XSL b 1899. FORTY-FOURTH ANNUAL REPORT ON THE Health and Sanitary Condition OF THE Parish of St. Marg, Islington. ALFRED EDWIN HARRIS, MEDICAL OFFICER OF HEALTH. London: Vail & Co., 170, Printers, Farringdon Road, W.C. 1900. LS>l (o OFFICERS OF THE Public Health Department. Medical Officer of Health. ALFRED EDWIN HARRIS, L.R.C.S., L.R.C.P.Edin. Solicitor. ARTHUR MELLOR BRAMALL. Public Analyst. FRANK LITHERLAND TEED, D.Sc., F.I.C., F.C.S. Superintendent of Public Health Department and Chief Sanitary Inspector. JAMES RICHARD LEGGATT. Inspector of Meat. THOMAS DUNLOP YOUNG, Cert. Sanit. Inst. Inspector of Workshops, Bakehouses and Smoke Nuisances. GEORGE WEST. Inspector of Houses let in Lodgings. JAMES JARVIS JORDAN. Inspector of Workshops, &-c., in which Females are employed. JESSY MACDONALD STEWART GRAY, Cert. Sanit. Inst. Inspectors of Nuisances and Sanitary Inspectors. District 1 .. WILLIAM COOK, Cert. Sanit. Inst. „ 2 .. JAMES WILLIAM COWLING. „ 3 .. WILLIAM WALTER WARD „ 4 .. ELIAS JAMES GRIVELL, Cert. Sanit. Inst. „ 5 .. WILLIAM HOLSGROVE FLOOD, Cert. Sanit. Inst. „ 6 .. ALLEN BAGSHAW, Cert. Sanit. Inst. „ 7 .. CHARLES LAWRENCE, Cert. Sanit. Inst. „ 8 .. JOHN METCALF, Cert. Sanit. Inst. „ 9 .. WILLIAM IRVING, Cert. Sanit. Inst. „ 10 .. HARRY JOHN JAMES WATSON, Cert. Sanit. Inst. „ 11 .. EDWARD ISAAC FORTUNE, Cert. Sanit. Inst. „ 12 .. ALFRED PEARCE PRESTON, Cert. Sanit. Inst. „ 13 .. WILLIAM ROLFE. „ 14 .. PATRICK MERNAGH, Cert. Sanit. Inst. Engineer in charge of Steam Disinfectors. JOSEPH TWIZELL. Caretaker of Shelter House. MRS. TWIZELL. Mortuary Keeper. ARTHUR ROBINSON. Distributor of Disinfectants. JOHN REDDY. Disinfectors. JOHN WRIGHT and THOMAS DIXON. Clerical Staff. Chief Clerk GEORGE HAROLD KING. Second Clerk HENRY ANGEL Third Clerk ALBERT ERNEST HITCHIN Fourth Clerk GEORGE JAMES ELDRIDGE. Fifth Clerk EDWARD ALBERT ABBOTT. Sixth Clerk WALTER JOSEPH WOLFE. Junior Clerk ARTHUR R. WITTRICK. Messenger. WILLIAM SMITH INDEX. Page. Adulteration of Food 215 Ages at Death 37 Area of Parish 9 Bacteriological Diagnoses 171 Bacteriological examination of milk 224 Bakehouses 198 Baths and Washhouses 229 Births 21 Cancer 110 Constitutional Diseases 109 Continued Fever 87,129 Deaths 27 ,, at different age periods 37,38 „ in the Quarters 43 „ in the Sub-Districts 36, 44 ,, Wards 45 ,, ,, Encircling Districts 96 ,, from Zymotic Diseases 48 Diarrhoea 41, 42 Diphtheria 69, 120 ,, Fatality from 122, 145 „ Notification of 120 Diphtheria and Croup 72 Disinfecting Station 178 Disinfection Work 177 District inspection 209 Dusting and Scavenging 181 Enteric Fever .85, 124 „ Fatality from 125 „ Notification of 124 Epidemic of Measles 60 Erysipelas, Fatality from 106, 127 ,, Notification 126 Factories and Workshops 192 Fatality from Infectious Diseases 142 Food, Adulteration of 215 Hospital Statistics 148 Infantile Mortality 114 Infectious Diseases in Schools 139 Iufluenza 99 Inspection of Workshops 192 „ Slaughter Houses and Cow Houses 185 Margarine Act 223 Marriages 19 Matters considered by Public Health Committee 234 Measles 60 Meat Inspection 183 Membranous Croup 122 Milk Adulteration on Sundays 219 Mortality in Sub-Registration Districts 31 Mortuary and Coroner's Court 228 Page. Notification of Infectious Diseases 117 ,, „ „ „ in Registration Sub-Districts 130 „ „ „ „ in the Sanitary Districts 132 „ „ „ „ in the Wards 131 „ „ „ ,, during the several months 133 .. .. „ .. in the Encircling Districts 135 „ „ „ „ in Metropolitan Districts 137 Notification of Scarlet Fever 119 „ ,, Small Pox 118 Occupation of persons attacked with Infectious Disease 152 Pauperism 214 Persons to au Acre 11 Phthisis 111 Population —Estimated in 1899 12 „ Sex and age Distribution 13 „ in Sub-Districts 11 „ and Density of Districts 11 Public Disinfection 177 Public Health legislation 235 Puerperal Fever 107 ,, „ Notification of 127 „ „ Fatality from 129 Relapsing Fever 129 Registered Lodging Houses 204 Sanitary Inspectors' Work 208 Scarlet Fever 66 „ „ Notification of 119 „ ,, Fatality from 120 Seasonal Mortality 38 Slaughter Houses 185 Small Pox 58,118 Streets where Infectious Disease occurred 156 Summonses, Summary of 214 Trades carried on in houses where Infectious Disease has occurred 148 Typhus Fever 85,126 Vaccination 173 Whooping Cough 83 Workshop Inspectors 192 Work of the Clerical Staff 239 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 QuarterE 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 cases of Infectious Sickness I Infectious Sickness in the several Wards from 1891-99 J to T „ „ „ Sub-Districts from 1891-99 UtoX Summary of Sanitary Work in fourteen Districts Y Summary of Applications for Removal of Dust Z Water Analysis — INDEX TO CONTENTS OF QUARTERLY REPORTS, 1899. SUBJECT. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Pages. Pages. Pages. Pages. Adulteration of Food 57 77 72 76 Appointment of Meat Inspector ... 72 ... ... Area & Density of Sub-districts & Wards 7 ... ... ... Antitoxin ... 33 ... ... Ages at Death ... ... 11 17 Bacteriological Diagnosis 43 59 ... ... Births 8, 66 5 5, 80 6, 84 Brooksby Mews 49 ... ... ... Bite from a Rabid Dog ... 64 ... ... Cancer 30 29 37 40 Continued Fever 35 45 52 48 County Council Drainage By-laws ... ... 64 Deaths—All Causes 9, 66, 70 6 7, 80 8, 84, 88 „ in Upper Holloway 11, 1'2, 66, 70 9. 10, 86, 90 10, 80, 84 12, 14, 84, 88 ,, in Islington, South-west 11, 12, 66, 70 9, 10, 86, 90 10, 80, 84 12. 14, 84, 88 „ in Islington, South-east 11, 12, 66, 70 9, 10, 86, 90 10, 80, 84 12, 14, 84, 88 „ in Highbury .. 11, 12, 66, 70 9, 10, 86, 90 10, 80, 84 12, 14, 84, 88 ,, in Public Institutions ... 17, 69 15, 89 18, 82 23, 86 „ from Zymotic Diseases 19, 67 17, 87 20, 81 25, 85 ,, from Respiratory Diseases 15 ... ... 13 in the Wards 24 24 10, 31 10, 32 Diarrhoea 22, 67 21, 87 26, 81 30, 84 Diphtheria 21, 33, 42, 74, 75 20, 33, 56, 94, 95 25,40,62,81,88.89 28, 44, 85, 92, 93 Disinfection 46 53 61 61 Disinfecting Station 47 53 60 61 Enteric Fever at Workhouse Schools .. ... ... 42 ... Enteric Fever 22, 34 21, 37 !6. 42, 81, 88, 89 29, 46, 85, 92, 93 Erysipelas 35 44 50, 88, 89 47 Fatality 41 54 61 58 Female Sanitary Inspector, work of 51 67 66 70 Gas Supply 77 97 91 85 Houses Let in Lodgings 53 70 69 74 Hospital Treatment of Infectious Diseases 44 51 58 54 Ice Creams .. 62 ... Infantile Mortality i6 13 14 20 Influenza 29 28 36 37 Inspection of Workshops 50 66 66 69 Measles 20, 67 19, 87 23, 81 26, 85 Mortuary and Coroner's Court 63 83 77 81 Margarine Act 63 79 74 81 Meat Inspection 73 64 66 Membranous Croup 34 37 49, 88, 89 45, 92, 93 Notification of Infectious Disease 31, 74, 75 30, 94, 95 38 41 Nuisances, Summary of 79 99 93 97 Index to Contents or Quarterly Reports, 1899—continued. SUBJECT. 1st Quarter. 2nd Quarter. 3rd Quarter. uarter. Pages _ Pages. Pages. Pages. Prosecutions 60 80 75 79 Puerperal Fever 35 45 50, 88, 89 40, 48, 92, 93 Pauperism in the Parish 76 96 90 94 Phthisis 30 28 36 38 Respiratory Diseases ... ... ... 13 Scarlet Fever 21, 32, 167. 74, 75 19, 32, 87, 94, 95 24, 40, 81, 88, 89 27, 43, 85, 92, 93 Shelter House 47 54 61 62 Small Pox 20, 32 19, 32 23, 39 26, 43 Summary of Sanitary Work 81 101 95 99 Sickness in Schools 47 58 64 63 Sanitary Inspectors, work of 56 65 66 73 Summary of Vital Statistics for Year 1899 . . "* ... 102 Stables and Manure .. 59 ... » Typhus Fever 22 21, 44 26, 49 29 Urinals at Public Houses ... 61 ... Water Supply 78 98 92 96 Whooping Cough 22, 67 21. 87 26, 81 29, 85 Vestry Hall, Upper Street, N. To the Chairman and Members of the Vestry of St. Mary, Islington. Sir, Madam, and Gentlemen, It is not without great regret that I present to you my Annual Report as Medical Officer of Health on the Health and Sanitary condition of your great Parish during the year 1899, for it is the last occasion on which 1 shall have the honour to address you on the subject. Before another year rolls round, the Vestry shall have ceased to exist, and a new Corporation shall have taken its place. I am glad to think, however, that, whatever may have been the care and attention bestowed on Sanitation prior to the Public Health (London) Act 1891 coming into force, since then no Authority, in the Metropolis or in the Provinces, could have had the health interests of their districts dearer to their hearts than you have had those of yours during these years. The public health laws, and the bylaws framed under them, have been administered impartially ; the adulteration Acts have been enforced in a manner to which Islington had hitherto been a stranger ; while the inspection of food has been thorough. The natural consequence has been that people now live in more sanitary houses, that more genuine food and drugs are sold, and that your food supplies are exceptionally sound. I cannot forget that much ol the active health administration of Islington has been due to the gentleman (R. S. Cufflin, Esq.) who from 1891 down to 1900 so ably presided over and guided the deliberations of the Public Health Committee, and that they with him have always supported the staff of the Public Health Department in the discharge of its duties. Recollecting these facts I now tender on behalf of myself and the staff under me our sincerest gratitude and thanks for that support, without which we could have effected very little good. In conclusion I pray that we as a staff may be fortunate enough under the new Council to serve a Public Health Committee composed of gentlemen who will discharge their duties with such a single eye to the best interests of their Borough as those whom they will succeed. I am, Your obedient Servant, ALFRED E. HARRIS, July 1st, 1900. Medical Officer of Health. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1899. The general health of Islington during the year 1899 was satisfactory, for I find that its death-rate was better than that experienced in England and Wales by 0*3 per 1,000, than that in the 33 Great Towns by 2*4 per 1,000, than that of London by 1*3, and than that of the Seven Sanitary Areas which encircle it by i*3 per 1,000. The zymotic death rate was 2*21 per 1,000, which was the average rate of the Country, and was below that of the 33 Great Towns, where it averaged 2'8i, of the 67 other Great Towns in which it was 2*45, of the Encircling Districts wherein it was 2*53 per 1,000. The case-rate arising from the notified cases of infectious disease was 8*44 per 1,000 of the population, as against an average of 9*53, which obtained in the preceding eight years. The calculations contained in this report are based on the following figures. AREA, POPULATION AND DENSITY OF ISLINGTON. Area.—Islington covers 3,109 acres, inclusive of canals, railways, markets and open spaces, while its net area is slightly over B 1899] 10 2,884½ acres. The difference between the gross and net areas is made up as follows :— Water (Canals and New River Aqueducts) 13*2 acres. Railways 158*5 „ Markets 15*5 „ Parks and Open Spaces 37*5 „ Total unavailable space 2247 „ Water covers 4*1 acres in the Sub-district of South-west Islington, 67 acres in South-east Islington, and 2*4 acres in Highbury. Railways occupy 21*5 acres in Upper Holloway, 55 in Southwest Islington, and 82 in Highbury. Markets render 15*5 acres unavailable for habitation in Islington South West. Parks and Open Spaces occupy 7 acres in South-west Islington, 3*5 acres in South-east Islington, and 27 acres in Highbury. Net Area of Sub-Districts.—On deducting these areas from the gross acreage of the several sub-districts there remain available In Upper Holloway 1,006½ acres. In South-west Islington 731½ „ In South-east Islington 452¾ ,, In Highbury 693¾ „ 2,884¾ „ Density of Population.—There are 112 persons living on each acre of the parish, a figure far in excess of any that is known in the Great Towns, the most densely populated of which is Bolton with 68*8 persons per acie. In Huddersfield the density is only 87 per acre, which is the lowest in these great centres of population. To show the enormous difference between the density of Islington, as well as of other London districts, and that of provincial towns, it is necessary to state that in Nottingham it is only 21*8 per acre, in Leicester 24*9, in Hull 26*0, in Bristol 27*5, in Birmingham 40*5, in Manchester 42*1, in Liverpool 47*9. No doubt if this density 11 [1899 were calculated on net acreage considerable allowances would have to be made, but nevertheless, the difference between 112 persons per acre, as in Islington, and the densities of the places mentioned is so great that it is almost certain that they would hardly approach this district when every allowance had been made. If the density of the population of Islington be calculated on its net area, it would be found to be 121 (actually 120-9) instead of 112 persons to the acre. The following figures give the densities of the sub-districts as calculated on their gross and net acreage:— Densities calculated on Gross Acreage. Densities calculated on Net Acreage. Increased Density. Upper Holloway 100*8 103-0 2*2 South-west Islington 133*6 148-4 14*8 South-east Islington 147-2 150-5 3*7 Highbury 84-7 98*3 13-6 Islington i 12*0 120*9 8-9 These figures show that the densities of the districts are considerably affected in South-west Islington and in Highbury. Table I. Showing the Areas, Densities, and Estimated Populations of the Sub-registration Districts. Sub-Districts. Areas in Acres. Persons to an Acre. Acres to a Person. Estimated Number of Persons living at the middle of 1899. Upper Holloway 1,028 100-8 0*0099 103,732 Islington, South-west 813 133-6 0-0075 108,593 ,, South-east 463 147-2 0-0068 68,172 Highbury 805 84-7 0-0118 68,234 The Parish b 2 3,109 I 12*0 0-0089 348.731 1899] 12 Table II. Showing the Areas, Densities, and Estimated Populations of the Wards. Wards. Area in Acres. Persons to an Acre. Acres to a Person. Estimated Number of Persons living at the middle of 1899. Tufnell 420 81 0.01 34,049 Upper Holloway 291 131 0.008 38,182 Tollington 320 98 001 31,551 Lower Holloway 415 102 001 42,357 West Highbury 452 85 001 38,437 East Highbury 353 84 001 29,797 Thornhill 172 195 0 005 33,586 Barnsbury 141 166 0 006 23,413 St. Mary's 148 121 0 008 17,882 Canonbury 234 111 0009 26,060 St. Peter's 163 205 0 005 33,467 Islington 3,109 112 0 009 348,731 Population.—It was estimated to have been 348,731 at the middle of the year. This is an increase of 3,723, or 1*1 per cent., on the population of 1898. This percentage increase is not nearly so great as that which has been known in the past history of the parish, for during the decennial periods from 1801 to 1891 the average annual increases have been as follows:— From 1801 to 1810 3*97 per cent, per annum. „ 1811 „ 1820 4*05 „ „ „ 182 „ 11830 6*64 „ „ „ 1831 „ 1840 4-94 „ „ „ 1841 „ 1850 7*07 „ „ „ 1851 „ 1860 6*31 „ „ „ 1861 „ 1870 ... 3*71 „ „ „ 1871 „ 1880 3*23 „ „ ,, 1881 „ 1890 ... 1*28 ,, ,, „ 1891 „ 1895 ... 11*0 „ „ (5 years) 13 [1899 From 1850 to 1895 the percentage increase has gradually become less, so that in the last-mentioned period it had fallen to 1*10 per cent, per annum. It is on this latter basis that the increase of the population from 1895 to the present time has been calculated. The rate of increase in London was 1*00 per cent., and is therefore slightly below that of Islington. The estimated population of each sub-registration district is as follows:— Sub-Districts. Populations. Increase. Percentage. Increase. 1899 1898. Upper Holloway 103,732 102034 1,698 1*6 South-west Islington 108,593 108,211 382 0*3 South-east ,, 68,172 67,667 505 0*7 Highbury 68,234 67 096 1,138 1*7 Total 348,731 345,008 3,723 1*1 The Ages of the Population.—This estimate is based on the results of the Census of 1891, for in 1895 no return was made of the ages of the several persons living in London. At that period the following information was obtained respiting Islington. In every 1,000 of the population 118 were under 5 years of age. 206 were between 5 years and 15 years. 200 „ ,, 15 ,, 25 ,, I72 .» » 25 .. 35 ,, 124 ,, ,, 35 ,, 45 ,, 87 „ „ 45 ,, 55 ,, 54 ,, ,, 55 ,, 65 ,, 28 ,, ,, 65 ,, 75 ,, 11 „ „ 75 ,, 85 „ and upwards. From these figures it has been calculated that the ages of the population at the several periods of life were as given in the subsequent statement. 1899] 14 Table III. Showing the Estimated Number of Persons living in the Parish at the middle of 1899, at Nine Age Periods, and distinguishing Males atid Females. 1899. Ages. Males. Females. Persons. 0—5 20,566 20,582 41,148 5—15 35,628 36,210 71,838 15—25 32,292 37,450 69,742 25—35 28,490 31,490 59,980 35—45 20,560 22,680 43,240 45—55 14,060 16,280 30,340 55—65 7,943 10,890 18,833 65—75 3,970 5,800 9,770 75 and upwards 1,231 2,609 3,840 All ages 164,740 183,991 348,731 In order that the relative importance of the figures given in this report concerning England and Wales, the Urban Districts, the Rural Districts, and London, may be better appreciated, I reprint Table IV. It will be noticed that the age distribution in London and in Islington is almost identical. For this reason the several nativity and mortality returns are comparable without any correction being necessary for age. The two Tables immediately following have been prepared from the retnrns of the Registrar-General, and will be found useful for comparative purposes. 15 * [1899 Table IV. Showing the number of Persons in the several Districts mentioned living at Nine Groups of Ages in every thousand of their population. DISTRICTS. —5 —15 —25 —35 —45 —55 —65 —75 75 and upwards. England and Wales 123 228 193 151 115 86 57 34 13 Urban Districts 123 225 199 157 118 85 53 30 10 Rural ,, 123 237 178 134 107 88 67 46 20 London 119 207 201 170 123 87 53 29 11 Islington 118 206 200 172 124 87 54 28 11 The two Tables immediately following have been prepared from the returns of the Registrar-General with a view to rightly appreciating the comparative returns from other places, which are given throughout this report. 1899] 16 Table V. Showing the Estimated Populations, Densities and Death Rates of the 33 Great Towns, arranged in order of Density. Districts. Estimated Populations, 1899. Density (Persons to an Acre). Death Rates. Area in Acres. All Causes. Zymotic Diseases. Huddersfield 103,464 8.7 16.2 1 79 11,852 Halifax 97,721 11.5 18.3 1.50 8,530 Croydon 127,759 14.2 15.0 1.56 9.012 Norwich 113,266 15.0 17.3 2.40 7,558 Sheffield 361.169 18.4 22.2 4.39 19,651 Blackburn 135,154 19.4 19.1 2.67 6,974 Leeds 423,889 19.6 19.1 2 79 21,572 Swansea 103,722 20.4 18.1 2.67 5 087 Nottingham 239,?84 21.8 20.0 3.33 10,935 Bradford 236,241 21.9 18.4 2.33 10,791 Leicester 213,851 24. 9 17.7 3.31 8,586 Wolverhampton 88,821 25.2 21.8 2.56 3,525 Hull 234.270 26.0 19.3 3.66 8,226 Bristol 320,911 27.5 182 1 86 4,461 Burnley 113,081 28.8 196 4.35 3,923 Preston 117,622 28.8 22.8 3.93 4 089 Cardiff 185,826 30.6 15.4 2.06 6,064 Derby 106.401 30.8 16.9 1.65 3.400 Oldham 150,772 31.9 20.5 2. 16 4,730 Birkenhead 115,162 33.0 19.2 2.65 3,849 Gateshead 106,552 34.0 18.8 2.09 3,138 Birmingham 514,956 40.5 20.8 2.96 12,705 Portsmouth 190,741 40.9 19.7 3.51 4,820 Manchester 543,902 42.1 24.6 3.92 12 911 Salford 218,244 42 2 23.8 4.32 5,171 Newcastle 228,625 42.6 20.6 182 5,371 Plymouth 100,637 43.9 21.7 1.93 1,540 Sunderland 145,613 44.2 21.5 2.50 2,868 Liverpool 634,212 47-9 26 4 3 77 6,552 Brighton 123,226 48.7 19.0 2.50 2,529 London 4,546,752 60.9 19.3 2.46 74.672 West Ham 300,241 63.8 16.7 3.50 4,706 Bolton.. 162,221 68 8 19.9 3.18 2,357 Islington 348,731 112.0 18 O 2.21 3,109 17 [1899 Table VI. Showing the Estimated Populations, Areas, Densities and Death-rates of London, and the several Metropolitan Sanitary Districts in 1899, arranged in order of Density. Districts. Estimated Population, 1899. Area in Acres. Persons to each Acre. Death Rates. All Causes. Zymotic Diseases. Cols. 1 2 3 4 5 London 4,546,782 74,672 60.9 19.3 2.46 Lee 40,219 7,000 5.7 15.1 2.06 Lewisham 91,027 5,773 15.7 10.3 2.23 St. Mariin-in-the-Fields .. 12,142 654 18.5 15.6 1.07 Plumstead 64,031 3,383 18.9 14.3 1.35 Wandsworth 209,655 9,285 22.0 15.3 1.89 Hampstead 80,252 2,248 35.7 11.6 1.16 Woolwich 41,542 1,120 36.9 21.2 2.44 Hammersmith 108,785 2,286 47.6 19.0 2.11 Greenwich 182,513 3,425 53.3 18.8 2.76 Kotherliithe 41,050 754 54.4 21.1 2.80 Stoke Newington 35,187 638 55.1 12.7 1.33 Camberwell 264,817 4,450 59.5 17.4 2.52 Westminster 52.117 813 64.1 22 3 1.64 Hackney 222,571 3,299 67.5 16.9 2.22 St.Geoige, Hanover Square 80,876 1,117 72.4 14.2 1.09 Poplar 170,000 2,333 73.1 22.1 8.41 Fulham 130,720 1,701 76.8 19.2 3.23 Lambeth 308,108 3,941 78.2 19. 2 2.65 Kensington 172 899 2,188 79.0 17.7 1.53 Battersea 174,990 2,109 80.6 16.7 2 2.2 St. Ulave, Southwark 11,098 125 88.8 24.9 2.61 St. Pancras 244,548 2,072 91.5 20.3 2.69 Marylebone 140,139 1,500 93.0 18.6 1.70 London City 27.986 286 97.8 21.3 1.36 Paddington 128.794 1,250 102.5 16.1 1.55 Islington 348.731 3,109 112 0 18 O 2.21 St. Saviour, Souihwark 24,207 204 118.6 25.1 3.51 Chelsea 96,721 794 121.8 19.6 2.13 Limehouse 58,804 465 126.4 25.6 3.78 St. James, Westminster 21,827 103 133.8 17.9 1.12 Bermondsey 85,835 627 136.9 24.1 3.46 Strand 23,016 166 138.0 22.7 1.30 St. Giles' 37,190 244 152.4 19.9 1.40 Mile End Old Town 113,101 077 107.1 21.3 2.27 Bethnal Green 128,938 755 170.7 22.8 3.15 St. Luke 40,868 237 172.4 28.4 3.03 Clerkenwell 66,068 380 173.8 22.6 3.04 Holborn 29,621 168 176.3 24.9 2.23 Shoreditch 121,071 048 186.8 23.8 3.64 Newington 124,160 031 196.7 24.0 3.67 St. George-in-the-East 48,560 244 199.0 27.1 3.44 St. George, Southwark 00,536 284 213.1 27.7 4.53 Whitechapel 81,391 357 228.0 211 212 In this Table it is seen that there are 25 Metropolitan Sanitary Districts with a lesser, and 17 with a greater, density than Islington. 1899] 18 The New Census.—In the early part of next year a new census will be taken, but it is not anticipated that the rate of increase will differ very materially in Islington from that which was ascertained in 1895. It is to be hoped when the enumeration is made, that the work will devolve on trusty enumerators, who will not perform it hurriedly, or in any way scamp it. In the past this has too often been the case throughout the country, where instances have been known of the enumerators, duly appointed for the purpose, getting their work done by others, to whom they paid a small fee for their trouble, and who, therefore, were more or less careless in its execution. Many complaints have been made that the enumerators have been poorly paid, and that they, therefore, did not give that great care and attention to their work which its great importance deserved. The matter rests, to a large extent, in the hands of the Registrar-General, for undoubtedly, if the persons who are selected, provided that they are in every way suitable, be paid well for their labours, results more exact than hitherto will be obtained. There was never a period in the history of the Metropolis when it was so necessary as now to ascertain how the people are housed, or when it was so necessary to have accurate returns as to the numbers of occupiers dwelling in tenements. Figures that are beyond dispute are much required, so that the Sanitary Authorities of London may be placed in possession of particulars of every house let in lodgings or occupied by members of more than one family. It is only when they receive them that they will be able to deal with much of the overcrowding that undoubtedly prevails, more or less, in every district, and which affects not only the health of the occupiers directly, but of the public indirectly. In my last annual report I discussed briefly the conditions as to overcrowding in Islington, and, therefore, I do not propose to pursue the subject now, beyond noting that at the present time it is almost impossible for the working classes to procure rooms. Indeed, the difficulties which those who have the misfortune to have large families have to overcome in obtaining apartments are 19 [1899 almost insuperable, for owners or tenants will not let their tenements to them. Consequently I have not been surprised to find that some of these people have been compelled to undertake the serious responsibility of renting a whole house, trusting to meet their obligations by letting those rooms which they do not require for their own use. I was much surprised, recently, to find that a house, which is on the register of Houses let in Lodgings, was occupied by a blind man, who told me that he had been for thirty years in the receipt of parish relief. This man, of course, let his rooms to others, who only just paid him their exact proportion of rent, and no more, so that the remainder had to be made up by whatever money his wife could make by charing and similar work. Of course he had no means with which to affect the annual cleansing which the by-laws require. The owners of the property, a well-known firm, when appealed to, positively refused to do it, and in a letter addressed to myself have thrown the responsibility on the Vestry. To take such a case to a Court would only result in the tenant, already a pauper, being mulct in a fine which he could not pay; while, on the other hand, if a summons were issued against the owners under the Public Health (London) Act requiring them to cleanse the premises, it would to a certainty be dismissed on the ground that cleansing, lime-washing, etc., was decorative work, and did not come under the sections dealing with nuisances. I have frequently heard Magistrates deciding in this manner, as I have also heard them affirm that dilapidations, broken walls, floors, ceilings, etc., cannot be dealt with under the Act. There can be no doubt that the law requires amendment, for undoubtedly such defects are * nuisances, for they harbour dust and dirt, and afford lodgment for the germs of infectious disease. MARRIAGES. During the year 6,508 persons were married, which is equal to a rate of 18*8 persons per 1,000 of the population. This was an increase of 1,068 persons married on the average number recorded during the preceding ten years. 1899] 20 The following statement shows the number of persons married during each quarter:— No. Persons married. ns married per 1,000 inhabitants. ist quarter 996 = 11.42 2nd „ 1,654 = 18.97 3rd „ 2,028 = 23.26 4th „ 1,830 = 21.17 The year 6,508 = 18.82 In the preceding ten years the marriages and the marriage-rates are shown below:— Years. No. Persons Married. Persons married per 1,000 inhabitants. 1889 4,886 = 15.62 1890 4,970 = 15.70 1891 5,482 = 16.95 1892 5,566 = 17.14 1893 5,306 = 16.16 1894 5,388 = 16.23 1895 5,36o = I5.97 1896 5,938 = 17.25 1897 6,000 = 17.58 1899 6,410 = 18.57 Mean of 10 years 5,530 = 16.81 1899 6,508 =18.82 Increase on mean . 1,068 = 2.01 21 [1899 The following are the annual rates of persons married per 1,000 of the population in the places mentioned :— England and Wales 16.5 London 18.4 Islington 18.8 Table VII. Showing the Marriages and Marriage Rates in the several periods mentioned. Periods. Marriages. Persons married per 1,000 of the Population. 1841-50 6,109 1603 1851-60 10,901 18.12 1861-70 16,194 17.55 1871-80 20,958 16.88 1881-90 23,324 15.49 1891-98 (8 years) 22,725 17.09 BIRTHS. There were 9,658 living children born, or 205 more than the return of the year 1898, but 549 below the corrected average of the preceding ten years. It is, however, 31 above the average of those years before correction had been made for the increase in the population. The birth-rate was 277 per 1,000 compared with 29.3, which had obtained during the ten years 1889-98. There has been, therefore, a decrease of 5½ per cent, on the decennial mean rate. It is also lower than that which has been noted from other places. Thus, it is 1.6 per 1000 below the rate of England and Wales, 3.0 below that of the 32 Great Provincial Towns, 1.7 below that of the 67 Lesser Towns, 1.7 below that of London, and 16 below that of the sanitary areas which encircle the Parish. 1899] 22 The birth-rate was almost identical with the rate of 1898, when it was 27.4 per 1,000, which was the lowest on record. Islington is not, however, alone in low birth-rates, for the Registrar-General has reported that the birth-rate for England and Wales during 1899 was lower than in any other year on record, and he has also intimated that this was also the case in London. The birth-rates of the London Districts ranged from 12.2 in St. Martin to 44.4 in St. Luke, while in the Great Towns the lowest birth-rate (20.2 per 1,000) was known at Bristol, and the highest at Gateshead (36.6 per 1,000). The following statement gives the birth-rate for the country as well as for some of the most populous places:— England and Wales 29.3 per 1,000. 33 Great Towns 30.2 ,, „ „ less London 30.7 ,, 67 Urban Districts 29.4 ,, London 29.4 ,, Birmingham 34.3 ,, Liverpool 35.6 ,, Manchester 32.6 ,, Leeds 30.6 ,, Sheffield 34.6 ,, Bristol 29.2 ,, The Encircling Districts 29.3 ,, St. Pancras 2 7.1 ,, Stoke Newington 22.8 „ Hackney 29.1 ,, Hornsey 22.1 ,, Clerkenwell 31.1 ,, St. Luke 44.4 „ Shoreditch 34.2 ,, Islington 27.7 ,, 23 [1899 Locally the birth-rate was nowhere high. It ranged from 24.20 in Highbury to 30.10 in Islington South West, while in Upper Holloway it was 26.91 and in Islington South East 28.55 Per 1.000. Births. Birth-rate. Upper Holloway 2,792 = 26.91 per 1,000. Islington South West 3,269 = 30.10 „ Islington South East. 1,946 = 28.55 „ Highbury 1,651 = 24.20 „ The Parish 4,958 = 2770 „ Table VIII. Showing the Population, Births and Birth-rates in the several decades since 1841, in the eight years 1891-8, and in 1899. Periods. 1 Mean Popnlation in each Decade. 2 N umber of Births in each Period. 3 Birth-rates. 4 Average Yearly Number of Births, corrected on the basis of the Population of 1899. 5 1841-50 72,767 20,850 28 65 9,993 1851-60 121,353 41,915 34 54 12,045 1861-70 181,529 67,520 37 20 12,970 1871-80 244,884 89,627 3660 12,762 1881-90 299,857 97,647 3256 11,355 1891-98 (8 years) 332,366 77,695 29 22 8,151 1899 348,731 9,658 27 70 9,658 1899] 24 Table IX. Showing the Births, Birth-rates, &c., in Islington, for the year 1899, and for the preceding 27 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 1899 9,658 27.7 4,958 4,700 94.8 3,365 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 9,32 37.5 4,657 4,375 93'9 4,376 1876 9,186 37.1 4,735 4,45i 94.0° 4.397 1877 9,3io 36-6 4,807 4.503 937 4,472 1878 9,456 36-1 4.736 4,720 997 4,298 1879 9,917 36-8 4.965 4.952 997 4.596 1880 9,846 35.5 5.155 4.693 9i.i 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.o 5,i3i 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 31.9 4.929 4.797 9 7.3 4.326 1888 9.568 3°*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 30.6 4,891 4.906 100.3 3.940 1892 9,552 29'5 4.904 4,648 947 3,867 1893 9,749 29.8 5.032 4.717 937 3.358 1894 9,502 287 4,862 4,640 95'4 4,239 1895 9,879 29.6 4.963 4>916 99'0 4,119 1896 9,921 28.8 5,054 4,867 96.3 4,o37 1897 9.842 28.8 5,045 4.797 95.1 4.447 1898 9,453 27.4 4,759 4,694 98.6 3.748 25 [1899 Table X. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1899 and in the four quarters of the year, together with the rates in 1898 and of London and the Great Towns during the same period. Quarter. Males. Females. Total. Birth Rate. Birth Rates. 1898. London, 1899. 33 Great Towns, 1899. 1st 1,291 1,202 2,493 28.59 27.83 30.8 30.8 2nd 1,229 1,196 2,425 27.81 26.82 29.6 30.8 3rd 1,258 1,172 2,430 27.87 28.59 28.6 29.8 4th 1,160 1,130 2.310 26.49 26.34 28.4 29.4 The Year 1899 4,958 4,700 9.658 27.70 27.39 29.4 30.2 1898 4,759 4,694 9,453 27.39 27.70 29.5 30.3 Increase or decrease on 1898 + 199 + 6 + 205 + 0.31 +0.31 -0 1 -0.1 Table XI. Showing the Births of Mules and Females for each quarter and for the year in the several Sub-registration Districts. Upper Holloway. Islington South-west. Islington South-east. Highbury. Whole Parish. 1st. Qr. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. j Total. Males. Females. Total. 355 330 685 449 412 861 276 248 524 211 212 423 1,291 1,202 2,493 2nd „ 370 358 728 392 393 785 223 246 469 244 199 443 1,229 1,196 2,425 3rd ,, 382 367 749 420 386 806 242 240 482 214 179 393 1,258 1,172 2,430 4th ,, 334 296 630 394 423 817 240 231 471 212 180 392 1,180 1,130 2,310 Year C 1,441 1,351 2,792 1,655 1,614 3,269 981 965 1,946 881 770 1,651 4,958 4,700 9,658 1899] 26 Table XII. showing the Birth-rate for each quarter and tor the year, of Islington, of London, and of the 33 Great Towns. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Upper Holloway 26.41 28.07 28.88 24.29 26.91 Islington, South-west 31.71 28.91 29.69 30.09 30.10 Islington, South-east 30.74 27.52 28.28 27.63 28.55 Highbury 24.79 25.97 23.04 22.98 24.20 Islington 28.59 27.81 27.87 26 49 27.70 London 30.8 29.6 28.6 28.4 .. 33 Great Towns 30.8 30.8 29.8 29.4 .. 27 1899 DEATHS. The mortality returns are higher than at any period during the preceding five years. The deaths numbered 6,293, of which 3,217 were those of males and 3,076 females, and are 89 above the corrected mean of the preceding fourteen years. Years. Deaths. Deaths per 1000 population. 1885 5,740 19.3 1886 5,434 18.0 1887 5,699 18.7 1888 5,197 16.8 1889 5,035 16.1 1890 6,198 19.2 1891 6,326 19.8 1892 6,075 18.8 1893 6,391 19.5 1894 5,263 15.9 1895 5,760 17.2 1896 5,884 17.1 1897 5,395 15.8 1898 5,705 16.5 Mean 5,718 17.78 Corrected Mean 6,201 17.78 1899 6,293 18.04 Increase on corrected mean 89 0.26 The death-rate of Islington, a very large urban district, much congested, is, however, lower than that of the country (England C 2 28 1899] and Wales) by 0.2 per 1,000. It is also lower than the death-rate of the 33 Great Towns, which includes London, by as much as 2.4 per 1,000; it is also below that of the same towns less the Metropolis by 2.5 per 1,000; and it is identically the same as the death-rates experienced in the 67 Other Large Towns, not included among the Great Towns. The London death-rate is higher than it by 1.3 per 1,000, and only 14 out of the 42 Metropolitan areas occupy so good a position in the mortality bills. Because of the great difference between one town and another in the age distribution of the population (for example vide Table IV., page 15) the recorded death-rates, also called crude death-rates, require to be corrected before they are rightly available for comparative purposes. In the two following Tables (XIII. and XIV.) factors are given for the necessary corrections both for the 33 Great Towns and for the Metropolitan Sanitary Areas. By multiplying the crude death-rates by these factors the corrected death-rates are obtained. In calculating the "comparative mortality figure" given in the fifth column the death-rate of England and Wales has been taken as the standard, and as 1,000, and the corrected death-rate has been reduced to a figure comparable with that number. This column in these tables may be read as follows: After making approximate correction for differences of age and sex constitution, the same number of lives that in the year 1899 gave 1,000 deaths in England and Wales as a whole, gave 1191 in the 33 Great Towns, 855 in Croydon, 984 in West Ham, 1,019 in Derby, 1,053 in Islington, 1,183 in St. Pancras, 1,580 in Liverpool, and 1,675 in St. Luke. It is, therefore, in the light of these corrections that comparisons between the several places mentioned in the two subsequent tables should be made. 29 [1899 Table XIII. Recorded and Corrected Death-rates per 1,000 persons living in 33 Great T»wns in 1899 and it Islington, arranged in order of their Corrected Death-rates. Towns, in the order of their Corrected Death-rates. Standard Death-rate.* Factor for Correction for Sex and Age Distribution.† Recorded Death-rate, 1899. Corrected Death-rate, 1899. ‡ Comparative Mortality. Figure, 1899. § Cols. 1. 2. 3. 4. 5. England and Wales 19.15 1.0000 18.33 18.33 1,000 England and Wales, less the 33 Towns 19.45 0.9845 17.29 17.02 929 33 Towns 17.71 1.0813 20.19 21.83 1,191 Croydon 11.37 1.0424 15.04 15.68 855 Norwich 19.99 0.9579 17.29 16.56 903 Cardiff 17.16 1.1159 15.42 17.21 93 West Ham 17.75 1.0788 16.71 18.03 984 Derby 17.36 1.1031 16.93 18.68 1,019 Huddersfield 16.47 1.1627 16.19 18.82 1,027 Bristol 18.45 1.0379 18.25 18.94 1,033 Brighton 18.94 1.0110 18.95 19.16 1,045 Leicester 17.64 1.0855 17.71 19.22 1,049 Islington 17.90 1.06983 18.0 19.3 1,053 Swansea 17.53 1.0924 18.15 19.83 1,082 Portsmouth 18.73 1.0224 19.70 20.14 1,099 Gateshead 17.83 1.0740 18.79 20.18 1,101 Hull 18.23 1.0504 19.30 20.27 1,106 Halifax 17.20 1.1133 18.25 20.32 1,109 Birkenhead 17.42 1.0993 19.16 21.06 1,149 London 17.97 1.0656 19.78 21.08 1,150 Plymouth 19.70 0.9720 21.72 21.11 1,152 Bradford 16.73 1.1446 18.44 21.11 1,152 Leeds 17.28 1.1082 19.14 21.21 1,157 Blackburn 17.05 1.1231 19.13 21.48 1,172 Nottingham 17.81 1.0752 19.99 21.49 1,172 Newcastle 17.58 1.0892 20.56 22.39 1,221 Sunderland 18.25 1.0493 21.48 22.54 1,230 Bolton 16.90 1.1331 19.89 22.54 1,230 Burnley 16.67 1.1487 19.63 22.55 1,230 Wolverhampton 18.30 1.0464 21.81 22.82 1,245 Birmingham 17.33 1.1050 20.84 23.03 1,256 Oldham 16.72 1.1453 20.47 23.44 1,279 Sheffield 17.22 1.1120 22.16 24.64 1,344 Preston 17.42 1.0993 22.84 25.11 1,370 Salford 17.03 1.1244 23.80 26.76 1,460 Manchester 16.90 1.1331 24.61 27.89 1,522 Liverpool 17.44 1.0980 26.38 28.97 1,580 * The Standard Eeath-rate signifies the rate at all ages calculated on the hypothesis that the rates at each of twelve age-periods in each town were the same as in England and Wales during the ten years 1881-90, the rate at all ages in England and Wales during that period having been 19.15 per 1,000 † The Factor for Correction is obtained by dividing the Standard Death-rate in England and Wales by the Standard Death-rate in each town, and is the figure by which the Recorded Death-rate should be multiplied in order to correct for variations of sex ana age distribution. ‡ The Corrected Death-rate is the recorded Death-rate multiplied by the Factor for Correction. § The Comparative Mortality Figure represents the Corrected Death-rate in each town compared with the Recorded Death-rate at all ages in England and Wales in 1899, taken as 1,000. 30 1899] Table XIV.* Recorded, and Corrected Death Rates per 1,000 Persons living in Metropolitan Sanitary Districts, arranged in order of their Corrected Death-rates. Metropolitan Areas in the order of their Corrected Death rates. Standard Death-rates. Factor for Correction for Sex and age Distribution. Crude or Recorded Death-rates. 1899. Corrected Death-rates. 1899. Comparative Mortality Figure, 1899. Cols. 1 2 3 4 5 England and Wales 19.15 1.0000 18.33 18.33 1,000 England and Wales, less the 33 Towns 19.45 0.9845 17.29 17.02 929 33 Towns 17.71 1.0813 20.19 21.83 1,191 London 17.97 1.0656 19.78 21.08 1,150 Hampstead 16.63 1.15153 11.6 13.3 725 Stoke Newington 17.85 1.07283 12.7 13.6 742 Plumstead 19.09 1.03458 14.3 14.8 807 St. George, Hanover Sq. 17.34 1.10438 14.2 15.7 856 Wandsworth 17.93 1.06804 15.3 16.3 889 Lee 17.67 1.08376 15.1 16.4 894 Lewisham 17.92 1.06864 16.3 17.4 949 Paddington 17.72 1.08070 16.1 17.4 949 Hackney 18.30 1.04645 16.9 17.7 965 Battersea 17.80 1.07584 16.7 18.0 982 Camberwell 18.10 1.05801 17.4 18.4 1,000 St. Martin-in-the-Fields 15.74 1.21665 15.6 19.0 10,36 Islington 17.90 1.06983 18.0 19.3 1,053 Greenwich 18.63 1.02791 18.8 19.3 1,053 Kensington 17.38 1.10184 17.7 19.5 1,063 St. James, Westminster 17.16 1.11597 17.9 20.0 1,091 Marylebone 17.82 1.07464 18.6 20.0 1,091 Fulham 18.27 1.04817 19.2 20.1 1,096 Lambeth 18.24 1.04989 19.2 20.1 1,096 Hammersmith 18.05 1.06094 19.0 20.2 1,102 Chelsea 17.95 1.06685 19.6 20.9 1,140 St. Fancras 17.89 1.07043 20 ..3 21.7 1,183 Rotherhithe 18.49 1.03569 21.1 21.8 1,189 Mile End Old Town 18.58 1.03068 21.3 21.9 1,194 St. Giles 17.27 1.10886 19.9 22.1 1,205 Whitechapel 17.74 1.07948 21.1 22.8 1,244 Poplar 18.49 1.03569 22.1 22.9 1,249 Bethnal Green 18.39 1.04133 22.8 23.7 1,293 Woolwich 16.99 1.12713 21.2 23.9 1,303 City of London 16.65 1.15015 21.5 24.7 1,347 Shoreditch 18.45 1.03794 23.8 24.7 1,347 Clerkenwell 17.28 1.10822 22.6 25.0 1,363 Newington 18.32 1.04531 24.0 25.1 1,369 Westminster 16.94 1.13046 22.3 25.2 1,374 Bermondsey 18.10 1.05801 24.1 25.5 1,391 St. Olave, Southwark 18.42 1.03963 24.9 25.9 1,418 St. Saviour, Southwark 18.29 1.04702 25.1 26.3 1,434 Strand 16.24 1.17919 22.7 26.8 1,462 Holborn 17.62 1.08683 24.9 26.9 1,467 Limehouse 17.59 1.08869 25.6 27.9 1,522 St. George-in-the-East 18.43 1.03907 27.1 28.1 1,533 St. George, Southwark 17.35 1.10375 27.7 30.6 1,669 St. Luke 17.72 1.08070 28.4 30.7 1,675 * Vide Notes to preceding Table. 31 [1899 By applying these tables to Islington, it is found that with regard to the 33 Great Towns Islington occupies tenth place, Croydon, Norwich, Cardiff, West Ham, Derby, Huddersfield, Bristol, Brighton, and Leicester alone being placed in a better position. Similarly, in the Metropolis only 12 out of the 43 sanitary areas of which it is constituted show so low a comparative mortality figure. These districts are Hampstead, Stoke Newington, Plumstead, St. Georges Hanover Square, Wandsworth, Lee, Lewisham, Paddington, Hackney, Battersea, Camberwell, and St. Martin's-in-the-Fields. MORTALITY IN THE SUB-REGISTRATION DISTRICTS. Upper Holloway. In this sub-registration district, whose population is greater than several of the Great Towns, the mortality returns were very satisfactory, for only 1,698 persons, 859 being males and 839 females, died. These deaths were equal to a death-rate of 16.37 per 1,000, compared with an average of 18.04 for the parish, and with a mean death-rate of 17.75 which obtained in the district itself during the eight years 1891-98. During the last five years it has been very healthy, the deathrates having been 15.30, 16.12, 15.93, 14.75 and 15.00 per 1,000. The present return of 16.37 per 1,000 compares favourably with those of the Great Towns whose populations are nearly equal to that of Upper Holloway. Indeed, only one town, Huddersfield, presents so small a mortality. The towns with which comparison may be made are subjoined:— 32 1899] Towns. Populations. Death-rates. Croydon 127,759 16.7 Brighton 123,226 19.0 Plymouth 100,637 21.7 Swansea 106,722 18.1 Wolverhampton 88,821 21.8 Birkenhead 115,162 19.2 Burnley 113,081 19.6 Preston 117,622 22.8 Huddersfield 103,464 16.2 Halifax 97,721 18.2 Gateshead 106,552 18.8 Upper Holloway 103,732 16.4 For some reason, which it is not easy to explain, an idea has obtained currency even among the residents, that this district is an unhealthy one. These figures ought surely dissipate it. But in order to be convinced that in London itself there are few places of its size, and none of its density, so healthy, a reference may be usefully made to Table VI. (page 17), which gives the populations, densities, and death-rates of the metropolitan sanitary districts. The deaths and death-rates for each year since 1891 are given in Table XVI. (page 35). The mortality returns were proportionally heavier in Southwest Islington than in the other sub-registration districts. The deaths numbered 2,184, which represent a death-rate of 20.11 per 1,000, as against a corrected average of 2,040 deaths, and a mean death-rate of 1878 in the preceding eight years. The population of this sub-district is also so large, that, if it were a separate provincial community, it would be included among South-West Islington. 33 [1899 the Great Towns, and would be fairly comparable with the towns I have mentioned in discussing the mortality in Upper Holloway. Its present death-rate is higher than any experienced since 1893 when it was 21.65 per 1,000. An examination of the mortality returns shows that in every one of the great classes of disease the death-rates arising therefrom were above the average of Islington itself, and also that Miasmatic, Constitutional and Developmental diseases, as well as Diseases of the Digestive and Urinary systems were more fatal than in any other sub-district, as were those diseases classed under the heading "ill-defined." Further particulars respecting this district are given in Tables XV. and XVI. page 35. South-East Islington. The registered deaths amounted to 1,318, which is 85 more than the corrected average of the preceding eight years. The death-rate was 19.33 compared with a mean rate of 18.09 Per 1,000 of the population. The death-rates from Constitutional, Nervous, and Respiratory Diseases, and also from Violence, were higher than in any other sub-district, and it is chiefly to them that the increase in the mortality is due. This sub-district as well as Highbury is fairly comparable, so far as population is concerned, with ten of the Large Towns, some of which, however, have natural advantages which South-east Islington does not possess, and are also more favourably circumstanced as regards the status in life of their inhabitants. These towns, together with their respective populations and mortality returns for the year are as follows:— 34 1899] Towns. Populations. Death-rates. Bournemouth 67,771 10.5 Reading 70,888 14.5 Hornsey 66,057 10.6 Northampton 69,743 14.1 Ipswich 63,821 18.8 Devonport 61,459 19.3 West Bromwich 62,296 19.6 Grimsby 64,404 17.6 Wigan 61,359 23.4 Warrington 66,372 19.5 South-east Islington 68,172 19.3 Highbury 68,234 16.0 Additional particulars will be found in Tables XV. and XVI. page 35. Highbury. The returns show an increase of 80 on the corrected average of the preceding eight years. The number of deaths registered was 1,093, which represent a death-rate of 16.01 per 1,000. The latter is 1.16 above the mean rate experienced during the year 1891-98, and is the highest, with one exception (1893), in this period. It will be noticed that its death-rate compares favourably with the rates experienced in many of the Large Towns which have been given above, only Bournemouth, Reading, Hornsey, and Northampton, showing lesser returns. In London, St. George Hanover Square, Hampstead, Stoke Newington, St. Martin, Wandsworth, and Lee, alone show such good health as Highbury, their death-rates being respectively, 14.2, 11.6, 12.7, 15.9, 15.3, and 15.1 per 1,000. Additional particulars are given in Tables XV. and XVI. on page 35. Table XV. Showing the Deaths and Death-rates from eleven Classified Causes of Disease in the Sub-registration districts and in the Parish. Classified Diseases Upper Holloway. South-west Islington. South-east Islington. Highbury. The Parish. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Miasmatic 202 1.95 226 2.08 92 1.35 125 1.83 645 1.85 Diarrhœal 76 0.73 112 1.03 40 0.59 30 0.44 258 0.74 Constitutional 289 2.78 381 3.50 252 3.70 193 2.82 1,115 3.19 Developmental 181 1.74 226 2.08 124 1.82 115 1.68 646 1.85 Nervous 131 1.26 159 1.46 108 1.58 99 1.45 497 1.43 Circulation 143 1.38 165 1.52 112 1.64 98 1.43 518 1.48 Respiration 321 3.10 436 4.01 308 4.52 207 3.03 1,272 3.64 Digestive Org's 131 1.26 174 1.60 106 1.55 76 1.11 487 1.39 Urinary System 47 0.45 50 0.46 20 0.29 29 0.43 146 0.42 Violence 50 0.48 82 0.75 55 0.86 42 0.62 229 0.66 Ill-defined 80 0.77 118 1.08 69 1.01 36 0.52 303 0.87 The black figures denote that these were the highest rates experienced in the several districts. Table XVI. Showing the Deaths and Death-rates of each Sub-district and of the Parish during the eight years 1891-8 and in 1899. Years. Upper Holfoway. S.W. Islington. S.E. Islington. Highbury. Parish. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rate. Deaths. Death Rates. Deaths. Death Rates. 1891 2,176 24.01 2,065 19.56 1,148 17.86 937 15.76 6,326 19.8 1892 2,158 23.40 1,813 17.10 1,152 17.79 952 15.73 6,075 18.8 1893 1,702 18.14 2,303 21.65 1,378 21.12 1,008 16.37 6,391 19.5 1894 1,458 15.30 1,859 17.42 1,081 16.45 865 13.80 5,263 15.9 1895 1,564 16.12 2,023 18.90 1,234 18.65 939 14.73 5,760 17.2 1896 1,603 13.93 2,099 19.16 1,185 17.44 997 15.08 5,884 17.1 1897 1,481 14.75 1,855 17.20 1,173 17.46 886 13.43 5,395 15.8 1898 1,530 15.00 2,050 18.94 1,194 17.64 931 13.87 5,705 16.5 Corrected mean 1,841 17.75 2,040 18.78 1,233 18.09 1,013 14.85 6,127 17.60 1899 1,698 16.37 2,184 20.11 1,318 19.33 1,093 16.01 62.93 18.04 36 1899] Table XVII. Showing the Sexes of the Persons who died in 1899. Registration Sub-Districts. Males. Females. Persons. Death Rates. Upper Holloway 859 839 1,698 16.37 Islington, S.W. 1,151 1,033 2,184 20.11 Islington, S.E. 667 651 1,318 19.33 Highbury 540 553 1,093 16.01 The Parish 3,217 3,076 6,293 18.04 AGES AT DEATH. An examination of the mortality returns shows that at every age period, with two exceptions, there was an increase on the average of the preceding six years. The exceptions occurred in the two periods which cover the greater part of juvenile life, namely, from 1 year to 5 years of age, and from 5 years to 15 years. Infants under twelve months old died in greater numbers than usual, the returns showing an increase of 119. Nevertheless, the total increase under 5 years was only 19. The largest increase at any period occurred between the ages of 55 and 65, and for this Influenza was largely responsible. The following Tables give very full particulars of the deaths at each period of life, and also of the death-rates at those periods. 37 [1899 Table XVIII. Showing the Ages at Death during the Years 1893—1899. Years. AGES. Totals 0—1 1—5 All under 5 yrs. 5—15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85—95 95 &c. All above 5 yrs. 1893 1,595 903 2,498 301 248 410 537 587 596 664 436 111 3 3,893 6,391 1894 1,229 885 2,114 259 231 329 388 452 485 541 389 72 3 3,149 5,263 1895 1,416 803 2,219 220 231 333 461 507 561 616 500 104 8 3,541 5,76o 1896 1,490 1,008 2,498 277 228 290 465 564 493 591 385 91 2 3,386 5,884 1897 1,338 679 2,017 207 230 297 474 496 546 585 449 91 3 3,378 5,395 1898 1,504 924 2,428 161 196 292 435 497 560 585 444 105 2 3,277 5,705 Mean. 1,429 867 2,296 238 227 325 460 517 540 597 434 96 3 3,437 5,733 1899 1,548 767 2,315 212 248 349 486 610 700 712 540 115 6 3,978 6,293 Increase or Decrease + 119 —100 +19 — 26 + 21 + 24 + 26 +93 + 160 + 115 + 106 + 19 + 3 + 541 + 560 38 1899] Table XIX. Showing the Population, together with the Deaths and Death-rates from All Causes at Nine Age-periods of life among Males, Females and Persons. Males. Females. Persons. Ages. Population. Deaths. Death Rates. Population. Deaths. Death Rates. Population. Deaths. Death Rates. 0—5 20,566 1,255 61.02 20,582 1,060 51.50 41,148 2,315 56 26 5—15 35,628 111 3.11 36,210 101 2.79 71,838 212 2 95 15—25 32,292 152 4.71 37,450 96 2.56 69,742 248 3 55 25—35 28,490 196 6.88 31,490 153 4.86 59,980 349 5-82 35—45 20,560 271 13.18 22,680 215 9.48 43,240 486 11 24 45—55 14,060 302 21.48 16,280 308 18.92 30,340 610 2010 55—65 7,943 358 45.07 10,890 342 31.40 18,833 700 37 16 (55—75 3,970 340 85.65 5,800 372 64.13 9,770 712 72-88 75 and upwards 1,231 232 188.44 2,609 429 164.43 3,840 661 172 14 All ages 164,740 3,217 19.52 183,991 3,076 16.72 348,731 6,293 1804 The deaths of 695 persons who had come from other districts of London for treatment in the Public Institutions of Islington are excluded from these returns, while the deaths of 593 persons who had died outside the district are included. SEASONAL MORTALITY The heaviest mortality occurred in the fourth quarter, when 1,759 deaths were registered, and when the resulting death-rate was 20.17 per 1,000. The least number of deaths occurred in the second quarter in which only 1,281 deaths were known, and when the death-rate was 14.69 per 1,000. Deaths. Death Rate. 1899. Mean Death Rate 1885-98. First Quarter 1,681 = 19.28 20.81 Second Quarter 1,281 = 14.69 16.30 Third Quarter 1,572 = 18.03 16.24 Fourth Quarter 1,759 = 20.17 17.77 The Year 6,293 18.04 17.78 39 [1899 First Quarter.—1,681 deaths, equal to a death-rate of 19.28 per 1,000, were registered. Compared with the mean mortality of 20.81 per 1,000 experienced at the same period of the year during the preceding fourteen years, it must be considered satisfactory, more especially as it contrasts favourably with the mortality in the 33 Great Towns, whereof the death-rate was 20'6 per 1,000, and with the Encircling Districts wherein it was 19.92. Miasmatic and Developmental diseases, as well as Diseases of the Urinary System, were more fatal than at any other period of the year. Among the Miasmatic diseases Whooping Cough and Influenza were the chief factors in the mortality, the former causing 61 deaths and the latter 52; while of the developmental diseases old age was the ascribed cause of 160 deaths, or 43 more than in any other quarter of the year, and 72 more than in the corresponding period of the previous year. This increase was most probably due to Influenza, which either had not been recognized or had not been entered as the primary cause of death. Among the diseases of the urinary system, Bright's Disease was the registered cause of 11 more deaths than in any of the other quarters. Second Quarter.—The return of 1,281 deaths was most satisfactory, representing a death-rate of only 14.69 per 1,000 inhabitants. Indeed, this death-rate is so low that it must be considered remarkable for so large and complex a district as Islington. The deaths showed a falling off of 139 on the corrected average of fourteen years, a decrease equal to 1.60 per 1,000 on the mean death rate. Third Quarter.—The mortality returns showed that 1,572 deaths were recorded, which was an increase of 156 on the corrected average of fourteen years. The death-rate was 18.03 or 1.79 per 1,000 above the mean rate. The most fatal diseases were those included under the heading of Diarrhœal and Constitutional diseases, as well as under Diseases of the Digestive system and "Ill-defined Causes." 40 1899] The increased mortality under these headings may really be ascribed to Summer or Epidemic Diarrhoea, for without doubt they were all more or less connected with it or with bowel disorders. Among Diarrhœal Diseases Simple Cholera caused 16 deaths, and Diarrhoea 220. Under Constitutional Diseases, Tabes Mesenterica (Consumption of the Bowels) was responsible for 16 deaths, and Tubercular Meningitis, which so often accompanies Diarrhœa during this quarter, for 37. It is, however, among diseases of the digestive system that the effect of bowel disturbances was most fatal, for no less than 175 deaths were registered from Enteritis and Gastritis, as against 16 in the first quarter, 18 in the second, and 27 in the fourth quarter. Among the deaths from "Ill defined Causes" Marasmus and Atrophy caused 64 deaths, or 19 more than in any other quarter. These departures from the normal mortalities are due to atmospheric and telluric influences, which are discussed in a later part of the report. Although the mortality in Islington was high yet it was not nearly so high as that experienced in other places as will be seen by the following figures. England and Wales 19.2 per 1,000 inhabitants. 33 Great Towns 21.9 „ „ 67 Other Large Towns 20.1 ,, ,, London 20.1 „ „ Birmingham 24.2 „ „ Liverpool 29.9 „ ,, Manchester 27.6 „ „ Leeds 20.1 „ ,, Sheffield 27.4 „ „ The Encircling Districts 20.4 „ „ Islington 18.0 „ „ 41 [1899 Table XX. Shewing the Mean Temperatures for each week of the Third Quarter 1899, together with those of the corresponding periods in 1898, and also the Deaths from Diarrhœa in the same periods. Weeks of Quarter. Mean Air Temperature. Earth Temperature at 8 feet. Rainfall in inches. Diarrhneal Deaths. 1898. 1899. Difference between 1898 and 1899. 1898. 1899. Difference between 1898 and 1899. 1898. 1899. 1898. 1899. Difference. ° ° ° ° ° ° July 8 60.0 62.3 + 2.3 58.89 60.40 + 1.51 0.00 0.13 — 1 + 1 „ 15 61.9 66.2 + 4.3 58.95 62.10 + 3.15 0.02 0.09 1 2 + 1 ,, 22 62.8 70.2 + 7.4 60.71 64.09 + 3.38 0.45 0.06 2 3 + 1 „ 29 61.0 64.8 + 3.8 61.49 65.41 + 3.92 0.72 0.97 2 9 + 7 61.4 65.9 + 4.5 60.01 63.00 + 2.99 1.19 1.25 5 15 + 10 Aug. 5 63.8 57.5 + 3.7 61.11 65.74 + 4.63 0.06 0.09 5 19 + 14 „ 12 61.9 63.8 + 1.9 60.92 66.34 + 6.42 0.56 0.02 14 31 + 17 „ 19 69.5 66.5 - 3.0 63.43 66.13 + 2.70 0.03 0.00 23 38 + 15 „ 26 65.4 66.4 + 1.0 64.80 66.16 + 1.36 0.14 0.00 37 34 - 3 65.1 66.0 + 0.9 62.56 66.09 + 3.53 0.79 0.11 79 122 + 48 Sept. 2 61.1 63.5 + 2.4 63.28 66.18 + 2.90 0.08 0.29 39 82 - 7 „ 9 70.4 65.6 - 4.8 63.74 65.29 + 1.55 0.00 0.54 34 24 - 10 .. 16 66.4 57.5 - 8.9 64.65 64.00 - 0.65 0.02 0.27 26 23 - 3 ,, 23 57.2 54.6 - 2.6 63.57 61.63 - 1.94 0.12 0.36 26 13 - 13 „ 30 52.9 52.1 -0.8 60.76 58.98 - 1.78 0.16 1.01 29 7 - 22 61.6 58.7 - 2.9 63.20 63.21 + 0.01 0.38 0.59 154 99 - 55 d 42 1899] Table XXI. Shewing the Diarrhœal Deaths in the Third Quarter ending September 30th, 1899. 1899. Deaths. Death-Rates. Meteorology. Week Ending. UH. S.W. S.E. H. Total. U.H. S.W. S.E. H. Total. Mean temperature of air in degrees. Departure from mean temperature. Temperature of the earth 3 ft. below surface. Rainfall in inches. No. of days on which rain fell. July 8th . . . . 1 . . 1 . . . . 0.76 . . 0.14 62.3 + 0.4 60.40 0.13 2 „ 15th . . 1 1 . . 2 . . 0.48 0.76 . . 0.29 66.2 + 3.6 62.16 0.09 1 „ 22nd 1 1 1 . . 3 0.50 0.48 0.76 . . 0.44 70.2 + 7.2 64.09 0.06 1 „ 29th 3 5 1 . . 9 1.50 2.40 0.76 . . 1.34 64.8 + 2.4 65.41 0.97 3 4 7 4 . . 15 0.33 0.84 0.76 . . 0.56 65.9 + 3.4 63.00 1.25 7 August 5th 2 8 5 4 19 1.00 3.84 3.82 3.05 2.84 67.5 + 5.3 65.74 0.09 1 „ 12th 7 20 3 1 31 3.52 9.61 2.29 0.76 4.63 63.8 + 1.3 66.34 0.02 1 „ 19th 16 17 2 3 38 8.04 8.16 1.53 2.29 5.68 66.5 + 4.5 66.13 0.00 0 „ 26th 9 10 8 7 34 4.52 4.80 6.12 5.35 5.08 66.4 + 5.4 66.16 0.00 0 34 55 18 15 122 4.27 6.60 3.44 2.87 4.56 66.0 + 4.1 66.09 0.11 2 September 2nd 9 13 4 6 32 4.52 6.24 3.06 4.58 4.78 63.5 + 3.3 66.18 0.29 6 „ 9th 8 8 3 5 24 4.02 3.84 2.29 3.82 3.59 65.6 + 6.5 65.29 0.54 2 „16th 5 10 6 2 23 2.51 4.80 4.59 1.52 3.44 57.5 - 0.4 64.00 0.27 2 „ 23rd 4 8 1 . . 13 2.01 3.84 0.76 . . 1.94 54.6 + 0.2 61.63 0.36 4 „ 30th 2 3 1 1 7 1.00 1.44 0.76 0.76 1.04 52.1 - 2.7 58.98 1.01 5 28 42 15 14 99 2.82 4.04 2.29 2.14 2.96 58.7 + 6.9 63.21 2.47 19 Third quarter 66 104 37 29 236 2.54 3.83 2.17 1.70 2.71 63.5 + 4.8 64.10 3.83 28 43 [1899 Fourth Quarter.—1,759 deaths were registered, equal to a deathrate of 20.17 per annum. The deaths were 209 above the corrected average, and the death-rate (20.17) was 2.40 above the mean of the years 1885-98. The chief factors in the increased death-rate are included under the heading of Respiratory Diseases, which numbered 480 as against 237 in the corresponding quarter of 1898 and more than accounts for the greater mortality. The chief items were Bronchitis 288, and Pneumonia 161 deaths. These numbers are respectively an increase of 155 and 78 on the returns of the previous and the corresponding quarter. In the following Table are collected the deaths and death-rates of each quarter since 1885:— Table XXII. Years. quarters. First. Second. Third. Fourth. Annual. Deaths Death Rates. Deaths Death Rates. Deaths Death Rates. Deaths Death Rates. Deaths Death Rates. 1885 1,551 20.83 1,445 19.40 1,392 18.68 1,352 18.15 5,740 19.3 1886 1,675 22.22 1,151 15.26 1,364 18.09 1,244 16.50 5,434 18.0 1887 1,474 19.32 1,365 17.89 1,450 19.00 1,410 18.48 5,699 18.7 1888 1,629 21.09 1,163 15.05 1,072 13.88 1,333 17.25 5,197 16.8 1889 1,440 18.42 1,186 15.17 1,101 14.07 1,308 16.73 5,035 16.1 1890 1,789 22.60 1,359 17.16 1,282 16.20 1,722 20.20 6,152 19.4 1891 1,698 21.22 1,725 21.56 1,299 16.23 1,604 20.05 6,326 19.8 1892 2,193 27.13 1,260 15.57 1,231 15.22 1,391 17.20 6,075 18.8 1893 1,597 19.53 1,485 18.16 1,558 19.06 1,751 21.41 6,391 19.5 1894 1,613 19.52 1,284 15.54 1,131 13.68 1,235 14.94 5,263 15.9 1895 1,936 23.18 1,210 14.48 1,292 15.47 1,322 15.83 5,760 17.2 1896 1,664 19.71 1,382 14.63 1,336 15.83 1,502 16.52 5,884 17.1 1897 1,421 16.61 1,081 12.67 1,335 15.64 1,558 18.26 5,395 15.80 1898 1,744 20.21 1,246 14.44 1,439 16.68 1,276 14.79 5,705 16.53 Corrected Mean 1,814 20.81 1,421 16.30 1,416 16.24 1,550 17.77 6,201 17.78 1899 1,681 19.28 1,281 14.69 1,572 18.03 1,759 20.17 6,293 18 04 Increase or Decrease -133 -1.53 -140 -1.61 + 156 + 2.79 + 209 + 2.40 + 92 + 0-26 D 2 44 1899] Here it will be noticed that the healthiest first and second quarters occurred in 1897, the healthiest third quarter in 1894, and the healthiest fourth quarter in 1898. The healthiest year was 1897. The figures for these periods are printed in heavy type. Table XXIII. Showing the Deaths and Death-rates from All Causes in the Four Quarters and in the Sub-districts, together with the Death rates in the Parish during the same periods. Quarters. Upper Holloway. South-west Islington. South-east Islington. Highbury. The Parish. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. First Quarter 465 17.93 580 21.36 336 19.71 300 17.58 1681 19.28 Second Quarter 323 12.45 446 16.42 285 16.72 227 13.30 1281 14.69 Third Quarter 442 17.04 558 20.55 315 18.48 257 15.06 1572 18.03 Fourth Quarter 468 18.04 600 22.10 382 22.41 309 18.11 1759 20.17 The Year 1698 16.37 2184 20.11 1318 19.33 1093 16.01 6293 18.04 N.B.—The figures for the healthiest quarter of each district are printed in black type. 45 [1899 Table XXIV. Showing the Deaths and Death-rates from All Causes in the Wards during the Four Quarters of 1899. Wards. First Quarter. Second Quarter. Third Quarter. Fourth Quarter Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 145 17.03 93 10.92 140 16.44 143 16.80 521 15.30 Upper Holloway 184 19.30 135 14.16 156 16.36 172 18.04 647 16.96 Tollington 136 17.24 95 12.04 146 18.51 153 19.40 530 16.80 Lower Holloway 218 20.58 184 17.37 214 20.21 230 21.71 846 19.97 West Highbury 180 18.73 132 13.73 154 16.03 210 21.85 676 17.58 East Highbury 120 16.10 95 12.75 103 13.83 99 13.29 417 13.99 Thornhill 179 21.31 112 13.34 196 23.34 200 23.81 687 20.45 Barnsbury 117 19.99 104 17.77 111 18.96 124 21.18 456 19.47 St. Mary's 108 24.15 82 18.34 71 15.88 96 21.47 357 19.96 Canonbury 102 15.65 98 15.04 121 18.57 125 19.18 446 17.11 St. Peter's 192 22.94 151 18.05 160 19.12 207 24.74 710 21.21 Totals 1,681 19.28 1,281 14.69 1,572 18.03 1,759 20.17 6,293 18.04 N.B.—The black figures show the healthiest Ward in the several periods to which they refer. 46 1899] Table XXV. Showing the Death-rates from All Causes in the several under mentioned places during the Four Quarters and during the entire year. Places. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. The Year 1899. England and Wales 18.9 16.6 ' 19.2 18.6 18.3 33 Great Towns 20.6 17.5 21.9 20.8 20.2 67 Other Large Towns 17.8 16.0 20.1 18.0 18.0 Rural England 17.9 16.2 17.1 17.3 17.1 London (Registration) 20.1 16.2 20.1 20.9 19.3 Bristol 18.4 15.7 17.5 21.4 18.25 Birmingham 19.8 18.5 24.2 20.9 20.84 Liverpool 26.4 22.7 29.9 26.6 26.38 Manchester 25.9 23.6 27.6 21.3 24.61 Leeds 20.3 17.1 20.1 19.0 19.14 Sheffield 21.3 18.2 27.4 21.8 22.16 The Encircling Districts 19.9 16.3 20.3 20.6 19.3 The Encircling Districts. St. Pancras 21.4 17.0 19.6 23.0 20.2 Stoke Newington 11.9 11.9 13.9 13.2 12.7 Hackney 16.7 15.6 18.1 17.1 16.9 Hornsey 11.8 8.0 11.7 10.4 10.5 Clerkenwell 24.3 17.0 23.8 25.4 22.6 St. Luke 29.0 25.3 31.5 27.8 28.3 Shoreditch 24.5 18.6 27.0 25.0 23.7 Islington 19.2 14.6 18.0 20.1 18.0 47 [1899 Table XXVI. Showing the Deaths (arranged in Classes) from All Causes, in the Four Quarters. Classified Causes of Death. Quarters. Year. 1st. 2nd. 3rd. 4th. I. Specific or Febrile Causes 190 171 371 215 947 1. Miasmatic Diseases „ 183 154 126 182 645 2. Diarrhœal „ 1 7 236 14 258 3. Malarial „ .. .. .. .. .. 4. Zoogenous „ .. .. .. .. .. 5. Venereal „ 3 1 2 3 9 6. Septic ,, 3 9 7 16 35 II. Parasitic Diseases 1 1 1 .. 3 III. Dietic „ 7 10 10 5 32 IV. Constitutional Diseases 272 273 288 282 1,115 V. Developmental „ 205 138 131 172 646 VI. Local „ 880 575 629 934 3,018 1. Diseases of Nervous System 134 112 114 137 497 2. ,, Organs of Special Sense 5 2 1 3 11 3. „ Circulatory System 139 114 104 161 518 4 „ Respiratory „ 447 222 123 480 1,272 5. „ Digestive „ 81 75 236 95 487 6. „ Lymphatic „ .. 2 1 1 4 7. „ Glandlike Organs of uncertain use 1 .. 1 3 5 8. „ Urinary System 48 30 31 37 146 9. „ Reproductive System 7 10 8 10 35 10. „ Bones and Joints 5 5 5 2 17 11. „ Integumentary 13 3 5 5 26 VII. Violence 50 60 49 70 229 1. Accident or Negligence 40 48 37 58 183 2. Homicide 4 1 3 1 9 3. Suicide 6 11 9 11 37 VIII. Ill-defined Causes 76 53 93 81 303 All Causes 1,681 1,281 1,572 1,759 6,293 Note.—The heavy figures denote that the diseases to which they are applied were most fatal in the Quarter to which they refer. 48 1899] DEATHS FROM THE PRINCIPAL ZYMOTIC DISEASES. There were 773 deaths registered from the principal zymotic diseases. These were equal to a death-rate of 2.21 per 1,000. In the preceding year 930 deaths were known, and the death-rate was 2.69 per 1,000. The mortality was also less than the average which prevailed during the years 1885-98 (inclusive), when it was 893 while the death-rate was 2.56. Table XXVII. Showing the Deaths from the principal Zymotic Diseases for the Fourteen years 1885-98 and in 1899. Years. Deaths. Deathrates. Years. Deaths. Deathrates. 1885 1,099 3.69 1894 798 2.41 1886 760 2.52 1895 643 1.92 1887 1,036 3.39 1896 1,028 3.04 1888 714 2.31 1897 622 1.82 1889 604 2.01 1898 930 2.69 1890 771 2.44 Corrected mean number of deaths—1885-98 893 2.56 1891 879 2.75 1892 776 2.40 1893 873 2.67 1899 773 2.21 In England and Wales the death-rate was the same as locally, while in the 33 Great Towns it was 2.81, in the 67 Other Large Towns 2.45, and in Rural England 1.71 per 1000. The Islington death-rate contrasted favourably with the rates experienced in the populous districts of England and Wales. This is satisfactory. An examination of the returns of the sanitary areas which surround the Parish shows that the average rate experienced by them was 2.53 per 1,000, or 0.32 per 1,000 more than in Islington. The following death-rates which prevailed in other places are given for the purpose of comparison :— 40 [1899 Zymotic death-rate. England and Wales 2.21 per 1,000 inhabitants. 33 Great Towns 2.81 „ „ 67 Other Large Towns 2.45 „ „ Rural Districts 1.71 „ „ The Encircling Districts St. Pancras 2.67 „ „ Stoke Newington 1.33 „ „ Hackney 2.21 „ „ Hornsey 0.99 „ „ Clerkenwell 3.02 „ „ St. Luke 3.01 „ „ Shored itch 3.61 „ „ The Encircling Districts 2.53 „ „ London West London District 1.91 „ „ North „ „ 2.16 „ „ Central „ „ 2-21 „ „ East ,, „ 3.17„ „ South „ „ 2 62 ft ) 3 London 2.4„ „ Islington 2.21 „ „ Zymotic death-rate West Ham 3.50 per 1,000 inhabitants. Bristol 1.86 „ „ Birmingham 2.96 „ „ Nottingham 3.33 „ „ Liverpool 3.77 „ „ Manchester 3.92 „ „ Salford 4.32 „ „ Bradford 2.33 „ „ Leeds 2.79 „ „ Sheffield 4.39 „ „ Hull 3.66 „ „ Edinburgh 2.31 „ „ Glasgow 3.19 „ „ Dublin 4.58 „ „ Islington 2.21 „ „ 50 1899] In the succeeding Table it will be noticed that there was a decrease on the average of the preceding fourteen years of mortality from every zymotic disease except diarrhoea, which showed an increase of 120. Table XXVIII. Showing the Corrected Mean Number of Deaths from the principal Zymotic Diseases, 1885-98, together with the deaths registered in 1899. Diseases. Corrected Mean Number of Deaths, 1885-98. 1899. Increase or Decrease. Small Pox 11 – –11 Measles 215 155 –60 Scarlet Fever 59 33 –26 Diphtheria 138 120 –18 Whooping Cough 199 160 –39 Typhus Fever 1 – –1 Enteric Fever 50 47 –3 Continued & Ill-defined Fevers 1 – –1 Diarrhœa 219 258 + 39 The Above Diseases 893 773 –120 The mortality in the Sub-Districts varies from 1.62 per 1,000 in Islington South-East, to 2.69 per 1,000 in Islington South-West. In Highbury the rate was 1.83, and in Upper Holloway 2.69. In the Wards the death-rate was lowest in St. Mary's, where it was 1.23 per 1,000, and in East Highbury where it was 1.24, while in Thornhill it was 2.77, and in Lower Holloway 2.88. 51 [1899 DEATHS FROM THE ZYMOTIC DISEASES IN THE SUB-DISTRICTS. Upper Holloway. Zymotic Diseases. 1891. Deaths. 1892. Deaths. 1893. Deaths. 1894. Deaths. 1895. Deaths. 1896 Deaths. 1897. Deaths. 1898. Deaths. Mean Eight Yrs. 1899. Deaths. Death. rates Small Pox – 1 2 1 1 1 1 – 1 – – Measles 70 38 24 53 27 53 38 91 49 44 0.42 Scarlet Fever 22 10 19 23 19 17 15 8 16 4 0.04 Diphtheria 87 77 54 70 49 86 49 18 61 67 0.65 Whooping Cough. 74 39 50 44 16 87 28 43 48 35 0.34 Typhus Fever 2 10 1 – 1 – – – 2 – – Enteric Fever 10 12 17 7 9 13 16 10 12 18 0.17 Continued and Illdefined Fevers ) – – – – – – – – – – Diarrhœa 41 51 79 33 77 50 26 75 54 76 0.73 Total 306 238 246 231 199 307 173 245 243 244 2.35 Islington South-West. Zymotic Diseases. 1891. Deaths. 1892. Deaths. 1893. Deaths. 1894. Deaths. 1895. Deaths. 18%. Deaths. 1897. Deaths. 1898. Deaths. I Mean Eight Yrs. 1899. Deaths Death. rates. Small Pox – 2 – 2 – – – – – – – Measles 77 65 56 106 64 141 26 152 86 59 0.54 Scarlet Fever 14 12 40 27 22 17 22 5 20 17 0.16 Diphtheria 25 23 68 69 43 95 36 30 49 20 0.18 Whooping Cough.. 87 51 73 79 37 66 46 63 63 73 0.67 Typhus Fever – – – – – – – – – – – Enteric Fever 13 15 14 12 8 12 12 10 12 12 0.11 Continued and Illdefined Fevers – – 1 – 3 1 – – 1 – – Diarrhœa 57 59 89 29 66 48 75 109 456 112 1.03 Total 273 227 341 324 243 380 217 369 297 293 2.69 1899] 52 Islington South-East. Zymotic Diseases. 1891. Deaths. 1892. Deaths. 1893. Deaths. 1894. Deaths. 1895. Deaths. 1896. Deaths. 1897. Deaths. 1898. Deaths. Mean Eight Yrs. 1899. Deaths. Death rates. Small Pox – – – – – – – – – – – Measles 28 47 24 23 34 54 21 53 35 18 0.26 Scarlet Fever 9 14 14 14 14 13 17 5 13 3 0.40 Diphtheria 19 14 48 37 27 36 13 29 28 17 0.25 Whooping Cough. 31 39 30 30 17 49 31 34 33 27 0.40 Typhus Fever – – – – – – – 1 – – – Enteric Fever 3 10 8 10 6 8 11 8 8 6 0.08 Continued and illdefined Fevers – – 1 – – 1 – – – – – Diarrhœa 28 31 47 21 32 31 39 43 34 40 0.59 Total 118 155 172 135 130 192 132 173 151 111 1.62 Highbury. Zymotic Diseases. 1891. Deaths. 1892. Deaths. 1893. Deaths. 1894. Deaths. 1895. Deaths. 18%. Deaths. 1897. Deaths. 1898. Deaths. Mean Eight Yrs. 1899. Deaths. Deathrates. Small Pox . – – – – – – – – – – – Measles 32 21 15 17 10 40 12 29 22 34 0.49 Scarlet Fever 7 8 21 5 n 10 7 8 9. 9 0.13 Diphtheria 25 12 19 32 18 30 17 13 21 16 0.23 Whooping Cough. 44 22 28 35 11 32 25 28 28 25 037 Typhus Fever – – – – – – – – – – – Enteric Fever 5 7 9 7 7 13 5 8 8 11 0 16 Continued and Illdefined Fever – – – – – – – – – – – Diarrhœa 23 23 22 12 14 24 34 56 26 30 0.44 Total 136 93 114 108 71 149 100 143 114 125 1.83 53 [1899 The following statement shows the fatal incidence of the Zymotic Diseases in the several districts arranged in order from least to highest death-rate :— Sub-Districts. Death-rates s. Islington, South-east 1.62 111 Highbury 1.83 125 Upper Holloway 2.35 244 Islington, South-west 2.69 293 Table XXIX. Heaths from the principal Zymotic Diseases during the year 1899, inclusive of the deaths of Islington Patients in Hospitals outside the District. DISTRICTS. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric (Typhoid Pever). Diarrhoea. S. Upper Holloway .. 44 4 67 35 .. 18 76 244 Islington, South West .. 89 17 20 73 •• 12 112 293 Islington, South East .. 18 3 17 27 .. 6 40 111 Highbury .. 34 9 16 25 .. 11 30 125 Totals 155 33 120 160 .. 47 258 773 1899] 54 Table XXX. 1)etitlt-rates from the principal Zymotic Diseases duriny the year 1899, inclusive of the Palish Patients in Hospitals outside the District. DISTRICTS. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric (Typhoid Fever). Diarrhoea. TOTAL DEATH-RATES. U pper Holloway .. 0. 42 0.04 0.65 0.34 .. 0.17 0.73 2.35 Islington, South West .. 0.54 0.16 0.18 0.67 .. 0.11 1.03 2.69 Islington, South East .. 0.26 0.04 0.25 0.40 .. 0.08 0.59 1.62 Highbury .. 0.49 0.13 0.23 0.37 •• 0.16 0.44 1.83 Death-rates .. 0.44 0.09 0.34 0.46 •• 0.13 0.74 2.21 In the following statement the wards are arranged in order from least to greatest incidence of mortality:— Wards. Deaths. Death-rates. St. Mary's 22 1.23 per 1,000 inhabitants. East Highbury 37 1.24 „ ,, Canonbury 45 1.72 „ ,, St. Peter's 59 1.76 „ ,, Upper Holloway 71 1.86 „ „ West Highbury 88 2.29 „ „ Tufnell 88 2.58 „ Tollington 85 2.69 „ ,, Barnsbury 63 2.69 „ ,, Thornhill 93 2.77 „ ,, Lower Holloway 122 2.88 „ ,, Total 773 221 55 6681] Table XXXI. Showing the Deaths and Death-rates from the Principal Zymotic Diseases in the Wards during the Several Quarters of 1899. Wards. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Year Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 13 1.53 7 0.82 42 4.93 26 3.05 88 2.58 Upper Holloway 5 0.52 13 1.36 34 3.57 19 1.99 71 1.86 Tollington 12 1.52 9 1.14 43 5.45 21 2.66 85 2.69 Lower Holloway 36 3.40 20 1.89 58 5.48 8 0.75 122 2.88 West Highbury 11 1.14 29 3.01 30 3.12 18 1.87 88 2.29 East Highbury 3 0.40 16 2.14 14 1.88 4 0.58 37 1.24 Thornhill 15 1.79 7 0.83 50 5.95 21 2.50 98 2.77 Barnsbury 10 1.71 13 2.22 26 4.44 14 2.89 63 2.69 St. Mary's 7 1.56 2 0.44 7 1.56 6 1.34 22 1.28 Canonbury 7 1.07 9 1.38 22 3.38 7 107 45 1.72 St. Peter's 12 1.43 8 0 95 32 3.82 7 0.84 59 1.76 Totals 131 1.50 133 1.52 358 4.11 151 1.78 773 2.21 56 [6681 Table XXXII. Showing the Deaths from the Principal Zymotic Diseases in the several Wards during the Year 1899. WARDS. Small Fox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. ; Enteric Fever. Continued and Ill-defined Fever. Diarrhoea. Total Zymotic Deaths. Death-rates from Zymotic Diseases. Tufnell ... 9 3 88 16 ... 3 ... 24 88 2.58 Upper Holloway ... 9 ... 19 7 ... 9 ... 27 71 1.86 Tollington ... 26 1 15 12 ... 6 ... 25 85 2.69 Lower Holloway ... 22 3 7 87 4 ... 49 122 2.88 West Highbury ... 21 7 11 22 ... 9 ... 18 88 2.29 East Highbury ... 13 2 5 3 ... 2 ... 12 37 1.24 Thornhill ... 25 1 4 22 ... 4 ... 37 93 2.77 Barnsbury ... 11 9 5 18 ... 2 ... 23 63 2.69 St. Mary's ... 1 4 6 2 ... 3 ... 6 22 1.23 Canonbury ... 9 2 7 10 ... 2 ... 15 45 1.72 St. Peter's ... 9 1 8 16 ... 3 ... 22 59 1.76 Totals ... 155 83 120 160 ... 47 ... 258 778 2.21 67 [1899 Table XXXIII. Showing the Death-rates in the Wards from the Principal Zymotic Diseases during the Year 1899. wards. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Continued and Ill-defined Fever. Diarrhoea. Death-rates from Zymotic Diseases. Tufoell ... 0.26 009 0.97 0.47 ... 0.09 ... 0.70 2.58 Upper Holloway ... 0.24 0.49 018 ... 0.24 ... 0.71 1.86 Tollington ... 0.82 003 0.47 0.38 ... 0.19 ... 0.79 2.69 Lower Holloway ... 0.52 0.07 0.17 0.87 ... 0.09 ... 1.16 2.88 West Highbury ... 0.55 0 18 0.29 0.57 ... 0.23 ... 0.47 2.29 East Highbury ... 0.43 007 0.17 0.10 ... 0.07 ... 0.40 1.24 Thornhill ... 0.74 003 0 12 0.66 ... 0.12 ... 1.10 2.77 Barnsbury ... 0.47 0.88 0.21 0.56 ... 0.09 ... 0.98 2.69 St. Mary's ... 0.06 0.22 0.33 Oil ... 0.17 ... 0 35 1 28 Canonbury ... 0.84 007 0.27 0.38 ... 0.07 ... 0.58 1.72 St. Peter's ... 0.27 0.03 0.24 0.48 ... 0.09 ... 0.65 1.76 Totals ... 0.44 0 09 0.34 0 46 ... 0.13 ... 0.74 2.21 M 58 1899] MORTALITY FROM THE SEVERAL ZYMOTIC DISEASES. Small Pox. Not for two years have there been any deaths from Small Pox, and in 14 years there have occurred only 14, or an average of one death per annum. The last occasion when this disease was extensively and fatally prevalent was in 1885, when 129 deaths were registered. Towards the end of the year (December) cases of the disease occurred in Hackney, but so far it has not spread into Islington, and it is very unlikely that it will do so now, as all the cases were promptly isolated. I have extracted from various sources, as indeed I have also of the principal Zymotic Diseases, returns relating to Small Pox in Islington in past years. They are arranged in the following tabular statement in periods of five years, so that its prevalence at the several periods may be the more easily differentiated. Periods. Deaths as given in Medical Officer of Health's Report. Deaths as given by the RegistrarGeneral. Deaths as distributed by the RegistrarGeneral. 1 2 3 4 1856-60 89 545 Deaths were not distributed before 1881. 1861-65 213 772 1866-70 250 1,026 1871-75 432 573 1876-80 210 423 1881-85 246 418 379 1886-90 3 1 3 1891-95 9 16 9 1896-99 (4 years) 2 1 2 Deaths as given in the second column are altogether understated, because previous Medical Officers of Health did not include in their 59 [1899 returns the deaths of persons who were treated in their fatal illnesses in Public Instituti ns outside Islington, although they very rightly excluded strangers who had come into the Parish for treatment here. That this mode of tabulating deaths must have caused very grave errors I am assured, and I will illustrate it by an example. In the year 1885 the Registrar-General undertook the task of distributing all the deaths in the Public Institutions to the sanitary districts to which they should rightly be referred. Now, in that year I find that my predecessor debited Islington with only 38 deaths from Small Pox, whereas they should have numbered 129. As a matter of fact during that year 156 persons died here, but as many of the deaths, particularly at the Small Pox Hospital, were those of persons who had come here for treatment, they were rightly not included in the returns, while Islingtonians who died in the Metropolitan Asylums Board's Hospitals were also, but wrongly, excluded. The study of the table as a whole shows that there has been a marvellous and most gratifying decrease of Small Pox in Islington since 1885. Indeed the decrease is startling, and speaks well for the manner in which up to a very recent date the Board of Guardians discharged the very responsible duty of administering the Vaccination Acts. Latterly, vaccination has been allowed to fall into abeyance. The state of vaccination in Islington is shown in Table C on page 175, and it affords much food for serious thought. The deaths in the Parish during the preceding fourteen years were :— 1885 129 deaths. 1894 3 deaths. 1886 3 ,, 1895 1 ,, 1887 — ,, 1896 1 ,, 1888 — ,, 1897 1 ,, 1889 — ,, 1898 0 ,, 1890 — ,, — 1891 — ,, Corrected average 11 1892 3 ,, 1893 2 ,, 1899 .. 0 death. E 2 60 1899] MEASLES. Measles caused 155 deaths, as against 325 registered in 1898, and compared with a corrected average of 216 during the years 1885-98. The death-rate was 0.44 per 1,000 inhabitants, as against an average rate of o.65 in the years 1885-98. It is higher than that which generally obtained in the country, although it has been exceeded in some of the largest towns. England and Wales 0.31 per 1,000 inhabitants. 33 Great Towns 0.46 „ „ 67 Other Large Towns 0.28 „ ,, Rural England & Wales 0.21„ „ London 0.47 ,, „ Birmingham 0.38 „ „ Liverpool 0.50 „ Manchester 1.30 „ „ Leeds 0.37„ „ Sheffield 0.61 „ „ Islington 0.44 ,, „ In past years Measles has obtained as follows :— Quinquennial Periods. Deaths. Mean Populations. Death Rates. 1856-60 424 136,132 0.63 1861-65 457 167,076 0.55 1866-70 514 195,982 0.52 1871-75 633 227,798 0.56 1876-80 629 261,970 0.48 1881-85 898 290.750 0.62 1886-90 924 308,963 0.60 1891-95 856 326,988 0.52 1896-99 865 343,180 0.63 (4 years). 61 [1899 Here it is seen that the death-rate from Measles has varied considerably in the several Quinquennial periods, being as low as C48 per 1,000 in the years 1876-80, and as high as 0.63 in the 1856-60 and 1896-99 periods. In London the death-rate has varied even more considerably, having been as low as 0.25 in 1852, and as high as 0.94 in 1864. During the last four years the numbers have varied greatly, as may be seen by the following figures:— 1896 288 deaths = 0.85 per 1,000 inhabitants. 1897 97 „ 0.28 „ „ 1898 325 „ 0.94 „ „ 1899 155 „ 0.44 „ „ The disease was most fatal in Islington South-west, where it was the cause of 59 deaths, equal to a death-rate of 0.54 per 1,000 of its inhabitants, particularly in the first and second quarters of the year in that part lying along the Clerkenwell boundary from Liverpool Road to Penton Street. It was also present fatally in the fourth quarter in those streets to the east and west of Bemerton Street, but particularly in those towards the west. In the Highbury sub-district it was prevalent as well as fatal in the second quarter, especially around Queensland Road, Queen's Square, Brand Street, and other small streets in that neighbourhood. In Upper Holloway, during the fourth quarter it was the cause of 15 deaths, most of which occurred in those streets situated within the rectangle formed by Hornsey Road on the west, Seven Sisters Road on the south, Fonthill Road on the east, and Moray Road and the Workhouse Schools on the north. In Islington South-east the deaths numbered 18, 15 of which occurred in the first half of the year. The known cases and the deaths occurred in Pickering Street, Popham Street, Grosvenor Street, and Hanover Street. The death-rate (0.44) from Measles was slightly below the rate of 0.47 experienced in the Encircling Districts, in which 380 deaths were registered. 62 1899] Table XXXIV. Showing the Deaths from Measles in the Sub-Districts for each quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 11 5 13 15 44 Islington, South West 24 14 7 14 59 Islington, South East 7 8 2 1 18 Highbury 3 20 4 1 34 The Parish 45 53 26 31 155 Table XXXV. Showing the Death-rates from Measles of the Sub-Districts for each quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0 .42 0.19 0.50 0.58 0.42 Islington, South West 0.88 0.52 0.26 0.52 0.54 Islington, South East 0 .41 0.47 0.12 0.06 0.26 Highbury 0.17 1.52 0.23 0.6 0.50 The Parish 0.52 0.60 0.30 0.36 0.44 Table XXXVI. Showing the Death-rates of the Encircling Districts from Measles in the Jour quarters of 1899. Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year.—1899. St. Pancras 0. 66 0. 61 0.28 0.13 0.42 Stoke Newington 0.11 0.57 0.34 0.11 0.28 Hacknev 0.56 1.10 0.22 0. 11 0. 49 Hornsey 0.06 0.06 — 0.24 0.09 Clerkenwell 1.09 0.73 0. 30 0. 06 0. 54 St. Luke 0.59 0.88 0. 88 0.19 0. 63 Shoreditch 0.86 0.93 0.50 0.69 0.74 The Above Districts 0. 62 077 0. 31 0.21 0.48 Islington 0.52 0.60 0.30 0.36 0.44 63 [1899 Table XXXVII. Showing the Secondary Causes of the deaths from Measles. Secondary Diseases. Quarters. The Year. 1 2 3 4 Males. Females. Totals. Pneumonia 27 31 14 16 54 34 88 Bronchitis 9 9 2 9 10 19 29 Whooping Cough 1 4 2 — 2 5 7 Convulsions 1 2 — 1 2 2 4 Croup 1 — — — — 1 1 Laryngitis 1 1 — 2 3 1 4 Phthisis 1 — 1 — 2 — 2 Marasmus 2 — 1 — 1 2 3 Diarrhoea 1 2 2 — 3 2 5 Syncope — 1 — — — 1 1 Membranous Croup — 1 — — 1 — 1 Enteritis — — 2 — 1 1 2 Stomatitis — — 1 — — 1 1 Dentition — — 1 — — 1 1 Cancrum Oris — — — 1 1 — 1 Total Secondary Diseases 44 — 26 29 81 69 150 Deaths where no secondary disease was entered 1 2 — 2 1 4 5 Total Deaths 45 58 26 31 82 73 155 I have frequently commented in past reports on the want of care taken of children when attacked with Measles. Instead of being put to bed, kept warm, guarded against chills, and treated as for a serious disease, they are allowed to sit up, run from room to room, to play on the staircase, and sometimes to wander into the streets. 64 1899] The result of course is calamitous. Many are stricken with secondary diseases, particularly pneumonia, and less often with bronchitis. It is no surprise, therefore, to find that 117 deaths out of the 155 in which measles was ascribed as the primary cause, were set down to pneumonia and bronchitis. These 117 deaths represent just 75½ per cent of all the deaths from measles. One has only to look at the spot maps which are kept in the Public Health Department to see at a glance that the mortality occurrs chiefly among the poor, the uneducated, the uninformed, and rarely among those that are educated and well to do. There is no doubt that much good could be effected if these people could be reached, and instructed. Ordinary notification, as I have pointed out before now is not speedy enough to enable Sanitary Authorities to effect much good, nor would a tenth of the cases be heard of, because medical men are only exceptionally called in, that is to say when the patients have come into a parlous state because of the supervention of pneumonia or bronchitis. It is to anticipate such attacks as these that the earliest information is desired. I expressed an opinion before, and I am still of the same mind, that the earliest notification can only be obtained from the school teachers of our great elementary schools, who are the very first to hear of the presence of disease in their scholars, and who ought to be as much compelled by the law to send information to the Medical Officer of Health as the Medical Officer of Health is compelled to send information of other infectious diseases to the school teachers. Closure of Schools for Measles—It was not necessary to close any schools as a whole, although in a few instances, acting on requests from me the school authorities closed class rooms in the Infants' departments of the following schools :— Upper Hornsey Road. Matthias Road Board School. Ambler Road ,, Cottenham Road „ 65 [1899 The reason that the whole of the Infants' departments was not closed was that it was found that the class rooms indicated were those which were alone infected, and I, therefore, concluded that the necessary protection against infection, and the prevention of the spread of disease would be obtained by closing only the infected rooms. The results were entirely satisfactory. Table XXXVIII. Showing the Deaths from Measles in Islington during each week of 1899. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Week. Deaths. Week. Deaths. Week. Deaths. Week. Deaths. 1 2 14 1 27 2 40 1 2 — 15 5 28 — 41 2 3 2 16 3 29 4 42 4 4 2 17 6 30 1 43 — 5 2 18 2 31 1 44 3 6 4 19 9 32 3 45 1 7 2 20 4 33 3 46 1 8 4 21 4 34 2 47 3 9 6 22 5 35 4 48 5 10 9 23 3 36 2 49 2 11 6 24 2 37 1 50 4 12 4 25 7 38 2 51 2 13 2 26 2 39 1 52 3 Total 45 Total 53 Total 26 Total 31 66 1899] Table XXXIX. Showing the deaths from Measles in the several quarters, 1885-98 and 1899. Years. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. 1885 33 152 88 21 294 1886 9 34 15 5 63 1887 57 213 43 22 335 1888 27 12 17 91 147 1889 81 70 15 11 177 1890 48 114 23 17 202 1891 29 63 39 93 224 1892 70 56 23 30 179 1893 25 52 31 11 119 1894 66 118 14 1 199 1895 7 36 50 42 135 1896 170 84 25 9 288 1897 15 2 8 72 97 1898 183 107 23 12 325 Mean number of deaths 58 80 30 31 199 Corrected Mean 62 87 32 34 215 1899 45 53 26 31 155 SCARLET FEVER. Scarlet Fever only caused 33 deaths, which are equal to a death-rate of 0.09 per 1000 inhabitants. This rate is not only below that experienced in England and Wales, but it is also lower than the rate of the 33 Great Towns, the 67 Other Large Towns, and of Rural England. Showing the Oases of Scarlet Fever notified during each week in 1899, together with the averages for the corresponding weeks in the years 1891-98. VAIL • Ct. PRlNTiNft, FARBlMtOON *•, w c The Red lines indicate the cases In 1899. The Green lines Indicate the average number of eases in each week of the 8 years, 1891-98. 67 [1899 The deaths are also 26 below the corrected mean of the preceding fourteen years, which returns have been as follows:— 1885 36 deaths. 1894 69 deaths. 1886 26 ,, 1895 66 „ 1887 59 ,, 1896 57 ,, 1888 64 „ 1897 61 „ 1889 40 „ 1898 26 „ 1890 65 „ — 1891 50 ,, Corrected Mean 59 .. 1892 53 „ — 1893 94 „ 1899 33 „ The returns of the last 15 years have been very different from what they were in former years, for I find that — From 1856 to i860 they averaged 119 per annum. „ 1861 to 1865 „ 215 „ „ 1866 to 1870 „ 240 „ „ 1871 to 1875 „ 117 „ „ 1876 to 1880 „ 88 „ In the succeeding quinquennial period, 1881-5, the deaths fell to 51 per annum, but in the next five years, 1886-90, there was a slight increase, for they averaged 66, only to fall, however, to an average of 44 per annum in the last four years (1896-99). I shall have to speak further on this matter in discussing the mortality from Diphtheria. In the sanitary areas surrounding the Parish the death-rate was 0.10 per 1,000. 68 1699] Table XL. Shelving the Deaths from Scarlet Fever in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 2 .. 1 1 4 Islington, South West 1 1 4 11 17 Islington, South East .. 1 2 3 Highbury •• 4 3 2 9 The Parish 3 5 9 16 33 Table XLI. Showing the Death-rates from Scarlet Fever of the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0.08 .. 0.04 0.04 0.04 Islington, South West 0.04 0 .04 0.15 0.40 0.16 Islington, South East ...... .... 0.06 0.12 0.04 Highbury .. 0.23 0.18 0.12 0.13 The Parish 0.03 0.06 0.10 0.18 0.09 It will be noticed from the two preceding tables that there was an almost entire absence of deaths in Upper Holloway and Islington South East. Showing the Oases of Diphtheria notified during each week in 1899, together with the averages for the corresponding weeks in the years 1891-98. VAIL • Cf. M INTER*. PARRIWtOOH R', W.C The Red lines Indicate the cases In 1899. The Green lines Indicate the average number of eases In each week of the 8 years, 1891-98. 69 [1899 DIPHTHERIA. Diphtheria was the registered cause of 120 deaths, which resulted in a death-rate of 0-34 per 1,000 inhabitants. This return, although 30 more than that of the year 1898, is nevertheless 17 below the corrected average of the preceding fourteen years. So far the mortality may be considered satistactory, but only so far, for it is a fact that whereas deaths from Scarlet Fever have steadily grown fewer, those from Diphtheria have advanced. I think it was in 1855 that the Registrar-General first distinguished between the deaths from Diphtheria and those from Scarlet Fever, both of which up to that time had been included in the returns for the latter disease. In Islington the quinquennial returns have been as follows:— Deaths. Deaths per 1,000 inhabitants. Deaths that would have occurred if the population had been the same as in 1899. 1861—65 194 = 0.23 405 1866—70 137 = 0.14 244 1871—75 115 = 0.10 176 1876—80 165 = 0.12 220 1881—85 418 = 0.29 50I 1886—90 311 = 0.20 351 1891—95 842 = 0.51 898 1896—99 (4 years) 572 = 0.41 581 I have prepared the fourth column of figures so that the increased mortality may be more clearly understood. It shows the number of deaths that would have occurred supposing the mean population at each period was the same as in 1899. From these figures we learn that from 1861 to the present time the number of deaths from Diphtheria varied considerably. In the three quinquennial periods 1866-70,1871-75, and 1876-80, the lowest mortality was registered. It then rose very considerably, so that there was an increase of 123 per cent, in the 1880-5 period on the corrected 70 1899] figures. Next there was a drop of 30 per cent., then in the 1891-5 period an increase of 155 per cent., while in the next four years there was a decrease of slightly over 19 per cent. We are therefore at present on the downward curve; but that it will continue to fall is open to considerable doubt. Since 1885 the deaths and death-rates from Diphtheria in Islington have been as follows :— Deaths. Death-rates. Deaths. Death-rates. 1885 167 0.56 1894 208 0.63 1886 72 .. 0.24 1895 137 0.41 1887 46 0.15 1896 247 0.73 1888 50 0.16 1897 115 0.34 1889 62 0.20 1898 90 0.26 1890 81 0.26 - - - 1891 158 0.49 Crctd. Mean 138 0.39 1892 150 0.46 - - - 1893 189 0.58 1899 120 0 34 Decrease, 18 deaths. In the several Towns and London Districts with which I usually contrast the Islington returns I find the death-rates were as follows:— London 0.43 per 1,000 inhabitants. Birmingham 0.28 „ Liverpool 0.33 ,, Manchester 0.15 ,, Leeds 0.77 ,, Sheffield 1.27 ,, St. Pancras 0.45 ,, Stoke Newington 0.17 ,, Hackney 0.40 ,, Hornsey 0.06 ,, Clerkenwell 0.42 ,, St. Luke 0.24 ,, Shoreditch 0.54 ,, Islington 0.34 ,, 71 [1899 The death-rate from Diphtheria in the 33 Great Towns was 0.40, and was 0.08 above the mean rate of the preceding ten years. The highest rates occurred in West Ham (0.61), Portsmouth (0.64), Swansea (1.36), Leicester (1.06), Leeds (0.78), and Sheffield (1.28). From these returns it is seen that Islington occupied a good position as regards the mortality from this disease. Locally the highest death-rate was recorded in the sub-district of Upper Holloway, where it amounted to 0.65 per 1,000 of the population ; while the lowest was referred to Islington South-west, where it was only o-i8 per 1,000. Islington South-east and Highbury produced nearly similar rates, namely 0.25 and 0.23. The disease was responsible for the least number of deaths in the first quarter when only 12 were registered, while the number was only one more in the second quarter. In the' third quarter they rose to 46, and thence to 49 in the last quarter. Table XLII. Showing the Deaths from Diphtheria in the Sub- Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 2 6 28 31 67 Islington, South-west 4 3 7 6 20 Islington, South-east 3 2 8 4 17 Highbury 3 2 3 8 16 The Parish 12 13 46 49 120 72 1899] Table XLIII. Showing the Death-rates of the Sub-Districts from Diphtheria for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0.08 0. 23 1.08 1.20 0. 65 Islington, South-west 0.15 0.11 0.26 0.22 0.18 Islington, South-east 0. 18 0. 12 0.47 0.23 0.25 Highbury 0.17 0. 12 0.18 0.47 0.23 The Parish 0.14 0. 15 0. 53 0.56 0.34 Confusion between Diphtheria and Croup.—I have mentioned that formerly deaths from Diphtheria were ascribed to Croup, and even to Laryngitis and Quinsey, although chiefly to the first-mentioned disease. I think it might be of interest, therefore, to see how we stand to-day, as compared with the past, with respect to these two diseases when combined in one return. The following are the figures which I have abstracted from previous reports:— 73 [1899 Table XLIV. Showing the Deaths from Diphtheria and Croup from 1861 to 1898, together with the Death-rates per Million from these Diseases in three decennial periods and in the period 1891-98. Years. Deaths. Mean Annual Death-Kates per million inhabitants in the decennial periods. Diphtheria. Croup. Diphtheria, and Croup. Diphtheria. Croup. Diphtheria and Croup. 1861 1862 38 34 25 31 63 65 1863 57 52 109 1864 35 49 84 1865 30 25 55 1866 23 43 66 1867 29 28 57 1868 33 18 51 1869 25 23 48 1870 27 26 53 1861-70 331 320 651 182 176 358 1871 30 21 51 1872 26 24 50 1873 10 29 39 1874 23 48 71 1875 26 32 58 1876 34 42 76 1877 21 34 55 1878 38 26 64 1879 45 23 68 1880 27 33 60 1871-80 280 312 592 114 127 241 1881 42 36 78 1882 54 58 112 1883 70 66 136 1884 114 32 146 1885 167 56 223 1886 72 47 119 1887 46 36 82 1888 50 40 90 1889 62 26 88 1890 81 38 119 1881-90 758 435 1193 253 145 398 1891 158 42 200 1892 150 40 190 1893 189 23 212 1894 208 28 236 1895 137 17 154 1896 247 24 271 1897 115 18 133 1898 90 8 98 1891-98 (8 years). 1294 200 1494 487 75 562 f 74 1899] From 1861 to 1870 the death-rate from Diphtheria and Croup averaged 358 per million of the population*, whereas in the succeeding ten years it was only 241, a decrease of 327 per cent. In the same periods the death-rates from Diphtheria alone were respectively 182 and 114 per million, or a decrease of 37.4 per cent. Thus there was practically almost a similar decline in both rates, which showed that up to then, at all events, there had been no change for the better in the comparison that existed between Croup and Diphtheria. Indeed the death-rate from Croup in this period declined only 27.9 per cent. In the succeeding ten years (1881-90) the death-rate from the diseases taken together was 398 per million, while that from Diphtheria alone was 253 per million. In other words, whereas the death-rate from Diphtheria and Croup combined increased only 65.1 per cent. that from Diphtheria alone increased 121.9 per cent., thus showing that either the deaths from Croup had greatly decreased or that deaths which had previously been ascribed to that disease were then more generally ascribed to Diphtheria. At this time the death-rate from Croup increased only from 127 per million to 145, or 14.1 per cent. In the succeeding eight years (1891-98) the mean annual death-rate from Croup and Diphtheria further advanced from 398 to 562 per million, an increase of 41.2 per cent. whereas the death-rate from Diphtheria alone rose from 253 per million to 487, being an increase of 92.4 per cent. But during the same eight years the death-rate from Croup fell from 145 per million to 75 per million, or no less than 48.3 per cent. From these facts it is self-evident that in former days great confusion existed in the minds of practitioners as to the disease now so generally recognized as Diphtheria, and that very many of the deaths formerly registered as arising from Croup were really deaths from Diphtheria. * I have made the calculation per million so as to avoid decimals and also that the figures given by the Registrar-General for other places may be more readily compared with those of Islington. 75 [1899 In his report for the year 1898 the Registrar General remarks, in discussing the increase of Diphtheria, as follows " (a) The great epidemic of 1858-9 was preceded by a marked increase in the mortality from croup and quinsey, by a still greater increase in the mortality from cynanche maligna, and also by some increase from that from laryngitis. " (b) The diphtheria epidemic of 1863 was accompanied by parallel movements in the mortality ascribed to croup, and also in that ascribed to cynanche maligna. " (c) The incidence of croup in regard both to season and to the ages at death of those attacked is found to have been similar to that of diphtheria. " (d) Whereas the deaths attributed to croup 1861-75 were more numerous by one-third than those attributed to diphtheria, the deaths attributed to croup in 1896-98 were less than one-sixth part as many as the deaths attributed to diphtheria. " These facts taken in conjunction, whilst they afford statistical support to the current medical opinion as to the identity of the two diseases, certainly warrant the assumption that by far the greater number of the death hitherto attributed to croup have really been caused by diphtheria Other places have been similarly affected by the confusion that has occurred in the certification of Diphtheria and Croup This is well seen in the following Table:— F 2 76 1899] Table XLV. Shewing the Death Rates per million from Diphtheria and Croup, in the places mentioned, at five different periods. Diphtheria. Croup. Diphtheria and Croup. 1861-70 1871-80 1881-90 1891-95 1896-98 1861-70 1871-80 1881-90 1891-95 1896-98 1861-70 1871-80 1881-90 1891-95 1896-98 England & Wales 185 121 163 254 261 246 168 144 70 38 431 289 307 324 299 England & Wales (less London) 186 121 146 205 220 244 167 141 71 41 430 288 287 278 261 London 176 122 260 544 502 255 177 159 49 20 431 299 419 593 522 Islington 182 114 253 515 441 176 127 145 92 49 358 241 398 607 490 77 [1899 Many theories have been advanced by scientists as to the great variations that have occurred with respect to this disease, but it seems to me that the strongest arguments yet adduced have been those advanced by Dr. Newsholme, in his work on Epidemic Diphtheria, where he shows by numerous diagrams that, to quote, his words, " Diphtheria only becomes epidemic in years in which the rainfall is deficient, and the epidemics are on the largest scale when three or more years of deficient rainfall immediately follow each other. . . . . Conversely, Diphtheria is nearly always at a very low ebb during excessive rainfall, and is only epidemic during such years when the disease in the immediately preceding dry years had obtained a firm hold of the community, and continues to spread presumably by personal infection." He also avers and proves that " There are no instances of a succession of wet years in which Diphtheria was epidemic." Which practically means that a high subsoil water by locking up the bacillus diphtheria prevents epidemics, whereas a low subsoil water allows them to escape. I have carefully compared the Diphtheria returns of Islington with the rainfall and I find that these statements are practically borne out. There were some discrepancies noted in the early years of registration, but these were, I am convinced, entirely due to the fact that deaths from Diphtheria were in those days frequently returned as from croup, laryngitis and quinsey. It would take too long and occupy too great a portion of this report to enter fully into the question. It must not, however, be claimed for dry seasons that they are the sole cause of this disease. "The essential cause," to again quote from Dr. Newsholme's valuable contribution to the literature of Diphtheria, " causa causans of diphtheria is the invasion of susceptible persons by the Klebs-Loeffler bacillus. This does not exhaust the causation of diphtheria. If we find this bacillus in a house or town, an epidemic of Diphtheria is not sufficiently explained. The bacillus may constantly be found in the throats of sporadic cases of Diphtheria during inter-epidemic periods, and yet no epidemic arises in these intervals, which are sometimes protracted over long years. It may also be found in the throats of attendants 78 1899] upon diphtheria patients without any illness on their part. To exhaust the etiology of an infectious disease like Diphtheria, we require,—adopting the phraseology of the old scholastic logicians,— to know not only the causa causans of the disease (that is the specific micro-organism) but also the causa efficiens and the causa movcns, which must be present in order that the disease may become widely prevalent. To use a simple illustration. A drunken man is thrown by a restive horse, and dies from a broken and dislocated neck. The cause of death may with accuracy be ascribed to the man's drunkenness, to the restiveness of the horse, or to the fractured and dislocated vertebra. Properly it is ascribed to the conjunction of all these circumstances. A neglect to consider any one of these factors will give a distorted and imperfect view of the cause of the accident and its fatal issue. So it is with infectious diseases, and especially Diphtheria, in which the element of personal predisposition and of environment is so marked. The bacteriological study of Diphtheria, far from being the negation of traditional etiology, is but the logical outcome of it; and secondary causes still maintain their traditional value as the indispensable concomitants of the Klebs-Lœffler bacillus. The causa efficiens and the causa movens consist of the combined favouring influence of personal constitutions and conditions of environment, which Colin has named le melien épidémique." Now and again, when the external conditions are favourable to Diphtheria, there is no outbreak of the disease, while on the other hand though the season be wet an occasional outbreak may arise from personal infection in a crowded school or in a densely populated district, " but," to again quote Dr. Newsholme, " this does not controvert or deprive the statement here advanced that the chief efficient and motive cause of epidemics, and still more of pandemics, of diphtheria is the occurrence of a series of dry years, giving rise to conditions which favour the multiplication and probably at the same time increase the virulence of the diphtheria bacillus." Before leaving this question of the influence of rainfall I would remark that Dr. Newsholme, as indeed I have myself done, noticed that, if a heavy rainfall, accompanied with a low barometer, 79 [1899 occurred during a prolonged dry period, an outbreak of diphtheria to a certainty followed. But this is easily explained by the circumstance that the micro-organisms that cause diphtheria increase and multiply in a warm soil that is free from excessive moisture. It is not surprising, therefore, " that they should subsequently become displaced from the soil by rainfall, or become aspirated from the soil, when apart from rainfall the barometer falls, or the interior of a house is at a much higher temperature than the subsoil underlying it. The idea that micro-organisms may be displaced from contaminated soil by means of rain may cause momentary surprise, as the first thought would be that they would be washed into the deeper subsoil. But this notion ignores the fact that in towns, and even in villages, the area on which direct percolation of rainfall from the ground level can occur is, in these days of impervious pavements and roads, becoming rapidly diminished ; while at the same time the entire ground under dwelling houses is in only a small minority of instances of covered with impermeable material, or with this material in sufficient thickness to exclude the ground air. Consequently when rain falls there is a great lateral as well as upward displacement of ground-air, and the rainfall in conjunction with the simultaneous aspirating effect of a lower barometric pressure, ensures the entry of ground air into the house." I trust that these remarks will be carefully considered, and that they will have a strong effect in inducing members of the Vestry, property owners, and builders to see that it is absolutely essential to have the surface of the ground surrounding houses made as impervious as possible, and that no houses are permitted to be occupied until the ground on which they stand had been solidly concreted. This is all the more necessary since rainfall has also a very similar effect on other diseases such as Scarlet Fever, Rheumatic Fever, Erysipelas, and Puerperal Fever. Among the predisposing causes must be reckoned primarily general dampness of the soil and of the dwelling, for each by tendering to lower the vital functions leaves the system less able to meet the attack of the bacillus when it invades the throat. Here again is a great reason why the surroundings of homes should be 80 1899] well paved, and why damp courses should always be placed between the foundations and the walls of houses, and why the sites on which the houses stand should be covered with a thick layer of concrete. The aspect of a house is also important, for an exposure to cold wet winds tends both to foster the disease and to cause fatal results to the persons attacked. Direct infection is a most potent factor in the disseminating of the disease. Speaking on this subject in his Milroy Lectures on " Diphtheria : Its Natural History and Prevention," the late Sir Richard Thorne, C.B., Medical Officer to the Local Government Board, said that " school influence would appear, then, to be operative in a number of ways." " 1st. It brings together those members of the community, who are by reason of age, most susceptible to diphtheria. " 2nd. The children thus brought together are placed, and remain for many hours of the day in exceptionally close relation with each other. In this connection it must be remembered we are dealing with a disease, the communication of which from person to person is largely dependent on the closeness of the mouth and noses of the individual by whom the infection is imparted. And when it is remembered that children are so placed in elementary schools as necessarily to be for a long period inhaling the lung exhalations of their fellows, and that collective singing and a kindred form of general intoning often forms part of the school programme, it will not be difficult to understand how especially favourable such circumstances are to the transmission of a specific infection which has a primary seat upon the mucous membrane and in the secretions of diseased fauces. "3rd. The closer the aggregation and the greater the lack of ventilation with corresponding hindrance to the free movement of air, the greater is the risk. "4th. Such faulty sanitary circumstances of the school house and its surroundings, and such other conditions as tend to a condition of general ill-health, in that they induce sore throat, favour the reception, by children so suffering, of any imported diphtheria infection. 81 [1899 " 5th. There are ample grounds for believing that the aggregation of children in elementary schools constitutes one of the conditions under which a form of disease of particular potency for spread and for death may be so to speak manufactured. " 6th. The danger of school aggregation is by no means limited to the period in which the throat disease is acute. . . . "7th. The practice of kissing and of transferring sweetmeats from mouth to mouth—practices which are more common amongst girls than boys—also the joint use of drinking cups, etc., must according to experience be credited with assisting in the diffusion of diphtheria amongst school fellows." Here we have summarized the dangers arising from the aggregation of children in schools, apart from such influences as may arise from the faulty sanitation of the building themselves. Milk has often been the means by which diphtheria has been conveyed, and indeed twenty-one years ago the present Medical Officer to the Local Government Board, Mr. W. H. Power, traced the epidemic which prevailed in St. John's Wood and Kilburn to such a source. The disease may also be conveyed by bedding and by the personal clothing, both of the patients and their attendants, and contracted by the occupation of rooms recently tenanted by persons suffering from the disease, which have not been disinfected. My experience is, however, that these are less potent factors than is the case with scarlet fever. They are, nevertheless, real elements of danger, and as such, should be rigidly guarded against. It has been alleged that the disease has sometimes been spread by animals, especially cats, who are themselves liable to contract the disease. I have, however, never been able to trace a case to such a source, although for some years back I have always made, or caused to be made, special inquiries in this direction. So far, as my inquiries in Islington have led me to conclusions I have found that the cases have been caused chiefly by direct infection, whether in home life or in schools, while the great predisposing causes have undoubtedly been dampness in the house, or 82 1899] dampness of its site, or dampness of its surroundings. It cannot, therefore, be too strongly impressed on the public, on property owners, and on those who exercise sanitary control that everything possible should be done by them to remove these conditions. In the county borough of which I was Medical Officer of Health for many years and where my advice in this respect was followed the death rate from diphtheria in the ten years was very low being only 0.08 per 1,000 of the population, and in 1899 it was only 0.06 per 1,000 as against 0.50 per 1,000 here. In other words the death rate from the disease in Islington is 525 per cent. higher than that of the northern borough. I ascribe this in a very great degree, although not altogether, to the fact that the surroundings of the houses, especially the back yards are paved with a substance that is impermeable, and which is generally good cement concrete. During the years I was Medical Officer of Health of that borough I always advised that the yards should be paved in this manner, and I am, therefore, glad to note that although diphtheria has of late years increased and multiplied in the large towns, it has at all events up to now taken no hold on Sunderland, although its juvenile population is proportionally much greater than in Islington. I am aware that the circumstances of the two districts are not quite the same. There, for instance, it is not the custom to have gardens at the rear of the houses, while it has been so here. Of late years thousands of houses in Islington that were once occupied by private wealthy families are now tenanted by three, four or even more artizans families, while the gardens which once flourished, are now very often nothing but trodden and sodden earth which is frequently permeated with the drainings from clothes hung out to dry, slop water intentionally or accidently spilt, the excremental filth from dogs, cats, poultry and even from little children who play in such places. Such yards as these are only the breeding places of diseases, such as diarrhoea, enteric fever and diphtheria, for in winter they are sloppy dirty places, and in summer with every wind that blows they fill the house with dust laden with the germs of disease. So long as human nature is what it is, and so long as houses are let out to many tenants, so long will 83 [1899 these yards continue to be a danger, and, unfortunately, an ever increasing danger to the public, for they will necessarily become more foul as time advances. It is time strong measures were adopted to put an end to them. The sanitary authority possesses the power, for it has made by-laws which have been duly sanctioned by the Local Government Board, under which it can compel owners to pave these insanitary places with an impervious pavement, which, properly sloped to gullies, will allow all water to flow freely away. I am sure when the sanitary authorities and property owners once grasp the facts they will be quite willing to provide impervious yards to all houses that are let out in tenements, and thereby safeguard the tenants from the ills that I have mentioned. WHOOPING COUGH. The deaths attributed to this disease numbered 160, which are 8 fewer than were registered in the preceding year, and 40 less than the corrected average of the preceding 14 years. The 160 deaths represent an annual death-rate of 0.46 per 1,000, which is 0.08 higher than the Metropolitan rate, and also than that of the Encircling Districts. In the 33 Great Towns it was 0.38 per 1,000, in the 67 Other Large Towns 0.32, and in Rural England and Wales 0.25 per 1,000. Locally, the heaviest incidence of the disease was experienced in the Sub-District of Islington South West, where 73 deaths produced a death-rate of 0.67 per 1,000, while it was least felt in Upper Holloway, where 35 deaths represented a death-rate of 0.34 per 1,000. The deaths in Highbury numbered 25, equal to a death-rate of 0.37, and in Islington South East 27, producing a death-rate of 0.40. Of the total deaths from the disease 66, or 41.2 per cent., occurred among infants under 12 months old, and 88, or 55.0 per cent., among children between that age and five, and 5, or 3.1 per cent., between five and fifteen. One person's death was registered as over thirty-live years old. 84 18991 The preceding records of the disease have been as follows:— 1885 210 deaths. 1894 188 deaths. 1886 214 „ 1895 81 „ 1887 240 „ 1896 234 „ 1888 231 „ 1897 130 „ 1889 86 „ 1898 168„ 1890 204 „ Corrected mean 200 „ 1891 255 „ 1892 161 „ 1893 181 „ 1899 160 „ Table XLVI. Showing the Deaths from Whooping Cough in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 12 11 7 5 35 Islington, South West 34 22 14 3 73 Islington, South East 9 5 8 5 27 Highbury 6 12 2 5 25 The Parish 61 50 31 18 160 Table XLVII. Showing the Death-rates from Whooping Cough of the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 0.46 0. 42 0.27 0.19 0.34 Islington, South West 1.25 0.81 0.52 0.11 0.67 Islington, South East 0.53 0.29 0.47 0.29 0.40 Highbury 0.35 0.70 0.12 0.29 037 The Parish 0.70 0.58 0.36 0.21 0.46 Showing the Cases of Enteric Fever notified during each week in 1899, together with the averages for the corresponding weeks in the years 1891-98. The Red lines Indicate the cases in 1899. The Green lines indicate the average number of cases In each week of the 8 years, 1891-98. 85 [1899 TYPHUS FEVER. As this disease has practically disappeared from the Metropolis, it is not surprising to find that no death was referred to it in Islington during the year. Indeed, in London, only two deaths were registered, one in Bermondsey and one in Rotherhithe. In fourteen years only twelve deaths have occurred locally, as may be seen by the following record:— 1885 3 deaths. 1894 0 deaths. 1886 2 „ 1895 1 „ 1887 2 „ 1896 0 „ 1888 1 „ 1897 0 „ 1889 0 „ 1898 1 „ 1890 0 „ Corrected Mean 1 „ 1891 1 „ 1892 0 „ 1893 1 „ 1899 0 „ ENTERIC FEVER. Enteric Fever accounted for 47 deaths, equal to a death-rate of 0.13 per 1,000 persons living in the district. The return although 11 above that of the preceding year is 3 less than the corrected average of the fourteen years 1885-98. The death-rate is less than that of the Metropolis, in which it was 0.17 per 1,000, than that of the Encircling Districts in which it was the same as in London, and than the rates experienced in England and Wales, the 33 Great Towns, the 67 Other Large Towns, and Rural England, in which they averaged respectively, 0.20, 0.22, 0.22 and 0.18 per 1,000 inhabitants. A comparison with the rates of the largest towns is made in Table From 1885 to the present time it was responsible locally for the following deaths:— 86 1899] 1885 63 deaths. 1894 36 deaths. 1886 60 „ 1895 30 „ 1887 45 „ 1896 46 „ 1888 59 „ 1897 44 „ 1889 61 „ 1898 36 „ 1890 39 „ Corrected mean 50 „ 1891 32 „ 1892 41 „ 1893 48 „ 1899 47 „ Table XLVIII. Showing the Deaths from Enteric Fever in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 3 3 4 8 18 Islington, South West 2 .. 2 8 12 Islington, South East 2 1 1 2 6 Highbury 2 1 3 5 11 The Parish 9 5 10 23 47 Table XLIX. Showing the Death-rates from Enteric Fever of the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 012 0.12 0.15 0.31 0.17 Islington South West 0.07 •• 0.07 0.29 0.11 Islington, South East 0.12 0.06 0.06 0.12 0.08 Highbury 0.12 0.06 0.18 0.29 0.16 The Parish 0.10 0.06 0.11 0.26 0.13 87 [1899 SIMPLE CONTINUED FEVER. No death was attributed to this affection, and I notice that only one was ascribed to it in London. The fact is that when cases which have been notified under this heading end fatally the death is usually certified as from Enteric Fever. As a rule, when the medical attendant notifies the case the symptoms are often obscure, and, therefore, in order to comply with the law, he returns it as Continued Fever, although, doubtless, long before its termination he has arrived at a precise conclusion as to its real character. DIARRHŒA. Since 1885 the following deaths were referred to Diarrhœa, the major portion of which occurred in the Summer months and among Infants:— 1885 197 deaths. 1894 95 deaths. 1886 320 „ 1895 189 „ 1887 309 „ 1896 153 „ 1888 162 „ 1897 174 „ 1889 178 „ 1898 283 „ 1890 180 „ Corrected Mean 219 „ 1891 159 „ 1892 189 „ 1893 237 „ 1899 258 „ from this statement we see that last year 258 deaths were entered in the registers from this one cause alone. They represent over four per cent. of the entire mortality, and as all the deaths, with the exception of 22 occurred in the third quarter of the year, the very fatal character of the disease, usually called at that period " epidemic diarrhœa," can be well understood. The 258 deaths represent a death-rate of 0.74 per 1,000 inhabitants, but as all these, with the exception of 17, occurred among children who had not yet reached five years of age, it is apparent that Diarrhoea is a very fatal disease to children, 208 of whom died while they were yet infants, not having reached the end of their first year, and 33 between that age and five years. 88 1899] 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. The Year. Under 1 year 1 5 194 8 208 1 to 5 years — 2 29 2 33 Over 5 „ — — 13 4 17 Totals 1 7 236 14 258 Unfortunately these are not all the deaths that should be ascribed to Diarrhcea, for it is a well known fact, and one too to which the Royal College of Physicians of London, the report of whose Special Committee I append, have this year drawn attention, that many deaths which should rightly be returned as from Diarrhœa are certified as Enteritis, Gastro-enteritis, Mucoenteritis, and Gastric Catarrh, and are, therefore, entered as Diseases of the Digestive System, and consequently are not included under the heading of Zymotic Diseases. In the returns for the year I find that some 236 deaths were so returned. They occurred as follows:— 1st Quarter. 2nd Quarter. 3rd Quarter, 4th Quarter. The Year. Under 1 year 12 10 135 15 172 1 to 5 years 2 3 23 4 32 Over 5 years 2 5 17 8 32 Total 16 18 175 27 236 Frequently, too, many deaths are included under the heading of Debility and Marasmus and Atrophy, which rightly might have been ascribed to Diarrhcea. The returns from these have been as follows:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Under 1 year 62 39 82 60 243 1 to 5 years 2 2 1 5 10 Over 5 years — — — 1 1 Total 64 41 83 66 254 Since, however, the Royal College of Physicians says nothing of the latter diseases, which it will be noticed are abnormally fatal in the Summer quarter, I will not pursue the subject further beyond 89 [1899 pointing out that the late Dr. Ballard, the first Medical Officer of Health of your Parish, in writing on this subject in his classic report to the Local Government Board, on Diarrhoea, says:— " I may be permitted to add that I have satisfied myself as regards public records of classified mortality, that though all deaths certified in every one of the above ways be included with '• Diarrhoea," nevertheless many other deaths directly due to that disease may remain omitted from their proper class. This is especially true of the deaths which are registered during the epidemic season; but the remark applies almost solely to infants. The hurry of extensive medical practice, especially in large and manufacturing towns, results I fear in a good deal of hurried, incomplete and unscientific certification of the cause of death in infants; so that many diarrhoeal deaths during the epidemic season get registered under 'atrophy,' 'marasmus,' 'want of breast milk,' etc., which are sometimes antecedent conditions determining the fatal issue; or under the terms 'convulsions,' 'hydrocephalus' (meaning mostly, I presume, the 'hydrencephaloid disease' of some writers), 'vomiting,' etc., which, like diarrhœa, are elements in the condition of the patient met with at some period, often the final period, of the malady." If the deaths from Enteritis and its sub-divisions be added to those from Diarrhœa we get a total of 494 deaths, which represent a death-rate of 1.41 per 1,000 inhabitants. As, however, 473 of these deaths occurred before the age of 5 years had been reached, it will be useful to inquire as to the rate of mortality among these children. Ages. Population. Deaths. Deaths per 1,000 living at each age. Under 1 year 8,877 380 42.8 1 to 5 years 32,271 65 2.0 Under 5 years 41,148 445 10.8 An examination as to the time of the year when these deaths occur is both interesting and useful, and therefore I have arranged the following figures in tabular form:— G 90 1899] Table L. Showing the Deaths from Diarrhœa) Diseases and from those classed tinder Enteritis and its sub-headings, arranged in quarterly periods, and at three groups of ages. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Diarrhoea. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Under 1 year 1 12 13 5 10 15 194 135 329 8 15 23 208 172 380 1 to 5 years — 2 2 2 3 5 29 23 52 2 4 6 33 32 65 Over 5 years — 2 2 — 5 5 13 17 30 4 8 12 17 32 49 Totals 1 16 17 7 18 25 236 175 411 14 27 41 258 236 494 91 [1899 Here it is very plainly seen that it is in the third, or Summer quarter that Enteritis, Gastro Enteritis, Muco Enteritis, and similar complaints are, like Epidemic Diarrhœa, most fatal, and that like it are also most fatal to infants under one year old, which, to an extent, goes to prove that they are in fact diarrhoeal diseases. Looking on them then in this light, I find that the death-rate among infant children is enormous during the third quarter, as the following figures prove:— Third Quarter's Deaths. Ages. Population. Deaths from Diarrhœa, Enteritis, etc. Deaths per 1.000 Annually. Under 1 year 8,877 329 148.2 1 to 5 years 33,2771 52 6.3 Under 5 years 41,148 381 37.0 These figures afford very serious food for reflection as to what should be done to prevent this terrible loss of life. Some of it, in fact a great deal of it, is absolutely preventible, if only the parents could be reached and taught what is the right thing to do to ward off the evil, and also when it attacks their children the right thing to do to prevent fatal results. There are several means of prevention parents can adopt. These are a few of them:— Before the attack. To 1. Keep their infants clean in person and clothing. 2. Keep their homes clean. 3. Keep their bed and bedding clean 4. Nurse their infants at the breast and avoid artificial feeding. 5. Give constant care and attention to their infants. 6. Store their food (milk) where it will not be contaminated with dust, whether blown from the street or from their back yards. 7. Keep the air in their rooms sweet by systematic and thorough ventilation. g 2 92 1899] When attacked. To 1. Seek immediate medical advice, for the disease is a dangerous one. As for Sanitary Authorities they can— 1. Keep the streets thoroughly well paved, channelled, and cleansed, and the poorer and more densely populated the locality the more stringently to adopt these precautions. 2. Thoroughly flush every sewer so that no deposits can remain in them to give off foul air during their decomposition. 3. Insist that all the yards (so-called gardens) in tenement houses shall be paved with an impervious material, so that no dirt and dust can find their way into the premises to contaminate the food of the infants, or to pollute the air of the house. 4. Insist that the sites of all houses shall be concreted to prevent the entrance of ground air into them. 5. Insist that the sanitary arrangements of houses are kept in good order by the owners. 6. Insist that the occupiers shall perform the duty that devolves on them to keep their sanitary conveniences in a cleanly state, and the water cisterns free from pollution. These diarrhœal diseases can never, I suppose, be absolutely prevented, for they are caused by micro organisms, which find their most potent breeding places in insanitary surroundings. I have in my report for the third quarter of 1898 already dwelt very fully on this subject, and I will not now repeat what I have there written. 93 [1899 Table LI. Showing the Deaths from Diarrhœa in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway .. 4 66 6 76 Islington South West .. 2 104 6 112 Islington, South East 1 1 37 1 40 Highbury .. .. 29 1 30 The Parish 1 7 236 14 258 Table LII. Showing the Death-rates from Diarrhœa of the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway .. 0.315 2.55 0.23 0.73 Islington, South West .. 0.07 3.83 0.22 1.03 Islington, South East 0.05 0.06 2.17 0.06 0.59 Highbury .. .. 1.70 0.06 0.44 The Parish 0.01 0.08 2.71 0.16 0.74 Tables relating to the Meteorological conditions that existed in the third quarter of the year have already been published in my report for that period, and should be consulted. 94 1899] The following is the report adopted by the Royal College of Physicians London, to which I referred on page 88. THE CLASSIFICATION OF DEATHS FROM DIARRHŒA. The Royal College of Physicians of London on July 27th, 1899, in response to a representation made by the Incorporated Society of Medical Officers of Health, appointed a Committee to consider the certification and classification of deaths from diarrhœa. The Committee consisted of Dr. Payne (Chairman), Dr. Corfield, Dr. Seaton, Dr. F. W. Andrewes, and Dr. J. F. W. Tatham This Committee presented the following unanimous report to the meeting of the College on January 25th : Report. 1. We find on enquiry, and especially from evidence furnished by Dr. Tatham, of the General Register Office, and by other members of the Committee, that many different terms are employed to designate the disease officially known as " epidemic diarrhoea," whereby its specific character is in danger of being ignored, and great confusion ensues. 2. The results of this confusion are serious and important, since this form of diarrhœa causes a large portion (about one-fourth) of the deaths attributed to zymotic diseases. We gather, from a statement furnished by Dr. Tatham, that his main difficulty lies in the impractibility of picking out, from the long list of fashionable but unauthorised synonyms, all the deaths which in their nature are indistinguishable from deaths by diarrhœa, and which ought to be called by the authorised name. At present he classes as diarrhœa (and therefore under zymotic disease) deaths certified as follows : Diarrhœa. Epidemic Diarrhœa. Dysentery and dysenteric diarrhœa. Intestinal (or enteric) catarrh. Gastro-intestinal (or gastro-enteric) catarrh. But the following he classes not as diarrhœa, but as diseases of the alimentary canal, thus excluding them from the zymotic class: Gastro-enteritis. Muco-enteritis. Gastric catarrh. 95 [1899 This second group of cases ought, he points out, for the most part, to be regarded as identical with epidemic diarrhœa, inasmuch as their age incidence, fatality curves, and general epidemiological characters correspond closely with those of that disease. In London, during the thirteen weeks ending with September last, the deaths medically certified as due to diarrhoea numbered 3,798; but in addition there were registered 2,289 deaths from enteritis, of which 1,880 were from gastroenteritis, the bulk of which ought certainly to be attributed to epidemic diarrhoea. The different counties of England vary very widely in the proportion of deaths returned respectively as due to diarrhoea and to enteritis, presumably in accordance with local fashion. Thus, for England and Wales as a whole, the diarrhoea death-rate amongst infants appears as 25 per 1,000 births, the enteritis death-rate as 12 per 1,000. But in East Yorkshire the proportions are 35 per 1,000 from diarrhoea, and 9 per 1,000 from enteritis, while in Cumberland they are 10 per 1,000 from diarrhoea, and 14 per 1,000 from enteritis. Dr. Tatham further points out that the fashion of discarding the familiar name " diarrhoea " in favour of such unsatisfactory and unauthorised names as " gastroenteritis," " gastric catarrh," etc., is of comparatively recent growth. But during the last fifteen, and especially during the last ten years, the fashion has prevailed so extensively as entirely to vitiate the diarrhoea mortality returns, which, for sanitary purposes, are of exceptional importance. We therefore consider that the present confusion of terms renders it impossible to determine accurately the prevalence of the disease in special places or at special times, the extent to which it influences public health in general, and the effects produced by sanitary measures. 3. We find that there is a widespread objection on the part of medical practitioners to the employment of the term " diarrhœa" in certifying the cause of death The term is generally held by the public to imply a mild disease, insufficient by itself to cause death. This fact explains the reluctance of the practitioner to employ it on the death certificate, since it may be conceived to imply a stigma upon his own capacity. It is therefore desirable, if possible, to substitute for it some name equally accurate, but conveying to the public the idea of a more serious affection. But we regard it as essential that the idea of specificity, intended to be conveyed by the term •'epidemic," should be retained, 4. Hence we would recommend the College to authorise the use of the term " epidemic enteritis " (or, if preferred by the practitioner, " zymotic enteritis " as a synonym for epidemic diarrhœa (Nomenclature of Diseases, p. 9, ed. 1896). And we would further recommend that the College should urge the entire disuse as synonyms of epidemic diarrhœa in medical certificates of death, of such terms as " gastro enteritis," " muco-enteritis," or " gastric catarrh." The report of the Committee was adopted by the College. 96 1899] Table LIII. Showing the Deaths occurring in the Parish and in the several Encircling Sanitary Districts from All Causes, from the principal Zymotic Diseases, and from Phthisis in the 52 weeks of the year 1899. the encircling districts. Estimated Populations. 1899. Total Deaths from All Causes. | Total Zymotic Deaths. Deaths from principal Zymotic Diseases. Deaths from Phthisis. Deaths of infants under 1 year of age. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Simple and Undefined Fevers. Diarrhœa. St. Pancras 244,548 4,948 653 ... 102 25 111 142 ... 42 ... 231 490 1,181 Stoke Newington 35,187 446 47 ... 10 3 6 4 ... 5 ... 19 31 82 Hackney 222,571 3,753 492 ... 110 16 89 48 ... 35 ... 194 332 985 Hornsey 66,057 694 66 ... 6 3 4 20 ... ... ... 33 56 155 Clerkenwell 66,068 1,492 200 ... 36 13 28 30 ... 23 ... 70 153 395 St. Luke 40,868 1,159 123 ... 26 8 10 14 ... 6 ... 59 144 270 Shoreditch 121,071 2,875 438 ... 90 13 65 47 ... 25 ... 198 253 844 The above Districts 796,370 15,367 2,019 ... 380 81 313 305 ... 136 ... 804 1,459 3,912 Islington 348,731 6,293 773 ... 155 33 120 160 ... 47 ... 258 583 1,548 97 [1899 Table LIV. Showing the Death-rates of Islington and of the several Encircling Sanitary Districts from All Causes, from the principal Zymotic Diseases, and from Phthisis in the 52 weeks of the year 1899. THE ENCIRCLING DISTRICTS. Estimated Populations, 1899. Total Deathrates from All Causes. Total Zymotic Death-rates. Death-rates from principal Zymotic Diseases. Death-rates from Phthisis. Deaths under 1 year to 1,000 Births. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Simple and Undefined Fevers. Diarrhœa. St. Pancras 244,548 20.2 2.67 ... 0.42 0.10 0.45 0.58 ... 0.17 ... 0.94 2.00 178 Stoke Newington 35,187 12.7 1.33 ... 0.28 0.09 0.17 0.11 ... 0.14 ... 0.54 0.88 102 Hackney 222,571 16.9 2.21 ... 0.49 0.07 0.40 0.22 ... 0.16 ... 0.87 1.49 152 Hornsey 66,057 10.5 0.99 ... 0.09 0.04 0.06 0.30 ... ... ... 0.50 0.85 106 Clerkenwell 66,068 22.6 3.02 ... 0.54 0.20 0.42 0.45 ... 0.35 ... 1.06 2.31 193 St. Luke 40,868 28.3 3.01 ... 0.64 0.20 0.24 0.34 ... 0.15 ... 1.44 3.52 149 Shoreditch 121,071 23.7 3.61 ... 0.74 0.11 0.54 0.39 ... 0.20 ... 1.63 2.09 204 The above Districts 796,370 19.3 2.53 ... 0.48 0.10 0.39 0.38 0.17 ... 1.01 1.83 168 Islington 348,731 18.0 2.21 ... 0.44 0.09 0.34 0.46 ... 0.13 ... 0.74 1.67 160 98 1899] Table LV. Showing the Death-rates from All Causes, from the principal Zymotic Diseases, together with Infantile Mortality, in the Country, in the Populous Towns, in Towns whose populations exceed 300,000 inhabitants, the Encircling Districts, and in Islington. ■ I 3 ■ u < . (A >>£ • n 3? rt.UJfO ■so » o- g M O 0. *n E in ■ <u s U 0> > 0) b j u rt o if) ei n V M a q dp c . n i hi <U > X ca 8 jl I £ U y. 2— c n 3 U« .ts ■s>o s-8 q - Cols. ]. 2. 3. 4. 5. 6 7. 8. 9. 10. England and Wales 18 3 2 21 0 01 0 31 012 0-29 0-30 0-20 0 98 163 33 Great Towns 202 2-81 0 01 0-46 0 13 0 40 0 38 022 1 21 181 67 Other LargeTowns 180 2 45 000 0 28 0 12 0 28 032 023 1 22 178 England and Wales 1 17 1 1 71 000 0 21 0 10 0 21 0-25 0 18 0 76 124 less the 100 Towns j London 19 3 246 000 047 009 0 43 0 38 0 18 092 166 Bristol 18 2 1 86 .. 013 004 0 10 037 0 11 111 158 Birmingham 20 8 2 96 0 38 006 029 0 32 0 24 1 67 1»1 Liverpool 26-4 377 000 0 50 0 26 034 0 49 0-31 1-87 198 Manchester 24-6 3-92 • • 1-30 008 0 15 0 42 0 14 1 83 206 Leeds 19 1 2 79 0-37 0 15 0 78 0 38 017 0 94 171 Sheffield .. 22 2 4 39 •• 0 61 0 25 1 28 016 0 51 1 58 194 St. Pancras 20 2 267 0 42 010 0 45 0-58 0 17 094 178 Stoke Newington .. 12 7 1 33 .. 0 28 009 0 17 0 11 0 14 054 102 Hackney 16 9 2 21 •• 049 007 040 022 0 16 0 87 152 Hornsey 105 099 •009 004 006 0-30 •• 0 50 106 Clerkenwell 22 6 302 0 54 0 20 0 42 0 45 0-35 1 06 193 St. Luke 28 3 301 064 0 20 0 24 0 34 0 15 1-44 149 Shoreditch 23-7 3-61 074 0 11 0 54 0 39 0 20 1 63 204 Encircling Districts 19 3 2 53 0 48 0 10 0 39 0 38 0 17 1 01 168 Islington 18 0 2-21 0 44 0 09 0-34 0 46 0 13 0 74 160 99 [1899 INFLUENZA. This disease, than which there is hardly any more infectious or leaves behind it such a stricken body as it does when it assumes an epidemic form, was more fatal than in any of the three years immediately preceding. It caused 126 deaths, the major portion of which was registered in the first and fourth quarters of the year. Thus in the first quarter it caused 52 deaths, in the second 25, in the third 4, and in the fourth 45. Ever since the great epidemic of 1889-90 Islington cannot be said to have been free from Influenza, for as a matter of fact there has not been a single quarter of any year in which deaths have not been registered from it. Sometimes, it is true, the deaths have been as few as 4, but on the other hand there have been as many as 60, 137, and even 159 registered in the short period of three months. These facts can be seen in the following tabular statement:— Years. Quarters. First. Second. Third. Fourth. Totals. 1891 3 159 15 7 184 1892 159 9 9 4 181 1893 31 23 9 60 123 1894 31 3 4 13 51 1895 137 29 4 9 279 1896 13 5 6 9 33 1897 14 11 4 18 47 1898 41 13 4 7 65 Corrected Average 65 33 7 17 122 1899 52 25 4 45 126 100 1899] This table shows that although the quarterly returns for the year were below the corrected average for the first three quarters yet in the fourth quarter they were considerably above it. This increase caused the deaths for the year to be above the average of the preceding eight years. I have, after very diligent and prolonged search, been able to compile the following returns of the deaths which had annually occurred in the Parish since 1856. Up to 1890 they were very few; so few indeed that Influenza as a serious disease might be said to have been non-existent. Years. Deaths. Years. Deaths. Years. Deaths. Years. Deaths. 1856 3 1866 5 1876 1 1886 0 1857 8 1867 0 1877 0 1887 0 1858 3 1868 1 1878 1 1888 1 1859 1 1869 4 1879 0 1889 1 1860 3 1870 0 1880 0 1890 38 1856-60 18 1866-70 10 1876-80 2 1886-90 40 1861 1 1871 0 1881 1 1891 184 1862 2 1872 0 1882 0 1892 181 1863 2 1873 0 1883 1 1893 123 1864 4 1874 2 1884 0 1894 51 1865 3 1875 0 1885 0 1895 279 1861-65 12 1871-75 2 1881-85 2 1891-95 818 Years. Deaths. 1896 33 1897 47 1898 65 1899 126 1896-99 271 101 [1899 I am unable to compare the mortality of the year with that which occurred in other places, because the report of the Registrar General for last year will not be available for a very considerable time. The 126 deaths registered in Islington were equal to a death rate of 0.36 per 1,000 inhabitants, and this, though a very heavy mortality from this disease, is not quite so bad as that which attained in the great epidemic year 1891, when all Great Britain and Ireland suffered in common with Europe and indeed with the civilized world, and not nearly so bad as the return for 1895. The disease was fatal during the year in the several subregistration districts as shown in the following statement:— 1 St Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Upper Holloway 12 2 2 15 31 Islington, South-west 15 13 0 17 45 Islington, South-east 12 3 1 4 20 Highbury 13 7 1 9 30 52 25 4 45 126 The resulting death rates which these deaths represent were as follows:— ISt Quarter 2nd Quarter. 3fd Quarter. 4th Quarter Year. Upper Holloway 0.46 0.08 0.08 0.58 0.29 Islington, South-west 0.55 0.48 — 0.6i 0.41 Islington, North-east 0.70 0.18 0.06 0.24 0.29 Highbury 0.76 0.41 0.06 0.53 0.44 The Parish 0.6o 0.29 0.05 0.38 0.36 The disease was nearly equally fatal during the year, in proportion to their population, in Islington South-west and in Highbury, in which districts the highest death rates were experienced, while in Upper Holloway and in Islington South-east the death rates which were exactly on a par with each other were not nearly so high. 102 1899 ] A few particulars concerning Influenza may be interesting, more especially as I do not observe that anything regarding its history or behaviour has been previously brought under your notice. It is an epidemic disease, generally re-appearing at considerable intervals, although at times only a few years may elapse. During the century which ends with this year, there were five great epidemics, namely in 1803, 1833, 1837-8, 1847-8 and 1889-90. In the intervals between these years there have been casual or, as they are called, sporadic cases, and indeed from 1848 to 1889 there has not been a single year in which some deaths, however few, have not been registered in England and Wales. In that interval they have been as few as 55 in 1889, the year preceding the last great outbreak and as many as 3,568. In London the number fell as low as 3 in 1888 but was as high as 354 in 1851. Thus it is seen that the disease was really never absent. There is a great difference between the fatality from influenza in the sporadic years and in the epidemic years. In the former it is not so great; it is a milder and altogether a more benign disease but it is more fatal to children than adults, while in the latter it is a serious disease bringing great danger of death to those whom it attacks, particularly adults, and even more particularly to those adults who have passed their fortieth year. When influenza is epidemic there is generally an increase in the deaths from diseases of the respiratory organs, and in this respect its behaviour is not unlike epidemic measles, which I have frequently noticed, and indeed, have so reported to you, is attended by numerous deaths from bronchitis and pneumonia, and possibly from a similar cause. This is the non-recognition of the disease, and the consequent neglect of nursing and confinement to bed, with the result that bronchitis or pneumonia intervenes. Then when a physician is called in, nothing is said either by the patient or his guardian about the earlier symptoms, and consequently should the patient die, the primary cause of death is attributed to those which are really only secondary. Influenza, judging by the London returns since 1846 is invariably more fatal in the first and fourth quarters of the year, 103 [1899 especially in the former, a circumstance which is probably due to the greater cold, and the consequent supervention of these respiratory diseases which easily cause the death of the already weakened patient. Influenza, which is an Italian name first given to it in the 17th century, is also known by its French name "La Grippe," and also in France as "Italian Fever" and "Spanish Catarrh." By Germans it has been called "Russian Influenza," from the fact that it started from that country in its invasion of Europe, and by the Russians "Chinese catarrh." When the epidemic of 1889-91 first made its appearance it was looked on by some observers as a disease of malarial origin, by others it was regarded as identical with the "dengue," "dandy fever," or "break bone fever" of tropical climates, but a more intimate acquaintance with it revealed points of marked difference in their symptoms, which it is now unnecessary to discuss. A description of the disease itself, which is one of the best I have read, is that " Influenza is a specific fever, epidemic and often pandemic, of sudden onset and short duration, attended with loss of appetite and very great prostration, associated often with more or less severe catarrh, neuralgic pains, and gastro-intestinal disturbances, and especially liable to be complicated by sevsre respiratory affections to which the mortality of the disease is chiefly due." This definition would have been as nearly as possible complete if it had also stated that it was highly infectious. It can easily be understood from this description of influenza that if the patient be not nursed with great care kept apart from the influences of cold, damp, or wet, from draughts and indeed from chills of any kind, he is extremely likely to be attacked with serious disease of the respiratory system, such as pneumonia or bronchitis. To go at once to bed is therefore, the first, best, and most imperative treatment for all attacked persons to adopt. If this rule were generally adopted there would be far less complications and far fewer deaths. 104 1899] Influenza is nevertheless a serious disease, and it reduces the patient to such a state that, when it has left him, he is so exhausted that diseases of the nervous system, of the circulatory system and of the respiratory system frequently fatally supervene. Diseases of these classes are its usual successors, and the inflated mortality returns from them when influenza is prevalent may very rightly be ascribed to it, in as much as it was the primary disease, although possibly it may have escaped the notice of the patient and of his friends. This was proved as regards the last outbreak of influenza in Islington by the following figures, the first column of which gives the average for the preceding five fourth quarters. Average 4th Quarter 1894-98. 4th Quarter. 1899. Excess. Disease of Nervous System 132 140 8 „ Circulatory System 107 l6l 54 ,, Respiratory System 294 480 186 533 781 248 There was an excess in the fourth quarter, during which time influenza was prevalent, of 8 deaths from nervous diseases, of 54 from diseases of the circulatory system, and of 186 from diseases of the respiratory system. It is more than probable that a very large part of this very great excess in the number of deaths from these diseases was due to influenza, and consequently the total of 45 which the mortality returns ascribe to it is very much understated. 105 [1899 Table LVI. Influenza. Secondary Causes of Death. Upper Holloway. South-West Islington. South-East Islington. Highbury. Totals. Quarters. Quarters. Quarters. Quarters. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th. Ill-defined Fevers .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. 2 Cyanosis .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Old Age 1 .. 1 .. .. .. .. 3 .. .. .. .. 1 .. .. 6 Meningitis .. .. .. .. .. .. .. .. .. .. .. 1 1 Apoplexy .. .. 1 .. .. 1 Convulsions .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Other Diseases of Heart 1 .. .. .. 1 1 .. 2 1 .. .. .. .. .. .. .. 6 Bronchitis 6 .. .. 5 2 3 .. 2 3 .. .. .. 3 2 .. 4 30 Pneumonia 2 2 1 8 8 8 .. 6 8 3 .. 3 8 3 .. 4 64 Pleurisy .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Asthma .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 Other Diseases of Respiratory System 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Gastritis .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 2 Peritonitis 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Disease of Bladder .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 All Secondary Causes 12 2 2 14 14 12 15 12 3 1 4 13 7 8 119 No Secondary Causes .. .. .. 1 1 1 .. 2 .. .. .. .. .. .. 1 1 7 Totals 12 2 2 15 15 13 .. 17 12 3 1 4 13 7 1 9 126 106 1899] SEPTIC DISEASES. Erysipelas. Sixteen deaths were referred to erysipelas, or one below the corrected average of eight years. These deaths are equal to a death rate of 0.04 per 1,000. It is noticeable that the mortality was greater at two periods of life, namely under one year, and between 45 and 55. At the former age period there were six deaths, and at the latter five, leaving only five to be distributed over the other periods of life. The mortality in each registration sub-district was as follows: Deaths. Death rates. Upper Holloway 4 = 0.04 per 1,000 inhabitants. Islington, South-west 3 = 0.03 ,, ,, „ South-east 7 = 0.10 ,, ,, Highbury 2 = 0.03 ,, ,, Islington16 = 0.04 ,, ,, During the preceding eight years the deaths have been:— Deaths. Death rates. 1891 9 = 0.03 per 1,000 inhabitants. 1892 20 = 0.06 ,, ,, 1893 34 = 0.10 ,, ,, 1894 15 = 0.04 „ „ 1895 16 = 0.05 „ „ 1896 16 = 0.05 „ „ 1897 11 = 0.03 „ „ i8q8 8 = 0.02 „ „ Corrected mean 17 = 0.05 „ „ 1898 16 = 0.04 „ „ Showing the Oases of Erysipelas notified during each week in 1899, together with the averages for the corresponding weeks in the years 1891-98. 107 [1899 Puerperal Fever. Fourteen deaths were registered, three of which occurred in Upper Holloway, seven in South-west Islington, two in South-east Islington, and two in Highbury. The total deaths were in the proportion of 1.45 to every 1,000 registered births, and were exactly twice the number of those known in the preceding year. Compared with the other districts the deaths in proportion to the births were excessive in South-west Islington. There the rate was 2.14 per 1,000 births, whereas in Upper Holloway it was 1.07, in South-east Islington 1.03, and in Highbury 1.21. The deaths and their proportion to the births were from 18911898 as follows:— Year. Deaths. Deaths to 1,000 births. 1891 8 0.82 1892 23 2.40 1893 13 1.33 1894 8 0.84 1895 12 1.21 1896 11 1.11 1897 10 1.01 1898 7 0.74 1899 14 1.45 Table lvii. Showing the Deaths from Puerperal Fever in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1 1 .. 1 3 Islington, South West 1 1 1 4 7 Islington, South East .. 1 .. 1 2 Highbury .. 1 1 .. 2 The Parish 2 4 2 6 14 h 2 108 1899] Table LVIII. Showing the Deaths from Puerperal Fever per 1,000 Births in the Sub-Districts for each Quarter. Sub'Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1.46 1.37 •• 1.59 1.07 Islington, South West 1.16 1.27 1.24 4.89 2.14 Islington, South East •• 2.13 •• 2.12 1.03 Highbury •• 2.26 2.54 •• 1.21 The Parish 0.80 1.65 0.82 260 1.45 109 [1899 CONSTITUTIONAL DISEASES. This large group of diseases shows a decrease of 29 on the corrected average of the preceeding six years, the particulars of which will be found in the succeeding table. The total deaths numbered 1,115, and are equal to a death-rate of 3.20 per 1000 inhabitants. Table LIX. Showing the Deaths from the several Constitutional Diseases during the years 1893-8, together with the Corrected Mean Number of Deaths for these years, together with the Deaths in 1899 1893. 1894. 1895. 1896. 1897. 1898. Corrected Mean. 1899. Increase or Decrease. Rheumatic Fever 18 14 9 17 20 22 17 26 + 9 Rheumatism 8 8 12 12 4 12 11 8 - 3 Gout 7 7 9 15 9 7 9 4 - 5 Rickets 9 10 17 12 17 19 15 25 +10 Cancer 238 239 266 291 304 283 282 270 -12 Gangren 9 8 9 14 11 8 10 15 + 5 Tabes Mesenterica 113 69 80 81 71 65 84 50 -34 Tubercular Meningitis 75 62 108 103 82 87 90 89 - 1 Phthisis 560 539 568 530 520 527 582 583 + 1 Other Tubercular & Scrofulous Diseases 10 3 7 16 16 7 10 7 - 3 Purpura 4 2 2 .. 2 1 2 4 + 2 Anaemia, Chlorosis, Leucocythaemia 8 13 10 9 12 11 11 11 .. Diabetes 20 23 16 19 13 18 19 20 + 1 Other Diseases 4 .. 1 3 3 •• 2 3 + 1 Totals 1,093 997 1,114 1,122 1,084 1,067 1,144 1,113 -29 110 1899] Cancer. Cancer caused 270 deaths, a number which is exactly equal to the corrected average of the preceding eight years. These deaths represent a death-rate of 0.77 per 1000. The rate of mortality is the smallest since 1894, when it was 0.72. Of the 270 persons who died, 104, or 38.5 per cent., were males, and 166, or 61.5 per cent., females. During the preceding eight years the deaths and death-rates were as follows:— Males. Females. Totals Death-rate. 1891 74 144 2l8 = 0.68 per 1,000 inhabitants. 1892 70 149 219 = 0.68 ,, ,, 1893 82 156 238 = 0.73 „ „ 1894 78 l6l 239 = 0.72 „ „ 1895 96 170 266 = 0.79 „ „ 1896 104 187 291 = 0.86 ,, ,, 1897 112 192 304 = 0.89 „ „ 1898 106 177 283 = 0.82 ,, ,, 1899 104 166 270 = 0-77 The chief mortality occurred between the ages of 45 and 75. Table LX. Showing the Deaths from Cancer in the several Sub-Districts during the Quarters and the Year. [###Quftrters. Upper Holloway. Islington South-west. Islington South. east. Highbury. The Parish.[/###Q 1st 19 22 7 10 58 2nd 25 20 14 6 65 3rd 24 24 12 16 76 4th 22 15 16 18 71 The Year 90 81 49 50 270 111 [1899 Of these 270 persons, 166 or 61.5 per cent. were women. The ages of all persons at death were as follows:— Ages. Deaths. Ages. Deaths. 0—25 3 75—85 18 25—35 8 85—95 2 35—45 19 95 and.upwards — 45—55 63 - 55—65 85 All ages 270 65—75 72 Tubercular Diseases. These Diseases include Phthisis, Scrofula, Tabes Mesenterica, and Hydrocephalus. Phthisis.—To it were attributed 583 deaths, 359 males and 224 females, which represent a death-rate of 1.67 per 1,000 inhabitants These figures show an increase of 21 deaths and a small rise in the death-rate of 0.06 per 1,000, when contrasted with the returns of the preceding eight years. Since 1891 the deaths and death-rates have been:— 1891 544 deaths 1.70 per 1,000 inhabitant. 1892 504 „ 1.56 „ „ 1893 560 „ 1.71 „ „ 1894 539 „ 1.63 „ „ 1895 568 „ 1.70 „ „ 1896 530 „ 157 „ „ 1897 520 1.52 „ „ 1898 527 „ 1.53 „ „ Corrected mean 562 „ 1.61 „ „ 1899 583 „ 1.67 „ „ Increase 21 „ 0.06 „ „ 112 1899] The greatest fatal incidence of the disease occurred in the Sub-Registration District of South East Islington, in which 150 deaths, equal to a death-rate of 2.20 per 1,000, occurred. This rate, although high for Islington, is not so high as in other parts of the Metropolis. Thus in Central London, which embraces seven Sanitary Districts, the rate was 2.75 per 1,000, the rate for Holborn being 2.32, and of St. Luke's as high as 3.53 per 1,000. The deaths in the Sub-Registration Districts:— Upper Holloway 130 deaths = 1.25 per 1,000 inhabitants. Islington, South-west 209 „ = 1.92 „ „ ,, South-east 150 „ = 2.20 „ „ Highbury 94 „ = 1.38 „ „ Total 583 „ =1.67 „ „ These rates may be usefully compared with those given below. London 1.86 per 1000 West London 1.65 „ North ,, 1.64 „ Central ,, 2.75 „ East „ 2.19 „ South „ 1.74 „ The following Table shows the distribution of the disease in the sub-districts and in the several quarters of the year:— Table LXI. Quarters. Upper Holloway. Islington South-west. Islington South-east. Highbury The Parish. 1st 37 67 35 26 165 2nd 31 53 30 25 139 3rd 85 36 38 16 125 4th 27 53 47 27 154 The Year 130 209 150 94 583 113 [1899 Perhaps no disease has been the object of so much interest to the public and the medical profession during late years as Phthisis and Tubercular diseases generally, particularly since they have been recognised as being to a large extent preventable. Although as yet little has been effected in Islington in its prevention I am glad to note among the medical men practising here an increasing anxiety to help the Sanitary Authority. It is hoped that before long, in addition to the bacterological diagnosis of Phthisis, at present effected free of charge to practitioners, that disinfection and repairof premises following on notification will be the general rule and not the exception, for it must not be forgotten that tuberculosis is not only a disease communicable by means of food such as milk, but is also generally to be found amidst insanitary surroundings, or under conditions which lessen vitality, especially where these include laok of light and ventilation. Tabes Mesenterica.—50 deaths were ascribed to this disease, of which 46 were under 5 years, the remaining 4 being under 15 years. The disease was fatal to 26 males and 24 females. The death-rate was 0.14 per 1,000 of the entire population, but the 46 deaths of children under 5 years old represesented a mortality of 1.11 per 1,000 among them. Tubercular Meningitis or Hydrocephalus was the registered cause of the deaths of 89 persons, 71 of whom had not reached 5 years of age, and of whom 44 were males and 45 females. The death-rate for the entire population was 0.26 per 1000, while among children under 5 years it was 172 per 1000. Scrofula was the ascribed cause of 7 deaths, 2 of which were under 5 years of age. 114 1899] Diseases. Ages. Sex. Districts. Total Deaths Death Rates. 0-1. 1-5. Over 5 M. F. U.H. s.w. S.E. H. 0-5. 5-15. Ages All Phthisis 27 28 528 359 224 130 209 150 94 583 1.34 0.18 1.67 Tabes Mesenterica 30 16 4 26 24 14 18 11 7 50 1.11 0.06 0.14 Tubercular Meningitis 30 41 18 44 45 23 35 14 17 89 1.72 0.25 0.26 Scrofula — 2 5 6 1 4 2 — 1 7 0.05 0.07 0.02 All Tubercular Diseases 87 87 555 435 294 171 264 175 119 729 4.23 0.56 2.09 INFANTILE MORTALITY. The deaths of 1,548 infants, who had not lived twelve months, were registered. These represent a mortality of 160 per 1,000 children born during the year. This proportion of infantile deaths to births is the highest experienced in Islington since 1893, and is 14 per 1,000 births more than the average of the fourteen years 1885-98. Infantile mortality is unusually low in this district. Indeed it compares very favourably with that experienced in the large centres of population. Even the present mortality, though high for the Parish, is lower than that which obtained in the 33 Great Towns, in which it was 181, also than that of the 67 Other Large Towns, where it was 178 per 1,000 births. The Islington records for the preceding sixteen years have been as follows:— Years. Deaths under 1 year. Deaths per 1,000 Births. Years. Deaths under 1 year. Deaths per 1,000 Births. 1883 1,312 132 1893 1,595 163 1884 1,506 150 1894 1,229 129 1885 1.387 144 1895 1,416 143 1886 1,512 154 1896 1,490 150 1887 1,557 160 1897 1,338 136 1888 1,271 133 i898 1,504 159 1889 1,261 132 1890 1,488 158 Mean 1,423 146 1891 1,481 151 1892 1,417 148 1899 1,548 160 115 [1899 While the infantile mortality rates in the undermention places were as follows :— England and Wales 163 per 1,000 births. Rural Districts 124 „ 33 Great Towns 181 ,, 67 Other Large Towns 178 ,, London 166 „ Birmingham 191 ,, Liverpool 198 „ Manchester 206 „ Leeds 171 ,, Sheffield 194 ,, The Encircling Districts— Encircling Districts. Hornsey 107 Stoke Newington 103 Hackney 153 Shoreditch 204 „ St. Luke 149 Clerkenwell 193 St. Pancras 178 Islington 160 The diseases which caused increased mortality were Diarrhœa, which was 60, Phthisis 5, Tubercular Meningitis 3, Premature Births 19, Erysipelas 3, Pneumonia 18, Enteritis 97, Gastritis 4, and Marasmus 28 in excess of the average of the preceding six years. The Infantile Mortality was least in the Highbury sub-district, and greatest in Islington South-west. The Infantile Mortality rates in the several sub-districts were— Deaths. Upper Holloway 146 per 1,000 births. Islington South-west 180 „ „ „ South-east 161 „ „ Highbury 144 ,, ,, The Parish l60 ,, ,, 116 1899] Table LXII. Showing the chief causes of Infantile Mortality in the year 1899, and in the six preceding years 1893-98. Diseases. Years. + Increase or -Decrease on mean of 6 years. 1893. 1894. 1895. 1896. 1897. 1898. Mean of 6 yrs. 1899. Measles 28 37 37 67 12 65 41 27 -14 Whooping Cough 70 72 34 103 58 67 67 66 -1 Diarrhœa 189 73 144 125 138 220 148 208 +60 Syphilis 21 14 11 6 17 12 14 7 -7 Tabes Mesenterica 83 45 56 64 55 48 58 30 -28 Phthisis 28 27 28 17 15 18 22 27 +5 Tubercular Meningitis 21 17 46 28 23 29 27 30 +3 Premature Births 173 148 151 169 174 191 168 187 +19 Other Developmental Diseases 48 48 37 40 39 30 40 21 -19 Erysipelas 4 2 3 5 2 ... 3 6 +3 Inflammation of Brain 32 19 14 21 27 25 23 16 -7 Convulsions 75 7i 63 74 60 46 65 62 -3 Bronchitis 138 121 125 141 129 129 130 124 -6 Pneumonia 74 88 97 129 86 87 94 112 +18 Dentition 19 23 29 25 21 23 23 16 -7 Enteritis 45 40 54 62 65 105 62 159 +97 Gastritis 4 9 11 10 8 9 9 13 +4 Suffocation 56 56 43 51 39 48 49 45 -4 Debility 102 7i 112 68 76 76 84 81 -3 Marasmus 176 111 141 114 131 129 134 162 +28 Inanition 89 50 54 60 49 39 57 42 -15 All other Diseases 120 87 126 111 114 108 111 107 -4 Totals 1595 1229 1416 1490 1338 1504 1429 1548 +119 In the four quarters the mortality was as follows:— Deaths. Deaths per 1,000 Births. First Quarter 308 123 Second „ 256 105 Third „ 622 256 Fourth „ 362 157 The great fatality in the third quarter was due to Diarrhœa, and other bowel disorders. 117 [1899 THE NOTIFICATION OF INFECTIOUS DISEASES. The separate cases of the infectious diseases, notifiable under sec. 55 of the Public Health (London) Act, 1891, numbered 2,942, as compared with 2,418 returned in the preceding year, and a corrected average of 3,324 in the eight years, 1891-8. The case rate was equal to 8.44 per 1,000 of the inhabitants, which, while it exceeds that which obtained in 1898 by 1.44, is almost identical with the mean rate which obtained since 1891. The case rate contrasts with the rates of London and the Encircling Districts as follows:— The Encircling Districts. London 9.3 per 1,000 inhabitants. St. Pancras 8.22 „ „ Stoke Newington 7.58 ,, ,, Hackney 10.29 ,, ,, Hornsey 7.64,, ,, Clerkenwell 10.47 ,, ,, St. Luke's 8.95 ,, ,, Shoreditch 9.25 ,, ,, The Encircling Districts (collectively) 9.11 ,, ,, Islington 8.44 „ ,, These rates are all above those experienced in the preceding year. Locally only Enteric Fever, Puerperal Fever and Cholera (English) exceeded the corrected average of the preceding eight years. The increase in the enteric fever cases is mainly explained by the outbreak of the disease, in the second and third quarters, at the Workhouse Schools, Hornsey Road, and that of the puerperal fever cases by the inclusion of both peritonitis and metritis when occurring in connection with parturition, as well as puerperal pyaemia, puerperal septicaemia and puerperal sapræmia among the diseases that were to be included under that heading. 118 1899] The preceding returns from the infectious diseases taken together have been as follows:— Cases. Case rate. 1891 2,063 = 6.4 per 1,000 inhabitants. 1892 3,320 = 10.3 „ ,, 1893 4,853 = 14.8 ,, ,, 1894 3,123 = 9.4 ,, ,, 1895 2,840 = 8.5 ,, ,, 1896 3,822 = 11.3 ,, ,, 1897 2,906 = 8.5 „ ,, 1898 2,418 = 7.0 ,, ,, Corrected mean 3,266 = 8.43 ,, ,, 1899 2,943 8.44 „ ,, Decrease on mean 323 + 0.01 ,, ,, In the several sub-registration districts the figures were as follows:— Upper Holloway 1,105 = 10.65 per 1,000 inhabitants. Islington, South-west 800 = 7.37 „ ,, Islington, South-east 546 = 8.01 „ ,, Highbury 492 = 7.21 „ ,, Total 2,943 = 8.44 „ ,, The cases that occurred in the several wards are given in Table LXXXII., page 131. SMALLPOX. Three cases were notified, but in my opinion the diseases was not smallpox. Altogether 29 cases were notified in London. The cases were 40 below the corrected average of the preceding six years. 1891 1 case. 1897 3 cases. 1892 42 cases. 1898 0 „ 1893 118 „ 1894 90 „ Corrected mean 43 ,, 1895 25 ,, 1896 50 „ 1899 3 „ 119 [1899 SCARLET FEVER. There were 1,494 notifications made, or 270 less than the corrected average. The disease was very equally distributed in proportion to the population in the several Sub-districts. The case-rate was 4.28 per 1,000 inhabitants. 1891 728 cases = 2,27 case-rate per 1,000 inhabitants. 1892 1,710 „ = 5.29 ,, ,, ,, 1893 2,880 „ =8.81 ,, ,, ,, 1894 1,493 ,, = 4.52 ,, ,, ,, 1895 1,692 „ = 5.06 ,, ,, ,, 1896 2,031 „ = 6.01 ,, ,, ,, 1897 1,577 ,, = 4.62 ,, ,, ,, 1898 1,336 ,, = 3.87 ,, ,, ,, Corrected mean 1,764 ,, = 5.06 ,, ,, ,, 1899 1,494 4.28 ,, ,, ,, Table LXIII. Showing the Sickness from Scarlet Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 125 98 99 133 455 Islington, South West 90 96 114 139 439 Islington, South East 50 56 106 94 306 Highbury 56 68 77 93 294 The Parish 321 318 396 459 1,494 1899] 120 Table LXIV. Showing the Sickness rates from Scarlet Fever for the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 4.82 3.78 3.82 5.13 4.38 Islington, South West 3.32 3.54 4.20 5.12 4.04 Islington, South East 2.93 3.28 6.22 5.51 4.49 Highbury 3.28 3.99 4.51 5.45 4.31 The Parish 3.68 3.65 4.54 5 26 4-28 Table LXV. Showing the Fatality from Scarlet Fever. (Deaths to 100 cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1.6 .. 1.0 0.7 0.8 Islington, South West 1.1 1.0 3.5 8.0 3.8 Islington, South East • • • • 0.9 2.1 0.9 Highbury .. 6.0 4.0 2.1 3.0 The Parish 0.9 1.6 2.3 3.5 3.2 DIPHTHERIA. The cases of this disease that were notified were also less by 95 than the average of the preceding eight years. The case rate was 1.97 per 1,000 inhabitants, compared with a rate of 3.98 in the Metropolis, and of 2.56 in the Encircling Districts. Only twelve of the London districts showed a lesser case rate. 121 [1899 The record of this disease since 1891 has been as follows:— Years. Cases Case-rates. Deaths Fatality (deaths per 100 cases). 1891 712 2.22 158 22.2 1892 695 2.15 150 21.6 1893 855 2.61 189 22.1 1894 843 2.55 208 24.7 1895 564 1.69 137 24.3 1896 1,067 3.16 247 23.1 1897 700 2.05 115 16.4 1898 531 1.54 90 16.9 Corrected mean 783 2.24 170 21.7 1899 688 19.7 120 17.4 Table LXVI. Showing the Sickness from Diphtheria in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 34 44 141 116 335 Islington, South West 35 17 44 35 131 Islington, South East 29 34 33 36 132 Highbury 18 12 18 42 90 The Parish 116 107 236 229 688 I 122 1899] Table LXVII. Showing the Sickness rates from Diphtheria of the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1.31 1.70 5.44 4.47 3.23 Islington, South West 1.29 0.63 1.62 1.29 1.21 Islington, South East 1.70 1.99 1.94 2.11 1.93 Highbury 1.6 0.70 1.06 2.46 1.82 The Parish 1.33 1.23 2.71 2.63 1.97 Table LXVII I. Showing the Fatality from Diphtheria. (Deaths to 100 cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 6.0 13.6 19.1 26.7 20.0 Islington, South West 11.4 18.0 15.9 17.1 15.2 Islington, South East 10.3 6.0 24.2 11.1 13.0 Highbury 17.0 16.6 17.0 19.0 17.7 The Parish 10.3 12.1 19.5 21.4 17.4 MEMBRANOUS CROUP. The notifications numbered only 17 as against a corrected average of 29. 123 [1899 The cases of this disease notified in previous years were as follows:— 1891 44 cases 1897 29 cases 1892 43 „ 1898 13 „ 1893 30 „ — 1894 24 " Corrctd. mean 29 „ 1895 18 „ — 1896 24 „ • 1899 17 „ Table LXIX. Showing the Sickness from Membranous Croup in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway •• 1 2 1 4 Islington, South West 3 1 2 2 8 Islington, South East 1 •• 1 1 3 Highbury 1 •• 1 •• 2 The Parish 5 2 6 4 17 Table LXX. Showing the Sickness rates from Membranous Croup of the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quaiter. 2nd Quarter. * 3rd Quarter. 4th Quarter Whole Year. Upper Holloway .. 0.04 0.08 0.04 0.04 Islington, South West 0.11 0.04 0.07 0.07 0.07 Islington, South East 0.05 .. 0.06 0.06 0.04 Highbury 0.05 •• 0.06 .. 0.03 The Parish 0.06 0.02 0.07 0 04 0.05 i 2 124 18991 Table LXXI. Showing the Fatality from Membranous Croup. (Deaths to 100 cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway .. • * •• •• Islington, South West 66.6 100.0 50.0 •• 50.0 Islington, South East .. •• 100.0 •100.0 100.0 Highbury 100.0 •• •• • • 50.0 The Parish 60.0 50.0 33.3 50.0 47.0 * This percentage refers to two cases, of which only one was notified, the other occurring in an outlying Institution. ENTERIC FEVER. The cases, 353 in number, were 116 above the corrected average of eight years. They represented a case-rate of 1.01 per 1,000, as compared with 0.98 in London and 1.07 in the Encircling Districts. The previous returns were as follows:— 1891 189 cases = 0.59 per 1,000 inhabitants. 1892 219 „ = 0.68 „ „ 1893 251 „ = 0.77 „ „ 1894 245 „ = 0.74 „ „ 1895 184 „ = 0.55 „ „ 1896 229 „ = 0.68 „ „ 1897 256 „ = 0.75 „ „ 1898 237 „ = 0.68 „ „ Corrected mean 237 „ = 0.68 „ „ 1899 353 „ = 101 „ 125 [1899 Table LXXII. Showing the Sickness from Enteric Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 33 23 60 57 173 Islington, South West 8 5 23 47 83 Islington, South East 5 2 6 18 31 Highbury 8 8 10 40 66 The Parish 54 38 99 162 353 Table LXXII I. Showing the Sickness rates from Enteric Fever of the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 1.27 0.89 2.32 2.20 1.67 Islington, South West 0.29 0.18 0.85 1. 73 0.76 Islington, South East 0.30 0.12 0.35 1.06 0.45 Highbury 0.47 0.47 0.59 2.34 0.97 The Parish 0.62 0.43 1.14 1.86 1.01 Table LXXIV. Showing the Fatality from Enteric Fever. (Deaths to ioo cases of Sickness) Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway 9.1 13.0 6.6 14.0 10.4 Islington, SouthWest 25.0 •• 8.7 17.0 14.4 Islington, South East 40.0 50.0 16.6 11.1 19.4 Highbury 25.0 12.5 30.0 12.5 16.6 The Parish 16.6 13.2 10.1 14.2 13.3 126 1899] TYPHUS FEVER. No case was notified, nor has any been known since the fourth quarter of 1898. ERYSIPELAS. 350 cases, equal to a case-rate of 1.00, were notified. These are 77 below the corrected average. In London the rate was 1.23, and in the Encircling Districts 1.28 per 1,000. In preceding years the returns were as follows:— 1891 343 cases = 1..07 per 1,000 inhabitants. 1892 550 „ = 1.70 „ „ 1893 672 „ = 2.05 „ „ 1894 395 „ = 1.19 „ „ 1895 319 „ = 1 00 „ „ 1896 385„ = 1.14 „ „ 1897 312 „ = 0.91 „ „ 1898 279 „ = 0.80 „ „ Corrected mean 427 „ = 1.22 ,, ,, 1899 350 „ 4.00 „ „ Table LXXV. Showing the Sickness from Erysipelas in the Sub-Districts for each Quarter and for the Year. Sub-Distsicts. 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. Whole Year. Upper Holloway 22 30 36 33 121 Islington, South West 22 24 25 51 122 Islington, South East 19 12 14 24 69 Highbury 5 7 10 16 38 The Parish .. 68 73 85 124 350 127 ["1899 Table LXXVI. Showing the Sickness rates from Erysipelas of the Sub-Districts for each Quarter and for the Year. • Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter.. Whole Year. Upper Holloway 0.85 1.16 1.39 1.27 1.17 Islington, South West 0.81 0.88 0.92 1.88 1.12 Islington, South East 1.12 0.70 0.82 1.41 1.01 Highbury 0.30 0.41 0.59 0.94 0.56 The Parish 0.78 0.84 0.97 1.42 1.00 Table LXXVII. Showing the Fatality from Erysipelas. (Deaths to 100 cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway .. 6.6 .. 6.0 3.3 Islington, South West .. .. 4.0 4.0 2.4 Islington, South East .. 8.8 7.1 20.8 10.1 Highbury .. .. 10.0 6.2 5.3 The Parish .. 4.1 3.5 8.1 4.5 PUERPERAL FEVER. There were 33 cases notified; and these were in the proportion of 3.42 per 1,000 inhabitants. This rate is slightly above (0.15) the proportion of the preceding eight years. 128 1899] 1891 36 cases = 3.67 per 1,000 registered births. 1892 51 „ = 5.34 „ „ 1893 38 „ = 3.90 „ „ 1894 23 .„ = 2.42 „ „ 1895 22 ,, = 2.23 „ „ 1896 30 „ = 3.02 „ „ 1897 27 „ = 2.74 „ „ 1898 19 „ = 2.86 „ ,, Mean 31 „ = 3.27 „ „ 1899 33 „ = 3.42 „ „ Table LXXVIII. Showing the Sickness from Puerperal Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Upper Holloway •• 3 5 4 12 Islington, South West 3 3 3 7 16 Islington, South East •• 1 1 1 3 Highbury •• 1 1 •• 2 The Parish 3 8 10 12 33 Table LXXIX. Showing the Sickness rates from Puerperal Fever per 1,000 registered births in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year Upper Holloway .. 4.12 6.67 6.35 4. 30 Islington, South West 3.48 3.82 3.72 8.57 4.89 Islington, South East .. 2.13 2.07 2.12 1.54 Highbury •• 2.26 2.54 .. 1.21 The Parish 1.20 3.30 4.11 5.19 3.42 129 [1899 Table LXXX. Showing the Fatality from Puerperal Fever. (Deaths to 1oo cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quurter. 4th Quarter. Whole Year. Upper Holloway •100.0 33.3 •• 25.0 25.0 Islington, South West 33.3 33.3 33.3 57.1 43.8 Islington, South East •• 100.0 100.0 66.6 Highbury •• 100.0 100.0 •• 100.0 The Parish 66.6 50.0 20.0 50.0 42.4 • This percentage refers to a case which was not notified. CONTINUED FEVER. Only 2 cases of this fever were notified, as against an average of 5 in the preceding eight years. RELAPSING FEVER. No case was known. CHOLERA. Three cases of English Cholera were notified. 130 1899] Table LXXXI. Showing the number of Cases of Infectious Diseases notified for the Sub-registration Districts during 1899. Sub-Registration Districts. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Totals. Rate per 1,000 of the Population. Upper Holloway 2 455 335 4 173 ... 121 12 ... ... 3 1,105 10.65 Islington, South West ... 439 131 8 83 ... 122 16 1 ... ... 800 7.37 Islington, South East i 306 132 3 31 ... 69 3 1 ... ... 546 8.01 Highbury ... 294 90 2 66 ... 38 2 ... ... ... 492 7.21 The Parish 3 1.494 688 17 353 ... 350 33 2 ... 3 2.943 8.44 (All Duplicates have been excluded). 131 [1899 Table LXXXII. Showing the number of Cases of Infectious Disease notified in the Wards during the Year 1899. n.b.—(Duplicate cases have been deducted.) WARDS. Estimated Population, 1899. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (T yphoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Contiuued Fever. Relapsing Fever. Cholera. Totals. 1 Cases Notified per 1.000 of Population. i 2 3 4 5 6 7 8 9 10 11 12 !3 13 15 Tufnell 34,049 100 148 2 39 ... 15 1 ... 305 8-96 Upper Holloway ... 38,132 172 99 1 40 70 7 2 391 10-25 Tollington 31.551 ^3 88 1 94 ... 36 4 i 409 12-96 Lower Holloway ... 42.357 178 56 2 24 ... 47 9 ... 3l6 7-46 West Highbury ... 38,437 ... 176 62 1 49 ... 25 1 3H 8-17 East Highbury 29,797 ... 118 28 1 17 12 1 ... 177 5'94 Thornhill ... 33.586 ... "7 28 3 31 ... 39 4 223 6-64 Barnsbury ... 234J3 ... 102 29 2 17 23 3 176 7-52 St. Mary's .. 17,882 ' ... 79 39 1 r5 22 ... j56 8-73 Canonbury 26,060 ■ ... 98 52 ... 16 19 1 ... 186 TH St. Peter's 33.467 i 171 59 3 11 ... 42 2 I ... 290 8-66 Totals 348.731 3 1.494 688 ' 353 ... 350 33 2 ... 3 2.943 8-44 1897 ... 3 1.577 700 29 256 ... 312 27 I ... I 2,906 8-51 1898 ... ... J.336 531 13 237 2 279 19 I ... ... 2,418 7*oi 132 1899] Table LXXXIII. Showing the Number of Cases of Infectious Diseases which were investigated, by the several Sanitary Inspectors during the Year ending 30th December, 1899. Sanitary Inspectors. Number of the Sanitary District. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever Relapsing Fever. Cholera. Total. Mr. Cook 1 ... 74 138 2 33 ... 13 1 ... ... ... 261 „ Cowling 2 ... 173 99 1 40 ... 69 7 ... ... 2 391 ,, Ward 3 2 86 27 ... 17 ... 10 3 ... ... 1 146 „ Grivell 4 ... 154 86 2 85 ... 37 1 ... ... ... 365 „ Flood 5 ... 81 22 2 17 ... 7 1 ... ... ... 130 ,, Bagshaw 6 ... 123 42 ... 17 ... 38 1 ... ... ... 226 „ Lawrence 7 ... 78 29 ... 33 ... 13 1 ... ... ... 154 „ Metcalf 8 ... 92 16 1 13 ... 6 1 ... ... ... 129 „ Irving 9 ... 98 22 2 29 ... 25 3 ... ... ... 179 ,, Watson 10 ... 92 36 ... 13 ... 16 1 ... ... ... 158 „ Fortune 11 1 138 55 i 11 ... 34 1 ... ... ... 241 „ Preston 12 ... 111 33 3 22 ... 34 4 1 ... ... 208 ,, Rolfe 13 ... 84 30 1 9 ... 20 2 ... ... ... 146 ,, Mernagh 14 ... 110 53 2 14 ... 28 1 1 ... ... 209 Totals ... 3 1,494 688 17 353 ... 350 33 2 ... 3 2,943 133 [1899 Table LXXXIV. Showing the Number of Cases of Infectious Disease which were notified in the several Months during the Year 1899 N.B.—(Duplicate Notifications have been deducted.) Month. 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 ... 106 43 ... 26 ... 26 1 ... ... ... 202 February ... 117 32 1 10 ... 19 1 1 ... ... 181 March ... 98 41 4 18 ... 23 1 ... ... ... 185 April 2 70 16 ... 11 ... 20 ... ... ... ... 119 May ... 108 45 1 9 ... 15 5 ... ... ... 183 June 1 140 46 1 18 ... 38 3 1 ... ... 248 July ... 126 75 4 22 ... 22 ... ... ... ... 249 August ... 109 58 2 44 ... 27 6 ... ... ... 246 September ... 161 103 ... 33 ... 36 4 ... ... 3 340 October ... 214 94 2 56 ... 40 3 ... ... ... 409 November ... 130 75 ... 55 ... 48 6 ... ... ... 314 December ... 115 60 2 5i ... 36 3 ... ... ... 267 Totals 3 1,494 688 17 353 ... 350 33 2 ... 3 2,943 134 1899] Table LXXXV. Showing the number of Cases of Infectious Diseases notified during each year since 1891, together with the mean number for the eight years 1891-8, and in 1899. (Duplicate certificates excluded.) Year. 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 1891 1 728 712 44 189 1 343 36 4 1 4 2,063 6.4 1892 42 1,710 695 43 219 ... 550 51 6 ... 4* 3,320 10.3 1893 118 2,880 855 30 251 1 672 38 7 ... 1 4.853 14.8 1894 90 1,493 843 24 245 1 395 23 9 ... ... 3,123 9.4 1895 25 1,692 564 18 184 5 309 22 9 2 ... 2,840 8.5 1896 50 2,031 1,067 24 229 ... 385 30 6 ... ... 3.822 11.15 1897 3 1.577 700 29 256 ... 312 27 1 ... 1 2,906 8..51 1898 ... 1,336 531 13 237 2 279 19 1 ... ... 2,418 7.01 Corrected Mean, 1891-8 43 1,764 783 29 237 1 427 33 6 ... 1 3.324 9.53 1899 3 1.494 688 17 353 ... 350 33 2 ... 3 2,943 8.44 Increase or Decrease on Mean -40 — 270 -95 --12 + 116 — 1 -77 ... -4 ... + 2 -381 — 1.09 * 3 of these were Asiatic Cholera. 135 [1899 Table LXXXVI. Showing the Cases of Infectious Disease notified during the Year 1899 in Islington and in its Encircling Districts. The Encircling Districts. Estimated Populations, 1899. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total Cases. St. Pancras 244,548 ... 862 562 16 246 — 311 13 — — 1 2,011 Stoke Newington 35.187 ... 182 29 — 17 — 32 7 — — — 267 Hackney 222,571 2 988 689 19 268 — 302 19 5 — — 2,292 Hornsey 66,057 2 343 98 — 22 — 39 1 — — — 505 Clerkenwell 66,068 ... 322 197 3 91 — 72 6 1 — — 692 St. Luke 40,868 ... 162 99 4 36 — 65 — — — — 366 Shoreditch 121,071 1 363 363 11 169 — 195 10 6 — 1 1,119 The Encircling Districts 796,370 5 3,222 2,037 53 849 — 1,016 56 12 — 2 7,252 Islington 348,731 3 1,494 688 17 353 — 350 33 2 — 3 2,943 136 1899] Table LXXXVII. Showing the Case Rates arising from the Infectious Diseases notified during the Year of 1899, in Islington and in its Encircling Districts. The Encircling Districts. Estimated Populations, 1899. Small Pox. Scarlet Fever or Scarlatina Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total Case Rates. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 St. Pancras 244,548 ... 3.53 2.30 0.07 1.00 ... 1.27 0.05 ... ... 0.00 8.22 Stoke Newington 35,187 ... 5.17 0.82 ... 0.48 ... 0.91 0.20 ... ... ... 7.58 Hackney 222,571 0.00 4.44 3.10 0.08 1.20 ... 1.36 0.08 0.02 ... ... 10.29 Hornsey 66,057 0.03 5.19 1.48 ... 0.33 ... 0.59 0.02 ... ... ... 7.64 Clerkenwell 66,068 ... 4.87 2.98 0.05 1.38 ... 1.09 0.09 0.02 ... ... 10.47 St. Luke 40,868 ... 3.96 2.42 0.10 o.88 ... 1.59 ... ... ... ... 8.95 Shoreditch 121,071 0.01 3.10 3.00 0.09 0.40 ... 1.61 o.08 0.05 ... 0.01 9.25 The Encircling Districts 796,370 0.01 4.05 2.56 0.07 1.07 ... 1.28 0.07 o.o1 ... 0.00 9.11 Islington 348,731 00.1 428 1.97 0.05 1.01 ... 1.00 0.09 0.01 ... 0.01 8.44 137 [1899 Table LXXXVIII. Showing the number of Cases of Infectious Disease notified in the several Metropolitan Districts. Districts in which the Patients were resident. Estimated Population, 1899. Small Pox. Scarlet Fever. Diphtheria. Membranous Croup. Typhoid or Enteric Fever. Typhus Fever. Continued Fever. Cholera. Erysipelas. Puerperal Fever. Totals. Battersea 174,996 • • 723 594 15 162 • • .. .. 208 14 1,716 Berraondsey 85,835 • • 402 536 7 110 3 1 .. 88 3 1,150 Bethnal Green 128,938 • • 431 323 22 203 • • .. 1 326 19 1,325 Camberwell 264,817 3 1,146 1,221 22 176 1 4 .. 259 19 2,851 Chelsea 96,721 • • 282 234 4 64 • • 4 1 83 9 681 Clerkenwell 66,068 • • 322 197 3 91 • • 1 .. 71 6 691 Fulham 130,720 1 849 518 10 111 • • 1 4 181 13 1,688 Greenwich 182,513 1 1,206 650 34 167 • • 2 1 272 14 2,347 Hackney 222.571 2 988 689 20 268 • • 5 .. 302 19 2,293 Hammersmith 108,785 • • 441 184 7 115 1 .. .. 110 12 870 Hampstead 80,252 • • 289 112 4 45 • • .. .. 52 5 507 Holborn 29,621 1 117 63 1 36 • • 2 .. 44 1 265 Islington 348 731 3 1,494 688 17 353 • • 2 3 350 33 2,943 Kensington 172,899 • • 443 254 3 107 1 17 .. 210 11 1,046 Lambeth 308,108 1 1,016 1,101 23 222 1 10 3 337 27 2,741 Lee 40,219 • • 195 135 • • 21 • • .. .. 29 2 382 Lewisham 91,027 1 580 477 4 58 • • 1 .. 84 7 1,212 Limehouse 58,804 2 171 130 2 135 • • .. .. 78 3 521 Marylebone 140,139 2 400 192 4 118 • • 1 .. 202 6 925 Mile End Old Town 113,161 • • 296 361 12 138 • • 2 .. 149 7 965 Paddington 128 794 • • 384 204 1 98 1 1 .. 148 7 844 Plumstead 64,031 • • 708 180 2 25 • • 1 .. 65 4 985 Poplar 170,606 2 422 404 20 278 • • 4 .. 230 14 1,374 Rotherhithe 41,050 • • 256 156 4 54 1 .. .. 83 2 556 Shoreditch 121,071 1 365 363 11 169 • • 6 1 202 10 1,128 St. George-in-the-East 48,560 1 99 95 9 72 • • .. .. 78 5 359 St. George, Hanover Sq 80,876 • • 198 87 4 46 • • .. .. 74 2 411 St. George, Southwark.. 60 536 1 238 442 6 56 • • 1 .. 76 2 823 St. Giles 37,196 • • 76 28 2 24 • • .. .. 55 1 186 St. James, Westminster 21,827 • • 49 37 • • 34 • • .. .. 22 .. 142 St. Lukes, Middlesex 40,868 • • 162 99 4 36 • • .. .. 65 .. 366 St. Margaret and St. John, Westminster 52,117 • • 199 100 1 45 • • 1 .. 56 .. 402 St. Martin-in the-Fields 12,142 • • 31 17 • • 7 • • .. .. 9 1 65 St. Mary, Newington 124,166 • • 509 707 22 111 • • .. .. 201 5 1,555 St. Olave, Southwark 11,098 • • 64 32 • • 11 • • .. .. 3 1 111 St. Pancras 244,548 • • 862 562 16 246 • • .. 1 311 13 2,011 St. Saviour, Southwark 24,207 • • 91 120 2 11 • • .. .. 34 3 261 Stoke Newington 35,187 • • 182 30 • • 17 • • • • .. 32 7 268 Strand 23,016 • • 55 37 • • 12 • • • • .. 17 .. 121 Wandsworth 209,655 • • 912 611 7 127 • • 1 .. 239 13 1,910 Whitechapel 81,391 2 210 190 12 139 4 • • .. 125 5 687 Woolwich 41,542 1 167 130 1 27 • • • • .. 27 5 358 City of London 27,986 • • 74 57 • • 86 • • 1 .. 21 .. 239 Port of London 4 2 10 • • 21 • • • • .. 2 .. 39 Grand Totals 29 18,106 13357 338 4452 14 69 15 1010 330 | 42,320 138 1899] Table LXXXIX. Showing the Case Rates per 1,000 of the population arising from the several Infectious Diseases in the several Metropolitan Sanitary Districts. Name of District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Totals. Paddington .. 2.97 1.58 0.76 0.00 0.00 0.05 1.14 .. 6.5 Kensington 2.50 1.48 0.61 0.00 0.09 0.06 1.21 .. 6.0 Hammersmith 4.05 1.76 1.06 0.00 .. 0.11 1.05 .. 7.9 Fulham 0.00 6.50 4.00 0.82 .. 0.00 0.08 1.54 0.03 12.9 Chelsea .. 2.91 2.46 0.60 .. 0.04 0.08 0.85 0.00 7.0 St. George, Hanover Sq. .. 2.44 1.12 0.56 .. .. 0.02 0.91 .. 5.0 Westminster .. 3.81 1.91 0.86 .. 0.01 .. 1.07 .. 7.7 St. James, Westminster .. 2.24 1.69 1.55 .. .. .. 1.00 .. 6.6 St. Marylebone 0.01 2.85 1.39 0.84 .. 0.00 0.04 1.42 .. 6.5 Hampstead .. 3.60 1.44 0.56 .. .. 0.06 0.64 .. 6.3 St. Pancras .. 3.53 2.30 1.00 .. .. 0.05 1.27 0.00 8.2 Islington 0.01 4.28 2.02 1.01 .. 0.01 0.09 1.00 0.00 8.4 Stoke Newington .. 5.17 0.82 0.48 .. .. 0.91 0.99 .. 7.6 Hackney 0.00 4.44 3.10 1.20 .. 0.02 0.08 1.36 .. 10.3 St. Giles, Bloomsbury .. 2.04 0.80 0.64 .. .. 0.02 1.47 .. 5.0 St. Martin-in-the-Fields .. 2.55 1.40 0.57 .. .. 0.08 0.73 .. 5.4 Strand .. 2.29 1.54 0.50 .. .. .. 0.70 .. 5.0 Holborn 0.03 3.94 2.16 1.21 .. 0.06 0.03 1.48 .. 8.9 Clerkenwell .. 4.87 2.98 1.38 .. 0.02 0.09 1.09 .. 10.5 St. Luke, Middlesex .. 3.96 2.42 0.88 .. .. .. 1.59 .. 8.9 City of London .. 2.64 2.03 3.42 .. 0.03 .. 0.75 .. 8.9 Shoreditch 0.01 3.00 3.09 1.40 .. 0.05 0.08 1.61 0.01 9.3 Bethnal Green .. 3.34 2.67 1.57 .. .. 0.14 2.52 0.00 10.2 Whitechapel 0.02 2.57 2.48 1.70 0.04 .. 0.06 1.53 .. 8.4 St. George-in-the-East 0.02 2.04 2.12 1.48 .. .. 0.10 1.60 .. 8.3 Limehouse 0.03 2.90 2.24 2.29 .. .. 0.05 1.32 .. 8.8 Mile End .. 2.61 3.30 1.22 .. 0.01 0.06 1.31 .. 8.5 Poplar 0.01 2.46 2.48 1.62 • • 0.02 0.08 1.34 .. 8.0 St. Saviour, Southwark .. 3.76 5.04 0.45 .. .. 0.12 1.40 .. 10.7 St. George, Southwark 0.01 3.93 7.40 0.92 0.01 0.01 0.03 1.25 .. 13.6 Newington .. 4.10 5.87 0.88 .. .. 0.04 1.62 .. 1.25 St. Olave, Southwark .. 5.76 2.88 1.00 .. .. 0.09 0.27 .. 10.0 Bermondsey .. 4.68 6.32 1.18 0.08 0.01 0.03 1.03 .. 12.2 Rotherhithe .. 6.24 3.90 1.31 0.02 .. 0.04 2.04 .. 13.5 Lambeth 0.00 3.29 3.64 0.72 0.00 0.03 0.09 1.09 0.00 8.8 Battersea .. 4.13 3.47 0.92 .. .. 0.08 1.18 .. 9.8 Wandsworth .. 4.34 2.94 0.64 .. 0.00 0.06 1.13 .. 9.1 Camberwell 0.01 4.32 4.69 0.66 0.00 0.01 0.07 0.97 .. 10.8 Greenwich 0.00 0.62 3.75 0.91 .. 0.01 0.07 1.49 0.00 12.8 Lewisham 0.01 6.37 5.28 0.63 .. 0.01 0.07 0.92 .. 13.3 Woolwich 0.02 4.02 3.15 0.65 .. 0.12 0.35 .. 8.6 Plumstead .. 10.9 2.84 0.39 .. 0.01 0.06 1.01 .. 15.3 Lee .. 4.85 3.35 0.52 .. .. 0.05 0.72 .. 9.5 London* 0.00 3.98 3.02 0.98 0.00 0.01 0.07 1.23 0.00 9.3 * Includes 39 cases notified to the Port of London Sanitary Authority. 139 [1899 INFECTIOUS DISEASES IN PUBLIC ELEMENTARY SCHOOLS. Inquiries into the notifiable infectious diseases showed that 1,087 the sufferers were children attending Public Elementary Schools, and that 670 scholars, who had not been themselves attacked, lived in houses in which the diseases were present. Of the 1087 scholars who were attacked 725 suffered from Scarlet Fever 290 „ „ Diphtheria 61 ,, ,, Enteric Fever 11 „ „ from other notifiable diseases. These figures are higher than those which were known in the two preceding years, though not so high as those of 1896. 1896 1897 1898 1899 Small Pox ... 3 — — — Scarlet Fever 842 753 640 725 Diphtheria... 355 267 206 290 Enteric Fever 28 38 37 61 Other notifiable diseases 12 12 8 11 Total 1,240 1,070 891 1,087 The number of scholars, who live in infected houses, discovered in attendance at school was 670, or 56 more than in 1898, but respectively 154 and 10 less than in 1896 and 1897. The particulars for each disease for these years is as follows: 1896 1897 1898 1899 Small Pox 17 2 — — Scarlet Fever 329 284 237 257 Diphtheria. 240 182 163 161 Enteric Fever 72 94 93 95 Other notifiable diseases 166 118 121 157 824 680 614 670 In every instance, except where the disease was Erysipelas, these scholars were not allowed to return to school until the patients k 2 1899] 140 were well, or had been removed to hospital, and then not until seven days had elapsed from the disinfection of the premises. There were 829 cases notified to me by the teachers of the Elementary Schools in which children were excluded from school either because they were ill themselves or lived in homes wherein an infectious disease was present. Complaint must again be made as to the manner in which these diseases, Measles, Whooping Cough, Chicken Pox, and Mumps, are notified to the Medical Officer of Health. Only a few days ago I received a list of over thirty children who were ill or excluded from school because of illness at home during a period extending over nearly a month. When I applied for the dates on which the children had been first absent or excluded, I discovered that the latest date was seven days prior to the information being sent to me. In another instance some ten days had elapsed. Many similar instances could be given, and indeed reference has been made to them in some of my quarterly reports. I trust that neglect of this kind will be rare in the future, and that teachers will be prompt in sending information. It is satisfactory to note that the School Board for London, on the advice of their Medical Officer, have altered the wording of their School Code, so that in future teachers cannot excuse themselves on the plea that they did not think the code required them to notify the cases of the non-notifiable deseases, Measles, Whooping Cough, Chicken Pox, and Mumps, to the Medical Officers of Health. The Public Health Committee may be congratulated on having effected this very needful reform, for they on more than one occasion drew attention to the neglect. The alteration in the Code has been made with respect to the first two paragraphs of Sec. III. of Article 148. It now reads as follows : "(iii) The following infectious diseases are not dealt with as notifiable by the Public Health (London) Act, 1891:— Measles. Chicken Pox. Mumps. Whooping Cough. Any child showing symptoms of any of the above diseases, or any child coming from a house where such a disease exists must be sent home at once, and the Divisional Superintendant, the 141 [1899 Board's Medical Officer and the Local Medical Officer of Health at once informed of the case, care being taken to state the name and address of the child or family affected, with the reason for the exclusion. This information is to be sent on a form supplied by the Head Office. "It is only through information derived from the teachers that the existence of the above diseases is known, either to the School Board Authorities or to the Local Sanitary Authorities. Information must therefore be given at once to the above three officers of all cases coming to the knowledge of the teacher, whether such cases are excluded by them or are kept at home by the parents." The particulars of the cases notified by the Head Teachers of the Schools are as follows:— Table XCI. Showing the infectious diseases—Measles, Chicken Pox, Whooping Cough and Mumps notified by Teachers to Medical Officer of Health. School. Measles. Chicken Pox. Whooping Cough. Mumps. Total. Yerbury Road 91 30 15 6 142 Winchester Street 15 9 .. 7 31 Popham Road 21 3 1 .. 25 Pooles Park 48 4 10 5 67 Caledonian Road 11 .. 18 1 30 Vittoria Place 22 .. .. .. 22 Hargrave Park 9 .. .. 1 10 Blundell Street 17 1 .. 1 19 Whittington 39 .. 2 2 43 Ecclesbourne Road 6 2 .. .. 8 Montem Street 1 2 .. .. 3 Duncombe Road 28 .. 26 2 56 Hanover Street 33 3 .. .. 36 Upper Hornsey Road 43 4 9 .. 56 Gifford Street 30 .. .. .. 30 Richard Street 42 .. 1 .. 43 Matthias Road 47 1 .. 1 49 Forster 21 .. .. .. 21 Pakeraan Street 21 .. .. .. 21 Ambler Road 5 .. 5 .. 10 Shepperton Road 5 .. .. .. 5 Gillespie Road 14 19 8 3 44 York Road 1 .. .. .. 1 Grafton Road 14 .. 22 .. 36 Buckingham Street 7 .. .. 1 8 Cottenham Road 1 .. .. .. 1 Westbourne Road 1 .. .. .. 1 Canonbury Road 11 .. .. .. 11 Total 604 78 117 30 829 1899] 142 FATALITY FROM THE NOTIFIABLE INFECTIOUS DISEASES. Out of 2,943 notified cases of Infectious Disease 254 died. These represent a fatality of 8.6 per ccnt. 1,039 cases, exclusive of the Cholera infantum cases, remained at home to be nursed, while 1,094 were treated in Hospitals. Of the former 117 died, or 11.8 per cent.; and of the latter 121, or only 6.3 per cent. Thus the fatality among hospital cases was barely more than half of that which occurred in the home cases. This is a very strong argument for the treatment, whenever it is possible, of infectious diseases in hospitals for the patients' sake, even if there were objections on the part of the parents or guardians to have them taken there for the purpose of isolation and the protection of the public. Exclusive of the cases of Cholera Infantum, 1,039 patients, or 35.9 per cent. of all the cases (2,940), were treated at home, while 1,901, or 64.1 per cent., were conveyed to hospital. Of the more infectious diseases such as Small Pox, Scarlet Fever, Diphtheria (inclusive of Membranous Croup) and Enteric Fever (inclusive of Continued Fever) 71*1 per cent. were afforded the advantages of hospital treatment, while 28.9 were retained at home. The difference between the results of the home treatment and the hospital treatment of Scarlet Fever was very marked, for whereas 3.6 per cent. of the former died only 1.7 of the latter proved fatal, or nearly 50 per cent. less. As regards Diphtheria (inclusive of Membranous Croup) 58 cases out of 274 treated at home died, or a fatality of 21.2 per cent., while only 70, or 16.2 per cent., out of 431 cases removed to hospital, ended fatally. Of the Enteric Fever cases (inclusive of Continued Fever) 21, or 20.0 per cent., home-treated patients died, whereas only 26 out of 250 cases, or 10.4 per cent., proved fatal in the hospitals. 143 [1899 Table XCII. Cases of Infectious Sickness and, the Deaths arising therefrom distinguishing the cases which were treated at Home and in Hospitals, together with percentages of Deaths to Cases. Diseases. Cases treated at Home. Cases treated in Hospital. All Cases. Cases. Deaths Fatality Cases Deaths Fatality Cases Deaths Fatality Small Pox 3 .. .. .. .. .. 3 .. .. Scarlet Fever 361 13 3.6 1133 20 1.7 1494 33 2.2 Diphtheria 262 51 19 5 426 69 16.2 688 120 17.4 Membranous Croup 12 7 58.3 5 1 20.0 17 8 47.0 Enteric Fever 103 21 20.4 250 26 10.4 353 47 13.3 Typhus Fever .. .. .. .. .. .. .. .. .. Erysipelas 276 13 4.7 74 3 4.0 350 16 4.5 Puerperal Fever 20 12 60.0 13 2 15.4 33 14 42.4 Continued Fever 2 .. .. .. .. .. 2 .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. Cholera 3 *16 .. .. .. .. 3 16 .. Total 1042 133 12.7 1901 121 6.3 2943 254 8.6 * These deaths refer to Cholera Infantum, and were not notified. 144 1899] Table XCIII. Showing the number of Patients per 100 cases who were removed to Hospital, together with the Fatality among all cases, among cases treated at Home and in Public Institutions. Diseases. Per-centage of Cases notified Treated at Home. Per-centage of Cases notified Treated in Hospital. Cases. Per-centage. Cases. Per-centage. Small Pox 3 100.0 .. .. Scarlet Fever 361 24.2 1133 75.8 Diphtheria 262 38.1 426 61.9 Membranous Croup 12 70.6 5 29.4 Enteric Fever 103 29.2 250 70.8 Typhus Fever .. .. .. .. Erysipelas 276 78.9 74 21.1 Puerperal Fever 20 60.6 13 39.4 Continued Fever 2 100.0 .. .. Relapsing Fever .. .. .. .. Cholera 3 100.0 .. .. Total 1042 35.4 1901 64.6 Cases of Diphtheria Nursed in Hospital. Quarter. Cases. Deaths. Fatality. ISt 69 8 11.6 2nd 67 7 10.4 3rd 151 34 22.5 4th 139 20 14.4 The Year 426 69 16.2 Cases of Diphtheria Nursed at Home. Quarter. Cases. Deaths Fatality ISt 47 4 8.5 2nd 40 6 15.0 3rd 85 12 14.1 4th 90 29 32.2 The Year 262 51 19.4 145 [1899 Table XCIV. Showing the Fatality from Diphtheria* at each year of life up to 15 years of age, and at each decennial period after that age. Ages. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. The Year. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. 0—1 ... ... ... 1 ... ... 1 1 100 5 2 40 7 3 43 1—2 11 3 27 8 1 12 10 4 40 18 5 28 47 13 28 2—3 8 1 12 12 3 25 22 9 41 30 8 27 72 21 29 3—4 15 3 20 9 2 22 27 12 44 26 7 27 77 24 31 4—5 19 4 21 10 2 20 25 3 12 26 11 42 80 20 25 5—6 14 2 14 16 2 12 25 3 12 28 7 25 83 14 17 6—7 6 1 17 4 ... ... 34 7 21 15 2 13 59 10 17 7—8 2 ... ... 6 1 17 15 4 27 15 4 27 38 9 23 8—9 5 ... ... 10 2 20 11 1 9 6 1 17 32 4 12 9—10 2 ... ... 7 1 14 11 ... ... 6 1 17 26 2 8 10—11 2 ... ... 2 ... ... 11 3 27 10 1 10 25 4 16 11—12 ... ... ... 4 ... ... 6 ... ... 10 ... ... 20 ... ... 12—13 4 1 25 3 ... ... 7 ... ... 6 1 17 20 2 10 13—14 3 ... ... 2 ... ... 2 1 50 2 ... ... 9 1 11 14—15 2 ... ... 1 ... ... 3 ... ... 3 ... ... 9 ... ... 15—25 15 ... ... 8 ... ... 18 ... ... 14 ... ... 55 ... ... 25—35 10 ... ... 5 ... ... 7 ... ... 8 ... ... 30 ... ... 35—45 2 ... ... 1 ... ... 4 ... ... 4 1 25 11 1 9 45—55 1 ... ... ... ... ... 3 ... ... 1 ... ... 5 ... ... 55—65 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 65-upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 121 15 12 109 14 13 242 48 20 233 51 22 705 128 18 * Inclusive of Membranous Croup. 1899] 146 Fatality from Diphtheria.—Altogether 688 cases of this disease were notified, out of which 120 died; that is to say 17.4 per cent. The fatality varied somewhat in the several districts, for in Upper Holloway out of 335 reported cases 67 died, or 20.0 per cent.; in Islington South-west out of 131 cases 20 died, or 15.2 per cent.; in Islington South-east out of 132 cases 17 died, or 13.0 per cent.; and in Highbury out of 90 cases 16 died or 177 per cent. It was greatest in the fourth quarter of the year when 21.9 per cent, of the cases died, and least in the first quarter when only 12.4 died. It was only slightly above this figure in the second quarter when 12.8 per cent. succumbed, but in the third quarter it was 19.8 per cent. From 1891 to 1899 the fatality from Diphtheria, inclusive of Membranous Croup, has been 22.0 per cent., for I find that out of 6899 cases 1520 have died. During these years it reached its highest point in 1894 when it was 247 per cent. of the cases. In the two succeeding years it was respectively 247 and 23.5 per cent., but in 1897 there was a great decrease, for the proportion of deaths to cases was only 18.0 per cent. This low percentage was followed by a still lower one, 17.1, in 1898, which was in turn succeeded by a rate which was higher by 1 per cent. I will not now discuss the cause of this reduction in the fatality from Diphtheria, but will content myself by saying that most competent observers agree in ascribing it chiefly to the antitoxin serum treatment. 147 [1899 Table XCV. Showing the Cases and Deaths from Diphtheria together with the Fatality and the Departure from the Mean Fatality (1891-99), during the nine years ending 1899. Cases. Deaths. Fatality. Year. Diphtheria. Membranous Croup. Total of Diphtheria and Membranous Croup. Diphtheria. Membranous Croup. Total of Diphtheria and Membranous Croup. Deaths to 100 cases of Diphtheria and Membranous Croup. Department trom Average Fatality of 9 years. 1891 712 44 756 158 19 177 23.4 + 1.4 1892 693 43 738 150 22 172 23.3 + 1.3 1893 855 30 885 189 11 200 22.6 + 0.6 1894 843 24 867 208 10 218 25.1 + 8.1 1895 564 18 582 137 7 144 24.7 + 2.7 1896 1,069 24 1,093 247 10 257 23.5 + 1.5 1897 700 29 729 115 16 131 18.0 - 4.0 1898 531 13 544 90 3 93 17.1 - 4.9 1899 688 17 705 120 8 128 18.1 - 3.9 1891-99 6,657 248 6,899 1,414 106 1,520 22.0 - 0.2 1899] 148 HOSPITAL STATISTICS. Table XCVI. Showing the number of cases of the several infectious diseases removed from Islington to Metropolitan Asylums Board's Hospitals for treatment and isolation during 1899. Metropolitan Asylums Board's Hospitals. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Diseases. Total Admissions. Total Deaths. Eastern • • 50 276 60 • • 40 426 66 North Eastern • • 835 3 • • 71 909 24 North Western • • 88 99 58 • • 19 264 35 Western • • 2 10 17 • • 1 30 3 South Western • • 2 • • • • • • • • 2 • • Fountain • • • • • • • • • • • • • • • • South Eastern • • 1 1 • • • • • • 2 • • Small Pox • • .. • • • • • • • • • • Northern Convalescent • • • • •• • • • • • • • • • • Totals • • 978 386 138 • • 131 1,633 128 TRADES AND BUSINESS CARRIED ON IN INFECTED HOUSES. The table which accompanies this part of the report is sufficient evidence of the great utility of and the necessity for the notification of the infectious diseases. In every instance where disease was reported stringent precautions were insisted on in the premises where they occurred, but particularly so in the cases where Scarlet Fever appeared in houses in which wearing apparel was made, cleaned, or repaired. Indeed in these cases, if the patients were not allowed to be removed to hospital, the business was stopped, for it must be remembered that the Factory and Workshop Act, 1895, makes it a penal offence to carry on business while the premises are infected with either Smallpox or Scarlet Fever. 149 [1899 Table XCVII. List of Trades and Businesses carried on in Houses wherein Infectious Diseases have occurred during 1899. TRADES AND BUSINESSES. Small Fox. Scarlet Fever or Scarlatina. Diphtheria. Memb. Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Apron Makers ... ... 1 ... ... ... ... ... ... 1 Artificial florists ... ... ... ... ... ... ... ... ... 1 Boot Repairing ... 1 ... ... ... ... ... ... ... 1 Bakers ... 1 2 ... 2 ... ... ... ... 5 Builders ... ... 4 ... 3 ... ... ... ... 10 Brush Makers ... ... 1 ... ... ... ... ... ... 1 Butchers ... ... 1 ... ... ... ... ... ... 6 Beerhouse ... 1 1 ... ... ... ... ... ... 2 Boxmakers ... 1 ... ... ... ... ... ... ... 1 Boarding House ... ... ... ... ... ... ... ... ... 1 Blouse Making ... ... 1 ... ... ... ... ... ... 5 Confectioners ... ... 1 ... ... ... ... ... ... 5 Cornchandlers ... 1 ... ... ... ... ... ... 1 Coffee House ... 1 2 ... 3 ... ... ... ... 6 Chemist ... ... ... ... 1 ... ... ... ... 3 Corset Making ... ... ... ... 1 ... ... ... ... 1 Cork Cutting ... 1 ... ... ... ... ... ... ... 1 Coal Merchants ... ... ... ... 1 ... ... ...... ... 1 Cheesemongers ... 1 ... ... ... ... ... ... ... 1 Candle Shade Making ... ... ... ... ... ... ... ... ... 1 Cycle Works ... ... 3 ... ... ... ... ... ... 3 Dentists ... 1 ... ... ... ... ... ... ... 1 Dressmaking ... 11 7 ... 2 ... 3 ... ... 23 Drapers ... ... 2 ... 2 ... 3 ... ... 9 Doll Dressing ... 1 ... ... ... ... ... ... ... 1 Fruiterers ... 1 ... ... ... ... ... ... ... 1 Furniture Dealers ... 1 ... ... ... ... 1 ... ... 2 Furriers ... ... 1 ... ... ... 2 ... ... 5 French Polishing ... 1 1 ... ... ... ... ... ... 2 Farriers ... 1 ... ... ... ... ... ... ... 1 Florists ... 2 ... ... ... ... ... ... ... 2 Fried Fish Shop ... 2 1 ... ... ... ... ... ... 3 Greengrocers ... 3 3 ... 2 ... 1 ... ... 9 General Dealers ... 7 4 ... 2 ... 4 ... ... 17 Grocers Hotel ... 2 1 1 ... 1 ... 1 ... ... 5 1 Hair Dressers ... 5 1 ... 1 ... ... ... ... 8 Hosiers ... 1 ... ... ... ... ... ... 1 1899] 150 Table XCVII—continued. Trades and businesses. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Mernb. Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total Harness Makers ... ... ... ... ... ... 1 ... ... 1 Ironmongers ... 1 ... ... ... ... ... ... ... 1 Ironers ... ... ... ... ... ... 1 ... ... 1 Jewel-case Makers ... ... ... ... 1 ... ... ... ... 1 Laundry ... 8 5 ... 6 ... 1 ... ... 20 Marble Masons ... 1 ... ... ... ... ... ... ... 1 Marine Stores ... 2 ... ... ... ... ... ... ... 2 Machining ... ... ... ... ... ... ... ... ... 1 Mantle Makers ... 3 2 ... ... ... 1 ... ... 6 Milk Shop ... 6 4 ... 1 ... ... ... ... 11 Milliners ... 2 1 ... 1 ... 2 ... ... 6 Mangling ... 2 1 ... 1 ... 2 ... ... 6 Newsagent ... 2 1 ... ...... ... ... ... ... 3 Naturalists ... 1 ... ... ... ... ... ... ... i Needlework ... ... ... ... 1 ... ... ... ... 1 Nursing Home ... 1 ... ... 1 ... ... ... ... 2 Oilshop ... 6 1 ... ... ... 1 ... ... 8 Off-license ... ... ... ... 1 ... ... ... ... i Public House ... 4 1 ... 2 ... 2 ... ... 9 Provisions, etc. ... ... 2 ... ... ... ... ... ... 2 Pianoforte Makers ... 2 1 ... ... ... ... ... ... 3 Printers ... 1 2 ... ... ... ... ... ... 3 Plumbers ... 1 1 ... ... ... ... ... ... 2 Photographers ... 1 ... ... ... ... ... ... ... 1 Perambulator Makers ... 2 ... ... ... ... ... ... ... 2 Police Station ... 2 ... ... ... ... ... ... ... 2 Picture Frame Making ... 2 ... ... ... ... 1 ... ... 3 Packing ... 1 ... ... ... ... ... ... ... 1 Poulterers ... ... 1 ... ... ... ... ... ... 1 Surgery ... 3 2 ... ... ... ... ... ... 5 Shoemakers ... 8 2 ... ... ... 5 ... ... 17 School ... 1 ... ... 2 ... 2 ... ... 5 Sweetstuff Shop ... 3 2 ... ... ... ... ... ... 6 Stationers ... 1 ...... ... ... ... ... ... ... 1 Surgical Instrument Makers ... ... ... ... ... ... 1 ... ... 1 Temperance Bar ... ...... 1 ... ... ... ... ... ... 1 Timber Merchants ... 1 ... ... ... ... ... ... ... 1 Toymakers ... 1 ... ... ... ... ... ... ... 1 Toothpick Cutting ... 1 ... ... ... ... ... ... ... 1 Tie Makers ... 3 ... ... ... ... ... ... ... 3 Tailors ... 6 1 ... 1 ... ... ... ... 8 Tobacconists ... 1 1 ... ... ... ... ... ... 2 Tennis Ball Makers ... ... 1 ... ... ... ... ... ... 1 151 [1899 Table XCVII— continued. TRADES AND BUSINESSES. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Memb. Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Undertakers ... ... ... ... ... ... 1 ... ... 1 Wood Chopping ... ... 1 ... ... ... ... ... ... 1 Watchmakers ... 1 ... ... ... ... ... ... ... 1 Wood Turning ... ... ... ... ... ... 1 ... ... 1 Wardrobe Dealers ... 1 1 ... ... ... 1 ... ... Wine and Spirit Merchants ... ... ... ... 1 ... ... ... ... 1 Waistcoat Making ... ... ... ... ... ... 1 ... ... 1 Totals ... 151 73 ... 42 ... 42 4 ... 312 1899] 152 Table XCVIII. Showing the Occupations of Patients suffering from the several Infectious Diseases during the year 1899. OCCUPATIONS. Small Pox. Scarlet Fever. Diphtheria Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Actor ... 1 ... ... ... ... ... ... ... 1 Apprentice ... 4 ... ... 1 ... 1 ... ... 6 Artificial Florist ... ... ... ... ... ... 1 ... ... I Agent ... ... ... ... ... ... 1 ... ... i Accountant ... ... ... ... ... ... 1 ... ... 1 Baker ... ... ... ... 1 ... ... ... ... i Blindmaker ... ... ... ... 1 ... ... ... ... i Bottle Washer ... ... ... ... 1 ... ... ... ... 1 Brush Maker ... ... 1 ... 1 ... ... ... ... 2 Barmaid ... 2 ... ... 2 ... ... ... ... 4 Barman ... 1 ... ... 1 ... 1 ... ... 3 Bookbinder ... 1 1 ... 1 ... ... ... ... 3 Butcher ... ... ... ...... 1 ... ... ... ... 1 Builder ... ... ... ... ... i ... ... 1 Bus Driver ... ... ... ... ... ... i ... ... 1 Book Folder ... ... ... ... ... ... 3 ... ... 3 Book Sewer ... 1 ... ... ... ... 1 ... ... 2 Bottle Maker ... ... ... ... ... ... 2 ... ... 2 Blacksmith ... ... ... ... 1 ... ... ... ... 1 Box Maker ... 1 2 ... 1 ... i ... ... 5 Bricklayer ... ... ... 1 ... 2 ... ... 3 Brewer ... 1 ... ... ... ... ... ... ... 1 Bootmaker ... ... ... ... ... ...... 1 ... ... 1 Book-keeper ... ... ...... ...... ... ... 1 ... ... 1 Clerk ... 11 3 ... 10 ...... 6 ... ... 30 Carpenter ... 2 2 ... 1 1 ... ... 6 Cashier ... 1 1 ... 1 ... ... ... ... 3 Coach Builder ... ... ... ... 2 ... ... ... ... 2 Carman ... 1 ... ... 6 ... 7 ... Capsule Maker ... 1 ... ... 1 ... ... ... ... 2 Carpet Sewer ... 1 ... ... ... ... ... ... ... 1 Collar Maker ... ... ... ... 1 ... ... ... ... 1 Cigarette Maker ... ... ... ... 1 ... ... ... ... 1 Charwoman ... ... ... ... 1 ... 6 ... ... 7 Compositor ... ... 1 ... ... ... ... ... ... 1 Costumier ... 1 ... ... ... ... ... ... ... 1 Cabinet Maker ... ... ... ... 1 ... ... ... ... 1 Caterer ... ... 1 ... • • • ... 1 ... ... 2 153 [1899 Table XCVIII—continued. OCCUPATIONS. Small Pox. Scarlet Fever. Diphtheria Memb. Croup. ! Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Cholera. . Cabman ... ... ... ... ... ... 2 ... ... 2 Civil Servant ... 1 ... ... ... ... ... ... ... I Coachman ... ... ... ... 1 ... ... ... I Cellarman ... ... 1 ... 1 ... ... ... ... 2 Card Colourer ... ... ... ... ... 1 ... ... I Costermonger ...... ... ... ... ... 2 ... ... 2 Coal Porter ... ... ... ... 2 ... 1 ... ... 3 Candle Shade Maker ... ... ... ... ... 1 ... ... 1 Coachbuildar ... ... ... ... 2 ... ... ... 2 Card Beveller ... ... ... 1 ... ... ... ... 1 Dressmaker ... 3 ... ... ... 5 ... ... 8 Drayman ... ... 1 ... 1 ... 2 ... ... 4 Diamond Polisher ... 1 ... ... ... ... ... ... 1 Doctor ... 2 1 ... 1 ... ... ... ... 4 Dispenser ... ... 1 ... ... ... ... ... ... 1 Drover ... ... ... ... I ... 1 ... ... 2 Diamond Setter ... ... ... I ... ... ... ... 1 Draper ... ... ... ... 1 ... ... 1 Engineer ... ... ... I ... ... ... ... 1 Errand Boy ... 2 2 ... 2 ... ... ... 6 Electrician ... ... ... I ... ... ... ... 1 Florist ... ... 1 ... ... ... ... ... ... 1 Fancy Worker ... ... 1 ... ... ... 1 ... ... 2 Factory Hand ... ... ... ... I ... ... ... ... 1 Feather Worker ... ... ... ... I ... ... ... 1 Feather Dyer ... ... ... ... ... 1 ... ... 1 Fireman ... ... ... I ... ... ... 2 French Polisher ... 1 ... ... 2 ... ... ... ... 3 Greengrocer ... ... ... ... I ... ... ... 1 Guard ... ... ... ... ... ... ... ... 1 General Dealer ... ... ... ... ... ... 1 ... ... 1 Gas Index Maker ... ... ... ... ... ... ... 1 Gentleman ... ... ... ... ... ... ... ... 1 Glass Blower ... ... ... ... ... ... ... ... 3 Gilder ... ... ... ... ... ... ... ... 1 Housewife ... 6 ... ... 12 ... 26 ... ... 68 Housekeeper ... ... ... ... ... ... 1 ... ... 1 Housemaid ... 1 ... ... ... ... 1 ... ... 2 Horsekeeper ... 1 ... ... ... ... 1 ... ... 3 Handbag Maker ... 1 ... ... ... ... ... ... i Hydrometer Maker ... ... ... ... 1 ... ... ... ... 1 Hawker ... ... ... ... 1 ... ... ... ... 1 Hose Maker ... ... ... 1 ... ... 1 Ironworker ... ... 1 ... ... ... ... ... 1 L 1899] 154 Table XCVIII—continued. occupations. Small Pox. Scarlet Fever. Diphtheria Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Ironer ... ... ... ... ... ... 1 ... ... 1 J eweller ... 1 ... ... ... ... 1 ... ... 2 Joiner ... 1 • • • ... ... ... 2 ... ... 3 Journalist ...... ... ... ... ... 1 ... ... 1 Kitchenmaid ... 2 ... ... ... ... ... ... ... 2 Locksmith ... 1 ... ... ... ... ... ... ... 1 Labourer ... 1 3 ... 7 ... 5 ... ... 16 Leather Trade ... 1 ... ... ... ... ... ... ... 1 Laundress ... 1 1 ... 6 ... 2 ... ...... 10 Laundryman ... ... ... 2 ... ... ... ... 2 Leadworker ... 1 ... ... 1 ... ... ... ... 2 Lawn Tennis Bat Maker ... ...• • • ... 1 ... ... ... ... 1 Machinist ... 1 2 ... 2 ... ... ... 6 Messenger ... 1 ... ... ... ... ... ...... ... 1 Manager ... 1 ... ... 1 ... 1 ... 3 Milk Carrier ... 1 ... ... ... ... ... ... 1 Mantle Maker ... 4 ... ... ... ... ... ... 4 Milliner ... 1 1 ... 1 ... ... ... ... 3 Marbler ... 1 ... ... ... ... .. ... ... 1 Merchant ...... ... ... ... 1 ... ... ... 1 Nurse ... 3 2 ... 2 ... 1 ... ... 8 Newsboy ... ... 1 ... 1 ... ... ... ... 1 Organ Builder ... ... ... ... ... ... 1 ... 1 Office Boy ... 1 ... ... ... ... ...... ... 1 Packer ... 2 1 ... ... ... ... 3 Printer ... 2 ... ... 1 ... 3 ...... ... 6 Page Boy ... 2 ... ... ... ... ... ... 2 Painter ... 3 1 ... 1 ... 1 ... ... 6 Porter ... 1 1 ... 3 ... 1 ... ... 6 Pipe Mounter ... 1 ... ... ... ... ... ... ... 1 Paper Cutter ... ... ... ... ... ... 1 ... ... 1 Paper Stainer ... ... ... 1 ...... ... ... ... 1 Postman ... 2 ... ... ... 1 ... ... 3 Paperhanger ... ... ... ... 1 ... ... ... ... 1 Photographer ... ... ... ... 1 ... ... ... ... 1 Plumber ... 1 ... 1 ... 1 ... ... 3 Policeman ... 2 ... ... 1 ... 2 ... ... 5 Publican ... ... ... ... ... ... 1 ... 1 Pupil Teacher ... 3 ... ... ... ... ... ... 3 Picture Frame Maker ... ... ... ... ... ... 1 ... ... 1 Platelayer ... ... ... ... ... ... 1 ... ... 1 Rocking Horse Maker ... ... 1 ... ... ... ... ... ... 1 Reader ... 2 ... ... ... ... ... ... ... 2 Scholar ... 862 1 4 65 ... 18 ... ... 1260 155 [1899 Table XCVIII—continued. OCCUPATIONS. Small Pox. Scarlet Fever. Diphtheria Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. J Puerperal Fever. Cholera. Total. Servant ... 5 4 ... 7 ... 7 ... ... 23 Soap Trimmer ... ... 1 ... ... ... ... ... ... 1 Scaffolder ... ... ... ... 1 ... ... ... ... 1 Salesman ... ... 2 ... ... ... ... ... ... 2 Shop Assistant ... 9 2 ... ... ... ... ... ... 15 Sorter (G.P.O.) ... 2 ... ... 1 ... ... ... ... 3 Silverchaser ... ... 1 ... 1 ... ... ... ... 2 Shunter ... 1 1 ... ... ... ... ... ... 4 Shopwalker ... 2 ... ...... ... ... ... ... ... 2 Stick Mounter ... 1 ... ... ... ... ... ... ... 1 Soldier ... ... ... 1 ... ... ... ... 1 Solicitor ... 1 ... ... 1 ... ... ... ... 2 Sign-writer ... 1 ... ... ... ... ... ... ... 2 Seamstress ... ... ... ... ... ... 1 ... ... 1 Slater ... ... ... ... ... ... 1 ... ... 1 Sawyer ... ... ...... ... 1 ... ... ... ... 1 Surveyor ... ... ... ... 1 ... ... ... ... 1 Steel Engraver ... ... ... ... 1 ... ... ... ... 1 Sweet Stuff Making ... ... ... ... 1 ... ... ... ... 1 Traveller ... ... ... ... ... ...... ... ... ... 3 Telegraphist ... 1 ... ... 1 ... ... ... ... 2 Teacher ... ... ... ... 1 ... ... ... ... 2 Tailor ... ... ... ... 1 ... ... ...... ... 2 Timekeeper ... 1 ... ... ... ... ... ... ... 1 Tobacconist ... ... ... ... 1 ... ... ... ... 1 Toy Painting ... 2 ... ... ... ... ... ... ... 2 Thimble Maker ...... ... ... ... ... ... 2 ... ... 2 Upholsterer ... ... ... ... ... ... 3 ... ... 3 Umbrella Maker ... 1 ... ... 1 ... ... ... ... 2 Undertaker ... ... ... ... ... ... 1 ... ... 1 Van Boy ... 1 ... ... ... ... ... ... ... 2 Warehouseman ... 2 ... ... 1 ... 3 ... ... 6 Waitress ... ... ... ... ... ... 2 ... ... 5 Waistcoat Maker ... 1 ... ... ... ... ... ... ... 1 Wigmaker ... 1 ... ... ... ... ... ... ... 1 Wood Turner ... 1 ... ... ... ... 1 ... ... Wireworker ... ... ... ... ... ... 1 ... ... 1 Wheelwright ... ... ... ... ... ... 1 ... ... 1 Waiter ... ... ... ... ... ... 1 ... ... 1 Washerwoman ... ... ... ... ... ... 1 ... ... 1 Watchman ... ... ... ... ... ... 1 ... ... 1 Warder ... ... ... ... 1 ... ... ... ... 1 Totals ... 986 369 4 210 ... 166 l6 1 1752 L 2 1899] 156 Table XCIX. Showing the Streets in which the several cases of Infectious Disease occurred during 1899. (The large figures denote the number of cases and the small figures the number of infected houses.) NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Andover Road ... 22 38 ... 22 ... ... 11 ... 87 Albert Street ... 51 11 ... ... ... ... ... ... 61 Avenell Road ... 38 11 ... 43 ... ... ... ... 87 Ashburton Grove ... 86 11 ... ... ... 11 ... ... 108 Alexander Road ... 11 44 ... ... ... ... ... ... 56 Arthur Road ... 11 ... ... 11 ... ... ... ... 22 Albion Street ... 22 ... ... 11 ... 22 ... ... 55 Arlington Street ... 74 42 ... ... ... ... ... ... 116 Anatola Road ... 22 52 ... 21 ... ... ... ... 95 Albany Cottages, Popham St. ... 64 ... 11 ... ... ... ... ... 86 Austin Terrace, Cheverton Rd. ... 11 ... ... ... ... ... ... ... 11 Ashbrook Road ... 22 ... ... 11 ... ... ... ... 31 Athelstane Road ... 11 21 11 ... ... ... ... ... 42 Aberdeen Road ... 22 ... ... ... ... ... ... ... 22 Aubert Park ... 11 11 ... ... ... ... ... ... 22 Arundel Grove ... 11 ... 11 ... ... ... ... ... 22 Astey's Row ... 22 ... ... ... ... ... ... ... 22 Ambler Road ... 86 74 ... ... ... ... ... ... 1510 Ashley Road ... 22 ... ... ... ... 11 ... ... ... Annesley Road ... 11 11 ... ... ... ... ... ... 22 Alwyne Road ... 11 ... ... ... ... ... ... ... 11 Archway Road ... 11 ... ... ... ... ... ... ... 11 Almington Street ... 11 ... ... 11 ... ... ... ... 22 Arlington Square ... 33 ... ... ... ... ... ... ... 44 Albert Place, Queensland Rd. ... ... 11 ... ... ... ... ... ... 11 Almeida Street ... 32 ... ... ... ... ... ... ... 32 Alsen Road ... 11 11 ... ... ... 44 ... ... 32 Arundel Square ... 44 ... ... ... ... ... ... ... 76 Albion Grove ... 44 11 ... ... ... 11 ... ... 86 All Saints' Street ... 76 11 ... ... ... ... ... ... 52 Allen Street ... 42 ... ... ... ... ... ... ... 11 Abercorn Terrace, Hatchard R. ... 11 ... ... ... ... ... ... ... 11 Alfred Street ... 38 21 ... ... ... 11 ... ... 65 Adelaide Square ... 11 ... ... ... ... 11 ... ... ... Ancona Road ... 32 ... ... ... ... 11 ... ... 22 Ann Street ... 11 ... ... ... ... ... ... ... 32 Aberdeen Park ... 11 ... ... ... ... ... ... ... 22 Adam's Place, George's Road ... ... ... ... ... 11 ... ... ... 11 157 [1899 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued | Fever. Total. Anchor Dwellings, Biewery Rd. ... 31 11 ... ... ... ... ... ... 42 Alma Road ... 11 ... ... ... ... ... ... ... 11 Albany Place, Hornsey Road ... ... ... 11 ... ... ... ... ... 11 Almorah Road ... 54 21 ... ... ... ... ... ... 75 Aberdeen Place, Brewery Road ... ... 11 ... ... ... ... ... ... 11 Balls Pond Place ... 11 11 ... ... ... ... ... ... 21 Bemerton Street ... 139 21 11 74 ... 33 ... ... 2617 Brecknock Road ... 44 11 ... ... ... ... ... ... 55 Beaconsfield Buildings ... ... 11 ... 11 ... 44 21 ... 87 Blundell Street ... 33 53 ... 11 ... 22 11 ... 128 Blackstock Road ... 56 ... ... ... ... ... 11 ... 6s Boleyn Road ... 48 11 ... 11 ... ... ... ... 6s Barnsbury Grove ... ... ... ... ... ... 31 ... ... 31 Bickerton Road ... 43 32 ... ... ... ... ... ... 75 Barnsbury Road ... 1511 ... ... 33 11 ... ... 1915 Baxter Road ... 44 ... ... 11 ... 11 ... ... 54 Bedford Terrace ... 32 ... ... ... ... 23 ... ... 54 Bingfield Street ... 74 ... ... 11 ... 32 ... ... 115 Brecknock Terrace ... 11 ... ... ... ... ... ... ... 11 Britannia Row ... 68 11 ... 11 ... ... ... ... 83 Bryan Street ... 42 ... ... ... ... 11 ... ... 53 Birnam Road ... 22 75 ... 11 ... 11 ... ... 118 Brook Road 38 ... ... ... ... ... ... ... 33 Bryan Vale, Caledonian Road ... ... ... ... 11 ... ... ... ... 11 Brunswick Grove ... 11 ... ... ... ... ... ... ... 11 Bardolph Road ... ... 11 ... ... ... ... ... ... 11 Battledean Road ... 52 22 ... 11 ... ... ... ... 85 Bismarck Road ... ... 22 ... ... ... ... ... ... 22 Brunswick Road ... 22 54 ... ... ... 11 ... ... 87 Brooksby Street ... 21 33 ... ... ... 11 ... ... 65 Baldwin Terrace ... 32 ... ... 11 ... ... ... ... 48 Bride Street ... 66 ... ... 11 ... 11 11 ... 99 Barnsbury Street ... 42 22 ... ... ... ... ... ... 64 Bryan Place ... 11 ... ... ... ... 11 ... ... 22 Blythwood Road ... 42 ... ... ... ... ... ... ... 42 Brand Street ... ... 11 ... ... ... ... ... ... 11 Bracey Street ... 73 11 ... 41 ... ... ... ... 125 Balls Pond Road ... 54 ... ... 22 ... ... ... ... 76 Ben well Mews ... ... 11 ... ... ... ... ... ... 1l Barbara Street ...... 55 32 ... ... ... 11 ... ... 98 Baring Street ... ... 11 ... ... ... ... ... ... 11 Blenheim Road ... 33 11 ... 11 ... ... ... ... 55 Brewery Road ... 97 22 ... 11 ... ... ... ... 1210 Bishop's Grove ... ... ... ... ... ... 22 ... ... 22 1899] 158 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Merab. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Beresford Road ... 53 ... ... ... ... ... ... ... 53 Bryantwood Road ... 11 ... ... ... ... ... ... ... 11 Barnsbury Park ... ... 11 ... ... ... ... ... ... 11 Barnsbury Square ... ... 22 ... ... ... ... ... ... 22 Bratton Street ... 11 ... ... ... ... ... ... ... 11 Beversbrook Road ... 21 33 ... 11 ... ... ... ... 65 Belitha Villas ... ... ... ... ... ... 11 ... ... 11 Brunswick Street ... ... ... ... ... ... 11 ... ... 11 Ben well Road ... 77 11 ... 11 ... 11 ... ... 1010 Canonbury Avenue ... 43 I212 ... ... ... ... ... ... 1615 Cross Street ... 22 ... ... ... ... 11 ... ... 33 Corbyn Street ... 159 ... 2a ... ... ... 1711 Caledonian Road ... 1614 22 ... 44 ... 38 11 ... 2624 Canonbury Lane ... 11 ... ... ... ... ... ... 11 Cathcart Hill ... ... • • • ... 11 ... ... ... ... 11 Camden Road ... 11 21 ... ... ... 32 ... ... 65 Cardozo Road ... 11 11 ... ... ... ... ... ... 22 Calverley Grove ... 32 11 ... 11 ... 22 ... ... 76 Caledonia Crescent ... 11 ... ... ... ... ... ... ... 11 Copenhagen Street ... 99 ... ... 22 ... 22 ... ... 1414 Calabria Road ... 11 ... ... ... ... ... ... 11 Cornwall Cottages, Popham St. ... 11 ... ... ... ... 22 ... ... 54 Cumberland Street ... 22 ... ... ... ... ... ... 22 Chatterton Road ... 22 ... ... ... ... ... ... ... ... Cottenham Road ... 96 54 ... 7... ... ... ... ... 2115 Charteris Road ... 22 118 ... ... ... ... ... ... 1411 Canterbury Place, Myrtle St. ... 11 ... ... ... ... ... ... ... 11 Campbell Road ... 65 38 ... 33 ... 22 ... ... 1413 Cromwell Road ... 11 2418 ... 44 ... 22 ... ... 3124 Cloudesley Street ... ... ... ... 11 ... 11 ... ... 22 Cheverton Road ... 22 ... ... ... ... ... ... ... 22 Compton Terrace ... 11 ... ... ... ... ... ... ... 11 Camden Dwellings ... 11 11 ... ... ... ... 11 ... 33 Coleman Street ... 54 22 ... ... ... ... ... ... 76 Canterbury Terrace ... 11 ... ... ... ... ... ... ... 11 Camden Street ... ... ... ... ... ... 11 ... ... 11 Cardigan Street ... 11 22 ... ... ... ... ... ... 32 City Garden Row ... 32 ... ... ... ... ... ... ... 32 Citizen Road ... 74 ... ... ... ... ... ... 74 College Street / ... ... 11 ... ... ... ... / 11 Corporation Street ... ... ... ... 11 ... ... ... ... 22 Charlotte Terrace ... 11 ... ... ... 11 ... ... 22 Clayton Terrace ... ... I1 ... ... ... ... ... 11 Comwallis Road ... 44 85 ... ... .... ... ... ... 129 159 [1899 Table XCIX-continued Name of street. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Carlsbad Street ... 38 22 ... ... ... ... ... ... 55 Canonbury Place ... 21 ... ... ... ... ... ... ... 21 Church Lane ... 32 ... ... ... ... ... ... ... 32 Clarence Terrace, Rufford St. ... 11 ... ... ... ... ... ... ... 11 Courtney Road ... ... 11 ... ... ... ... ... ... 11 Cornwallis Road Workhouse ... 3 ... ... ... ... ... ... ... 3 City Arms Buildings ... 43 11 ... ... ... ... ... ... 53 Clayton Street ... 43 ... 11 ... ... ... ... ... 54 Cloudesley Place ... 11 ... ... ... ... 1l ... ... 22 Charlotte Street ... 33 32 ... ... ... 11 ... ... 76 Canning Road ... 38 ... ... 11 ... 11 ... ... 56 Canonbury Street ... 11 ... ... ... ... ... ... ... 11 Celia Road ... 11 ... ... ... ... ... ... ... l1 Cloudesley Square ... ... 11 ... ... ... ... ... ... 11 Crane Grove ... 11 ... ... ... ... 11 ... ... 22 Cromartie Road ... 21 ... ... 11 ... 11 ... ... 43 Chalfont Road ... 11 1l ... ... ... ... ... ... 22 Cloudesley Road ... 38 21 ... 11 ... 38 ... ... 98 Colebrooke Row ... 11 ... ... ... ... 11 ... ... 33 Charles Street, Barnsbury ... ... ... ... ... ... 11 ... ... 11 Canonbury Square ... 11 ... ... ... ... ... ... ... 1l Cleveland Road ... 31 ... ... ... ... ... ... ... 31 City Road ... 33 ... ... 11 ... ... ... ... 66 Compton Mews ... 11 ... ... ... ... ... ... ... l1 Clephane Road ... 11 ... ... ... ... ... ... ... 11 Crayford Road ... 32 ... ... ... ... ... ... ... 43 Caledonia Street ... ... 11 ... ... ... 11 ... ... 32 Canonbury Road ... 32 33 ... ... ... 22 ... ... 98 Carleton Road ... 22 ... ... ... ... ... ... ... 22 Canonbury Park South ... 11 1l ... ... ... ... ... ... 22 Cardale Street ... ... ... ... ... ... ... ... ... I11 Church Road ... 11 22 ... 11 ... ... ... ... 44 Corsica Street ... 1l ... ... ... ... ... ... ... 11 Caroline Cottages, Matthias Rd. ... ... 11 ... ... ... ... ... ... 11 Cornwall Cottages, Eden Grove ... ... ... ... ... ... ... ... ... 52 Cattle Market ... 11 ... ... ... ... ... ... ... 11 Charles Street, Oxford Road ... ... ... ... ... ... ... 11 ... 11 Charlton Crescent ... 11 ... ... 11 ... ... ... ... 22 Crinan Street ... 11 ... ... ... ... 11 ... ... 22 Cottenham Terrace ... ... 11 ... ... ... ... ... ... 11 Charlesworth Street ... 11 ... ... 11 ... ... ... ... 22 Conewood Street ... ... 11 ... ... ... ... ... ... 11 Church Passage ... ... 11 ... ... ... ... ... ... 11 Canterbury Road ... 11 ... ... ... ... ... ... ... 11 1899] 160 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Campdale Road ... ... ... ... ... ... 11 ... ... 11 Crossley Street ... 1l ... ... 22 ... 11 ... ... 54 Canonbury Park North ... 11 ... ... ... ... ... ... ... 11 Church Street ... 1l ... ... ... ... ... ... ... 11 Canonbury Villas ... 1l ... ... ... ... ... ... ... 11 Clarence Street ... 11 11 ... ... ... ... ... ... 22 Downham Road ... 43 11 ... ... ... ... ... ... 54 Danbury Street ... 1l ... ... 11 ... 1l ... ... 38 Delhi Street ... 1l ... ... 11 ... ... ... ... 22 Devonshire Street ... 1l ... ... ... ... ... ... ... 11 Durham Road ... 39 44 ... 22 ... 22 ... ... 1111 Dorinda Street ... 22 52 ... ... ... 11 ... ... 85 Duncombe Road ... 87 22 ... 11 ... 11 ... ... 1210 Devonshire Road ... 22 22 ... 11 ... 11 ... ... 66 Denmark Street ... ... 11 11 ... ... ... ... ... 22 Dibden Street ... 32 ... ... ... ... ... ... ... 32 Dartmouth Park Hill ... 54 ... ... ... ... 11 ... ... 65 Despard Road ... 52 11 ... ... ... ... ... ... 63 Dresden Road ... 22 22 ... ... ... ... ... ... 48 Dame Street ... 22 11 ... ... ... 22 ... ... 55 Dillon Place ... ... ... ... ... ... 11 ... ... 11 Dennis Street ... 22 44 ... 11 ... ... ... ... 78 Dunford Road ... 22 11 ... ... ... ... ... ... 33 Dean Street ... 11 11 11 ... ... ... ... ... 38 Davenant Road ... 38 48 ... ... ... ... ... ... 76 Drayton Park ... 22 22 ... 32 ... 38 ... ... 109 Duncan Terrace ... 2 21 ... ... ... 11 ... ... 54 Duncan Street ... 11 ... ... ... ... ... ... ... 11 Dalmeny Road ... 48 ... ... ... ... ... ... ... 43 Dorset Street ... 22 ... ... ... ... 11 ... ... 38 Douglas Road ... 21 ... ... ... ... ... ... ... 32 Denmark Road ... 21 ... ... 11 ... ... ... ... 32 Denmark Grove ... 32 33 ... ... ... ... ... ... 65 Elthorne Road ... ... 44 ... 11 ... 38 ... ... 14.13 Elmore Street ... 58 t 11 ... 11 ... 11 ... ... 86 Edinburgh Place ... 11 11 ... ... ... ... ... ... 22 Evershot Road ... 38 ... ... ... ... 11 ... ... 44 Edward Square ... 44 11 ... ... ... 11 ... ... 68 Essex Road ... 77 4a ... 11 ... 56 ... ... 1718 Everilda Street ... 1l ... ... 21 ... ... ... ... 32 Ecclesbourne Road ... 48 33 ... ... ... 11 ... ... 87 Elphinstone Street ... 11 ... ... 21 ... 11 ... ... 48 Elton Street ... 11 ... ... 11 ... 11 ... ... 39 Enkel Street ... 11 ... ... 11 ... ... ... ... 22 161 [1899 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Elfort Road ... 11 ... ... 11 ... ... ... ... 22 Ellenborough Road ... 11 ... 11 ... 11 ... ... 32 Eaton Grove ... ... 31 ... ... ... ... ... ... 31 Elliott's Place, Essex Road 11 1l 11 ... ... ... ... ... ... 33 Everleigh Street ... 11 22 ... ... ... ... ... ... 33 Eden Grove ... 108 . . . ... .... ... 21 ... ... I29 Edinburgh Cottages,Popham St. ... 32 22 ... ... ... 11 ... ... 69 Elwood Street ... 43 11 ... 22 ... ... ... ... 76 Englefield Road ...... 22 11 ... ... ... ... .... ... 33 Eddington Street ... 11 11 ... ... ... ... ... ... 21 Ebenezer Buildings, Rotherfield Street ... ... ... ... ... ... 11 ... ... 11 Edwards Cottages, Canonburv Road ... 21 ... ... ... ... 11 ... ... 32 Electric Parade ... 11 ... ... ... ... ... ...... ... 11 Fortnam Road ... 22 ... ... ... ... ... ... ... 22 Frederick Street ... 33 ... ... ... ... ... ... ... 38 Fonthill Road ... 54 7' ... 32 ... 11 ... ... 1611 Fairbridge Road ... 32 22 ..., 32 ... 33 ...i1 ... 1211 Francis Street ... 21 ... ... ... ... ... ... 21 Furlong Road ... ... ... ... 11 ... ... ... 11 Freeling Street ... 32 11 ... ... ... ... ...... ... 48 Foxham Road ... ... 11 ... ... ... ... ... ... 11 Fowler Road ... 11 11 ... ... ... ... ... ... 22 Florence Street ... 22 22 ... ... ... ... ... ... 44 Fakenham Street ... 43 11 ... ... ... ... ... ... 54 Francis Terrace, Junction Rd. ... ... 11 ... 31 ... ... ... ... 42 Ferntower Road ... 32 ... ... ... ... ... ... ... 32 Fairmead Road ... 11 ... ... ... ... ... ... ... 11 Freegrove Road ... 54 11 ... ... ... ... ... ... 65 Friend's Cottages, Canonbury Road ... ... 11 ... 11 ... ... ... ... 22 Frome Street ... 11 ... ... ... ... ... ... ... 11 Fordhams Grove ... 11 ... ... ... ... ... ... 11 George's Road ... 98 11 ... 11 ... 55 11 ... 1716 Grove Road ... 109 22 ... ... ... 2 2 ... ... 1413 Giesbach Road ... 32 ... ... ... ... 11 ... ... 42 Grovedale Road ... 52 33 ... 11 ... ... ... ... 96 Great Northern Hospital ... ... ... ... 11 ... ... ... ... 11 Goodinge Road ... 66 22 1 11 ... 2 2 ... ... 1211 Gatcombe Road ... 11 ... ... ... ... ... ... ... 11 Grafton Road ... 38 11 ... ... ... 11 ... ... 55 Grace Street ... ... ... ... ... ... ... 11 ... 11 Greeley Road ... 48 ... ... ... ... ... ... ... 43 1899] 162 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. George Street ... 21 ... ... ... ... ... ... ... 21 Goldsmith's Place ... 11 22 ... ... ... 22 ... ... 55 Graham Street ... ... ... ... ... ... 22 ... ... 22 Gallia Road ... ... ... ... ... ... ... ... ... 11 Goswell Road ... 11 ... ... ... ... ... ... ... 11 Grove Street ... 22 ... ... ... ... ... ... ... 32 Gifford Street ... 56 11 ... 22 ... 44 ... ... 1212 Gordon Street ... 22 ... ... ... ... ... ... ... 22 Gainford Street ... 48 ... ... ... ... ... ... ... 43 Grosvenor Road ... 31 ... ... 1l ... ... ... ... 42 Gillespie Road ... 64 22 ... 88 ... 11 ... ... 1715 Grosvenor Street ... 11 11 ... 11 ... 29 ... ... 54 Gibson Square ... 21 11 ... 11 ... ... ... ... 48 Gerrard Street ... 11 ... ... ... ... ... ... ... 11 Gladsmuir Road ... 32 11 ... 11 ... ... ... ... 54 Gladstone Street ... 11 ... ... ... ... 1l ... 22 Grenville Road ... 74 22 ... 31 ... ... ... ... 129 Girdlestone Road ... 22 ... ... ... ... ... ... ... 22 Highgate Hill ... 22 22 ... 11 ... 22 ... ... 77 Holloway Road ... 139 128 ... 22 ... 38 ... ... 3021 Hanley Road ... 32 38 ... ... ... 22 ... ... 87 Highbury Quadrant ... 11 ... ... ... ... ... ... ... 11 Hertslet Road ... 22 ... ... 11 ... ... ... ... 33 Hotnsey Road ... 129 119 ... 44 ... 32 ... ... 3024 Hanover Street ... 54 ... ... ... ... ... ... ... 54 Hawthorn Street ... 11 ... ... ... ... ... ... ... 11 Henry Place ... 38 ... ... ... ... ... ... ... 33 Hercules Road ... 22 ... ... 22 ... ... ... ... 44 Hale Street ... 11 ... ... ... ... ... ... ... 11 Hornsey Rise ... ... 11 ... ... ... ... ... ... 11 Hillmarton Road ... 11 ... ... ... ... ... ... 11 Halse Street ... 21 1l ... 22 ... ... ... ... 54 Hartham Road ... 22 ... ... ... ... 11 ... ... 38 Highbury Crescent West ... 11 ... ... 11 ... ... ... ... 11 Hatley Road ... 22 48 ... ... ... 11 ... ... 76 Hungerford Road ... 21 ... ... ... ... ... ... ... 21 Horsell Road ... ... 11 ... ... ... ... ... ... 11 Hemingford Road ... 1310 1l ... ... ... 22 ... ... 1618 Huddlestone Road ... ... 1l ... 11 ... ... ... 22 Hampden Road ... 11 1818 1l 21 ... 11 ... ... 2316 Hargrave Park ... ... ... ... 11 ... ... ... ... 11 Harvist Road ... 44 ... ... ... ... ... ... ... 44 High wood Road ... ... ... ... 11 ... ... ... ... 11 Hope Street ... ... ... ... ... ... 11 ... .... 11 163 [1899 Table XCIX.—continued, « NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Hollingsworth Street ... 1l ... ... ... 22 ... ... 38 Hornsey Street ... 22 • •• ... ... ... ... 11 ... 38 Hatchard Road ... 11 33 ... 11 ... 11 ... ... 66 Highbury Hill ... 48 ... ... 11 ... ... ... ... 54 Hazellville Road ... 11 ... ... ... 11 ... ... 22 Havelock Street ... 11 ... ... ... ... 11 ... ... 22 H.M. Prison, Holloway ... 2 ... ... 1 ... ... ... ... 31 H.M. Prison, Pentonville ... ... ... 1 ... ... ... ... 11 Hilldrop Crescent ... 22 • - ... ... ... ... ... 22 Highbury Grange ... 21 ... ... ... ... 11 ... ... 32 Highbury Park ... 21 ... ... ... ... ... ... ... 21 Hardinge Street ... .. ... ... ... ... 11 ... ... 11 Holborn Infirmary ... 11 ... ... ... ... ... ... 11 Herrick Road ... 11 ... ... ... ... ... ... ... 11 Halton Road ... 54 66 ... ... ... ... ... ... 1l9 Highbury Grove ... 22 ... ... ... ... ... ... ... 22 Hamilton Road ... 42 ... ... ... ... ... ... ... 42 Highbury New Park ... 43 ... ... ... ... ... ... ... 48 Hyde's Place ... ... ... ... ... ... 11 ... ... 11 Hilton Road ... 38 ... ... ... ... ... ... ... 38 Highbury Terrace ... 1l ... ... ... ... ... ... ... 11 Harberton Road ... 11 32 ... ... ... ... ... ... 43 Half Moon Crescent ... ... ... ... 22 ... ... 11 ... 38 Halliford Street ... 48 11 ... ... ... 11 ... ... 64 Hornsey Rise Gardens ... .. 11 ... ... ... ... ... ... 11 Hargrave Road ... 21 11 ... ... ... ... ... ... 32 Hornsey Lane ... 11 ... ... ... ... ... ... ... 11 High Street ... 11 ... ... ... ... 11 ... ... 22 Hugo Road ... ... 11 ... ... ... ... ... ... 11 Islington Infirmary ... 1 ... 2 ... 36 ... ... 441 Islington Green ... 11 ... ... ... ... .. ... ... 11 Isledon Road ... 54 32 ... 22 ... 22 ... ... 128 Islington Workhouse Schools ... 54 4 ... 51 ... 1 ... ... 1 101 Ingleby Road ... 22 ... ... ... ... ... ... ... 2 Junction Road ... 56 66 ... 11 ... ... ... ... 1211 Jackson Road ... 44 22 ... ... ... 11 ... ... 7 James Street, George's Road ... 11 ... ... ... ... ... ... ... 11 Jay's Buildings, Wynford Rd. ... ... ... ... ... ... 11 ... ... 11 King Henry's Walk ... 38 ... ... ... ... ... ... ... 38 King Edward Street ... 21 1l ... 11 ... ... ... ... 48 Kiver Road ... 22 ... ... ... ... ... ... ... 2a King Henry Street ... 22 1l ... ... ... 22 ... ... 55 Kingsdown Road ... 33 1l ... ... ... 11 ... ... 55 Kelvin Road ... 22 ... ... ... ... ... ... 22 1899] 164 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. T yphoid Fever. T yphus Fever. Erysipelas. Puerperal Fever.- Continued Fever. Total. Kingsland Passage ... ... ... ... ... ... 11 ... ... 11 Kingsbury Road ... 32 11 ... ... ... ... ... ... 43 Kinlock Street ... 11 ... ... ... ... ... ... ... 11 Leigh Road ... 11 ... ... ... ... ... ... ... 1l Lambton Road ... 33 11 ... ... ... 11 11 ... 66 Lesly Street ... 48 21 ... 11 ... ... ... ... 74 Liverpool Road ... 129 98 ... 2 2 ... 38 22 ... 2824 London Fever Hospital ... 5 4 ... ... ... ... ... ... 91 London Street ... ... 22 11 ... ... ... ... ... 38 Leconfield Road ... 11 72 ... ... ... ... ... ... 83 Lincoln House, Astey's Row ... 31 ... ... ... ... ... ... ... 31 Lofting Road ... 11 ... ... ... ... ... ... ... 11 Lome Buildings, Benwell Rd. ... ... 11 ... ... ... ... ... ... 11 Lonsdale Square ... 22 ... ... ... ... ... ... ... 22 Liverpool Buildings ... 33 22 ... 22 ... 38 ... ... 109 Langdon Road ... 22 11 ... 21 ... ... ... ... 54 Lavinia Grove ... 11 11 ... ... ... 11 ... ... 32 Lovman Road ... 38 ... ... ... ... ... ... ... 38 Little Cross Street ... 31 ... ... ... ... ... ... ... 31 Landseer Road ... 54 ... ... ... ... 11 ... ... 64 Linton Street ... 11 ... ... ... ... ... ... ... 11 Lennox Road ... 1l 31 ... 11 ... ... ... ... 81 Liberia Road ... ... 11 ... ... ... ... ... ... 11 Lyon Street ... 48 ... ... ... ... 2 2 ... 61 Loraine Road ... 11 ... ... ... ... 22 ... ... 38 Lidyard Road ... 23 1l ... ... ... ... ... ... 38 Lady Margaret Road ... 11 ... ... ... ... ... ... ... 1l Liverpool Street ... ... ... ... 11 ... ... ... ... 11 Miranda Road ... 22 ... ... ... ... 11 ... ... 38 Mercers Road ... 11 38 ... ... ... ... ... ... 44 Manhattan Mansions, Holloway Road ... 11 1l ... ... ... ... ... ... 22 Muriel Street ... ... 11 ... ... ... 11 ... ... 2 Matthias Road ... ... ... ... 38 ... ... ... ... 38 Moray Road ... 38 38 ... 11 ... 22 ... ... 99 Moon Street ... 31 ... ... ... ... 11 ... ... 42 Mulkern Road ... 32 44 ... ... ... 22 ... ... 97 Monnery Road ... 22 ... ... 11 ... ... ... ... 33 Marlboro' Road ... 2011 54 ... ... ... 22 ... ... 2716 Marcellus Road ... 32 32 ... ... ... 11 ... ... 75 Moreland Street ... 11 ... ... 11 ... 11 ... ... 38 Marquess Grove ... ... 11 ... ... ... ... ... ... 11 Monckley Terrace ... 11 ... ... ... ... ... ... ... 11 Manor Gardens ... 11 ... ... ... ... ... ... ... 11 165 [1899 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Milton Grove ... 22 53 ... 38 ... 22 ... ... 1210 Milton Yard, Cloudesley Place ... 11 ... ... ... ... ... ... ... 11 Mayville Street ... 74 ... ... 11 ... ... ... ... 85 Middlesex Street ... 1l ... ... 11 ... ... ... ... 22 Morley Mews, Durham Road ... ... ... ... ... ... 11 ... ... 11 Mitford Road ... 22 11 ... 43 ... ... ... ... 76 Montpelier Road ... 11 ... ... ... ... ... ... ... 11 Medina Grove ... 11 ... ... ... ... ... ... ... 11 Monsell Road ... 54 ... ... ... ... ... ... ... 54 Milton Place ... 22 ... ... 11 ... ... 11 ... 48 Market Road ... 42 ... ... ... ... ... ... ... 42 Morton Road ... 33 ... ... 11 ... ... ... ... 44 Mildmay Avenue ... 11 ... ... 22 ... 11 ... ... 44 Mayton Street ... 76 11 ... ... ... ... ... ... 87 Mildmay Park ... 58 ... ... 11 ... 11 ... ... 77 Market Street ... 32 ... ... ... ... ... ... ... 32 Mount Pleasant Road ... 11 ... ... ... ... ... ... 11 Melgund Road ... 11 11 ... ... ... ... ... ... 22 Myddelton Buildings ... 11 ... ... ... ... ... ... ... 11 Monte Christo Mansions ... 11 ... ... ... ... ... ... ... 11 Mayville Grove ... 1l ... ... ... ... ... ... ... 11 Malvern Terrace ... 11 ... ... ... ... ... ... ... 11 Mary Street ... ... ... ... ... 11 ... ... 11 Mildmay Road ... 44 ... ... ... ... ... ... ... 44 Matilda Street ... 33 ... ... ... ... ... ... ... 33 Mildmay Street ... 43 22 ... ... ... ... ... ... 66 Mildmay Grove ... 73 ... ... ... ... 11 ... ... 84 Montem Street ... 21 ... ... ... ... ... ... ... 2l Medina Road ... 22 11 ... ... ... ... ... ... 33 Myrtle Street ... 22 ... ... ... ... ... ... ... 22 Marriott Road ... ... ... ... ... ... ... 11 ... 11 Magdala Road ... 22 11 ... 11 ... ... ... ... 44 Maygood Street ... 21 11 ... ... ... 11 ... ... 42 Netherland Place ... 11 ... ... ... ... ... ... ... 11 Nailour Street ... 48 ... ... ... ... ... ... ... 48 Northampton Street ... 58 ... ... 11 ... ... ... ... 64 New Wharf Road ... ... .. . ... ... ... 11 ... ... 11 Nelson Terrace ... ... 32 ... ... ... ... ... ... 32 New North Road ... 86 33 ... 11 ... 11 ... ... 1311 Norfolk Street ... 11 ... ... ... ... 11 ... ... 22 Nicholay Road ... 21 ... ... 11 ... 11 ... ... 48 Nelson Cottages ... 11 11 ... ... ... ... ... ... 22 Norfolk Road ... 22 ... ... ... ... ... ... ... 22 Noel Street ... 11 ... 11 ... ... 11 ... ... 38 1899] ICG Table XClX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas, Puerperal Fever. Continued Fever. Total. Newington Green Road ... 43 ... ... ... ... 11 ... ... 54 Nelson Buildings, City Road ... 11 ... ... ... ... ... ... ... 11 North Road ... 11 ... ... 11 ... ... ... ... 23 Northampton Park ... ... 11 ... ... ... ... ... ... 11 Newhall Street ... 21 ... ... ... ... 11 ... ... 32 Northampton Grove ... 11 .. ... ... ... ... ... ... 11 Northolme Road ... ... 22 ... 11 ... ... ... ... 38 Orpingley Road ... 21 ... ... 11 ... 11 ... ... 48 Oxford Road ... 11 2 2 ... ... ... ... ... 33 Offord Road ... 65 ... ... 11 ... ... ... ... 76 Ormond Road ... 21 ... ... ... ... ... ... ... 21 Orchard Street ... 33 ... ... ... ... 11 ... ... 44 Outram Street ... ... 11 ... ... ... ... ... ... 11 Ockendon Road ... 11 11 ... ... ... ... ... ... 21 Oxford Terrace ... ... ... ... ... ... 11 ... ... 11 Parkfield Street ... 128 22 ... ... ... ... ... ... 149 Pooles Park ... 21 ... 11 11 ... ... ... 43 Plimsoll Road ... 41 11 ... ... ... ... ... ... 52 Poynings Road ... 11 ... 52 ... ... ... ... 62 Palmerston Road ... 44 22 ... ... ... ... ... ... 66 Peabody Buildings ... 66 11 ... 11 ... 11 ... ... 99 Packington Street ... 1010 ... ... ... ... ... ... ... 1010 Pleasant Passage ... ... ... ... 11 ... 11 ... ... 2 Pembroke Street ... 44 22 ... ... 22 ... ... 88 Prebend Street ... 44 ... ... ... 11 ... ... 55 Parolles Road ... 86 11 ... ... ... ... ... ... 97 Petherton Road ... 33 11 ... ... ... ... ... ... 44 Palmer Place ... 11 ... ... ... ... ... ... ... 11 Pakeman Street ... 1l ... ... ... ... ... ... ... 11 Providence Cottages, Upper St. ... ... 11 ... ... ... ... ... ... 11 Pentonville Road ... ... ... ... ... ... 11 ... ... 11 Prince's Mansions, Liverpool Road ... 11 ... ... ... ... ... ... 11 Prospero Road ... ... ... ... ... ... ... ... 11 Prospect Place, Barnsbury St. ... 21 ... ... ... ... ... 31 Pemberton Gardens ... ... ... ... ... ... 11 ... ... 11 Penn Road Mews ... 11 ... ... ... ... ... 11 Pickering Street ... 22 ... ... .. ... 11 ... ... 38 Pulteney Street ... 11 ... ... 11 ... 38 ... ... 54 Parkhurst Road ... ... ... ... 11 ... ... ... ... 11 Pulteney Terrace ... 48 ... ... 22 ... ... ... ... 65 Park Street ... 32 11 ... 11 ... 11 ... ... 66 Pyrland Road ... 11 ... ... .. ... ... ... ... 11 Popham Road ... 42 11 ... ... ... 11 ... ... 63 167 [1899 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Prospect Row, Ball's Pond ... 1l ... ... 1l ... ... ... ... 22 Pemberton Terrace ... 1l ... ... 1l ... ... • •• ... 22 Palm Terrace ... 1l ... ... • • • ... ... ... ... 1l Queen's Place, Rotherfield St. ... 3l 1l ... ... ... ... ... 42 Queen's Square, Queensland Road ... 1l ... ... ... ... ... ... 1l Queensland Road ... 33 22 ... 1l ... ... ... 66 Queen's Cottages, Popham St. ... 22 22 ... 33 ... ... ... ... 77 Quadrant Road ... 11 ... ... ... . • • ... ... 1l Quinn Buildings ... 55 38 ... 1l ... 1l ... ... 1010 Queen's Arms Buildings, Cattle Market ... 38 ... ... ... ... ... ... 33 Queen Margaret's Grove ... 1l 11 ... 1l ... ... ... ... 33 Queensbury Street ... ... 33 ... 1l ... 22 ... ... 66 Queen's Head Street ... 22 33 ... ... ... ... ... ... 56 Regina Road ... 1l 1l ... 11 ... ... ... ... 38 Rotherfield Street ... 38 22 ... ... ... 38 ... ... 88 Rock Street ... 1l ... ... ... ... ... 1l Riversdale Road ... 43 ... 1l ... 1l ... ... 65 Rufford Street ... ... ... ... ... 22 ... 22 Rhodes Street ... 44 53 ... ... ... 22 ... ... 117 Rupert Road ... 22 106 1l 1l ... ... ... ... 148 Roman Road ... 11 ... ... ... 22 11 ... 44 Rocliffe Street ... 22 ... ... ... ... ... 22 Rosemary Street ... ... 1l ... ... ... 1l ... ... 22 Rayner Place ... 11 1l ... ... ... ... ... ... 22 Rothery Street ... 11 ... ... ... ... ... ... 1l Road's Yard, Hornsey Road ... ... 1l ... 1l ... ... ... ... 21 Rheidol Terrace ... 32 22 ... 1l ... ... ... ... 65 Richmond Road ... 44 31 ... ... ... 11 ... 86 Romilly Road ... 11 1l ... 22 ... 1l ... ... 55 Rodney Place, Wynford Road ... ... 1l ... 21 ... ... ... ... 32 Ronalds Road ... ... 1l ... ... ... 1l ... ... 22 Richmond Crescent ... 11 ... ... ... 1l ... ... 22 Rydon Street .. 1l ... ... ... ... ... ... 1l Russell Road ... 42 1l ... 1l ... i1 ... ... 75 River Street ... 1l ... ... ... ... ... ... 1l Roden Street ... 43 22 ... 33 ... ... ... ... 98 Randall's Road ... 22 ... ... ... ... ... ... 22 Richard Street ... 1l ... ... ... ... ... ... 1l Rosa Alba Mews, Highbury Park ... 1l ... ... ... ... ... ... 1l Runton Street ... 21 ... ... ... ... ... ... 21 Shaftesbury Road .. 31 ... ... ... ... ... ... ... 31 1899] 168 Table -XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. St. John's Road ... 65 53 11 11 ... 22 ... ... 1512 Stroud Green Road ... 33 ... ... ... ... ... ... ... 33 Sherringham Road ... 2l ... ... ... ... ... ... ... 21 Sun Row ... ... ... ... ... ... I... ... ... 11 Swanley Street ... 22 11 ... 11 ... 11 ... ... 55 Station Parade, Hornsey Rise ... 22 ... ... ... ... ... ... ... 2s Swan Yard, Station Road ... ... ... ... 22 ... ... ... ... 22 Stanley Road ... 33 ... ... ... ... ... ... ... 33 St. Paul's Road ... 52 77 ... 11 ... ... ... ... 1310 Spencer Road ... 64 ... ... ... ... ... ... ... 64 St. Thomas' Road ... 22 22 ... 81 ... 11 ... ... 136 Surr Street ... 11 ... ... 11 ... ... ... ... 22 Southern Street ... 31 ... ... ... ... ... ... ... 31 Seven Sisters Road ... 22 21 ... 11 ... 22 ... ... 76 Sunnyside Road ... 42 32 ... 11 ... ... ... ... 83 St. Paul Street ... 54 44 ... ... ... ... ... ... 98 Sherborne Mews ... ... 11 ... ... ... ... ... ... 11 Stonenest Street ... 11 ... ... ... ... ... ... ... 11 St. Philip Street ... ... ... ... ... ... 11 ... ... 11 St. John's Park Mansions ... 11 ... ... ... ... ... ... ... 11 South Street ... 43 22 ... ... ... ... ... ... 65 Sebbon Street ... ... ... ... 11 ... ... ... ... 11 Shepperton Road ... 44 11 ... ... ... ... ... ... 55 St. Paul's Place ... 11 ... ... ... ... ... ... ... 11 Story Street ... ... 11 ... 53 ... ... ... ... 64 St. Peter's Street ... 77 21 ... ... ... 22 ... ... 1111 Spencer Street ... 22 11 ... ... ... ... ... ... 32 St. James' Street, St. Peters Street ... 32 ... ... ... ... ... ... ... 32 St. Jude Street ... 52 ... ... ... ... ... 11 ... 63 St. George's Avenue ... ... ... ... ... ... 11 ... ... 11 Sidney Place, City Road ... 11 ... ... ... ... ... ... ... 11 St. Clement's Street ... 22 11 ... ... ... ... ... ... 38 Sussex Road ... 11 ... ... ... ... ... ... ... 11 Sotheby Road ... 21 ... ... ... ... ... ... ... 21 Suffolk Place ... 21 ... ... ... ... ... ... ... 21 St. James' Road ... 33 ... ... ... ... 44 ... ... 1010 Sonderburg Road ... 11 ... ... ... ... ... ... ... 11 St. Aloysius Schools ... ... ... ... ... ... 2 ... ... 21 St. John's Villas, Holloway Rd. ... 22 11 ... ... ... ... ... ... 32 Sudeley Street ... 11 11 ... 11 ... ... ... ... 32 Summerfield Road ... 21 ... ... ... ... ... ... ... 21 St. Thomas Street ... ... ... ... ... ... 11 ... ... 11 Sheen Grove ... 11 ... ... 21 ... ... ... ... 32 169 1899 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. . St. John's Park ... 11 5l ... ... ... 11 ... ... 72 Sonning Street ... 11 ... ... ... ... ... ... ... 11 Southampton Street ... 11 ... ... ... ... ... ... ... 11 Sherbourne Street ... 22 22 ... 21 ... 22 ... ... 87 Stock Orchard Crescent ... 22 ... ... ... ... 11 ... ... 33 Salisbury Road ... ... ... ... ... ... 11 ... ... 22 Scholefield Road ... ... ... ... 11 ... ... 11 ... 33 Stanley Terrace ... ... 31 ... 11 ... ... ... ... 42 Sparsholt Road ... 21 ... ... ... ... ... ... ... 21 Southcote Road ... ... 11 ... ... ... ... ... ... 11 Tufnell Park Road ... 64 42 ... 11 ... ... ... ... 117 Trinity Street ... 22 11 ... ... ... ... ... ... 22 Tibberton Square ... 42 43 ... ... ... ... ... ... 84 Tollington Park ... 54 ... ... 11 ... 11 ... ... 76 Tollington Road ... 22 22 ... ... ... ... ... ... 44 Twyford Street ... ... 11 ... ... ... ... ... ... 11 Tyndale Place ... ... 22 ... ... ... ... ... ... 22 Theberton Street ... 11 ... ... 31 ... 22 ... ... 64 Tavistock Terrace ... 11 33 ... 22 ... ... ... ... 55 Thornhill Square ... 54 11 ... ... ... ... ... ... 65 Tabley Road ... 43 22 ... ... ... ... ... ... 66 Tollington Place ... 52 ... ... ... ... ... ... ... 52 Trinder Road ... 11 ... ... ... ... 11 ... ... 22 Thorpedale Road ... 43 97 ... 22 ... 11 ... ... 1613 Trinder Gardens ... 11 ... ... ... ... ... ... ... 11 Tiber Street ... 11 ... ... ... ... 22 ... ... 22 Thornhill Road ... 11 11 ... ... ... ... ... ... 22 Torrens Buildings, City Road ... 99 11 ... 11 ... ... 11 ... 1211 Thornhill Bridge Place ... 11 22 ... ... ... ... ... ... 33 Tremlett Grove ... 11 42 ... ... ... ... ... ... 42 Thane Villas, Seven Sisters Rd. ... 11 11 ... ... ... 11 ... ... 33 Union Street ... 11 ... ... ... ... ... ... ... 11 Union Square, New North Rd. ... 11 ... ... ... ... ... 11 ... 11 Upper Street ... 11 22 11 ... ... ... ... ... 44 Upper Tollington Road ... 32 11 ... ... ... ... ... ... 43 Victor Road ... 34 48 ... 11 ... ... ... ... 86 Victoria Road ... 55 31 ... ... ... 11 ... ... 96 Vorley Road ... 74 86 ... ... ... 11 ... ... 169 Vittoria Street ... 32 11 11 ... ... ... ... ... 54 Victoria Place, Queensland Rd. ... 11 ... ... ... 11 ... ... 22 Vincent Terrace, Colebrook ... ... ... ... ... ... ... ... Row ... 11 ... ... ... ... ... ... ... 11 Wall Street ... 33 22 ... ... ... ... ... ... 55 Windsor Road ... 22 11 ... ... ... 11 ... ... 44 m 1899] 170 Table XCIX.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total Warner Street ... 44 22 ... ... ... 22 ... ... 88 Warrender Road ... 11 ... ... ... ... ... ... 11 Wynford Road ... 32 11 ... 11 ... 22 ... ... 76 Windsor Street ... 44 ... ... ... 33 ... ... 77 Wellington Road ... 33 44 ... ... ... ... 11 ... 88 Whistler Street ... 11 ... ... ... ... ... ... ... 11 Westbourne Road ... 33 11 ... ... ... 22 ... ... 66 Wray Crescent ... 52 ... ... ... ... ... ... ... 52 Warlters Road ... ... ... ... 11 ... ... ... ... 11 Whitehall Mansions ... ... ... ... 11 ... ... ... ... 11 Wharfdale Road ... 33 22 ... ... ... ... ... ... 55 Wolsey Grove ... ... ... 11 ... ... ... ... 11 Woodville Road ... 33 33 ... ... ... ... ... ... 65 Whewell Road ... ... 11 ... 32 ... ... ... ... 48 Winchester Street ... 22 ... ... ... ... ... ... 22 Wedmore Street ... 22 76 ... ... ... ... 11 ... 107 Wilton Square ... ... ... 11 ... 11 ... ... 22 Ward Road ... 22 22 ... ... ... ... ... ... 44 Whitehall Park ... 32 11 ... ... ... ... ... ... 43 Wyatt Road ... 22 ... ... ... ... ... ... ... 22 Witherington Road ... ... ... ... 22 ... ... ... ... 22 William Street, St. Peter's St. ... 63 ... ... ... ... ... ... ... 63 William Street, Bamsbury ... 22 ... ... ... ... ... ... ... 33 Williamson Street ... 73 ... ... ... ... ... ... ... 78 Wedmore Gardens ... 32 33 ... ... ... ... ... ... 65 Whitehall Parade ... 11 11 ... 11 ... ... ... ... 33 Wolsey Road ... 11 ... ... ... ... ... ... ... 11 Wellington Place ... ... ... ... ... ... 11 ... ... 11 Waterloo Terrace ... ... ... ... ... ... 11 ... ... 11 York Road ... 33 11 11 11 ... ... ... ... 66 York Villas, Hargrave Park ... 11 ... ... ... ... ... ... 11 Yerbury Road ... 11 66 ... 11 ... 11 ... ... 97 Yonge Park ... 22 11 ... ... ... ... ... ... 38 171 1899 BACTERIOLOGICAL DIAGNOSES. At the beginning of the third quarter of 1898 the Public Health Committee decided to enter into an arrangement with the Jenner Institute to have bacteriological examinations made, free of charge for medical men practising in Islington, of the sputum and blood of any of their patients suspected to be suffering from diphtheria or enteric fever. The result has been a complete success, and has quite justified the action of the Committee, for it has enabled physicians to make positive diagnoses in 252 instances. As the examinations for these diseases had been availed of by many of the medical profession, I recommended the Committee at the close of 1898 to go one step farther and to make bacteriological examinations for the detection of phthisis in its early stages, when its symptoms are ill defined, and when at best the disease has been only suspected. The Committee readily acted on my advice, and immediately made arrangements with the same corporation to make the necessary examinations. The medical profession at once took advantage of the Vestry's offer, so that during the year 79 specimens of mucous secretions from the lungs or throat of patients were examined. In 36 instances the disease was found to be present while in 43 the tubercle bacilli could not be detected. The examinations for diphtheria were 97, of which 47 resulted in the disease being diagnosed, while 50 gave negative results. The "Widal reaction" was sought for in 76 specimens of blood obtained from patients suspected to be suffering from Enteric Fever, of which 25 gave positive and 51 negative results. I have received many letters from medical men expressing their thanks for the trouble taken in the matter by the Public Health Department. I am glad to think that its work in this direction has been appreciated, and that it has been the means of diagnosing so many doubtful or obscure cases of diphtheria, enteric fever, and phthisis. M 2 1899] 172 Periods. Diphtheria. Enteric Fever. Phthisis. Positive Results. Negative Results. Total Examined Positive Results. Negative Resnlts. Total Examined Positive Results. Negative Results. Total Examined 1898. 3rd Quarter 3 6 9 9 8 17 — — — 4th 8 14 22 22 9 31 — — — 1899. 1st Quarter 12 16 28 4 7 11 7 6 13 2nd 10 7 17 1 9 10 16 19 35 3rd 10 14 24 6 19 25 4 9 13 4th 15 13 28 14 16 30 9 9 18 Totals 58 70 128 56 68 124 36 43 79 In the examination for the diagnosis of Diphtheria and Phthisis the presence of the bacilli, characteristic of the diseases, is sought in the throat secretions or in the sputum of the patients, but in the case of Enteric Fever a small quantity of blood, generally a few drops, obtained by pricking the tip of a finger or the lobe of an ear, is examined for what is called " Widal's Reaction." This examination is made by mixing a loopful of blood from a patient with a loopful of young typhoid broth culture, in a hanging drop on a hollow-ground slide, and covering with a cover-glass and examining under the microscope with a 1/6-inch objective. If the patient is suffering from enteric fever agglutination and immobility of the Eberth-Gaffky bacilli* takes place. This test depends upon the effect of the blood of a person suffering from enteric fever has upon the B. Typhosus. In the first place it causes it to become immobile, and in the second creates an agglutination or grouping together of the bacilli in colonies. These characteristics are not attained when the blood of a healthy person is brought into contact with a culture of the Bacillus Typhosus.† * Bacillus Typhosus. "Bacteria," by Newman, London, John Murray. 173 [1899 VACCINATION. Since 1897 I have not presented a report to the Vestry on the state of Vaccination in Islington. At that time I had to animadvert on the faulty manner in which the Acts dealing with it had been enforced, and I pointed out that the number of children where vaccination was not finally accounted for had risen to 24.0 per cent, of the births. This was up to then the highest per centage known. It is said that in every deep there is a deeper still, and if so this was reached in 1898, when the altogether unprecedented record of 32.3 per cent, of the births was finally unvaccinated. No doubt in 1895, '96, '97 and '98 people who objected to vaccination refused to have the operation performed on their children in the hope that the legislation then expected, now accomplished, would provide them with a loophole by which they might evade their obligation. The new Act, known as "The Vaccination Act, 1898," did provide such a loophole in its second section, which enacts " that no parent or other person shall be liable to any penalty under section twenty-nine or section thirty-one of the Vaccination Act of 1867, if within four months from the birth of the child he satisfies two justices or a stipendiary or metropolitan police magistrate, in petty sessions, that he conscientiously believes that vaccination would be prejudicial to the health of the child, and within seven days thereafter delivers to the Vaccination Officer for the district a certificate by such justices or magistrate of such conscientious objection." This section came into force on the passing of the Act, but in its application to a child born prior to that date it says " there shall be substituted for the period of four months from the birth of the child the period of four months from the passing of this Act." It appears that the parents or guardians of 14 children born in 1897, and of 108 born in 1898, were granted exemption under these provisions, before the other clauses of the Act came into force. These numbers are not very large, and indeed only represent 0.14 per cent, of the births in 1897, and ro8 per cent, of those in 1898. 174 1899 Exact figures are only available for 1898 up to the end of its first six months, in which period only ro6 per cent. escaped vaccination under the conscience clause. These exemptions then cannot account for the large per centages of cases not finally vaccinated that obtained in 1897, 1898, and in the first six months of 1899, when it was again high, namely, 30:7 per cent. As the returns for these periods are of the deepest interest I give them in full. 1897. 1898. 1899. (Six months) 1 Births, number of 9,878 9,478 4,911 2 Successfully vaccinated 6,539 5,422 2,88l 3 Insusceptible to vaccination 30 44 49 4 Had Smallpox — — — 5 Died unvaccinated 954 1,068 527 6 Exemptions under sec. 2, Act '98 14 103 52 7 Postponed by Medical Certificate 220 251 220 8 Removed to other districts 81 92 55 9 Removed to places unknown 1,205 1,421 776 10 No. of cases unaccounted for 835 1,070 351 11 Percentage of exemptions under sec. 2, Act 1898 0.14 1.09 1.o6 12 Percentage of cases exempted by Medical Certificate 2.22 2.65 4.48* 13 Percentage of cases not finally accounted for and for which no vaccination certificates have been received 24.0 32.2 30.7 When one compares these figures with those which obtained from 1872 down to as late as 1891 he cannot fail to notice, and also to regret, the great change for the worse that has overtaken vaccination in Islington. * This proportion is very high, and there is grave doubt that it will be considerably reduced by the time the final returns for the year are made up, as I am informed that the Public Vaccinators are unwilling to vaccinate children that have the least rash or blemish. 175 1899 TABLE C. Showing the State of Vaccination in Islington, 1880-98, also in London and England and Wales, 1880-96. Year . No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Died unvaccinated. No. of exemption certificates. Postponed by Medical certificate. Remaining. Cases (cols. 6,7, & 8), not finally vaccinated per 100 births. In London. Rest of England. 1 2 3 4 5 6 7 8 9 10 11 1880 9,931 8,123 26 885 Not granted for years previous to 1897. 118 779 9.0 7.0 4.5 1881 9,993 8,339 21 812 89 730 8.2 5.7 4.3 1882 10,000 8,360 22 819 155 644 8.0 6.6 4.5 1883 9,950 8,192 25 890 194 644 8.4 6.8 4.9 1884 9,892 8.121 47 924 191 601 8.0 6.8 5.3 1885 9,683 7,874 41 991 157 617 8.0 7.0 5.5 1886 9,844 7,944 39 1,091 148 622 7.8 7.8 6.1 1887 9,732 7,769 44 1,133 171 615 8.1 9.0 6.7 1888 9,620 7,522 39 1,112 219 728 9.8 10.3 8.2 1889 9,638 7,581 22 1,120 198 717 9.5 11.6 9.6 1890 9,239 7,250 19 1,117 122 731 9.2 13.9 10.9 1891 9,823 7,584 33 1 145 131 930 10.8 16.4 12.9 1892 9,626 7,221 28 1,182 127 1,048 12.2 18.4 14.3 1893 9,757 7,251 38 1.222 132 1,114 12.7 18.2 15.7 1894 9,574 7,151 39 1,067 101 1,215 13.7 20.6 19.0 1895 9,959 7,079 50 975 237 1,620 18.7 24.9 19.8 1896 9,752 6,575 46 854 223 2,054 23.4 26.4 22.3 1897 9,878 6,539 30 954 14 220 2,135 24.0 not available. not available. 1898 9,478 5,422 44 1,068 103 251 2,693 32.2 ,, ,, 1890 six m'ths 4,911 2,881 49 527 52 226 1,234 30.7 ,, ,, Note.—The figures in Column 8 are obtained by adding together the numbers given in Columns 3, 4, sand 7 and deducting the total from the number in Column 2. The figures in Column 9 is a percentage statement, obtained by adding together the numbers given in Columns 6, 7 and 8 and applying them to the numbers in Column 2. The very responsible duty of enforcing the vaccination laws now clearly rests on the Vaccination Officers, if Boards of Guardians fail in their manifest duty, as it has been decided in Bramble v. Love, "that a vaccination officer is, without any special authority in that behalf from the Guardians of the Union for which he acts, empowered to take proceedings under sec. 31 of the Vaccination Act, 1867, for an order directing an unvaccinated child to be vaccinated, notwithstanding the provisions of art. 16 of the Order of the Local Government Board of the 31st October, 1874." 176 1899 Personally I am not much in favour of compulsion, but in the case of such a disease as small pox, against which science has provided an efficient as well as a long and well-tried palliative if not preventive, something should be done to enforce the law of the land, and that quickly, and to reduce the numbers of unvaccinated persons who inhabit this district. I have had bitter experience in other places of the dire results that have fallen on unvaccinated persons, and I would, indeed, be sorry to see it repeated here. But that it will be so repeated, whenever small pox overtakes this district, if it should remain in its present partially vaccinated state, I have no doubt. I, therefore, feel that I would not be doing my duty as the person primarily entrusted with the health concerns of this enormous district, if I did not most earnestly urge on the responsible authorities the absolute need that exists for increased activity in the vaccination of the children that are annually born here. It has been a great misfortune for this country that the duty of putting the Vaccination Acts into force has not fallen on the Public Health Authorities instead of on the Poor Law Guardians. If matters had been different, then, indeed, the present scandal with respect to vaccination would, in all probability, not have arisen. The Local Government Board, by not having made the necessary change in the Act of 1898, suppose mean to take on themselves the responsibility of enforcing these Acts; and indeed this was particularly shown by their circular of 21st October 1898, when they informed Boards of Guardians that the power and the duty of taking proceedings are vested in Vaccination Officers. But circulars are of little use unless the Board insist that these officers shall do their duty, and unless it uphold them when they have done it. Vaccination is not a local question, it is a national one, for small pox is essentially the one infectious disease which in this country has been conveyed to distant places and there caused serious epidemics. Consequently it behoves the Government acting as the central Health Authority (although, strange to say, there is no Board of Health) to see that the law is everywhere ally obeyed. 177 1899 Let it be hoped that there may be no outbreak of small pox in Islington while its vaccination defences are in their present weak state, for if there should be one the authorities responsible for their present neglected condition will find that having sown the wind their harvest will be the whirlwind. DISINFECTION. Premises.—2,676 rooms, as against 1,033 in 1898, were disinfected with sulphurous acid gas. 527 of these were treated in the first quarter, 516 in the second, 747 in the third, and 868 in the fourth. In previous years the number were:— 1896 3,495 rooms. 1897 2,701 „ 1898 2,358 „ 1809 2,676 „ In 1,375 instances the walls were stripped of their papers, and at the same time the ceilings and woodwork were cleansed. In 1896 1,045 rooms, in 1897 1,158 rooms, and in 1898 1,033 rooms were similarly treated. This work entails a great deal of labour, and engaged throughout the year a weekly average of eight men, exclusive of the man engaged in the disinfection with sulphurous acid gas. The two succeeding tables give particulars respecting the disinfection ,cleansing and stripping of rooms after infectious diseases had occurred in them. Table CI. Showing the Disinfection of Rooms, after Infectious Disease, in the Sanitary Inspectors' Districts. Sanitary Inspector' Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total 1898 1st Q'rter 35 62 27 53 31 42 32 17 35 26 62 33 24 48 527 256 2nd do. 19 47 20 59 40 44 26 26 27 30 56 33 20 69 516 232 3rd do. 93 85 29 73 29 44 37 36 38 32 94 45 29 83 747 236 4th do. 95 122 42 78 36 68 52 44 55 61 68 55 48 62 886 309 Year 242 316 118 263 136 198 147 123 155 149 280 166 121 262 2676 1033 178 1899] Table CII. Showing the Cleansing and Stripping of Booms after Infectious Disease, in the Sanitary Inspector's Districts. Sanitary Inspector's Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total 1898 lst Q'rter 21 47 13 41 12 14 18 4 21 11 47 12 12 16 289 256 2nd do. 12 28 12 29 14 13 13 7 12 17 35 9 18 18 237 232 3rd do. 65 37 16 40 9 15 20 17 19 16 54 7 13 26 354 236 4th do. 70 93 31 38 15 43 15 21 25 41 53 15 19 16 495 309 Year 168 205 72 148 50 85 66 49 77 85 189 43 62 76 1375 1033 Clothing, Bedding, &c.— As many as 25,378 articles, exclusive of many very small items too numerous to reckon, were disinfected in a thoroughly efficient and satisfactory manner by the Vestry's steam disinfectors at Seven Sisters Road. The number of articles disinfected shows an increase of 5,206 on the returns of the preceding year. The following statement gives a summary of the chief articles disinfected during the year as well as in 1898 :— Articles. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. 1898. Beds 409 392 671 707 2,179 1,704 Blankets 726 579 821 1,181 3,307 2,664 Bolsters 276 221 406 510 1,413 I,092 Carpets 151 136 152 232 671 489 Chair cushions 129 91 148 210 578 429 Mattresses 209 185 345 413 1,152 892 Palliasses 378 325 647 719 2,069 1,574 Pillows 747 604 986 1,280 3,617 2,979 Quilts 270 250 363 445 1,328 1,085 Sheets 495 498 90I 967 2,861 2,150 Other articles 1,121 1,166 1,621 2,295 6,203 5,114 Totals 4,911 4,457 7,061 8,959 25,378 20,172 179 1899 The disinfecting apparatus have now treated at least 133,350 separate large articles of bedding and clothing, apart from packages containing small things such as handkerchiefs, serviettes, stockings, etc., since their erection in 1895. The following is the record of the work of the machines:— 1895 17,240 Articlss. 1896 42,258 „ 1897 28,302 „ 1898 20,172 „ 1899 25,378 „ Total 133,350 ,, In addition to these articles the apparatus have also performed the disinfecting work of Stoke Newington. Disinfectants Distributed and Used. — The following statement gives the particulars of the amount of disinfectants distributed by the Vestry. How disposed of. Disinfecting Powder. Carbolised Creosote. Clear Carbolic Acid. To Inhabitants Tons. Cwt. Gallons. Gallons. 5 0 700 — Disinfecting Premises — — 40 This amount is not very large, compared with the quantities given away in previous years. It must be recollected, however, that no disinfectants are now given to the public unless they produce a card from a Sanitary Inspector showing that there is infection in the applicant's house, or that they are required because of sanitary work which is in progress. 180 1899 SHELTER HOUSES. Only ten families occupied these premises during the year. Families Accommodated. Date of Admittance. Address. Number in Family. Cause. March 2nd 3, Newhall Street 2 Scarlet Fever March 30th 64, Holloway Road 2 do. April 18th 21, Moreland Street 3 do. April 20th 122, Fonthill Road 2 Diphtheria June 14th 94, Canonbury Avenue 9 do. July 3rd 3, Eddington Street 2 do. August 25th 74, Campbell Road 1 do. October 4th 192, New North Road 3 do. November 8th 105, Cottenham Road 4 do. November 20th 3, Bratton Street 6 Scarlet Fever On the 6th February I made a report to the Public Health Committee on the state of the surroundings of this place. I am strongly of opinion that, if the waste ground in the rear of the Baths and Washhouses were made attractive, the Shelter House would be more extensively used. As it is I do not look forward to its being greatly patronised unless there should be an outbreak of smallpox, when I anticipate that there will be no difficulty in persuading the persons, in whose homes the disease has appeared, to avail themselves of the shelter it affords while disinfection is in progress in their rooms. At present the look out from the Shelter House is dismal, is unattractive and dreary, especially during the winter, as old gas columns and other material litter the ground. Surely the object of the Vestry should be to entice and not to repel the people for whom it was built, and, therefore, this ground should be kept in good order, and made an attraction instead of the reverse. 181 1899 The number of requests made by panshoners to have their dust and trade refuse removed only numbered 262, as against 303 in the preceding year, and 312 in 1897, and compared with the following returns in previous years. 1891 10,138 applications. 1896 245 applications. 1892 9,964 1897 312 „ 1893 4,986 1898 303 „ 1894 4,506 1899 262 „ 1895 2,506 The 262 applications represent only 0^57 per cent, of the assessments, Vide Table Z appendix. This work is carried out by the Vestry's own employees, no part of it being let out to contractors. Whatever may be said against the policy of public bodies employing their own labour to execute public work generally, there can be no doubt that as regards dusting and slopping the performance is infinitely better and more thorough when it is effected by Corporations themselves than when done by contractors. The Islington Vestry accomplishes this class of work with very great efficiency and at a reasonable cost, and I believe that, as regards dusting especially, the results will bear comparison with those obtained by any other urban district, whether in London or in the great provincial towns. Mr. Wroot, who is the Superintendant of these works, and his staff may be congratulated on the fact. It is a matter of regret that so much care is bestowed on the great central streets of all populous places to the neglect of those thoroughfares, courts and alleys in which the poor and needy reside—or perhaps I should say it is a matter of regret that these places are not cleaned as frequently, or even more frequently, than the more central streets, for I am convinced that their cleanly condition will have a more potent influence for good on the general DUSTING AND SCAVENGING. The Dusting Department is to be congratulated on the excellent manner in which its work was executed during the year, as, judging by the number of applications made at the Public Health Office for the removal of dust, the work was never previously so well done. 182 1899 health of the community than is generally thought. Dr. Cameron, the Medical Officer of Health of Leeds, details a very interesting experiment which he had carried out in 1892. "In consequence of a special report the Leeds Sanitary Authority determined to see whether any special means would reduce this high mortality from diarrhoea. It was accordingly resolved in one district, with a population of nearly 34,000, and comprising nearly a tenth of the town, to use certain special cleansing measures on the approach of summer. The result is noteworthy. In the dry autumn of 1893, Leeds, like other large towns, had a mortality from diarrhoea, high even compared with that of 1892. That autumn the death-rate from this cause rose to 5.19, as compared with 3.42 the preceding year, and 3.28, the autumnal rate for the decade 1883-92. Only in one district in Leeds did the rate not exceed that of 1892, and that was the one specially scavenged. In another district the increase was merely nominal, but in the "scavenged" district the death-rate actually decreased as compared with that of 1892 from 7.01 to 6.40." The effects of good scavenging cannot be easily overstated, for it is to the community at large what the cleanly and well-drained house is to the individual. It prevents the collection of foul matter in the roads and foul water in the channels, while it roots out from the holes and corners of the lanes and alleys those decaying animal and vegetable matters which have been deposited by dirty and careless citizens. No place should be allowed to remain so long as a week without scavenging, especially from midJune to mid-September, when diarrhoea is always more or less epidemic. MEAT INSPECTION. Inspector Young, who came from Glasgow, where he had charge of a district containing over 300,000 inhabitants, and in which was situated a public slaughter-house, 200 butchers' shops, three railway stations, at which large consignments of meat arrived, two auction marts, at which cattle were sold, nine sausage factories including a horse sausage factory, and one horse slaughtering 183 1899 factory. He bore very high recommendations from Dr. J. B. Russell, for many years Medical Officer of Health of Glasgow, and now the Head of the Medical Department of the Local Government Board of Scotland, and from Mr. Peter Fife, F.R.S.E., so well known as the Chief Inspector of the same city. The manner in which he has performed his work here has fully justified the high esteem in which he was held in Glasgow. His experience, too, has been gained after nine years work, seven of which has been served in Glasgow as an Inspector of Meat. With a knowledge of his duties such as his, the Vestry had no hesitation in appointing him, although he possessed no certificates from an Examination Board (the only one then in existence being the Sanitary Institute), especially as it was fully believed that he came within the requirements of the Public Health (London) Act, 1891, which enacts that "a Sanitary Inspector shall have been during three consecutive years preceding the year 1895 a Sanitary Inspector or an Inspector of Nuisances of a district of London or of an Urban Sanitary District out of London, containing, according to the last published census, a population of no less than 20,000 inhabitants." Extraordinary to relate, however, the Local Government Board declined to sanction the appointment, on the grounds that "they are advised that the reference in the latter part of the Section (i.e. Sec. 108 (2), (d) Public Health (London) Act, 1891), to Urban Sanitary District, must be held to refer to an Urban Sanitary District in England and Wales." As there is nothing in the Act itself to uphold this contention, inquiries made by myself elicited the fact that there are no "Urban" but only "Local" Sanitary Districts in Scotland. Consequently Glasgow can no longer be looked on as a place from which to draw Sanitary Inspectors, although without doubt some of the finest sanitary work in the kingdom is effected there. At this time, as I have already stated, there was no Board of Examiners whose certificates were approved by the Local Government Board, other than the Sanitary Institute, in existence, and consequently Inspector Young at once prepared for its examination, so that he might become qualified for his position under the earlier 184 1899 part of the Section of the Act already quoted, which lays down that "a Sanitary Inspector appointed after 1st January, 1895, shall be the holder of a certificate of such a body as the Local Government Board may from time to time approve, that he has by examination shown himself competent for such office." He presented himself in due course at an examination held by the Sanitary Institute at Cardiff, and passed it most successfully. This fact was duly announced to the Local Government Board, but to the utmost surprise of the Vestry, the Board would not recognise this certificate for London (although they receive it for every other place in England), because they had approved of a Board of Examiners who would grant certificates of fitness for Inspectors appointed to London Districts. Nothing daunted, Inspector Young again set to work and presented himself before the Sanitary Inspectors' Examination Board for examination in December, 1899. He was again successful, and again his credentials were forwarded to the Local Government Board, who this time sanctioned his appointment, and the Vestry, as a mark of its appreciation of the trouble Inspector Young had been put to, paid his fees for the second examination. From the time that he commenced his work to the end of the year, he inspected the following animals : 2nd Quarter. 3rd Quarter. 4th Quarler. Total. Oxen 679 701 1,006 238,6 Cows 101 129 172 402 Bulls 13 15 22 50 Calves 175 176 85 436 Sheep 13,584 16,694 2,974 43,252 Pigs 130 383 390 903 14,682 18,098 14,649 47,429 The actual meat condemned weighed 4 tons, 4cwt., 1 qrs., 17 lbs. During the course of his inspection he made 3,042 visits to the several slaughter-houses, preserved meat factories and stalls. An interesting case of tuberculosis in a cow came under my notice in September on the report of the Meat Inspector. It is 185 1899 chiefly of importance because of the extent to which an animal may be affected with tuberculosis, and yet not come within the conditions, which the Tuberculosis Commission laid down, that render an animal unfit for human food. The appearance of the animal before its slaughter was healthy, no disease of any description being apparent. When, however, a post-mortem examination of the carcase was made the following were the conditions found:— Lungs were very much affected with tubercle. Heart was quite healthy. Pleura was covered with tubercles. Diaphragm ditto. Liver was covered with a tuberculous lymphy deposit. Spleen ditto. Stomach ditto. Intestines ditto. Peritoneum was covered with tubercles. Kidneys presented an appearance of disease. An examination of the lymphatic glands revealed no appearance of tubercle. The carcase was well nourished, and weighed about 6 cwt. After a minute examination of the carcase and organs, the pleura and peritoneum were carefully stripped out, and together with all the organs were destroyed. The remainder of the body was passed as fit for human food, but before it was removed for sale a portion of the muscular tissue underlying the peritoneum was cut from the thick of the flank, and forwarded for examination to the Jenner Institute, from which I received the following very satisfactory report:— "The sample was examined microscopically in section, and in smear preparations for the Tubercle Bacillus. None were found. Sidney Rowland." Subjoined is a list of the licensed slaughter-houses in Islington. This is three less than the return of last year, the London County Council having refused to renew the licenses of the premises at 62, Ball's Pond Road, 83, Holloway Road, and 8, Shepperton Road. N 186 1899 LICENSED SLAUGHTER-HOUSES. Registered No. Name of Licensee. Situation of Premises. Remarks. 501b Gayes, W. D. 4, Athelstane Mews .. 400 Cockerill, A E. 34, Balls Pond Road To kill not more than three beasts a week and small cattle. 438 Howard, T. 85, Balls Pond Road 451 Clarke, Jno 259, Balls Pond Road 475 Sharman, W. C. 53, Barnsbury Street.. To kill small cattle only and for purposes of own shop. 408 King, J. D. 64, Benwell Road Small cattle. 461 Hack, T. 40, Bingfield Street Small cattle. 401 Pearce, Hy. 18, Brecknock Road Small cattle. 116 Cornish, Jno. .. 41, Caledonian Road .. 413 Messent, D. 174, Caledonian Road 477 Jaeger, W. 309, Caledonian Road 490 Stone, T. 339, Caledonian Road 434 Luxton, J Carter's Yard, 170, Essex Rd 423 Selman, W. G... (Between) 185-7, Church Road 453 Toop, W. (Rear of) 1, Clayton Street .. 180 Clark, C. 12, Cloudesley Road 474 Mobbs, Jas. Hy 219, Copenhagen Street Small cattle. 486 Sparrey, T. 62, Essex Road Cattle admitted only between 11 p.m. and 1 a.m., and not more than five large animals to be killed per week. 449 Salter, Lewis 410, Essex Road 430 Wells, Arthur 18, Fonthill Road 425 Hammond, F. 6, George's Road 402 Wadsworth.A.B. 32, High Street 499 Webber. W. .. 81, Highgate Hill 484 Stone, S. 234, Holloway Road 443 Wilde, F. 498, Holloway Road 432 Watson, R. 576, Holloway Road 442 Tuck, W. 152, Hornsey Road 418 Worboys, R. 410, Hornsey Road 501c Warren, G. W. 12, Hazelville Road, Hornsey Rise 485 Webber, Jno. 9, Junction Road, Upper Holloway 399 Kidner, G. F. 68, King Henry's Walk 488 Buckingham. J. 393, Liverpool Road .. 420 Crisp, Tom 81, Newington Green Road .. Small cattle only belonging to licensee. 470 Wright, C. 275, New North Road Small cattle. 431 Watson, R. (Jr.) 317, New North Road 421 Folkard, H. L. 52, Packington Street Small cattle. 464 Townsend, M. 124, Packington Street Small cattle. Newbury, G. J. 102, Roman Road 472 Eteen, R E. 49, St. Peter Street Small cattle. 497 Lee, Edwin 21, Seven Sisters Road Small cattle. 498 Stone, A 194, Seven Sisters Road 129 Farmer, C. 280, Seven Sisters Road 467 Fothergill, H. 79, Stroud Green Road Cattle received upon the premises only between 7 p m. and 8 a.m., and killing limited to requirements of own shop. 414 Reynolds, H.T. & A. C. 10, Swan Yard, Upper Street 407 Burdge, W. J. 149, Upper Street Small cattle. 482 Wright, W. (E. side of), Wycombe Mews 419 Lidstone (Ltd.) 398, York Road 187 [1899 LIST OF LICENSED COWHOUSES IN THE PARISH OF ISLINGTON. Registered. No. Name Licensee. Situation of Prem ises. 432 Matthias, Thomas 66, Andover Road. 8,392 Watkins, Evan Benjamin 31, Ashbrook Road, Upper Holloway. 6,549 Davies, Thomas 120, Cottenham Road. 2,220 Bryant, Jane 108, Elmore Street. 891 Francis, John 3, Frome Street. 121 Jones, Rees 1, George Street. 6,592 Townsend, Alice 1, Gifiord Street. 3,522 Jenkins, Rees 1, Hale Street. 1,554 Jones, Samuel 24, Hercules Place, Holloway. 10.260 Davies, Ann and Elizabeth 11, Matilda Street. 1,062 Jenkins, David 1, Northampton Street. 8,846 Jones, Edward 88, Roman Road. 1,741 Arnold, George 233, Seven Sisters Road. 12,574 Hollingworth, Chas. Frank Wilson's Yard, Upper Street. Inspector Young has made a full report on his work during the year, which I herewith append. It is an interesting document and shows that he has performed excellent work—work, too, which I may add had to be carried out in the early morning as well as late at night. MEAT INSPECTOR'S REPORT. Public Health Department, Vestry Hall, January 10th 1900. To A. E. Harris, Esq., Medical Officer of Health. Dear Sir, I have the honour of submitting to you my report for the nine months ending 31st December, 1899. I find that there are at present 227 butchers' shops (including ham and beef shops), 7 meat stalls, and 3 preserved meat factories, within the Parish. Nearly 50 per cent. of the meat sold in these shops is refrigerated meat. Of the other 50 per cent., part consists of home-killed English and Scotch, while the remainder is obtained from foreign animals killed at Deptford, Birkenhead, etc. I observe that there are no low class butchers' shops within the Parish, such as are generally found in the poor localities of provincial towns. Thus the meat exposed for sale is of good quality, and where the butcher kills his own animals it is of superior quality. I am pleased to report that the butchers have received me and submitted to the periodical system of inspection in a kindly spirit, being always willing to supply any information desired, and even, on one or two occasions, asking me to come and examine a carcase which they had some doubt about. The Orders issued N 2 1899 188 by the Local Government Board in the month of March have caused a revolution in the manner of dealing with carcases affected with tuberculosis. Hitherto the decision given by Sheriff Berry at Glasgow in 1889, was very generally accepted as the standard of what meat should be passed or condemned. As that decision undoubtedly caused a great loss to the butchering trade, no one could help sympathising with the butcher who bought a sound looking animal, killed it, and derived therefrom only the price of the hide (the Inspector having taken the carcase because it was slightly infected with tuberculosis). Had this system still been, in force, there would have been within the Islington slaughterhouses 68 carcases of cows, seized and destroyed during the nine months March to December, lost to butchers. Taking the average price of these cows at £ 10, they would have lost £680, whereas by acting under the new Orders (which are simply the recommendations of the Tuberculosis Commission) only six carcases were destroyed as unfit for human food. There has thus been a saving to the butchers of £620. I have to thank you for the kind assistance you have given me in deciding as to what should be passed or detained, for although the Orders are of great help, yet much is left to the Inspector's discretion, due to the use of the words " may be seized," instead of "shall be." In this respect I think there is no greater proof that the trade are satisfied they are being justly dealt with than the fact that not a single complaint has been made during the year about any carcase that was detained as unfit for human food. Yet I fail to see how there could be, because each one was allowed to hang until the owner was satisfied, and in no case was an expert called in to contradict our decision. Only one prosecution was instituted, and that only after the parties had been twice warned within a week for having unsound food on their premises. The magistrate was satisfied that the meat seized was unfit for human food, and ordered it to be destroyed, but he was not satisfied that it would have been used for human food, so he dismissed the summons. No meat arrived at the railway stations from the country or elsewhere during the year. There were 50 licensed slaughterhouses within the Parish during the year, but the renewal of three licenses was refused by the London Country Council in December, the reason being " that these slaughterhouses had not been used for the purpose of slaughtering cattle for a period of nine months." There is, therefore, now 47 licensed slaughterhouses on the list. Although some of these premises are in very close proximity to dwelling houses, they have been kept clean, and the By-laws of the County Council carefully observed. As the slaughterhouses are scattered over a very wide area it is almost impossible to inspect every carcase, because the killing is done at all hours. One of these slaughterhouses is conducted as if it were a public abattoir. It is eminently fitted for this purpose, having large and good lairs. Great credit is due to the proprietor for the' cleanly way in which it is kept and the by-laws observed. In the absence of properly constructed public abattoirs this class of place is very desirable; it suits the convenience of the butchers, facilitates the inspection of the animals killed, and reduces the number of visits required by the County Council and Vestry Inspectors. 189 1899 During the year I inspected at your request the Horse Slaughtering Establishment at 186, York Road, and presented to you a report thereon, with the result that the firm was required to put the premises into a sanitary condition, to erect additional plant, and, before their licence would be renewed, to give a guarantee to the London County Council that they would execute all the works required by the Public Health Department of Islington. I append tables showing the number of my visits to shops, stalls, and preserved meat factories, and the amount of meat destroyed. Also the number of visits to the slaughterhouses, number of animals killed, number found affected with disease, the extent to which they were affected, and how the carcases were disposed of. In concluding this report, I beg to thank you and your Chief Inspector for the kind advice so willingly given. I also desire to thank your District Inspectors for their kind assistance. Your obedient servant, T. DUNLOP YOUNG, Meat Inspector. Inspection of Shops, Etc. Total number of stalls, shops, and preserved meat factories 237 ,, ,, inspections to do. do. 2,515 Unsound food destroyed with consent of the owners—Beef in lbs. 595 „ ,, „ „ „ ,, „ „ Mutton ,, 300 „ ,, „ „ „ ,, „ „ Pork ,, 20 „ ,, „ „ „ ,, „ „ Veal ,, 50 „ ,, „ „ „ ,, „ „ Offal ,, 362 Unsound fowls destroyed „ ,, „ „ Fowls. 24 Unsound food destroyed by Magistrate's Order—Brawn in lbs. 112 Slaughterhouse Inspection. Total number of slaughterhouses 47 ,, ,, inspections 1,986 „ „ animals slaughtered for human food 47,429 These consisted of Oxen 2,386 ,, ,, ,, Bulls — 50 ,, ,, ,, Cows 402 ,, ,, ,, Calves 436 ,, ,, ,, Pigs 903 ,, ,, ,, Sheep 43,252 Total Quantity of Unsound Food Destroyed. lbs. Unsound food destroyed in shops, etc 1,439 „ „ „ in slaughterhouses 8,014 Total 9,453 In addition to the above, a large quantity of pigs' and sheep's lungs and livers affected with parasitical disease was destroyed. 1899 190 No. Description How Affected. Disease. of Carcases. Destroyed with Destroyed by consent of Owner. Magistrate's order 2 Cow Carcase&Organsdiseasd Tuberculosis .. Carcases and organs destroyed 4 do. do. do. do. • • Carcase and Organs destroyed 1 do. Lungs, Liver & Fore- do. Diseased parts Quarters diseased destroyed 1 do. Lungs. Liver, and Mesen- do. Dise'd organs teric Glands diseased destroyed 4 do Livers do. do. do. 24 do. Lungs do. do. do. 25 do. Lungs and Costal Pleuras do. do. diseased 7 do. Lungs & Livers diseased do. do. 1 do. Carcase & Organs do. Dropsy .. Carcase and Organs destroyed 1 do. do. do. Actinomycosis & .. do. Emaciation 1 do. do. do. Emaciation •• do. 2 do. do do. do. & Dropsy .. do. 1 do. do. do. Dropsy Carcase and •• Organs destroyed 5 do. Mammary Glands do. Mammitis Dise'd Organs destroyed .. 3 do. Stomachs do. Inflammation do. .. 8 do & Oxen Livers do. Abscess do. 3 do. Legs bruised do. .. Bruised por- .. tions destroy'd 1 do. Head do. Abscess Head ed 3 Calves Carcase & Organs do. Unwholesome.. Carcase and Organs destroyed 1 Sheep do. do. Asphyxia do. 98 191 1899 FACTORIES AND WORKSHOPS. A very large amount of sanitary work has been effected in the factories and workshops of Islington during the year by the two Inspectors, Miss Gray and Mr. West. They have been fully employed, and the result of their labours has been most gratifying. It is also satisfactory to find that nearly all the irritation, never a great deal, which the employers of labour had formerly felt at what they called the "interference" of the inspectors has died away, so that now their work is accomplished in a pleasant and friendly manner. A synopsis of the work performed may be found in the following statement. Workrooms— Inspected 3,790 Overcrowded 14 Badly ventilated 5 Workshops— Newly discovered 234 Reported to H.M. Inspector 150 Removed from Register 106 Workroom cards distributed 289 Notices to abate nuisances served 281 Works carried out— Ventilation provided 92 Rooms cleansed 424 Yards, floors, and roofs 183 W.C.'s reconstructed or provided 107 Urinals 0 W.C.'s supplied with water, etc. 168 Water Cisterns for general use provided 1 Ditto cleansed and repaired 17 Water laid on 2 The above is no mean record of work, especially as it was all executed without resort to legal proceedings. 192 1829 MISS GRAYS REPORT. The Vestry Hall, Islington, N., 5th February, 1899. To A. E. Harris, Esq., Medical Officer of Health. Sir, I have the honour of laying before you a report of my work during the year 1899. Workshop and Laundry Registers.—There were on the Register at the end of the year 1,058 workshops, workplaces, and laundries where females are employed, compared with 1,028 at the end of the year 1898, and 948 at the end of 1897. In these workshops and laundries there are 1,664 workrooms. Two hundred of the total number of registered premises are "workshop" laundries i.e., those in which no mechanical power is used to work machinery. In 393 workshops, females are employed in mantle and blouse making, and in 463 miscellaneous trades are carried on, details of which will be found in the following table. Nature of Business. N umber of Workshops. Number of Workrooms. Dressmaking 282 323 Tie making 80 91 Mantle and costume making 74 109 Millinery (infant and adult) 74 110 Fur sewing 45 56 Blouse making 37 43 Tailoring 34, 35 Artificial flower making 29 57 Underclothing making 28 30 Jet and bead work 20 24 Leather goods making 14 22 Apron and pinafore making 10 11 Boot upper and infant shoe making 9 14 Dressing gown making 7 8 Corset making 6 6 Cardboard box making 5 12 Rag picking and sorting 5 17 Collar and cuff making 6 7 Fancy goods making 5 10 Wig making and dolls' hair work 4 7 Confectionery 4 23 Lamp and candle shade making 4 6 Drug packing 4 6 Curtain making 3 4 Boys' suit making 3 4 Umbrella making 3 3 Frilling making 3 4 193 1899 Name of Business. Number of Workshops. Number of Workrooms. Firewood cutting 3 5 Lace collar making 2 2 Brace making 2 4 Buttonhole making 2 2 Baby linen sewing 2 2 Toy making 2 5 Photograph frame making 2 4 Surplice making 2 2 Pickle making 2 2 Cabinet making 2 2 Waterproof making 2 2 Paint brush making 2 3 Boot polish making 1 1 Mattress making 1 2 Waste-paper sorting 1 1 Camera bellows making 1 1 Slate mantle polishing 1 2 Artificial fly making 1 1 Musical string making 1 4 Curry powder making 1 2 Surgical appliance making 1 2 Gaiter making 1 2 Curling pin making 1 1 Swansdown sewing 1 1 Valentine making 1 1 Cork cutting 1 1 Bassinette hood making 1 1 Medical capsule making 1 3 Funeral furnishing making 1 1 Cycle accessories making 1 2 Table linen sewing 1 2 Hosiery 1 1 Feather curling 1 3 Mandoline case making 1 2 Gold beaters' skin preparing 1 4 Bottle washing 1 2 Bath glove making 1 1 Photographic paper preparing 1 2 Jewel case making 1 1 Portmanteau making 1 1 Embroidering 1 5 Music packing 1 1 Picture-frame making 1 1 Furriers' clip making 1 1 Laundries 202 531 Total 1,058 1,664 194 1899] In the course of the year I have discovered and added to the registers 198 workshops and laundries, with 229 work-rooms. During the last quarter of the year, the number of registered workshops was decreased by fourteen. This is the first occasion on which a decrease has taken place since the registers were opened, and it is no doubt owing to the dulness of trade caused by the outbreak of the war. In spite of dulness of trade, employers complain that they cannot get good workers. It is supposed that numbers of the more intelligent girls who formerly worked in workshops now go in for clerkships, on account of the shorter hours and better pay. One hundred and sixty-six workshops and laundries have been removed from the Registers during the year, from various causes, such as the business being given up or transferred to other premises, the introduction of gas or steam into laundries, etc. Many laundry occupiers say they are compelled to have mechanical power in their works owing'to the irregularity of the attendance of the workers. The owners of large steam laundries also buy up the smaller businesses, and many places, in which work used to be carried on, are now used as "receiving offices" only. From a health point of view this is an advantage, as the work is done in specially adapted premises, and not in dwelling houses. I have reported to H.M. Inspectors of Factories and Workshops for the district the addresses of 134 workshops and laundries, not previously visited by them. Inspections.—I have during the year paid 3,373 visits, 1,894 of which were inspections and 1,479 were re-inspections and calls. The inspections include visits to workshops and laundries (in which I inspected 3,055 work-rooms), inspections of the homes of female outworkers, the public conveniences for women, and of the sanitary arrangements for women in factories and steam laundries. The re-inspections include visits paid with regard to work being done under my supervision, inquiries as to the employment of outworkers, the service of notices and distribution of workroom cards, etc. Overcrowding.—I found 14 workrooms overcrowded; in these, the overcrowding was abated upon representations being made to the employers. In most cases the overcrowding was caused by additional hands being employed in the beginning of the busy season without extra rooms being provided. I have distributed cards to be exhibited in 286 workrooms, stating the cubic capacity of the rooms and the number of persons who may be employed in each. Ventilation.—Three workrooms I found to be structurally insufficiently ventilated; in these additional means of ventilation has been provided. Besides these, I regret to say that I found, during the winter months, many workrooms where the atmosphere was very unsatisfactory, owing to the fact that the windows and ventilators were kept closed. Cleanliness.—The walls and ceilings of seventy-five workrooms, which I found in a dirty condition, have been cleansed and whitewashed during the year. The cleanliness of the workshop generally varies with the nature of the trade carried on in it; the standard of the first-class dressmaker and milliner being impossible in the rag-picker's shed. Much, however, depends upon the individual employers, some of whom train their work-people in habits of cleanliness and order, which are not to be found in others of the same class. 195 [1899 Sanitary Defects.—Besides the sanitary defects mentioned under the headings of "Ventilation" and "Cleanliness," I have reported to you 313 nuisances, liable to be dealt with under the Public Health Act, which I discovered on the premises inspected. As a result of my reports, the drains of 26 workshops have been tested and found defective by Inspector West, and relaid under his supervision. Among the other nuisances (details of which are in the appended summary of my work) were:—Fifty-eight sanitary conveniences without a water supply, 61 drains unventilated or with directly connected sink waste and rainwater pipes, eight cases of insufficient sanitary accommodation, seven defective cistern lids, 22 dilapidated dustbins, etc. I have served 85 intimation notices, and have personally supervised the abatement of 195 nuisances. Outworkers.—1 have, during the year, paid 103 visits to the homes of female outworkers, most of whom were working for Islington employers, from whom I obtained their names and addresses. I found on inquiry that in many cases no lists of outworkers were kept for inspection, and in other cases those kept were distinctly out of date, as when on one occasion I called to see a woman whose name figured on such a list, and found that she had been dead for three years In consequence of these difficulties, you drew up a circular, calling the attention of employers to the requirements of the Factory and Workshop Acts as regards outworkers, which I have found very useful. In accordance with the Order of the Home Secretary, the addresses of 138 outworkers, employed by Islington firms but residing in other districts, have been forwarded to the Medical Officers of Health of these districts. Though numbers of Islington outworkers get their work from other parishes, very few notifications regarding them have been received. The conditions under which I found the work being done varied greatly, but they were for the most part indifferent. I understand that in most cases the employer knows nothing of the home of the outworker, but simply judges her suitability by the sample of work which she can show and her personal appearance. I hear, however, of one firm who send to see where their work is done, and will allow nothing to be made in rooms used as sleeping rooms. This is a wise precaution, but it is very exceptional. I fear that in most cases the prices offered for work are so small that no such condition could possibly be imposed on the worker. If all premises where articles of wearing apparel, etc., are made, were systematically inspected, employers would no doubt be more careful regarding the homes of their outworkers, but the risk of the spread of infectious disease from homework would still remain, as unfortunately scarlet fever, measles, chicken-pox, etc., invade even cleanly and sanitary premises. I am, Sir, Your obedient servant, JESSY M. S. GRAY, Inspector of Workshops, etc. Table CIII.—Summary of Miss Gray's Work-shop Reports during the Year, 1899. description of work. Quarter ending 1st April, 1899. Quarter ending 1st July, 1899. Quarter ending 30th Sept., 1899. Quarter ending 30th Dec., 1899. Year ending 30th Dec. 1899. Dressmakers & Ladies' Tailors. Laundries. Miscellaneous Total Dressmakers & Ladies' Tailors. Laundries. Miscellaneous. Total. Dressmakers & Ladies' Tailors. Laundries. Miscellaneous. Total. Dressmakers & Ladies' Tailors. Laundries. Miscellaneous. Total. Dressmakers & Ladies' Tailors. Laundries. Miscellaneous. Total. Workshops, Workplaces, Laundries, &c. Number of on the Register 380 208 448 1036 389 209 457 1055 400 209 463 1072 393 202 463 1058 393 202 463 1058 ,, Number of Workrooms therein 401 550 638 1649 475 552 647 1674 485 552 653 1690 475 531 658 1664 475 531 658 1664 ,, Number of Inspections of 127 105 236 468 200 132 184 516 95 95 188 378 227 71 234 532 649 403 842 1894 „ Number of Re inspections of and Calls 125 153 176 454 129 53 153 335 81 115 166 362 142 40 146 328 477 361 641 1479 Workrooms, Number of Inspections of 158 286 357 801 261 304 256 821 111 253 288 652 281 178 322 781 811 1021 1223 3055 ,, found to be overcrowded 2 . . 2 4 . . . . 3 3 1 . . 1 2 3 . . 2 5 6 . . 8 14 ,, found to be insufficiently ventilated . . . . 1 1 . . . . . . . . 1 . . 1 2 . . . . . . 1 . . 2 3 „ found to be in a dirty condition . . 5 12 17 2 12 7 21 2 6 2 10 2 5 6 13 6 28 27 61 Workshops, &c., newly discovered and registered during the year 18 4 28 50 27 4 24 55 22 4 28 54 23 1 15 39 90 13 95 198 ,, Workrooms therein measured 18 8 32 58 32 8 25 65 22 8 31 61 24 2 19 45 96 26 107 229 ,, Reported to H.M. Inspector on discovery 12 2 22 36 20 . . 16 36 16 2 16 34 19 . . 9 28 67 4 63 134 „ Removed from the Register 17 3 20 41 18 3 15 36 13 4 29 37 30 8 15 53 78 18 70 166 Houses visited for enquiry at which no female hands were employed 9 1 22 32 14 3 13 30 5 6 10 21 10 . . 14 24 38 10 59 107 Workroom Cards distributed, showing number of persons permitted in each room 34 8 37 79 51 2 42 95 22 4 32 58 30 2 22 54 137 16 133 286 Statutory Notices and Written Intimations issued 4 15 7 26 6 10 8 24 5 7 7 19 5 6 5 16 20 38 27 85 Works carried out under supervision:— (a) Additional means of ventilation provided . . . . 1 1 . . . . . . . . . . . . 1 1 1 . . . . 1 1 . . 2 3 (b) Rooms cleansed and whitewashed 1 24 13 3b 1 2 1 4 5 10 10 25 3 4 1 8 10 40 25 75 (c) Yards, Floors, Roofs, &c., repaired 1 16 1 18 2 4 2 S 4 9 2 15 2 1 4 7 9 30 9 48 (d) Sanitary Conveniences repaired 2 11 1 14 3 8 1 12 1 9 3 13 4 2 2 8 10 30 7 47 (e) Miscellaneous 1 6 1 8 . . 1 2 3 . . 2 1 3 4 . . 4 8 5 9 8 22 Nuisances which came under notice during the inspections:— (/) Drains untrapped, unventilated, &c. 14 8 4 26 17 8 12 37 6 2 5 13 14 1 4 19 51 19 25 95 (g) Sanitary Conveniences ill-lighted, unventilated, and defective in water supply 4 7 6 17 4 12 3 19 2 3 3 8 7 5 2 14 17 27 14 58 (h) Sanitary Conveniences supplied from drinking water cisterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (i) Cisterns dirty or uncovered 1 . . . . 1 1 . . . . 1 1 . . 2 3 1 . . 1 2 4 . . 3 7 (j) Dustbins, wanting or defective . . 1 2 3 3 4 2 9 2 2 4 8 2 . . . . 2 7 7 8 22 (A) Miscellaneous 8 12 10 30 6 18 12 36 4 12 16 32 15 7 11 33 33 49 49 131 "Overcrowding" of Workrooms, Cases of, abated 2 . . 2 4 . . . . 3 3 1 . . 1 2 2 . . 4 6 5 . . 10 15 * Houses where a Business Plate or the Directory, or Newspaper Advertisements implied probability that female Workers would be employed, but at which none were found. TABLE CIV. Summary of Workshops Work from Inspector West's Reports during the Year 1899. DESCRIPTION OF WORK. Quarter ending 1st April, 1899. Quarter ending 1st July, 1899. Quarter ending 30th September, 1899. Quarter ending 30th December, 1899. Year ending 30th December, 1899. Tailors. Shoemakers. Pianoforte Makers. Cycle Makers. Bakehouses. Miscellaneous. Total. Tailors. Shoemakers. Pianoforte Makers. Cycle Makers. Bakehouses. Miscellaneous. Total. Tailors. Shoemakers. Pianoforte Makers. Cycle Makers. Bakehouses. Miscellaneous. Total. Tailors. Shoemakers. Pianoforte Makers. Cycle Makers. Bakehouses. Miscellaneous. Total. Tailors. Shoemakers. Pianoforte Makers. Cycle Makers. Bakehouses. Miscellaneous. Total. Workshops, Workplaces, Laundries, &c. Number of on the .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Number of Workrooms therein .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Number of Inspections of 7 30 10 5 131 342 525 2 2 4 .. 127 301 436 .. 1 19 2 134 369 525 3 1 3 1 152 97 262 12 34 41 8 544 1109 1748 ,, N umber of Re-inspections of 14 13 30 10 54 410 531 17 20 20 .. 79 316 452 .. 2 25 .. 59 387 473 1 3 8 3 178 463 656 32 38 83 13 370 1576 2112 Workrooms, Number of Inspections of .. .. .. .. .. .. .. 3 .. 4 .. 14 33 54 .. 2 33 2 193 54 284 3 2 14 3 303 72 397 6 4 51 5 510 159 735 ,, found to be overcrowded .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ,, found to be insufficiently ventilated .. 1 .. .. .. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 2 ,, found to be in a dirty condition 3 3 6 .. .. 3 15 .. 1 2 .. .. 1 4 .. .. .. .. 15 2 17 1 1 .. .. .. .. 2 4 5 8 .. 15 6 38 Workshops, &c., newly discovered and registered 4 4 3 2 .. 6 19 .. .. 1 .. .. .. 1 .. .. .. .. .. 15 15 .. 1 .. .. .. .. 1 4 5 4 2 .. 21 36 ,, Workrooms therein measured 5 4 7 2 .. 30 48 .. .. 3 .. .. .. 3 .. .. .. .. .. 5 5 2 .. .. .. .. .. 2 7 4 10 2 .. 35 58 ,, Reported to H.M. Inspector on discovery 3 b .. 3 .. 5 16 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 5 .. 3 .. 5 16 ,, Removed from the Register .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Houses visited for enquiry at which no male hands were .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Workroom Cards distributed, showing number of persons .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 3 .. .. .. .. .. .. .. .. .. .. .. .. 3 3 Intimation Notices served 4 2 9 184 5 26 46 1 2 3 .. 7 36 49 .. .. .. .. 4 52 56 .. .. 1 1 4 27 33 5 4 13 1 20 141 184 Statutory Notices „ .. .. .. .. .. .. .. 1 .. 1 .. 2 3 7 .. .. .. .. .. .. .. .. .. .. .. .. 5 5 1 .. 1 .. 2 8 12 Works carried out under supervision Drains Constructed .. .. .. .. .. 7 7 .. .. .. .. 1 6 7 .. .. .. .. .. 6 6 .. .. 1 .. 1 8 10 .. .. 1 .. 2 27 30 Improved or Repaired .. 1 4 .. .. 9 14 1 .. .. .. 3 11 15 .. .. 2 1 .. 16 16 .. .. .. .. .. 16 16 1 1 6 1 3 52 64 Traps fixed .. 1 1 .. .. 32 34 2 .. .. .. 1 24 27 .. .. .. .. .. 29 29 .. .. 7 .. 2 25 34 2 1 8 .. 3 110 124 Water Closets W.C.'s constructed or provided .. .. .. .. .. 16 16 .. .. 8 .. .. 2 10 .. .. 5 .. .. 7 12 .. .. 1 .. 1 20 22 .. .. 14 .. 1 45 60 Urinals constructed .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pan, trap & water supply furnished .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pan and trap only furnised .. .. 4 1 .. 39 44 .. .. 7 .. 1 21 29 .. .. 3 .. .. 19 22 .. .. 1 .. 1 30 32 .. .. 15 1 2 100 127 Water supply furnished .. 1 5 1 1 31 39 .. .. 8 .. 1 18 27 .. .. 5 .. 1 13 19 .. .. 1 .. 1 23 25 .. 1 19 1 4 85 110 Dust Bins Constructed .. 2 .. .. .. 4 6 .. .. .. .. 1 6 7 .. .. .. .. .. .. .. .. .. .. .. .. 5 5 .. 2 .. .. 1 15 18 Repaired and Covers adapted .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. ... 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 2 Surface Drains Constructed .. .. .. .. .. 15 15 .. .. .. .. 1 9 10 .. .. .. .. .. 15 15 .. .. .. .. 2 9 11 .. .. .. .. 3 48 51 Relaid .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. General Water Cisterns provided .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Cisterns repaired and cleansed .. 1 .. .. .. 2 3 .. .. 2 .. .. 1 3 .. .. .. .. .. 3 3 .. .. .. .. .. 1 1 .. 1 2 .. .. 7 10 Water supply provided .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 1 2 Ventilation and Cleansing, etc. Additional means of ventilation provided .. •• 1 •• •• 27 28 1 1 3 •• •• 17 22 •• •• •• •• •• 36 15 12 15 51 •• •• 3 •• •• •• 1 23 12 24 124 1 5 1 4 4 8 •• •• 1 292 82 40 89 349 Rooms cleansed and limewashed.. .. 1 •• •• 71 11 83 5 •• 5 •• 76 5 91 •• •• 3 •• •• 29 30 •• •• •• •• 109 28 31 4 1 8 1 8 113 135 Yards, Floors, Roofs, &c., repaired Miscellaneous •• 1 1 4 3 4 1 •• •• 5 31 12 36 26 4 3 •• 1 4 5 •• •• 5 1 25 28 38 38 •• •• 1 •• •• 1 15 16 •• 1 •• •• 3 35 36 4 6 9 •• 7 90 116 Nuisances which came under notice during the inspections Drains, untrapped, unventilated, &c •• 2 3 •• •• 23 28 •• •• •• •• 1 9 10 •• •• •• •• 4 19 23 •• •• •• •• 1 9 10 •• 2 3 •• 6 60 71 Sanitary Conveniences ill-lighted, unventilated, and defective in water supply •• •• •• •• •• 3 3 •• •• 1 1 1 19 22 •• •• •• •• •• 11 11 •• •• •• •• •• 4 4 •• •• 1 1 1 37 40 Sanitary Conveniences supplied from drinking water cisterns •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Cisterns dirty or uncovered •• •• •• •• •• 4 4 •• •• •• •• •• •• •• •• •• •• •• •• 2 2 •• •• •• •• •• •• •• •• •• •• •• •• 6 6 Dust bins, wanting or defective 1 2 •• •• •• 3 6 •• •• •• •• •• 1 31 •• •• •• •• •• .6 6 •• •• •• •• •• 3 3 1 2 •• •• •• 13 16 Miscellaneous 3 1 13 •• 44 61 1 1 •• •• •• 29 •• •• •• •• •• •• 38 38 2 •• •• •• •• 21 23 6 2 13 •• •• 132 153 " Overcrowding " of Workrooms, Cases of, abated •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Smoke observations •• •• •• •• •• 268 268 •• •• •• •• •• 227 227 •• •• •• •• •• 255 255 •• •• 1 •• 11 117 129 •• •• 1 •• 11 867 879 Totals 45 79 103 26 267 1406 1925 41 28 81 1 323 1148 1622 .. 5 96 5 447 1399 1952 12 12 43 8 770 1053 1898 98 124 323 39 1807 5006 7397 INSPECTOR WEST'S REPORT. Vestry Offices, Upper Street, Islington, N. January, 1900. To A. E. Harris, Esq., Medical Officer of Health. Dear Sir, I have the honour to submit my report to you for the year ending 30th December, 1899. I have made 3,860 visits to factories, workshops and workrooms in the parish, viz.: 1,748 inspections, and 2,112 re-inspections; these include the following trades:—44 tailors, 72 shoemakers, 124 pianoforte makers, 21 cycle makers, 914 bakehouses, and 2,685 miscellaneous. 196 notices have been served for the abatement of various nuisances; 57 workshops and workrooms have been cleansed and lime-whited, whilst 879 other improvements were carried out under my supervision. Sanitary Defects.—I have found on inspection of several factories and workshops that inadequate accommodation had been provided in the way of sanitary conveniences for the workers, both male and female. In many instances it would appear that employers had commenced business in a small way, but as trade increased more workers were employed, and any open spaces there existed at that time are now covered in, thus leaving the w.c.'s in the middle of the workshop, without any means of external ventilation. These I have had abolished and others provided in more suitable places, with proper external ventilation, and so that they may not be entered directly from the workshop. I am happy to say that during the year 60 additional w.c.'s have been provided, besides in many cases having the drains reconstructed. I feel sure that what has been done up to the present will not only prove beneficial to the health of, but also great boon to, those who are employed in these places, because in many instances no separate accommodation had been provided up to the time of my inspection. I hope in my next annual report I shall be able to show another large increase and improvement in this respect. Bakehouses.—During the year, 914 visits have been paid to bakehouses, of which 292 have been lime-whited. I am pleased to say that many of the occupiers do their utmost to keep them in a good sanitary condition; drains have also been reconstructed and many other improvements carried out for the benefit of the employees. Miscellaneous Trades.—As the column in the appended table does not give particulars, I may mention that it includes: — Smoke Nuisances.—879 visits have been made by me during the above-mentioned time in various localities in the Parish for the purpose of taking observations of smoke from the chimneys of factories and workshops, and although there have been no prosecutions during the year, 42 notices have been served on offenders after having been first cautioned. This usually has had the desired effect for a time. Proceedings are now pending against several offenders. Printers Box-makers Bedstead makers Engineers Birdcage-makers. Furriers. Rag sorters. Wood choppers Farriers Builders. Telescope Makers. Wheelwrights. Dressmakers Paper bag Makers. Pianoforte string makers Laundries. Cabinet makers. Paper sorters. Coach builders. Barrow makers. Upholsterers. Polishers. Ladder makers. Ticket writers. I am, Sir, Your obedient servant, GEORGE WEST, Inspector of Workshops, etc. 1899] 198 BAKEHOUSES IN ISLINGTON. Reg. No Street or Road. Above or below level of Street 1 8, Clayton Terrace, Archway Road Above 2 17, Whitehall Parade, Archway Road Below 3 84, Ashbrook Road . „ 4 5, Andover Road Below, not used 5 88, „ „ Above 6 104, „ „ „ 7 50, Arlington Street Below 8 24, Alfred Street „ 9 1, Balls Pond Road Above and below 1052, „ „ ,, ,, 11 98, „ „ not used 12 117, „ „ „ and below 13 229, „ „ Above 14 257, „ ,, „ 15 62, Barnsbury Street Below 16 6, Barnsbury Road „ 17 21, „ „ „ 18 68, „ „ „ 19 129, „ „ Above 20 76, Baxter Road „ 21 33, Bedford Terrace Below 22 12, Bemerton Street Above 23 72, „ „ Below 24 100, „ „ ,, 25 32, Bingfield Street Above 26 44, „ „ Below 27 60, ,, ,, ,, 28 53, Boleyn Road Above 29 77, „ „ Below, not used 30 10, Blackstock Road Above 31 66, „ „ Below 32 128, ,, ,, ,, 33 146, ,, ,, ,, 34 156, „ „ „ 35 202, „ „ Above 36 225, „ ,, „ 37 26, Blenheim Road Below 38 National Bakery, Brewery Road Above 39 V.V. Bakery, Brewery Road „ 40 16, Brecknock Road „ 41 19, Brooksby Street „ 42 49, Campbell Road „ 43 10, Campdale Terrace, Tufnell Park Below 44 21, Caledonian Road „ 45 36, „ „ „ 46 59, „ „ 47 159, „ „ ,, [1899 199 Reg. No. Street or Road. Above or below level of Street or Road. 48 170, Caledonian Road Below 49 199, „ „ „ 50 275, „ „ „ 51 299, „ „ „ 52 370, ,, „ „ 53 371, ,, „ ,, 54 415, „ „ „ 55 421a, „ „ Above 56 480, „ „ Below 57 30, Canonbury Street Below, not used 58 3, Cardwell Terrace, St. Peter's Park Below 59 14, Charlton Crescent „ 60 39, Charlesworth Street „ 61 29, Camden Street Below, not used 62 102, Cheverton Road Above 63 52, City Garden Row „ 64 29, Cottenham Road „ 65 62, „ „ „ 66 38, Coleman Street Below 67 25, Cornelia Street Above 69 57, Copenhagen Street ,, 70 112, ,, ,, ,, 71 181, „ „ Above, not used 72 185, „ „ Above 73 205, „ „ Above, not used 74 213, „ „ Above 75 24, Church Street Below 76 1, Cross Street „ 77 40, „ „ Above 78 4, Cloudesley Road „ 79 40, „ „ Below 80 55, Clephane Road „ 81 8, Danbury Street „ 82 49, Dorset Street Below, not used 83 Oxford House, Downham Road Below 84 64, Drayton Park „ 85 112a, „ „ Above, and 1 below 86 182, „ „ Below, not used 87 67, Durham Road Above 88 27, Dennis Street Below 89 57, Elthorne Road Above 90 75, „ „ ,, 91 103, „ „ „ 92 144, „ „ „ 93 47, Nicholay Road „ 94 1, Essex Road Below 95 57, „ ,, „ 96 67, „ „ „ 1899] 200 Reg. No. Street or Road. Above or below level of Street or Road. 97 68, Essex Road Below 98 102, „ „ „ 99 114, „ „ „ 100 172, „ „ „ 101 202, „ „ „ 102 226, „ „ „ 103 285, „ „ „ 104 322, „ „ „ 105 350, „ „ „ 106 398, „ „ „ 107 103, Fairbridge Road Above 108 166, „ „ „ 109 Suffolk Bread Co., Fakenham Street „ 110 81, Fonthill Road „ 111 114, „ „ „ 112 1, Frederich Street Below 113 70, George's Road „ 114 98, Gillespie Road „ 115 23, Girdlestone Road „ 116 80, Goodinge Road „ 117 60 Grove Road Above 118 90, „ „ Below 119 58, Hazellville Road Above 120 87, „ „ Below 121 26, Half Moon Crescent „ 122 125, Hanley Road Above 123 29, Hemingford Road Below 124 179, „ „ „ 125 S.A. Bakery, Hawthorne Street Above 126 12, Hercules Road „ 127 13, Highbury Place Below 128 3, Highbury Park Above 129 17, Broadway, Highbury Park „ 130 2, High Street Below 131 6, „ „ 132 38, ,, ,, ,, 133 44, „ „ ,, 134 78, ,, ,, ,, 135 6, Highgate Hill „ 136 29, „ „ Above 137 49, „ „ „ 138 102, „ „ „ 139 1, Hope Street „ 140 69, Holloway Road „ 141 85, „ „ „ 142 132, „ „ Above and below 143 232, „ „ Above 144 251, „ „ „ [1899 201 Reg. No. Street or Road Above or below level of Street or Road. 144 251, Holloway Road Above 145 261, „ „ „ 146 370, ,, „ ,, 147 575, „ „ „ 148 582, „ ,, „ 149 599, „ „ Below 150 626, „ „ „ 151 634, ,, „ ,, 152 676, „ ,, „ 153 758, „ „ Above 154 265, „ „ Below, not used 155 56, Hornsey Road Above 156 86, ,, ,, „ 157 100, ,, „ ,, 158 154, „ „ „ 159 246, „ „ Below 160 264, ,, ,, ,, 161 346, „ „ Above 162 402, „ „ „ 163 420, ,, ,, „ 164 484, ,, ,, 165 14, Station Parade, Hornsey Road Below 166 27, Hornsey Rise „ 167 8, Islington Green Above 168 7, Junction Road Below 169 59, „ „ „ 170 81, ,, „ „ 171 104, „ „ „ 172 167, ,, ,, ,, 173 239, „ „ „ 174 30, King Henry Street Above 175 57, King Henry's Walk Below 176 25, Lennox Road Above 177 25, Lowman Road Below 178 126, Liverpool Road „ 179 262, ,, ,, ,, 180 269, „ „ Below, not used 181 279, ,, ,, ,, ,, 182 463, „ „ Above 183 5, Crossley Terrace, Liverpool Road Below 184 47, Landseer Road Above 185 57, Marlborough Road Below 186 110, „ „ Above 187 127, „ „ „ 188 32, Milton Grove Below 189 33 „ „ „ 190 1, Mildmay Park Above 191 84, „ „ Below 202 1899] Reg. No Street or Road. Above or below level of Streey or Road. 192 77, Newington Green Road Below 193 42, ,, ,, ,, 194 123, ,, ,, ,, ,, 195 192, New North Road „ 196 263, „ „ „ ,, 197 298, „ „ ,, Above 198 313, „ „ „ ,, 199 361, „ „ „ ,, 201 29, Offord Road Below, not used 202 123, „ „ Below 203 26, Orchard Street Below, not used 204 44, Outram Street Above 205 47, Palmerston Road „ 206 121, Packington Street Below 207 126, ,, ,, ,, 208 33, Park Street ,, 209 32, Parkfield Street Below, not used 210 110, Petherton Street Below 211 53, Poole's Park Above 212 20, Popham Road „ 213 50, „ ,, ,, 214 2, Queen's Square Below 215 53, Queensbury Street Above 216 16, Rheidol Terrace Below 217 46, Roman Road „ 218 107, „ „ ,, 219 118, ,, ,, „ 220 3, Richmond Road „ 221 12, Randall's Road „ 222 31, Salisbury Road „ 224 22, Seven Sisters Road Above 225 48, ,, ,, ,, „ 227 163, „ „ „ „ 228 190, „ „ „ Below 229 258, „ „ „ Above 230 32, Shepperton Road Below 231 3, St. Paul's Street Below, not used 232 76, „ „ ,, 233 226, St. Paul's Road Below 234 69, St. Peter Street „ 235 84, „ „ „ 236 52, Stanmore Street „ 237 16, St. Jude Street Above 238 32, St. James's Road Below 239 106, „ „ Above 240 110, „ „ ,, 241 132, „ „ Below 242 Victoria House, Stapleton Hall Road „ [1899 203 Reg. No. Street or road Above or below level of Street or Road. 243 8, Finsbury Park Buildings Below 244 51, Stroud Green Road Above 245 212, Tufnell Park Road Below 246 144, Tollington Park Above 247 1, Theberton Street Below 248 157, Thorpedale Road „ 249 86, Thornhill Road Below, not used 250 14, Upper Street „ „ 251 102, „ „ Below 252 107, „ „ Above 253 129, „ „ ,, 254 230, ,, „ ,, 255 16, Westbourne Road Below 256 25, Wellington Road Below, not used 257 92, ,, ,, ,, ,, 258 16, Sherringham Road „ „ 259 51, Windsor Street Above 260 6, Wharfdale Road Below 261 62, Winchester Street „ 262 22, Wynford Road Above 263 120, York Road Below 264 214, „ „ ,, 265 254, „ Above 256 376, „ Below 267 84, Yerbury Road „ 268 334, Caledonian Road „ 1899] 204 HOUSES LET IN LODGINGS. There are 493 houses now on the Register, of which 45 were added during the year, a number all too small considering the manner in which Islington is gradually but surely being crowded. Nevertheless, the work of inspecting them systematically has proved too much for one inspector, chiefly because the Parish is so large and the houses are so widely apart. Many more houses will no doubt be added to the Register this year, as the services of an additional inspector, who has recently been appointed, will be available for the duty. The Public Health Committee has been for some time satisfied that this additional inspector was required, but only waited for an opportune moment to make the recommendation to the Vestry, who a short time since agreed to the Report of the Committee on the subject. The appointment has been duly approved by the Local Government Board. I fully indorse the remarks of Inspector Jordan on the difficulties that the poor with large families endure in obtaining lodgings, indeed I have remarked on them in the earlier part of this report, and I am not at all surprised at the leniency of the magistrates towards overcrowding—a leniency, I may say, with which the Public Health Department sympathises. Frequently cases come before the Public Health Committee where persons have been guilty of overcrowding, but they, too, dreading the scandal that would be created by putting these people on the streets, without a home to go to, because they cannot readily get rooms, have felt, as all engaged in this work must feel, that every consideration and latitude, short of allowing actual and immediate danger to the public health, should be extended to them, while at the same time the inspector should satisfy himself that a real endeavour was made by the heads of the families to secure suitable accommodation. [1899 205 The following houses were placed on the Register during the year:— Ebury Street, Nos. 2, 4, 6, 3, 5, 7, 9, 11. Trinity Street, No. 27. Evershot Road, Nos. 1, 5, 7. Bride Street, No. 45. Sun Row, Nos. 5, 6, 7, 8. Shepperton Road, No. 139. Newhall Street, Nos. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 17, 19, 20. Brunswick Grove, Nos. 1, 2, 3, 5, 6, 9. Lowther Road, No. 3. Story Street, No. 21. George Street, Nos. 5, 6. Popham Road, No. 2. 1899] 206 INSPECTOR JORDAN'S REPORT. Public Health Department, Vestry Offices, Upper Street, N. January, 1900. To A. E. Harris, Esq., Medical Officer of Health. Dear Sir, In submitting this report of the works carried out during the year 1899 under my supervision, according to Section 94 of the Public Health (London) Act, 1891, in respect to houses let in lodgings or occupied by members of more than one family, I am sorry to say that there is not much new matter to report to you. The work of the lodging-house inspector is one constant fight with dirty and destructive tenants and neglectful owners and agents. Again the overcrowding question is a matter of great concern, the poor people with a family only being able in most cases to obtain accommodation in a house already occupied by families with children, and for which accommodation a very high rent has to be paid. The abatement of overcrowding is a slow process, the difficulty of obtaining fresh apartments, with additional rent in most cases, causes delays, and often when notices have long expired the magistrate has then given another three or four weeks to the defendant to get out. I served 259 intimation notices for the abatement of nuisances, and during the month of March I served a cleansing notice at each of the 459 houses on the register, calling the landlords' attention to By-law 17 re annual cleansing in the month of April. During the year I have made 5,210 inspections and 1,206 re-inspections and calls, and have had 1,704 improvements carried out on 1,054 premises,* the tabulated statement attached hereto showing the details under their respective headings. Forty-six houses were added to the Register during 1899, and as each house has to be measured up room by room for its cubic capacity to be obtained, and as the improvements required must be supervised, my duty has found me plenty of work. I am, Sir, Yours respectfully, JAMES J. JORDAN, Inspector of Houses let in Lodgings. * Some of the premises had nuisances abated on several occasions. [1899 207 Table CV. Summary of Sanitary Work from Inspector Jordan's report on Houses Let in Lodgings during the year 1899. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Number of Houses inspected 1,198 1,443 1,181 1,388 5,210 Re-inspections, Calls made, &c. 599 134 220 253 1,206 Total Inspections, &c. 1,797 1,577 1,401 1,641 6,416 Improvements. Drains — Constructed 5 3 - - 8 Improved or repaired 69 52 48 80 249 Traps fixed 16 10 — — 26 Cesspools— Abolished - — — — — Cleansed or disinfected - - - — — Privies and Water Closets— Pan, trap and water supply furnished 5 7 1 1 14 Pan and trap only furnished 17 9 2 2 30 Water supply furnished 33 22 47 1 103 Extra closets 5 5 1 46 57 Dust Bins— Constructed 10 4 6 3 23 Repairs and covers adapted 3 1 — 1 5 Surface Drains and Pavement of Yards— Constructed - 3 1 — 4 Relaid 20 26 21 25 92 General Water— New receptacles provided 2 — — 1 3 Receptacles repaired and cleansed 31 96 122 57 36 Water supply provided 1 1 — 2 4 Other Improvements — Houses generally repaired 9 10 22 5 46 „ &c., cleansed or limewashed 15 110 68 51 244 „ ventilated 1 - — - 1 Overcrowding abated 4 10 21 20 55 Illegal use of underground rooms for sleeping discontinued 2 — 1 — 3 Other Amendments and Nuisances abated 122 96 90 123 431 Rooms Disinfected — — — — — Total Improvements 370 465 451 418 1,704 Total Premises Improved 182 339 250 283 1,054 1899] 208 SANITARY WORK. The sanitary work of the Parish was carried out under the supervision of one chief inspector and eighteen inspectors. Of these fourteen have charge of separate districts, while two devote their attention to workshops and factories, one looks after houses let in lodgings, and one examines food, chiefly meat. The last mentioned inspector only commenced his duties in March, and is the first appointment for this special work that has been made in Islington. The inspector (Preston) appointed for No. 12 District commenced his duties in January, having succeeded Inspector Peers, who had been appointed Chief Inspector of Nuisances at Wolverhampton. His successor came to Islington with strong testimonials from Cardiff, a borough in which sanitation is most actively pursued. Table CVI. Giving a Summary of the Sanitary Work performed by the District Inspectors. Places Inspected. QUARTERS. The Year. First. Second. Third. Fourth. House to House Inspections .. 80 134 173 387 Other Houses inspected 1,716 1,631 1,505 1,535 6,387 Re-inspections, Calls made, &c. 14,644 13,980 11,437 13,776 53,837 Visits to Bakehouses 1 2 .. .. 3 Do. Cowhouses 8 25 17 1 51 Do. Slaughter-houses 24 17 4 3 48 Do. Stables and Yards 577 971 672 508 2,728 Do. Courts, &c. 1 5 .. 2 8 Do. Factories and Workshops .. 1 2 5 8 Do. Fields, Lanes, &c. 1 .. 2 1 4 Do. Factories, Horse Slaughterhouses, Piggeries, &c.,Belle Isle 1 .. .. 23 24 Do. Under Sale of Food and Drugs Acts 284 264 233 281 1,062 Dust Removals Ordered .. .. •• 4 4 Total Inspections, &c. 17,257 16,976 14,006 16,312 64,551 [1899 209 DISTRICT INSPECTION. During the year, 6,387 houses were thoroughly inspected by the fourteen district inspectors, 387 being the result of a house to house inspection. These inspections entailed 53,837 subsequent visits for the examination of the works that were required under the Vestry's Notices. Altogether 22,455 improvements were effected in 5,505 houses. All these benefits were not attained, however, without resort to legal action, for it became necessary to issue 91 summons to enforce the requirements of the Vestry's Statutory Notices. In 60 instances the Vestry was successful in obtaining the magistrates' orders for the execution of the works, in 24 instances the summons were withdrawn, the notices having been complied with in the interval between the dates of their issue and of their hearing, and in 7 instances they were dismissed, chiefly because of inability to prove ownership. It is not always an easy matter to prove the ownership of property, as was instanced in the Brooksly Mews Case, and more recently in the case of the mews at the rear of Highbury Terrace. It is particularly difficult when properties are in the hands of trustees, who invariably seek to do as little as possible, and who conceal their identity in every conceivable manner. The rule of the Sanitary Authority is to summon the persons who receive the rents. This, unfortunately, sometimes brings the Vestry into antagonism with these persons, many of whom carry on business as house agents. Some of them very much resent being called on to execute works, and plead that they are only agents. The law on the subject is, however, very clear, and does not leave them a loophole for escape. I confess that as a rule the Public Health Department would much prefer to deal directly with the landlords than with agents, a few of whom seem 1899] 210 to consider that their sole duty is to endeavour to evade the Vestry's notices, and to execute as little work, as possible. On the other hand some agents, particularly those living in Islington (although here there is at least one noteable exception) and in the Western District of the Metropolis readily meet the Vestry's demands and execute really creditable work. It is a singular fact, but none the less true, that the more impoverished the property is, and the more it is occupied by poor people, the more difficult it is to get the owners to effect necessary work, particularly where the ground landlords have neglected to make them keep the property in fair condition. As a rule this class of property is held on short leases, and is owned by persons wh se only anxiety is to receive the maximum amount of money with the minimum of expenditure. Yet this is the very description of house that requires most to be done to it, in fact costs most to keep up, both structurally and sanitarily. There is no doubt that as leases in Islington approach their termination, houses of this class will increase, and will require the closest supervision. The Sanitary Staff of the Vestry are now doing this as far as possible, and, I trust, not without success. [1899 211 Table CVII. Giving a Summary of the Sanitary Work performed by the Inspectors in 1899. Places Inspected. QUARTERS. The Year. First. Second. Third. Fourth. House to House Inspections .. 80 134 173 387 Number of Houses Inspected 1,716 1,631 1,505 1,535 6,387 Re-inspections, Calls made, &c. 14,644 13,980 11,437 13,776 53,837 Visits to Bakehouses* 1 2 .. .. 3 Do. Cowhouses 8 25 17 1 51 Do. Slaughter-houses 24 17 4 3 48 Do. Stables and Yards 577 971 672 508 2,728 Do. Courts, &c. 1 5 •• 2 8 Do. Factories and Workshops† .. 1 2 5 8 Do Fields, Lanes, &c. 1 .. 2 1 4 Do. Factories, Horse Slaughterhouses, Piggeries, &c., Belle Isle 1 .. .. 23 24 Do. Under Sale of Food and Drugs Acts 284 264 233 281 1,062 Dust Removals ordered .. •• .. 4 4 Registered Lodging Houses‡ •• •• •• .. .. Total Inspections 17,257 16,976 14,006 16,312 64,551 * See also Inspector West's report ante p 197. † „ and Miss Gray's report ante pp. 196-197. ‡ „ „ Jordan's report ante p. 206. 1899] 212 Table CVIII. Giving a Summary of the Nuisances discovered by Sanitary Inspectors during the Four Quarters and for the Year 1899, for the abatement of which notices were served. NUISANCES. QUARTERS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. 1. The house or part of the house in a dirty condition 130 138 149 143 460 2. „ ,, in a damp condition 65 42 32 87 226 3. ,, in a dilapidated condition 72 70 91 102 335 4. The inlet of surface drain improperly trapped 166 194 143 146 649 5. The water-closet so foul as to be a nuisance 228 172 158 176 734 6. „ „ without a water supply 61 47 50 35 193 7. ,, „ with a deficient supply of water 41 57 51 53 202 8. „ „ improperly constructed so as to be a nuisance 306 293 238 283 1,120 9. „ „ so defective as to be a nuisance 106 129 117 102 454 10. „ „ stopped 22 24 22 15 83 11 „ ,, placed in an improper position 8 16 10 26 60 12. Insufficient external ventilation to water-closet 20 54 21 42 137 13. Insufficient water-closet accommodation 11 22 46 25 104 14. The soil pipe defective 60 67 38 61 226 15. „ unventilated 120 113 80 92 405 16 „ improperly ventilated 51 80 42 45 218 17. The yard in a condition injurious to health by reason of the want proper paving 248 214 187 223 872 18. The yard dirty 30 20 28 19 97 19. ,, undrained 61 60 39 45 205 20. A gully trap improperly placed within the house 124 133 88 107 452 21. The waste pipe of sink directly connected with the drain 87 93 61 79 320 22. „ improperly trapped 52 62 33 33 180 23. .. „ untrapped 33 51 41 43 168 24. ,, of lavatory directly connected with the drain 3 4 6 6 19 25. „ ,, improperly trapped 2 3 1 1 7 26. „ untrapped 31 20 12 11 74 27. „ of bath directly connected with the drain 7 12 11 10 40 28. „ improperly trapped .. 1 6 3 3 13 29. „untrapped 22 17 12 13 64 30. The water cistern so foul as to be a nuisance 34 55 63 57 209 31. „ „ being without a close-fitting cover 89 129 119 125 462 32. „ „ being placed in an improper position 18 33 41 43 135 33. ,, „ defective .. 8 10 7 11 36 < Table CVIII.—Continued. nuisances. quarters. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. 34. An accumulation or deposit of refuse injurious to. health, by reason of the want of a proper dustbin or ashpit 32 43 21 34 130 35. The dustbin or ashpit defective 175 148 159 152 634 36. „ ,, placed in an improper position 15 15 10 7 47 37. The drain foul 45 15 23 9 92 38. " defective 384 362 320 340 1,406 39. „ choked or stopped 79 68 72 45 264 40. ,, unventilated 304 220 189 201 914 41. The rainwater pipe in direct communication with the drain 150 153 119 125 547 42. ,, ,, in direct communication with the soil-pipe 9 13 7 10 39 43. ,, defective 57 44 35 54 190 44. The water supply used for domestic purposes connected with the cistern which is used for flushing the w.c 7 7 9 6 29 45. The house without a proper water supply 45 30 35 39 149 46. The roof defective 58 50 49 100 257 47. The guttering defective 39 31 23 51 144 48. The area improperly paved 45 35 10 44 134 49. ,, dirty 9 19 12 7 47 50. ,, undrained 27 26 9 13 75 51. The paving of the washhouse defective 46 27 41 23 137 52. The back addition walls defective 9 3 6 5 23 53. The want of a proper manure receptacle 17 7 7 4 35 54. Tha bakehouse walls dirty .. .. .. .. .. 55. An animal kept in such a manner as to be a nuisance 26 13 27 29 95 56. The house or part of the house so overcrowded as to be injurious or dangerous to the health of the inmates. 33 23 48 27 131 57. An underground room occupied as a dwelling contrary to the provisions of the Act 13 8 13 13 47 58. A tent, van, shed, or similar structure used for human habitation which is in such a state as to be injurious or dangerous to the health of the inmates 2 1 .. .. 3 59. The space below floor in the basement or ground floor being unventilated 43 25 15 25 108 60. The space below floor in the basement or ground floor being improperly or insufficiently ventilated 122 125 91 107 445 All Nuisances 4,108 3,951 3,390 3,732 15,181 213 [1899 1899] 214 SUMMARY OF SUMMONSES.—Year ending 30th December, 1899. Prosecutions. Successful. Dismissed. Withdrawn. " Sale of Food and Drugs Acts, 1875-9 " 56 54 ... 2 " Public Health (London) Act, 1891 " 91 60 7 *24 " Margarine Act, 1887 " 11 9 ... 2 Total 158 123 7 28 * Included in this total are 19 which were withdrawn as the work had been satisfactorily carried out. PAUPERISM IN ISLINGTON. In my reports for the several quarters I gave a return of the state of pauperism in the parish for each week of the year. I now append a statement showing the average number of indoor and outdoor paupers relieved during the year and during the preceding four years. In was 1985 the average weekly number of paupers (in and out door) 6,291 1896 „ „ „ „ 6,436 1897 „ „ „ „ 6,486 1898 „ „ „ „ 6,635 1899 „ „ „ „ 6,854 From these figures it appears that the weekly average number of paupers, in or out door, was 392 in excess of the average of the four preceding years. [1899 215 Table CIX. Showing the State of Pauperism in the Parish during the years 1896-99. Years. 1 Average Number Relieved during each week. Indoor Paupers, Adults and Children. 2 Outdoor Paupers. Totals Outdoor. 5 Totals. All paupers relieved, cols. 2 & 5. 6 Vagrants Relieved. 7 Children Boarded out. 8 Deathrates. 9 Adults. 3 Children under 164 1896 2,912 2,215 1,309 3,524 6,436 24 117 17.09 1897 2,951 2,250 1,285 3,535 6,486 25 108 15.80 1898 3,168 2,224 1,243 3,467 6,635 27 116 16.53 1899 3.351 2,237 1,266 3,503 6,854 16 131 18.04 Table CX. Showing the State of Pauperism in the Parish during the year 1899. Quarters. 1 Average Number Relieved during each week. Indoor Paupers, Adults and Children. 2 Outdoor Paupers. Totals. 5 Totals corresponding quarter, 1898. 6 Vagrants Relieved. 7 Children Boarded out. 8 Deathrates. 9 Adults. 3 Children under 16. 4 1st Qr. 3,455 2,294 1,306 7,055 6,686 21 129 19.28 2nd „ 3,254 2,199 1,261 6,653 6.483 14 132 14.69 3rd „ 3,215 2,210 1,270 6,694 6,503 13 129 18.03 4th 3,480 2,244 1,228 6,952 6,833 15 135 20.17 The Year 3,351 2,237 1,266 6,838 6,854 16 131 18.04 THE ADULTERATION OF FOOD. During the year 899 samples of food and drugs were bought or procured for analysis under the provisions of the Sale of Food and Drugs Acts. This was the largest number hitherto analysed in a year in Islington. Of these foods and drugs 820 were genuine and 79, or 879 per cent., adulterated. 1899J 216 In addition to the above samples 48 were bought under the Margarine Act, of which 7, or 14*7 per cent., were sold contrary to its provisions. In the following statement will be seen the result of the analyses for each quarter :— No. of Samples. Genuine. Adulterated. Per cent, adulterated. 1899. 1898. 1st Quarter 240 212 28 11.7 16.5 2nd „ 229 213 16 6.9 8.8 3rd „ 215 194 21 9.7 7.2 4th „ 215 201 14 6.6 8.2 Totals 899 820 79 8.79 10.5 The proportion of articles proved on analysis to have been adulterated was lower than in any year since 1891, being only 8.8 per cent I do not for a moment believe that this correctly represents the fraudulent practices that are indulged in by traders in Islington, but in order to detect them it is essential that an inspector who devotes the whole, or a considerable portion, of his time to the administration of the Adulteration Acts work, should be appointed for the purpose. At the present moment an experiment is being made in this direction, and with very good results, for the amount of fraud unearthed has been considerably increased. The following are the particulars for past years contrasted with the returns of 1899 :— Year. No. of Samples. Genuine. Adulterated. Per cent. Adulterated. 1891 368 345 23 6.2 1892 367 302 65 17.7 1893 378 327 51 13.5 1894 390 342 48 12.3 1895 772 673 99 12.8 1896 755 661 94 12.4 1897 863 765 98 11.3 1898 875 784 9i 10.5 1899 899 820 79 8.8 Totals (9 years) 5,667 5,019 648 11.4 [1899 217 Milk.—532 samples of milk were examined, of which 181 were bought on Sundays, and 231 on other days of the week, while 120 were procured in course of transit at railway stations. In the following table will be found the particulars of the milk taken during each quarter on sundays, on week-days, and at the railway stations. 1899. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Week-days. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Week-days. Railway Stations. All Milks. ! Sundays. Week-days. Railway Stations. All Milks. 1st Qtr 56 62 30 148 48 50 30 128 8 12 0 20 14 3 19.3 0.0 13.5 2nd ,, 48 59 30 137 41 56 30 127 7 3 0 10 14 8 5.0 0.0 7.3 3rd „ 28 61 30 119 19 54 29 102 9 7 1 17 32.1 11.4 3.3 14.2 4th „ 49 49 30 128 46 44 30 120 3 5 0 8 6.1 10.2 0.0 6.2 The Year 181 231 120 532 154 204 119 477 27 27 1 55 14.9 11.2 0.8 10.3 Sunday Milks.—Of the 231 samples, 27, or 14*9 per cent, were found to be sophisticated. The analyses of these milks showed that they contained the undermentioned parts. Somerset House Standard. Fat 3.50 per cent, as against 3.o per cent. Solids not Fat 8.49 „ „ 8.5 „ Total Solids 11.99 „ „ 11.5 „ Here we see in these milks that, although 14.9 per cent, of the samples had been interfered with, they contained 19.6 per cent, more fat than the "standard" laid down by Somerset House, while the " solids not fat " are almost identical with the figures of the official analysts. Week Day Milks.—These 233 milks, like those taken on Sundays, were purchased from the vendors on their rounds, or were bought P 1899] 218 in milk-shops. 27, or 11.6 per cent., were adulterated. Notwithstanding this fact, the analyses showed that their average composition was higher than the Somerset House standard. Somerset House Standard. Fat 3.58 per cent. 3.0 per cent. Solids not Fat 8.53 „ 8.5 „ Total Solids 12.11 „ 11.5 ,, Railway Station Milks.—120 samples were procured and of these only 1, or o.8 per cent., was adulterated. Their analyses showed a very high standard of quality, compared with which the official standard is absurd. Somerset House Standard. Fat 4.23 per cent. 3.0 per cent. Solids not Fat 8.82 „ 8.5 „ Total Solids 13.05 „ 11.5 „ The figures, it will be noticed, are very much above the official standard, and, consequently, these milks left a large margin for the abstraction of fat and the addition of water. Indeed, it would be possible to deprive them of 29.1 per cent, of their fat, and to adulterate them with 3.6 per cent, of water, before they would come under the ban of Somerset House. As a matter of fact, no prosecution is, or rarely, ever instituted unless the adulteration reaches 5 per cent., because of the almost certainty that, should the sample be referred by the Court to Somerset House for analysis, the government analysts would declare their inability to discover adulteration. They say that they are in a position to give a positive analysis of milk that has been for several weeks (at least three, and sometimes four and five or more) undergoing decomposition. The Public Analysts do not agree with their contention, and consequently they are chary in recommending prosecutions where the adulteration is less than 6 per cent. As the composition of milk is at the present time a matter of great moment, indeed, a Committee of Experts, appointed by the Board of Agriculture is inquiring into the subject, I herewith append the result of the analyses of the milks taken in Islington since the fourth quarter of 1897. [1899 219 Table CXI. Showing the average Analyses of 1,210 Milks procured or purchased in Islington during the periods mentioned. Periods of the year when Samples were obtained. Railway Milks. Sunday Milks. Week Day Milks. No. Analysed. Fat per cent. Solids not fat, per cent. Total Solids, per cent. No. Analysed. Fat, per cent. Solids not fat, per cent. Total Solids, per cent. No. Analysed. Fat, per cent. Solids not fat, per cent. Total Solids, per cent. 1897. 4th Quarter 60 4.39 8.65 13.04 48 3.99 8.48 12.47 27 3.86 8.28 12.14 1898. 1st Quarter 30 3.55 9.06 12.61 52 3.54 8.58 12.12 52 3.33 8.44 11. 77 2nd „ 30 3.50 8.77 12.27 49 337 8.61 11.98 47 3.46 8.59 12.05 3rd „ 30 5.25 8.52 13.77 44 3.48 8.22 11.70 79 3.80 8.56 12.36 4th ,, 30 3.86 9.01 12.87 48 3.61 8.60 12.21 52 4.20 8.63 12.83 The Year 120 4.04 8.84 12.88 193 3.50 8.50 12.00 230 3.69 8.56 12.25 1899. 1st Quarter 30 4.72 8.73 13.45 56 3.52 8.48 12.00 62 3.48 8.55 12.03 2nd ,, 30 3.82 8.70 12.52 48 3.48 8.52 12.00 59 3.69 8.61 12.30 3rd 30 4.49 9.00 13 .49 28 3.27 8.29 11.56 61 3.57 8.36 11.93 4th „ 30 3.91 8.85 12.76 49 3.72 8.69 12.41 49 3..57 8.61 12.18 The Year 120 4.23 8.82 13.05 181 3.50 8.49 11.99 231 3.58 8.53 12.11 P 2 1899] 220 All these milks were analysed by Mr. F. L. Teed, D.Sc. (London), who is the Public Analyst for Islington, and who found that only one milk procured at the railway stations showed a lower percentage of the parts than the standard laid down by Somerset House, which is altogether too low in the figures for fat. Their standard lends itself to the dishonest abstraction of fat, or rather I should say to the addition of separated milk to genuine milk, for your modern vendor does not trouble himself to skim his milk. He prefers the easier practice of adding to genuine milk machine separated milk, worth half the price. Once he knows the amount of fat in his milk, it becomes a very easy matter for him to reduce it to the " standard " of Somerset House by adding the necessary quantity of the inferior article. The use of Preservatives in milk lends itself to fraud, because it enables milk vendors to keep skimmed or separated milks sufficiently sweet for the purpose of mixing with genuine milks. Without their aid it would be more difficult, because it must be recollected that as a rule separated milk is older at least by a day, and sometimes even more, than the genuine milk. In Table CX. I have shown that the average analysis of the milk from the farmers, taken from the railway stations in 1899 was Fat ... ... ... 4*23 per cent. Solids not Fat ... 8*82 „ Now by the addition of separated milk, which usually contains 0.25 per cent of fat and 9.2 per cent, of solids not fat, in proper proportion to the farmers' milk, it is possible to produce the standard milk of Somerset House. It may be done, and I suppose is largely done as follows:— [1899 221 This sophisticated milk is a little better than the standard milk of Somerset House, for it contains 0.09 per cent, more fat and 0.42 per cent, more non-fatty solids, and would, therefore, still admit of a little skimming and a little watering. Preservatives in Milk.—All the Milks, 532 in number, were examined for the presence of boric acid, which was found to be present in in 142, or 26.7 per cent. Of the milks treated with this preservative 15, or 10.6 per cent., were adulterated, while of the 390 non-preserved milks 30, or 7.7 per cent., were adulterated. Of the 181 Sunday Milks, 55 were preserved with boric acid, and of these 8, or 14.5 per cent., were adulterated, while of the remaining 126, 19, or 15.1 per cent had been tampered with. Of the 231 Week Day Milks, 58 were treated with preservatives, of which 6, or 10.3 per cent., were adulterated, while of the remaining 173 non-preserved milks, 21, or 12.1 per cent, were sophisticated. Of the 120 Railway Milks 29, or 24.2 per cent contained boric acid, of which 1 was adulterated. Sunday Milks. Weekday Milks. Railway Milks. All Milks. Number of Samples l8l 23I 120 532 ,, preserved with boric acid 55 58 29 142 Percentage with boric acid 30.4 25.1 24.2 26.7 Number of preserved milks adulterated 8 6 1 15 Ditto percentage adulterated 14.5 10.3 3.4 10.6 By taking Fat. Solids not Fat. 5 parts of Farmers' Milk 21.15 44.10 2 „ " Separated Milk" 0.50 18.40 We get 7 „ a Sophisticated Milk 21.65 62.050 Containing 3.09 8.92 as against the Somerset House Standard 3.00 8.50 Difference in favour of Sophisticated Milk 0.09 0.42 1899] 222 Butter.—132 samples were examined, of which 10, or 7.6 per cent., were adulterated. This proportion is less than in the preceding year, when 10, or 9.8 per cent, out of 102, samples were wrong. The fraud in the case of butter is as a rule the substitution of margarine, a substance made of animal fat, for the genuine article, although occasionally a mixture of margarine and butter has been sold. The first mentioned practice is at present being closely inquired into. It is not one which the great majority of the local traders pursue, but is practically confined to certain Welshmen, who seem to make a trade of this description of fraud in several parts of London, and who boldly announce that they sell dairy products, when there is no dairy produce except eggs on their premises. Fines to the amount of £11 10s. od. were imposed on defendants, together with £4 9s. 6d. costs. Cheese.—Out of 18 samples analysed none was adulterated. The usual practice where fraud is attempted is to substitute margarine-cheese for the genuine article. Spirits.—49 samples of whiskey, 5 of rum, 11 of brandy and 5 of gin were examined, of which 4 whiskeys and 1 brandy were found to be adulterated with water. Margarine.—48 samples were procured, of which 7, or 14.6 per cent, were sold contrary to the provisions of the Margarine Act. In 6 cases the wrappers in which the articles were sold were not properly labelled, and in 1 instance the bulk from which it was taken was not marked. [1899 228 SALE OF FOOD AND DRUGS ACTS.—The Public Analyst, Mr. F. L. Teed D.Sc. (London) examined the following samples, which were submitted to him for analysis:— Samples taken. Description. Genuine. Adulterated Percentage Adulterated. 532 Milk 477 55 10.3 6 Malt Vinegar 6 .. .. 4 Ground Ginger 4 .. .. 132 Butter 122 10 7.6 4 Mustard 4 .. .. 49 Whisky 45 4 8.2 4 Cocoa 3 1 25.0 5 Lard 5 .. .. 4 Olive Oil 4 .. .. 5 Gin 5 .. .. 3 Pepper 3 .. .. 18 Cheese 18 .. .. 20 Coffee .. 19 1 5.0 6 Arrowroot 6 .. .. 1 Saffron 1 .. .. 7 Glycerine 7 .. .. 6 Linseed Meal 6 .. 11 Brandy 10 1 9.1 2 Tincture of Rhubarb 2 .. .. 5 Precipitated Sulphur 5 .. .. 5 Rum 5 .. .. 1 Castor Oil 1 .. .. 2 Citric Acid 2 .. .. 1 Skim Milk 1 .. .. 7 Flour (Wheaten) 7 .. .. 3 Sweet Spirits of Nitre 3 .. .. 6 Camphorated Oil 6 .. .. 11 Lime Water 10 1 9.1 6 Camphor 6 .. .. 4 Juniper Oil 1 3 75. 0 8 Almond Oil 6 2 25. 0 1 Milk Sulphur 1 .. .. 3 Sulphate of Quinine 3 .. .. 3 Liquid Extract of Belladonna 3 .. .. 7 Spirits of Camphcr 7 .. .. 2 Purified Cream of Tartar 2 .. .. 4 Salad Oil 4 .. .. 1 Demerara Sugar .. 1 100.0 899 All Articles 820 79 8 79 MARGARINE ACT. Samples taken. Description. Samples sold in contravention of Act. Percentage sold in contravention of the Act. 48 Margarine 7 14 6 1899] 224 BACTERIOLOGICAL EXAMINATION OF MILK. The Public Health Committee of Islington, like several other bodies having charge of the health interests of large communities, carefully considered its duties in relation to the prevention of the possible infection of human beings with milk derived from tubercular cows, with the result that it decided that two hundred samples of milk should be examined. This was the first attempt by any London authority to deal with the matter, although subsequently Hackney and St. Pancras caused investigations to be made, but on a smaller scale. The examination proved beyond doubt that much milk is sold in Islington which contains the Bacillus Tuberculosis, which is the germ which causes phthisis, or, as it is more popularly known, " consumption." The samples were obtained from two sources, from cow keepers in Islington and from farmers. The general result of the investigation was as follows:— Number of samples examined 200 Sample curdled when examined 1 Number of samples inoculated 199 „ in which guinea pigs did not live sufficiently long for the disease to develop 81 Result obtained in 118 Of these 118, 17 died with tubercular lesions, the bacilli being proved to be present. There were also 17 others in which there were suspicious signs, such as enlarged glands, enlarged nodular spleens, etc., but in which no tubercle bacilli were found. Thus 14.4 per cent, of the milks were infected with tubercle, while a similar proportion was most gravely suspected. In other words 28.8 per cent, were of such a character that their use was open to serious objection. 225 [1899 These figures are very similar to those obtained in Hackney, where out of 77 absolute tests 17, or 22.1 per cent., were found to be infected. In St. Pancras no inoculation experiments were made, "but if they had been," says Dr. Sykes, Medical Officer of Health, "no doubt a larger number of the samples would have shown the presence of the organisms of consumption," but, nevertheless, tubercle bacilli were discovered in 5 out of 50, or in 10 per cent. of the milks. Of these 50 milks only 16 were normal, 3 being dirty, 8 containing an excessive number of microbes, 6 an excessive number of leucocytes, and 12 pus in smaller or greater amounts. In Liverpool in 1898, 112 samples were examined for tubercle, of which 12, or 10.2 per cent., contained the germ of consumption; and in 1899 in the same city 352 milks were examined, with the result that in 50 instances the inoculated guinea pigs died before the observation was completed, while in the remaining 302, 16, or 5.29 per cent., were found to have developed tuberculosis. A peculiarity, which most people would not expect, was remarked in the farmers' milks, both in Islington and in Liverpool, that they were more largely infected with tubercle than were the milks obtained from cows that were kept in the cow-houses in those boroughs. In Islington out of 105 farmers' milks examined, 14, or 13.3 per cent., contained the tubercle bacilli, while in Liverpool, out of 186 examined in 1898 and 1899, 20, or 107 per cent., contained them, whereas out of 12 town milks 1, or 8.3 per cent., was infected in Islington, and in Liverpool, out of 228, only 8, or 3.1 per cent., were infected. These figures teach this lesson, that urban communities should be in no hurry to effect the removal of cow-sheds to the country until such time as rural authorities, either of their own accord or under compulsion from the Local Government Board, enforce the milkshop, dairies and cow-shed regulations, which in many places at the present time are a dead letter. A few years ago it became my duty in investigating the causes that led to a serious outbreak of scarlet fever in the northern part 1899] 226 of Islington, to visit the cow-sheds and examine the cows of a large number of farmers in a midland grazing county. The experience I then gained I shall never forget, for writing calmly on the subject now, I can aver without any exaggeration that some of these places were a disgrace to their owners, and a disgrace to the rural authorities whose duty it was to supervise them. Cow-houses were irregularly cleansed, their channels choked, their pavement broken, their walls plenteously bespattered with dung, their white-washing and ventilation neglected, and the animals were dirty, especially their flanks and teats, while men with uncleanly clothes and uncleanly hands milked the cows, which were not as a rule such good class animals as those found in the Islington sheds. Before any of the samples taken for examination in Islington were forwarded to the Jenner Institute, where the milks were dealt with, I inspected them to ascertain the amount of sediment they contained. But first I should explain that the milks were drawn from the bottom of the churns by means of glass pipettes, 4 feet 6 inches in length, so that a fair portion of the sediment might be obtained. I found that it contained dirt of all descriptions, broken debris, hay, chaff, dust, and particles of cow dung. In some of the bottles, which held a pint each, fully an eighth part of their contents was sediment, and consequently I do not wonder that so large a proportion as 81 out of 199, or 40.7 per cent., guinea pigs died before the examination for the results of the inoculation could be made. The milks noted with very dirty sediment, of which there were 25, were farmers' milks, and represented 14 per cent. of all the farmers' milks examined. There were also some 20 other milks with very decided sediments. The general result of the bacterological examination of the milks was as follows:— Milks obtained at Islington cow-houses * 16 Tests void 4 Positive results, bacilli found 1 Suspicious results, but bacilli not found 2 Negative results 9 * There are only 16 cow-houses in Islington. 227 [1899 Thus out of 12 milks available for complete testing, 1, or 8.3 per cent., contained the tubercle bacillus, while 2, or 16.3 per cent., showed suspicious signs. As regards farmers' milks:— Milks obtained from farmers 178 Tests void 73 Positive results, bacilli found 14 Suspicious results, but bacilli not found 16 Thus out of 105 milks available for complete testing, 14, or 13.3 per cent., contained the tubercle bacillus, while 16, or 15.2 per cent., showed suspicious signs. The report of the Jenner Institute is as follows:— JENNER INSTITUTE OF PREVENTIVE MEDICINE. Chelsea Gardens, Grosvenor Road, London, S.W. October 7th, 1899. Report upon 200 Samples of Milk and Cream examined on behalf of the Vestry of Saint Mary, Islington. To A. E. Harris, Esq., Medical Officer of Health, Vestry Hall, Upper Street, N. Sir, We beg to report that we have completed the examination of the samples of milk and cream forwarded by you to this Institute with the request that they should be examined for the presence of the tubercle bacillus. The total number of samples examined was 200. In each case the sample was received on the day of collection. The accompanying table gives a full account of the results we obtained:— The naked eye examination in several cases revealed an unwarrantable contamination with foreign matter. We have duly noted in our results those samples of bad quality in this respect. An immediate microscopical examination of each sample was made, but in every case the only absolute test for the presence of the tubercle bacillus was made, viz., an inoculation experiment. It is on these inoculation experiments that our report is based. 1899] 228 Method:—200 c.c. of each milk sample was centrifugalised for one hour. At the end of half an hour the centrifugalisation was intermitted, and the cream stirred in at the top. The centrifugalisation was then completed. This ensures a practical sedimentation of the tubercle bacilli, and, if scanty in number, greatly increases the chance of their detection. The sediment was used for inoculation. Of course, in such a favourable nidus for bacteria as milk a large number of bacterial forms are present, and are therefore particularly abundant in the sediment obtained. Amongst these are to be found septicaemic and other organisms, which may produce quickly fatal results in the test animals. The test for tubercle bacilli requires that the test animal be kept under observation for at least four weeks. A number of the inoculated animals succumbed at an earlier period from the above-mentioned causes, and the test thus became void. We have excluded these from our results re tubercle. From our experience as regards milk the number of samples containing tubercle bacilli would have been found to be higher, if it had been in our power to test all the samples rigorously. In one case the sample was not used as the milk was sour when received. It will be noted that in a number of instances where the animal died prematurely, the samples were found to be very dirty. The following are the results:— Test void (animals died prematurely) 80 samples. Samples not used 1 ,, This leaves 119 samples which were fully tested. Of these, tubercle bacilli were found in 17 samples, and were not found in 102 samples. The percentage of samples definitely proved to contain tubercle bacilli was, therefore, about 14 per cent. There were, however, 18 cases in which the lesions found suggested tuberculosis, although no tubercle bacilli were detected. These samples should, therefore, be regarded as of a suspicious character. We are, dear Sir, Yours faithfully, allan macfadven, m.d. richard t. hewlett, m.d. MORTUARY AND CORONER'S COURT. During the year 712 bodies were received into the Mortuary, of which 402 were of persons as to the cause of whose death the Coroner deemed it necessary to hold an inquiry. 229 [1899 The following table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1898 and 1899. 1898. No. of bodies received. Daily Average. No. of Inquests held. 1899. No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 215 2.4 132 1st Quarter 205 2.3 125 2nd ,, 151 1.7 88 2nd „ 172 1.9 105 3rd „ 180 2.0 79 3rd „ 185 2.0 91 4th „ 166 1.8 103 4th „ 245 2.6 148 Total for Year 712 1.9 402 Total for Year 807 2.2 469 THE BATHS AND WASH-HOUSES. These most useful and necessary adjuncts to the health defences of Islington were again largely availed of by its citizens, and show a net increase on the previous year in the number of persons using them of 6,080, the figures being 829,217 in 1899 as against 823,137 in 1898. Swimming Baths.—The bathers in the three sets of swimming baths at Hornsey Road, Caledonian Road and Tibberton Square, numbered 402,376 as compared with 395,366 in 1898. There was thus an increase of 7,010 bathers. In the Hornsey Road Baths there was an increase of 745 bathers, and in Caledonian of 18,921, but there was a decrease at Tibberton Square of 12,656. This was, however, due to no inherent fault in the baths themselves, but solely to the fact that the Shoreditch Vestry Baths were opened in 1899, and, therefore, naturally attracted to them the numerous bathers, residents in Shoreditch, who previously patronized the Tibberton Square Baths. 1899] 230 The total number of boy and girl bathers from schools who attended the baths was 159,845, 64,161 of whom bathed at Hornsey Road, 51,297 at Caledonian Road, and 44,387 at Tibberton Square, as against respectively 60,159, 33,946, and 40,824 in 1898. Apart from the school children there were 242,531 other attendances of the general public, namely, 114,911 at Hornsey Road, 67,336 at Caledonian Road and 60,284 at Tibberton Square. Private Slipper Baths were used by 215,938 visitors, as against 308,244 in 1898, of whom 90,688 availed themselves of the 1st class baths and 217,556 of the 2nd class. Of the former 8,792 and of the latter 57,467 were females. Wash-houses.—130,903 persons used these houses for the purpose of washing and mangling clothes. This is an increase of 11,376 on the preceding year. The numbers for the last two years at the several baths were :— Hornsey Rd. Caledonian Rd. Tibberton Sq. Total. 1899 25,875 37,278 67,750 130,903 1898 25,385 32,501 61,641 119,527 Increase 490 4,777 6,109 11,376 It will be seen from this statement that there was an increase at each of the wash-houses, particularly in those at Caledonian Road and Tibberton Square, which are each situated in the midst of populations who live for the greater part in tenement houses, and who, therefore, have not the means at home for washing clothes. 231 [1899 Swimming Baths. Bathers. Hornsey Road. Caledonian Road Tibberton Square. Total. Public. 1st class Males 56,429 17,692 15,672 89,793 Females 5,220 1,296 1,511 8,027 2nd class Males 48,001 44,199 38,975 131,175 Females 5,261 4,149 4,126 13,536 Schools. 1st class Boys 10,403 1,992 1,714 14,109 Girls 2,650 684 9 3,343 2nd class Boys 36,986 34,474 34,983 106,443 Girls 14,122 14,147 7,681 35,950 Totals 179,072 118,633 104,571 402,376 Private (Slipper) Baths. 1st class Males 31,999 18,354 19,237 69,590 Females 4,171 1,778 2,843 8,792 2nd class Males 49,553 57,377 53,159 160,089 Females 18,237 16,250 22,980 57,467 Totals 103,960 93,759 98,219 295,938 Washhouses. Washers 25,875 37,278 67,750 130,903 Total Persons' Using each Establishment. Total persons using each establishment in 1899 308,907 249,670 270,640 829,217 1899] 232 WATER SUPPLY. The water supply of the district was satisfactory, no complaint having been made to the Public Health Department either as to its quantity or quality. For several years past the New River Company has been actively engaged in supplying the district with a constant water supply, and I am now able to announce that it has completed its work. During the year 45 new houses have been examined to see that the Vestry's regulations as regards water supply have been carried out before certificates have been given to their owners (under Sec. 2 of the Public Health (London) Act, 1891) to allow the houses to be occupied. This section says that "a house .... shall not be occupied as a dwelling house until the Sanitary Authorities have certified that it has a proper and sufficient water supply." The examination of the water fittings of new houses has in many instances led to the discovery that the service pipes had not been laid sufficiently deep in the ground, and, where they pass through cellars or where fixed to eternal walls, had not been protected from frost. The trouble and care expended on these inspections will without doubt result in the houses being assured their water supply in very cold weather. Before a certificate is granted by the Sanitary Authority it is necessary that each house shall be provided with an adequate and sufficient water supply, and that the following requirements are carried out:— 1. The water service pipe has been buried in the ground to a depth of at least two feet six inches. 2. Where such service pipe passes through the open air or through cellars it has been amply protected from frost. 233 [1899 3. A Draw Tap for dietetic purposes has been fixed to the main supply pipe in a suitable position, and in the case of houses let in flats that a similar tap has been fitted to each tenement. 4. The storage cistern has been placed in an easily accessible position and has been of sufficient capacity for the household requirements for at least twenty-four hours. The New River Company still adheres to its regulation requiring a storage cistern to each house. I have, however, always advised that water should not be drawn from these receptacles for dietetic purposes, as it is a rare thing to find that the occupiers systematically and thoroughly cleanse them. The Vestry holds similar opinions, and hence the third regulation, insisting on a separate draw tap from the supply pipe "in a suitable position," was adopted. In nearly all houses that possessed draw taps prior to the adoption of this regulation, it was found that they were situated in the coal cellar or in some dark hole close to the point where the service pipes entered the buildings. Now they are invariably placed in such a position in the kitchen or scullery as will render them most available for use. The fourth regulation was adopted in order to prevent the cisterns, which the New River Company require, being placed in positions not easily accessible for cleansing. Hitherto they were placed in positions which the builder of the house most fancied, perhaps on the roof, on a staircase landing, in a W.C., under the bedroom floor, in sleeping rooms, or in some secret recess which could only be approached by means of a long ladder through a small opening in the ceiling of the staircase where its existence after a time has been forgotten. I find it stated in the last annual report of the Local Government Board that two districts in Islington, containing 4,974 houses, were brought under constant water supply in 1898. The New River Company, from which the local supply is entirely drawn, supplied during that year for all purposes 13,719,506,190 gallons of water. Q 1899] 234 The daily supply used by consumers was as follows:— For domestic purposes 30,070,150 gallons For other purposes 7,517,538 „ All purposes 37,587,688 ,, Houses supplied 144,465 Population supplied 1,192,371 Daily supply per house 228 gallons „ „ inhabitant 31.52 „ MATTERS CONSIDERED BY THE PUBLIC HEALTH COMMITTEE On Reports by the Medical Officer of Health. At each fortnightly meeting of the Public Health Committee a full statement as to the state of the health of Islington was submitted, together with charts and maps showing the movement of the several infectious diseases. A return showing the work of the sanitary inspectors was also laid before them, and, indeed, their books showing the number of notices outstanding were examined. The very fullest information was placed before the Committee so that the exact state of the district might be understood. The following among many other matters were brought under the consideration of the Committee on reports from me. Date of Report. Duties of a Meat Inspector January 23 The Serum or Antitoxin Treatment of Diphtheria „ „ Urinal Accommodation to Public Houses February 6 Brooksby Mews. Sanitary State of „ „ Underground Bakehouse, Drayton Park „ „ Shelter House, State of Ground around „ „ Norfolk Square Area „ „ Inspection of W.C.'s while in course of erection „ 20 London Government Bill March 6 Rabies „ 20 235 [1899 Date of Report Influenza April 10 Urinal, Newington Green „ 24 Ballast Burning „ „ Proposed Amendments to Public Health (London) Act, 1891 May 5 Seizure of Unsound Food June 19 Sanitary State of Workhouse Schools July 10 Stable Manure August 14 Tuberculosis in Milk October 9 Harrison, Barber and Co.'s Knackers' Yard „ „ The Clerking of the Public Health Committee „ „ Untrapped Gullies „ „ Diphtheria in Tufnell Ward „ „ State of Vaccination in Islington „ „ 12, Hercules Road, insanitary state of „ 23 G.E.R. Sidings, Hampden Road November 6 Scarlet Fever, Compulsory Removal of Patient „ „ Pied Bull Yard, Sanitary State of „ 20 Cattle Market „ „ „ „ The Vestry's Regulations as applied to Works carried out under the P. H. L. Act December 4 PUBLIC HEALTH LEGISLATION. During the Parliamentary Session of 1899 several (7) Acts of Parliament relating or having reference to Public Health work were passed. These are contained in chapters 7, 8, 15, 21, 29, 44 and 51 of the 62 and 63 Victoria, a.d. 1899. Metropolis Water Act, 1899.—An Act to enable and require the Metropolitan Water Companies to supply each other with water in cases of emergency. The Local Government Board are the Authority to decide when this arises. The Infectious Diseases Extension Act, 1899.—It extends the provisions of the Infectious Diseases Act, 1889 to every urban, rural, and port sanitary district, whether that Act has or has not been adopted by them before this Act came into force. The result is that notification in England and Wales instead of being only partial will in future be general. Q 2 1899] 236 The London Government Act 1899 is an Act to make better provision for the government of London. Its provisions have already been fully discussed by the Vestry. It had been expected that it would have contained clauses for the transfer from the London Council of several matters dealt with by it under the provisions of the Public Health (London) Act, 1891, but the only transfer of Public Health interest seems to be that of registering dairymen, subject to the power of the London County Council making the by-laws. Metropolis Management Acts Amendment (By-Laws) Act, 1899.—It extends the powers of the London County Council to make by-laws under section 202 of the Metropolis Management Act, 1855, for the following purposes, "requiring persons about to construct, reconstruct, or alter pipes, drains, or other means of communicating with sewers, or the traps and apparatus connected therewith, to deposit with the Sanitary Authority of the district such plans, sections and particulars of the proposed construction or reconstruction, or alterations as may be necessary for the purpose of ascertaining whether such construction, reconstruction or alteration is in accordance with the statutory provisions relative thereto, and with any by-laws made under the said section." Seats for Shop Assistants Acts, 1899.—This Act provides that where female assistants are employed for the retailing of goods to the public the employer shall provide seats behind the counter in some suitable position in the proportion of one seat to every three female assistants employed in each room. It is enforceable by the London County Council, although it might possibly have been more usefully and better carried out by the Local Authorities. Baths and Washhouses Act, 1899.—This Act amends the provisions of the Baths and Washhousss Act, 1878, by repealing its fifth section, so as to enable covered or open swimming baths to be used for music and dancing under certain conditions. Small Dwellings Acquisition Act, 1899.—This is an Act to empower Local Authorities to advance money enabling persons to acquire the ownership of Small Houses in which they reside; providing that any advance shall not exceed 237 [1899 (a) Four-fifths of that which in the opinion of the Local Authority is the market value of the ownership; nor (b) Two hundred and forty pounds; or in the case of a fee simple or leasehold of not less than ninety-nine years unexpired at the date of the purchase, three hundred pounds. In the application of this act to London any Sanitary Authority shall have the same powers as an Urban District Council, and the expenses shall be paid out of the General rate, except in the City of London where it shall be paid out of the Consolidated rate. The Act provides among other things that the proprietor of the house shall reside in it; that the house shall be kept insured; and that it shall be kept in a good sanitary condition. Sale of Food and Drugs Act, 1899.—This is an Act to amend the law relating to the Sale of Food and Drugs. Sec. 1 provides precautions against the importation of margarine, margarine-cheese, adulterated or impoverished butter, milk or cream, condensed separated or skimmed milk, or any adulterated or impoverished food except in conspicuously marked packages or receptacles. Sec. 2 enables the Local Government Board and the Board of Agriculture to procure for analysis samples of any articles of food, but the local authority must pay the fee to the analyst. Sec. 3 makes it compulsory on Local Authorities to appoint a public analyst, and to enforce the powers under the Adulteration Acts with which they are invested. Sec. 4 gives power to the Board of Agriculture to make regulations as to what is to be considered the normal constituents of milk, butter and cheese. Sec. 5 extends the provisions of the Margarine Act, 1887, to margarine-cheese. Sec. 6 makes provision for the branding or marking of packages of margarine or margarine-cheese. Sec. 7 enacts that manufacturers of and wholesale dealers in margarine and margarine-cheese shall keep a register showing to whom they send their goods. Sec. 8 restricts the amount of butter that may be mixed with margarine to ten per cent. 1899] 238 Sec. 9 makes provision for the inscription of the names and addresses on the cans, receptacles and vehicles of persons who sell milk in the public highways. Sec. 10 provides that a portion of any sample of milk taken in course of delivery or transit shall be forwarded to the consignor. Sec. 11 enacts that tins containing condensed separated or skimmed milk must bear labels with the words "Machineskimmed Milk" or " Skimmed Milk" printed in large type. Sec. 12 provides that notices of mixture under the Act of 1875 shall not be obscured by other matter on the label. Sec. 14 applies the provisions (as to taking samples of milk in course of delivery) of the Act of 1879 to every other article of food. Sec. 16 provides penalties to be inflicted on any person who obstructs or impedes an inspector in the execution of his duty, or who attempts to bribe him. Sec. 17 increases the penalties for certain offences under the 1875 Act. Sec. 19 restricts the time for instituting prosecutions under the Act to twenty-eight days from the time of purchase. Sec. 20 provides that a warranty shall not be available as a defence unless the defendant gives notice of his intention to rely on it within seven days after the service of the summons. Sec. 21 provides that the justices shall on the request of either party cause the alleged adulterated article to be sent to the Commissioners of Inland Revenue for analysis, or if they think fit they can send it themselves. Sec. 22 makes provision that the production of a certificate of analysis by a Public Analyst shall be sufficient evidence of the facts stated in it; but a copy of it must be sent to the prosecutor three clear days before the trial. Sec. 26 defines "food" to include "every article used for food or drink by man, other than drugs or water, and any article which ordinarily enters into or is used in the composition or preparation of human food; and shall include flavouring matters and condiments." 239 [1899 Local Acts of Parliament.—In addition to the preceding public Acts of Parliament, 87 Acts, dealing with many public health matters, such as prevention of disease, parks, open spaces, housing, street improvements, water, etc., were obtained by Local Authorities throughout the country. The titles of many of them would not at first sight lead one to suspect that they contained sections dealing with other matters than those to which they made special reference. Thus the title of an Act might be "― Corporation (Gas and Water)" or "― Corporation (Finance)" or "― Corporation (Tramways)"; yet these Acts might contain matters deeply concerning the public health. This is explained by the fact that when any of the provincial corporations proceed to Parliament to obtain powers with respect to some special undertaking such as tramways, gas, or electric lighting, they at the same time avail themselves of the opportunity to obtain special powers as regards the prevention of infectious diseases and cognate health matters. In this way wellmanaged boroughs keep their health legislation fairly abreast of the requirements of the period, and considerably ahead of the Metropolis. THE WORK OF THE CLERICAL STAFF. Not the least worthy of comment is the manner in which the clerical work of the Public Health Department was conducted during the year. Year by year it has grown larger and larger, until as at present, it requires all the energy of its undoubtedly efficient staff to complete each day's work within its working hours. The clerks are punctual in their attendances at 9 a.m., and at once commence their work, so that that portion of it which is intended for the sanitary inspectors may be completely ready for them before they leave their office at or before 10.30 a.m. It has always been my anxiety that there shall be no work in the office after the hour fixed by the Vestry for its closing, 5 p.m., and I am glad to think that it is, indeed, a rare event for any of the staff to be compelled to work overtime. 240 1899] It would be almost invidious to select for special mention the names of particular members of the staff, but it is impossible to pass over the chief clerk, Mr. G. H. King, who so quietly and diligently transacts his work and looks after his office, and than whom the Vestry possesses no better servant. I append a statement, which must not however be taken as nearly complete, showing the work done by the clerical staff. STATEMENT SHOWING THE WORK PERFORMED BY THE CLERICAL STAFF. No. of Notifications entered in Register 3,164 „ „ forwarded to Metropolitan Asylums Board 3,164 „ „ „ Schools 2,129 „ Letters typed and forwarded from office 2,851 ,, Intimation Notices written (and copied) 5,122 „ Statutory „ „ „ 474 „ Minutes of Public Health Committee entered in Minute Book 29 „ Minutes of Sub-Committees entered in Minute Book 19 ,, Reports from Public Health Committee to Vestry prepared 29 „ References „ „ „ other Committees prepared 38 „ Summonses prepared under the Public Health Acts 97 „ „ „ „ Adulteration Acts 69 „ Notices of Public Health Committee Meetings prepared 725 „ „ Sub-Committee Meetings prepared 144 „ Bacteriological Diagnoses forwarded to Medical Practitioners 264 „ Reports of Inspectors on Infectious Diseases entered in Registers 3,164 „ Rooms Fumigated entered in Register 2,676 „ „ Stripped 1,375 „ Articles of Bedding, Clothing, &c. entered in Register 1,909 „ M.O.H.'s Reports sent out 865 „ Notices of Completed Disinfection forwarded to Schools 1,649 „ Deaths tabulated in Annual Register 6,293 „ „ „ in Register during first quarter 1,681 „ „ „ „ „ second „ 1,281 „ „ „ „ „ third „ 1,672 „ „ „ „ „ fourth „ 1,759 „ Reports on Sanitary Work tabulated in Register 728 ,, Entries on 6 Maps showing where Infectious Disease had occurred 2,905 „ „ 6 Charts showing the weekly number of Infectious Cases 312 „ Complaints and Results of Inspection entered in Complaint Book 1,421 ,, Letters Received entered in Correspondence Book 11,902 „ Entries in Lodging-House Register 46 „ Lodging-House Notices prepared 539 „ Medical Practitioners'Accounts kept 832 APPENDIX. VITAL AND SANITARY STATISTICS, 1899, together with Abstracts for Sixteen Years, 1883-98. Table A. Showing the Population, Inhabited Houses, Marriages, Births, and Deaths for the year 1899, and 16 years preceding. gross numbers. The Year. Estimated Population. No. or 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 1899 348731 42,973 3,254 9,658 6,293 1,548 2,315 1,586 1883 290,711 2,371 9,888 5,140 1,312 2,239 442 1884 294,267 2,394 10,011 5,229 1,506 2,420 391 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 319,991 37,875 2,741 9,797 6,326 1,481 2,388 1,095 1892 323,451 38,183 2,783 9,552 6,075 1,417 2,186 1,050 1893 326,958 38,595 2,653 9,749 6,391 1,595 2,498 1,128 1894 330,485 39,015 2,694 9,502 5,263 1,229 2,114 1,090 1895 334,058 39,440 2,680 9,879 5,760 1,416 2,219 1,245 1896 337,661 39,860 2,969 9,921 5,884 1,490 2,498 1,434 1897 341,319 40,079 3,000 9,842 5,395 1,338 2,017 1,295 1898 345,008 42,672 3,205 9,453 5,705 1,504 2,428 1,327 Average of 16 years. 317,912 2,586 9,708 5,654 1,423 2,286 977 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 = 3,109. 4. Average number of persons living on each acre at Census, 1891= 102 5. „ „ „ in 1899=112 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 1899 and 16 years preceding. Year. Birth-rates per 1,000 of the population. Deathrates 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 8 1899 27.70 18.04 19.30 160 246 368 252 1883 34.0 17.6 18.8 132 255 435 86 1884 34.0 17.7 18.9 150 288 462 75 1885 32.3 19.3 20.6 144 224 446 141 1886 32.5 18.0 19.3 154 278 443 150 1887 31.9 18.7 20.0 160 273 468 145 1888 30.9 16.8 18.0 133 244 425 158 1889 30.5 16.1 17.2 132 250 404 171 1890 29.7 19.2 21.0 158 240 417 158 1891 30.6 19.8 21.2 151 234 407 173 1892 29.5 18.8 20.1 148 233 384 172 1893 29.8 19.5 20.9 163 249 398 190 1894 28.7 15.9 17.0 129 233 401 207 1895 29.6 17.2 18.4 143 245 385 216 1896 28.8 17.1 18.3 150 253 424 244 1897 28.8 15.8 16.9 136 248 374 240 1898 27.4 16.5 17.6 159 264 425 233 Average of 16 years 1883-1898 30.6 17.8 19.0 146 251 419 172 * The Death Rates in column 4 are corrected for sex and age distribution for the purpose of contrasting them on an equal basis with those of England. Table C. Showing Deaths from All Causes during the Year 1899. (Deaths of Non-Resident 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 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. I. Specific, Febrile, &c 322 337 78 24 36 30 30 32 33 21 4 .. 659 288 454 493 947 II. Parasitic Diseases 3 .. .. .. .. .. .. .. .. .. .. .. 3 .. 3 .. 3 III. Dietic Diseases 2 1 .. 1 3 9 10 2 3 1 .. .. 3 29 16 16 32 IV. Constitutional Diseases 100 106 39 104 147 166 181 135 107 25 5 .. 206 909 597 518 1115 V. Developmental Diseases 208 .. .. 1 .. .. .. 14 102 249 69 3 208 438 284 362 646 VI. Local Diseases 566 285 78 107 152 254 364 492 448 234 35 3 851 2167 1529 1489 3018 VII. Deaths from Violence 57 28 16 11 10 27 25 25 19 9 2 .. 85 144 154 75 229 VIII. Deaths from Ill-deflned Causes 290 10 1 .. 1 .. .. .. .. 1 .. .. 300 3 180 123 303 TOTALS 1548 767 212 248 349 486 610 700 712 540 115 6 2315 3978 3217 3076 6293 I. Specific or Febrile Causes. 1. Miasmatic Diseases 101 303 77 21 25 26 19 29 25 15 4 .. 404 241 304 341 645 Small Pox Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 27 119 6 1 2 .. .. .. .. .. .. .. 146 9 82 73 155 Scarlet Fever (Scarlatina) .. 22 9 2 2 .. .. .. .. .. .. .. 22 11 18 15 33 Diphtheria 3 70 46 .. .. 1 .. .. .. .. .. .. 73 47 51 69 120 Whooping Cough 66 88 5 .. .. .. .. 1 .. .. .. .. 154 6 70 90 160 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric or Typhoid Fever .. 2 9 14 11 7 4 .. .. .. .. .. 2 45 28 19 47 SimpleContinued&Ill-defined Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza 4 2 2 4 12 17 15 28 24 14 4 .. 6 120 54 72 126 Other Miasmatic Diseases 1 .. .. .. .. 1 .. .. 1 1 .. .. 1 3 1 3 4 2.—Diarrhœal Diseases 208 33 .. .. 1 1 2 2 5 6 .. .. 241 17 133 125 258 Simple Cholera 14 2 .. .. .. .. .. .. .. .. .. .. 16 .. 8 8 16 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhæa, Dysentery 194 31 .. .. 1 1 2 2 5 6 .. .. 225 17 125 117 242 3. -Malarial Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Remittent Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4.-Zoogenous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox, Effects of Vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Splenic Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5. -Venereal Diseases 7 .. .. .. 1 .. 1 .. .. .. .. .. 7 2 5 4 9 Syphilis 7 .. .. .. 1 .. .. .. .. .. .. .. 7 1 4 4 8 Gonorrhoea, Stricture of Urethra .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. 1 6. Septic Diseases 6 l 1 3 9 3 8 1 3 .. .. .. 7 28 12 23 35 Erysipelas 6 1 .. .. .. 1 5 1 2 .. .. .. 7 9 7 9 16 Pyæmia, Septicæmia .. .. 1 .. 2 .. 1 .. 1 .. .. .. .. 5 5 .. 5 Puerperal Fever .. .. .. 3 7 2 2 .. .. .. .. .. .. 14 .. 14 14 II. Parasitic Diseases 3 .. .. .. .. .. .. .. .. .. .. .. 3 .. 3 .. 3 Thrush 3 .. .. .. .. .. .. .. .. .. .. .. 3 .. 3 .. 3 Hydatids .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Worms .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Animal Parasitical Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 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. III. Dietic Diseases 2 1 .. 1 3 9 10 2 3 1 .. .. 3 29 16 16 32 Starvation, Want of Breast Milk 2 1 .. .. .. .. .. .. .. .. .. .. 3 .. 1 2 3 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Alcoholism, Delirium Trem. .. .. .. 1 3 9 10 2 3 1 .. .. .. 29 15 14 29 IV. Constitutional Diseases 100 106 39 104 147 166 181 135 107 25 5 .. 206 909 597 518 1115 Rheumatic Fever & Rheum. of Heart .. 2 6 2 6 5 4 .. .. .. 1 .. 2 24 15 11 26 Rheumatism .. .. .. 1 .. 1 2 .. 3 1 .. .. .. 8 2 6 8 Gout .. .. .. .. .. 1 .. .. 1 2 .. .. .. 4 2 2 4 Rickets 8 14 .. 1 .. 1 .. 1 .. .. .. .. 22 3 15 10 25 Cancer, Malignant Disease .. .. 1 2 8 19 63 85 72 18 2 .. .. 270 104 166 270 Gangrene 3 .. .. .. .. .. 2 1 6 1 2 .. 3 12 7 8 15 Tabes Mesenterica 30 16 4 .. .. .. .. .. .. .. .. .. 46 4 26 24 50 Tuberclr. Meningitis, Hydrocephalus 30 41 12 4 2 .. .. .. .. .. .. .. 71 18 44 45 89 Phthisis 27 28 13 85 127 136 105 42 18 2 .. .. 55 528 359 224 583 Other Tubercular and ScrofulousDis. .. 2 2 1 .. .. .. 1 1 .. .. .. 2 5 6 1 7 Purpura, Hæmorrhagic Diathesis 2 .. .. 1 .. .. 1 .. .. .. .. .. 2 2 2 2 4 Anæmia, Chlorosis, Leucocythæmia .. 2 .. 3 .. 1 1 1 2 1 .. .. 2 9 4 7 11 Glycosuria, Diabetes Mellitus .. 1 1 4 4 2 3 2 3 .. .. .. 1 19 10 10 20 Ot0her Constitutional Diseases .. .. .. .. .. .. .. 2 1 .. .. .. .. 3 1 2 3 V. Developmental Diseases 208 .. .. 1 .. .. .. 14 102 249 69 3 208 438 284 362 646 Premature Birth 187 .. .. .. .. .. .. .. .. .. .. .. 187 .. 103 84 187 Atelectasis 10 .. .. .. .. .. .. .. .. .. .. .. 10 .. 6 4 10 Spina Bifida 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. 2 2 Cyanosis 2 .. .. 1 .. .. .. .. .. .. .. .. 2 1 2 1 3 Congenital Malformations 7 .. .. .. .. .. .. .. .. .. .. .. 7 .. 4 3 7 Old Age .. .. .. .. .. .. .. 14 102 249 69 3 .. 437 169 268 437 VI. Local Diseases. 1.—Diseases of Nervous System 84 41 12 20 25 45 67 79 78 42 4 .. 125 372 255 242 497 Inflammation of Brain or Membranes 16 22 6 4 2 3 3 3 2 .. 1 .. 38 24 40 22 62 Apoplexy 1 1 .. 1 4 6 32 38 43 21 1 .. 2 146 63 85 148 Softening of Brain .. .. .. 1 2 2 4 6 9 1 .. .. .. 25 16 9 25 Hemiplegia 1 1 .. .. .. 1 3 5 5 5 1 .. 2 20 7 15 22 Brain Paralysis .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 1 Insanity, Genl. Paralysis of the Insane .. .. .. 1 9 15 .. 9 2 3 1 .. .. 40 25 15 40 Epilepsy .. .. 1 8 4 6 6 4 2 3 .. .. .. 34 19 15 34 Convulsions 62 8 .. 1 .. .. .. .. .. .. .. .. 70 1 34 37 71 Laryngismus Stridulus 2 5 .. .. .. .. .. .. .. 1 .. .. 7 1 7 1 8 Paralysis Agitans .. .. .. .. .. .. .. .. 1 1 .. .. .. 2 2 .. 2 Paraplegia .. 1 1 1 1 4 12 7 8 5 .. .. 1 39 18 22 40 Diseases of Spinal Cord .. .. 1 1 .. 4 4 5 3 1 .. .. .. 19 10 9 19 Other Diseases of Nervous System. 2 3 3 2 3 4 3 2 2 1 .. .. 5 20 14 11 25 2.—Dis. of Organs of Special Sense 1 1 4 5 .. .. .. .. .. .. .. .. 2 9 7 4 11 Ear, Diseases of 1 1 4 5 .. .. .. .. .. .. .. .. 2 9 7 4 11 Eyes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nose .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3.— Diseases of Circulatory System 10 7 15 34 38 59 72 116 106 56 4 1 17 501 258 260 518 Endocarditis .. .. 1 1 2 2 .. 1 1 .. .. .. .. 8 6 2 8 Valvular Diseases of Heart .. 1 4 8 9 14 17 27 15 15 1 1 1 111 59 53 112 Pericarditis 1 1 .. 5 1 .. .. .. .. .. 2 6 5 3 8 Other Diseases of the Heart 9 5 10 19 20 41 49 84 80 39 3 .. 14 345 172 187 359 Aneurism .. .. .. .. 3 1 1 2 3 .. .. .. .. 10 8 2 10 Embolism, Thrombosis .. .. .. 1 2 .. 2 2 4 2 .. .. .. 13 5 8 13 Other Diseases of Blood Vessels .. .. .. .. 1 1 3 .. 3 .. .. .. .. 8 3 5 8 4.—Diseases of Respiratory System 240 80 23 21 51 79 136 215 194 113 18 2 420 852 628 644 1272 Croup 1 11 1 .. .. .. .. .. .. .. .. .. 12 1 9 4 13 Laryngitis 2 7 1 .. 1 .. .. .. .. .. .. .. 9 2 7 4 11 Bronchitis 124 52 7 2 10 20 70 148 151 93 17 2 176 520 318 378 696 Pneumonia 112 108 14 16 33 46 47 49 33 l6 1 .. 220 255 253 222 475 Pleurisy .. 1 .. 3 3 5 9 3 2 1 .. .. 1 26 15 12 27 Emphysema .. .. .. .. .. .. 2 4 2 1 .. .. .. 9 4 5 9 Asthma .. 1 .. .. 2 3 5 10 5 1 .. .. 1 26 17 10 27 Other Diseases of Respiratory System 1 .. .. .. 2 5 3 1 1 1 .. .. 1 13 5 9 14 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. 1 Under 5 1 Over 5 I Males. Females. Totals. 5.—Diseases of Digestive System 214 52 19 9 17 35 49 47 32 9 4 .. 266 221 263 224 487 Dentition 16 8 .. .. .. .. .. .. .. .. .. .. 24 .. 18 6 24 Sore Throat, Quinsey .. .. .. .. .. .. 1 1 .. .. .. .. .. 2 .. 2 2 Diseases of Stomach 3 2 2 2 3 7 2 6 3 .. .. .. 5 25 11 19 30 Enteritis 159 27 5 1 .. 4 4 4 3 2 .. .. 186 23 112 97 209 Gastritis 13 5 1 1 1 1 3 .. 1 1 .. .. 18 9 15 12 27 Peritonitis 2 4 3 1 7 5 4 1 2 .. .. .. 6 23 15 14 29 Ulceration of Intestines .. 1 .. .. .. 2 .. .. 1 .. .. .. 1 3 1 3 4 Hernia .. .. .. .. 1 1 1 4 8 2 1 .. .. 18 9 9 18 Stricture of Intestines .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 Obstructive Diseases of Intestines 11 2 5 3 2 3 6 6 3 1 3 .. 13 32 29 16 45 Ascites .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. 1 Cirrhosis of Liver .. .. 1 1 1 9 24 17 5 1 .. .. .. 59 25 34 59 Other Diseases of Liver 6 .. 2 .. 2 2 3 6 6 2 .. .. 6 23 21 8 29 Other Diseases of Digestive System 4 2 .. .. .. 1 1 1 .. .. .. .. 6 3 6 3 9 6.—Diseases of Lymphatic System 1 .. 1 .. .. 1 .. .. .. 1 .. .. 1 3 3 1 4 Lymphatics and of Spleen 1 .. 1 .. .. 1 .. .. .. 1 .. .. .. 3 3 1 4 7.—Diseases of Glandlike Organs of Uncertain Use 1 .. .. 2 1 1 .. .. .. .. .. .. 1 4 2 3 5 Bronchocele 1 .. .. 1 .. 1 .. .. .. .. .. .. 1 2 .. 3 3 Addison's Disease .. .. .. 1 1 .. .. .. .. .. .. .. .. 2 2 .. 2 8.—Diseases of Urinary System .. 1 .. 10 10 16 31 28 34 11 5 .. 1 145 88 58 146 Nephritis .. 1 .. 6 2 5 13 12 10 2 1 .. 1 51 33 19 52 Bright's Disease, Albuminuria .. .. .. 2 5 4 14 13 13 4 2 .. .. 57 28 29 57 Disease of Bladder .. .. .. .. 1 2 1 .. 5 3 1 .. .. 13 10 3 13 Disease of Prostate .. .. .. .. .. .. .. 2 3 2 1 .. .. 8 8 .. 8 Other Diseases of the Urinary System .. .. .. 2 2 5 3 1 3 .. .. .. .. 16 9 7 16 9.—Dis. of Re-productive System 4 .. .. 2 10 12 4 1 2 .. .. .. 4 31 3 32 35 A—Of Organs of Generation. Male Organs of Generation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Female Organs of Generation .. .. .. .. .. 4 4 1 2 .. .. .. .. 11 .. 11 11 B—Of Parturition. Abortion. Miscarriage .. .. .. .. 1 1 .. .. .. .. .. .. .. 2 .. 2 2 Puerperal Convulsions .. .. .. 1 1 1 .. .. .. .. .. .. .. 3 .. 3 3 Placenta Prævia, Flooding .. .. .. .. 4 2 .. .. .. .. .. .. .. 6 1 5 6 Other Accidents of Child Birth 4 .. .. 1 4 4 .. .. .. .. .. .. 4 9 2 11 13 10.—Diseases of Bones and Joints 1 1 4 2 .. 4 1 2 2 .. .. .. 2 15 8 9 17 Caries, Necrosis .. .. 1 2 .. 2 .. .. .. .. .. .. .. 5 2 3 5 Arthritis, Ostitis, Periostitis .. .. 1 .. .. 2 .. 2 2 .. .. .. .. 7 4 3 7 Other Diseases of Bones and Joints 1 1 2 .. .. .. .. .. .. .. .. .. 2 2 2 2 4 Spine Diseases •• .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 1 11.—Dis. of Integumentary System 10 2 .. 2 .. 2 4 4 .. 2 .. .. 12 14 14 12 26 Carbuncle .. .. .. .. .. .. 1 1 .. .. .. .. .. 2 1 1 2 Phlegmon .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cellulitis 2 .. .. 1 .. .. 3 3 .. .. .. .. 2 7 5 4 9 Other Dis. of Integumentary System 8 2 .. l .. 2 .. .. .. 2 .. .. 10 5 8 7 15 VII.-Violence 57 28 16 11 10 27 25 25 19 9 2 .. 85 144 154 75 229 1.—Accident or Negligence 51 28 16 11 3 18 17 13 16 8 2 .. 79 104 117 66 183 Fracture and Contusion 3 11 10 8 2 14 12 11 13 6 2 .. 14 78 64 28 92 Gunshot Wound .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. 1 .. Cut, Stab .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Burn and Scald 3 14 5 .. 1 .. .. 1 2 2 .. .. 17 11 12 16 28 Poison .. 1 .. .. .. .. 3 .. .. .. .. .. 1 3 2 2 4 Drowning .. .. .. 1 .. 2 2 .. 1 .. .. .. .. 6 5 1 6 Suffocation 45 2 1 1 .. 2 .. .. .. .. .. .. 47 4 33 18 51 Otherwise .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. 1 2.-Homcide 6 .. .. .. 1 .. 2 .. .. .. .. .. 6 3 7 2 9 Manslaughter .. .. .. .. l .. 2 .. .. .. .. .. .. 3 3 .. 3 Murder 6 .. .. .. .. .. .. .. .. .. .. .. 6 .. 4 2 6 3.—Suicide .. .. .. .. 6 9 6 12 3 1 .. .. .. 37 30 7 37 VIII. Deaths from Ill-defined Causes 290 10 1 .. 1 .. .. .. .. 1 .. .. 300 3 180 123 303 Dropsy .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 1 Hæmorrhage 5 .. .. .. .. .. .. .. .. .. .. .. 5 .. 2 3 5 Debility 81 1 .. .. .. .. .. .. .. .. .. .. 82 .. 52 30 82 Marasmus and Atrophy 162 9 1 .. .. .. .. .. .. .. .. .. 171 1 102 70 172 Inanition 42 .. .. .. .. .. .. .. .. .. .. .. 42 .. 24 18 42 Sudden Death .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other causes not specified or ill-defined .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. 1 1 Totals MALES 866 389 111 152 196 271 302 358 340 199 33 .. 1255 1962 3217 .. .. FEMALES 682 378 101 96 153 215 308 342 372 341 82 6 1060 2016 .. 3076 .. Table D. Shewing the Deaths from All Causes registered in each District during the Fifty-two Weeks ending 30th December, 1899, at three periods of life. Causes of Death. Upper Holloway. Total Islington, South-West. Total. Islington, South-East. Total. Highbury. 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 I. Specific, Febrile, &c. 89 99 99 287 136 135 83 354 52 49 44 145 45 54 62 161 II. Parasitic Diseases .. .. .. .. 2 .. .. 2 .. .. .. .. 1 .. .. 1 III. Dietic Diseases .. .. 11 11 1 .. 9 10 1 .. 5 6 .. 1 4 5 IV. Constitutional Diseases 22 24 243 289 32 48 301 381 20 19 213 252 26 15 152 193 V. Developmental Diseases 54 .. 127 181 73 .. 153 226 43 .. 81 124 38 .. 77 115 VI. Local Diseases 153 75 572 800 213 93 705 1011 116 75 476 667 84 42 414 540 VII. Deaths from Violence 11 5 34 50 21 9 52 82 13 7 35 55 12 7 23 42 VII. Deaths from Ill-defined Causes 78 2 .. 80 112 6 .. 118 68 .. 1 69 32 2 2 36 TOTALS 407 205 1086 1698 590 291 1303 2184 313 150 855 1318 238 121 734 1093 I. Specific or Febrile Causes. 1.—Miasmatic Diseases 26 90 86 202 42 117 67 226 15 45 32 92 18 51 56 125 Small Pox Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 12 29 3 44 7 50 2 59 2 16 .. 18 6 24 4 34 Scarlet Fever (Scarlatina) .. 2 2 4 .. 13 4 17 .. 2 1 3 .. 5 4 9 Diphtheria 1 36 30 67 .. 15 5 20 2 12 3 17 .. 7 9 16 Whooping Cough 12 22 1 35 33 38 2 73 10 15 2 27 11 13 1 25 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric or Typhoid Fever .. 1 17 18 .. .. 12 12 .. .. 6 6 .. 1 10 11 Simple Continued & Ill-DEfined Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza 1 .. 30 31 2 1 42 45 .. .. 20 20 1 1 28 30 Other Miasmatic Diseases .. .. 3 3 .. .. .. .. 1 .. .. 1 .. .. .. .. 2.—Diarrhœal Diseases 61 8 7 76 89 18 5 112 33 4 3 40 25 3 2 30 Simple Cholera 11 2, .. 13 1 .. .. 1 1 .. .. 1 1 .. .. 1 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea, Dysentery 50 6 7 63 88 18 5 111 32 4 3 39 24 3 2 29 3.-Malarial Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Remittent Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4.—Zoogenous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox, Effects of Vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Splenic Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. V.-Venereal Diseases 1 .. .. 1 3 .. 2 5 2 .. .. 2 1 .. .. 1 Syphilis 1 .. .. 1 3 .. 1 4 2 .. .. 2 1 .. .. 1 Gonorrhœa, Stricture of Urethra .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 6. Septic Diseases 1 1 6 8 2 .. 9 11 2 .. 9 11 1 .. 4 5 Erysipelas 1 1 2 4 2 .. 1 3 2 .. 5 7 1 .. 1 2 Pyæmia, Septicaemia .. .. 1 1 .. .. 1 1 .. .. 2 2 .. .. 1 1 Puerperal Fever .. .. 3 3 .. .. 7 7 .. .. 2 2 .. .. 2 2 II.-Parasitic Diseases .. .. .. .. 2 .. .. 2 .. .. .. .. 1 .. .. 1 Thrush .. .. .. .. 2 .. .. 2 .. .. .. .. 1 .. .. 1 Hydatids .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Worms .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Animal Parasitical Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Table D.—Continued. Causes of Death. Upper Holloway. Total. Islington, South-West. Total. Islington South-East. Total. Highbury. 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 .. .. 11 11 1 .. 9 10 1 .. 5 6 .. 1 4 5 Starvation, Want of Breast Milk .. .. .. .. 1 .. .. 1 1 .. .. 1 .. 1 .. 1 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Alcoholism, Delirium Trem. .. .. 11 11 .. .. 9 9 .. .. 5 5 .. .. 4 4 IV. Constitutional Diseases 22 24 243 289 32 48 301 381 20 19 213 252 26 15 152 193 Rheumatic Fever, & Rheum. of Heart .. 1 7 8 .. .. 6 6 .. .. 6 6 .. 1 5 6 Rheumatism .. .. 3 3 .. .. 2 2 .. .. 2 2 .. .. 1 1 Gout .. .. .. .. .. .. 1 1 .. .. 2 2 .. .. 1 1 Rickets 2 1 1 4 2 8 2 12 2 2 .. 4 2 3 .. 5 Cancer, Malignant Disease .. .. 90 90 .. .. 81 81 .. .. 49 49 .. .. 50 50 Gangrene 1 .. 2 3 1 .. 3 4 1 .. 4 5 .. .. 3 3 Tabes Mesenterica 8 4 2 14 9 9 .. 18 6 3 2 11 7 .. .. 7 Tuberclr. Meningitis, Hydrocephalus 7 10 6 23 10 18 7 35 3 9 2 14 10 4 3 17 Phthisis 3 6 121 130 9 10 190 209 8 5 137 150 7 7 80 94 Other Tubercular and Scrofulous Dis. .. 2 2 4 .. .. 2 2 .. .. .. .. .. .. 1 1 Purpura, Hæmorrhagic Diathesis 1 .. .. 1 1 .. .. 1 .. .. 1 1 .. .. 1 1 Anæmia, Chlorosis, Leucocythæmia .. .. 4 4 .. 2 1 3 .. .. 3 3 .. .. 1 1 Glycosuria, Diabetes Mellitus .. .. 5 5 .. 1 5 6 .. .. 4 4 .. .. 5 5 Other Constitutional Diseases .. .. .. .. .. .. 1 1 .. .. 1 1 .. .. 1 1 V. Developmental Diseases 54 .. 127 181 73 .. 153 226 43 .. 81 124 38 .. 77 l15 Premature Birth 46 .. .. 46 67 .. .. 67 39 .. .. 39 35 .. .. 35 Atelectasis 2 .. .. 2 3 .. .. 3 4 .. .. 4 1 .. .. 1 Spina Bifida 1 .. .. 1 1 .. .. 1 .. .. .. .. .. .. .. .. Cyanosis .. .. .. .. 2 .. 1 3 .. .. .. .. .. .. .. .. Congenital Malformations 5 .. .. 5 .. .. .. .. .. .. .. .. 2 .. .. 2 Old Age .. .. 127 127 •• .. 152 152 .. .. 81 81 .. .. 77 77 VI. Local Diseases. 1.—Diseases of Nervous System 16 8 107 131 36 13 110 159 19 10 79 108 13 10 76 99 Inflammation of Brain or Membranes 8 5 4 17 5 7 10 22 1 5 4 10 2 5 6 13 Apoplexy .. .. 40 40 1 1 41 43 .. .. 38 38 .. .. 27 27 Softening of Brain .. .. 6 6 .. .. 7 7 .. .. 8 8 .. .. 4 4 Hemiplegia .. .. 6 6 1 1 4 6 .. .. 6 6 .. .. 4 4 Brain Paralysis .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. Insanity, Genl. Paralysis of the Insane .. .. 12 12 .. .. 10 10 .. .. 5 5 .. .. 13 13 Epilepsy .. .. 11 11 .. .. 14 14 .. .. 3 3 .. .. 6 6 Convulsions 6 2 .. 8 27 1 .. 28 18 2 1 21 11 3 .. 14 Laryngismus Stridulus 1 .. 1 2 1 1 .. 2 .. 2 .. 2 .. 2 .. 2 Paralysis Agitans .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 1 Paraplegia .. .. 13 13 .. 1 12 13 .. .. 8 8 .. .. 6 6 Diseases of Spinal Cord .. .. 6 6 .. .. 6 6 .. .. .. .. .. .. 7 7 Other Diseases of Nervous System 1 1 8 10 1 1 4 6 .. 1 6 7 .. .. 2 2 2.—Dis. of Organs of Special Sense .. 1 2 3 1 .. 1 2 .. .. 2 2 .. .. 4 4 Ear, Diseases of .. 1 2 3 1 .. 1 2 .. .. 2 2 .. .. 4 4 Eyes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Noses .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3.—Diseases of Circulatory System 2 3 138 143 5 4 156 165 3 .. 109 112 .. .. 98 98 Endocarditis .. .. .. .. .. .. 5 5 .. .. 3 3 .. .. .. .. Valvular Diseases of Heart .. 1 29 30 .. .. 40 40 .. .. 20 20 .. .. 22 22 Pericarditis 1 .. 1 2 .. 1 1 2 .. .. 1 1 .. .. 3 3 Other Diseases of the Heart 1 2 102 105 5 3 99 107 3 .. 80 83 .. .. 64 64 Aneurism .. .. 3 3 .. .. 3 3 .. .. 1 1 .. .. 3 3 Embolism, Thrombosis .. .. .. .. .. .. 6 6 .. .. 3 3 .. .. 4 4 Other Diseases of Blood Vessels .. .. 3 3 .. .. 2 2 .. .. 1 1 .. .. 2 2 4.—Diseases of Respiratory System 71 47 203 321 84 58 294 436 47 52 209 308 38 23 146 207 Croup .. 1 .. 1 1 6 .. 7 .. 3 1 4 .. 1 .. 1 Laryngitis 1 3 .. 4 1 2 1 4 .. 2 .. 2 .. .. 1 1 Bronchitis 30 10 121 161 46 12 175 233 27 23 135 185 21 7 89 117 Pneumonia 40 33 62 135 35 36 98 169 20 24 53 97 17 15 42 74 Pleurisy .. .. 9 9 .. 1 12 13 .. .. 3 3 .. .. 2 2 Emphysema .. .. 3 3 .. .. .. .. .. .. 5 5 .. .. 1 1 Asthma .. .. 4 4 .. 1 5 6 .. .. 9 9 .. .. 8 8 Other Diseases of Respiratory System .. .. 4 4 1 .. 3 4 .. .. 3 3 .. .. 3 3 Table D.—Continued Causes of Death. Upper Hollo way. Total. Islington, South-West. Total. Islington South-East. Total. Highbury. 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 60 14 57 131 81 18 75 174 45 12 49 106 28 8 40 76 Dentition 4 2 .. 6 7 2 .. 9 3 3 .. 6 2 1 .. 3 Sore Throat, Quinsey .. .. 1 1 .. .. .. .. .. .. 1 1 .. .. .. .. Diseases of Stomach 1 2 4 7 1 .. 8 9 1 .. 9 10 .. .. 4 4 Enteritis 42 6 7 55 63 13 6 82 35 5 6 46 19 3 4 26 Gastritis 6 1 3 10 3 1 3 7 2 2 2 6 2 1 1 4 Peritonitis .. 1 7 8 1 .. 10 11 1 2 4 7 .. 1 2 3 Ulceration of Intestines .. .. 2 2 .. 1 .. 1 .. .. 1 1 .. .. .. .. Hernia .. .. 5 5 .. .. 5 5 .. .. 3 3 .. .. 5 5 Stricture of Intestines .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Obstructive Diseases of Intestines 4 2 8 14 5 .. 7 12 1 .. 7 8 1 .. 10 11 Ascites .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. Cirrhosis of Liver .. .. 14 14 .. .. 26 26 .. .. 10 10 .. .. 9 9 Other Diseases of Liver 2 .. 5 7 .. .. 7 7 1 .. 6 7 3 .. 5 8 Other Diseases of Digestive System. 1 .. 1 2 1 1 2 4 1 .. .. 1 1 1 .. 2 6.—Diseases of Lymphatic System .. .. 1 1 .. .. 1 1 1 .. .. 1 .. .. 1 1 Lymphatics and of Spleen .. .. 1 1 .. .. 1 1 l .. .. 1 .. .. 1 1 7.-Diseases of Glandlike Organs of Uncertain Use .. .. .. .. .. .. 2 2 .. .. 2 2 1 .. .. 1 Bronchocele .. .. .. .. .. .. 1 1 .. .. 1 1 1 .. .. 1 Addison's Diseases .. .. .. .. .. .. 1 1 .. .. 1 1 .. .. .. .. 3.—Diseases of Urinary System .. .. 47 47 .. .. 50 50 .. 1 19 20 .. .. 29 29 Nephritis .. .. 15 15 .. .. 22 22 .. 1 7 8 .. .. 7 7 Bright's Disease, Albuminuria .. .. 18 18 .. .. lb 16 .. .. 10 10 .. .. 13 13 Disease of Bladder .. .. 4 4 .. .. 4 4 .. .. 1 1 .. .. 4 4 Disease of Prostrate .. .. 5 5 .. .. .. .. .. .. .. .. .. .. 3 3 Other Diseases of the Urinary System .. .. 5 5 .. .. 8 8 .. .. 1 1 .. .. 2 2 9.—Dis. of Re-productive System 2 .. 10 12 2 .. 7 9 .. .. 5 5 .. .. 9 9 A-Of Organs of Generation. Male Organs of Generation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Female Organs of Generation .. .. 4 4 .. .. 1 1 .. .. 3 3 .. .. 3 3 B—Of Parturition. Abortion, Miscarriage .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 1 Puerperal Convulsions .. .. 1 1 .. .. .. .. .. .. 1 1 .. .. 1 1 Placenta Prævia, Flooding .. .. 1 1 .. .. 4 4 .. .. .. .. .. .. 1 1 Other Accidents at Child Birth 2 .. 3 5 2 .. 2 4 .. .. 1 1 .. .. 3 3 10. Diseases of Bones and Joints .. .. 5 5 .. .. 2 2 .. .. 2 2 1 1 6 8 Caries, Necrosis .. .. 3 3 .. .. .. .. .. .. 1 1 .. .. 1 1 Anthritis, Ostitis, Periostitis .. .. 1 1 .. .... 1 1 .. .. 1 1 .. .. 4 4 Other Diseases of Bones and Joints. .. .. 1 1 .. .. l 1 .. .. .. .. 1 1 .. 2 Spine Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 11.—Dis. of Integumentary System 2 2 2 6 4 .. 7 11 1 .. .. 1 3 .. 5 8 Carbuncle .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 1 Phlegmon .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cellulitis .. .. 2 2 2 .. 4 6 .. .. .. .. .. .. 1 1 Other Dis. of Integumentary System 2 2 .. 4 2 • • 2 4 1 .. .. 1 3 .. 3 6 11. Violence 11 5 34 50 21 9 52 82 13 7 35 55 12 7 23 42 1. Accident or Negligence 8 5 22 35 20 9 41 70 13 7 23 43 10 7 18 35 Fracture and Contusion .. 2 l6 18 3 6 32 41 .. 3 17 20 .. .. 13 13 Gunshot Wound .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. Cut, Stab .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Burn and Scald .. 2 4 6 1 2 3 6 .. 4 2 6 2 6 2 10 Poison .. 1 .. 1 .. .. 1 1 .. .. .. .. .. .. 2 2 Drowning .. .. 1 1 .. .. 2 2 .. .. 3 3 .. .. .. .. Suffocation 8 .. 1 9 16 1 3 20 13 .. .. 13 8 1 .. 9 Otherwise .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 2.- Homicide 3 .. 2 5 1 .. .. 1 .. .. 1 1 2 .. .. 2 Manslaughter .. .. 2 2 .. .. .. .. .. .. 1 1 .. .. .. .. Murder 3 .. .. 3 1 .. .. 1 .. .. .. .. 2 .. .. 2 3.—Suicide .. .. 10 10 .. .. 11 11 .. .. 11 11 .. .. 5 5 VIII. Deaths from Ill-defined Causes 78 2 .. 80 112 6 .. 118 68 .. 1 69 32 2 2 36 Dropsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Hæmorrhage 2 .. .. 2 2 .. .. 2 1 .. .. 1 .. .. .. .. Debility 21 1 .. 22 24 .. .. 24 24 .. .. 24 12 .. .. 12 Marasmus and Atrophy 38 1 .. 39 74 6 .. 80 35 .. 1 36 l5 2 .. 17 Inanition 17 .. .. 17 12 .. .. 12 8 .. .. 8 5 .. .. 5 Sudden Death .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other causes not specified or ill-defined .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 r Table E. Showing the Deaths from All Causes registered in each Quarter during the 52 weeks ending 30th December 1899 at three periods of life. Causes of Death. 1st Quarter. Total. 2nd Quarter. Total. 3rd Quarter. Total. 4th Quarter. Total. Total for Year. 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 34 85 71 190 38 78 55 171 219 93 59 371 31 81 103 215 947 II. Parasitic Diseases 1 .. .. 1 1 .. .. 1 1 .. .. 1 .. .. .. .. 3 III. Dietic Diseases 1 .. 6 7 1 1 8 10 .. .. 10 10 .. .. 5 5 32 IV. Constitutional Diseases 15 26 231 272 24 27 222 273 39 26 223 288 22 27 233 282 1115 V. Developmental Diseases 45 .. 160 205 50 .. 88 138 58 .. 73 131 55 .. 117 172 646 VI. Local Diseases 125 98 657 880 74 54 447 575 206 61 362 629 161 72 701 934 3018 VII. Deaths from Violence 13 5 32 50 19 5 36 60 7 10 32 49 18 8 44 70 229 V111. Deaths from Ill-defined Causes 74 2 .. 76 49 2 2 53 92 1 .. 93 75 5 1 81 303 TOTALS 308 216 1157 1681 256 167 858 1281 622 191 759 1572 362 193 1204 1759 6293 I. Specific or Febrile Causes. 1.—Miasmatic Diseases 31 85 67 183 31 76 47 154 23 64 39 126 16 78 88 182 645 Small Pox Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 4 40 1 45 9 38 6 53 7 18 1 26 7 23 1 31 l55 Scarlet Fever (Scarlatina) .. 2 1 3 .. 3 2 5 .. 5 4 9 .. 12 4 16 33 Diphtheria .. 8 4 12 .. 6 7 13 1 26 19 46 2 30 17 49 120 Whooping Cough 24 34 3 61 20 28 2 50 l5 15 1 31 7 11 .. 18 160 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric or Typhoid Fever .. 1 8 9 .. .. 5 5 .. .. 10 10 .. 1 22 23 47 Simple Continued & Ill-defined Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza 2 .. 50 52 2 1 22 25 .. .. 4 4 .. 1 44 45 126 Other Miasmatic Diseases 1 .. .. 1 .. .. 3 3 .. .. .. .. .. .. .. .. 4 2.—Diarrhœal Diseases 1 .. .. 1 5 2 .. 7 194 29 13 236 8 2 4 14 258 Simple Cholera .. .. .. .. .. .. .. .. 14 2 .. 16 .. .. .. .. 16 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery 1 .. .. 1 5 2 .. 7 180 27 13 220 8 2 4 14 242 3.—Malarial Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Remittent Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4.—Zoogenous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox, Effects of Vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Splenic Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5.—Venereal Diseases 2 .. 1 3 1 .. .. 1 1 .. 1 2 3 .. .. 3 9 Syphillis 2 .. 1 3 1 .. .. 1 1 .. .. 1 3 .. .. 3 8 Gonorrhoea, Stricture of Urethra .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 6.—Septic Diseases .. .. 3 3 1 .. 8 9 1 .. 6 7 4 1 11 16 35 Erysipelas .. .. .. .. 1 .. 2 3 1 .. 2 3 4 1 5 10 16 Pyaemia, Septicaemia .. .. 1 1 .. .. 2 2 .. .. 2 2 .. .. .. .. 5 Puerperal Fever .. .. 2 2 .. .. 4 4 .. .. 2 2 .. .. 6 6 14 II. Parasitic Diseases 1 .. .. 1 1 .. .. 1 1 .. .. 1 .. .. .. .. 3 Thrush 1 .. .. 1 1 .. .. 1 1 .. .. 1 .. .. .. .. 3 Hydatids .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Worms .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Animal Parasitical Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Table E.—Continued. Causes of Death. 1st Quarter. Total. 2nd Quarter. Total. 3rd Quarter. Total. 4th Quarter. Total. Total for Year. 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 Diteases 1 .. 6 7 1 1 8 10 .. •• 10 10 .. .. 5 5 32 Starvation, Want of Breast Milk 1 .. .. 1 1 1 .. 2 .. .. .. .. .. •• .. .. 3 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Alcoholism, Delirium Trem .. .. 6 6 .. •• 8 8 .. .. 10 10 •• •• 5 5 29 IV. Constitutioual Diseases 15 26 231 272 24 27 222 273 39 26 223 288 22 27 233 282 1115 Rheumatic Fever, & Rheum of Heart .. .. 3 3 .. .. 4 4 .. 2 9 11 .. .. 8 8 26 Rheumatism .. .. 5 5 .. .. .. .. .. .. 2 2 .. .. 1 1 8 Gout .. .. 2 2 .. .. 2 2 .. .. .. .. .. .. .. .. 4 Rickets .. 6 .. 6 2 6 2 10 3 1 .. 4 3 1 1 5 25 Cencer, Malignant Disease .. .. 58 58 .. .. 65 65 .. .. 76 76 .. .. 71 71 270 Gangrene 1 .. 3 4 .. .. 2 2 .. .. 5 5 2 .. 2 4 15 Tabes Mesenterica 4 3 1 8 10 4 2 16 12 3 1 16 4 6 .. 10 50 Tuberclr. Meningitis, Hydrocephalus 2 9 1 12 5 10 8 23 17 15 5 37 6 7 4 17 89 Phthisis 7 8 150 165 7 5 127 139 6 4 115 125 7 11 136 154 583 Other Tubercular & Scrofulous Dis. .. .. 1 1 .. 1 1 2 .. 1 1 2 .. .. 2 2 7 Purpura, Hæmorrhagic Diathesis 1 .. .. 1 .. .. .. .. 1 .. 2 3 .. .. .. .. 4 Anæmia, Chlorosis, Leucocythæmia .. .. 2 2 .. 1 3 4 .. .. 2 2 .. 1 2 3 11 Glycosuria, Diabetes Mellitus .. .. 5 5 .. .. 3 3 .. .. 5 5 .. 1 6 7 20 Other Constitutional Diseases .. .. .. .. .. .. 3 3 .. .. .. .. .. .. .. .. 3 V. Developmental Diseases 45 .. 160 205 50 .. 88 138 58 .. 73 131 55 .. 117 172 646 Premature Birth 37 .. .. 37 45 .. .. 45 54 .. .. 54 51 .. .. 51 187 Atelectasis 4 .. .. 4 2 .. .. 2 1 .. .. 1 3 .. .. 3 10 Spina Bifida .. .. .. .. .. .. .. .. 2 .. .. 2 .. .. .. .. 2 Cyanosis 1 .. .. 1 1 .. .. 1 .. .. 1 1 .. .. .. .. 3 Congenital Malformations 3 .. .. 3 2 .. .. 2 1 .. .. 1 1 .. .. 1 7 Old Age .. .. 160 160 .. .. 88 88 .. .. 72 72 .. .. 117 117 437 VI. Local Diseases. 1.—Diseases of Nervous System 18 14 102 134 16 10 86 112 26 12 76 114 24 5 108 137 497 Inflammation of Brain or Membranes 2 3 4 9 5 8 5 18 7 7 8 22 2 4 7 13 62 Apoplexy .. 1 42 43 .. .. 31 31 .. .. 29 29 1 .. 44 45 148 Softening of Brain .. .. 8 8 .. .. 7 7 .. .. 5 5 .. .. 5 5 25 Hemiplegia .. .. 3 3 .. .. 3 3 .. 1 5 6 1 .. 9 10 22 Brain Paralysis .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Insanity, Genl, Paralysis of the Insane .. .. 10 10 .. .. 12 12 .. .. 7 7 .. .. 11 11 40 Epilepsy .. .. 9 9 .. .. 7 7 .. .. 7 7 .. .. 11 11 34 Convulsions 14 3 .. 17 11 1 1 13 19 3 .. 22 18 1 .. 19 71 Laryngismus Stridulous 1 5 1 7 .. .. .. .. .. .. .. .. 1 .. .. 1 8 Paralysis Agitans .. .. .. .. .. .. 2 2 .. .. .. .. .. .. .. .. 2 Paraplegia .. .. 14 14 .. 1 10 11 .. .. 5 5 .. .. 10 10 40 Diseases of Spinal Cord .. .. 5 5 .. .. 4 4 .. .. 5 5 .. .. 5 5 19 Other Diseases of Nervous System 1 2 5 8 .. .. 4 4 .. 1 5 6 1 .. 6 7 25 2—Dis. of Organs of Special Sense. 1 1 3 5 .. .. 2 2 .. .. 1 1 .. .. 3 3 11 Ear, Diseases of 1 1 3 5 .. .. 2 2 .. .. 1 1 .. .. 3 3 11 Eyes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nose .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3.-Diseases of Circulatory System 2 3 134 139 4 1 109 114 1 .. 103 104 3 3 155 161 518 Endocarditis .. .. 2 2 .. .. 1 1 .. .. 2 2 .. .. 3 3 8 Valvular Diseases of Heart .. .. 26 26 .. .. 27 27 .. .. 21 21 .. 1 37 38 112 Pericarditis 1 .. .. 1 .. .. 1 1 .. .. 3 3 .. 1 2 3 8 Other Diseases of the Heart 1 3 99 103 4 1 72 77 1 .. 69 70 3 1 105 109 359 Aneurism .. .. 2 2 .. .. 3 3 .. .. 2 2 .. .. 3 3 10 Embolism, Thrombosis .. .. 4 4 .. .. 2 2 .. .. 3 3 .. .. 4 4 13 Other Diseases of Blood Vessels .. .. 1 1 .. .. 3 3 .. .. 3 3 .. •• 1 1 8 4.-Diseases of Respiratory System 75 70 302 447 35 33 154 222 27 23 73 123 103 54 323 480 1272 Croup 1 3 .. 4 .. 4 .. 4 .. 3 .. 3 .. 1 1 2 13 Laryngits 2 3 .. 5 .. 3 1 4 .. 1 1 2 .. .. .. .. 11 Bronchitis 34 21 201 256 17 11 77 105 14 3 30 47 59 17 212 288 696 Pneumonia 37 43 78 158 18 15 63 96 13 15 32 60 44 35 82 161 475 Pleurisy .. .. 6 6 .. .. 6 6 .. .. 7 7 .. 1 7 8 27 Emphysema .. .. 4 4 .. .. 1 1 .. .. .. .. .. .. 4 4 9 Asthma .. .. 10 10 .. .. 2 2 .. 1 1 2 .. .. 13 13 27 Other Diseases of Respiratory System 1 .. 3 4 .. .. 4 4 .. .. 2 2 .. .. 4 4 14 R 2 Table E.—Continued. Causes of Death. 1st Quarter. Total. 2nd Quarter. Total. 3rd Quarter. Total. 4th Quarter. Total. Total for Year. 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 23 8 50 81 17 9 49 75 148 26 62 236 26 9 60 95 487 Dentition 4 5 .. 9 5 1 .. 6 3 1 .. 4 4 1 .. 5 24 Sore Throat, Quinsey .. .. 1 1 .. .. .. .. .. .. 1 1 .. .. .. .. 2 Diseases of Stomach 1 .. 7 8 .. 1 7 8 .. 1 5 6 2 .. 6 8 30 Enteritis 10 1 2 13 7 2 3 12 129 21 13 163 13 3 5 21 209 Gastritis 2 1 .. 3 3 1 2 6 6 2 4 12 2 1 3 6 27 Peritonitis 1 .. 9 10 .. 1 7 8 1 .. 6 7 .. 3 1 4 29 Ulceration of Intestines .. .. 1 1 .. 1 .. 1 .. .. .. .. .. .. 2 2 4 Hernia .. .. 4 4 .. .. 4 4 .. .. 3 3 .. .. 7 7 18 Stricture of Intestines .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 Obstructive Diseases of Intestines 4 .. 6 10 1 1 6 8 2 1 8 11 4 .. 12 16 45 Ascites .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 Cirrhosis of Liver .. .. 16 16 .. .. 13 13 .. .. 16 16 .. .. 14 14 59 Other Diseases of Liver .. .. 3 3 1 .. 7 8 5 .. 4 9 .. .. 9 9 29 Other Diseases of Digestive System 1 1 1 3 .. 1 .. 1 2 .. 1 3 1 .. 1 2 9 6.—Diseases of Lymphatic System .. .. .. .. .. .. 2 2 .. .. 1 1 1 .. .. 1 4 Lymphatics and of Spleen .. .. .. .. .. .. 2 2 .. .. 1 1 1 .. .. 1 4 7.—Diseases of Glandlike Organs of Uncertain Use .. .. 1 1 .. .. .. .. .. .. 1 1 1 .. 2 3 5 Bronchocele .. .. 1 1 .. .. .. .. .. .. .. .. 1 .. 1 2 3 Addison's Disease .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 1 1 2 8.—Diseases of Urinary System .. .. 48 48 .. 1 29 30 .. .. 31 31 .. .. 37 37 146 Nephritis .. .. 19 19 .. 1 7 8 .. .. 10 10 .. .. 15 15 52 Bright's Disease, Albuminuria .. .. 21 21 .. .. 9 9 .. .. 12 12 .. .. l5 l5 57 Disease of Bladder .. .. 4 4 .. .. 3 3 .. .. 3 3 .. .. 3 3 13 Disease of Prostate .. .. 2 2 .. .. 3 3 .. .. 1 1 .. .. 2 2 8 Other Diseases of the Urinary System •• .. 2 2 .. .. 7 7 .. .. 5 5 .. .. 2 2 16 9.—Dis. of Re-productive System l .. 6 7 .. .. 10 10 1 .. 7 8 2 .. 8 10 35 A—Of Organs of Generation. Male Organs of Generation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Female Organs of Generation .. .. 2 2 .. .. 1 1 .. .. 3 3 .. .. 5 5 11 B—Of Parturition. Abortion, Miscarriage .. .. .. .. .. .. 2 2 .. .. .. .. .. .. .. .. 2 Puerperal Convulsions .. .. .. .. .. .. 2 2 .. .. 1 1 .. .. .. .. 3 Placenta Prævia, Flooding .. .. 1 1 .. .. 1 1 .. .. 3 3 .. .. 1 1 6 Other Accidents of Child Birth l .. 3 4 .. .. 4 4 1 .. .. 1 2 .. 2 4 13 10.-Diseases of Bones and Joints .. 1 4 5 .. .. 5 5 l .. 4 5 .. .. 2 2 17 Caries, Necrosis .. .. 1 1 .. .. 2 2 .. .. 1 1 .. .. 1 1 5 Arthritis, Ostitis, Periostitis .. .. 2 2 .. .. 2 2 .. .. 2 2 •• .. 1 1 7 Other Diseases of Bones and Joints. .. 1 1 2 .. .. .. .. 1 .. 1 2 .. .. .. .. 4 Spine Diseases .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 11.—Dis. of Integumentary System 5 1 7 13 2 .. 1 3 2 .. 3 5 1 1 3 5 26 Carbuncle .. .. 2 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 Phlegmon .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cellulitis 1 .. 2 3 1 .. .. 1 .. .. 3 3 .. .. 2 2 9 Other Dis. of Integumentary System 4 1 3 8 1 .. 1 2 2 .. .. 2 1 1 1 3 15 VII. Violence 13 5 32 50 19 5 36 60 7 10 32 49 18 8 44 70 229 1.-Accident or Negligence 10 5 25 40 19 5 24 48 5 10 22 37 17 8 33 58 183 Fracture and Contusion .. 1 16 17 .. 3 17 20 1 5 20 26 2 2 25 29 92 Gunshot Wound .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 Cut, Stab .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Burn and Scald 2 3 6 11 .. 2 .. 2 .. 4 .. 4 1 5 5 11 28 Poison .. .. .. .. .. .. 2 2 .. 1 1 2 .. .. .. .. 4 Drowning .. .. 1 1 .. .. 3 3 .. .. 1 1 .. .. 1 1 6 Suffocation 8 1 1 10 19 .. 2 21 4 .. .. 4 14 1 1 16 51 Otherwise .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 2.-Homicide 3 .. 1 4 .. .. 1 1 2 .. 1 3 1 .. .. l 9 Manslaughter .. .. 1 1 .. .. 1 1 .. .. 1 1 .. .. .. .. 3 Murder 3 .. .. 3 .. .. .. .. 2 .. .. 2 1 .. .. 1 6 3.—Suicide .. .. 6 6 .. .. 11 11 .. .. 9 9 .. .. 11 11 37 VIII.—Deaths from Ill-defined Causes 74 2 .. 76 49 2 2 53 92 1 .. 93 75 5 1 81 303 Dropsy .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 Hæmorrhage .. .. .. .. 2 .. .. 2 2 .. .. 2 1 .. .. 1 5 Debility 26 1 .. 27 15 .. .. 15 19 .. .. 19 21 .. .. 21 82 Marasmus and Atrophy 36 1 .. 37 24 2 •• 26 63 1 .. 64 39 5 1 45 172 Inanition 12 .. .. 12 8 .. •• 8 8 .. .. 8 14 .. .. 14 42 Sudden Death .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other causes not specified or ill-defined .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 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 † 1884 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 † 1885 297,867 under 5 years 592 749 217 706 530 1,197 172 191 36 268 55 102 5,740 19.3 above 5 „ 157 489 667 19 232 47 † 1886 301,512 under 5 years 313 396 292 772 495 1,201 291 307 49 231 57 127 5,434 18.0 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 5,699 18.7 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 5,197 16.8 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 5,035 16.1 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 6,198 19.6 above 5 „ 80 525 837 15 168 93 † 1891 319,991 under 5 years 486 587 207 717 624 1,476 131 146 82 263 65 133 6,326 19.8 above 5 „ 101 510 852 15 181 68 † 1892 323,451 under 5 years 378 481 198 677 509 1,301 143 156 88 270 71 139 6,075 18.8 above 5 „ 103 479 792 13 182 68 1893 326,958 under 5 years 466 634 224 758 452 1,313 223 237 136 379 84 206 6,391 19.5 above 5 „ 168 534 861 14 243 122 1894 330,485 under 5 years 547 703 176 673 420 973 84 93 131 330 78 173 5,263 15.9 above 5 „ 156 497 553 9 199 95 1895 334,058 under 5 years 341 450 240 763 461 1,131 172 188 168 389 76 191 5,760 172 above 5 „ 109 523 670 16 221 115 1896 337,661 under 5 years 693 875 218 730 494 997 141 153 158 380 80 206 5,884 17.1 above 5 „ 182 512 503 12 222 126 1897 341,319 under 5 years 328 448 178 689 419 975 161 174 151 380 69 186 5,395 15.8 above 5 „ 120 511 556 13 229 117 1898 345,008 under 5 years 557 647 179 686 426 1,013 266 283 208 409 68 174 5,705 16.5 above 5 „ 90 507 587 17 201 106 1899 348,731 under 5 years 397 515 174 729 420 1,272 241 258 266 487 85 229 6,293 18.0 above 5 „ 118 555 852 17 221 144 *This includes Small-Pox, Measles, Scarlatina, Typhoid Fever, Diphtheria and Whooping Cough † The3 deaths in these years do not include those of residents occurring in outlying institutions. 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 11 15 26 20 16 36 30 24 54 27 28 55 88 83 171 South West Islington 31 17 48 23 17 40 39 21 60 42 29 71 135 84 219 South East Islington 10 8 18 20 10 30 23 12 35 22 16 38 75 46 121 Highbury 10 9 19 11 10 21 7 9 16 16 10 26 44 38 82 The Parish 62 49 111 74 53 127 99 66 165 107 83 190 342 251 593 TABLE H. (Local Government Board Return). Deaths during the year 1899 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. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Upper Holloway 1,698 407 205 72 70 540 404 Under 5 .. 2 37 .. .. 1 .. .. .. 13 2 41 34 56 1 9 113 5 1 16 281 612 5 upwds .. 2 30 .. .. 17 .. .. 3 .. 2 3 1 7 7 121 192 138 30 34 499 1,086 Islington, South West 2,184 590 291 63 85 745 410 Under 5 .. 13 15 4 .. .. .. .. .. 1 2 57 71 106 .. 19 130 9 3 30 421 881 5 upwds .. 4 5 .. .. 12 .. .. 5 .. 1 2 2 5 6 190 285 156 42 52 536 1,303 Islington, South East 1,318 313 150 39 49 484 283 Under 5 .. 2 14 2 .. .. .. .. .. 1 2 18 25 36 .. 13 94 3 .. 20 233 463 5 upwds .. 1 3 1 .. 6 .. .. 2 .. 5 .. 2 3 6 137 191 109 20 35 334 855 Highbury 1,093 238 121 38 44 376 276 Under 5 .. 5 7 1 .. 1 .. .. .. 1 1 30 24 27 1 14 60 .. 2 19 166 359 5 upwds .. 4 9 .. .. 10 .. .. 2 .. 1 4 1 2 5 80 133 98 28 23 334 734 Totals 6,293 1,548 767 212 248 2,145 1,373 Under 5 .. 22 73 7 .. 2 .. .. .. 16 7 146 154 225 2 55 397 17 6 85 1,101 2,315 5 upwds .. 11 47 1 .. 45 .. .. 12 .. 9 9 6 17 24 528 801 501 120 144 1,703 3,978 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 the above totals. 5 upwds Deaths occurring within the district among persons not belonging thereto. 695 62 57 21 46 379 130 Under 5 .. 1 2 .. .. .. .. .. .. .. .. 6 3 11 .. 8 48 .. .. 2 38 119 5 upwds .. 4 4 .. .. 7 .. •• 1 .. 1 .. .. 2 2 164 133 48 16 19 175 576 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 1899, 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 from their Homes in the several localities for treatment in isolation Hospitals. Last Census 1896. Estimated to middle of 1899. 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 Small Pox. Scarlatina. Diphtheria. Membranous Croup. Fevers Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria Membranous Croup. Fevers. Choiera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing Puerperal. Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. Upper Holloway 98,682 103,732 2792 Under 5 .. 95 124 4 .. 5 .. .. .. 1 5 .. .. .. 66 78 1 .. 4 .. .. .. .. .. .. .. 5 upwds 2 313 206 .. .. 106 .. .. 7 2 80 •• .. .. 213 121 .. .. 73 .. .. 4 .. 8 .. .. Islington, South West 107,457 108,593 3,269 Under 5 .. 136 59 8 .. 3 .. .. .. .. 8 .. .. .. 106 43 3 .. 1 .. .. .. .. 2 .. .. 5 upwds .. 303 72 .. .. 80 1 .. 16 .. 114 .. .. .. 236 51 .. .. 58 .. .. 5 .. 20 .. .. Islington, South East 66,671 68,172 1,946 Under 5 1 109 56 2 .. 1 .. .. .. .. 11 .. .. .. 91 34 .. .. 2 .. .. .. .. 1 .. .. 5 upwds .. 197 76 1 .. 30 1 .. 3 .. 58 .. .. .. 161 48 .. .. 16 .. .. 1 .. 7 .. .. Highbury 64,851 68,234 1,651 Under 5 .. 74 28 2 .. 1 .. .. .. .. 3 .. .. .. 58 13 1 .. 1 .. .. .. .. .. .. .. 5 upwds .. 220 62 .. .. 65 .. .. 2 .. 35 .. .. .. 156 33 .. .. 35 .. .. 1 .. 8 .. .. Public Institutions .. .. .. Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds .. 47 5 .. .. 62 .. .. 5 .. 36 .. .. .. 46 5 .. .. 60 .. .. 2 .. 28 .. .. Totals 337,661 348,731 9,658 Under 5 1 414 267 16 .. 10 .. .. .. 1 27 .. .. .. 321 168 5 .. 8 .. .. .. .. 3 .. .. 5 upwds 2 1,080 421 1 .. 343 2 .. 33 2 323 .. .. .. 812 258 .. .. 242 .. .. 13 .. 71 .. .. Table J. Showing the Cases of Small Pox that occurred in the several Wards from 1891 to 1899. Year. Tufnell. *Upper Holloway. Tollington. Lower Holloway. West Highbury. †East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... ... ... 1 ... ... ... ... ... ... ... 1 1892 ••• 12 ... 12 ... 7 ... ... 9 1 1 42 1893 ... 41 ... 28 6 3 14 6 6 5 9 118 1894 17 8 1 5 2 3 10 ... 15 2 26 90 1895 1 6 3 1 1 1 2 4 1 ... 5 25 1896 8 3 25 1 6 5 1 1 ... ... ... 50 1897 1 1 ... ... ... ... ... ... 1 ... 3 1898 ... ... ... ... ... ... ... ... ... ... ... ... 1899 ... ... 2 ... ... ... ... ... ... ... 1 3 * The figures for 1891-2-3 are inclusive of Tufnell and Tollington Wards. † The figures for 1891-2 include West Highbury. Table K. Showing the Cases of Scarlet Fever that occurred in the several Ward from 1891 to 1899. Year. Tufnell. *Upper Holloway. Tollington. Lower Holloway. West Highbury. †East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... 229 ... 108 ... 99 55 59 27 46 105 728 1892 ... 435 ... 225 ... 313 148 100 94 194 200 1710 1893 ... 790 ... 368 ... 633 355 209 136 201 187 2880 1894 176 235 114 196 152 67 165 116 91 90 91 1493 1895 142 166 220 214 168 117 182 89 108 112 174 1692 1896 181 244 191 169 230 127 150 149 104 191 295 2031 1897 144 153 193 187 137 126 155 91 76 113 202 1577 1898 159 151 152 182 151 102 114 38 58 107 122 1336 1899 100 172 183 178 176 118 117 102 79 98 171 1494 * The figures for 1891-2-3 are inclusive of Tufnell and Tollington Wards. † The figures for 1891-2-3 are inclusive of West Highbury. Table L. Shewing the Cases of Diphtheria that occurred in the several Wards from 1891 to 1899. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... 305 ... 43 ... 112 37 44 44 54 73 712 1892 ... 299 ... 43 ... 95 49 43 54 37 75 695 1893 ... 283 ... 57 ... 140 94 46 55 62 117 855 1894 86 91 177 131 93 40 81 37 45 25 97 843 1895 64 77 50 67 80 21 46 28 21 34 76 564 1896 129 177 84 89 87 46 200 95 29 49 82 1067 1897 71 77 118 66 43 60 81 43 30 52 59 700 1898 44 52 50 36 41 64 54 30 26 92 42 531 1899 148 99 88 56 62 28 28 29 39 52 59 688 Table M. Showing the Cases of Membranous Croup that occurred in the several Wards from 1891 to 1899. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... 20 ... 2 ... 5 3 1 1 2 10 44 1892 ... 10 ... 3 ... 10 3 1 2 8 6 43 1893 ... 10 ... 5 ... 3 3 3 1 ... 5 30 1894 2 2 ... 5 ... 2 6 1 ... 5 1 24 1895 1 3 ... 3 3 1 1 ... 1 1 4 18 1896 3 3 ... 4 4 1 3 1 1 1 3 24 1897 2 4 2 5 ... ... 1 ... 3 3 3 29 1898 2 4 ... 1 1 ... 4 ... 1 ... ... 13 1899 2 1 1 2 1 1 3 2 1 ... 3 17 Table N. Showing the Cases of Typhoid Fever that occurred in the several Wards from 1891 to 1899. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... 61 ... 25 ... 33 31 15 8 5 11 189 1892 ... 78 ... 19 ... 49 25 16 7 12 13 219 1893 ... 88 ... 19 ... 56 17 17 9 24 21 251 1894 24 23 18 32 25 23 19 21 9 21 30 245 1895 21 16 12 25 26 22 10 9 9 14 20 184 1896 17 22 19 35 30 15 40 10 9 12 20 229 1897 25 25 43 34 25 27 20 18 10 11 18 256 1898 22 34 24 30 26 21 18 16 10 15 21 237 1899 39 40 94 24 49 17 31 17 15 16 11 353 Table O. Showing Cases of Typhus Fever that occurred in the several Wards from 1891 to 1899. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... ... ... ... ... ... ... 1 ... ... 1 2 1892 ... ... ... ... ... ... ... ... ... ... ... ... 1893 ... 1 ... ... ... ... ... ... ... ... ... 1 1894 ... ... ... 1 ... ... ... ... ... ... ... 1 1895 3 ... ... ... ... ... ... 2 ... ... ... 5 1896 ... ... ... ... ... ... ... ... ... ... ... ... 1897 ... ... ... ... ... ... ... ... ... ... ... ... 1898 ... ... 1 ... ... ... ... ... ... 1 ... 2 1899 ... ... ... ... ... ... ... ... ... ... ... ... Table P. Showing the Cases of Erysipelas that occurred in the several Wards from 1891 to 1899. Year Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... 139 ... 23 ... 42 30 28 13 23 45 343 1892 ... 194 ... 46 ... 80 35 39 44 39 73 550 1893 ... 244 ... 70 ... 75 63 51 49 41 79 672 1894 34 85 23 59 29 19 43 19 20 26 38 395 1895 29 62 23 38 36 24 26 21 16 12 33 319 1896 54 65 20 51 35 30 22 29 18 22 39 385 1897 24 66 21 38 25 26 19 15 16 19 43 312 1898 23 60 20 31 22 16 15 17 13 22 40 279 1899 15 70 36 47 25 12 39 23 22 19 42 350 Table Q. Showing the Cases of Puerperal Fever that occurred in the several Wards from 1891 to 1899. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... 10 ... 9 ... 7 2 1 1 ... 3 36 1892 ... 28 ... 5 ... 7 5 2 2 ... 2 51 1893 3 5 4 7 5 3 3 3 2 ... 3 38 1894 1 3 6 4 3 2 2 1 1 ... ... 23 1895 1 2 1 2 6 2 3 1 1 3 ... 32 1896 3 2 3 5 2 1 5 2 1 3 3 30 1897 5 6 2 4 3 1 4 ... 1 1 ... 27 1898 ... ... 2 2 ... 2 3 2 1 4 3 19 1899 1 7 4 9 1 1 4 3 ... 1 2 33 Table R. Showing the Cases of Continued Fever that occurred in the several Wards from 1891 to 1899. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 ... 1 ... 2 ... ... 3 ... ... ... ... 6 1892 ... 2 ... ... ... 3 ... ... ... i ... 6 1893 1 ... ... ... 1 ... 1 ... 1 1 2 7 1894 ... ... 2 1 3 ... ... ... ... 1 ... 7 1895 ... 4 1 ... 1 3 ... ... ... ... ... 9 1896 1 2 ... ... ... 1 1 1 ... ... ... 6 1897 ... ... ... ... ... ... ... ... ... ... 1 1 1898 ... ... ... ... ... ... ... ... ... 1 ... 1 1899 ... ... ... ... ... ... 1 ... ... ... 1 2 Table S. Showing the Cases of Relapsing Fever that occurred in the several Wards from 1891 to 1899. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's Totals. 1891 .. 1 .. .. .. .. .. .. .. .. .. 1 1892 .. .. .. .. .. .. .. .. .. .. .. .. 1893 .. .. .. .. .. .. .. .. .. .. .. .. 1894 .. .. .. .. .. .. .. .. .. .. .. .. 1895 .. .. .. 1 .. .. .. .. 1 .. .. .. 1896 .. .. .. .. .. .. .. .. .. .. .. .. 1897 .. .. .. .. .. .. .. .. .. .. .. .. 1898 .. .. .. .. .. .. .. .. .. .. .. .. 1899 .. .. .. .. .. .. .. .. .. .. .. .. Table T. Showing the Cases of Cholera that occurred in the several Wards from 1891 to 1899. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. West Highbury. East Highbury. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's Totals. 1891 .. .. .. .. .. .. .. .. .. .. .. .. 1892 .. 1 .. .. .. .. .. .. .. .. 3* 4 1893 .. .. .. .. .. .. 1 .. .. .. .. 1 1894 .. .. .. .. .. .. .. .. .. .. .. .. 1895 .. .. .. .. .. .. .. .. .. .. .. .. 1896 .. .. .. .. .. .. .. .. .. .. .. .. 1897 .. .. .. .. .. .. 1 .. .. .. .. 1 1898 .. .. .. .. .. .. .. .. .. .. .. .. 1899 .. 2 1 .. .. .. .. .. .. .. .. 3 *Asiatic Cholera. INFECTIOUS DISEASES IN THE REGISTRATION SUB-DISTRICTS. Table U. Showing the Cases of Infectious Diseases notified from Upper Holloway in the nine years 1891—99. Year. Small Pox. Scarlatina. Diphthera. Membranous Croup. Enteric. Typhus. Erysipelas. Puerpera Continued. Relapsing. Cholera. Totals. 1891 .. 229 305 20 61 .. 139 10 1 1 .. 766 1892 12 435 299 10 78 .. 194 28 2 .. 1 1,059 1893 41 790 283 10 88 1 244 12 1 .. .. 1,470 1894 26 525 294 4 65 .. 142 10 2 .. .. 1,068 1895 10 528 191 4 49 3 114 4 5 .. .. 908 1896 36 616 390 6 58 .. 139 8 3 .. .. 1,256 1897 2 490 266 8 93 .. 111 13 .. .. .. 983 1898 .. 462 146 6 80 1 103 2 .. .. .. 800 1899 2 455 335 4 173 •• 121 12 .. .. 3 1,105 Table V. Showing the Cases of Infectious Diseases notified from Southwest Islington in the nine years 1891—99. Year. Small Pox. Scarlatina. Diphtheria. Membranous Croup. Enteric. Typhus. Erysipelas. Puerperal. Continued. Relapsing. Cholera. Totals. 1891 1 230 141 6 74 1 86 13 5 .. .. 557 1892 17 523 166 9 63 .. 136 13 .. .. .. 947 1893 50 1022 218 11 59 .. 208 15 2 .. 1 1586 1894 23 524 272 12 79 1 131 7 1 .. .. 1050 1895 8 538 156 5 50 2 90 7 .. 2 .. 858 1896 3 517 401 8 91 .. 106 12 2 .. .. 1140 1897 .. 473 207 6 78 .. 81 9 .. .. 1 855 1898 .. 368 133 6 69 .. 68 7 .. .. .. 651 1899 .. 439 131 8 83 .. 122 16 1 .. .. 800 Table W. Showing the Cases of Infectious Diseases notified from South-east Islington in the nine years 1891—99. Year. Small Pox. Scarlatina. Diphtheria. Membranous Croup. Enteric. Typhus. Erysipelas. Puerperal. Continued. Relapsing. Cholera. Totals. 1891 .. 170 154 13 21 1 76 3 .. .. .. 438 1892 6 438 135 14 29 .. 140 3 1 .. 2 768 1893 18 434 213 6 48 .. 145 3 3 .. .. 870 1894 35 225 144 6 53 .. 74 1 1 .. .. 539 1895 5 341 116 5 37 .. 56 3 .. .. .. 563 1896 .. 541 143 5 35 .. 75 7 .. .. .. 806 1897 1 351 124 9 33 .. 69 1 1 .. .. 589 1898 .. 253 147 .. 41 1 70 8 1 .. .. 521 1899 1 306 132 3 31 •• 69 3 1 .. •• 546 Table X. Showing the Cases of Infectious Diseases notified from Highbury in the nine years 1891—99. Year. Small Pox. Scarlatina. Diphtheria. Membranous Croup. Enteric. Typhus. Erysipelas. Puerperal. Continued. Relapsing. Cholera. Totals. 1891 .. 99 112 5 33 .. 42 7 ... ... 298 1892 7 313 95 10 49 .. 80 7 3 ... ... 564 1893 9 633 140 3 56 .. 75 8 1 925 1894 5 219 133 2 48 .. 48 5 3 ... ... 463 1895 2 285 101 4 48 .. 60 8 4 ... ... 512 1896 11 357 133 5 45 .. 65 3 1 ... ... 620 1897 ... 263 103 6 52 .. 51 4 ... ... ... 479 1898 ... 253 105 1 47 .. 38 2 ... ... 446 1899 ... 294 90 2 66 .. 38 2 ... ... ... 492 Table Y. Showing summary of Sanitary Work from Inspectors' reports for the Year 1899. DISTRICTS. Totals. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13 14. House to House Inspections 25 12 36 27 18 14 45 53 12 109 14 27 387 Number of Houses inspected 341 634 571 526 310 525 417 308 333 514 604 436 439 429 6,387 He-inspections, Calls made, &c. 4,130 3,599 3,129 4,067 3,317 3,235 3,781 4,046 3,052 4,240 4,744 4,006 3,756 4,735 53,837 Visits to Bakehouses ... ... ... ... ... ... ... ... ... 1 2 ... 3 Do. Cowhouses ... ... ... ... ... ... ... 4 1 6 19 21 ... 51 Do. Slaughter-houses ... 29 1 1 ... 1 1 4 6 2 3 48 Do. Stables and Yards 115 128 60 243 33 17 88 30 74 106 78 130 1,119 507 2,728 Do. Courts, &c. ... ... 1 ... ... 4 ... ... 2 1 8 Do. Factories and Workshops ... ... ... ... ... ... ... ... 5 3 ... 8 Do. Fields, Lanes, &c. ... ... ... ... ... ... ... ... 4 ... ... 4 Do. (Factories, Horse Slaughter-houses, Piggeries, &c., Belle Isle) ... 1 23 ... ... ... 24 Do. Under Sale of Food and Drugs Acts 65 176 54 70 68 62 95 61 66 86 82 53 59 65 1,062 Dust Removals ordered 4 ... ... ... ... ... ... ... ... ... ... ... 4 Registered Lodging Houses ... ... ... ... ... ... ... ... ... ... ... ... ... Total Inspections ordered 4,680 4,549 3,879 4,935 3,742 3,854 4,386 4,446 3,601 5,006 5,534 4,760 5,416 5,763 64,551 IMPROVEMENTS. Drains Constructed 129 45 46 166 58 87 101 92 117 107 38 131 120 104 1,341 Improved or repaired 24 26 61 28 29 38 12 26 72 108 131 50 26 631 Traps fixe 1 423 116 312 282 328 448 474 433 424 403 189 460 384 510 5,186 Cesspools Abolished ... ... 16 4 11 ... ... 4 ... 4 14 1 54 Cleansed or disinfected ... 3 10 ... ... ... ... ... ... ... ... ... ... ... 13 s Table Y.—continued. DISTRICTS. Totals. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Privies and Water Closets Pan. trap and water supply furnished 216 73 149 120 47 163 1 11 13 26 2 19 129 42 1,011 Pan & trap only furnished 5 28 1 51 81 15 167 129 144 150 94 210 3 136 1,214 Water supply furnished 9 9 15 4 12 79 20 15 4 9 30 10 13 15 244 Dust Bins Constructed 52 3 20 102 25 31 20 38 57 60 89 88 45 64 694 Repaired & covers adapted 2 49 5 16 68 1 16 7 10 1 2 1 178 Surface Drains and Pavements of Yards Constructed 1 12 2 28 1 29 122 92 19 95 60 65 81 71 678 Relaid 99 44 104 111 64 117 7 22 123 35 70 125 84 52 1,057 General Water New receptacles provided 3 70 7 7 ... 24 2 2 5 2 12 47 3 184 Receptacles repaired and cleansed 66 2 97 17 23 43 5 13 10 42 44 74 59 120 615 Water supply provided 28 3 6 25 13 46 10 21 4 34 37 6 65 9 307 Other Improvements Houses generally repaired 2 10 37 23 7 14 2 3 27 13 58 35 24 18 273 „ &c., cleansed or limewashed 25 51 33 30 10 122 4 4 6 27 87 114 69 35 617 „ ventilated 1 65 107 29 10 35 18 77 56 54 217 669 Overcrowding abated ... 2 5 1 2 1 1 19 24 9 7 71 Illegal use of underground Rooms for sleeping discontinued 2 13 19 3 5 7 1 4 54 Other Amendments, or Nuisances abated 347 174 355 442 231 176 176 374 324 649 252 182 1,063 678 5,423 Rooms Disinfected 214 156 82 142 185 41 49 74 215 134 176 149 115 209 1,941 Total Improvements 1,646 890 1,513 1,606 1,130 1,572 1,200 1,371 1,560 1,941 1,426 1,901 2,594 2,105 22,455 Total Premises Improved 461 287 212 373 288 169 245 278 322 425 521 603 900 421 5,505 Table Z. Summary of Applications for Removal of Dust, from 2nd January, 1899, to 30th December 1899. Ward. Three Months ending 1st April, 1899. Three Months ending 1st July, 1899. Three Months ending 31st Sept., 1899. Three Months ending 30th Dec., 1899. Total during Twelve Months. Number of Assessments Lady-day, 1899. Number of Applications to every 100 Assessments. 1 2 6 3 7 18 4,460 0.403 2 4 6 8 0 18 4,652 0.387 3 1 3 3 0 7 4,304 0.163 4 13 17 12 2 44 4,937 0.891 5 6 21 15 12 54 5,580 0.968 6 5 12 8 4 29 4,175 0.695 7 3 4 7 4 18 3,956 0.455 8 3 4 7 3 17 2,704 0.629 9 7 1 3 3 14 2,626 0.533 10 1 8 5 4 18 3,373 0.534 11 6 7 6 2 21 4,460 0.471 Totals 51 89 77 41 258 45,227 0.570 WATER ANALYSIS. In the following tables I state the analyses (made monthly) of the New River Company's Water recorded during the year. Analyses of Samples taken from the Works of the Company. 1899. 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 boliing ¼ of an hour. Organic Carbon. Organic Nitrogen. January 25.00 1,368 2.242 0.222 0.000 0.030 17.37 5.10 .. .. February 23.20 1,368 2,242 0.226 „ 0.026 17.16 4.50 .. .. March 21.80 1,368 2,242 0.205 „ 0.023 16.73 4.50 .. .. April 24.60 1,368 2,242 0.132 „ 0.011 15.68 4.10 .. .. May 24.40 1.440 2.360 0.125 „ 0.019 14.42 4.40 .. .. June 20.40 1.440 2.360 0.118 „ 0.015 14.42 3.50 .. .. July 21.40 1.368 2.242 0.135 „ 0.019 15.05 2.91 .. .. August 19.80 1.440 2.360 0.146 „ 0.019 14.00 3.00 .. .. September 19.00 1.440 2.360 0.146 „ 0.020 12.60 2.36 •• .. October 25.60 1.440 2.360 0.135 „ 0.015 16.95 3.00 .. .. November 22.10 1.368 2.242 0.167 „ 0.016 17.16 3.99 .. .. December 25.80 1.368 2.242 0.177 „ 0.003 17.79 3.70 .. .. Average 22.76 1.396 2.291 0.162 0.000 0.018 15.78 3.75 .. .. Analyses of Samples taken from the Mains of the Company. 1899. 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 .. 1.404 2.301 0.240 0.000 0.035 16.79 .. 0.106 0.017 February .. 1.416 2.321 0.268 „ 0.026 16.38 .. 0.097 0.015 March .. 1.440 2,360 0.214 „ 0.013 16.21 .. 0.065 0.013 April .. 1.440 2,360 0.184 „ 0.008 14.70 .. 0.049 0.009 May .. 1.422 2.330 0.203 „ 0.012 14.73 .. 0.044 0.009 June .. 1.422 2.330 0.169 „ 0.015 15.10 .. 0.046 0.007 July .. 1.422 2.330 0.151 „ 0.014 14.79 .. 0.026 0.006 August .. 1.464 2.399 0.167 „ 0.010 15.47 .. 0.031 0.006 September .. 1.464 2.399 0.160 „ 0.012 16.24 .. 0.031 0.005 October .. 1,422 2.330 0.151 „ 0.009 16.47 .. 0.028 0.006 November .. 1.368 2.242 0.190 „ 0.022 16.94 .. 0.071 0.012 December .. 1,392 2.281 0.212 „ 0.006 17.65 .. 0.042 0.007 Average .. 1.423 2.332 0.192 0.000 0.015 15.95 .. 0.053 0.009