.51 0.63 0.76 0.57 A study of these rates must convince the sceptical that sanitary conditions have a great deal to do with this disease, for it was in those districts in which house drains are worst, and in which overcrowding is greatest, that the disease was most fatal. The two following tables give the deaths and death-rates from Membranous Croup, a disease which frequently conceals Diphtheria under this term. Table XXXV. Giving the Deaths for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1 1 1 .. 3 Islington, South West •• 1 2 1 4 Islington, South East • • .. 1 2 3 Highbury .. 1 •• .. 1 The Parish 1 3 4 3 11 48 Table XXXVI. Giving the Death-rates for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0·04 0·04 0·04 .. 0·03 Islington, South West .. 0·03 0·07 0·03 0·03 Islingten, South East •• .. 0·06 0·12 0·04 Highbury .. 0·06 .. •• 0·01 The Parish 0·01 0·03 0·06 0·03 0·03 WHOOPING COUGH. Whooping Cough, although more fatal than in the preceding year, did not destroy as many children as in 1891, and it was also less fatal than in the decade 1881-90. During the decade 1861-70, the average number of deaths per annum was 172, in the succeeding decennial period (1871-80) it was 206, and in the last period 1880-91, it was 204. The deaths now recorded are 181, in 1892 they were 130, and in 1891, 235. The death-rates in these several periods were— 1861—70 0·94 per 1,000 of the population. 1871—80 0·83 „ „ „ 1881—90. 0·67 „ „ „ 1891 0·73 ,, ,, ,, 1892 0·46 „ „ „ 1893 0·55 „ „ „ These figures are most satisfactory, and prove that generally the disease continues to hold a downward progress. In proportion to population it was most fatal in the Sub-districts of Islington, South West, and least so in Highbury. 49 Table XXXVII. Showing the Deaths for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1 7 16 26 50 Islington, South West 18 23 21 11 73 Islington, South East, 9 12 9 •• 30 Highbury 4 13 7 4 28 The Parish 32 55 53 41 181 Table XXXVIII. Showing the Death-rates for each Quarter of the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0·04 0·29 0·67 1·08 0·52 Islington, South West 0·67 0·86 0·78 0·41 0·68 Islington, South East 0·65 0·74 0·55 .. 0·46 Highbury 0·26 0·85 0·46 0·26 0·45 The Parish 0·39 0·67 0·64 0·50 0·55 TYPHUS FEVER. Only one death was registered from Typhus Fever, and no other case was known. This was notified as Enteric Fever, but on removal to the Asylums Board Hospital its true character was recognised. Since 1881 no entry of a death from this disease appears on the records of the Public Health Department, although I find that in the preceding decade (1871-80) no fewer than 169 deaths were registered. I cannot explain this phenomenon—for it certainly is most extraordinary. -that during thirteen years only one fatal case was known in such an enormous district. D 50 ENTERIC FEVER. Forty-eight deaths were registered from Enteric Fever. This is 10 more than in 1892, and 23 more than in 1891, but 13 less than the average of the ten years 1881—90. The 48 deaths produced a death-rate of 0·14 per 1,000 inhabitants, which is 0·06 below the mean death-rate of the district during the last decennial period. The particulars of the deaths and death-rates will be found in the following tables, in which it will be noted that there was no death from the disease in Highbury in the first quarter, or in Islington South East, in the second quarter. Table XXXIX. Showing the Deaths for each quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 4 5 2 6 17 Islington, South West 3 2 3 6 14 Islington, South East 2 .. 4 2 8 Highbury •• 1 4 4 9 The Parish 9 8 13 18 48 Table XI. Showing the Death-rates for each quarter of the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0·16 0·20 0·08 0·25 0·17 Islington, South West 0·11 0·07 0·11 0·22 0·13 Islington, South East 0·12 0·06 0·24 0·12 0·12 Highbury .. 0·06 0·26 0·26 0·14 The Parish 0·10 0·09 0·15 0·21 0·14 51 SIMPLE CONTINUED FEVER. Only two deaths were registered from this disease, and these occurred in Islington South East, and in Islington South West, SubDistricts. DIARRHŒA. Diarrhœa caused 237 deaths, and was more fatal than in any year since 1887, when 291 were recorded. These 237 deaths are 30 above the mean number registered in the decade 1881-90. The death-rate was equal to 0·72 per 1,000 of the population. The disease was most fatal in proportion to population in Islington South West, where the death-rate was 0·83 per 1,000 (89 deaths). but this rate was almost equalled in Upper Holloway, where with 79 deaths, it was 0·82. In Islington South East it was 0·72 (47 deaths), and in Highbury it was as low as 0·36. with 22 deaths. The mortality in the Parish, as well as in London, from this serious disease has been in the past as follows:— Period. Average deaths per annum. Death-rates. The Parish. London. 1861-70 182 0·98 1·04 1871-80 223 0·90 0·94 1881-90 207 0·69 0·74 Deaths. 1891 146 0·46 0·57 1892 158 0·48 0·59 1993 237 0·72 0·80 Here it is seen that in every period the Islington death-rate is less than that of the rest of the Metropolis. It is also less than in the 33 large towns. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Year. London 0·18 0·72 2·03 0·27 0·80 33 Large Towns 0·22 0·81 3·48 0·39 1·23 Islington 0·14 0·65 1·87 0·20 0·72 From these figures it is seen that, whether the Islington figures are compared with those of the Metropolis, or of the great towns the Diarrhœa mortality was not excessive. d 2 52 Even in the third quarter when Diarrhoea is always most prevalent the death-rate was most satisfactory. The death-rate in that quarter was greatest in the Upper Holloway Sub-district, but why it should be so cannot be easily explained, as, judging from its sanitary conditions, compared with Islington South West and IslingtonSouth East, it should have been in a more favourable position. It must not be forgotten, however, that it is built on a heavy clay soil, and that this soil so long as wet weather continues, and so long as the soil retains sufficient moisture, holds the bacilli of Diarrhœa tightly locked up, but the moment it dries, owing to a long continued heat, such as existed for a considerable portion of the year, these germs escape and speedily give rise to the disease. In no other manner is the heavy death-rate in Upper Holloway at present explicable. Table XLI. Showing the Deaths for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 5 15 56 3 79 Islington, South West 1 23 55 10 89 Islington, South East 4 10 31 2 47 Highbury 2 6 12 2 22 The Parish 12 54 154 17 237 Table XLII. Showing the Deaths-rates for each Quarter of the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. Whole Year. Upper Holloway 0·20 0·62 2·34 0·12 0·82 Islington, South West 0·03 0·86 2·06 0·37 0·83 Islington, South East 0·24 0·61 1·91 0·12 0·72 Highbury 0·13 0·39 0·78 0·13 0·36 The Parish 0·14 0·65 1·87 0·20 0·72 53 INFLUENZA. To Influenza 123 deaths were referred. These are, however, 52 less than the record of the preceding year, and 60 less than that of 1891. Fourteen of the total number were of children under 5 years, which is an increase of four on last year's deaths at this age. Influenza prevailed to a considerable extent in the first quarter of the year, when it was the cause of 31 deaths; this number, however, fell to 23 in the second quarter, and to 9 in the third quarter. With the advent of the fourth quarter the disease became very prevalent, and was fatal to 60 persons. Deaths. Death rate per 1,000. First Quarter 31 0.38 Second Quarter 23 0.28 Third Quarter 9 0.11 Fourth Quarter 60 0.73 The Year 123 0.37 The following table shows the deaths and death-rates at the several periods of life. Age. Deaths Death-rates per 1,000 living at the age. 0—5 14 0.36 5—15 1 0.01 15—25 8 0.12 25—35 16 0.28 35—45 17 0.41 45—55 13 0.45 55—65 21 1.18 65—75 18 1.95 75 and upwards 15 4.15 Total 123 0.37 The deaths in the district were— Heaths. Death-rates. Upper Holloway 33 0.34 Islington, South West 42 0.39 Islington, South East 26 0.40 Highbury 22 0.36 The Parish 123 0.37 54 SEPTIC DISEASES. PUERPERAL FEVER. This Septic Fever caused the deaths of 13 women, 11 of whom were between the ages of 25 and 45 years, while 2 were under 25. These deaths were distributed in the districts as follows:—5 in Upper Holloway, 4 in Islington South West; and 4 in Highbury. There were no deaths in Islington South East. Table XLIII. Showing the deaths for each quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway .. 1 2 2 5 Islington, South West .. 1 •• 3 4 Islington, South East .. .. .. .. .. Highbury 2 .. .. 2 4 The Parish 2 2 2 7 13 Table XLIV. Showing the Death-rates from Puerperal Fever for each Quarter in the several Sub-Districts for every 1,000 births. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway .. 1·57 2·90 3·03 1·81 Islington, South West .. 1·15 .. 3·65 1·18 Islington, South East .. .. .. .. ..• • Highbury 2·03 •• .. 5·45 2·49 The Parish 0·80 0·79 0·83 2·97 1·33 It is rather a noticeable circumstance that Puerperal Fever was most fatal in the aristocratic district of Highbury, and that there 55 were no deaths in the, by comparison, insanitary area of Islington South-East. The records of Islington for the past 23 years are as follows:— In the 10 years 1871 —80, the deaths numbered 208, being an average of 21 per annum. In the 10 years 1881-90, the total number of deaths was 167, or an annual average of nearly 17. In this period there were 89,593 births registered, so that deaths were at the rate of 1 .86 per 1,000 children born. The deaths in proportion to every 1,000 births in 1891 were 0.8l, in 1892 2.40, and in 1893 1.33. The mortality has been calculated on the number registered births as it is believed to be the only accurate manner in which it can be exhibited. ERYSIPELAS. The deaths from Erysipelas were 3 in number, compared with 20 in the preceding year, and with 9 in 1891. The deaths give a death rate of 0.41. In proportion to population it was most fatal in Upper Holloway, and least so in Highbury. In the former district it caused 13 deaths, and in the latter 4, while in Islington South East and Islington South West, 11 and 6 deaths were respectively registered. Table XLV. Showing the deaths for each quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 2 2 3 6 13 Islington, South West 1 4 • • 6 11 Islington, South East 1 1 1 3 6 Highbury 2 .. 2 •• 4 The Parish 6 7 6 15 34 56 Table XLVI. Showing the Death-rates for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0·08 0·08 0·12 0·26 0·54 Islington, South-West 0·03 0·15 .. 0·22 0·41 Islington, South-East 0·06 0·06 0·06 0·18 0·37 Highbury 0·13 .. 0·13 •• 0·26 The Parish 0·07 0·08 0·07 1·89 0·41 CONSTITUTIONAL DISEASES. This large classification includes, among many others, such diseases as Rheumatic Fever, Gout, Rickets, Cancer, and all tubercular ailments. The most fatal of these was Phthisis, which caused 560 deaths, compared with 504 in the preceding year, and 544 in 1891. They produced a death-rate of 1·70 per 1,000 of the population. In the 10 years 1871-80 the yearly average number of deaths was 511, and the death-rate 2·06. During the ten following years the average number of deaths was 498 per annum, and the mean annual death-rate l·66 per 1,000 inhabitants. These deaths were registered in the districts as follows:— Upper Holloway 158=1.66 per 1,000 of population Islington South West 186=1.74 „ „ Islington South East 134=2.06 „ „ Highbury 82=1.34 „ „ 57 Seventy-five deaths occurred among persons under 15 years old, 83 between the ages of 15 and 25, 130 between the ages of 25 and 35, 125 between 35 and 45, 84 between 45 and 55, while 63 were above the latter age. The deaths and death-rates were:— Deaths. Death-rate. First quarter 123 1.50 Second quarter 121 1.47 Third quarter 157 1.90 Fourth quarter 159 1.92 The year 560 1.70 In England during the last quinquennial period the death-rate was 1.63 per 1,000 inhabitants, so that the death-rate of Islington cannot be considered unsatisfactory. TABES MESENTERICA. This is eminently a disease of childhood. It caused 113 deaths, of which 64 were among male and 49 among female children. The disease was most fatal to infants under one year old, of whom 83 died from its effects, while 27 deaths occurred among children between the ages of 12 months and five years. It was most fatal in Islington South East, where 43 deaths occurred; next came Islington South West with 30 deaths; then Upper Holloway with 25 ; and, lastly, Highbury with 15. It was most fatal in the third quarter, when 46 deaths were registered. This is usually the case, for this period is particularly trying to children with delicate bowels, who are invariably attacked with diarrhoea, which is very generally given as a secondary cause of death. The deaths in the quarters were consecutively 15, 32, 46, and 20. CANCER. Cancer was fatal to 82 males and 156 females, making a total of 238 persons, and produced a death-rate of 0.71 per 1,000 inhabitants. 58 It is pre-eminently a disease of middle and old age, for while only 13 deaths occurred among persons below the age of 25, 143 took place among those above it. The following table shows the ages at death :— Ages. Deaths. Ages. Deaths. Below 25 years 13 65-75 69 25-35 21 75-85 24 35-45 56 85-95 2 45-55 53 95 and upwards 0 In Upper Holloway it was the registered cause of 76 deaths, in Islington South West of 73 deaths, in Islington South East of 48 deaths, and in Highbury of 41 deaths. The number of deaths in each quarter varied very little, although they were slightly in excess in that ending September. The figures given in order where 58, 53, 68, and 59. In the following table are given the death-rates from this disease in Islington, in England, and in London since 1861:— Periods. England. London. Islington. 1861-70 0.39 0.49 0.40 1871-80 0.47 0.55 0.48 1881-85 0.55 — 0.51 1886-90 0.63 — 0.61 1891 0.69 — 0.68 1892 0.69 — 0.67 1893 — — 0.71 THE NOTIFICATION OF INFECTIOUS DISEASES. During the 52 weeks of the year 4,851 separate cases of infectious diseases were notified under the compulsory notification clauses of the Public Health (London) Act, 1891. This is an increase of 1,542 cases, or 46.5 per cent. on the return of the preceding year, and an increase of 2,837 or 1408 per cent. on that of 1891. The gravity of these figures cannot be denied, for they indicate not only a very considerable increase of sickness from infectious diseases 59 in 1893 compared with that of 1892, but an alarming increase when compared with the return for 1891. With the exception of small decreases in the returns from Membranous Croup, Puerperal Fever, and Cholera, every other disease showed an increase, more or less great. Thus, Small Pox increased 78, Scarlet Fever 1,876, Diphtheria 154, Enteric Fever 35, Typhus Fever 1, Erysipelas 126, and Continued Fever 1. In the following Table will be found the number of cases notified in each year since notification became compulsory :— DISEASES. 1891. 1892. 1893. Compared with 1892. Increase. Decrease l 2 3 4 5 6 Small Pox 1 40 118 78 Scarlet Fever 700 1,703 2,879 1,876 - Diphtheria 708 700 854 154 — Membranous Croup 37 43 30 — 13 Enteric Fever 185 216 251 35 — Typhus Fever 1 0 1 1 — Erysipelas 337 546 672 126 — Puerperal Fever 36 51 38 — 13 Continued Fever 4 6 7 1 — Relapsing Fever 1 0 0 — - Cholera 4 4 1 — 3 All notifiable diseases 2,014 3,309 4,851 1,542 Infectious Sickness Rates 6.3 10.2 14.7 4.5 •• A glance at these figures reveals the fact that Scarlet Fever was the chief cause of the very large increase in the notified cases, and that the other diseases which showed a marked increase were Small Pox, Diphtheria, Enteric Fever, and Erysipelas. 60 Table XLVII. The following table gives the number of cases of Infectious Diseases notified under the "Public Health (London) Act, 1891 " during the year ending 30th December, 1893. (N.B.—Duplicate cases have been deducted). Wards. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total. Cases notified per 1,000 of Population. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Upper Holloway 41 790 283 10 88 1 244 12 1 ... ... *1,470 ... Lower Holloway 28 368 57 5 19 ... 70 7 ... ... ... 554 ... Highbury 9 633 140 3 56 ... 75 8 1 ... ... 925 ... Thornhill 14 355 94 3 17 ... 63 3 1 ... 1 551 ... Barnsbury 6 209 46 3 17 ... 51 3 ... ... ... 335 ... St. Mary's 6 136 55 1 9 ... 49 2 1 ... ... 259 ... Canonbury 5 201 62 ... 24 ... 41 ... 1 ... . 334 ... St. Peter's 9 187 117 5 21 ... 79 3 2 ... ... 423 ... Totals 118 2879 854 30 251 1 672 38 7 ... 1 4,851 ... 1891 1 700 708 37 185 1 337 36 4 1 4 2,014 6·3 1892 40 1703 700 43 216 ... 546 51 6 ... † 4 3,309 10·2 * This number includes 64 cases in the Holborn Infirmary (non-residents in the Parish), †2 cases of true cholera imported from Hamburg. 61 Table XLVIII. Showing the Cases of Infectious Disease which were investigated by the several Sanitary Inspectors. 1893. Sanitary Inspectors. No. of the Sanitary Districts. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Memcranous Croup. Enteric (Typhoid Fever.) Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. TOTAL. Inspector Sweeney 1 14 236 72 2 25 1 39 1 - - - 390 ,, Cowling 2 27 245 79 4 42 143 5 1 546 „ Ward 3 1 138 81 2 8 19 1 250 ,, Pain 4 4 259 45 2 17 42 4 1 374 ,, Flood 5 3 149 38 1 8 18 1 218 ,, Smith 6 14 239 37 3 14 - 41 8 - - 356 ,, Lawrence 7 2 237 30 - 22 22 2 315 ,, West 8 1 212 71 1 15 - 23 3 - - - 326 „ Watson 9 24 329 93 2 19 - 66 2 1 - - 536 ,, Mitchener 10 3 210 54 - 20 39 - 1 327 ,, Fortune 11 5 124 79 3 18 — 49 1 2 — — 281 ,, Hillyard 12 8 182 45 2 12 - 49 3 - - - 301 „ Rolfe 13 3 175 36 - 14 - 36 3 - - - 267 ,, Jordan 14 7 137 95 3 16 — 69 2 1 — — 330 TOTALS 1 16 2872 855 25 250 1 655 36 7 — — 4817 Note. In the above table the investigations ascribed to Inspector Pain are incorrect, as for a long while he was engaged in making an inspection of the outworkers' lists, and his cases were taken chiefly by Inspectors Cowling and Ward. 62 Small Pox. There were 131 certificates received from medical practitioners respecting cases of Small Pox. Of these 118 referred to individual cases, while a few others proved to have been incorrect in diagnosis. Towards the end of 1892 several cases had been notified, but in its last three weeks none had been known. However, with the first week of the year 1893 two were notified, and from this period, with one exception, cases occurred every week up to and including the last week of June. The disease never assumed a grave epidemic form, although in the months of March and April its behaviour gave some cause for anxiety. In the chart accompanying this report it will be noticed that after the second week in April it commenced to subside, and that in August it assumed a sporadic form. In the following Tables are given the number of notifications and the sickness rates per 1,000 of the population. Table XLIX. Showing the Sickness from Small Pox for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. Whole Year. Upper Holloway 16 19 7 4 46 Islington, South West 27 21 1 7 56 Islington, South East 5 11 1 1 18 Highbury 1 8 2 •• 11 The Parish 49 59 11 12 131 63 Table L. Showing the Sickness-rates from Small Pox for each Quarter of the several Sub-Districts. Sickness-Rates. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0·67 0·79 0·29 0·16 0·48 Islington, South West 1·01 0·78 0·03 0·26 0·52 Islington, South East 0·30 0·67 0·06 0·06 0·27 Highbury 0·06 0·62 0·13 .. 0·18 The Parish 0·59 0·71 0·13 0·14 0·39 Table LI. Showing the fatality of Small Pox. (Deaths percentage of Sickness recorded). Suc-Districts. 1st. Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway .. .. 28·6 .. 4·3 Islington, South West .. .. .. .. .. Islington, South East .. .. .. .. .. Highbury .. .. .. .. .. The Parish .. .. 18·1 .. l·5 In this Table it will be seen that out of the total number of cases reported only 1·5 per cent, died, which shows that the disease assumed a very modified form. The fatality in the third quarter was heavy, for while the cases notified Were only 11 in number, the deaths were 2, and these were the only deaths during the year. 64 Scarlet Fever. During the year 3,082 certificates were received, of which 2,879 were known to have been genuine cases of this disease. There was an increase of 1,876 cases on the return of 1892, and of 2,179 on that of 1891. This is a truly alarming increase, although the alarm is somewhat discounted by the fact that the fatal cases were only 3.0 per cent. of those notified. In proportion to population Scarlet Fever was most prevalent in Highbury and least in Islington East. Its seasonal incidence was least in the first quarter, and greatest in the third. Its weekly rise and fall will be best studied in the chart which accompanies this report. Table LII. Showing the sickness from Scarlet Fever for each Quarter in the several Sub-Districts. Sub Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th. Quarter. Whole Year. Upper Holloway 141 196 256 260 853 Islington, South West 108 245 433 295 1,081 Islington, South East 50 118 151 147 466 Highbury 127 113 288 154 682 The Parish 426 672 1,128 856 3,082 65 Table LIII. Showing the sickness rates from Scarlet Fever for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 5·90 8·21 10·72 10·89 8·91 Islington, South West 4·06 9·21 16·28 11·09 10·13 Islington, South East 3·08 7·28 9·31 9·06 7·16 Highbury 8·35 7·41 18·95 10·13 11·18 The Parish 5·19 8·19 15·76 10·44 9·38 The present epidemic has been more widely prevalent than any previous one. Scarlet Fever began to assume an epidemic form in May, 1892, having in that month risen nearly 100 per cent. above the weekly average (15 cases) of the year 1891. In June the weekly average was 24 cases, rising to 27 in July, and to 42 in August. September showed a great increase, the cases averaging 72 per week. In October they averaged 75, in November 60, and in December 44. The average number of cases per week in 1892 was 34, or 126 per cent. more than in 1391. The year 1893 began with 37 cases per week in January, which fell to 29 in February. In March they were 34, in April 31, in May 48, in June 71, in July 73, in August 80, in September 99, in October 91, in November 69, and December 43. So far as the record of the year is concerned I must point out that, high as the weekly average was in 1892, the cases reported each week up to April were only below it on 11 occasions, and that since that date the cases have been always considerably above it. e 66 If you refer to the Scarlet Fever Chart, you will find that the curves of the disease for this and for last year are very similar, rising and falling almost exactly at the same periods of the year. I have compared these curves with the well-known mortality curves for London, prepared some years ago by Dr. Buchan and Sir Arthur Mitchell, and I find they, too, are very similar, although the mortality curve reaches its maximum a little later, which is, of course, only natural, for death succeeds the attack. I should have mentioned, as particularly bearing on this subject, that Dr. Ballard, when Medical Officer of Health for Islington, investigated the seasonal behaviour of this disease in Islington, and he found that it was most prevalent here in the last quarter of the year and least so in the first quarter. This is exactly the case now. The records of the Metropolitan Asylums Board also entirely bear out the truth of these observations, for it is found that the admissions of Scarlet Fever patients have been always greatest in the last quarter of the year. In Islington the force of the epidemic seems to have fallen most heavily on District 9, which lies south of Brewery Road and west of Caledonian, Road. In District No. 11, which is situated in the south of the parish in St. Peter's Ward, its effect was least felt. I note that the force of the disease was felt (going in order from that of least to greatest virulence) in the Sanitary Districts as follows:— I note that the force of the disease was felt (going in order from that of least to greatest virulence) in the Sanitary Districts as follows:— District 11 District 8 „ 14 „ 1 „ 3 „7 „ 5 „ 6 „ 13 „2 „ 12 „ 4 „ 10 „ 9 It will be recollected that, when the Sanitary Districts were formed, I divided the parish so that each district should contain as nearly as possible an equal number (2,732) of houses. 67 in examining into the incidence of the disease since it assumed such great proportions, I find that the number of cases per every 100 houses varies very considerably in the various districts. Thus in No. 3 there were only 0·65 cases to each 100 houses, while in No. 9 there were 3·73 cases. And this is just what we might reasonably expect, for whereas No. 3 district is inhabited for the most part by persons living in good houses, with one family to each house, No. 9 is inhabited by persons living for the most part in tenement houses. The proportion of cases to houses, in order from lowest to highest in each district is as follows :— District 11 4.53 cases per 100 houses. „ 14 5.0l „ „ „ „ 3 5.05 „ ,, „ „ 5 5.45„ ,, „ „ 13 6.40 „ „ „ „ 12 6.66 „ ,, „ „ 10 7.68 „ „ „ „ 8 7.75 „ „ „ „ 1 8.63 „ „ „ „ 7 8.67 ,, „ „ „ 6 8.74 „ „ „ „ 2 8.96 „ „ „ „ 4 9.48 ,, ,, ,, „ 9 12.04 „ „ „ In the same period the cases per 100 houses in the whole 14 districts taken together was I do not know if the closing of the schools in August for the annual holidays had anything to do with the fall in the Scarlet Fever curve, but certainly after the first week it was very marked; and it is a significant fact, that when the schools opened in September, the curve at once rushed upwards. There can be no doubt that schools are a considerable factor in the spread of infectious disease among young children. This fact is so well recognised that I will not now discuss it. £ 2 68 But there were other influences at work, and one of these is:— The non-notification of the disease by persons who have not called in medical assistance. The epidemic, from its very commencement, assumed a very mild character, and let me here state that during the year it caused only 94 deaths in 2,879 cases, or a fatality of 3·0 per cent. This is very small, and is very much below the usual mortality, which is something like 10 per cent. Many persons, consequently, did not call in a practitioner to their aid, but treated their children themselves. I have come across cases that were so mild that the children were never in bed, never, in fact, felt sick, and never ailed anything beyond a slight throat affection. These children showed scarcely any signs of desquamation, and, indeed, some did not desquamate at all. But, nevertheless, they were all sources of great danger to others, and I have no hesitation in stating were in a great measure responsible for spreading the disease broadcast. Again, many persons, especially among the poorer classes, owing to the mildness of the disease, were indifferent, when it made its appearance, as to the adoption of effective isolation, and allowed the patients to live with their brothers and sisters, and also permitted their friends to visit them indiscriminately. People seem to have the impression that this disease must be contracted some time or other by children. This is a most popular error, resulting sometimes seriously, when little children are allowed— deliberately allowed—to contract the disease. It is a fact as regards Scarlet Fever that the older the child grows, the less likely it is that he will contract the disease, or that it will be severe or fatal. Then there is carelessness in the management of the disease:— Although in my visits I have seen hundreds of cases, yet in no instance did I find that patients were rubbed down with an unguent or oil to prevent the desquamating skin conveying the disease to others. I know this is not the fault of the profession, who, as a whole, usually recommend this treatment, although I am bound to say some of its members never order it, which is to be regretted, as personally I have found it most efficacious. 69 Use of Disinfectants.—Again it has been almost impossible to persuade people to adopt means for preventing the spread of the disease by hanging up sheets saturated with disinfectants. One reason for this is, I believe, that while the first stage of the disease is acute, and the patient is confined to bed, and is really ill, yet after about a week, the acute symptoms having passed away, the patient feels tolerably well, and is most anxious to get out. His parents will then tell you he is quite well, become indignant when you instruct them that he must not leave the house, and are more than astonished when they are informed that, while the child is desquamating, he is a source of great danger to the public. They do not believe you, and straightway down comes the sheet from the door, and presently the youngster has the run of the house, to the great danger of others. Hospital Accommodation.—But it may very properly be asked, why was not such a case, especially if living in a tenemented house, removed to a hospital, where he would cease to be a source of public danger ? You may well ask! And the reply is not far to seek. There was no room in the hospitals, and when beds were vacant the most urgent cases were not always those that were taken away. There have been many anxious scenes in the Public Health Offices of this Vestry during this epidemic, created by the great anxiety of parents to get their children removed. The causes of this anxiety have been many and varied. Thus, for instance, there have been many cases where women were near their confinement, and where the patient was treated in the mother's rooms. There have been cases where there have been families of seven or eight in number living in two rooms; there have been cases where there was only one room; there have been cases where the breadwinner of the family was prevented from going to work, and where consequently he could not provide for his home. Laundresses have been stopped work, and charwomen prevented from going out, while outworkers have had to cease bringing their work home, and all because the cases could not be taken into hospital. With the epidemic at its height we were getting practically no patients into hospital. At that time there were numerous cases of urgency 70 ready to be removed, but there was no room in the hospitals. But even when there was a vacant bed it was not at all certain that the cases recommended by the Public Health Department would be removed. On one occasion a gentleman living at Colebrooke Row called on me to have his house disinfected, as the patient had been removed to the Metropolitan Asylums Board's hospital. I was naturally surprised, and while I congratulated him on his good fortune, I could not help saying it was a public scandal that, whilst there were numbers of persons in tenemented houses anxious for removal who could not possibly be isolated at home, and who, therefore, urgently needed removal, cases such as his should be taken away on his personal application. I assert now, as I have asserted before to the Public Health Committee, that while in non-epidemic times, when there is a freedom from infectious disease, the Metropolitan Asylums Board ought to be allowed to isolate such cases as they desired, yet when an epidemic was prevalent and there was a serious demand for beds, that then only the cases recommended by the sanitary authorities, including, of course, the paupers, should be removed. The sanitary authorities know the necessities of every case, and are consequently better able to judge than either the Metropolitan Asylums Board or private practitioners as to who should be first removed. The Metropolitan Asylums Board cannot, and does not, know the particulars of each case, and medical men only know those which come under their own observation. It is our duty, as the sanitary authority, to prevent disease, and we therefore made the necessary enquiries with this object, but our best efforts were defeated by the non-removal of our urgent cases. In consequence of this state of affairs the following communication was addressed to the Clerk of the Metropolitan Asylums Board on the 30th November, 1893:— Dear Sir, The Public Health Committee has recently had under its consideration the question of the removal of patients during periods when epidemic diseases are prevalent; and it has passed the accompanying resolution which it believes will tend to the greater certainty of having the fittest cases removed to your Hospitals. 71 It is of this opinion because the Public Health Department has cognizance of the surroundings of every case, and of the necessity, or otherwise, of each patient's removal. The Committee and myself are aware that cases have been removed on the application of medical men, and private individuals, when it is believed much more public good would have resulted by isolating other cases of greater urgency, known to the Sanitary Authority. I am desired to request you to bring this matter before the proper Committee. The resolution of the Committee had referenca only to those times when your beds, owing to the great prevalence of an epidemic, are not so numerous as the applications. I am, Dear Sir, Yours faithfully, ALFRED E. HARRIS, T. DunCOMbe Mann, E.q., Clerk, Medical Officer of Health. Metropolitan Asylums Board. Resolved : That a communication be addreseed to the Metropolitan Asylums Board requesting that all cases of infectious disease removed to its hospitals, should only be romoved on the application of the Sanitary Authority. As was to be expected from a body who is very anxious to obtain additional powers, this most reasonable application was refused, as will be seen by the following letter:— The Metropolitan Asylum Board, Norfolk House, Norfolk Street, W.C., 11 th December, 1893. Alfred E. Harris, Esq., Medical Officer of Health, Islington Vestry. Dear Sir, I submitted to the Managers at their meeting on Saturday last your letter of the 30th ult, forwarding a copy of the resolution passed by your Vestry, requesting that all cases of infectious disease removed to the Managers' Hospitals, should be on the application of the Sanitary Authority. After consideration, the Managers' adopted the resolution, a copy of which I forward you on the other side. Yours faithfully, T. DUNCOMBE MANN, Clerk to the Board. Resolved: That in reply to their letter, the Islington Vestry bo informed that the managers do not see their way to restrict the means of application for the removal of patients to hospital from any portion of the Metropolis in the manner suggested by the Vestry, or to adopt any other method for the selection of cases for admission than that at present in force. 72 This hospital question is a most important and difficult one. We pay an enormous sum for hospital provision, something over 3d. in the pound in Islington (over £20;000 per annum), and yet when we require it most it is not available. I cannot help saying that with this rate of 3d. we could erect and manage splendid institutions of our own. But unfortunately we cannot "come out" of the Metropolitan Asylums Board, and Islington, as part of the metropolitan area, is bound to pay its share of its debts. It would be futile, therefore, to suggest that the Vestry should build hospitals, because ratepayers would never consent to pay for two institutions. I would still press on the Vestry to urge the Metropolitan Asylums Board to remove no cases from our district when an epidemic prevails and when there is a rush for hospital isolation, except through and on the request of the Public Health Department. It could then be arranged that only the most urgent cases should be removed when beds became vacant. It would also be known instantly when a case was isolated, and the Public Health Department would be able to proceed at once with the disinfection of the house. I trust this matter will be fully considered, and that if in the future an epidemic should assume the proportions of the one under considertion, Islington shall be in a more satisfactory position to cope with it, Table LIV. Showing the fatality of Scarlet Fever. (Death percentage of Sickness recorded). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 4·2 1·0 3·1 1·1 2·2 Islington, South West 8·3 4·4 1·6 4·4 3·7 Islington, South East 6·0 3·3 1·9 2·7 3·0 Highbury 4·7 2·6 1·7 4·5 3·0 The Parish 5·6 2·9 2·0 3·1 3·0 Infectious Disease Notification CHARTS. Showing the rise and fall of Infectious Diseases each week during 1893. SCARLET FEVER CHART. 73 Table LV. Return of Cases of Infectious Disease notified during the undermentioned periods in accordance with the "Public Health (London) Act, 1891" (Sec. 55b.) month ending Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total Each Month. January 10 130 43 1 16 - 33 1 - - - 234 February 10 113 46 2 14 - 36 1 1 - - 222 March 28 159 46 4 15 - 32 2 l - - 287 April 27 118 48 4 12 - 38 2 — - - 250 May 15 182 52 1 9 - 32 1 — - - 292 June 12 335 88 1 23 - 64 5 l - - 529 July 5 268 58 1 18 — 53 2 — - - 405 August 1 296 76 1 17 - 52 2 — - - 445 September 2 467 100 6 32 - 86 2 1 - - 696 October 1 351 94 4 24 - 96 9 l - 1 581 November — 263 102 2 34 1 69 5 1 - - 477 December 7 197 101 3 37 - 81 6 1 - - 433 TOTALS 118 2,879 854 30 251 1 672 38 7 - 1 4,851 74 Diphtheria. No notifiable disease caused so much anxiety as Diphtheria, which, as I have already stated, was very prevalent, and very fatal, during the year. The chief cause of anxiety arose from the difficulty of getting patients isolated, owing to the want of a sufficient number of beds in the Metropolitan Asylums Board's Hospitals. This insufficiency of beds has been fully recognised by the Board themselves, who point out that it is with this disease particularly that this insufficiency is most acutely felt. "The unavoidable delay,"' their annual report states, "sometimes experienced in ascertaining, if any, where a vacant bed exists, and the deplorable necessity of transporting some patients to a hospital at a considerable distance from their homes, or the general hospital to which they have in the first instance been taken, cause, it is feared, a great increase of both risk and discomfort to the sufferer, and certainly much dissatisfaction to all concerned." Dissatisfaction has been, without doubt, frequently expressed by the Islington parents and guardians, who desired the removal of their patients, and many times they seemed to think that the difficulty and the delays arose in the Public Health Department, which, however, had nothing whatever to do with it. The hospital accommodation for Diphtheria patients, owing to the great increase of the disease in the metropolis, is the most crying question of the moment. The Metropolitan Asylums Board fully recognise this, and I feel bound to say that they are most anxious to do what they can to provide it. I append an extract from the Statistical Committee's report to the Managers, so that their position may be made clear:— (6.) Diphtheria Accommodation.—It will be within the recollection of the Managers that it was not until the end of October, 1888, that they were called upon to admit diphtheria patients into their hospitals. At first only 94 beds in two hospitals were set apart for the reception of these cases; but each year the number admitted has materially increased, as will be seen from the following figures:— Year 1889 1890 1891 1892 1893 Admissions 722 949 1,312 2,009 2,848 75 In the past year the diphtheria accommodation was not sufficient to meet all demands, so that the figures, like those for scarlet fever, represent the actual admissions, but not the number that would have been admitted had there been room for all applicants. At the end of 1893 the beds set apart for diphtheria cases numbered 252, distributed as follows:— Eastern Hospital 48 beds. North-Western „ 88 „ Western „ 36 „ South-Western „ 52 „ South-Eastern „ 28 „ 252 beds. On the 18th March, 1893, the Managers instructed a Special Committee to consider and report upon the increase of admissions of cases of diphtheria into the Managers' hospitals, and generally upon the whole question of the accommodation which was then provided for the treatment of such cases, and to make such recommendations as regards its enlargement, improvement, and distribution as the past experience and the probable necessities of the future might appear to demand. In submitting their Report to the Board on the 13th May, the Special Committee referred to the annually increasing number of patients received into the Managers' hospitals, and stated that the whole of the beds hitherto provided at those hospitals for cases of diphtheria had on several occasions been exhausted. In the opinion of the Committee, "these facts and figures show that the Managers may not unreasonably anticipate "a far greater proportionate number of patients suffering from diphtheria being "admitted into their hospitals in the future than in the past; but, although your "Committee are convinced of the urgent need of making further provision for the "accommodation of diphtheria (as well as of scarlet fever), they feel that it would "be premature to make any suggestions as to its enlargement, improvement, or "distribution until additional hospital sites are at the disposal of the Board. "When these additional sites shall have been acquired by the Managers, "your Committee consider that, in designing the hospitals to be erected thereon, "particular attention should be paid to the probable increase in the number of "diphtheria patients, and the accommodation for patients in such hospitals so "designed and distributed as to admit of a greater proportionate number of "diphtheria patients being accommodated and isolated than is the case in some "of the hospitals of the Managers where cases of diphtheria are now received." Until this accommodation is provided and patients are speedily isolated it is hopeless to expect that the disease, which from its first appearance is so infectious, can be stamped out, especially in Islington, where the people are aggregated on such a limited space. The cases of diphtheria in this parish occurred for the greater part in its upper and lower thirds, leaving the intermediate area with 76 paratively few cases. The lower third would consist of all that portion of the district to the south of the North London Railway, while the upper third would comprise all the district to the north of Camden, Parkhurst, and Seven Sisters' Roads. There were 902 certificates received from practitioners. In proportion to population the greatest sickness occurred in the subdistrict of Islington South East, where the sickness rate was 3·35 per 1,000 inhabitants, while the least (2·24) was in Islington South West. The disease, which had been very prevalent in the preceding year, and which had averaged 20 cases per week during December, began the year by showing a downward tendency. This, however, only lasted through January, for in February the cases commenced to increase, although they still remained below the average (14 cases) per week of the year 1892. In March, April, and May they oscillated considerably, their movement was uncertain, and hopes were entertained in the lastmentioned month that the disease would not assume so serious an aspect as in the preceding year, chiefly because the weekly sickness curves were not so high. With the advent of June, however, these hopes were dissipated, and the curve steadily arose above previous records, and continued to do so until the end of the year. In the chart which accompanies this report, the behaviour of the disease in 1892 and 1893 is given. Table LVI. Showing the Sickness for each Quarter in the several Sub-Districts. Sub- Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 41 52 58 151 302 Islington, South West 38 69 88 44 239 Islington, South East 25 50 61 81 217 Highbury 40 30 41 33 144 The Parish 144 201 248 309 902 77 Table LVII. Showing the Sickness-Rates from, Diphtheria for each Quarter in the several Sub-Districts. Sub-Distric's. 1st Quarter. 2nd Quarter. 3rd. Quarter. 4th Quarter. Whole Year. Upper Holloway 1·71 2·17 2·43 6·32 3·15 Islington, South West 1·42 2·59 3·30 1·65 2·24 Islington, South East l·54 3·08 3·76 4·99 3·35 Highbury 2·63 1·97 3·69 2·17 2·36 The Parish 1·75 2·45 3·02 3·76 2·74 The fatality was very considerable, no less than 20·9 (say 21) per cent. of the total cases notified having died. It was greatest in the first quarter of the year, when 22·2 per cent. of the patients died, and least in the fourth quarter, when 20·3 per cent. succumbed. The fatality varied very considerably in the districts; for example, it was as low as 7·4 in Highbury in the third quarter, and as high as 42·1 per cent. in Islington South East in the first quarter. The figures in the following table are of serious interest, for they declare with unspeakable force that Diphtheria is one of the most fatal diseases that dwells with us at the present time. Table LVIII. Showing the fatality from Diphtheria for each Quarter in the several Sub-Districts. (Deaths per-centage of Sickness recorded.) Sub-Districts. 1st Quarter 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 19·5 23·0 10·3 18·5 17·8 Islington, South West 42·1 17·3 29·5 31·8 28·4 Islington, South East 20·0 22·0 27·8 18·5 22·1 Highbury 7·5 23·3 7·4 18·1 13·1 The Parish 22·2 20·8 20·9 20·3 20·9 78 Membranous Croup. The cases notified as Membranous Croup, although they might very well have been included in the Diphtheria returns, are kept separate, as they have been notified separately. Table LIX. Showing the sickness from Membranous Croup for each quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 3 3 2 4 12 Islington, South West 2 2 4 3 11 Islington, South East 1 •• 2 4 7 Highbury 1 1 .. •• 2 The Parish 7 6 8 11 32 Table LX. Showing the sickness rate from Membranous Croup for each quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0·12 0·12 0 ·08 0·16 0·12 Islington, South West 0·07 0·07 0·15 0·11 0·10 Islington, South East 0·06 .. 0·12 0·24 0·10 Highbury 0·06 0·06 .. .. 0·03 The Parish 0·08 0·07 0·09 0·13 0·09 79 Table LXI. Showing the fatality from Membranous Croup in each Quarter for the several Sub-Districts. (Death percentage of Sickness recorded.) Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. Whole Year. Upper Holloway 30·3 30.3 50·0 .. 25·0 Islington, South West ... 50·0 60·0 33·3 36·3 Islington, South East .. •• 50·0 60·0 42·8 Highbury .. 100·0 .. .. 50·0 The Parish 14·2 50·0 62·5 27·2 34·3 Enteric Fever. The notifications from this disease, which had averaged 4·4 per week in 1892, rose to 5·2. The total certificates received numbered 270, of which 105 were delivered in the fourth quarter. The disease was most prevalent in proportion to population in Upper Holloway, and most fatal in proportion to the cases notified in Islington South West. Seventy-four cases were removed to the Metropolitan Asylums Board's Hospitals. Table LXII. Showing the Sickness from Enteric Fever in each Quarter for the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 22 20 15 42 99 Islington, South West 8 1 2 19 22 61 Islington, South East 10 4 23 15 52 Highbury 7 12 13 26 58 The Parish 47 48 70 105 270 80 Table LXIII. Showing the Sickness-rates in each Quarter for the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0·92 0·83 0·62 1·75 1·03 Islington, South West 0·30 0·45 0·71 0·82 0·57 Islington, South East 0·61 0·24 1·41 0·92 0·80 Higbury 0·46 0·78 0·85 1·71 0·95 The Parish 0·57 0·58 0·85 1·28 0·82 Table LXIV. Showing the fatality from Enteric Fever for each Quarter in the several Sub-Districts. (Death per-centage of Sickness recorded.) Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 18·1 25·0 13·3 14·2 17·1 Islington, South West 37·5 16·6 l5·7 27·2 22·9 Islington, South East 20·0 • • 17·3 13·3 16·3 Highbury •• 8·3 30·6 15·3 15·5 The Parish 19·1 16·0 18·5 17·1 17·7 Puerperal Fever. There were 41 cases known, of which 22 were notified in the fourth quarter. The largest number reported occurred in Islington South West, when the sickness was 0·50 per 100 births. 81 Table LXV. Showing the sickness from Puerperal Fever for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1 2 4 6 13 Islington, South West 1 5 .. 11 17 Islington, South East .. 1 2 .. 3 Highbury 2 1 .. 5 8 The Parish 4 9 6 22 41 Table LXVI. Showing the Sickness-rates from Puerperal Fever per 100 registered Births for each Quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0·14 0·27 0·58 0·90 0·46 Islington, South West 0·11 0·67 .. 1·33 0·50 Islington, South East .. 0·20 0·39 .. 0·15 Highbury 0·49 0·23 .. 1·36 0·49 The Parish 0·16 0·35 0·25 0·93 0·42 Table LXVII. Showing the fatality of Puerperal Fever for each Quarter in the several Sub-Districts. (Death per-centage of Sickness recorded.) Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway .. 50·0 50·0 33·3 38·5 Islington, South West .. 20·0 .. 27·2 23·5 Islington, South East .. .. .. .. .. Highbury 100·0 .. .. 40·0 50·0 The Parish 5·00 22·2 33·3 31·8 31·7 82 Erysipelas. As many as 719 cases, or an average of 13·8 per week, were reported. The number is nearly three per week more than that of the preceding year. From the beginning to nearly the close of the year the curve of the disease was marked by a steady upward tendency. Thus, in the first quarter there were 103 cases, in the second 146, in the third 206, and in the fourth 264. The highest sickness-rate was registered in Upper Holloway, and the lowest in Highbury. These rates were respectively 2·65 and l·09 per 1,000 inhabitants, Table LXVIII. Showing the cases of Erysipelas for each quarter in the several Sub-Districts. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 42 52 55 106 254 Islington, South West 26 47 78 72 223 Islington, South East 19 33 54 69 165 Highbury 16 14 19 28 77 The Parish 103 146 206 264 719 Table LXIX. Showing the Sickness-rates from Erysipelas for each Quarter,r for the several Sub-Districts. (Sickness Rates.) Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1·75 2·17 2·30 4·39 2·65 Islington, South West 0·97 1·76 2·93 2·70 2·09 Islington, South East 1·17 2·03 3·33 3·64 2·53 Highbury 1·05 0·92 1·25 1·84 1·09 The Parish 1·25 1·78 2·51 3·22 2·19 83 Table LXX. Showing the fatality of Erysipelas for each Quarter in the several Sub-Districts. (Deaths Percentage of Sickness recorded.) Sub-Distric's. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 4·7 3·8 5·4 6·7 5·1 Islington, South West 3·8 8·5 .. 8·3 4·9 Islington, South East 6·8 3·0 1·8 5·0 3·6 Highbury 5·2 .. 10·5 •• 5·2 The Parish 12·5 4·8 2·9 5·6 4·7 HOSPITAL STATISTICS. Table LXXI. Showing the number of cases of the several infectious diseases removed to the Metropolitan Asylums Board's Hospitals for treatment and isolation. Hospitals. Scarlet Fever. Diphtheria. Kuteric Fever. Other Diseases.* Total Admissions. Total Deaths. Eastern 127 31 18 26 202 27 North Eastern 548 1 1 19 569 22 North Western 204 135 16 11 366 50 Western 8 .. .. 1 9 •• South Western 1 .. .. .. 1 .. South Eastern 4 .. .. .. 4 .. Totals 892 167 35 57 1,151 99 * Not inclusive of Small Fox. F 2 84 INFANTILE MORTALITY. Table LXXII. Showing the number of Births together with the number of Deaths of Children under 1 year, and the proportion of such deaths to every 1,000 births. YEAR. Births. Deaths. Infantile Mortality Rate. 1871—80 89,627 13,243 148 81 9,968 1,400 140 82 10,061 1,403 140 83 9,888 1,312 133 84 10,011 1,506 150 85 9,643 1,387 144 86 9,814 1,510 154 87 9,726 1,549 159 88 9,568 1,262 132 89 9,559 1,242 129 90 9,419 1,484 158 1881—90 97,647 14,055 143 91 9,797 1,464 150 92 9,952 1,390 140 93 9,749 1,595 164 During the year, out of 9,749 children horn, 1,595 died before they had attained the age of twelve months. These deaths represent an infantile mortality rate of 164 for every 1,000 registered births. This rate was exactly the same as that for the whole of London, but was above that of the neighbouring parish of Hackney, where the rate was 152, and below that of St. Pancras, in which it was 172. The highest rate in the Metropolis was 219 in the Strand, and the lowest, in Hampstead, where it was 102. The infant mortality rate in the preceding two years (1891 and 1892) was respectively 150 and 140. In the 1st quarter the mortality rate was 109 per 1,000 children born. ,, ,, 2nd ,, ,, ,, ,, ,, 156 „ ,, ,, ,, ,, ,, 3rd ,, ,, ,, ,, ,, 211 ,, ,, ,, ,, ,, ,, 4th ,, ,, ,, ,, ,, 166 „ ,, ,, The chief causes of death in the first quarter were Whooping Cough 10, Tabes Mesenterica 10, Premature Birth 42, Convulsions 20, Bronchitis 35, Pneumonia 18, Suffocation 18, Debility 21, Marasmus 34, and Inanition 19. 85 In the 2nd quarter the principal causes were Measles 13 deaths, Whooping Cough 25, Diarrhoea 49, Tabes Mesenterica 26, Premature Birth 48, Meningitis 12, Convulsions 23, Bronchitis 21, Pneumonia 15, Suffocation 14, Debility 20, Marasmus 36, and Inanition 22. The returns of the 3rd quarter show that the chief factors of the mortality were Whooping Cough 22, Diarrhoea 121, Tabes Mesenterica 35, Phthisis 10, Premature Birth 36, Convulsions 16, Bronchitis 19, Pneumonia 12, Enteritis 26, Debility 34, Marasmus 63, and, Inanition, 22. In the 4th quarter the principal causes were Whooping Cough 13, Diarrhoea 12, Tabes Mesenterica 12, Premature Birth 47, Convulsions 16, Bronchitis 63, Pneumonia 29, Suffocation 15, Debility 27, Marasmus 43, and Inanition 26. The excessive heat of the second and third quarters was without doubt the cause of the excessive mortality from diarrhœal diseases, as well as from diseases of the digestive organs, and these raised the deathrate among infants above that of the preceding year. 86 THE YEAR'S WORK OF THE PUBLIC HEALTH DEPARTMENT. Yerbury Road Board Schools. At the commencement of the year the action against the School Board for London re, the insanitary condition of the Yerbury Road Schools had not been concluded, inasmuch as the decision of the magistrate had not been given. However, on January 7th, he (Horace Smith, Esq.) delivered his judgment. This decision was reported to the Public Health Committee, who decided that a report should be presented to the Vestry as to the steps taken by them respecting these schools. Accordingly the Committee presented the following report:— January 9th, 1893. To the Vestry of St. Mary, Islington. Yerbury Road Board School—Proceedings against School Board for London. Your Public Health Committee begs to report the steps that hare been taken in the recent proceedings by the Vestry against the School Board for London, in respect to the insanitary condition of the Yerbury Road Hoard School. Your Committee, as the Vestry is quite aware, has had under its consideration for a very long while the cause of the large number of cases of Diphtheria occurring amongst the scholars attending the Yerbury Road Board School. During the year 1891 your Committee became seriously anxious, and directed the late Medical Officer of Health to make such enquiries as he deemed proper. These enquiries were duly made by him, and as the result, he presented a report to your Committee on the 18th of January, 1892, in which he said "I do not consider, beyond the School being a large meeting house for children, that it can be accused of having caused the outbreak." From this report it does not appear that the School was inspected by the late Medical Officer of Health, or by any Official of the Vestry by his direction. He had, however, been in correspondence with the Medical Officer of the School Board to whom he wrote on or about the 15th December, 1891, in reply to a communication, that he thought the condition of the School ought to be looked into by that Officer. An interview also took place between both Officers, and the result was that it was distinctly understood in the Public Health Department that there were no sanitary defects existing in the School. 87 It should be stated that the question of closing the School for the purpose of disinfection was also discussed, but the Medical Officer to the School Board, on the 18th of December, 1891, objected to this course being followed, (1st) because he did not think the facts justified it, there having been only sixteen cases in the three weeks ending December loth, thirteen of these cases being in the Infants' Department; and (2nd) because the closing of the School would add to the scare then unnecessarily existing, and would merely provide facilities for the children meeting and playing in the streets, and thus directly frustrate the object in view. Diphtheria cases, however, continued to occur, as the following statement will demoustrate:— In February, 1802, 6 cases were reported. „ March „ 10 „ „ April „ 3 „ ,, May,, 3,, „ June „ 14 „ „ July „ 9 „ „ August „ 1,, (School closed.) „ September „ 3 „ „ October „ 11 „ „ November „ 6 „ On the 27th September, 1892, the Medical Officer of Health (Dr. A. E. Harris) received information that smells were perceptible in the Infant School Room, and on making enquiries he then learned for the first time the history of this school with regard to Diphtheria. On the same date therefore, he, with the Inspector (Cowling) for the district, visited the School and proceeded to make a thorough examination of its sanitary fittings. He was so astonished and alarmed at the discoveries he then made, that he wrote at once to the Clerk to the School Board as follows:— "I have discovered very grave sanitary defects in connection with this School, "which, in my opinion, would account for the many cases of the disease "that have occurred therein. These defects were pointed out to one of "your Clerks of Works, and to the Vicar of the district, who is one of the "School Managers. Further investigations will be made to-morrow. In " my opinion the Infant School should not be occupied." The examination was continued next day (28th September) and the defects discovered were communicated to the School Board on the 28th September. This letter crossed a communication from that Board, in which your Medical Officer was requested "to state what are the grave sanitary defects in connection with the above "School, as the Board are informed by their expert that only certain improvements "are needed to meet modern requirements. There is nothing to show that any "leakage into the School occurs, or reason to suppose that Diphtheria is caused by "any defect in the building." 88 A telegram was sent in reply by your Medical Officer to the following effect:— " School should be closed at once. Defects are most grave. Must request immediate attention.'' This telegram was preceded by the letter already alluded to, and which was as follows:— Vestry Hall, Upper Street, N., 28th September, 1892. Dear Sir, Yerbury Road Board School. Without entering into very full details I desire to say in reply to your communication of yesterday that the following are the more serious defects in the drainage of the School. 1. There is no sufficient disconnection between the sewer and the drains, the result being that sewer gas can pass freely from the former to the latter. 2. Sewer gas can pass into the school through the drain pipes that are laid within the school to carry away the rain from the stackpipes which are situated within the building. 3. There are gully traps within the building in connection with these drains from the stackpipes, which in dry weather will become unsealed, and which at all times are dangerous. Gullies should never be placed inside a building. 4. The drains are not ventilated. 6. All the drains leak very much, so that water discharged into them finds its way very freely into the ground. 6. There is no proper ventilation to the school drainage system as a whole. Yours faithfully, (Signed) ALFRED E. HARRIS. G. H. Croad, Esq., Secretary, London School Board. Your Medical Officer also wrote on the same day to J. W. Sharp, Esq., the Chairman of Managers of the School, calling his attention to its sanitary condition, and in this communication he said—"If a meeting of my sanitary authority were to "be held immediately, I would have had to call on it to issue an order for its (i.e., the "school's) closing, but unfortunately there will be no such meeting for some days. "I now, as Medical Officer of Health for this parish, give you notice that in its "present condition this school is dangerous to the health of the scholars and of the " teachers." 89 In a further letter to the Board on the 29th of September, your Medical Officer of Health wrote expressing his surprise that no skilled persons had been sent immediately to the School to examine it on the part of the School Board, more especially in view of its past history with regard to Diphtheria, adding—"I cannot but regret the "failure of your authority to have done this, for it could hardly be supposed that any "person occupying the responsible position of Medical Officer of Health would have "made such a serious statement without a solid foundation. I would also remind "you that I informed you that the investigation would be continued on Tuesday, "and, considering its great importance, I am surprised to find that no one representing "your Works Department was present. Lastly, let me say that I am much surprised "at the unnecessary delay on the part of the School Board from Tuesday to Friday in " making an investigation." This letter is important, because it was stated subsequently at the Police Court investigation, that your officer had shown a want of courtesy to the Board in not informing it of his intention to examine the school. From this letter it will be seen that the Board was informed, but sent no person to make an examination with Dr. Harris. On Friday, September 30th, your Medical Officer met, bv appointment, General Moberly, Chairman of the Works Committee, Professor Smith, the Medical Officer, and some other Officials at the School, when his right of entry and examination were at once challenged by the first-named gentleman, who distinctly stated that the Sanitary Authority possessed no right of entry into the London Board Schools. In reply he was informed that while your Medical Officer of Health was aware that certain Government Buildings, such as Prisons and Barracks were exempt from the supervision of Sanitary Authorities, he had yet to learn that the Board Schools of this country, which were largely supported out of the rates, were similarly free. The various defects in the sanitary arrangements were then pointed out. The statement that the drains were leaking received little consideration, and indeed one of the School Board representatives stated that he was "not surprised to hear it, but it was not a matter of great consequence." A water test had been applied to the drains, so that the Chairman and Officials might see their defective condition, but only the most cursory and perfunctory inspection was made. Your officer at the conclusion of the interview was informed that the defects pointed out by him would be considered. Up to the following Tuesday (October 4th) nothing was heard from the Board and your Medical Officer therefore wrote to the Clerk, informing him that unless an assurance was received that something would be done at once, a recommendation would be made to the Vestry on Friday, October 7th, to close the Schools. This letter elicited a reply to the effect that certain work would be commenced at once, viz.:—(1) The disconnection of the drains from the sewer by constructing an 90 intercepting chamber with channelled floor and trap; (2) The ventilation of the drains; and (3) The disconnection of the drains inside the building from those on the outside. No proposal, however, was made to remedy the leaky drains. It was satisfactory, however, to find, although the Medical Officer of the Schools combated the notion that Diphtheria could arise from these defects, that he recommended his Board to carry out the work necessary to sever the drains from the building. Up to this point everything had been done on the initiation of your Medical Officer of Health, for it was vacation time, and your Public Health Committee was not sitting. However, on the 9th October, a full report of everything that had been undertaken was submitted to your Committee, who entirely approved of his action At this meeting the question of relaying the drains was carefully considered, and as the evidence clearly showed (1st) that the drains were not discharging their contents, but in fact allowed large quantities of soil to accumulate in them, and (2nd) that they were leaking to a serious extent, and were contaminating the subsoil, it appeared to your Committee absolutely essential that it should insist on the drains being made perfect. Your Committee felt that if it did not insist on this necessary work being executed in the case of a School, at which some 1,200 children attended daily, although such School was managed by so powerful a body as the School Board for London, it could not with any consistency require private individuals to relay faulty drains attached to their houses. Your Committee, therefore, passed the following resolution:—"That the School Board for London be required to reconstruct the drainage of the Yerbury Road School." This resolution was duly forwarded on the 11th October, but the School Board still declined to accede to the requirements of your Committee, and, therefore, at its meeting on the 29th October, a statutory notice was ordered to be served on that body, requiring it to take up the defective 9-inch drains, and replace them with 6-inch pipes. In the hope that litigation might be avoided, the Medical Officer of Health, before serving the statutory notice, addressed another communication to the Board, in which he said his Committee was very anxious that it should not come into conflict with the School Board over this matter, but as it seemed to be of the utmost importance that there should not be the slightest flaw in the drainage of the Board Schools, it trusted that its requirements would be carried out without a resort to legal proceedings, which his Committee was most desirous of avoiding, and that the Board would reconsider its decision, and execute the necessary works. To this communication, a reply, dated 2nd November, was received to the effect that the Works Committee was not prepared to comply with the requirements of the Vestry that the drains from the closets should be relaid. The statutory notice was, therefore, immediately served on the School Board, calling on it to carry out the necessary work. 91 From this resume of the measures adopted by the Public Health Department it will be seen that no other alternative was left to your Committee than to resort to litigation if the statutory notice was not complied with, and therefore your Medical Officer of Health was authorised to employ experts to support your surveyor's and his evidence, and your solicitor, Mr. William Lewis, was empowered to engage Counsel to conduct the case. For these purposes Professor Corfield, M.D., and Mr. De Courcy Meade, Surveyor, were engaged as witnesses, and Mr. Alexander Macmorran as Counsel. Ultimately the case was heard at the Clerkenwell Police Court, and after a most patient hearing, extending over three days, and after a visit to the schools, the magistrate, Horace Smith, Esq., delivered his judgment in favour of the Vestry as follows: —"I have come to the conclusion that both the drains in question are inefficient, and "are a nuisance and injurious to health. I find as a fact that the 9-inch drain is laid in an improper manner. Firstly, the gradient is irregular and insufficient; and, "secondly, the joints are so badly put together that they cause a leakage of sewer matter "into the soil. It was suggested by the School Board that although the gradients were "irregular, yet, by a sufficiently frequent and ample flushing the drain might be left "clear; but I find as a fact that even if a full flushing was regularly performed (about "which in practice there would be some difficulty) there is not sufficient power to flush "a 9-inch pipe. "Even if a sufficient quautity of flushing could be obtained to cleanse a 9-inch "drain, I find that the leakage of the joints of the drain would still render it "inefficient, and would allow the sewage to percolate the soil. It was further urged "by the Board that, admitting that the drain was badly laid, and that sewage matter "percolated into the soil, yet the soil was stiff London clay, and so no escape of gas ''would be possible. I do not decide whether a drain perfectly cased in London clay "would or would not be so secure as to prevent the possibility of any escape of sewage "gas, but I find, as a fact, that the drain in question, and also the 6-inch drain, are not "perfectly cased in clay, but are laid in a great measure in a soil of a varied character "and quite capable of being percolated by sewage and sewage gas. It was further "urged that the drains were some distance from the schoolrooms, and that the play"ground and schoolrooms were covered with a thick coating of tar paving. I am of "opinion, however, that it is far from impossible that sewage gas should not reach as "far as the school buildings, and that in case of any cracking of the surface at any "time there would be great danger. This being the case, I am further of opinion that "there is danger from the roof water pipes which run inside the school building "becoming contaminated by reason of the percolations from the leakage of the badly"laid pipes; but if the drainage was made thoroughly efficient, there would be no "objection to the position of the roof water pipes. The 6-inch pipe running from the "caretaker's house appears to leak throughout, aud must be properly re-laid and made "watertight. I make an order for the abatement of the nuisance, and a closing order 92 "prohibiting the school from being used for habitation until I am satisfied that it has " been made fit for habitation." The magistrate also allowed five guineas costs. All which is submitted. ROBERT S. CUFFLIN, Chairman. Moved by Mr. Cufflin, seconded, and resolved—That the foregoing report be received and approved. A reference has already been made on page 41 as to the influence of these schools on Diphtheria both before and after the execution of the works ordered by the magistrate. Hanover-street Board School. On the decision of the magistrate respecting the drains of the Yerbury-road Board School being made known, the School Board for London, against whom a summons had been issued, calling on them to carry out similar works at the Hanover-street Board School, agreed to comply with the demands of the Public Health Department. The summons was therefore held over sine die, and finally withdrawn on the completion of the works. DISINFECTION OF HOUSES. The calls on the Department to disinfect houses after infectious disease have been so numerous that the ordinary staff (one man) was found altogether unable to cope with it. In consequence additional assistance was engaged, and at least four men were constantly employed at disinfecting rooms and stripping walls, and at times five and even six men were at work. The Public Health (London) Act, 1891, sec. 60, provides that when the Medical Officer of Health, or any practitioner, certifies that the cleansing and disinfecting "of any house or part thereof" would tend to prevent or check any dangerous infectious disease, "the sanitary authority shall serve notice on the master or owner that the house, &c., will be cleansed and disinfected unless he informs the sanitary authority within 24 hours from the receipt of the notice that he will do it himself." 93 The service of this notice has been found to be an utter waste of time, for in 999 out of every 1,000 cases either no notice is taken of the intimation, or else a reply is received calling on the Vestry to do the necessary work. Nevertheless, the law has been complied with, for the Act says the sanitary authority shall serve the notice; but such compliance has caused delay in carrying out the fumigation, stripping and cleansing. The stripping of walls has frequently been attended with difficulty, owing to the fact that in old houses it has often been found that the old paper, sometimes six layers thick, had been the support of the plaster, and consequently when that support was removed the plaster came down. There is no work that the Public Health Department is engaged on which is so expensive to the ratepayer as the stripping and cleansing of rooms after infectious disease. At best a man can strip only one room in a day, often not so much, as a great deal depends not only on the number of papers on the walls, but also on the condition of the walls themselves. Even with the staff of men that were constantly employed during the year the work was not as expeditiously done as I should wish, for frequently there were considerable delays owing to the rushes that were made on the Department during the height of the epidemic. This question is at present engaging my serious attention, and I hope before long to submit a report which will deal fully with it. INCREASE IN THE STAFF OF THE SANITARY INSPECTORS. When 1892 was coming to a close the Public Health Committee had under consideration the pressing necessity of increasing the number of Sanitary Inspectors in the employment of the Vestry. This question arose on a report which I had presented, and on which the Committee made a report to the Vestry on January 23rd, 1893. 94 ADDITIONAL SANITARY INSPECTORS. To the Vestry of St. Mary, Islington. Your Public Health Committee begs to report that on July 18th, 1892, in its report on the clauses of the Public Health (London) Act, 1891, it expressed the opinion that an addition to the staff of Sanitary Inspectors was necessary, but deferred making any definite recommendation on the subject until it had had an opportunity of further conference with the Medical Officer of Health. The Committee has now received an exhaustive report from Dr. Harris, which is appended, and after careful consideration thereof is of opinion that the Medical Officer has made out a case for the increase in the staff for which he asks, and also for the placing of the staff in uniform. It therefore recommends— 1. That the staff of Sanitary Inspectors be increased to fourteen, and that the sanction of the Local Government Board be sought for this increase. 2. That the increase be provided, subject to the approval of the Local Government Board, by the appointment permanently of the four temporary Inspectors during the pleasure of the Vestry, and by the appointment of two additional Inspectors. 3. That it be referred back to the Committee to advertise the appointments, to invite applications for the two additional appointments about to be created, and to submit names to the Vestry. 4. That the Sanitary Inspectors be henceforth supplied with uniforms, and that the General Purposes Committee be instructed to provide such uniforms. 5. That the Superintendent of the Public Health Department (Mr. J. R. Leggatt) be appointed, subject to the approval of the Local Government Board, a Sanitary Inspector, with power to act in any part of the Parish, on the terms of his original appointment, and that he be styled henceforth "Superintendent of the Public Health Department and Chief Sanitary Inspector." All which is submitted. ROBERT S. CUFFLIN, Chairman. REPORT by the Medical Officer of Health on the number of Additional Sanitary Inspectors required for executing the Sanitary Work in the Parish of St. Mary, Islington. To the Chairman and Member of the Public Health Committee. Mr. Chairman and Gentlemen,— In proposing to you to increase the staff of Sanitary Inspectors, I have very carefully and anxiously approached the question and studied it in all its bearings, and 95 the conclusion I have come to represents the minimum requirements of the Parish of Islington, which, I may remind you, is by far the most populous Sanitary Division of the Metropolis. I may also remind you that this district, over which you have the sanitary control, and into whose hands its great health interests are committed, is in point of population the sixth largest community in England, and the seventh in Great Britain and Ireland. It thus occupies the first place in London, and also a leading place in the United Kingdom. This being so, it is apparent that its requirements will be proportionate to its size and importance. Now the Vestries in London, owing to the manner in which certain work is delegated to other bodies, do not possess such plenary powers in general government as the provincial Town Councils, but this is not so with rospect to its sanitary government. Indeed, it is the very opposite, because "The Public Health (London) Act, 1891," places fuller and more complete power in the hands of the London authorities than is possessed by the provincial bodies under the Public Health Act, 1875. The largest towns of the country are not, however, as your Vestry is, under the surveillance of a Couuty Council, for they are counties in themselves, a fact which makes it all the more necessary for such authorities as yours to place themselves beyond the reach of a higher power to find fault with, cavil at, or rebuke for neglect in their sanitary administration. I would point out, too, that in many of the large towas the general inspection of houses and properties is not nearly so difficult as it is with you, because here the excreta are all water borne (i.e., carried away by means of a water-flush through drains to a sewer), while to an enormous extent with them the dry system of disposal persists. The condition of ash-closets, earth-closets, and privy-middens can be arrived at easily, almost at a glance, and their defects noted, whereas the sound or defective condition of drains which are laid in the ground, which pass underneath houses, and which are frequently of a most complicated character, is, in consequence, very difficult to determine, for it is not easy to ascertain hidden defects. But defects in these are a common source of disease in this district, and I believe notably of the large amount of diphtheria and sore throats which exists. Then the examination of drains occupie i a long time, sometimes many hours, but varying according to the complications and the tests applied. Thus there is all the more reason why your staff of Inspectors taking the great towns as your models, should be at leant proportionate to theirs, and until this is so Islington cannot be said to possess a staff to meet its sanitary requirements. Now the exact comparison between the six largest towns and Islington may be stated thus:— Islington possesses one Inspector for each 39,928 of its population. The six towns „ one „ „ 13,674 „ „ 96 From this it will be seen that one of your Inspectors is expected to protect the Sanitary interests of oyer three times the number of persons that an Inspector in the six greatest towns cares for. Again— Islington possesses one Inspector for every 4,783 inhabited houses. The six towns „ one „ „ 2,645 „ „ In other words, an Islington Inspector has under his charge 1 4/5 houses (nearly 2 houses), for every one under the care of the Inspector in the large towns; but to make your deficiency plainer, an Islington house contains 8·3 persons, whereas in the six largest towns a house only contains 5·1 persons. But if I take the fifteen large towns whose population is over 100,000, it will be noticed that each Inspector there looks after 14,397 persons, and 2,700 houses, but a house in these towns is occupied by only 5·3 people, instead of 8·3 persons as in Islington. Therefore, arguing on this basis, your staff is very deficient. Finally, if I compare Islington with the other districts in London, and here let me say that, generally speaking in sanitary matters, their example is by no means the best, and consequently not to be taken as a model, although, if there be anything good, by all means let us follow it, I find— London possesses one Inspector to each 27,403 persons, and „ „ one „ ,, 3,568 inhabited houses; and each house contains 7·6 persons, compared with Islington's 8·3. To each Inspector. Persons in each House. No of Inspectors required in Islington on the basis of the Houses. Persons. Inhabited Houses in the several districts. Population of the several districts. Islington 4,782 39,928 8·3 — — Six greatest towns 2,645 13,674 5·1 14·4 23·4 Fifteen large towns 2,700 14,397 5·3 14·1 22·2 London 3,566 27,403 7·6 10·7 11·7 London, less Islington 3,488 26,602 7·6 10·9 12·0 From this statement it will be seen that, whether judged by the standard of the six largest towns, the fifteen towns over 100,000 inhabitants, or of London, your Parish is found sadly wanting in sanitary supervision. I ask you to consider these figures carefully; for I believe the more they are looked into, the more certainly will the strong conviction be entertained by you, as the Committee having care of the greatest interest that can be given to anybody, namely, the health of the community, that your district requires more sanitary supervision, and therefore a considerable addition to the staff of Sanitary Inspectors. 97 The scheme of fourteen Inspectors will provide— one Inspector to every 2,732 houses, or „ „ „ „ 22,999 persons. In considering my proposals I will ask you to remember at the same time that the public, who are now more deeply and anxiously solicitous about their surroundings and their health than they were even ten years ago (for enlightenment on health matters is spreading apace, partly owing to a higher education, and partly to the influence of the public press) will not be content unless sanitary work is more energetically carried out and more efficiently administered than it has been in the past. It will not be sufficient in the future to inspect premises hastily, by merely, as it were, looking at them. If they are to be inspected at all they must be inspected more thoroughly than they have been hitherto. For instance, the chief test relied on to detect leakage in drains was the peppermint and similar tests giving off strong odours; but these, when applied to deep drains, are not efficient. The "smoke" test was rarely applied, aud the "water" test never. Indeed, these could not be used because the Inspectors had not the necessary means wherewith to apply them. Such a state of affairs must cease, and it is to be hoped that in the future, when an Inspector has examined a house, he shall have discovered all its sanitary faults, and that there will be no occasion for him to visit the house again, except to see that its sanitary fittings are kept in good repair, or when owing to damage to them, whether by accident or design, or by fair wear and tear, he is called in. As for underground drains, once they are efficiently laid they should not require his attention for years. Thug it will be seen that in the future the Inspector will not be able to rush through so many houses, and say, " I have inspected them." He must spend time over his inspections, and go back more frequently to examine the work he has ordered to be carried out, to see that it is not soamped, but that every joint and every part is carefully made, that the materials are good and sound, and that the work and the workmanship are thorough. To do this will require more Inspectors, and the number I have come to the conclusion that you require in this large town, of which I have the honour to be Medical Officer, is fourteen at thE, vEry least. With the figures of the great towns before me I cannot ask for fewer, and with the knowledge that in some of these towns even now the number of the staff is not deemed sufficient, I would only be betraying the important trust committed to me by doing so. I have asked for the least number possible if the work is to be carried out with anything like efficiency. The increase of the staff of Inspectors in Islington has been of slow growth; for in 1856 there were two Inspectors, in 1866 four, and in 1886 eight. When in the latter year additional Inspectors were appointed, the Committee in their report, described their demand as "moderate," and claimed credit for their moderation. This was tantamount to saying " we require more Inspectors, but we are afraid to G 98 ask for them, lest we should be refused by the Vestry." And you, therefore, inherit a legacy from your predecessors through their modesty in not demanding their full requirements. But since that time much has happened; and sanitary legislation has gone on apace. Thus the following Acts of Parliament have been passed:— The Margarine Act. The Local Government Act. Sale of Horse Flesh Act. Infectious Disease Notification. Infectious Disease Prevention. Public Health Act Amendment Act. Housing of the Working Classes. Factory and Workshops Act. Inland Revenue Act, 1891. Public Health (London) Act, 1891. Thus ever-increasing duties were placed on a staff which had been openly acknowledged to be deficient. If then it was deficient in 1886 it clearly cannot be nearly sufficient now, when such a number of new duties have devolved on the Inspectors. The Notification of Infectious Disease has, at one stroke, more than quadrupled the compulsory visits that have to be made by the staff. Thus, in 1887, before the passing of the Act, there were 591 new cases of such diseases reported at the office, while last year there were 2,091 oases. But this increase represents proportionally far more work than appears by the mere mention of the figures, because every case must be visited at once, and the name of the school ascertained so that the information can be forwarded the same day to the various schools. But the time spent at each house is longer, for now that the causes of infection are better understood, the more numerous are the queries as to the milk supply, conditions, and habits, that have to be made, and the more searching must be the examination of the premises. In every instance, too, the premises have to be re-visited to make inquiries as to the recovery of those who were ill, so that the houses or parts of them shall be disinfected, because in the majority of cases the people are not to be relied on to send early information. It is estimated that each case entails four calls. Additional duties have been thrown on the staff by the Registration of Houses let in Lodgings, or occupied by members of more than one family, and by their consequent inspection from time to time. But this registration has been left in abeyance for several years owing to the number of Inspectors being insufficient to carry on the work. It should be resumed, and instead of having only between 300 and 400 on the register there should be very many more. 99 The Inland Revenue Act most unjustly threw on Local Authorities the burden of giving certificates of exemption from Imperial Taxes to persons owning certain houses intended for the most part for the working classes. But as the giving of such a certificate by the Medical Officer of Health is a guarantee that the house receiving it is in a sanitary condition, such examination must be minute and thorough; and consequently it will occupy an unusually long period of time. When application is made for a certificate a preliminary examination is undertaken by a Sanitary Inspector, who reports to me on the existing defects. The owner is then informed of them, and when they have been remedied I visit the house, and, if I find everything in a sanitary state, I grant the certificate. Then the Housing of the Working Classes Act, whose fringe only has been touched as yet, will entail heavy labour and responsibilities on the Inspectors if its most valuable clauses are to be made use of for the promotion of health. There are many matters in the Public Health (London) Act, 1891, which to a large extent now impose additional or increased duties—for instance, smoke abatement, removal of stable manure, the inspection of vans, tents, and the like; the closing of underground rooms when not in accordance with the Act (the examination of which formerly devolved on the District Surveyor), and the duty of examining new houses to see if they are supplied with a proper and sufficient supply of water. Attention to the notices of the New River Company, when water is lawfully cut off from any inhabited dwelling-house, is also obligatory. But another reason remains why I most strongly urge the permanent increase of the staff to fourteen Inspectors, and it is to enable the Public Health Department to commence and adequately carry out a house to house inspection of the district. It has been attempted more than once, but it has never yet been brought to a complete and satisfactory finish. This most useful and absolutely necessary work must be undertaken and completed, and until it has been so completed I will not feel satisfied, and I believe you will not feel satisfied, that the sanitary work of the department has been conducted on a sound and proper system. House to house inspection is the only efficient remedy for extensive sanitary evils. It is the life and soul of sanitary work. It is not by casual visiting, by the mere attention to complaints made to you as the sanitary authority, but by the systematic examination of properties, that great and good work is effected; for the former, although necessary, does not seem to lessen sickness and mortality to the same extent that the latter does. The Inspectors should beconstantly engaged in house to house inspection, while not at the same time neglecting those complaints of sanitary defects, which frequently are of a most urgent and pressing character Again, the recent circular from the Local Government Board respecting the examination of the places wherein men, who carry work home from their employers, live will entail a very serious addition to the duties of the department, and will alone G 2 100 provide work for at least one inspector in this district. It is full time that such examinations are made, for in my experience, and in that of every Medical Officer of Health, who has had charge of even a moderate-sized district, much disease has been spread by persons carrying on their trade in the midst of infection. I have known tailors, dressmakers, bookmakers, fancy wool workers, and others, working at home when serious infectious disease was present in their families; and only a few days since, as you are aware, I discovered the mother of a patient suffering from smallpox, making quilted cloaks for infants, while sitting in the room with him. Finally, the new By-laws—now under the consideration of the Local Government Board—when sanctioned, will cause additional work to be cast on the InspectorsHence it is apparent that the increase of staff advocated by me is none too great for the largely-increased work that has devolved on an already admittedly deficient staff, and it is, as a fact, only the same in proportion to the number of the houses as the staff in the large towns, although the number of persons dwelling in vour houses is considerably greater. If I had made an estimate based on the relative populations of these great towns and Islington, the number of Inspectors required would be 22. I may add that generally in making calculations as to staff, account is taken of population, for the greater the number the greater the dirt created, and the more numerous the nuisances. Yet I cannot shut my eyes to the fact that it is easier to keep watch over 400 people living in 50 houses, provided they have ample accomodation, than over the same number living in 100 houses; and therefore I have departed from a usual mode of reckoning the numerical staff of a Sanitary Authority, viz., of allowing one Inspector for every 10,000 of the population, in which case Islington would have required 32 Inspectors. INSPECTORS' UNIFORM. Then there is the question of clothing. From the return already placed in your hands you will perceive that all the provincial towns, without exception, provide uniforms for their Inspectors, while in London fourteen Sanitary Authorities act similarly. My experience of uniform is that it carries with it a certain amount of weight, influence and respect, which is entirely absent when the Inspector wears his own clothing. A man in uniform, especially with the lower classes, among whom so much work is done, can accomplish more, and get his orders more quickly attended to, than a man in mufti. Again, it is a protection for the public against the possibility of impostors entering houses, and, under pretence of inspection, committing robbery. But above everything it is a protection against the Inspector conveying infectious disease to his home and to the public, because when he has been brought in contact with it, he can at any time get his uniform disinfected, meanwhile wearing his own clothing. 101 It is also a very great guarantee that the Inspectors do not idle their time, nor commit acts which would lessen their authority and influence, or lower them in the public estimation. I also recommend that the three men engaged in disinfecting and stripping houses should receive blouses or overalls, so as to prevent them conveying infection to the public. Under these circumstances, I recommend to you that a uniform be allowed to the staff. 1 am, Gentlemen, Your obedient Servant, ALFRED E. HARRIS, Medical Officer of Health. • Vestby Offices, Islington, November 11 th, 1892. DIPHTHERIA APPARENTLY CONTRACTED FROM A PATIENT RECENTLY DISCHARGED FROM HOSPITAL. The Public Health Committee's attention was attracted by me to the following case of Diphtheria, which was apparently contracted from a patient recently discharged from the Hampstead Hospital. The following are the facts ascertained by myself:— 1. F. P., a girl, aged 5 years, was removed to Hospital on January 10th suffering from Scarlet Fever. 2. At the end of about four weeks she suffered apparently from a relapse, or from an attack of Post Scarlatinal Diphtheria, when her throat was poulticed externally and sprayed internally. 3. Her hair was not cut while under treatment. 4. She was discharged from hospital on January 10th. 5. On January 13th her sister, E. P., aged 6 years, developed Diphtheria. 6. On January 15th her brother, J. P., aged 3 years, was attacked, and died on the 18th, or exactly 8 days after his sisters return home. 7. On January 20th I examined her (F. P.), and found a considerable quantity of dandriff in her hair, which 102 8. Her mother states was in it on her arrival home from hospital on the 10th. In my opinion these facts point indisputably to the conclusion that the infection was conveyed to the home by the discharged patient- The relapse and the poulticing and spraying the throat, indicate that throat complications arose, which was in all probability Diphtheria. I am, however, of opinion, and this opinion is based on an experience of twelve years, as physician to the Sunderland Fever Hospital, that no matter what precautions have been taken by Matrons, Nurses, and the Staff generally, that infection will be carried home occasionally by patients. I have known cases where children were discharged from Hospital as clean as they ever were, or ever will be, in their lives, free apparently from all possible sources of infection, and yet in a few days after arrival home the disease from which they had suffered has appeared among other members of the family. I have long thought that in such cases the infection has been conveyed by the mouth; that it lies therein attached to the teeth, which it is almost impossible, especially in the case of young children, to get thoroughly clean, and equally impossible to disinfect. Consequently when brothers and sisters, or playfellows, meet and kiss each other, or breathe into each others faces, the disease is transmitted. To a lesser extent, it is believed by some medical authorities, that patients arriving newly at home, straight from the infected wards, convey the infection in their lungs, in which some of the contaminated hospital air still remains, and which when exhaled into the faces of other persons, transmits the disease. Beyond calling the attention of the Metropolitan Asylums Board to this matter, the Public Health Committee felt they could do nothing. 103 THE APPOINTMENT OF THE SUPERINTENDENT OF THE PUBLIC HEALTH DEPARTMENT AS CHIEF SANITARY INSPECTOR. The anomalous position which the Superintendent occupied under "The Public Health (London) Act, 1891," was brought before the Public Health Committee, who being desirous 1. That he should devote more of his time to outdoor work than he had hitherto done, and knowing (2) that he was to all intents and purposes an Inspector, but that (3) be had no legal status under the Act, for he had never been appointed under it, and that, therefore (4) he could not prosecute, nor conduct a prosecution, and the Committee feeling that (5) he should possess these powers, and also that (6) he should be able to seize unsound food, decided to recommend the Vestry to appoint him Chief Sanitary Inspector. The Vestry was consulted, and agreed to the recommendation of the Committee, and on the Local Government Board being appealed to, and the circumstances of the case being pointed out, they at once sanctioned the appointment. PRECAUTIONS ADOPTED AGAINST THE SPREAD OF INFECTIOUS DISEASES. The usual modes of procedure were adopted:— 1. On the same day (with very occasional exceptions) as that on which the disease was notified, a Sanitary Inspector called on the parents or guardians to get particulars of the case, and to examine the condition of the premises. 2. The patient was removed to hospital whenever consent to the removal could be obtained, and when there was a bed available. 3. Intimation was at once sent to the school which the patient, if a child, attended, and also to any other schools which were attended by children belonging to the same family or living in the same house. 104 4. The origin of the disease was traced as far as possible, and when discovered, if the source were direct infection, similar steps were adopted. 5. Disinfectants were supplied gratuitously on application at the Vestry Hall, and 6. Printed instructions as to the best methods of prevention, of which the following is a copy, were given to the heads of the households:— INSTRUCTIONS FOR PREVENTING THE SPREAD OF SCARLET FEVER, SMALL POX, And other Dangerous Infectious Diseases. 1.— Send immediate information of the presence of infectious disease to the Medical Officer of Health. Non-compliance with this instruction entails a penalty not exceeding FORTY SHILLINGS. 2.—The Patient, if there be insufficient accommodation at home should be removed immediately to Hospital, where good nursing, suitable food, and skilled Medical attendance will be provided. 3.—If the patient be not removed to Hospital, then separate the infected person from the rest of the family, and remove carpets, curtains, and other unnecessary woollen or linen articles. 4.—Admit fresh air by opening the upper window sash. Keep the fire-place and chimneys open, using a small fire when possible. Allow Air to pass freely through the other part of the house by means of open windows and doors. 5.—Hang up a sheet outside the door of the sick room, and keep it wet with a quarterpint of Carbolic Acid (No. 4), or liquid Sanitas, or a pound of Chloride of Lime, mixed in a gallon of water. 6.—When possible, all persons who have not had the disease should be sent out of the house to lodge elsewhere. 7.—Receive all discharges from the patient into a solution of Carbolic Acid or Sanitas. Add Carbolic Acid or Sanitas plentifully to the discharges before emptying them into the closet. 8.—Pour daily into every sink, closet, or privy, a quantity of the above-named disinfectants. 9.—All cups, glasses, spoons, See., used by the patient, should be first washed in the solution of Carbolic Acid or Sanitas, and afterwards in boiling water. 10.—No article of food should be allowed to remain in the room, nor consumed by any person when removed from the room. 105 11.—All bed and body linen used by the sick person should be at once steeped for a few hours in any of the above-mentioned solutions, and afterwards BOILED in water. 12.—Instead of handkerchiefs, small pieces of rag should be used, and these should be burnt when soiled. 13.—Persons attending on the Sick should wear garments made of cotton, or other washable material. Woollen dresses should not be worn. The attendants should wash their hands after waiting on the sick person and before eating, using Carbolic or Sanitas soap, or Condy's fluid. They should also rinse their mouths with a little Condy's fluid and water. 14.—No unnecessary communication should take place between the nurse in the sick-room and the other inmates of the house. 15.—The sick room must on no account be visited by others than those in immediate attendance on the patient, as visitors are very liable to carry away infection. N.B.—The non-observance of this instruction has been the cause of much illness and many deaths. 16.—When recovering, and if the body of the patient is peeling, camphorated or carbolized oil should be rubbed over the sick person every day. The sick person must not be allowed to mix with the rest of the family until the peeling has entirely ceased. 17.—The mouth, throat and nose should be very frequently washed with a disinfecting solution, such as water containing some Condy's Fluid, by gargling, swabbing, or syringing, to destroy the infection coming off by the breath. 18.—When the sickness has terminated, the sick room should be cleansed, and information sent to the Vestry Hall, when a Disinfector will attend and thoroughly fumigate the place, and remove for disinfection all clothing that has been in use in the sick room. Afterwards, the room should be freely ventilated, and the ceiling lime-washed, the paper stripped from the walls, and burned; if the walls have been previously lime-washed lime washing should be repeated; and the furniture and all the wood-work washed with soap and water containing a little chloride of lime. All bedding and articles that cannot be washed should be disinfected by the Vestry. Until this process of disinfection is properly carried out the room cannot be safely occupied. 19.—Children must on no account be allowed to attend School from a family, or even a house, in which any infectious disease exists. 20.—When Small-Fox breaks out in a house the inmates should be immediately vaccinated or re-vaccinated, It is the most certain prevention of this disease. SHOULD THE SICK PERSON DIE. 1.— The body should not be removed into another room to spread infection over the house. It is still infectious. 106 2.—No articles of bedding or clothing should be removed from the room until disinfected as formerly stated. 3.—In washing the body, Carbolic Acid (a dessert-spoonful to the gallon of water) should be used. 4.—The body should be put into the coffin as soon as possible, with a disinfectant. Carbolic Powder may be used, sprinkled freely underneath and over the corpse, or rags soaked in strong Carbolic Acid may be laid beneath it and over it (beneath the clothing). The coffin should be screwed down and the body buried within 48 hours. N.B.—Disinfectants may be bought of any Druggist, or may be had gratis at the Vestry Hall, by those who cannot afford to buy them. All Clothing, Bedding, &c., is disinfected free of charge. SHOULD RECOVERY TAKE PLACE. 1.—Warm baths with soap should be used repeatedly until all roughness of the skin has disappeared; a little Carbolic Acid added renders the washing more effective for disinfection. 2.—Until all roughness of the skin has disappeared, the person should not be allowed to mix with the rest of the family, and then only in new clothes or in clothes which have been thoroughly disinfected. DISINFECTION OF A ROOM AFTER SCARLET FEVER, SMALL-POX, OR OTHER INFECTIOUS DISEASES. The infection hangs about a room or house for a very long time, and is difficult to dislodge Fumigation with Sulphur, however, may be employed by any one, and must first be carried out. A pound of Brimstone, broken into small pieces, should be put into an iron dish (or the lid of an iron saucepan turned upside down) supported by a pair of tongs over a bucket of water. The fireplace and outer openings, such as the crevices of the windows, are then to be closed by pasting paper over them, and a shovelful of live coals is to be put upon the brimstone. The door is then to be quickly shut, the crevices pasted up with paper, and the room kept closed for five or six hours. Articles of clothing hung up loosely, and beds, bedding and other things left uncovered in the room are fumigated at the same time. The paper on the walls must then, in every instance, be wetted with Carbolic Acid, or Sanitas, stripped off and burned; and the walls, ceilings, paint and floors must be well washed with a solution of Carbolic Acid or Sanitas. After this a thorough cleaning should be made; everything that can should be washed with a little Carbolic Acid, or Sanitas, in the water and boiled. The ceiling of the room should then be whitewashed. Anything short of this is not a proper disinfection; but the room may afterwards, when possible, be left unoccupied, with the windows open, for a week or a fortnight with great advantage. N.B.—The Disinfection will be best carried out by the Vestry; when it is done by the head of the family a Certificate from the Medical Attendant will be required. 107 SUGGESTIONS FOR THE PREVENTION OF CHOLERA AND DIARRHŒA It is most important, in view of the possibility of an outbreak of Cholera, that owners and keepers of houses should be more than ordinarily careful in the management of their property, thus supporting the Sanitary Inspectors in the diligent performance of their duties. I advise:— 1.—That everywhere the utmost cleanliness should be enforced in respect to the condition of all areas, basements, cellars, kitchens, yards, and other damp and dark places, and that all rubbish, dirt, dust, and other offensive matters should be carefully, completely and regularly removed. (Complaints of non-removal of dust, &c., to be addressed to the Public Health Department, Vestry Hall, Islington.) 2.—That the closets, drains and sinks of houses should be kept in a proper condition. 3.—That the water butts and cisterns be kept free from sedimentary accumulations, and maintained in such a state as that the water shall be sweet and wholesome. And further, that the water used for drinking purposes should be recently boiled. 4.—That the water furnished by pumps and surface wells should be avoided for drinking purposes. 6.—That the interior of houses occupied by the poor shall be, in all needful cases, thoroughly cleansed and whitewashed. 6.—That in case of an attack of Diarrhoea, especially if it be without pain, immediate advice should be sought, either from the Medical attendant of the family, or from the Medical Officer, appointed by the Guardians for the District. 7—That it is imperatively needful that all discharges from the body should be immediately disinfected and rendered innocuous by the addition to them of a table spoonful of Chloride of Zinc or common Carbolic Acid. 8.—That all soiled clothing should immediately have boiling water poured upon it. 9.—That a handful of Carbolic Powder, or Chloride of Lime, or Sanitas Powder, be placed three times a week in the dust-bins, water-closets, or privies. 10.—That all vegetable refuse should be at once burned, and should never be put into the dust-bin. 11—That fermented liquors should be used in moderation. 12.—That unripe or unsound fruit should be avoided. 13.—That fish, unless quite fresh, should not be eaten. 14.—That the food of infants should be chiefly milk, which should always be boiled before use, and, if the child be not hand-fed, should be given in scrupulously clean feeding bottles. ALFRED E. HARRIS, Medical Officer of Health. 108 REGENT'S CANAL. That portion of the Canal flowing through Islington was specially inspected, owing to a communication received by the Vestry, in common with all other Metropolitan Authorities, interested in its sanitary condition. Beyond its usual semi-stagnant condition, and the collection of a deposit of mud at Chatterton's lay-by, together with the discharge of rainwater pipes from a barber's shop, no nuisances were discovered. The question of the purity of this waterway is eminently one to be dealt with by the County Council, and not by local authorities, beyond the duty of seeing that it is not polluted in their districts by the influx of obnoxious matters. The condition of the Canal formed the subject of a conference between the local authorities and the London County Council, at which the Vestry was represented by the Chairman of the Public Health Committee and myself. PRECAUTIONS AGAINST CHOLERA. From the early part of the year the Public Health Committee and the officials of the Public Health Department were fully alive to the great responsibility that rested on their shoulders. On February 6th, in a brief report to the Committee, I pointed out that (1) it would be absolutely necessary, in view of the possibility of Cholera reaching London during the spring, that arrangements should be made to appoint medical men, to whom the public might look for treatment, should the disease make its appearance; and that (2) districts should be assigned to them, (3) the amount of their fees should be fixed, and (4) that chemists who would dispense their medicines should be provided, and I therefore asked that a Sub-Committee should be appointed to assist me. The Public Health Committee, being unanimously of the same opinion, and also feeling strongly that the most populous district in London should not hold any but one of the best positions in its 109 preparedness to meet any emergency, at once referred the matter to the Bye-Laws Sub-Committee, which consisted of the following members:— the Chairman (Mr. R. Cufflin), Vice-Chairman (Mr. H. Ansell), A. Howell (Dr.), Bartram, Hollyman, Keeves, Slater (Dr.), Lancaster, and Buckell (Dr.). This Sub-Committee accordingly met on February 13th, when after mature deliberations it was decided to recommend to the Committee that:— 1. The Parish should be divided into separate areas for Cholera purposes. 2. A medical practitioner should be appointed to each area, and that he should be a practitioner living therein. 3. The practitioner should be paid 2s. 6d. per visit during the day (8 a.m. to 8 p.m.), and 5s. Od. during the night (8 p.m. to 8 a.m.) 4. A Chemist should be appointed in each district for the dispensing of medicines, and that he should be paid at the rate of 6d. for every mixture up to six ounces, and 1d. for each ounce above that quantity, and at the rate of 6d. per dozen for pills. These prices were not, however, to cover the cost of certain expensive drugs (specified). These recommendations having met with the approval of the Public Health Committee, were laid before the Vestry, who decided to adopt them. A letter was next addressed to every practitioner in Islington, who was asked whether, if appointed, he would undertake the duties. As a result numerous replies were received, so that the Sub-Committee experienced no difficulty in making a selection. Chemists were also fixed upon, so that on the scheme being brought before the Public Health Committee it met with approval, and was recommended to the Vestry for its adoption. Posters and handbills similar to those published in 1892, containing instructions as to the precautions to be adopted, were also issued. 110 The following is a copy:— VESTRY OF ST. MARY, ISLINGTON. PRECAUTIONS AGAINST CHOLERA. In view of the appearance of Cholera at European Ports, between which and London there is constant passenger and other traffic, it has been deemed advisable to issue the following precautions:— PRECAUTIONS. 1. Immediately disinfect all discharges from the stomach and bowels which are choleraic in character, and deal with them in such a manner that they cannot contaminate the water supply. 2. Disinfect or destroy by fire all infected bedding, clothing, towels, handkerchiefs, &c., and do not send them to the wash or laundry in an infected state. 3. Take care that no unhealthy conditions, such as uncleanliness, tho collection of filthy matter, dirty water, or the retention of excrement, are allowed to exist. 4. Do not drink water which has been contaminated or is even in the slightest degree open to tho suspicion of being tainted by sewer gas, house refuse, or other like kinds of filth, for example: By outflow, leakage, or filtration from sewers, house drains, privies, cesspools, or the like, to the water supply. 5. Do not breathe air that has been contaminated with similar impurities. 6. Do not eat unsound, unwholesome, or unripe fruits or vegetables. 7. Do not eat tainted meat or poultry, nor use foods, whether liquid or solid, which experience has taught will cause diarrhoea. 8. Take care that no water used for any household purposes is stored in any tank or vessel which has any communication, directly or indirectly, with the drains, or has been kept in unclean vessels. All cisterns should be at once cleaned; any connection of waste pipes with drains should be at once severed; and water from a cistern common to the house supply and the W.C., should on no account be used. 9. Leaky water-pipes, though running full of water, with considerable velocity, are liable to receive by lateral insuction at their points of leakage, external matters that may bo dangerous, and should therefore be immediately repaired. 10. Where pollution is discovered everything practicable should be done to prevent such pollution, and until that object is attained the water should not be drunk, or used for any other purpose. 11. All water should be boiled before use, and used within 24 hours; filtering is not sufficient. 12. All milk should be boiled before use. 13. There should be at once a thorough removal of all kinds of house refuse, dust and other filth, which has accumulated in ne glected places. Future accumulation of filth should be prevented. 11l 14. All vegetable and animal refuse should be burned, and not thrown into the ashpits or dustbins. 15. All defective house drains and sinks through which offensive smells are let into the house should be immediately seen to. All soil pipes should bo ventilated. 16. Uncleanly premises should be thoroughly and constantly limewashed, especially if occupied by many persons. 17. Ventilate the house by open windows and open doors from cellars to roofs. Pure air is the greatest disinfectant. 18. Disinfection should be freely and frequently employed in, round, and about the house, wherever there are receptacles or conduits for filth, and wherever there is filth, sodden earth, or anything tending to make the atmosphere foul. It cannot be too distinctly understood that the dangerous qualities of impure water are not obviated by the addition of Wine or Spirits. The duty of immediately observing the above precautions is incumbent on every person at the present time, and these precautions should not be neglected. The existence of any nuisance should be immediately reported to the Medical Officer of Health at the Vestry Hall, Upper Street, N. Do Not Neglect Diarrhœa as it is the premonitory symptom of Cholera. Disinfectants can be obtained at nearly all Chemists; or at the Vestry Hall. ALFRED E. HARRIS, Medical Officer of Health. CHOLERA AMBULANCES. The Ambulance Stations, which had been decided on in August, 1892, at which hand Ambulances should be kept, were fixed on after consulation with an official of the Metropolitan Asylums Board. These Stations were— The Workhouse, St. John's Road. The Great Northern Hospital. Police Station, Hornsey Road. „ „ Caledonian Road. Vestry Hall, Upper Street. London Fever Hospital.* I have to acknowledge the receipt of a large number of intimations from the various Port Sanitary Authorities throughout the country, of * Beds were also arranged for, as in the preceding year, at the following Institutions, Great Northern Hospital, Islington Workhouse, Cornwallis Road, London Fever Hospital, and German Hospital. 112 the arrival of passengers from infected parts, who had proceeded to this Parish. In every instance enquiries were made at the addresses given, which in the main proved to be correct, only one or two being false, and instructions were given as to the steps to be adopted in the event of the traveller being seized with Cholera. Fortunately all these precautions proved unnecessary, because the dread visitor did not arrive, but, nevertheless, it was a satisfaction to know that the Parish was prepared to meet any cases that might arrive. COMBINED DRAINAGE. From time to time considerable difficulty has arisen in deciding as to who was responsible for the repair and maint enance of combined drains, some owners of property contending that it was the duty ef the Vestry, while the Vestry held the opposite opinion, an opinion too which was not shared in by the Public Health Department. As the head of that department I made serious representations to the Public Health Committee, with the ultimate result that a joint SubCommittee of the two Committees, Works and Public Health, was appointed. A case was stated for counsel's opinion, and this having been considered by the Special Sub-Committee, reported that they are " of opinion that every drain into which two or more premises drain, is a sewer liable to be repaired by the Vestry, unless such drain was constructed since 1856, pursuant to an order of the Vestry, or before that date, pursuant to an order or direction, or with the sanction or approval of the Metropolitan Commissioners of Sewers, and recommends that the Works and Public Health Committees recognise such liability, and in future either keep such sewers in repair, or, where it may be thought preferable break up such sewers, and provide the persons whose premises drained into such sewers with new drainage into some other sewer at the expense of the Vestry." This view was ultimately adopted by the Committees concerned. 113 DISINFECTING STATION. The difficulty of getting infected bedding and clothing properly and expeditiously disinfected has been long felt by the Public Health Department. This arose because Islington possessed no disinfecting chambers of its own, but depended on a private firm, supplemented for a time during the outbreak of small pox, by the disinfecting chamber owned by the Vestry of St. Luke. The work performed by the private contractor was never deemed satisfactory, both on account of the uncertainty that existed that the disinfection was thorough, and the length of time it occupied, twelve hours being the time allotted to each chamber full. In addition to these reasons, it was felt that very much more work would be got through if the Vestry possessed one of its own. On the passing of the Public Health (London) Act, 1891, the provision of adequate means for disinfecting infected articles became compulsory; but it was not until August, 1892, that the matter was seriously taken in hand. At this date I was ordered by the Committee to make enquiries, and on September 26th (following) I reported to the Committee, who decided to inspect the two machines which alone were considered suitable, and in which the disinfection was effected by means of highpressure steam. The Committee, having carefully considered the whole subject, decided on recommending the Vestry to obtain two chambers on the Goddard, Massey & Warner principle, which, in their opinion, were the most suitable for the work that was to be done in Islington. The two cardinal reasons for the preference were (1) that the chambers did not require separate boilers, and (2) that the shape of the machine enabled it to hold more articles, especially those that were large or bulky, such as bedding. It was also decided that a small laundry should be erected, so that all articles soiled by the patients should be properly cleansed before return to the infected home, because it was felt that even in the h 114 disinfected state it was highly undesirable that linen, bedding, and clothing generally, that had been soiled by the excreta of patients, should be sent to either a public or private laundry to be washed. In addition to these it was also thought that a crematory suitable for the destruction of infected bedding, clothing, or other articles, which for one reason or another, it was considered desirable to get rid of,should be erected. Thus a most complete scheme had been determined on when the year 1892 came to a close. A suitable site was fixed on at the rear of the Hornsey Road Public Baths and Washhouses, and negociations were entered into with the Commissioners. Many delays occurred in obtaining the land but at length it was bought for the sum of £4,000. Before the transfer was effected, however, a new difficulty arose, for it was discovered that the School Board for London had scheduled it in their Educational Provisional Order (Confirmation) Bill as being a place suitable for school purposes. The Vestry, therel'ore, decided on opposing the provisional order before a Committee of the House of Lords. In support of this opposition the Vestry Clerk (W. F. Dewey, Esq.), the Chief Surveyor (J. Patten Barber, Esq.) and myself, gave evidence, with the result that the School Board failed to obtain the site. The land, therefore, passed into the possession of the Vestry. The difficulties did not, however, end here, for just as the contract was about being placed with Messrs. Goddard, Massey & Warner, of Nottingham, for the immediate erection of the building and plant, it was made known by that firm that an injunction had been obtained against them by the patentee (Mr. Wm. Lyon) of a rival machine, for infringement of his patent. Negociations followed, which when the year came to a close had not been completed, and thus the opening of another year found the Vestry, through no fault of its own, without a disinfecting station, although with every prospect that within a measurable time all difficulties would be removed.* *As a matter of fact these difficulties were overcome, and at the present moment the station is in course of erection, and within two months it is expected that the works will be completed. 115 THE CLERICAL STAFF OF THE PUBLIC HEALTH DEPARTMENT. In consequence of the increased clerical work of the department involved by the impetus given to sanitary matters by the Public Health (London) Act, 1891, the Clerical Staff of the department was unable to get through its every day routine business. A representation was therefore made by me to the Public Health Committee, who after mature deliberation, recommended to the Vestry that the staff should be increased by the addition of two clerks, and that a re-arrangement of the work of the officials should be effected. These proposals were agreed to, and therefore two additional clerks were appointed, which has resulted already in an increased efficiency as well as in the almost entire abolition of overtime. BY-LAWS. The Public Health Committee held numerous meetings to consider the making of By-Laws under Section 16, 39 and 50, of the Public Health (London) Act, 1891.* These By-Laws related to the following subjects :— For the prevention of nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish, or filth, or other matter or thing in any street. For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughter-house, knacker's yard, butcher's or fishmonger's shop, or dunghill, into any uncovered place, whether or not surrounded by a wall or fence. For the prevention of keeping animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. As to the paving of yards and open spaces in connection with dwelling houses. *The By-laws framed by the London County Council under secs. 16 (2) and 39 (1) were also before the Public Health Committee, having been submitted to them for their consideration. H 2 116 With respect to the keeping of water-closets supplied with sufficient water for their effective action. For securing the cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing of water, used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. OFFICE ACCOMMODATION. I was reluctantly forced to bring before the Public Health Committee the altogether inadequate provision of office accommodation afforded to the Public Health Department. The following is a copy of the Report I then submitted:— REPORT on the Deficiency of the Accommodation, and the necessity for an Increased Clerical Staff, for the Public Health Department. To the Chairman and Members of the Public Health Committee. Gentlemen, In consequence of the urgency of these matters, I desire to bring them before you now, so that something may be decided on before the Vestry rises for its annual vacation, and that something may be effected during that period. The staff of the Department consists of Four Clerks, fourteen Sanitary Inspectors, and the Messenger, in addition to whom there are Mr. Leggatt (Superintendent and Chief Inspector) and myself. First, as to the accommodation provided for this staff. At the present time ten Inspectors perform their clerical work in the large office, in which also the clerical staff and the Messenger are located. This gives a total of fifteen persons working in the one room. Desks are supplied to the clerical staff, to the Messenger, and to eight inspectors. Two Inspectors have no desks for their papers and books, but write at a table. Four other Inspectors perform their work wherever they can best find a habitation in the committee-rooms upstairs. Here, however, their tenure is uncertain and insecure, for they are frequently hustled from one place so another, according to the exigencies of the committee meetings. They have, also, every day, to bring their books, papers, and records upstairs to the place where they may happen to be temporarily accommodated, and then to bring them back again, This may lead to the loss of documents or to delay in looking for them, and certainly leads to loss of time. 117 These Inspectors should have a fixed habitation, and they should not be allowed to continue in their present unsettled condition, which is alike prejudicial to good work, and fruitful of wasted time. Then there is the accommodation afforded to Mr. Leggatt and myself. There is one small office for the two of us, whereas each requires a separate private room. There is no official of the Vestry who, from day to day, has to decide on more important matters than myself, for these refer, for a great part, to questions of life and death, which demand immediate attention. I am visited daily by the public, and the members of the Medical Profession; I have to deal with plans, to consider reports of Inspectors, to advise on them, to receive and advise the public, the members of the Vestry, and to hold communication with the other head officials of the Vestry, and with officials of the London County Council, and other Local Authorities. I am continually engaged in making reports, annual, monthly, and others of a varied character, many of which contain intricate calculations, and all of which are of considerable value. I can only perform my duties amidst constant interruptions, owing to the fact that the Superintendent holds his interviews with the Inspectors in this office; that he is constantly in and out of this office; that the clerks are continually the same; and that the public, who come on the most trivial matters, with which Mr. Leggatt can, and does deal, are shown into this room for an interview, much to the delay of my work, simply because there is no other place to receive them. If, at any time, a person is desirous of speaking to me alone, then the Superintendent is forced to take his letters, papers, and books into the outer office, which up till 11 a.m. is usually very crowded, and there he is compelled to perform his work wherever he can best find room. At times, notably in the forenoon, this is impossible, and then his work must remain in abeyance, while the Inspectors are delayed in starting for their districts, until such time as my visitor leaves. I wish to say emphatically that such a state of affairs should not be allowed to continue. It is unfair to the Clerks, the Inspectors, to the Superintendent, and particularly to myself. I desire to say most respectfully that I must positively decline to be held responsible for the work of my department if I do not receive the necessary accommodation in which the officials can execute it. I believe you have an able, and certainly, a willing staff of Officials, who are all anxious to do their work in an efficient manner, but they require the means to enable them to perform it in the way in which they are desirous, and which doubtless, you expect. The large office is open to the public, who, owing to the absence of a counter or barrier, are free to move about it as they please. And they make full use of this liberty, for as soon as any one entering the office sees the Inspecor or Clerk to whom, he desires to speak, he advances to him to relate his business, with the result that sometimes it is almost impossible to move in the office. 118 I have on occasions seen people talking to all the Inspectors at one and the same time. Of course this is subversive of all order, system, and regularity in work, and also necessarily leads to the waste of time. Having made certain suggestions as to the necessity of increasing the number of Clerks in the office I proceeded to say: The staff would then comprise— Sanitary Inspectors 14 persons. Clerks 6 „ Superintendent 1 „ Medical Officer of Health 1 „ Messenger 1 „ Total 23 „ To accommodate this staff only two methods are feasible:— 1. To rent or buy a building away from the Vestry, or 2. To arrange that the present large office shall be re-aringed to accommodate— 10 Inspectors. 6 Clerks. 1 Messenger. ¯ 17 ¯ and to allot a committee-room to the Inspectors during certain hours of the day. In the morning till 11 o'clock, and the in afternoon from 4.30 to 5.30, To give the present office used by the Superintendent and myself to the former, and to give me the Burial Board Office for a private office. There are serious objections to the first proposal. At the present time, and in the future perhaps it will be even more so, there is a constant inter-communication between the Surveyor's Department and the Public Health Department relative to drainage matters, and consequently great inconvenience would be caused to the Departments if the officials of one had to travel from one building to another, possibly from one part of the district to another, to communicate with each other, more especially when plans, books, &c., would have to be carried. On days when the Public Health Committee would meet the carriage of books alone would cause great inconvenience, unless it met in the same building in which 1he staff performed its work; while if the Committee did so meet, great inconvenience would arise from time to time when it became necessary to consult the Vestry records. Pending 1hen the building of a Town Hall or Municipal Buildings, which I may say, is an urgent matter now, for the Works and Finance Departments are also very straightened for room, I advise the adoption of the second plan as being the only temporary way out of a very serious difficulty. I can thoroughly appreciate the desire 119 of the Vestry not to sever its connection with the Burial Board, but, after all, the first and plainest duty of the Vestry is to properly, efficiently and energetically administer all matters dealing with Public Health, and I must remind you that this is the raison d'etre of its existence. But this duty cannot be performed satisfactorily, unless su'table accommodation be given to its servants and advisers to carry out the work devolving on them. I, therefore, strongly press on this committee the urgent necessity that exists for appointing a sufficient staff, and the absolute necessity of providing accommodation for that staff. I am, Gentlemen, Your obedient servant, ALFRED E. HARRIS, Medical Officer of Heilth. Vestry Hall, Islington, July 10th, 1893. I have nothing to add to this report, except that since it was made on very many occasions very serious delays have occurred, not only in attending to the general routine work of the department, but also in delays to the public in obtaining speedy attention. This report gave rise to one good result, for it has brought prominently before the Vestry, not only the inadequacy of the offices I am interested in, but also the overcrowded condition of every department of the Vestry. It is now the month of June, and nothing has yet been effected. It must be stated, however, that the matter of providing accommodation for the staff of the Vestry, as a whole, is engaging the attention of a Special Committee, who have already propounded one scheme which on the face of it, was certain to, and indeed did, fail to be carried by the Vestry. WATER SUPPLY. In the appendix will be found the result of the chemical examination of the water supplied by the New River Company to this district. It calls for no special comment, for its general results show that the district is provided with a good and pure water. In his report to the Registrar Genera', Professor E. Frankland, F.R.S., says of this supply: "The water derived chiefly from the Lea by the New River and East London Companies, was almost invariably superior to the Thames-derived water of the Chelsea, West Middlesex, 120 Southwark, Grand Junction, and Lambeth Companies; the New River Company's water often rivalling the deep well waters in respect of organic purity." The importance of the freedom from bacteria of any water supply is so great that I have pleasure in quoting Professor Frankland's remarks on this subject, and in giving the results of his examination of the New River Company's supply. BACTERIOSCOPIC EXAMINATION. It has been proved by an overwhelming amount of evidence that Cholera and Typhoid Fever, are, the first generally, and the second frequently, propagated through the agency of water. The fact that Cholera generally travels up stream in tidal rivers is only apparently inconsistant with this statement. The disease almost always arrives at the mouths of rivers by sea. The choleraic dejections are thrown into the river and are carried by water up stream as far as the tide reaches; but there are few tidal rivers which are not navigable by barges far above the range of the tide. The bargemen almost always dip their drinking water out of the river, even in the tidal reaches, and consume it without any filtration. They thus become infected, and convey the zymotic poison up stream as far as the river is navigable, and, it may be still further by means of canals. The use of raw or imperfectly filtered water for dietetic purposes from such sources is, therefore, in times of epidemic especially, fraught with extreme danger. Fortunately, however, recent bacteriological research, together with experience bought through the sacrifice of thousands of lives, has demonstrated, in Hamburg and Altona, that efficient sand Alteration is practically, a perfect safeguard against the introduction of the cholera bacillus into drinking water, and it can scarcely be doubted that what is true of the cholera bacillus is also true of the typhoid bacillus, although in the latter case there has been no such rigorous demonstration. To attain this desirable result, however, it has been no less convincingly shown that the filtration must be efficient, for the experience, gained so dearly in the great cholera epidemics in London, has been strikingly confirmed by Dr. Koch's exhaustive investigation of the cholera epidemics at Altona and the Nietleben Lunatic Asylum in Germany. The bacterioscopic examination of the water supplied to vast communities like London has therefore become an investigation of the highest importance from a hygienic point of view, and I am, therefore, each year devoting an increased amount of attention to the bacteriological character of the various waters supplied to the metropolis. The samples of water submitted to this examination were obtained at the works of the respective Companies immediately after the water left the filters, and before it was pumped into the distributing mains. By this method of sampling, the maximum degree of sterility of each water is determined. This utmost freedom from microbes, after all sources of contamination have been passed, is obviously the most important moment in the history of the water; for the smaller the number of microbes found in a given volume at that moment, the less is the probability of pathogenic organisms being present; and, although the nonpathogenic may, and probably will, afterwards multiply indefinitely, this is of no consequence in the initial absence of the pathogenic. In this determination of maximum sterility, it is of course of the utmost importance that multiplication should be prevented 121 during the few hours which, in the absence of suitable arrangement at the works of the different Companies, must necessarily elapse before the samples can be submitted to cultivation in my laboratory. This is secured by immediately sealing, hermetically, the glass tubes containing the samples and then packing them in ice. At the freezing point of water, microbes either do not multiply at all, or do so with extreme slowness. Although the collection of the samples for microbe cultivation from the filter-wells on the works of the seven different Water Companies drawing their supplies from rivers entails great additional labour, which can only be performed by an expert in bacteriology, I am of opinion that it is the only trustworthy method by which the efficient filtration and comparative bacterial purity of the Metropolitan waters can be ascertained. NEW RIVER COMPANY. Amount of storage 4•8 days. Average thickness of sand on filters 1.8 foot. Average rate of filtration per square foot per hour 2•3 gallons. Maximum percentage of microbes removed 99•9 Minimum percentage of microbes removed 97•39 Average percentage of microbes removed 98•89 Table No. 7.—Microbe Determinations in the New River Company's Water. Source of Sample. January. February. March. April. Temp. C. Microbes per c.c. Temp. C. Microbes per c.c. Temp. C. Microbe per c.c. Temp C. Microbes per c.c. New River unfiltered water o 4•0 31,421 o 5•0 1,842 o 7•6 500 o 12•7 763 New River Compy's supply 3•1 30 6•0 32 7•0 12 12•4 6 Source of Sample. May. June. July. August. Temp. C. Microbes per c.c. Temp. C. Microbes per c.c. Temp. C. Microbes per c.c. Temp. C. Microbes per c.c. New River unfiltered water o 15•8 1,973 o 15•8 2,079 o 17•0 3,934 o 20•0 1,303 New River Compy's supply 17•2 12 18•4 35 17•5 37 19•3 34 Source of Sample. September. October November. December. Mean Microbes per c.c. Temp. C. Microbes per c.c. Temp. C. Microbes per c c. Temp C. Microbes per c.c. Temp. C. Microbes per c.c. New River unfiltered water o 11•3 1,053 o 11•7 2,276 o 5•6 2,131 o 5•4 3,408 2,867 New River Compy's supply 12•6 10 12•7 30 5•5 23 5•7 22 24 This table shows an excellent record. Throughout the year, there is not a single sample which approaches nearer the limit of 100 microbes per c.c. than 37. In January this Company reduced the number of microbes from 31,421 in the unfiltered water to 30 per c.c. in the filtered water as pumped into the supply mains. Only one microbe in a thousand survived the operation of filtration. 122 PROCEEDINGS TAKEN UNDER "THE HOUSING OF THE WORKING CLASSES ACT, 1891." There were no new proceedings taken under this Act during the year, the Public Health Committee having been more than occupied with those taken in respect to the Norfolk Square Area. Although at nearly every meeting of the Committee something with respect to this insanitary area was considered, nevertheless, at the end of the year a termination to the proceedings by possession of the houses and land seemed as far off as possible. The Public Health Committee have done their very best to bring the negotiations with the various persons interested to a conclusion, but endless legal and other difficulties have spun out matters indefinitely. The Norfolk Square Area covers only 2½ acres of ground, and consequently one might reasonably expect that in a few mouths at most, after the representation of the Medical Officer (the late Dr. Tidy), it would have come into the hands of the Vestry. It is now nearly three years since that representation was made, and the negotiations are not yet concluded. The experience of this Act of Parliament in Islington has not been such as to induce the Vestry to lightly take proceedings under it (at all events, under Part I.) again. PUBLIC DISINFECTION. Street Watering and Disinfectants.—The mixing of Carbolic Acid with the water used in street watering was continued during the summer months, with satisfaction to the Public Health Department. Courts, Lanes, and Street Channels.—Carbolic Acid Disinfecting Powder was applied during the hottest portions of the year to these places, and also to the channels in some of the dirtiest parts of the district. 123 Dust-bins. —These were also disinfected (after emptying by the Dustmen) during the long period that the weather continued warm. Disinfectants Distributed and used. —In the following statement particulars are given of the manner in which the disinfectants were distributed. Disinfecting Powder. Crude Acid. Clear Acid. Tons. Cwts. Gallons. Gallons. To Inhabitants 61 15 7,201 115 Works Dept. Horse and Depôt 41 2 40 — Sewers 5 14 1,512 — Highways 7 10 525 — Totals 116 1 9,278 115 There were, compared with the preceding year, 20 tons mora Powder, 3,038 gallons more Crude Acid, and 55 gallons more Clear Acid used. SUMMARY OF SUMMONSES. Year ending 31st December, 1893. Prosecutions. Successful. Dismissed. Withdrawn. Adjourned sine die. "Sale of Food and Drugs Acts, 1875-9" *93 64 6 21 1 "Public Health (London) Act, 1891" †48 40 7 • • • • "Margarine Act, 1887" 17 14 3 • • • • 158 118 16 21 1 * In one case the defendant absconded before the hearing. † One summons not served, defendant having gone away. Further particulars of these prosecutions are given by the Vestry Clerk in his Annual Report to the Vestry. 124 THE SLAUGHTER AND COW-HOUSES IN ISLINGTON, 1893. At the Annual Licensing in October, 1893, there were 62 applications for the renewal of licenses to Slaughter-houses, all of which were granted. For the renewal of licenses to Cow-houses, 31 applications were made, and all were granted. The annual inspection of these places, prior to the licensing, proved them to be generally in a satisfactory condition. Some defects were, however, noticed, but they were not considered of a nature that would justify me in recommending the Vestry to oppose the renewal of the licenses. Table LXXIII. Showing the Fumigation of Rooms after Infectious Disease. Half-Year ending 30th June, 1893. District. North 1. North 2. South 1. South 2. East 1. East 2. West 1. West 2. Totals. 1st Quarter 74 84 77 45 76 109 61 58 584 2nd do. 115 72 68* 85* 82 115 96 90 723 189 156 145 130 158 224 157 148 1307 *Includes One Cab fumigated at Police Station, Upper Street. Half-Year ending 30th December, 1893. District. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total. 3rd Quarter 77 60 43 90 32 62 81 85 145 65 104 94 62 89 1,089 4th do. 106 142 97 113 46 114 90 63 134 70 117 72 63 124 1,351 183 202 140 203 78 176 171 148 279 135 221 166 125 213 2,440 N.B.—This Table has been divided into two half-yearly returns because, it will be recollected, a re-arrangement of the Sanitary Districts was made in the middle of the year. 125 Table LXXIV. Showing the Stripping of Rooms after Infectious Disease. Half-Year ending 30th June, 1893. District. North 1. North 2. South 1. South 2 East 1 East 2. West 1. West 2. Totals. 1st Quarter 7 4 14 12 8 27 5 3 80 2nd do. 11 4 13 14 15 25 14 10 106 18 8 27 26 23 52 19 13 186 Half-Year ending 30th December, 1893. Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total. 3rd Quarter 6 8 2 5 3 3 6 4 11 2 21 7 13 24 115 4th do. 5 10 5 10 1 13 21 5 16 7 27 2 9 18 149 11 18 7 15 4 16 27 9 27 9 48 9 22 42 264 N.B.—This Table has been divided into two half-yearly returns because, it will be recollected, a re-arrangement of the Sanitary Districts was made in the middle of the year. ADMINISTRATION OF "THE SALE OF FOOD AND DRUGg ACTS" FOR THE YEAR 1893. During the year 377 samples of foods and drugs were submitted to the Public Analyst, Dr. Frank L. Teed. Of these samples 213 were milk, of which 40 were found to be adulterated. The adulteration of milk is the meanest of all petty swindles, for it is the robbery, as a rule, of the poorest and of the youngest members of the population of their sustenauce. It is much to be regretted that the fines inflicted have not been commensurate with the meanness of the swindle. As a rule Magistrates inflict heavier penalties for the adulteration of spirits than they do for the adulteration of milk. For what reason, it is impossible to say, for very frequently in the former case no real harm is done, while in the latter a staple food is deprived of its nutrient 126 qualities by the abstraction of its fat, or else it is weakened by the addition of water. It is exceedingly to be regretted that there is not a minimum penalty, say of 20/- on the thief for the first offence, an increased penalty for the second offence, and imprisonment without the option of a fine for the third transgression. Unless this be done milk will continue to be extensively adulterated. The results of the analyses of the 378 samples submitted to the Public Analyst are given in the following Table. Table LXXV. No. of Samples. Description. Genuine Adulterated. 213 Milk 173 40 8 Brandy 7 1 6 Whisky 5 1 8 Rom 6 2 5 Gin i I 10 Cocoa 7 3 12 Coffee 10 2 5 Green Tea. 5 — 5 Black Tea 5 — 5 Moist Sugar 5 — 10 Black Pepper 10 — 6 White Pepper 6 — 7 Mustard 6 1 7 Arrowroot 7 — 7 Flour 7 5 Lime Juice 5 . — 9 Pickles 9 — 8 Vinegar 8 — 5 Bread 5 — 6 Butter 6 — 6 Lard 6 — 7 Cheddar Cheese 7 — 9 Precipitated Sulphur 9 — 2 Acetic Acid 2 — 7 Diluted Acetic Acid 7 — 378 327 51 From this Table it is seen that 51 samples (15£ per cent.) were adulterated. Prosecutions followed in 48 cases, and in 42 instances penalties ranging from 5s. 0d. to £20 were inflicted. In 6 instances the cases were dismissed. 127 Unsound Food. The following seizures of Unsound Food were made. Date. Description of Food. Result of Summons. 1893. January 13th Hams, Cheeses, Butter and Bacon exposed on premises 89, Holloway Road. Fined 40s. and 2s. costs. March 8th Carcase of a diseased Cow on premises in preparation for sale at 13, Brandon Road. Summons dismissed it not being proved the carcase was intended for the food of man. No costs allowed. Eight boxes of Apples at St. Katharine's Wharf, sold to Vendor in the Parish. Summons dismissed on the ground that at the time the Apples were sold the defendant had no reason to believe them to be unfit for food. No. costs allowed. May Two trunks of Fish (Plaice) exposed on premises 291, Caledonian Road. Summons dismissed without costs, it not being proved that the Fish was unfit for food at the time of its exposure. July 29th Unsound Fruit (to wit)—Lemons and Onions, exposed for sale at 127, Copenhagen Street. Fined £8 and 2s. costs. August 5th Unsound Fruit in preparation for sale at 23, Sutterton Road. Defendant vacated premises before hearing of Summons. September 7th Unsound Fruit (to wit)—Pears, Plums and Grapes on premises 110, Seven Sister's Road. Summons dismissed, too long a time having elapsed between seizure of Fruit and its being brought before the Magistrate. ,, 8th Unsound Cheese, Cooked Ham, Bacon, Butter, Rabbits and Fowls exposed for sale on premises 166, Essex Road. Fined £5 and 12s. 6d. costs. ,, 9th Unsound Meat (to wit)—5 pieces Beef and 3 parcels Cut Meat exposed for sale on premises 49, St. Peter's Street. Fined £3 and 12s. 6d. costs. ,, 9th Unsound Fruit (to wit)—Plums and Pears on premises 414, Essex Road. Fined £1 and 12s. 6d. costs. ,, 9th Unsound Fish on stall opposite 38, Ball's Pond Road. Fined 10s and 12s. 6d. costs. August 17th (Summons heard on Oct. 17th) Unsound Cheese, Butter and Eggs, on premises 179, Caledonian Road. Fined £10 and 2s. costs. October 31st Unsound Fruit (to wit)—Pears exposed for sale on premises 294, Pentonville Road. Summons dismissed with a caution to defendant to be more careful in future. 128 In concluding this report I must acknowledge the cordial assistance that has been afforded to me by every member of the staff of the Public Health Department, from the Superintendent (Mr. J. R. Leggatt) to the Junior Clerk. They have all endeavoured to assist me in the work of re-organization, and to them in a very large measure is to be attributed any success which has attended my efforts daring the year. I have above all to thank the Public Health Committee for the manner in which they have received and unanimously supported the suggestions I have made to them from time to time, while to the Chairman, Mr. R. S. Cufflin, in particular, I have to express my deep obligation for the readiness with which he has always placed his time at my disposal when I desired to discuss questions of interest to my department with him. I am, Gentlemen, Your obedient Servant, ALFRED E. HARRIS, Medical Officer of Health. Vestry Hall, Islington, June 25th, 1894. APPENDIX. VITAL AND SANITARY STATISTICS, 1893, TOGETHER WITH ABSTRACTS FOR TEN YEARS, 1883-92. 130 Table A. Showing the Population, Inhabited Houses, Marriages, Births, and Deaths for the year 1893, and 10 years preceding. gross numbers. The Year. Estimated Population. No. of Inhabited Houses. Marriages. Registered Births. Number of Deaths. Deaths in Public Institutions. Total all ages. Under one year. Under five. 1 2 3 4 5 6 7 8 9 1893 328303 2,653 9,749 6,391 1,595 2,498 1,128 1883 290,711 2,371 9,888 5,140 1,312 2,239 — 1884 294,267 2,394 10,011 5,229 1,506 2,420 — 1885 297,867 2,279 9,643 5,740 1,387 2,377 810 1886 301,512 2,177 9,814 5,434 1,512 2,289 817 1887 305,112 2,236 9,726 5,699 1,557 2,530 832 1888 308,936 2,266 9,568 5,197 1,271 2,067 823 1889 312,713 2,443 9,559 5,035 1,261 1,924 864 1890 316,543 2,485 9,419 6,198 1,488 2,390 984 1891 320,418 37,875 2,741 9,797 6,326 1,481 2,388 1,095 1892 324,339 2,783 9,552 6,075 1,417 2,186 1,050 Average of 10 years. 307,241 2,417 9,697 5,607 1,419 2,281 727 average of 8 years. Notes.—1. Population of Census, 1891 = 319,143 = 150,760 Males 168 383 Females 2. Average number of persons in each house at Census, 1891 = 8.47. 3. Area of Parish in acres = 3,107. 4. Average number of persons living on each acre at Census, 1891 = 102. 5. „ „ „ in 1893 = 106. 131 Table B. Showing the Annual Birth and Death Rates, Death-rates of Children, and proportion of Deaths in public Institutions in 1,000 Deaths, for the year 1893 and 10 years preceding:— Year. Birth-rates per 1,000 of the population. Corrected Death-rates per 1,000 of the population. Deaths of Children under 1 year per 1,000 of Registered Births. Deaths of Children under 1 year per 1,000 of Total Deaths. Deaths of Children under 5 years per 1,000 of Total Deaths. Deaths in public Institutions per 1,000 of Total Deaths. 1. 2. 3. 4. 5. 6. 7. 1893 29.6 21.33 163 249 398 190 1883 34.0 19.30 132 255 435 - 1884 34.0 19.41 150 288 462 — 1885 32.3 19.52 144 224 446 141 1886 32.5 18.75 154 278 443 150 1887 32.2 19.30 160 273 468 145 1888 30.9 17.22 133 244 425 158 1889 30.5 16.56 132 250 404 171 1890 29.7 19.74 158 240 417 158 1891 30.8 19.96 151 234 407 173 1892 29.4 19.19 148 233 384 172 Average of 10 years, 1883 - 1892 31.6 18.89 146 253 429 129 Average of 8 years. * The Death Rates in column 3 are corrected for sex and age distribution for the purpose of contrasting them on an equal basis with those of England. I 2 132 Table C. Showing Deaths from all causes during the Year 1893. (Deaths of Non-Residents in Hospitals excluded}. (Deaths of Residents in Public Institutions are distributed). Causes of Death. Under 1 1 to 5 5 to 15 15 to 25 25 to 35 36 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 to 95 95 and upwards. Under 5 Over 5 Males. Females. Totals. I. Specifle, Febrile, &c. 333 401 120 29 47 35 29 33 26 21 5 ... 734 345 521 558 1079 II. Parasitic Diseases 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 2 III. Dietic Diseases 5 ... ... ... 5 17 12 4 1 ... ... ... 5 39 31 13 44 IV. Constitutional Diseases 138 101 48 101 146 163 149 106 108 28 5 ... 239 854 551 542 1093 V. Developmental Diseases 221 1 1 ... ... ... ... 4 77 148 72 2 222 304 232 294 526 VI. Local Diseases 466 352 115 115 193 294 375 435 438 228 27 1 818 2221 1508 1531 3039 VII. Deaths from Violence 63 21 13 3 19 27 22 14 14 8 2 ... 84 122 130 76 206 VIII. Deaths from Ill-defined Causes 367 27 4 ... ... 1 ... ... ... 3 ... ... 394 8 227 175 402 TOTALS 1595 903 301 248 410 537 587 598 664 436 111 3 2493 3893 3201 3190 6391 I. Sneciflc of Febrile Causes. 1. Miasmatic Diseases 118 363 118 25 32 24 20 23 19 15 3 ... 481 279 359 401 760 Small Pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated 1 ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 2 2 Unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 28 85 4 ... 1 ... ... ... ... 1 ... ... 113 6 54 65 119 Scarlet Fever (Scarlatina) 4 53 33 3 1 ... ... ... ... ... ... ... 57 37 51 43 94 Diphtheria 6 113 59 4 3 2 1 ... ... 1 ... ... 119 70 75 114 189 Whooping Cough 70 102 9 ... ... ... ... ... ... ... ... ... 172 9 92 89 181 Typhus Fever ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 Enteric or Typhoid Fever ... 4 11 9 10 5 5 2 1 1 ... ... 4 44 27 21 48 Simple Continued & Ill-defined Fever 1 ... ... 1 ... ... ... ... ... ... ... ... 1 1 1 1 2 Influenza 8 6 1 8 16 17 13 21 18 12 3 ... 14 109 58 65 123 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2.—Diarrhœal Diseases 189 34 1 1 1 1 ... 3 2 4 1 ... 223 14 122 115 237 Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 189 34 1 1 1 1 ... 3 2 4 1 ... 223 14 122 115 237 3.—Malarial Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cow Pox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.- Venereal Diseases 21 1 ... ... ... 1 2 ... ... ... ... ... 22 3 15 10 25 Syphilis 21 1 ... ... ... ... 1 ... ... ... ... ... 22 1 13 10 23 Gonorrhœa, Stricture of Urethra ... ... ... ... ... 1 1 ... ... ... ... ... 2 2 ... 2 6.—Septic Diseases 5 3 1 3 14 9 7 7 5 2 1 ... 8 49 25 32 57 Erysipelas 4 1 ... 1 4 4 6 6 5 2 1 ... 5 29 20 14 34 Pyæmia, Septicæmia 1 2 1 ... 3 1 1 1 ... ... ... ... 3 7 5 5 10 Puerperal Fever ... ... ... 2 7 4 ... ... ... ... ... ... ... 13 ... 13 13 II. Parasitic Diseases 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 2 Thrush 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 2 Hydatids ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Worms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Animal Parasitical Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 133 Table C.—continued. Causes of Death. Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 to 95 95 and upwards Under Over 5 Males. Females. Totals. III. Dietic Diseases 5 ... ... ... 5 17 12 4 1 ... ... ... 5 39 31 13 44 Starvation, Want of Breast Milk 5 ... ... ... ... ... ... ... ... ... ... ... 5 ... 3 2 ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism, Delirium Trem. ... ... ... ... 5 17 12 4 1 ... ... ... ... 39 28 11 39 IV. Constitutional Diseases 138 101 48 101 146 163 149 106 108 28 5 ... 239 854 551 542 1093 Rheumatic Fever, & Rheum, of Heart ... 1 8 4 3 1 ... 1 ... ... ... ... 1 17 8 10 18 Rheumatism ... ... 2 3 ... 3 3 3 2 ... 2 ... ... 18 9 9 18 Gout ... ... ... ... ... 1 1 ... 4 1 ... ... ... 7 5 2 7 Rickets 3 6 ... ... ... ... ... ... ... ... ... ... 9 ... 6 3 9 Cancer, Malignant Disease ... 2 1 1 9 21 56 53 69 24 2 ... 2 236 82 156 238 Gangrene ... ... 1 ... ... 1 ... ... 4 2 1 ... ... 9 3 6 9 Tabes Mesenterica 83 27 1 1 ... ... 1 ... ... ... ... ... 110 3 64 49 113 Tuberclr Meningitis, Hydrocephalus 21 36 12 2 2 2 ... ... ... ... ... ... 57 18 37 38 75 Phthisis 28 27 20 83 130 125 14 42 21 ... ... ... 55 505 313 247 560 Other Tubercular and Scrofulous Dis. 1 1 3 1 1 3 ... ... ... ... ... ... 2 3 7 3 10 Purpura, Hæmorrhagic Diathesis ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... 4 2 2 4 Anœmia, Chlorosis, Leucocythæmia 2 1 ... ... ... 2 2 1 ... ... ... ... 3 5 4 4 8 Glycosuria, Diabetes Mellitus ... ... ... 5 1 3 2 4 5 ... ... ... ... 20 11 9 20 Other Constitutional Diseases ... ... ... ... ... ... ... 1 3 ... ... ... ... 4 ... 4 4 V. Developmental Diseases 221 1 1 ... ... ... ... 4 77 148 72 2 222 304 232 294 526 Premature Birth 173 1 ... ... ... ... ... ... ... ... ... ... 174 ... 97 77 174 Atelectasis 15 ... ... ... ... ... ... ... ... ... ... ... 15 ... 9 6 15 Spina Bifida 10 ... ... ... ... ... ... ... ... ... ... ... 10 ... 6 4 10 Cyanosis 2 ... 1 ... ... ... ... ... ... ... ... ... 2 1 1 2 3 Congenital Malformations 21 ... ... ... ... ... ... ... ... ... ... ... 21 ... 10 11 21 Old Age ... ... ... ... ... ... ... 4 77 148 72 ... ... 303 109 194 303 VI. Local Diseases. 1.—Diseases of Nervous System 131 64 30 15 33 48 77 74 110 57 9 ... 195 453 331 317 648 Inflammation of Brain or Membrane 32 37 18 1 3 1 2 1 ... 1 ... ... 69 27 55 41 96 Apoplexy 7 1 ... 2 1 10 30 27 46 21 7 ... 8 144 50 8 152 Softening of Brain ... ... 2 1 4 8 8 16 18 10 1 ... ... 68 21 47 68 Hemiplegia ... ... ... ... 1 ... 4 6 10 5 ... ... ... 26 9 17 26 Brain Paralysis ... ... ... ... ... 3 3 2 4 4 ... ... ... 16 8 8 16 Insanity ,Genl . Paralysis of the Insane ... 1 ... 3 8 13 18 11 12 13 1 ... 1 79 52 28 80 Epilepsy ... ... 3 4 8 4 3 ... 3 ... ... ... ... 25 16 9 25 Convulsions 75 14 1 ... 2 1 ... ... ... ... ... ... 19 4 56 37 93 Laryngismus Stridulus 13 5 ... ... ... ... ... ... ... ... ... ... 18 ... 12 6 18 Paralysis Agitans ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 ... 2 Paraplegia ... 1 ... ... 1 1 3 5 12 3 ... ... 1 25 15 11 26 Diseases of Spinal Cord ... ... 1 ... 3 ... 3 1 3 ... ... ... ... 11 6 5 11 Other Diseases of Nervous System 4 5 5 4 2 7 3 4 1 ... ... ... 9 26 19 16 35 2.—Dis. of Organs of Special Sense ... 2 5 4 1 ... 1 1 ... ... ... ... 2 12 8 6 14 Ear, Diseases of ... 2 5 4 1 ... 1 1 ... ... ... ... 2 12 8 6 14 Eyes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nose ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Diseases of Circulatory System 5 4 26 31 23 56 55 77 77 37 3 ... 9 385 170 224 394 Endocarditis ... 1 1 3 ... ... 1 ... 1 ... ... ... 1 6 5 2 7 Valvular Diseases of Heart 1 1 8 4 2 11 8 9 9 6 ... ... 2 57 16 43 59 Pericarditis 1 1 1 ... 2 1 1 ... ... ... ... ... 2 5 5 2 7 Other Diseases of the Heart 1 1 16 24 17 41 38 60 62 30 ... ... 2 291 130 168 293 Aneurism ... ... ... ... ... 2 2 5 1 ... ... ... ... 10 6 4 10 Embolism, Thrombosis ... ... ... ... 2 ... 3 1 4 ... ... ... ... 10 5 5 10 Other Diseases of Blood Vessels 2 ... ... ... ... 1 2 2 ... 1 ... ... 2 6 3 5 3 4.—Diseases of Respiratory System 222 220 32 24 61 95 155 191 184 105 1 1 452 861 681 632 1313 Croup 3 16 4 ... ... ... ... ... ... ... ... ... 19 4 18 7 23 Laryngitis 5 6 1 ... ... 1 1 ... ... ... ... ... 11 3 8 6 14 Bronchitis 138 89 5 5 15 28 68 105 114 78 12 1 227 481 309 349 558 Pneumonia 74 119 20 17 37 58 73 65 52 23 1 ... 193 341 297 257 534 Pleurisy ... ... 1 ... 5 3 7 5 5 ... ... ... ... 26 18 3 26 Emphysema 1 ... ... ... ... 1 ... 3 1 2 ... ... 1 7 5 3 8 Asthma ... ... ... 1 1 2 4 8 11 1 ... ... ... 28 11 17 28 Other Diseases of Respiratory System 1 ... 1 1 3 7 2 5 1 1 ... ... 1 21 17 5 22 134 Table C.—continued. Causes of Death. Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 to 95 95 and upwards. Under 5 Over 5 Males. Females. Totals. 5.—Diseases of Digestive System 96 40 15 17 26 41 50 50 32 11 1 ... 136 243 186 193 379 Dentition 19 18 ... ... ... ... ... ... ... ... ... ... 37 ... 23 14 37 Sore Throat, Quinsey 3 1 1 1 2 3 ... ... ... ... ... ... 4 7 8 3 11 Diseases of Stomach 8 ... 1 ... ... 2 3 6 2 2 1 ... 8 17 13 12 25 Enteritis 45 12 l 4 3 1 2 5 3 1 ... ... 57 20 39 38 77 Gastritis 4 2 ... 1 2 3 2 3 3 ... ... 6 14 8 12 20 Peritonitis ... 6 9 6 5 8 7 3 1 ... ... ... 6 39 14 31 45 Ulceration of Intestines 1 ... ... 1 1 2 1 3 ... ... ... ... 1 8 5 4 9 Hernia 3 ... ... ... ... 1 4 5 4 1 ... ... 3 15 4 14 18 Stricture of Intestines ... ... ... ... 1 ... ... 2 1 ... ... ... ... 4 3 1 4 Obstructive Diseases of Intestines 3 ... 1 2 2 1 3 1 4 ... ... ... 3 14 13 4 17 Ascites ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... 1 Cirrhosis of Liver ... ... ... 8 11 15 15 7 ... ... ... ... 66 26 30 56 Other Diseases of Liver 5 ... ... 2 3 7 7 7 5 3 ... ... 5 34 19 20 39 Other Diseases of Digestive System 5 1 2 ... 1 3 5 1 1 1 ... ... 6 14 10 10 20 6.—Diseases of Lymphatic System ... 2 ... 1 ... 2 1 1 1 ... ... ... 2 6 5 3 8 Lymphatics and of Spleen ... 2 ... 1 ... 2 1 1 1 ... ... ... 2 6 5 3 8 7.—Diseases of Glandlike Organs ... ... ... ... 2 ... ... ... ... ... ... ... ... 2 ... 2 2 Bronchocele ... ... ... ... 2 ... ... ... ... ... ... ... ... 2 ... 2 2 Addison's Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases of Urinary System 1 2 2 8 18 33 27 30 23 13 ... ... 3 154 93 64 157 Nephritis 1 2 1 6 7 4 6 3 3 3 ... ... 3 38 21 20 41 Bright's Diseases, Albuminuria ... ... 1 1 9 18 11 15 7 ... ... ... ... 62 36 26 62 Diseases of Bladder ... ... ... ... 1 ... 1 1 3 2 ... ... 8 6 2 8 Disease of Prostate ... ... ... ... ... ... ... 2 6 ... ... ... 8 8 ... 8 Other Diseases of the Urinary System ... ... ... 1 1 11 9 6 8 2 ... ... ... 38 22 16 38 9.—Dis. of Re-nrodnctive System ... ... ... 10 21 13 3 3 2 ... ... ... ... 52 1 51 52 A—Of Organs of Generation. Male Organs of Generation ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... 1 Female Organs of Generation ... ... ... ... 3 5 2 2 2 ... ... ... ... 14 ... 14 14 B.—Of Parturition. Abortion, Miscarriage ... 8 4 l ... ... ... ... ... ... ... ... ... 8 8 Puerperal Convulsions ... ... ... 1 2 1 ... ... ... ... ... ... ... 4 ... 4 4 Placenta Prævia, Flooding ... ... ... 2 2 ... ... ... ... ... ... ... 4 ... 4 4 Other Accidents of Childbirth ... ... ... 6 10 4 1 ... ... ... ... ... ... 21 ... 21 21 10.—Diseases of Bones and Joints 2 1 4 1 2 2 2 3 3 ... ... ... 3 17 11 9 20 Caries, Necrosis ... ... 4 1 ... ... 1 2 ... ... ... ... 8 4 4 8 Arthritis, Ostitis, Periostitis ... ... ... ... 2 1 ... ... 2 ... ... ... ... 5 2 3 5 Other Diseases of Bones and Joints 2 1 ... ... ... 1 1 1 1 3 4 5 2 7 Spine Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11.—Dis. of Integumentary System 9 7 1 4 6 5 3 5 6 5 1 ... 16 36 22 30 52 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cellulitis 1 1 ... ... ... 3 1 1 1 ... ... ... 2 6 4 4 8 Other Dis. of Integumentary System 8 6 1 4 6 2 2 4 5 5 1 ... 14 30 18 26 44 VII. Violence. 63 21 13 3 19 27 22 14 14 8 2 ... 84 122 130 67 206 1.-Accident or Negligence 61 21 13 2 19 27 22 14 14 8 2 ... 82 121 128 75 208 Fracture and Contusion 1 12 6 2 6 10 7 7 8 7 1 ... 13 54 47 20 67 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... 1 Burn and Scald 1 7 3 ... 2 2 1 1 ... 1 1 ... 8 11 8 11 19 Poison ... ... 1 ... 1 1 2 ... ... ... ... ... ... 5 4 1 5 Drowning 1 1 1 ... 3 2 1 ... ... ... ... ... 2 7 7 2 9 Suffocation 56 1 1 ... ... 1 ... ... ... ... ... ... 57 2 28 31 59 Otherwise 2 ... 1 ... ... 2 2 ... 2 ... ... ... 2 7 5 4 9 2.—Homicide 2 ... ... 1 ... ... ... ... ... ... ... ... 2 1 2 1 3 Manslaughter ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 1 Murder 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 2 3.—Suicide ... ... ... ... 7 8 9 6 4 ... ... ... ... 34 28 6 34 VIII. Deaths from Ill-defined Causes 367 27 4 ... ... 1 ... ... ... 3 ... ... 394 8 227 175 402 Dropsy ... ... ... ... ... 1 ... ... ... 3 ... ... ... 4 1 3 4 Hæmorrhage ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Debility 102 4 ... ... ... ... ... ... ... ... ... ... 106 ... 61 45 106 Marasmus and Atrophy 176 23 3 ... ... ... ... ... ... ... ... ... 199 3 114 88 202 Inanition 89 ... ... ... ... ... ... ... ... ... ... ... 89 ... 51 38 89 1 Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other causes not specified or ill-defined ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TOTALS Males 909 467 134 128 192 286 310 304 272 167 32 ... 1376 1825 3201 ... ... Females 686 436 167 120 218 251 277 292 392 269 79 3 1122 2068 ... 3190 ... 135 Table D. Showing the Deaths from all Causes registered in each District during the FiftyTwo Weeks ending 30th December 1893, at three periods of life Causes of Deaths Upper Holloway. Islington, South West. Islington, South East. Highbury. Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 I. Specific, Febrile, &c. 105 102 101 127 164 122 59 86 65 42 49 57 II. Parasitic Diseases ... ... ... 2 ... ... ... ... ... ... ... ... III. Dietic Diseases ... ... 10 1 ... 13 3 ... 6 1 ... 10 IV. Constitutional Diseases 30 22 254 48 41 268 38 21 204 22 17 128 V. Developmental Diseases 40 ... 80 96 1 108 40 ... 57 45 ... 59 VI. Local Diseases 119 89 595 194 133 742 94 92 485 59 39 399 VII. Deaths from Violence 12 6 25 31 5 47 13 9 29 7 1 21 VIII. Deaths from Ill-defined Causes 103 9 1 148 8 4 73 3 1 43 7 2 TOTALS 409 227 1,066 647 352 1,304 320 211 847 219 113 676 I. Specific or Febrile Causes. 1.—Miasmatic Diseases 30 89 81 52 148 95 16 79 56 20 47 47 Small Pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated 1 ... 1 ... ... ... ... ... ... ... ... ... Unknown ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 17 2 15 38 3 5 18 1 3 12 ... Scarlet Fever (Scarlatina) 1 12 6 3 23 14 ... 7 7 ... 9 8 Diphtheria 3 28 23 1 46 21 1 29 18 1 12 10 Whooping Cough 18 29 3 31 40 2 7 21 2 14 12 2 Typhus Fever ... ... 1 ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... 1 16 1 13 Z 6 ... ... 9 Simple Continued & Ill-defined Fever ... ... ... 1 ... ... ... ... 1 ... ... ... Influenza 2 2 29 1 ... 41 3 2 21 2 2 18 Other Miasmatic Diseases ... ... ... ... ... 1 ... ... ... ... ... ... 2.—Diarrhœal Diseases 64 12 3 68 13 8 37 7 3 20 2 ... Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 64 12 3 68 13 8 37 7 3 20 2 ... 3.—Malarial Diseases ... ... ... ... ... ... ... ... ... ... ... ... Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases ... ... ... ... ... ... ... ... ... ... ... ... Cow Pox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases 9 ... ... 7 1 1 5 ... ... ... ... 2 Syphilis 9 ... ... 7 1 ... 5 ... ... ... ... 1 Gonorrhœa, Stricture of Urethra ... ... ... ... ... 1 ... ... ... ... ... 1 6.—Septic Diseases 2 1 17 ... 2 18 1 ... 6 2 ... 8 Erysipelas 2 1 10 ... ... 11 ... ... 6 2 ... 2 Pyaemia, Septicasmia ... ... 2 ... 2 3 1 ... ... ... ... 2 Puerperal Fever ... ... 5 ... ... 4 ... ... ... ... ... 4 II. Parasitic Diseases ... ... ... 2 ... ... ... ... ... ... ... ... Thrush ... ... ... 2 ... ... ... ... ... ... ... ... Hydatids ... ... ... ... ... ... ... ... ... ... ... ... Worms ... ... ... ... ... ... ... ... ... ... ... ... Other Animal Parasitical Diseases ... ... ... ... ... ... ... ... ... ... ... ... 136 Table D.—continued. Causes of Death. Upper Holloway. Islington, South West. Islington, South East. Highbury. Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 III. Dietic Diseases ... ... 10 1 ... 13 3 ... 6 1 ... 10 Starvation, Want of Breast Milk ... ... ... 1 ... ... 3 ... ... 1 ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism, Delirium Trem. ... ... 10 ... ... 13 ... ... 6 ... ... 10 IV. Constitutional Diseases 30 22 254 48 41 268 38 21 204 22 17 128 Rheumatic Fever, & Rheum, of Heart ... 1 5 ... ... 4 ... ... 3 ... ... 5 Rheumatism ... ... 7 ... ... 8 ... ... 2 ... ... 1 Gout ... ... ... ... ... ... ... ... 7 ... ... ... Rickets 1 1 ... 2 5 ... ... ... ... ... ... ... Cancer, Malignant Disease ... 1 75 ... 1 72 ... ... 48 ... ... 41 Gangrene ... ... 3 ... ... 3 ... ... 3 ... ... ... Tabes Mesenterica 19 6 ... 24 6 ... 29 13 1 11 2 2 Tuberclr.Meningitis, Hydrocephalus 5 6 ... 9 17 10 3 4 5 6 9 1 Phthisis 4 6 148 12 11 163 6 4 124 4 6 72 Other Tubercular and Scrofulous Dis. ... 1 2 1 ... 1 ... ... 3 ... ... 2 Purpura, Hæmorrhagic Diathesis ... ... 1 ... ... 1 ... ... 2 ... ... ... Anæmia, Chlorosis, Leucocythæmia 1 ... 4 ... 1 1 ... ... 1 1 ... ... Glycosuria, Diabetes Mellitus ... ... 9 ... ... 4 ... ... 2 ... ... 3 Other Constitutional Diseases ... ... ... ... ... 1 ... ... 3 ... ... 1 V. Developmental Diseases 40 ... 80 96 1 108 40 ... 57 45 ... 59 Premature Birth 26 ... ... 82 1 ... 34 ... ... 31 ... ... Atelectasis 5 ... ... 3 ... ... 1 ... ... 6 ... ... Spina Bifida 2 ... ... 5 ... ... 1 ... ... 2 ... ... Cyanosis 1 ... 1 ... ... ... ... ... ... 1 ... ... Congenital Malformations 6 ... ... 6 ... ... 4 ... ... 5 ... ... Old Age ... 79 ... ... 108 ... ... 57 ... ... 59 VI. Local Diseases. 1.—Diseases of Nervous system . 19 11 145 54 19 124 29 20 95 19 9 89 Inflammation of Brain or Membranes 6 11 6 13 10 9 6 9 8 7 7 4 Apoplexy 1 ... 42 4 ... 37 2 1 32 ... ... 3 Softening of Brain ... ... 26 ... ... 21 ... ... 10 ... ... 11 Hemiplegia ... ... 8 ... ... 6 ... ... 5 ... ... 7 Brain Paralysis ... ... 4 ... ... 6 ... ... 4 ... ... 2 Insanity, Genl. Paralysis of the lnsane ... 1 32 ... ... 21 ... ... 12 ... ... 14 Epilepsy ... ... 9 ... ... 8 ... ... 5 ... ... 3 Convulsions 17 3 1 29 5 ... 19 6 3 10 ... ... Laryngismus Stridulus 2 ... ... 7 1 ... 2 3 ... 2 1 ... Paralysis Agitans ... ... ... ... ... 1 ... ... 1 ... ... ... Paraplegia ... ... 6 ... ... 5 ... ... 10 ... 1 4 Diseases of Spinal Cord ... ... 3 ... ... 2 ... ... 1 ... ... 5 Diseases of Nervous System 3 1 8 1 3 8 ... 1 4 ... ... 6 2.—Dis. of Organs of Special Sence ... 2 1 ... ... 7 ... ... 3 ... ... 1 Ear, Diseases of ... 2 1 ...... ...... 7 ... ... 3 ... ... 1 Eyes ... ... ... ... ... ... ... ... ... ... Nose ... ... ... ... ... ... ... ... ... ... 3.—Diseases of Circulatory System ... ... 123 3 2 119 1 1 84 1 1 59 Endocarditis ... ... 2 ... ... 2 ... 1 1 ... 1 Valvular Diseases of Heart ... ... 21 1 1 14 ... ... 11 ... 11 Pericarditis Other Diseases of the Heart ... ... 94 l l 3 90 ... ... 2 65 1 1 42 Aneurism ... ... 2 ... ... 5 ... ... 1 ... ... 2 Embolism, Thrombosis ... ... 4 ... ... 3 ... ... 1 ... ... 2 Other Diseases of Blood Vessels ... ... ... 1 ... 2 1 ... 3 ... ... 1 4.—Diseases of Respiratory Syst'm 60 59 193 85 92 308 51 60 205 26 19 155 Croup 3 5 1 ... 5 1 ... 5 1 ... 1 1 Laryngitis ... 1 ... 4 4 1 ... 1 2 1 Bronchitis 38 22 95 54 32 148 37 28 116 9 12 72 Pneumonia 19 31 72 26 51 133 14 31 71 15 6 65 Pleurisy ... ... 7 ... ... 10 ... ... 5 ... ... 4 Emphysema ... ... 2 ... ... 1 ... ... 2 1 ... 2 Asthma ... ... 7 ... ... 10 ... ... 6 ... ... 5 Other Diseases of Respiratory System ... ... 9 1 ... 4 ... ... 2 ... ... 6 137 Table D.—continued. Causes of Death. Upper Holloway. Islington, South West. Islington, South East. Highbury. Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 5.—Diseases of Digestive System 29 9 59 46 15 84 11 6 52 10 10 48 Dentition 2 2 ... 8 6 ... 4 4 ... 5 6 ... Sore Throat, Quinsey ... ... 1 3 1 2 ... ... 2 ... ... 2 Diseases of Stomach 4 ... 6 3 ... 5 ... ... 1 1 ... 5 Enteritis 15 4 4 23 6 9 6 1 5 1 1 2 Gastritis 2 1 3 2 ... 5 ... ... 2 ... 1 4 Peritonitis ... 2 12 ... 1 10 ... ... 8 ... 2 9 Ulceration of Intestiues 1 ... 3 ... ... 3 ... ... 1 ... ... 1 Hernia ... ... 3 2 ... 5 ... ... 3 1 ... 4 Stricture of Intestines ... ... ... ... ... 2 ... ... 2 ... ... ... Obstructive Diseases of Intestines 1 ... 3 2 ... 4 ... ... 3 ... ... 4 Ascites ... ... ... ... ... 1 ... ... ... ... ... ... Cirrhosis of Liver ... ... 11 ... ... 28 ... ... 16 ... ... 6 Other Diseases of Liver 2 ... 11 1 ... 9 1 ... 7 1 ... 7 Other Diseases of Digestive System 2 ... 2 2 1 6 ... ... 2 1 ... 4 6.--Diseases of Lymphatic System ... ... ... ... 2 4 ... ... 1 ... ... 1 Lymphatics and of Spleen ... ... ... ... 2 4 ... ... 1 ... ... 1 7.—Diseases of Glandlike Organs of Uncertain Use ... ... 2 ... ... ... ... ... ... ... ... ... Bronchocele ... ... 2 ... ... ... ... ... ... ... ... ... Addison s Disease ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases of Urinary System ... 1 45 1 ... 57 ... 1 20 ... ... 32 Nephritis ... 1 18 1 ... 12 ... 1 5 ... ... 6 Bright's Disease, Albuminuria ... ... 13 ... ... 29 ... ... 5 ... ... 13 Disease of Bladder ... ... 1 ... ... 2 ... ... 3 ... ... 1 Disease of Prostate ... ... 1 ... ... 3 ... ... ... ... ... 4 Other Diseases of the Urinary System ... ... 12 ... ... 11 ... ... 7 ... ... 8 9.—Dis. of Re-productive System ... ... 16 ... ... 22 ... ... 11 ... ... 3 A —Of Organs of Generation. Male organs of Generation ... ... ... ... ... ... ... ... 1 ... ... ... Female Organs of Generation ... ... 6 ... ... 5 ... ... 3 ... ... ... B,—Of Parturition. Abortion, Miscarriage ... ... 3 ... ... 3 ... ... 1 ... ... 1 Puerperal Convulsions ... ... 1 ... ... 1 ... ... 2 ... ... ... Placenta Prævia, Flooding ... ... ... ... ... 3 ... ... 1 ... ... ... Other Accidents of Childbirth ... ... 6 ... ... 10 ... ... 3 ... ... 2 10.-Diseases of Bones and Joints ... 1 4 1 ... 5 ... ... 6 1 ... 2 Caries. Necrosis ... ... 2 ... ... 2 ... ... 3 ... ... 1 Arthritis, Ostitis, Periostitis ... ... 1 ... ... 2 ... ... 1 ... ... 1 Other Diseases of Bones and Joints ... 1 1 1 ... 1 ... ... 2 1 ... ... Spine Diseases ... ... ... ... ... ... ... ... ... ... ... ... 11.—Dis. of Integumentary System 1 ... 7 4 3 12 2 4 8 2 ... 9 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... Phlegmon ... ... ... ... 1 2 ... ... ... ... ... ... Cellulitis 1 ... 2 ... ... ... ... ... 1 ... ... 1 Other Dis. of Integumentary System ... ... 5 4 2 10 2 4 7 2 ... 8 VII. Violence. 12 6 25 31 5 47 13 9 29 7 1 21 1.-Accident or Negligence 111 6 25 30 5 47 13 9 29 7 1 20 Fracture and Contusion ... 5 11 1 2 25 ... 4 9 ... 1 9 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... Cut, Slab ... ... ... ... ... ... ... ... 1 ... ... ... Burn and Scald ... 1 1 1 3 5 ... 3 3 ... ... 2 Poison ... ... ... ... ... 2 ... ... 2 ... ... 1 Drowning ... ... 2 1 ... 2 ... 1 3 ... ... ... Suffocation 10 ... ... 26 ... 1 13 1 ... 7 ... 1 Otherwise 1 ... 2 1 ... 2 ... ... 2 ... ... 1 2.—Homicide 1 ... ... 1 ... ... ... ... ... ... ... 1 Manslaughter ... ... ... ... ... ... ... ... ... ... ... 1 Murder 1 ... ... 1 ... ... ... ... ... ... ... ... 3.—Suicide ... ... 9 ... ... 10 ... ... 9 ... ... 6 VIII. Deaths from I11 defined Causes 103 9 1 148 8 4 73 3 1 43 7 2 Dropsy ... ... ... ... ... 2 ... ... ... ... ... 2 Hæmorrhage ... ... 1 1 ... ... ... ... ... ... ... ... Debility 32 1 ... 40 1 1 21 1 ... 10 2 ... Marasmus and Atrophy 48 8 ... 78 7 1 30 2 1 19 5 ... Inanition 23 ... ... 29 ... ... 22 ... ... 14 ... ... Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... Othercauses not specified orill-deflned ... ... ... ... ... ... ... ... ... ... ... ... 138 Table E. Showing the Deaths from all Causes registered in each Quarter during the 52 weeks ending 30th December 1893, at three periods of life. Causes of Death. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 1 1 to 5 Over 6 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 I. Specific, Febrile, &c 36 73 72 94 109 72 164 130 62 39 89 139 1079 II. Parasitic Diseases 1 ... ... ... ... ... ... ... ... 1 ... ... 2 III. Dietic Diseases ... ... 9 3 ... 11 ... ... 9 2 ... 10 44 IV. Constitutional Diseases 18 15 196 37 23 195 54 39 221 29 24 242 1093 V. Developmental Diseases 51 ... 85 63 1 59 48 ... 58 59 ... 102 526 VI. Local Diseases 103 87 719 103 68 514 113 73 402 147 124 586 3039 VII. Deaths from Violence 20 2 29 15 9 24 10 4 37 18 6 32 206 VIII. Deaths from Ill-defined Causes 74 5 2 78 6 1 119 11 4 96 5 1 402 TOTALS 303 182 1112 393 216 876 508 257 793 391 248 1112 6391 1.—Miasmatic Diseases 21 68 64 42 106 54 33 101 50 22 88 111 760 Small Fox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... 1 ... 1 ... ... ... 2 Unknown ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 7 14 4 13 33 1 8 23 ... ... 10 1 119 Scarlet Fever (Scarlatina) 1 14 9 1 13 6 1 11 11 1 15 11 94 Diphtheria 1 15 16 1 26 15 1 38 13 3 34 26 189 Whooping Cough 10 21 1 25 27 3 22 28 3 13 26 2 181 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... 1 1 Enteric or Typhoid Fever ... 2 7 ... 1 7 ... ... 13 ... 1 17 48 Simple Continued & Ill-defined Fever ... ... ... 1 ... 1 ... ... ... ... ... ... 22 Influenza 2 2 27 1 1 21 ... 1 8 5 2 53 123 Other Miasmatic Diseases ... ... ... ... ... ... ... ... 1 ... ... ... 1 2.—Diarrhœal Diseases 7 3 2 49 2 3 121 28 5 12 1 4 237 Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 7 3 2 49 2 3 121 28 5 12 1 4 237 3.—Malarial Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... Cow Pox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... Splanic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 5.-Venereal Diseases 7 ... ... 2 1 2 8 ... 1 4 ... ... 25 Syphilis 7 ... ... 2 1 ... 8 ... 1 4 ... ... 23 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... 2 ...... ... ... ... ... ... 2 6.—Septic Diseases 1 2 6 1 ... 13 2 1 6 1 ... 24 57 Erysipelas 1 1 4 ... ... 7 2 ... 4 1 ... 14 34 Pyæmia, Septicæmia ... 1 ... 1 ... 4 ... ... ... ... ... 3 10 Puerperal Fever ... ... 2 ... ... 2 ... ... 2 ... ... 7 13 II. Parasitic Diseases 1 ... ... ... ... ... ... ... ... 1 ... ... 2 Thrush 1 ... ... ... ... ... ... ... ... 1 ... ... 2 Hydatids ... ... ... ... ... ... ... ... ... ... ... ... ... Worms ... ... ... ... ... ... ... ... ... ... ... ... ... Other Animal Parasitical Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 139 Table E.—continued. Causes of Death. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 III. Dietic Diseases ... ... 9 3 ... 11 ... ... 9 2 ... 10 44 Starvation, Want of Breast Milk ... ... ... 3 ... ... ... ... ... 2 ... ... 5 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism, Delirium Trem. ... ... 9 ... ... 11 ... ... 9 ... ... 10 39 IV. Constitutional Diseases 18 15 190 37 23 195 54 39 221 29 24 242 1093 Rheumatic Fever, & Rheum, of Heart ... 1 2 ... ... 6 ... ... 4 ... ... 5 18 Rheumatism ... ... 1 ... ... 5 ... ... 6 ... ... 6 18 Gout ... ... 4 ... ... 1 ... ... ... ... ... 2 7 Ricket 1 ... ... ... 2 ... 2 3 ... ... 1 ... 9 Cancer, Malignant Disease ... 2 56 ... ... 53 ... ... 68 ... ... 59 238 Gangrene ... ... 4 ... ... 3 ... ... 1 ... ... 1 9 Tabes Mesenterica 10 4 1 26 6 ... 35 11 ... 12 6 2 113 Tuberclr.Meningitis, Hydrocephalus 2 4 2 5 10 6 6 10 4 8 12 6 75 Phthisis 3 4 116 6 4 111 10 14 133 9 5 145 560 Other Tubercular and Scrofulous Dis. 1 ... ... ... ... 1 ... 1 2 ... ... 5 10 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... 3 ... ... ... ... ... 1 4 Anaemia, Chlorosis, Leucocythaemia 1 ... ... ... 1 4 1 ... ... ... ... 1 8 Glycosuria, Diabetes Mellitus ... ... 10 ... ... 2 ... ... 3 ... ... 5 20 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... 4 4 V. Developmental Diseases 51 ... 85 83 1 59 48 ... 58 59 ... 102 528 Premature Birth 42 ... ... 48 1 ... 36 ... ... 47 ... ... 174 Atelectasis 3 ... ... 3 ... ... 4 ... ... 5 ... ... 15 Spina Bifida 3 ... ... 4 ... ... 1 ... ... 2 ... ... 10 Cyanosis 2 ... 1 ... ... ... ... ... ... ... ... ... 3 Congenital Malformations 1 ... ... 8 ... ... 7 ... ... 5 ... ... 21 Old Age ... ... 84 ... ... 59 ... ... 58 ... ... 102 303 VI. Local Diseases. 1.—Diseases of Nervous System 36 16 120 39 14 137 30 21 101 26 13 105 648 Inflammation of Brain or Membranes 6 10 9 12 9 2 8 11 11 6 7 5 96 Apopelxy 2 ... 38 2 ... 45 2 1 26 1 ... 35 152 Softening of Brain ... ... 22 ... ... 17 ... ... 16 ... ... 13 68 Hemiplegia ... ... 10 ... ... 5 ... ... 4 ... ... 7 26 Brain Paralysis ... ... ... ... ... 8 ... ... 8 ... ... ... 16 Insanity, Genl, Paralysis of the lnsane ... ... 22 ... ... 20 ... ... 19 ... 1 18 80 Epilepsy ... ... 4 ... ... 8 ... ... 5 ... ... 8 25 Convulsions 20 2 ... 23 2 ... 16 5 2 16 5 2 93 Laryngismus Stridulus 8 3 ... ... 1 ... 2 1 ... 3 ... ... 18 Paralysis Agitans ... ... 1 ... ... ... ... ... 1 ... ... ... 2 Paraplegia ... 1 9 ... ... 8 ... ... 3 ... ... 5 26 Diseases of Spinal Cord ... ... 2 ... ... 2 ... ... 3 ... ... 4 11 Other Diseases of Nervous System ... ... 3 2 2 12 2 3 3 ... ... 8 35 2.—Dis. of Organs of Special Sense ... 1 3 ... 1 4 ... ... 2 ... ... 3 14 Ear, Diseases of Nervous System ... 1 3 ... 1 4 ... ... 2 ... ... 3 14 Eyes ... ... ... ... ... ... ... ... ... ... ... ... ... Nose ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Diseases of Circulatory System ... ... 98 3 3 87 1 ... 91 1 1 109 394 Endocarditis ... 3 ... ... 1 ... ... 1 ... 1 1 7 Valvular Diseases of Heart ... ... 16 1 1 7 ... ... 10 ... ... 24 59 Pericarditis ... ... 2 1 1 1 ... ... 1 ... ... 1 7 Other Diseases of the Heart ... ... 69 ... 1 68 1 ... 79 ... ... 75 293 Aneurism ... ... 2 ... ... 5 ... ... ... ... ... 3 10 Embolism, Thrombosis ... ... 4 ... ... 5 ... ... ... ... ... 1 10 Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... ... 1 ... 4 8 4.—Diseases of Respiratory Syst'm 54 59 303 39 37 170 34 40 78 95 94 241 1313 Croup 1 3 1 ... 3 1 1 5 1 1 5 1 23 Laryngitis ... ... 2 2 ... ... 2 2 ... 1 4 1 14 Bronchitis 35 29 206 21 14 65 19 10 26 63 36 134 658 Pneumonia 18 27 121 15 20 94 12 23 42 29 49 84 534 Pleurisy ... ... 8 ... ... 9 ... ... 3 ... ... 6 26 Emphysema ... ... 2 1 ... ... ... ... 1 ... ... 4 8 Asthma ... ... 12 ... ... 5 ... ... 1 ... ... 10 28 Other Diseases of Respiratory System ... ... 11 ... ... 5 ... ... 4 1 ... 1 22 140 Table E.—continued. Causes of Death. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 5.—Diseases of Digestive System 10 8 64 18 12 48 45 11 74 23 9 57 379 Dentition 1 2 ... 2 5 ... 8 5 ... 8 6 ... 37 Sore Throat, Quinsey 1 ... 1 ... ... 2 ... 1 2 2 ... 2 11 Diseases of Stomach 2 ... 4 1 ... 3 3 ••• 7 2 ... 3 25 Enteritis 5 2 5 9 4 3 26 4 9 5 2 3 77 Gastritis ... 2 4 1 ••• 4 2 ... 2 1 ... 4 20 Peritonitis ... 2 12 ... 2 9 ... 1 8 ... 1 10 45 Ulceration of Intestines ... ... 1 ... ... 2 1 ... 3 ... ... 2 9 Hernia ... ... 7 ... ... 3 2 ... 4 1 ... 1 18 Stricture of Intestines ... ... 1 ... ... 1 ... ... 1 ... ... 1 4 Obstructive Diseases of Intestines ... ... 3 2 ... 1 ... ... 6 1 ... 4 17 Ascites ... ... ... ... ... ... ... ... ... ... ... 1 1 Cirrhosis of Liver ... ... 14 ... ... 9 ... ... 16 ... ... 17 56 Other Diseases of Liver 1 ... 8 1 ... 7 1 ... 11 2 ... 8 39 Other Diseases of Digestive System ... ... 4 2 1 4 2 ... 5 1 ... 1 20 6.—Diseases of Lymphatic System ... ... 1 ... ... 1 ... 1 3 ... 1 1 8 Lymphatics and of Spleen ... ... 1 ... ... 1 ... 1 3 ... 1 1 8 7.—Diseases of Glandlike Organs of Uncertain Use ... ... ... ... ... ... ... ... 2 ... ... ... 2 Bronchocele ... ... ... ... ... ... ... ... 2 ... ... ... 2 Addison's Disease ... ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases of Urinary System ... ... 44 ... ... 41 ... ... 34 1 2 35 157 Nephritis ... ... 9 ... ... 14 ... ... 7 1 2 8 41 Bright's Disease, Albuminuria ... ... 19 ... ... 16 ... ... 13 ... ... 14 62 Disease of Bladder ... ... 3 ... ... 1 ... ... 2 ... ... 2 8 Diseases of Prostate ... ... 4 ... ... 1 ... ... 2 ... ... 1 8 Other Diseases of the Urinary System ... ... 9 ... ... 9 ... ... 10 ... ... 10 38 9.—Dis. of Re-productive System ... ... 8 ... ... 21 ... ... 9 ... ... 14 52 A —Of Organs of Generation Male Organs of Generation ... ... ... ... ... 1 ... ... ... ... ... ... 1 Female Organs of Generation ... ... 3 ... ... 5 ... ... 4 ... ... 2 14 R.—Of Parturition. Abortion, Miscarriage ... ... 1 ... ... 5 ... ... 1 ... ... l 8 Puerperal Convulsions ... ... 1 ... ... 3 ... ... ... ... ... ... 4 Placenta Prævia, Flooding ... ... 1 ... ... 2 ... ... ... ... ... 1 4 Other Accidents of Childbirth ... ... 2 ... ... 5 ... ... 4 ... ... 10 21 10.—Diseases of Bones and Joints ... ... 6 2 1 2 ... ... 4 ... ... 5 20 Caries, Necrosis ... ... 4 ... ... ... ... ... 2 ... ... 2 8 Arthritis, Ostitis, Periostitis ... ... 1 ... ... ... ... ... 2 ... ... 2 5 Other Diseases of Bones and Joints ... ... 1 2 1 2 ... ... ... ... ... 1 77 Spine Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 11.—Dis. of Integumentary System 3 3 12 2 ... 4 3 ... 4 1 4 16 52 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... Cellulitis ... ... 2 ... ... 1 1 ... ... ... 1 3 8 Other Dis. of Integumentary System 3 3 10 2 ... 3 2 ... 4 1 3 13 44 VII. Violence. 20 2 29 15 9 24 10 4 37 18 6 32 206 1.—Accident or Negligence 20 2 29 15 9 24 10 4 37 16 6 31 203 Fracture and Contusion ... 1 14 ... 7 12 ... 3 16 1 1 12 67 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ••• ... ... ... 1 ... ... ... ... ... ... 1 Burn and Scald ... 1 3 ... 1 1 1 ... 2 ... 5 5 19 Poison ... ... ... ... ... 2 ... ... ... ... ... 3 5 Drowning 1 ... 1 ... ... 2 ... 1 2 ... ... 2 9 Suffocation 18 ... 1 14 1 ... 9 ... 1 15 ... ... 59 Otherwise 1 ... 3 1 ... 1 ... ... 2 ... ... 1 9 2.—Homicide ... ... ... ... ... ... ... ... ... 2 ... 1 3 Manslaughter ... ... ... ... ... ... ... ... ... ... ... 1 1 Murder ... ... ... ... ... ... ... ... ... 2 ... ... 2 3.—Suicide ... ... 7 ... ... 5 ... ... 14 ... ... 8 34 VIII. Deaths from Ill-defined Causes 4 5 2 78 6 1 119 11 4 96 5 1 402 Dropsy ... ... 1 ... ... 1 ... ... 2 ... ... ... 4 Hæmorrhage ... ... ... ... ... ... ... ... 1 ... ... ... 1 Debility 21 ... ... 20 2 ... 34 2 ... 27 ... ... 106 Marasmus and Atrophy 34 5 1 36 4 ... 63 9 1 43 5 1 202 Inanition 19 ... ... 22 ... ... 22 ... ... 26 ... ... 89 Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... ... Other causes not specified or ill-defined ... ... ... ... ... ... ... ... ... ... ... ... ... 141 Table F. Showing the deaths since 1882 from the several diseases specified, under and above five years of age, and the total number of deaths, with death-rate per 1,000. Year. Population in the middle of the year. Ages. Deaths from the principal diseases of a Zymotic nature.* Deaths from Tubercular Diseases. Deaths from Diseases of the Respiratory Organs. Deaths from Diarrhœa. Deaths from Diseases of the Digestive Organs. Deaths from Violence. Total Deaths. Death Rate per 1,000. Total. Total. Total. Total. Total. Total. †1882 287,191 under 5 years 580 739 236 753 530 1,146 137 149 53 248 65 126 5,264 18.3 above 5 ,, 159 517 616 12 195 61 †1883 290,711 under 5 years 385 536 269 836 522 1,088 149 162 45 227 53 104 5,140 17.6 above 5 „ 151 567 566 13 182 51 †1886 294,267 under 5 years 502 683 313 835 465 978 247 266 43 274 71 129 5,229 17.7 above 5 „ 181 522 513 19 231 58 †1884 297,807 under 5 years 592 749 217 706 530 1,197 172 191 36 268 55 102 5,323 17.8 above 5 „ 157 489 667 19 232 47 †1885 301,512 under 5 years 313 396 292 772 495 1,201 291 307 49 231 57 127 5,159 17.1 above 5 „ 83 480 706 16 182 70 †1887 305,112 under 5 years 593 687 252 725 492 1,169 275 291 69 246 64 122 5,400 17.6 above 5 ,, 94 473 677 16 177 58 †1888 308,936 under 5 years 411 515 218 671 442 1,040 131 146 62 253 54 115 4,864 15.7 above 5 „ 104 453 598 15 191 61 †1889 312,713 under 5 years 326 425 194 702 395 970 157 170 67 250 60 120 4,752 15.1 above 5 „ 99 508 575 13 183 60 †1890 316,543 under 5 years 416 496 260 785 569 1,406 154 169 82 250 73 166 5,718 18.0 above 5 „ 80 525 837 15 168 93 †1891 320,418 under 5 years 486 587 207 717 624 1,476 131 146 82 263 65 133 5,857 18.2 above 5 „ 101 510 852 15 181 68 †1892 324,389 under 5 years 378 481 198 677 509 1,301 143 156 88 270 71 139 5,685 17.5 above 5 „ 103 479 792 13 182 68 893 328,303 under 5 years 112 163 224 758 452 1,313 223 237 136 379 84 206 6,391 19.4 above 5 „ 51 584 861 14 243 122 *This includes Small-Pox, Measles, Scarlatina, Typhoid Fever, Diphtheria and Whooping Cough, †The deaths in these years do not include those of residents occurring in outlying institutions. 142 Table G. Deaths of Residents in Public Institutions outside Islington distributed to their respective Sub-Registration Districts. Sub-Registration Districts. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. Males Females Total. Males Females Total Males Females Total Males Females Total Males Females Total Upper Holloway 14 16 30 16 19 34 23 8 31 15 13 28 67 56 123 South West Islington 30 22 52 33 19 52 27 26 53 34 25 59 124 92 216 South East Islington 14 7 21 22 17 39 18 11 29 22 15 37 76 50 126 Highbury 7 7 14 8 5 13 12 9 21 9 10 19 36 31 67 The Parish 65 52 117 78 60 138 80 54 134 80 63 143 303 229 532 Table H. (Local Government Board Return). Deaths during the Year 1893 in the Metropolitan Sanitary District of Islington, classified according to Diseases, Ages and Localities. Sub-Districts. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All Other Diseases. Total. Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Upper Holloway 1,702 409 227 84 74 568 340 Under 5 1 13 31 2 ... 1 ... ... ... ... 3 19 47 76 1 ... 10 110 ... 18 304 636 5 upwds 1 6 23 1 1 16 ... ... 5 ... 10 2 3 3 5 ... 139 174 123 25 529 1,066 Islington, South West 2,303 647 352 103 84 749 368 Under 5 ... 26 47 4 ... 1 1 ... ... ... ... 53 71 81 ... ... 23 163 5 36 488 999 5 upwds ... 14 21 ... ... 13 ... ... 4 ... 11 3 2 8 4 ... 163 291 119 47 604 1,304 Islington, South East 1,378 320 211 62 55 468 262 Under 5 ... 7 30 2 ... 2 ... ... ... ... ... 23 28 44 ... ... 10 105 2 22 256 531 5 upwds ... 7 18 1 ... 6 1 ... ... ... 6 1 2 3 3 ... 124 192 84 29 370 847 Highbury 1,003 219 113 52 35 344 245 Under 5 ... 9 13 ... ... ... ... ... ... ... 2 15 26 22 ... ... 10 42 2 8 183 332 5 upwds ... 8 10 1 ... 9 ... ... 4 ... 2 ... 2 ... 5 ... 72 141 59 21 342 676 Totals * 6,391 1,595 903 301 248 2,129 1,215 Under 5 1 55 121 8 ... 4 1 ... ... ... 5 110 172 223 1 ... 53 420 9 84 1,231 2,498 5 upwds 1 35 72 3 1 44 1 ... 13 ... 29 6 9 14 17 ... 498 798 385 122 1,845 3,893 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto. ... ... ... ... ... ... ... Under 5 These deaths are included in total above. 5 upwds Deaths occurring within the district among persons not belonging thereto. 458 30 27 22 29 300 50 Under 5 ... 1 6 ... ... ... ... ... ... ... ... 6 4 1 ... ... 4 10 ... ... 25 57 5 upwds 10 10 ... ... ... 1 ... ... ... ... 4 1 ... 4 2 ... 103 107 25 17 117 401 * These totals include Deaths of Residents occurring in Public Institutions in the District. TABLE I. (Local Government Board Return). Table of Population, Births, and of New Cases of Infectious Sickness coming to the knowledge of the Medical Officer of Health, during the year 1893, in the Metropolitan Sanitary District of Islington ; classified according to Diseases, Ages and Localities. Sub-Districts. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed form their Homes in the several Localities for Treatment in Isolation Hospitals. Census MM. Estimated to middle of 1893. 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 12 13 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Brysipelas. Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. (a.) (b.) (c.) (d) (e.) Upper Holloway 90,235 95,694 2,768 Under 5 2 153 73 8 ... 2 ... ... ... ... 12 ... ... 2 46 17 1 ... 1 ... ... ... ... ... ... ... 5 upwds 14 604 201 1 1 81 1 ... 12 ... 147 ... ... 11 178 42 ... 1 21 ... ... 1 ... 8 ... ... Islington, South West 105,557 106,614 3,386 Under 5 2 243 76 7 ... 4 ... ... ... ... 12 ... ... 2 63 36 ... ... 1 ... ... ... ... 2 ... ... 5 upwds 47 794 151 1 ... 58 1 ... 13 ... 182 ... ... 44 238 45 ... ... 17 ... ... ... ... 25 ... ... Islington, South East 64,168 64,996 1,994 Under 5 4 121 64 3 ... 4 ... ... ... ... 8 ... ... 4 27 20 ... ... 4 ... ... ... ... ... ... ... 5 upwds 11 320 157 3 ... 47 3 ... 3 ... 140 ... ... 9 110 38 2 ... 6 ... ... ... ... 9 ... ... Highbury 59,193 60,999 1,601 Under 5 ... 159 23 2 ... 1 ... ... ... ... 6 ... ... ... 31 2 1 ... ... ... ... ... ... ... ... ... 5 upwds 7 488 117 1 ... 46 1 ... 8 ... 60 ... ... 7 122 11 ... ... 10 ... ... ... ... 5 ... ... Public Institutions ... ... ... Under 5 3 7 ... ... ... ... ... ... ... ... 1 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds 26 45 6 ... ... 6 1 ... ... ... 90 ... ... 26 13 1 ... ... 6 1 ... ... ... ... ... ... Totals 319,143 328,503 9,749 Under 5 11 683 236 80 ... 11 ... ... ... ... 89 ... ... 11 167 75 2 ... 6 ... ... ... ... 2 ... ... 5 upwds 105 2,251 632 6 1 238 7 ... 86 ... 619 ... ... 97 661 137 2 1 60 1 ... 1 ... 47 ... ... 145 Table J.* Summary of Sanitary Work from Inspectors' Reports, from 2nd January, 1893, to 27th May, 1893. Islington, North. Islington, South. Islington, East. Islington, West. total. No. 1. No. 2. No. 1. No. 2. No. 1. No. 2. No. 1. No. 2. Number of Houses inspected 381 551 373 765 377 541 550 547 4085 Drains— Constructed .. 58 12 42 23 8 21 59 223 Improved or repaired 31 86 44 64 51 47 24 14 361 Traps fixed 73 412 105 255 159 114 200 233 1551 Cesspools— Abolished .. .. •• 2 .. .. .. •• 2 Cleansed or disinfected .. .. •• .. .. .. •• .. .. Privies and Water Closets— Pan, trap and water supply furnished 39 183 17 55 .. 41 81 102 518 Pan and trap only furnished 1 3 10 53 58 2 1 4 132 Water supply furnished 21 8 14 90 64 7 1 35 240 Dustbins— Constructed .. 29 7 13 5 11 10 14 89 Repaired and covers adapted •• 43 13 22 5 2 •• 40 125 Surface Drains & pavements of yards Constructed 21 17 11 62 54 44 10 31 250 Relaid 28 135 63 108 90 84 27 46 581 General Water Supply— New Receptacles provided 34 13 33 5 2 2 2 45 136 Receptacles repaired and cleansed 30 59 30 12 2 12 2 33 180 Water supply provided 6 12 •• 20 13 18 7 1 77 Other Improvements — Houses generally repaired 2 273 •• 45 1 2 1 37 361 ,, &c., cleaned or limewashed 9 97 86 235 9 2 5 120 563 ,, ventilated 31 128 15 27 .. 30 83 155 469 Overcrowding abated •• 1 1 10 3 4 1 12 32 Illegal use of undeground rooms for sleeping discontinued •• •• •• 1 •• •• •• 7 8 Other Amendments, or Nuisances abated 160 386 151 169 108 91 246 353 1664 Rooms disinfected 134 140 111 78 114 200 104 100 981 Rooms cleaned and walls stripped 13 5 19 16 18 45 15 11 142 1014 2639 1115 2149 1156 1307 1391 1999 12770 *This, and the following Table, although each referring to the work of the Sanitary Inspectors, are differently arranged, the one dividing the districts into eight divisions and the other into fourteen. This is due to the fact that the Parish was divided on 27th May into fourteen Sanitary areas, to each of which an Inspector was appointed. It was found impossible to make the returns for the year in a single table. K 146 Table K. Summary of Sanitary Work from Inspectors' Reports, from 39th May, 1893, to 30th December, 1893. DISTRICTS. Totals. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Number of Houses inspected 384 527 330 409 270 460 249 476 1172 487 703 499 554 652 7172 Re-inspections, Calls made, &c. 2435 2806 2346 2569 1718 4269 2979 2753 2198 2503 3587 2716 3597 3258 39734 Visits to Bakehouses 42 3 .. 20 1 34 5 16 1 13 5 13 2 16 171 Do. Cowhouses 1 .. .. 2 .. 1 3 .. 5 2 1 4 8 2 29 Do. Slaughter-houses 1 .. .. 5 3 2 2 9 7 19 4 12 15 4 83 Do. Stables and Yards 1 3 .. .. .. 1 .. 33 .. 26 3 5 103 20 195 Do. Courts, &c. .. .. .. .. .. 1 .. .. .. 3 .. 1 .. 1 6 Do. Factories and Workshops .. .. .. .. 6 .. .. 1 .. 7 3 .. 16 1 34 Do. Fields, Lanes, &c. .. .. .. .. 1 .. .. 2 .. .. .. .. .. 2 5 Do. Factories, Horse Slaughterhouses, Piggeries, &c., Bell Isle .. .. .. .. .. .. .. 2 25 3 9 22 8 8 77 Do. Under Sale of Food and Drugs Acts 6 11 .. 1 18 10 .. 36 16 12 32 19 28 8 197 Dust Removals Ordered 41 13 .. .. 1 .. .. 2 .. .. 2 2 7 .. 68 Registered Lodging Houses .. .. •• .. •• 5 .. .. .. .. .. .. .. .. 5 Total Inspections, &c. 2911 3363 2676 3006 2018 4783 3238 3330 3424 3075 4349 3293 4338 3972 47776 Improvements. Drains— Constructed 34 3 61 27 18 63 57 35 57 5 97 87 107 14 665 Improved or repaired 35 51 74 36 11 123 38 68 20 42 101 50 72 91 812 Traps fixed 206 115 484 131 233 356 400 260 284 101 437 400 538 188 4133 Cesspools- Abolished .. 1 .. 1 .. 5 .. .. .. .. 1 1 12 .. 21 Cleansed or disinfected .. 16 .. .. .. .. .. .. .. .. 1 .. .. 1 18 Privies and Water Closets— Pan, trap and water supply furnished 107 65 173 27 33 205 114 4 90 26 167 130 166 63 1370 Pan and trap only furnished 11 38 1 30 25 27 15 91 3 11 12 11 .. 15 290 Water supply furnished 6 47 9 8 6 38 16 107 84 5 8 17 17 19 387 Dust Bins— Constructed 29 3 11 10 10 63 3 12 9 2 57 57 14 14 294 Repaired and Covers adapted 31 9 8 13 2 26 10 3 2 8 57 34 15 14 232 Surface Drains and Pavements of Yards— Constructed 7 .. 7 15 1 1 66 88 15 27 56 60 64 75 482 Relaid 82 47 116 98 4 193 30 148 51 63 93 133 178 164 1400 General Water— New receptacles provided 3 46 5 63 1 8 7 .. 6 1 6 18 163 4 331 Receptacles repaired and cleansed 30 21 26 14 6 134 9 7 15 4 26 51 75 56 474 Water supply provided .. 8 3 1 9, 3 .. 6 7 4 12 15 13 17 91 Other improvements— House generally reparied 153 1 32 .. .. .. .. 7 26 .. 3 27 37 5 291 Do. &c., cleansed or limewashed 60 19 11 88 1 156 17 13 37 46 96 123 133 20 820 Do. ventilated 91 49 124 37 2 .. 111 .. 144 23 25 76 277 43 1002 Overcrowding abated 3 .. 5 .. 1 7 .. 2 10 1 7 1 2 5 44 Illegal use of underground Rooms for sleeping discontinued .. .. .. .. .. 1 .. .. .. .. .. 8 .. .. 9 Other Amendments, or Nuisances abated 129 278 450 211 111 174 67 194 295 140 38 308 1167 194 3756 Rooms fumigated 206 217 152 219 92 216 190 163 333 163 249 190 143 233 2766 Rooms stripped and cleansed 14 20 8 21 5 18 29 9 29 11 54 12 26 62 308 Total Improvements 1237 1054 1760 1050 564 1817 1179 1217 1517 683 1603 1809 3219 1287 19996 147 Table L. Summary of Applications for Removal of Dust, from 2nd January to 30th December, 1893. Ward Three Months ending 1st April, 1893. Three Months ending 1st July, 1893. Three Months ending 30thSept., 1893. Three Months ending 30th Dec., 1893. Total during Twelve Months. Number of Assessments 25th March, 1893. Number of Applications to every 100 Assessments. Applications during previous Twelve Months Applications to every 100 Assessments during same period. 1 383 258 145 102 888 12,760 6.9 1,676 13.4 2 79 97 73 63 312 4,895 6.4 678 13.8 3 304 307 220 173 1,004 9,284 10.8 2,043 22.3 4 183 144 121 84 532 3,891 13.6 849 22.0 5 74 96 64 40 274 2,674 10.2 623 23.2 6 221 176 158 132 687 2,596 26.4 1,314 51.1 7 221 175 78 64 538 3,396 15.8 1,092 32.1 8 345 218 99 89 761 4,449 16.9 1,689 38.0 Totals 1,810 1,471 958 747 4,986 43,945 11.3 9,964 26.9 On Inspectors' Reports 83 62 40 51 236 Total Removals 1,893 1,533 998 798 5,222 148 WATER ANALYSIS. In the following tables I state the analyses (made monthly) of the New River Company's Water recorded during the year. Table M. Analyses of Samples taken from the Works of the Company. 1893. Total Solid Matter. Chlorine. Equal to Chloride of Sodium. Nitrogen as Nitrates. Nitrogen as Ammonia. Oxygen required to oxidise Organic Matter. Degree of Hardness. Degree after boiling ¼ of an hour. Organic Carbon. Organic Nitrogen. January 26.90 1.224 2.006 0.312 0.000 0.012 18.84 4.20 .. .. February 25.40 1.368 2.242 0.271 „ 0.035 18.42 4.00 .. .. March. 23.30 1.440 2.360 0.240 „ 0.046 18.22 3.80 .. .. April 20.50 1.440 2.360 0.229 „ 0.012 15.26 3.90 .. .. May 21.20 1.296 2.124 0.135 „ 0.012 14.63 2.82 .. .. June 20.40 1.440 2.360 0.125 „ 0.012 14.42 3.20 .. .. July 20.00 1.368 2.242 0.135 „ 0.015 14.63 2.64 .. .. August 19.20 1.368 2.242 0.177 „ 0.008 14.00 2.91 .. .. September 23.40 1.296 2.124 0.125 „ 0.015 15.47 3.70 .. .. October 24.80 1.296 2.124 0.146 „ 0.008 14.84 3.60 .. .. November 24.40 1.296 2.124 0.198 „ 0.008 17.37 4.10 .. .. December 22.70 1.296 2.124 0.271 „ 0.016 16.95 4.10 .. .. Average 22.68 1.344 2.202 0.197 o.ooo 0.016 16.08 3.58 .. .. Table N. Analyses of Samples taken from the Mains of the Company. 1893. Total Solid Matter. Chlorine. Equal to Chloride of Sodium. Nitrogen as Nitrates. Nitrogen as Ammonia. Oxygen required to oxidise Organic Matter. Degree of Hardness. Degree after boiling¼ of an hour. Organic Carbon. Organic Nitrogen. January .. 1.200 l.967 0.295 0.000 0.029 18.35 .. 0.061 0.016 February .. 1.296 2.124 0.234 „ 0.038 18.26 .. 0.081 0.021 March .. 1.296 2.124 0.245 „ 0.035 16.89 .. 0.072 0.016 April .. 1.368 2.242 0.226 „ 0.014 15.61 .. 0.039 0.015 May .. 1.314 2.153 0.140 „ 0.022 14.63 .. 0.050 0.014 June .. 1.386 2.271 0.164 „ 0.017 15.15 .. 0.042 0.013 July .. 1.344 2.203 0.167 „ 0.016 15.19 .. 0.034 0.013 August .. 1.344 2.203 0.174 „ 0.016 14.77 .. 0.039 0.015 September .. 1.314 2.153 0.146 „ 0.011 15.10 .. 0.034 0.015 October .. 1.296 2.124 0.177 „ 0.012 16.05 .. 0.033 0.011 November .. 1.278 2.094 0.216 „ 0.012 17.37 .. 0.039 0.014 December .. 1.224 2.006 0.245 „ 0.020 18.11 .. 0.039 0.015 Average .. 1.305 2.138 0.202 0.000 0.020 16.29 .. 0.046 0.014