4361 +(06) SON 4 48 3 0 DAIRY RESEARCH DEPARMENT, UNIVERSITY COLLEGE, READING, 1919. SIXTY-FOURTH ANNUAL REPORT ON THE HEALTH & SANITARY CONDITION OF THE METROPOLITAN Borough of Islington. ALFRED EDWIN HARRIS, MEDICAL OFFICER OF HEALTH. London Vail & Co., Printers to the Council, 170, Farringdon Road, E.C. 1919. SIXTY-FOURTH ANNUAL REPORT ON THE HEALTH & SANITARY CONDITION OF THE METROPOLITAN Borough of Islington. ALFRED EDWIN HARRIS, MEDICAL OFFICER OF HEALTH. London Vail & Co., Printers to the Council, 170, Farringdon Road, E.C. ii MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1919, to November, 1920.) Mayor. Councillor ERNEST HENRY KING, J.P. AIdermen. FREDERICK EDWARD BRADSHAW ALFRED MYERS. J.P. Councillors. Ward 1. FREDERICK Wm. SEPTIMUSTAYLOR 2. ARTHUR Wm. PALMER 2. FREDK. JOSEPH SHIRLEY 2. JENNIE ANNIE WILKES 3. WILLIAM SAMPSON CLUSE 3. WILLIAM JOHN EVERETT 3. CHARLES GEO. WM. HILL 4. SARAH TRAFFORD Ward 5. MIRIAM PRICE 6. ABRAHAM LEVISON 7. CHARLES COX 9. HAROLD WALTER COSSINS 10. WILLIAM HENRY ANDREWS 10. SARAH JOHNSON 11. THOMAS WHITFIELD HUNT Chairman Councillor PALMER. Vice-Chairman Councillor SHIRLEY. III OFFICERS OF THE Public health Department. Medical Officer of Health. ALFRED EDWIN HARRIS, L.R.C.S., L.R.C.P.Edin. Public Analysts. FRANK LITHERLAND TEED, D.Sc. (Lond.), F.I.C., F.C.S. ERNEST ALFRED PINCHIN, B.Sc. (Lond.), F.I.C., F.R.M.S. Solicitor. ARTHUR MELLOR BRAMALL. Superintendent of Public Health Department and Chief Sanitary Inspector. JAMES RICHARD LEGGATT. Inspector of Meat. HARGREAVES WILKINSON, Cert. Sanit. Inst. Inspector appointed under the Sale of Food and Drugs Acts. TOM LEONARD BURRELL, Cert. Sanit. Inst. Inspector of Workshops and Bakehouses. HARRY JOHN JAMES WATSON. Inspectors of Workshops, &-c., in which Females are employed. ELEANOR HARRIET DANIELL. Cert. Sanit. Insp. Ex. Bd. CONSTANCE HUGHESDON, Cert. Sanit. Insp. Ex. Bd. Inspectors of Houses let in Lodgings. EDWARD GEORGE HOLMES, Cert. Sanit. Insp. Ex. Bd. SIDNEY WALTER CAPEL, Cert. Sanit. Insp. Ex. Bd. Sanitary Inspectors. District 1WILLIAM COOK, Cert. Sanit. Inst. ,,2HARRY JAMES BICKNELL, Cert. Sanit. Inst. ,,3ALLEN BAGSHAW, Cert. Sanit. Inst. ,,4GEORGE JAMES BRIDEL, Cert. Sanit. Insp. Ex. Bd. ,,5WILLIAM HOLSGROVE FLOOD. Cert. Sanit. Inst. ,,6CHARLES EDWIN HORSMAN, Cert. Sanit. Inst. ,,7EDWARD ISAAC FORTUNE, Cert. Sanit. Inst. ,, 8JOHN METCALF, Cert, Sanit Inst. ,,9THOMAS HENRY HANCOCK, Cert. Sanit. Insp. Ex. Bd. ,,10STANLEY PELTON MARKS, Cert. Sanit. Insp. Ex. Bd. ,,11ARTHUR BERTIE CRUTTENDEN, Cert. Sanit. Ex. Bd. ,,12EDWIN ERNEST WILLIS, Cert. Sanit. Insp. Ex. Bd. ,,13THOMAS WALLACE AGAR, Cert. Sanit.-Inst. ,,14HARRY CALLOW, Cert. Sanit. Inst. Health visitors. Mrs. FRANCES LOOKER, Cert. Cent. Midwives Bd. (Northern District.) Mrs. SUSANNAH UNDERY, Cert. Cent. Midwives Bd. (Southern District.) Clerical Staff. GEORGE HAROLD KING (First Clerk). HENRY ANGEL. EDWARD ALBERT ABBOTT. WALTER JOSEPH WOLFE WILLIAM GEORGE BUNCH. ARTHUR ROBERT WITTRICK. CLEMENT MARSTONE WHEBLE. NORMAN CLARENCE TURRELL. ALBERT EDWARD BOOKER WALTER ROBERT CAUSTON (Junior Clerk). FREDERICK CHARLES GREEN (Temporary). Engineer in charge of Steam Disinfectors. ALFRED LEWIS. Stoker at Disinfecting Station. CLARENCE SADGROVE. Caretaker of Shelter House. Mrs. LEWIS. Attendant in Charge of Cleansing Station. Mrs. HORNE. Mortuary Keeper. SAMUEL MAXWELL. Distributor of Disinfectants. JOHM REDDY. Disittfectors. WILLIAM HARDWICK and HARRY SANDERS. iv SUMMARY of Vital Statistics, 1919. Population (Enumerated at Census 1911)327,403 persons „ Total, Estimated 1919 (for calculating birth rate) 336,506 persons „ Civil, Estimated 1919 (for calculating death rate) 323,034 persons Estimated decrease on population, 1911 4,369 persons Mean Population, ten years (1909-1918) 316,981 persons Area3,092 acres Density 104 persons per acre Marriages 3,306 Persons married 6,612 Persons married rate 19.28 per 1,000 inhabitants Births Males 3,322 Persons 6,278 Females 2,956 Birth rate 18.30 per 1,000 inhabitants Deaths from All Causes Males 2,305 Females 2,335 } Persons 4,640 Death rate 14.09 per 1,000 inhabitants Death from Principal Epidemic Diseases Males 60 Females 76 136 persons Deaths from Principal Epidemic Diseases Males 60 136 persons Females76 Death rate 0.41 per 1,000 inhabitants Infantile Deaths under 1 year Males 299 Females 226} Total 525 Infantile mortality rate 83 per 1,000 births Excess of Births oyer Deaths 1,638 V. INDEX. Page. Adulteration of Food 68 Bacteriological Examinations 47 Births 3 „ Illegitimate 6 ,, ,,from 1841 to 1919 80 „ Notification of 6 „ Stillborn 6 „ and birth-rates from 1841 to 1919 79 Cancer 25 Chicken Pox 47 Cleansing of Verminous School Children 54 Constitutional Diseases 25 Cow Houses 66 Deaths from All Causes during the year 7-10-76 ,, Epidemic Diseases 21 ,, Respiratory Diseases 29 „ in Public Institutions 19 „ and death-rates from 1841 to 1919 81 Disinfectants distributed and used 53 Disinfecting Station 52 Disinfection Work 52 District Inspectors' Work 61 Dust, removal of 62 Dysentery 38 Encephalitis Lethargica 39 Epidemic Diseases 21 ,, Cerebro-Spinal Meningitis 38 Erysipelas 25-32 Factories and Workshops Administration 57 Fatality from Notifiable Infectious Diseases 33 Food, Adulteration of 68 Food Inspection 65 Hospital Isolation of Infectious Diseases 34 Houses let in Lodgings 64 Infant Mortality 10-14 from 1841 to 1919 82 Infant Welfare Work 14-19 Infectious Diseases in Schools 46 „ ,, (Non-notifiable) in Schools 47 ,, ,, Cases notified from 1891 to 1919 83 Influenza 24 Inspection of Food 65 ,, Kitchens of Restaurants 57 „ Slaughter Houses and Cow Houses 65-66 Inquests 30 Isolation of Infectious Diseases 34 London County Council Return of Sanitary Work 86 Malaria 38 Marriages — 2 Measles, Notification of 45 Meat Inspection 65 Ministry of Health Returns 84-85 vi. Page Milk (Mothers and Children) Order, 1918 15 Milk Adulteration 68-73 Milkshops and Dairies 67 Mortuary and Coroner's Court 30 Notification of Infectious Diseases 31-37 ,, „ Tuberculosis 40 „ ,, Births Act 6 Non-notifiable Infectious Diseases in Schools 47 Offensive Trades 67 Ophthalmia Neonatorum 39 Outworkers' Premises 57-60 Other Notifiable Diseases 38 Pauperism 65 Phthisis 27 „ Notification of 40 Places where food is prepared 57 Pneumonia 38 Population—Estimated in 1919 1 Prosecutions, Summary of 73 Puerperal Septic Diseases 25-33 Polio-myelitis, Acute 38 Pulmonary Phthisis 27 Respiratory Diseases 29 Samples analysed in 1919 72 Sanitary Inspectors' Work 61 Septic Diseases 25 Shelter House 54 Slaughter Houses 65 Smoke Nuisances 62 Tubercular Diseases 26-40 Tuberculosis Dispensaries 43-44 Tuberculosis, Pulmonary, Notification of 40 Unsound Food 65 Vaccination 48-51 Venereal Diseases 29 Verminous Children, Cleansing of 54 Verminous Premises 62 Voluntary Maternity and Child Welfare Centres 17 Workshops and Factories. Inspection of 57 Welfare Work by Health Visitors 14 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1919. Dear Mr. Mayor, Aldermen and Councillors of the Metropolitan Borough oj Islington. It affords me great satisfaction in presenting my Annual Report for 1919 to be able to congratulate you on the healthy condition of the borough as judged by its low death-rate, which, since 1838, has only been as low on two occasions, while at the same time the death-rate from the infectious diseases has been the lowest on record. It is reasonable, therefore, to conclude that the reduction of the death-rate during the last thirty years has been due in a large measure to the steady administrative efforts of the Public Health Department. It is also most satisfactory to find that the infantile mortality rate was also the lowest ever recorded in Islington. I am forced to attribute this pleasing fact to the good, indeed most efficient, work performed by the Maternity and Child Welfare Centres, whose promoters I had encouraged to cast their lot in the borough, because I knew there was room for a great improvement in the death-rate amongst infants. There is room—much room— yet; and I, therefore, trust that these Child Welfare Centres will receive every encouragement, financial and otherwise, not only from the public but from the Council. They need it. They are doing a great work, the possibilities of which are only limited by their resources. Last year (1919) the mortality among infants under one year of age in attendance at the four centres was only 32.3 per 1,000, whereas it was 117 per 1,000 among the infants whose parents did not avail themselves of the services of the centres. The subject is of such interest that I venture to give the figures for each Centre and for the borough :— Centre. No. of Infants in attendance Infant Deaths. Infant mortality per 1,000 births. North 1,009 21 208 South 576 22 382 East 324 16 494 West 566 21 371 2,475 80 32.3 Infants not in attendance 3,803 445 117.0 These figures prove that the mortality among infants who are not in attendance at Child Welfare Centres is 2(52 per cent, higher than among those who are in attendance. The argument against the centres is that it is only the anxious, earnest, thoughtful mothers who bring their infants to the centres, and that naturally the mortality is low. This is true to a certain extent, but the example of these mothers to the careless, unthinking mothers has an effect, often a great effect, on such mothers; and frequently it is found that one good mother by her example in a tenement house, whose infant is thriving at a centre, induces the careless and unthrifty mothers to bring their infants to it. And as a little leaven leavens the whole, it may be taken as a certainty that, as already just 40 per cent, of the infants are brought to the centres, in the near future very many of the remaining 60 per cent of the infants also will be brought to the Centres by their mothers, more especially if the fathers desire that they should do so. The teachings too of a Centre are felt far beyond its four walls and influence mothers other than those in attendance at it. I regret that owing to my illness in the early part of this year, as well as the great pressure of work in the Public Health Department, I am unable to include a report on Housing, but that will be forwarded to the Council at an early date as a separate document. In conclusion, I have to thank the members of the Public Health Committees of the old and new Council, and especially the late Councillor Thomas Luke Harwood, for many years its Chairman, for the assistance and support they and he gave me in promoting the Child Welfare Scheme, which was brought into being in the early part of this year. I am, Your faithful servant, Medical Officer of Health. Public Health Department, 20, Compton Terrace, N.l. September 1st, 1920. 1 [1919 REPORT OF THE Medical Officer of Health FOR THE YEAR 1919. Population.—The population of the Borough has been estimated by the Registrar-General for the calculation of the death rate and birth rate of the Borough for the year 1919, as follows:— For the death rate, 323,034 Do. birth rate, 336,506 The death rate population excludes all non-civilian males, whether serving at home or abroad. The Registrar-General has considered this necessary for the purpose of local death rates because it has proved impossible to transfer the deaths of non-civilians to their areas of residence, or to deal in any other satisfactory manner with the local mortality of this element in the population. These estimates are based mainly upon the rationing returns of the" Ministry of Food. The birth rate (and marriage' rate) population, on the other hand, is intended co include all elements of the population contributing to the birth and marriage rates. It consists, therefore, of the death rate or civilian population plus all non-civilians enlisted from this borough, whether serving at home or abroad. This non-civilian element has been distributed over all the districts in the country in proportion to their estimated civilian population. In 1919 there were 53 weeks in the official year, so that in order to obtain rates comparable with other years, they are calculated on a population the one fifty-second part larger than the estimate. 2 1919] Showing the Areas, Densities, and Populations at Census 1911, also the Estimated Populations of the Sub-registration Districts at the middle of the year 1914. Sub-Districts. Area in Acres. Estimated Acres to a person, 1914. Estimated Persons to an Acre, 1914. Estimated Population Mid-year 1914. Population at Census 1911. Increase or Decrease on Census. Tufnell 411 0.0I2I 83 33,920 33.526 +394 Upper Holloway 299 0.0079 127 37,930 37,116 +814 Tollington 315 0.0107 94 29,768 30,609 —841 Lower Holloway 414 0.0107 94 38,837 39.362 -525 Highbury 754 0.0I32 76 57,269 62,004 -4,735 Barnsbury 310 0.0059 170 52,648 53.011 -363 South-East Islington 589 0.0078 128 75,124 71,775 +3,349 The Borough 3.092 0.0095 105 325,496 327,403 - I,907 MARRIAGES. Marriages, 3,306; Marriage Rate, 19.28.—The number of persons married was 6,612, as contrasted with 5,942 in the preceding year, which is an increase of 670. The marriage rate was 19.28 per thousand inhabitants, as compared with 1851 in 1918. The following statement shows the figures for the previous ten years 1909-18, and in 1919. Years. Marriages. Marriage Rate. 1909 2,769 I6.84 1910 2,870 17.50 1911 2,843 17.37 1912 3,091 18.94 1913 2,984 17.98 1914 3,188 19.63 1915 4,252 26.12 1916 3,080 18.30 1917 2,689 16.23 1918 2,971 18.51 3 [1919 BIRTHS. There were 6,278 births registered, of which 3,322 were boys, and 2,956 girls. Of this number, however, 557 were born of mothers living in Islington, although they were confined in Lying-in Institutions, and in other homes situated outside the borough. The annual birth rate was equal to 18.30 per 1,000 of the population as compared with a mean birth rate of 18.40 in the preceding ten years. It is a noticeable fact that each succeeding quarter during the last year shows an increase of births over the preceding one, and of course the birth rate presents a corresponding rise. Thus in the several quarters of the year the birth rates were as follows:—First quarter, 14.19 per 1,000 inhabitants; second quarter, 15.17; third, 17.10; and then a large increase of more than 9 per thousand in the fourth quarter, when the birth rate was 26.16. There has recently, as everyone is aware, been a very great discussion on and inquiry into the decline of the birth rate of the country; but if the present increase continues, and it shows no sign of a decline in Islington, for the rate which was 26.16 in the fourth quarter rose to 33.04 in the first quarter of the current year, and so far as can be seen there is no sign of a decline up to the present moment; consequently, it is to be feared that the birth rate will go on increasing. Recent inquiries by a Special Committee into the causes of the decline of the birth rate of the country have clearly shown that such decline was due in a great part to the adoption of various kinds of preventive measures by parents. Various people hold different views as to whether this is good or bad for the nation, but there can be no doubt of this fact, that parents whose income is not sufficient to feed, clothe and rear their family amidst healthy conditions should not bring children into the world to be dragged up in poverty and miser, and in dwellings which are far from wholesome and healthy. It is not proposed to discuss this matter now, for to do so would occupy too much time; and indeed might easily fill a large volume; but if any person is anxious to study this subject, it would be well to read the two volumes issued by the National Birth Rate Commission, 1918-1920, and published by Chapman & Hall, entitled "The Declining Birth Rate"and" Problems of Population and Parenthood." The subsequent table gives particulars of the births in Islington, London and the great towns during the several quarters of the year, where it will be noticed that the birth rate of the Borough was identical with that of 1919] 4 the whole of the metropolis, while it was slightly below the average of the 96 great towns. It also shows that the birth rate for the entire year was 47 below the average for the preceding ten years in Islington. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1919, and in the four quarters of the year and of the County of London and the Great Towns during the same period; also in the year 1918; together with the mean Borough Birth-rates for the 10 years 1909-1918. Quarter. Males. Females, T otal. Birth Rates. Islington, 1919. Islington, 1909-18 London, 1919. 96 Great Towns, 1919 First 622 572 1,194 14.19 23.78 15.5 15.9 Second 693 583 1,276 15.17 23.25 16.1 16.2 Third 774 664 1,438 17.10 22.17 18.7 19.0 Fourth 1,233 1,137 2,370 26.16 21.70 25.5 25.1 The Year 1919 3,322 2,956 *6,278 18.30 23.00 18. 3 19.0 1918 2,723 2,474 5,197 16.20 18.30 16.1 17.6 Increase or decrease +599 +482 +1,081 +2.10 +4.70 +2.2 +1.4 * These include 557 births which occurred in Lying-in Institutions outside the borough. 5 [1919 Showing the Births of Males and Females in each quarter and for the year, 1919, and in the several Sub-registration Districts. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islingion South-East. The Borough. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Qr. 69 61 130 71 71 142 51 58 109 73 70 143 99 92 191 112 105 217 147 115 262 622 572 1194 2nd „ 65 64 129 77 65 142 61 51 112 83 73 156 102 94 196 134 112 246 171 124 295 693 583 1276 3rd ,, 84 60 144 90 59 149 72 49 121 100 85 185 111 97 208 135 140 275 182 174 356 774 664 1438 4th ,, 165 123 288 129 109 238 117 114 231 156 144 300 154 158 312 226 210 436 286 279 565 1233 1137 2370 Year 383 308 691 367 304 671 301 272 573 412 372 784 466 441 907 607 567 1174 786 692 1478 3322 2956 6278 1919] 6 Illegitimate Births (215).—The number of illegitimate births, 215, shows a decrease of 24 on the return of the year 1918. and is the lowest record since 1862, when the births numbered 207. The number of these births in 1919 is the lowest since 1841. This is satisfactory, although one cannot help thinking that the result has been obtained only by the adoption of preventive means. In the main it is a good thing that there were fewer of these little waifs brought into the world to be a burden on their unfortunate mothers, and, too frequently to grow up only to become ashamed of themselves, and castaways to be thrown on the rates or on the charity of public institutions. In the course of time the majority become nobody's children, are wanted by no one, and their fate is too often a very sad one. The number of illegitimate births in the borough since 1841 is shown in the following statement:— Periods. Illegitimate Births. Total Births. Illegitimate Births per 100 Registered Births. 1841-50 641* 20,850 3.07 1851-60 1,335 41,915 3.18 1861-70 2,651 67,520 3.92 1871-80 3,429 89,627 3.82 1881-90 3,475 97,420 3.57 1891-1900 2,719 97,278 2.79 1901-10 2,413 87,361 i 2.76 1911-19 (9 years) 2,463 64,971 3.79 1919 215 6,278 3. 42 * This is an estimated figure, as the returns for only seven years are available. Notification of Births Act, 1907.—5,628 births were notified or 89-6 per cent, of the total number that was registered during the year. Theywere notified by doctors, midwives, parents and guardians as follows :— Notified by Still Births. Live Births. Total. Doctors 23 44O 463 Certificated Midwives 79 3,070 3,149 Parents and other persons 55 1,961 2,0l6 157 5,471 5,628 7 [1919 DEATHS. The deaths numbered 4,640, while the death-rate was equal to 14.09 per 1,000 of the population or 6.31 lower than that of the preceding year (20.40), and was 1.58 less than the average of the previous 10 years. The death-rate of 14.09 per 1,000 of the population was lower than any rate entered in the Borough since 1910; and, indeed, only two death-rates since the registration of deaths in 1838 in any year, were below it. It is most satisfactory to be able to congratulate ourselves on this low death-rate after so devastating a war. The death-rates for each year in Islington since 1841, are given in Table D in the Appendix. The Deaths from All Causes in the Sub-registration Districts were as follows :— Sub-Districts. Quarters. The Year. 1 2 3 4 Tufnell 147 99 8l 116 443 Upper Holloway 195 106 94 145 540 Tollington 147 101 71 101 420 Lower Holloway 188 110 108 139 545 Highbury 288 160 131 202 781 Barnsbury 291 151 137 198 777 Islington (South-East) 406 233 202 293 1,134 The Borough 1,662 960 824 1,194 4,640 1919] 8 • Showing the Deaths and Death Rates of Islington in 1919, and in the four quarters of the year, and of the County of London and the Great Towns during the same period, the mean Borough Death Rates for the ten years 1909-18, and the deaths and death-rates in the year 1919. Quarter. Males. Females. Total. Death Rates. Islington, 1919. Islington. 1909 18 London, 1919. 96 Great Towns, 1919. First 833 829 1662 20.58 18.65 19.5 21.3 Second 449 511 960 11.88 14.23 11.2 11.6 Third 420 404 824 10.20 12.49 9.5 9.5 Fourth 603 591 1194 13.73 17.32 13.1 12. 6 The Year 1919 2305 2335 4640 14. 09 15. 67 13. 4 13. 8 1918 2835 3006 5841 20. 40 14.09 18. 9 18. 2 Increase or Decrease -530 -671 -1201 - 6.31 -1.58 5. 5 -4.4 9 [1919 Causes of Death (Classified.)—The following table shows the deatns arranged in classes of Disease from All Causes during the ten years 1909-18, and in 1919. Classified Causes of Death. Years. Mean 10 years- 1919 Difference. 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 I. Specific or Febrile Causes 548 539 722 397 448 572 618 380 391 1361 597 579 - 18 1. Miasmatic Diseases 426 403 330 300 284 299 451 268 293 1258 431 466 + 35 2. Diarrhæeal ,, 67 76 326 36 99 174 94 56 56 51 104 36 - 68 3. Malarial ,, ... 1 ... 1 ... 1 ... ... ... 2 ... 2 + 2 4. Zoogenous ,, ... 1 1 ... 4 2 ... 3 2 ... 1 1 — 5. Venereal ,, 15 15 13 17 19 21 23 15 15 15 17 13 - 4 6. Septic „ 40 43 52 43 42 75 50 38 25 35 44 61 + 17 II. Parastiic Diseases 1 1 2 ... 1 ... ... 1 1 ... 1 1 ... III. Dietic 27 11 18 19 17 11 36 3 3 4 15 2 - 13 IV. Constitutional Diseases 1032 989 957 1023 1032 1056 1132 1095 1114 1101 1053 973 - 80 V. Developmental 411 382 429 396 468 512 554 522 486 520 468 657 + 189 VI. Lccal 2564 2303 2401 2500 2718 2488 2847 2457 2314 2596 2522 2177 -345 1. Diseases of Nervous System 297 282 277 260 376 363 418 339 351 330 329 322 - 7 2. Organs of Special Sense 10 7 16 4 20 14 17 12 14 10 12 11 - 1 3. ,, Circulatory System 661 645 642 754 733 660 722 669 681 691 686 654 - 32 4. ,, Respiratory ,, 1087 870 858 980 958 896 1147 1006 887 1156 985 770 -215 5. ,, Digestive ,, 282 280 342 290 362 304 319 233 243 246 290 215 - 75 6. „ Lymphatic „ 17 9 10 6 10 15 9 16 9 3 10 11 + 1 7. ,, Urinary ,, 174 177 220 166 213 193 182 149 130 137 174 151 - 23 8. ,, Reproductive „ 20 17 12 25 26 18 13 24 18 8 19 17 — 2 9. ,, Bones and Joints 11 10 19 10 6 10 8 9 5 9 10 12 + 2 10. ,, Integumentary System 5 6 5 5 14 15 7 ... 6 6 7 14 + 7 VII, Violence 193 194 213 227 195 201 234 183 159 156 195 162 - 33 1 Accident or Negligence 147 188 167 177 157 165 194 156 122 115 154 132 - 22 2. Homicide 4 6 4 5 3 3 3 4 1 3 3 2 - 1 3. Suicide 42 46 42 45 34 33 37 23 11 27 34 28 - 6 4. Execution ... 2 ... ... 1 ... ... ... ... ... ... ... ... 5. By Bombs (Enemy Aircraft) ... ... ... ... ... ... ... ... 25 11 4 ... - 4 VIII. Ill-defined Causes 142 104 124 120 149 98 125 111 102 103 118 89 - 29 All Causes 4918 4523 4866 4682 5028 4938 5546 4752 4600 5841 4969 4640 -329 1919] 10 AGES AT DEATH. The following statement gives the ages at which persons died in the borough, and contrasts them with the returns for the preceding ten years:— Ages. Number of Deaths, 1919. Mean Deaths (10 years), 1909-18. Increase or decrease on mean. 0-1 year 525 769 - 244 1-5 years 239 492 - 253 5-15 „ 188 173 + 15 15-25 „ 199 186 + 13 25-35 „ 296 284 + 12 35-45 ,, 369 382 - 13 45-55 „ 499 546 - 47 55-65 „ 660 642 + 18 65-75 „ 828 762 + 66 75-85 „ 647 571 + 76 85 upwards 190 162 + 28 4,640 4,969 — 329 INFANTILE MORTALITY. Infant Deaths, 525; Mortality Rate, 83.—There were 525 deaths among infants under twelve months old during the year, or 244 below the decennial average (769), and they represented an infant mortality rate of 83 per 1,000 infants born. This rate is 19 per 1,000 births below the mean annual record of the preceding ten years, and, indeed, it is the lowest infantile mortality rate ever registered in the Borough. The nearest approach to it occurred in 1912, when it was 86 per 1,000 births. It is most satisfactory to note the fact that in the third quarter, when the rate is frequently very high, it only reached the small figure of 78 per 1,000 births. Satisfactory though this figure is, yet there is no doubt that with the greater care of children, the teaching of the Maternity and Child Welfare Centres or Schools for Mothers, and the general feeling among all classes that children should be taken greater care of than formerly, the time is fast approaching when we will not look on a rate of 40 per 1,000 births as anything unusual but as one that ought not to be exceeded. The conscience of the nation, for some years past, has become alive to the neglect in the past that has been exhibited in the care of children, especially those whose ages might be counted in months rather than years. Indeed, so long ago as 1878, your 11 [1919 Medical Officer of Health when in practice in a dockyard town was so struck by the want of knowledge among mothers, where the artizans and their wives were of a superior class, that he raised his voice in a plea for the better training of mothers so that they might rear healthy children. At that time the late Sir George Turner was the Medical Officer of Health of Portsmouth, and he gave the writer opportunities to study the question in that Borough, with the result that he took up the subject, lectured on it in that town, and from that day to now has never failed to do his utmost to prevent the serious waste of infant life as well as the unnecessary pain and anguish suffered by little children. His greatest regret was his failure in Islington, for so many years to prevail on the Council to do its duty with regard to this class of mortality, and were it not for the exertions he put forward privately, this great Metropolitan Borough, instead of being to-day the happy possessor of four Maternity and Child Welfare Centres and a Maternity Home, which are doing a glorious work, would have been a figure of scorn amongst the great communities of the country. Only the other day his long fight for the much to be desired health visitors finished, for they were at last appointed, and it is mainly, but not altogether, due to the zealous manner in which the present Council took up the subject as soon as it was brought before them. Perhaps the Labour Party as a class felt the want of instruction among the women more than any other body of people in the community, and was therefore most anxious to secure the services of educated and trained women to visit and instruct those among the working classes who could not afford to employ the services of medical men as readily as those in a better position in life than they.* The days of your adviser as Medical Officer of Health arc numbered, for the time must soon arrive when he must seriously think of handing over his most anxious and responsible duties—the greatest that can be borne by any borough official—to a younger and more vigorous man who, when the day comes, will be able to start with a Borough well equipped to secure good results in fighting the battle of the infants and young children in it. The Medical Officer of Health would indeed have looked on his failure to secure for Islington a well equipped staff and institutions as the greatest failure of his life ; but now he feels that whenever he retires it will be with the satisfaction of knowing that so far as he is concerned he has been the means of providing a staff that is second to none in London and far better than most, and that too whether having regard to maternity and child welfare or any other branch of public health work. " The previous Maternity and Child Welfare Committee had taken the matter up and at the time of the Election in November, 1919, had largely decided on their action with regard to child welfare work. 1919] 12 The mortality in the sub-districts ranged from 50 per 1,000 births in Tufnell to 101 in Lower Holloway. In London the infant mortality was 85 per 1,000 births, while in the six boroughs encircling Islington it was also 85. The rate for England and Wales was 89 per 1,000 births. Infantile Mortality during each of the Ten Years 1909-18 Deaths at various Ages under Ont Year of Age. Years. Under 1 week. Weeks. Total under 4 weeks. 4 weeks and under 3 months. Months. Total Deaths under 1 year. Deaths per 1000 births. 1-2 2-3 3-4 3-6 6-9 9-12 1909 156 52 26 35 269 147 148 144 133 841 102. 56 1910 163 45 41 29 278 131 144 106 118 777 94 73 1911 170 52 31 37 293 207 201 171 168 1040 128 19 1912 190 41 25 24 280 133 121 81 95 710 86 45 1913 195 49 47 29 320 187 178 111 102 898 107 42 1914 179 40 39 33 291 159 181 118 100 849 103 .82 1915 155 49 35 31 270 142 152 125 116 805 106 80 1916 129 32 27 21 209 128 116 92 89 634 87 31 1917 93 38 23 7 161 106 108 99 91 565 96.80 1918 123 31 19 14 187 87 112 78 107 571 109. 87 Totals 10 years 155 429 316 260 2558 1427 1461 1125 1119 7690 102.40 1919 158 32 22 21 233 95 92 60 45 525 81. 63 13 [1919 Showing the Deaths among Infants per 1,000 Births during the year 1919. and also the mortality rates for the years 1909-18. Sub-Districts. 1909 1910. 1911. 1912. 1913. 1914. 1915. 1916. 1917. 1918. Mean 10 years. 1919. Increase or decrease on mean. Tufnell - 107 78 85 6l 108 93 65 84 99 93 87 50 —37 Upper Hollo- way 77 88 115 85 119 86 118 67 68 83 91 79 —12 Tollington 96 88 131 88 104 92 135 93 102 135 106 98 — 8 Lower Hollo- 101 108 162 94 121 134 118 107 121 130 119 101 -18 way Highbury 93 82 104 80 89 93 109 74 83 99 91 83 — 8 Barnsbury 111 111 162 98 128 119 107 103 114 122 117 91 —26 Islington South East 117 94 128 94 98 105 108 91 89 107 I03 81 —22 The Borough 103 95 128 86 107 104 107 87 97 110 102 83 — 19 1919] 14 The following Table shows the diseases that proved most fatal in the first year of child life, together with the mortality rates per 1,000 births. Showing the Mortality per 1,000 Births among Infants under one year of age in the ten years 1909-18; and in 1919 from certain specified causes. Causes of Death 1919. Mean rate 10 years 1909-18 per 1,000 Births. Difference. Premature Birth and Congenital Defects.. 27.07 21.30 + 15.77 Bronchitis and Pneumonia 16.08 19.25 — 3.17 Atrophy and Marasmus 11.78 14.57 — 2.79 Diarrhæal Diseases (all forms) 3 .19 8.81 — 5. 62 Convulsions 0.80 1.98 — 1.18 Whooping Cough 0.32 4.42 — 4.10 Measles .. 3.17 — 3.17 Phthisis 0.32 0.37 — 0.05 Other forms of Tuberculosis 1. 12 3.49 — 2.37 Diphtheria 0. 16 0 .31 — 0. 15 Total of above 60.84 77.67 16.83 All other causes 22.78 24.74 — 1.96 Total 93.62 102 .41 — 18.79 WELFARE WORK BY HEALTH VISITORS. For the purpose of carrying out this work, the borough is divided into two districts, i.e., the part of Islington north of the Great Northern Railway, which is called the Northern District, and that south of the railway, which is known as the Southern District. To each a Health Visitor is appointed. 15 [1919 The work performed by the two Health Visitors, during the year 1919 is set out in the following summary :— Northern District. Southern District. Total. Investigations. Calls. Investigations. Calls. Investigations. Calls. Measles (notifications) 538 104 517 33 1055 137 Ophthalmia Neonatorum (notifications) 41 69 38 55 79 124 Diarrhoea and Dysentery (infant deaths) 12 ... 7 ... 19 ... Births - 188 141 124 34 312 175 Afternoons at Maternity Centres 135 ... 90 ... 225 ... Visits re Supply of Free Milk - 26 204 45 447 71 651 Other investigations ... 302 ... 251 ... 553 Total Visits 940 820 821 820 1761 1640 1760 1641 3401 MILK (MOTHERS and CHILDREN) ORDER, 1918. This order of the Ministry of Health has been in operation since September, 1918, and from that date up to the end of the year 1919, the sum of £2,137 18s. was expended by the Council in the provision of milk to necessitous mothers and childern under 5 years of age. It has been found very difficult to lay down a fixed rule as to what constituted a necessitous mother and therefore as to the cases which should be assisted, and as to whether milk should be supplied free of charge, or at a reduced cost, owing to the fact that the circumstances of each case differed so much, even when the wages were the same. The Maternity and Child Welfare Committee, however, requested the Medical Officer of Health and the four Welfare Centres to inquire carefully into the position of all applicants, the demands made on their purses, whether through illness or other causes, and as to their ability to pay even a portion of the cost of the milk supplied, and authorised the Medical Officer of Health to supply milk free of charge or at a reduced price, according to the circumstances of each family who applied for assistance. 192 cases with the periodical renewals were dealt with during the year, necessitating the issue of 378 orders on various dairymen in the borough. 1919] 16 The following is the inquiry form at present in use in the Borough. It shows that every care is taken to obtain an exact return of the means of the family requesting assistance. The information has been invariably and gladly given by the parents. Milk (Mothers and Children) Order, 1919] no re Mrs of No in Family Ages: Over S yrs ; ; ; ; Under 5 years (and date of Birth) Baby: Breast-fed or bottle-fed. Means: (Weekly Income) Earns (i) Father ' Occupation Gives Mother (ii) Other Sources (iii) Mother Weekly Expenses: Rent Doctor Gas ... Boot Club Coal Clothing Club Insurance Total Balance for people for Milkman of Milk used prior to application pints daily. Received milk from Council since Attends any Borough's Centres: (i) Yes. (ii) No. Nature of help therefrom (if any) Relief from (I) Parish i. Milk (2) Elsewhere ii. Other food Remarks : I declare that the foregoing statement as to my family and income is true in every particular. Date Father's Signature Quantity: For Mother pints: for child(ren) pints. Contribution by applicant towards milk supply per pint. Period Certified a necessitous case by Medical Officer of Health. Hon. Secretary of Date Centre 17 [1919 Scale of Income for Necessitous Cases. The net income mentioned below is the amount left after deducting the household and husband's expenses from his wages. No. in family. Net income per head per week. 2 10/- 3 8/- 4 7/6 5 6/6 6 or more 6/- Circumstances respecting illness, unemployment, etc., are taken into account when assessing cases. The above Scale is based on income of family from all sources. If any charge is made, the applicants pay according to their circumstances, one half, one third, or one fourth of the cost. STATEMENT OF WORK PERFORMED BY THE VOLUNTARY MATERNITY AND CHILD WELFARE CENTRES:— North Islington Maternity and Child Welfare. Centre. Number of Expectant Mothers on books - 370 „ Attendances - 1,290 „ Consultations held - 77 Number of Babies attending (all ages) - 1,315 „ „ (under 1 year) - 1,009 „ Attendances 9,063 „ Consultations held 3,055 Number of Attendances of Morning Callers 1,861 Number of Sewing Classes 56 „ Attendances 255 Number of Health Talks 71 „ Attendances 1,047 Number of Visits—Professional 7,998 „ „ —Voluntary 1,447 Dental Clinic—Attendances 621 „ ,, —Patients treated 1,255 Convalescent Homes—Mothers and children sent to 19 Number of Patients treated in Wards 119 Number of Deaths—Infant 21 „ „ —Other14 Infant Mortality (based on per 1,000 infants under 1 year) 20.8 Milk for necessitous Mothers281 1919] 18 South Islington Maternity and Child Welfare Centre. Ante-Natal Cases. Number of Mothers - 164 Full Term Births 91 Premature Births 2 Still Births 3 Miscarriages — Not yet confined 52 False Pregnancy 7 Left the neighbourhood before confinement 5 Number of Attendances 453 Home Visits 194 Post-Natal Cases. Number of Mothers 108 Number of Attendances 127 Number of Deaths—Infant 22 „ —Other — Infant Mortality (based on per 1,000 infants under 1 year) 382 Record of Children. Children on Books 31st March, 1919 575 New Children during the year 654 Children on Books 31st March, 1920 1,229 Ceased to attend since 31st March, 1919 259 In attendance at the present time 970 Analysis of Attendances. Children under 1 year 576 Do. over 1 year 394 Weighing and Consultations 5,217 Weighings only 1,910 Milk for necessitous Mothers 249 West Islington Maternity and Child Welfare Centre. No. of Expectant mothers 73 Do. Attendances 344 Do. Consultations 51 Do. Ailing mothers on roll 137 Do. Attendances 584 Total visits 5,936 Expectant mothers 198 Children 5,738 19 [1919 No, of Children on books 31st March 1920 843 Do. under 1 year 566 Do. over 1 year 277 No. of Consultations 4,922 Do. Weighings 2,711 Total attendances 7,633 No. of Deaths 21 Infant Mortality (based on per 1,000 infants under 1 year) 37.1 East Islington Maternity and Child Welfare Centre. Children under 1 year (attending Centred ) 324 Do. over 1 year „ „ 260 Mothers expectant 127 Consultations held 51 Total attendances 3,301 Home visits (by staff) 2,888 Do. (Voluntary) 43 Weighings only 940 Massage (attendances) 1,164 Deaths (under 1 year) 16 Do. (over 1 year) 3 Infant Mortality (based on per 1,000 infants under 1 year 49.4 Milk for necessitous mothers 140 DEATHS IN PUBLIC INSTITUTIONS.. Within the Borough.—1,946 persons died in the Public Institutions located in Islington, of whom 1,382 belonged to this borough, the remaining 564 having come here for treatment or relief. Of these, 377 died in the Holborn Infirmary and 93 in the Great Northern Central Hospital. Of the 1,382 deaths of inhabitants, 912 occurred in the Islington Infirmary, 316 in the Islington Institution, and 124 in the Great Northern Central Hospital. The proportion which the 1,382 deaths in these public institutions bore to the borough mortality was 29.8 per cent. Without the Borough.—702 deaths of persons belonging to Islington were registered as occurring in Public Institutions in districts of London outside the borough and in various provincial towns. They included, among others, 37 in the North-Western Fever Hospital, 52 in the Children's Hospital, Great Ormond Street, 89 in St. Bartholomew's Hospital, 49 in the Colney Hatch Asylum, 40 in the Royal Free Hospital, 41 in the 1919] 20 University College Hospital, 23 in the North-Eastern Fever Hospital, 14 in the Leavesden Asylum, and 35 in the Claybury Asylum. These 702 deaths represented 15.1 per cent, of all the deaths registered in the year. Within and Without the Borough.—The deaths of Islingtonians numbered 2,084, and were equal to 44.9 per cent, of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough.— Sixty-eight inhabitants died from accidental deaths, or suddenly, in places outside Islington. Showing the Deaths of Inhabitants in Local Institutions and in Institutions outside the Borough, also the Deaths of Non Inhabitants in Local Institutions during the ten years 1909-1918 and in 1919. Years. Total Deaths in Local Institutions (cols. 3 and 4). Inhabitants of Islington in Local Institutions. NonInhabitants of Islington in Local Institutions. Inhabitants in Islington Infirmary. Inhabitants of Islington in G.N.C. Hospital. Inhabitants of Islington in Institutions outside the Borough. Total Deaths of Inhabitants in all Institutions, (cols. 3 and 7). Proportion per 100 deaths from all causes (col. 8). 1 2 3 4 5 6 7 8 9 1909 1,672 1,055 617 755 113 735 1,790 36.4 1910 1,683 1,120 563 839 97 681 1,801 39.8 1911 1,804 1,181 623 817 113 760 1,941 39.9 1912 1,693 1,184 509 846 127 760 1,944 41.5 1913 1,938 1,361 577 980 115 844 2,205 43.8 1914 2,034 1,407 627 1,053 100 875 2,282 46.2 1915 2,288 1,606 682 1,193 98 872 2,478 44.9 1916 2,148 1,460 688 1,027 100 775 2,235 47.0 1917 2,145 1,383 762 952 93 848 2,231 48.5 1918 2,536 1,728 808 1,196 110 865 2,593 44.4 Average 1,994 1,348 646 966 107 802 2,150 43.2 1919 1,946 1,382 564 912 124 730 2,112 45.5 21 [1919 Transferable Deaths.—During the year 85 deaths that had occurred in outlying Institutions and other places outside the Borough were transferred by the Registrar-General to Islington. MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES Small Pox, Measles, Scarlet Fever, Whooping Cough, Fevers—Typhus, Enteric and Continued—and Diarrhœal Diseases. During the year 136 persons died from these diseases, the death rate being 0.41 per 1,000 inhabitants, as contrasted with 1.30 in the corresponding period last year and a decennial average mortality of 389 and a death rate of 1.23 per 1,000. This death rate teas the lowest annual rate hitherto recorded in the borough. In London the death rate from the epidemic diseases was 0.66 while in the six Boroughs encircling Islington, the death rate was 0.63. Locally the deaths in the Sub-Registration Districts and Wards were as follows :— 22 1919] Showing the Deaths from each of the Principal Epidemic Diseases in the several Wards and Sub- Registration Districts during the Year 1919. SUB-REGISTRATION DISTRICTS. WARDS. Enteric lever. Small Pox. Measles. Scarlet Fever Whooping Cough. Diphtheria. Diarrhœa. Totals. Deaths. Deaths. Deaths Deaths. Deaths. Deaths. Deaths. Deaths. Tufnell Tufnell 1* 1 1 ... ... 3 2 8 Upper Holloway Upper Holloway 1 ... ... ... 2 3 8 14 Tollington Tollington 1 ... ... 1 1 4 1 8 Lower Holloway Lower Holloway ... ... 4 2 1 4 6 17 Highbury Highbury ... ... ... ... 3 5 1 9 Mildmay ... ... 1 2 ... 10 2 15 Barnsbury Thornhill ... ... ... 3 8 2 3 16 Barnsbury 1* ... ... 1 ... 1 5 8 Islington South East St. Mary's ... ... ... 1 ... 3 ... 4 Canonbury 1 ... 3 4 ... 5 2 15 St. Peter's ... ... 3 ... 2 11 6 22 The Borough 5 1 12 14 17 51 36 136 Total Death Rates 0.02 0.00 0.04 0.04 0.05 0.15 0.11 0.41 * Malarial Fever. 23 [1919 Showning the. Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1909-18 and for the Year 1919. 1909. 1910. 1911 1912 1913 1914 1915 1910 1917 1918 Mean 10 years. 1919 Deaths Death Rates Deaths Death Rates Deaths Death Rates Deaths Death Rates Deaths Death Rates Deaths Death Rates Deaths Death Rates Deaths Death Rates Deaths Death Rates Deaths Death Pates Deaths Death Rates Deaths Death Rates Enteric Fever 12 0.04 17 0.05 12 0.04 8 0.02 4 0.01 14 0.04 5 0.01 9 0.03 4 0.01 7 0.02 9 0.03 5* 0.02 Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 0.00 Measles 197 0.60 166 0.51 124 0.38 151 0.46 101 0.31 97 0.30 153 048 80 0.26 149 0.50 114 0.39 133 0.42 12 0.04 Scarlet Fever 25 0.08 11 0.03 20 0.00 9 0.03 19 0.06 23 0.07 38 0.12 18 0.06 4 0.01 8 0.03 18 0.06 14 0.04 Whooping Cough 86 0.26 124 0.38 71 0.22 54 0.16 62 0.19 83 0.26 103 0.32 00 0.19 45 0.15 147 0.51 84 0.26 17 0.05 Diphtheria 31 0.09 34 0.10 54 0.16 38 0.12 37 0.11 44 0.13 57 0.18 45 14 33 0.11 45 0.16 42 0.13 51 0.16 Diarrhœa and Enteritis (under 2 years) 95 11.68 per 1,000 births 111 18.53 per 1,000 birth? 362 44.62 per 1,000 birth? 84 10.98 per 1,000 births 210 25.12 per 1,000 births 217 26.53 per 1000 births 154 20.43 per 1,000 births 117 16.11 per 1,000 births 106 18.16 per 1,000 birth? 82 16.78 per 1,000 births 154 20.50 per 1,000 births 85 13.53 per 1,000 births Showing the Deaths from Diarrhœal Diseases together with those classed under Enteritis and its sub-headings, arranged in quarterly periods, and in three groups of ages. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Diarrhœa Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diar hœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Under 1 year .. 11 11 3 5 8 10 20 30 7 24 31 20 60 80 1 to 5 years .. 3 3 .. 1 1 2 4 6 1 1 2 3 9 12 Over 5 years 0 2 8 1 1 2 6 2 8 .. 5 5 13 10 23 Totals 0 16 22 4 7 11 18 20 44 8 30 38 36 79 115 * Including 2 Malarial Fever. 1919] 24 INFLUENZA. During the year Influenza caused 356 deaths, which is a decrease of 575 on the return for the year 1918; and an increase of 223 on the average of the preceding ten years 1909-18. Showing the Deaths from Influenza in the Quarters of the Year 1919, together with the averages of the corresponding periods, 1909-18. Years. Quarters. Totals. First Second. Third. Fourth. 1909 36 19 4 11 70 1910 21 6 2 7 36 1911 18 9 1 9 37 1912 14 4 2 8 28 1913 25 18 5 10 58 1914 17 5 3 5 30 1915 52 11 3 5 71 1916 9 7 2 18 36 1917 22 8 1 5 36 1918 14 8 60 849 931 Average 23 9 8 93 133 1919 294 35 6 21 356 Increase or Decrease + 271 + 26 — 2 — 72 4- 223 The following statement gives the ages at death of the persons who suffered from Influenza during the preceding ten years as compared with the return for the year 1919 :— Ages. 1909. 1910. 1911. 1912. 1913. 1914. 1915. 1916 1917. 1918. Mean 10 yrs. 1919. Difference. 0- 5 1 2 3 1 5 1 3 — 1 106 12 19 + 7 5-10 1 — — — — 1 — — — 52 5 5 — 10-15 — — — — — — — — — 32 3 8 + 5 15-25 2 2 1 2 2 1 5 — — 141 l6 48 +32 25-35 4 2 4 1 4 1 4 — 2 252 27 82 +55 35-45 8 3 2 5 8 6 7 1 2 109 15 47 +32 45-55 10 5 6 1 17 5 15 6 7 93 17 48 +31 55-65 9 5 3 4 5 7 12 6 8 69 13 42 +29 65-75 20 5 10 7 7 7 11 10 10 50 14 36 + 22 75 upwards 15 12 8 7 10 1 14 13 6 27 11 21 +10 All Ages 70 36 37 28 58 30 71 36 36 931 133 356 +223 25 [1919 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the principal diseases of this class. Erysipelas.—13 deaths were returned from this disease, or 6 more than in the year 1918, and 3 above the average of the preceding ten years 1909-18. Puerperal Diseases.—These comprise Puerperal Pyæmia, Septicæmia, Septic Intoxication and Puerperal Fever, and they caused 13 death, which is 12 above the return of 1918, and 6 more than the average of the ten years 1909-18. CONSTITUTIONAL DISEASES. The chief of these diseases are Cancer, Tuberculosis, Rheumatism, Diabetes, Gout, Gangrene and Purpura. They were collectively responsible for 973 deaths, as contrasted with an average of 1,053 in the preceding ten years. The death rate represented 2.95 per 1,000, as contrasted with a decennial average of 3.32. Cancer.—The deaths from this disease number 438. They are the most sad of all which are recorded, for not only is Cancer a most painful disease, but a most hopeless one, and yet there is no affliction known to humanity to which scientists devote more time and energy to discover its cause. Year after year they seek it, but their efforts seem vain, for to-day it is as secret as it was a thousand years ago. Money is being lavished freely to assist our scientists in their endeavour to discover its origin, but so far it remains hidden. But it is thought that it cannot for ever remain hidden from them, and without doubt with its discovery will come a method for the treatment and cure of the most painful scourge which afflicts humanity. The number of deaths go on increasing from year to year, for whereas ten years ago it caused only 353 deaths, last year it is sad to have to state the number increased to 438. The actual number of deaths in each year since 1909 is given below. The deaths from this malignant disease during the year compared with 393 in 1918, and with an average of 383 in the previous decennium. The deaths represent a death rate of 1.33 per 1,000 of the civil population and is 0.12 above the average rate (1.21) of the last ten years, 211 deaths occurred 1919] 26 The following statement shows the ages at death of the persons attacked during the past eleven years: — Ages. 1909. 1910. 1911 1912. 1913. 1914. 1915 1916 1917. 1918 Average 19091918. 1919. Difference. 0- 5 — 2 1 1 1 — — — 2 — 1 2 + 1 5-15 3 1 3 2 — 2 1 3 2 — 2 1 — 1 15-25 3 5 4 4 7 2 2 — 5 — 3 4 + 1 25-35 10 6 5 7 13 11 7 4 8 8 8 5 — 3 35-45 27 40 32 25 31 37 24 30 31 27 30 36 + 6 45-55 79 72 67 71 83 69 75 86 73 75 75 101 + 26 55-65 96 100 92 130 99 121 120 124 131 99 111 120 + 9 65-75 94 85 87 86 115 96 105 114 120 126 103 123 + 20 75-85 34 47 31 51 49 40 39 48 55 52 45 39 — 6 85&upwards 7 3 7 5 6 6 4 3 5 6 5 7 + 2 353 361 329 382 404 384 377 412 432 393 383 438 +55 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quartets and the year 1919. Quarters. Tufnell Upper Holloway Tollington Lower Holloway Highbury Barnsbury Islington South-East The Borough First 10 10 6 16 17 9 23 91 Second 15 7 11 12 15 15 23 98 Third 20 18 10 18 22 19 24 131 Fourth 12 13 11 14 29 17 22 118 The Year 57 48 38 60 83 60 92 438 TUBERCULOSIS. The group of diseases, known as Tuberculosis, together caused 467 deaths which were 99 below the average of the last decennium, and were also 164 below the number registered in 1918. The death rate resulting from them was equal to 1.42 per 1,000 of the civil population, and represented 10.1 per cent., or one-tenth, of the deaths from all causes during the year. among males and 227 among females. 27 [1919 Pulmonary Phthisis—This disease, which is the principal one of the group, caused 388 deaths, as contrasted with the decennial average of 446, while the death-rate was 1.18 per 1,000 of the civil population, as against the decennial rate of 1.41 per 1,000. It shows a decrease of 58 on the number of deaths and 0.23 on the mean death-rate. The death-rate from Phthisis rose from 1.26 per 1,000 of the population, in 1913 to 1.80 in 1918, which was the highest rate recorded during 10 years. It is satisfactory to note that there was a slight decline in the death rate from this disease during 1919, but the decrease is very small. Indeed, when contrasted with the average rate of the previous ten years, it is found that it only amounted to 0.23 per 1,000 of the population, which is equal to 58 deaths. There is no doubt, however, that a decreased mortality, notwithstanding the exertions of the tuberculosis dispensaries, will be only gradua although with improved hcusing and improved living of the working classes a quickened decrease ought to be expected. The work before the sanitary authorities of the country is still very great, and good can only be effected by a continuous effort to improve the conditions under which the people live, together with the provision of cheaper food and the adoption of improved habits. It will be noticed from a statement given onp age 41 that the greatest number of attacks occurred in the period of early manhood, i.e., from 15-45 years, when 62.4 per cent, of the persons were attacked. The attack rate then went on 18.4 between the ages of 45-65 and finally decreased to 2.2 in the remaining period of life. These figures, however, include all the varied forms of tuberculosis, and are set out in the table given on paee 41. In studying tuberculosis it would be well to note the diminution of the cases of pulmonary tuberculosis notified during the year as seen in table on page 40 of this report. Pulmonary Phthisis. Proportion of Deaths from Phthisis per 100 Deaths from All Causes. Death rates from All Causes per 1,000 inhabitants. Years Deaths Death rates per 1,000 inhabitants. 1909 424 1.29 8.62 14.9 1910 390 1.19 8.62 13.8 1911 379 1.16 7.88 14.9 1912 427 1.31 9.12 14.3 1913 420 I.26 8.35 15.1 1914 461 1.42 9.33 15.2 1915 496 1.57 8.98 17.4 1916 458 1.48 9.64 15.3 1917 485 1.63 10.54 15.5 1918 516 1.80 8.83 20.4 Average 10 years 446 1.41 8.98 15.7 1919 388 1.18 836 14.1 1919] 28 The following return gives the deaths at each age period :— Age periods. Deaths. Age periods. Deaths 0-5 18 55-65 58 5-15 14 65-75 11 15-25 67 75 upwards — 25-35 72 Total 388 35-45 89 45-55 59 Showing the Deaths for Phthisis in the Sub-Districts during the Four Quarters of the Year 1919. Quarters. Tufnell Upper Holloway Tollington Lower Holloway Highbury Barnsbury Islington SouthEast The Borough First 10 15 12 10 20 22 34 123 Second 7 12 11 15 14 14 19 92 Third 7 5 12 9 6 12 27 78 Fourth 12 16 2 11 12 11 30 95 The Year 36 48 37 45 53 59 110 388 Showing the Deaths from the Tubercular Diseases during 1919. Diseases. Ages. Sex. Districts. Total Deaths. 0-1 1-5 over 5 M. F. Tuf. U.H. Toll. L,H. H. B. S.E. Phthisis 2 16 366 215 169 34 48 37 45 53 58 109 384 Tuberculosis of the Larynx .. .. 4 3 1 2 .. .. .. .. 1 1 4 Tubercular Meningitis 6 23 15 18 26 1 7 2 6 3 8 17 44 Abdominal Tuberculosis .. 4 19 13 10 1 5 1 3 2 5 6 23 General Tuberculosis .. 1 1 1 1 .. .. 1 .. .. 1 .. 2 Other Forms of Tuberculosis 1 3 6 5 5 1 .. .. .. 3 2 4 10 All Tubercular Diseases 9 47 411 255 212 39 60 41 54 61 75 137 467 29 [1919 DEATHS FROM THE DISEASES OF THE RESPIRATORY SYSTEM. These diseases, which include Chronic and Acute Bronchitis, Pneumonia, Pleurisy and Asthma, caused 770 deaths, or 386 more than in 1918. They were equal to a death-rate of 2'34 per 1,000 of the civil population, and represented 16'6 per cent, of the total deaths registered in the borough. Acute Bronchitis.—There were 149 deaths as compared with 144 in the previous year. 76 occurred among males, and 73 among females. The deaths of 30 infants under 12 months were registered. Chronic Bronchitis.—245 deaths were ascribed to it, 10*2 being males and 143 females. This return is 61 below that for 1918. Pneumonia (All forms).—Three hundred and twenty-four deaths were registered, of which 191 were males and 133 females. They are 325 above the number who died in 1918. It was very fatal to infants under a year old, among whom it caused 65 deaths, while between the ages of 1 and 5 years 63 died from it. Above 5 years of age the deaths numbered 196. 40 Deaths occurred in Public Institutions, chiefly the Workhouse Infirmaries. Pleurisy.—From this disease 160 deaths were registered, of which 1 was under five years old. Only 4 deaths occurred in Public Institutions. Asthma and Emphysema.—Twenty-seven deaths were recorded from these diseases, 26 of which were those of adults. Other Diseases of the Respiratory System. — Nine deaths were registered from them, as contrasted with 16 in 1918. VENEREAL DISEASES. Thirteen deaths were ascribed to these diseases, as compared with 15 for J918. They were 4 below the mean of the preceding ten years 1909-18. The annual average number of deaths recorded during ten years from them at three groups of ages has been as follows: — Under 1 year 10 deaths 1-5 years 1 death, and over 5 years 6 deaths, making an average total of 17 per annum. So far, nothing practical has been done in Islington to prevent these diseases, but it is to be hoped that measures will soon be taken to cope with them in a satisfactory manner. Very few cases come under the personal observation of the Medical Officer of Health, as apparently the persons attacked do not care to disclose their condition, but the few cases which have come under notice have been referred to the Clinic which has been established at the Great Northern Central Hospital, Holloway Road, for treatment. 1919] 30 INQUESTS AND MORTUARY. During the year 429 bodies were received into the Mortuary, as compared with an average of 567 in the preceding 10 years. The return is the lowest known for very many years. Ten infectious bodies were received during the year. The daily average number of bodies received was 1.1 as compared with 1.3 in 1918. In 321 cases inquests were held, as contrasted with an average of 399 in the ten years 1909-1918. Bodies received into Mortuary. Inquests. 1909 592 407 1910 609 385 1911 646 425 1912 634 443 1913 575 384 1914 537 369 1915 612 475 1916 507 394 1917 479 359 1918 476 348 Average 567 399 1919 429 321 The following Table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1919 and 1918. 1918. No. of bodies received. Dally Average. No. of Inquests held. 1919. No. of bodies received. Daily Average. No. of Inquests held 1st Quarter 115 12 97 1st Quarter 128 1.4 92 2nd ,, 91 10 80 2nd ,, ,, 94 1.0 76 3rd „ 92 10 69 3rd ,, ,, 81 0.9 53 4th ,, 178 19 102 4th ,, ,, 126 1.8 100 Total for Year 476 1.3 348 Total for Year 429 1.1 321 31 [1919 THE NOTIFICATION, ISOLATION, FATALITY, and PREVENTION OF INFECTIOUS DISEASES. Under the Provisions of the Public Health (London) Act, 1891. The Principal Diseases Comprise :— Small Pox, Scarlet Fever, Diphtheria, Membranous Croup, Enteric Fever, Typhus Fever, Continued Fever, Erysipelas and Puerperal Fever. There were 1,993 cases of the diseases which are notifiable under the Public Health (London) Act, 1891, in addition to which there were other communicable ailments, such as Tuberculosis, Ophthalmia Neonatorum, Acute Poliomyelitis, Cerebro-Spinal Fever, Encephalitis Lethargica, and Measles, which are notifiable either under Orders of the late Local Government Board, or of the London County Council with the approval of that Board. The total cases notified are 866 above those of the previous year (1,127), and 188 more than the average of the preceding ten years. The largest increases when contrasted with the decennial averages are to be found in the returns from Scarlet Fever and Diphtheria, which were respectively 116 and 99 in excess, while Puerperal Fever also showed an increase of 11. Enteric Fever, however, exhibited a decrease of 38. The 1,993 cases were equal to an attack-rate of 6.05 per 1,000 of the civil population. In London the attack-rate was 6.10 per 1,000 of the civil population, or 0.5 more than in Islington, while in the Encircling Boroughs it was 5.92, or 0.13 less than locally. The returns for the preceding ten years are given in the following statement:— Year. Cases. Attack-rates per 1,000 civil population. 1909 2,049 6.23 1910 1,525 4.65 1911 1,759 5.37 1912 1,577 4.83 1913 2,171 6.54 1914 2,947 9.08 1915 2,210 6.98 1916 1,439 4.65 1917 1,251 4.21 1918 1,127 3.93 10 years average 1,805 5.70 1919 1,993 6.05 1919] 32 Registration Sub-Districts.—The total number of cases notified in these districts was as follows : — Total cases notified. Tufnell 118 Upper Holloway 162 Tollington 196 Lower Holloway 195 Highbury 389 Barnsbury 464 Islington South-East 469 Total 1,993 Small Pox.—The 2 cases notified in the Borough during the year were children aged 7 and 9 years, neither of whom had been vaccinated. The average number of cases during the preceding ten years was only 1. Scarlet Fever—1,084 cases were notified, and they showed an increase of 116 or 12 per cent, on the average (968) of the ten years 1909-18. The attack-rate was equal to 3.29 per 1,000 of the civil population annually, which is an increase of 0.24 per 1,000 on the mean rate (3.05) of the preceding ten years. Diphtheria and Membranous Croup were responsible for 649 cases of illness, and were 99 above the average (5500 of the preceding ten years. The attack-rate was equal to 1.97 per 1,000 of the civil population annually, and was 0.24 above the mean rate (1.73) of the decennial period. In London the attack-rate was 2.14 per 1,000, and in the Encircling Boroughs 2.16. Enteric Fever was only notified in 16 instances which is 38 below the average (54) that obtained during the ten years 1909-18. The attack-rate was 0.05 per 1,000 annually, or 0.12 per 1,000 below the mean rate (0.17) of the last ten years. In London the rate was 0.08 and in the Encircling Boroughs 0.07 per 1,000 of the civil population. Typhus Fever.—Nil return. The disease, which is mainly one of overcrowding, combined with poverty and malnutrition, seems to have died out in Islington. Continued Fever.—Only one case was notified. Erysipelas.—212 cases were notified, or only 1 below the average (213) ot the preceding ten years, the attack-rate being 0.64 per 1,000 of the civil population, as compared with 0.64 in London and 0.61 in the Encircling Boroughs. 33 [1919 Puerperal Fever. —Twenty-nine cases were notified, being in the proportion of 4.62 per 1,000 births. The notifications were 11 above the average (18) of the preceding ten years, and showed an increase of 2.22 in the proportion of attacks to 1,000 births. The deaths numbered 13, which represented a fatality of 44.8 per cent. The deaths occurring in hospital numbered 10, and equalled a fatality rate of 50 per cent- of the cases treated. Cases of Puerperal Fever notified and inquired into during the year 1919. Tufnell. Upper Holloway Tollington Lower Holloway. Highbury Barnsbury Islington South-East The Borough. Cases notified by Doctor 6 4 1 1 5 5 7 29 Patient delivered by Doctor 2 1 .. .. 1 1 .. 5* „ „ by Midwife 4 2 .. i 3 1 3 14* Cases inquired into 3 3 .. i 4 4 4 19 ,, treated in Hospital 4 2 1 .. 2 4 6 19 „ treated at Home 2 2 .. 1 3 1 1 10 * Seven cases were also removed to hospital and three miscarriages occurred, but no information as to delivery of patients could be obtained. FATALITY FROM THE NOTIFIABLE INFECTIOUS DISEASES By " Fatality" is meant the percentage proportion of deaths to attacks of sickness. During the year it was found that or the 1,99.5 cases notified 95 deaths occurred, or 4.8 per cent., which contrasts with an average percentage of 4.7 in the preceding ten years 1909-18. Years. Cases. Deaths. Fatality. 1909 2,049 87 4.2 1910 1,525 79 5.2 1911 1,759 104 5.9 1912 1,577 62 3.9 1913 2,171 76 3.5 1914 2,947 112 3.8 1915 2,210 118 5.3 1916 1,439 87 6.0 1917 1,251 55 4.4 1918 1,125 67 6.0 Total 18,053 847 4.7 1919 1,913 95 4.8 1919] 34 Hospital Isolation.--Of the 1,993 cases of infectious diseases notified, 1,772 were isolated in hospital, or a percentage of 88.9, while only 11.1 per cent, of the patients, therefore, were nursed at home. The reluctance of parents, guardians and adult persons to allow patients to be removed to a hospital seems to have practically disappeared. The following tabular statement shows the number of cases treated in the various public institutions :— Year Cases treated in Hospital. Percentage of cases treated. 1909 1,705 83.2 1910 1,247 81.8 19II 1,416 80.5 1912 1,577 84.1 1913 1,866 85.9 1914 2,543 86.3 1915 1,991 90.1 1916 1,296 90.0 1917 1,099 87.8 1918 982 87.1 1919 1,772 88.9 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated Percentage of known cases. Small Pox 2 2 100.0 Scarlet Fever 1,084 1,034 95.4 Diphtheria 649 627 96.6 Enteric Fever 16 14 87.5 Erysipelas 212 74 34.9 Puerperal Fever 29 20 69.0 Continued Fever 1 1 100.0 1,993 1,772 88.9 35 [1919 Summary af Infectious Sickness and of Deaths arising therefrom, distinguishing the Gases treated at Home and in Hospitals; and showing the percentages of notified Cases removed to Hospitals, together with the Fatality among casts treated at Home and in Hospitals during the year 1919. Notified Cases Treated. Percentages of Notified Cases Treated Deaths Occurring. Percentage of Deaths Occurring. In Hospital. At Home. Total. In Hospital. At Home. In Hospital. At Home. Total. In Hospital. At Home. Total. Small Pox 2 .. 2 100.0 .. 1 1 50.0 .. 50.1 Scarlet Fever 1034 50 1084 95.4 4.6 11 3 14 1.1 60 1.3 Diphtheria 627 22 649 96.6 3.4 43 8 51 6.9 36.4 7.8 Enteric (Typhoid Fever) 14 2 16 87.5 12.5 3 .. 3 21.4 •• 19.0 Typhus Fever .. .. .. .. .. .. • • .. .. .. .. Erysipelas 74 138 212 34.9 65-1 9 4 13 122 29 6.4 Puerperal Fever 20 9 29 69.0 3io 10 3 13 50.0 33.3 44.8 Continued Fever 1 .. 1 100.0 .. .. .. .. .. .. Relapsing Fever .. .. .. .. •• .. .. .. .. .. .. Cholera •• .. •• .. .. •• .. •• •• •• •• Total 1772 221 1993 8 111 77 18 95 43 8.1 4.8 36 I—* CD CD i—j Showing the number of Cases and Attack-Rates of the several Notifiable Infectious Diseases which occurred during each o) the Ten Years 1909-18 and in 1919. DISEASES. YEARS Average numbsr of cases. Increase or Decrease. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1909-18 1919 Small Pox Cases 3 1 ... ... ... ... ... ... ... 2 1 2 + 1 Rate 0.01 0.01 ... ... ... ... ... ... ... 0.00 0.00 0.00 ... Scarlet Fever Cases 1285 730 804 8ll 1317 1853 1332 638 478 432 968 1084 +116 Rate 3.91 2.22 2.46 2.49 3.97 5.71 JJ 4.2I 2.06 1.61 1.51 3.05 3.29 +0.24 Diphtheria Cases 425 463 590 512 546 651 620 587 556 514 546 64 s 4- q Rate 1.29 1.41I 1.80 1.57 1.65 2.01 1.96 1.90 1.87 1.80 1.72 1.96 + 0.24 Membranous Croup Cases 5 8 3 4 4 8 4 6 5 4 5 4 — 1 Rate 0.01 0.03 0.01 0.01 0.01 0.02 0.01 0.02 0.02 0.01 0.01 0.01 - 0.00 Enteric Fever Cases 95 89 73 49 50 76 28 32 23 30 55 16 -39 Rate 0.29 0.27 0.22 0.15 0.15 0.23 0.09 0.10 0.08 0.10 0.17 0.05 -0.12 Typhus Fever Cases 1 1 ... ... ... ... ... ... ... ... ... ... ... Rate 0.00 0.00 ... ... ... ... ... ... ... ... ... ... ... Erysipelas Cases 221 212 275 1.85 226 334 203 155 172 141 212 212 ... Rate 0.67 0.84 0.84 0.57 0.68 1.03 0.64 0.50 0.58 0.49 0.67 0.64 ... Puerperal Fever* Cases 14 20 14 l6 28 25 23 21 16 4 18 29 +11 Rate 171 2.44 1.76 1.95 3.41 3.10 3.48 2.89 274 0.77 0.24 0.46 + 0.22 Continued Fever Cases ... 1 ... ... ... ... ... ... ... ... 1 1 ... Rate ... 0.00 ... ... ... ... ... ... ... ... 0.00 0.00 ... Totals Cases 2049 1525 1759 1577 2171 2947 2210 1439 1250 1127 1805 1993 + 188 Rates 6.23 4.65 5.37 4.83 6.54 9.08 6.98 4.65 4.21 3.93 5.69 6.05 + 0-46 * Per 1,000 Registered Births. 37 [1919 Showing the Cases of the Notifiable Infectious Diseases notified, in the Sub-Registration Districts unci the Wards during the Year 1919. SUB-REGISTRATION DISTRICTS. WARDS. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total. Tufnell Tufnell 2 37 59 1 ... ... 14 5 ... ... ... 118 Upper Holloway Upper Holloway ... 71 55 2 3 ... 27 4 ... ... ... 162 Tollington Tollington ... 111 64 ... 1 ... 19 1 ... ... ... 196 Lower Holloway Lower Holloway ... 124 53 ... 3 ... 13 2 ... ... ... 195 Highbury Highbury ... 108 55 ... ... ... 23 2 ... ... ... 188 Mildmay ... 111 70 1 1 ... 15 3 ... ... ... 201 Barnsbury Thornhill ... 212 52 ... 2 ... 28 4 ... ... ... 298 Barnsbury ... 100 43 ... 2 ... 19 1 1 ... ... 166 Islington South East St. Mary's ... 44 54 ... 2 ... 14 2 ... ... ... 116 Canonbury ... 73 54 ... 2 ... 22 2 ... ... ... 153 St. Peter's ... 93 86 ... ... ... 18 3 ... ... ... 200 Totals 2 084 645 4 16 ... 212 29 1 ... ... 1993 Attack-Rates per 1,000 population 0.00 3.29 1.96 0.01 0.05 ... 0.64 0.09 0.00 ... ... 6.05 1919] 38 OTHER NOTIFIABLE DISEASES. Acute Poliomyelitis, Cerebrospinal Meningitis, Encephalitis Lethargica, Ophthalmia Neonatorum, Tuberculosis and Measles. Acute Poliomyelitis Three cases were ascribed to this disease during the year, as contrasted with 5 in 1918. One death, however, was registered. 1919. 1918. Cases. Deaths. Cases. Deaths. 1st quarter nil nil nil nil 2nd ,, ,, ,, ,, 3rd ,, 2 ,, 1 1 4th ,, 1 1 4 nil 3 1 5 1 Epidemic Cerebro-Spinal Meningitis Sixteen cases were notified, or two cases more than in 1918. In only one of these had the patient been in direct contact with a soldier who had been sent home on leave from a military camp. During the ten years 1909-18 the cases averaged 18 per annum. A return of attacks of the disease during the past ten years is given in the following statement:— 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 Average ten years. 1909-18 1919 Total Deaths. 1909-19 1st quarter 2 3 4 1 1 2 12 7 15 7 5 8 J9 2nd „ 3 7 4 6 3 3 13 17 11 4 7 7 51 3rd „ 2 1 3 3 1 2 11 8 1 1 3 1 16 4th „ 3 4 2 3 1 — 4 7 3 4 3 Nil 18 Year 10 15 13 13 6 7 40 39 30 16 18 16 124 The deaths during the year numbered 10, and were equal to the very high rate of 62 per cent, of the cases notified. Public Health (Pneumonia, Malaria, Dysentery, etc.), Regulations, 1919. These Regulations came into force on the 7th January, 1919, and during the year the following cases were notified by medical practitioners to the Medical Officer of Health. Malaria 193 Dysentery 14 Acute Primary Pneumonia 12 Influenzal Pneumonia 12 Pneumonia 29 Total 260 39 [1919 In the cases of malaria and dysentery, investigations were made respecting the date of onset of the disease, and whether the patient had been abroad, either in a civil or military capacity. In the majority of the cases it was ascertained that the patient had served in H.M. Forces during the late War in one or other of the Eastern Theatres, and that the present attacks were repetitions of previous ones whilst serving abroad. In connection with the section relating to Pneumonia, arrangements were made with the North London Nursing Association for the nursing of cases of this disease, and eleven cases of Measles, complicated by pneumonia, or of pneumonia were attended. The nurses from this Institution also attended 45 cases of Measles. Acute Encephalitis Lethargica and Acute Polio-Encephalitis. These diseases became notifiable under an Order of the Local Government Board on the 1st January, 1919, and during the year 5 cases were made known in the borough, one of which proved fatal. Ophthalmia Neonatorum. Purulent Disease of the Eyes of Newly-born Children. This inflammatory disease of the eyes of infants was notified in 73 instances, of which 50 were attended by Doctors and 23 by Midwives; and as a result 54 cases were referred to Hospitals for treatment, while 19 were attended to in their homes. Midwives attended 45 cases, and undertook the care of the infants affected. As the result of visits by the Health Visitors, the Council provided Nurses in 40 cases at a cost of £39 5s. This was money well spent, for undoubtedly they have saved many eyes. The cases occurred in the sub-registration districts as follows :— Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbur y. Islington, South-hast. The Borough. Cases notified by Doctor 6 11 6 5 5 5 12 50 ,, ,, by Midwife 3 1* 6* .. 6 2* 5* 23 Cases inquired into 9 12 12 5 11 7 17 73 „ treated in Hospital 6 5 10 3 11 6 13 54 „ treated at Home 4 6 2 2 .. 1 4 18 ,, attended by Nurse .. 5 9 6 4 5 4 12 45 * Notifications which were also received from midwives, and had been notified by doctors, are not included. Of the 73 cases investigated, both of the infants' eyes were affected in 55 instances; while in 9 cases the right eye was involved and in 6 the left. There were 2 cases of permanent disablement and 1 of partial disablement. 1919] 40 Tuberculosis. During the year 880 cases of Tuberculosis in its different forms were notified. The attack-rate was equal to 2.67 per 1,000 of the civil population. This number shows a decrease of 309 on the return of the previous year, and of 1.48 per 1,000 on the attack-rate. It was also 175 below the number in 1917. Pulmonary Tuberculosis—759 notifications were received, of which 452 referred to males and 307 to females, and represented an attack-rate of 2'30 per 1,000. The return was a decrease of 247 on that of 1918, and 138 on 1917. Showing the Notified Cases of Tuberculosis in the Wards during 1919. Registration Sub-Districts. Wards. Pulmonary Phthisis. Other Forms of Tuberculosis. Grand Totals. Tuberculosis Ratn per 1,000 of Population. Males. Females. Total. Males. Females. Totals. Tufnell Tufnell 33 35 74 4 4 8 82 .. Upper Holloway Upper Holloway 35 29 64 7 7 14 78 .. Tollington Tollington 32 29 61 7 3 10 71 .. Lower Holloway Lower Holloway 43 36 79 9 3 19 91 .. Highbury Highbury 41 20 61 11 4 15 76 .. Mildmay 21 22 43 2 2 4 47 .. Barnsbury Thornhill 48 27 75 10 8 18 93 .. Barnsbury 41 21 62 4 4 8 70 .. Islington South-East St. Mary's 42 24 66 3 7 10 76 .. Canonbury 51 30 81 5 5 10 91 .. St. Peter's 59 34 93 6 6 12 105 .. Totals 452 .. 307 759 68 53 121 880 2.67 41 [1919 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1919. Tubercular Diseases. Sex. CASES NOTIFIED IN WHOLE DISTRICT. At all ages. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Phthisis (including Tuberculosis of Larynx M. 452 35 62 237 110 8 F. 307 — 7 28 73 146 44 9 Tubercular Meningitis M. 3 — 2 1 — — —. — F. 8 1 1 3 2 1 — — Tabes Mesenterica M. 15 — 3 9 2 — 1 — F. 6 — 1 4 — — 1 — General Tuberculosis M. 1 — — — 1 — — — F. 1 — 1 — — — — — Other forms of Tuberculosis M. 49 — 4 24 9 6 4 2 F. 38 — 3 23 7 3 2 — All Tubercular Diseases M. 520 9 69 74 243 115 10 F. 360 1 13 58 82 150 47 9 Totals j 880 1 22 127 156 393 162 19 Percentages at each life period to total cases 100 0.1 2.5 14.4 17.7 44.7 18-4 2 2 From the above statement it will be seen how the disease attacked people at the various ages, viz.: In every hundred cases 01 were under 1 year of age. „ „ 2.5 were aged 1 to 5 years. „ 14.4 „ 5 to 15 „ Prime of Life „ „ „ 17.7 80.8 were aged 15 to 25 years „ „ „ 44.7 „ 25 to 45 „ „ „ „ 18.4 were aged 45 to 65 years „ „ „ 2.2 „ 65 and upwards. 42 1919] Showing the Notified Cases of Tuberculosis in the Quarters during 1919. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. The Year. Males Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Phthisis 126 84 210 97 98 195 111 61 172 118 64 182 452 307 759 Tubercular Meningitis 2 1 3 .. 2 2 1 2 3 .. 3 3 3 8 11 Tabes Mesenterica 4 .. 4 5 4 9 1 1 2 5 1 6 15 6 21 General Tuberculosis 1 .. 1 .. 1 1 .. .. .. .. .. .. 1 1 2 Other Forms of Tuberculosis 13 16 29 11 8 19 12 7 19 13 7 20 49 38 87 146 101 247 113 113 226 125 71 196 136 75 211 520 360 880 43 [1919 Disinfection of Houses and Rooms after Phthisis. The following statement gives the particulars for the year : — Houses. Rooms 1st quarter 84 112 2nd „ 90 124 3rd „ 54 83 4th „ 53 67 Total 281 386 TUBERCULOSIS DISPENSARIES. The work of the Tuberculosis Dispensaries has been very satisfactorily performed, and during the year 1,341 persons were examined by the Tuberculosis Officers, and the patients made 10,839 attendances. At the Northern Dispensary there were 585 new cases, and at the Southern 756, while the attendances at the former were 4,057 and at the latter 6,782. The examination of contacts with tuberculous cases showed that 24 were suffering from tuberculosis, 44 were suspect, and 243 were not suffering. The nurses of the Northern Dispensary paid 1,730 visits, and those of the Southern 1,507, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 124 visits and of the Southern 197 visits to the patients' homes for the purpose of examining them. These dispensaries are undoubtedly doing a very great and good work in the borough, and it is satisfactory to find that so many people are anxious to receive the fall benefits which they provide. The number of persons in attendance at them in each year since their institution is as follows:— TUBERCULOSIS. 1916. 1917. 1918. 1919. North Dispy. South Dispy. North Dispy. South Dispy. North Dispy. South Dispy. North Dispy. South Dispy. New Cases — 312 628 717 635 872 585 756 Actual No. of Attendances — 944 2279 4291 3798 6511 4057 6782 Totals — 1256 2907 5008 4433 7383 4642 7538 A summary of this table gives the following figures : Cases. Attendances. 1916 312 944 1917 1,345 6,570 1918 1,507 10,309 1919 1,341 10,839 4,505 28,662 Table showing the number of Tuberculous Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1919. Date. Dispensary. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Year. Total. Attendances Northern 342 308 391 316 338 321 330 268 282 439 395 327 4,057 10839 Southern 647 563 576 579 592 475 545 445 570 636 590 564 6,782 New Cases Including Contacts. Northern 46 51 68 47 54 53 44 27 24 49 62 60 585 1,341 Southern 74 71 56 76 60 53 64 55 60 79 61 47 756 Contacts. Tuberculosis Northern — 1 1 2 — — — — — 1 2 1 8 24 Southern 1 2 2 3 — 2 2 — — 2 2 — 16 Suspects Northern 3 — — 1 3 1 1 — — 1 2 1 13 44 Southern — 3 1 4 3 2 2 5 3 4 2 2 31 Non-Tuberculous Northern 6 6 12 7 3 5 4 — 1 10 27 30 111 243 Southern 21 16 5 6 10 9 7 9 9 18 10 12 132 Nurses' Visits ... -J Northern 143 138 147 139 84 142 180 123 117 200 164 153 1,7 30 3,237 Southern 114 88 120 101 95 30 138 184 132 161 148 196 1.507 Tuberculosis Officers' Visits ... j Northern 11 5 2 10 10 8 7 7 3 18 24 19 124 321 Southern 13 14 15 16 18 13 l6 15 17 18 21 21 197 19l9] 44 45 [1919 MEASLES. During the year 1,269 cases of Measles were notified, being 146 more than in the corresponding period of 1918. The attack rate was equal to 3.85per 1,000 ot the civil population. 1,192 visits were paid by the two Health Visitors, who specially reported to the Medical Officer of Health on-each case where a nurse was needed, as a result of which 383 visits were made by the nurses of the North London Nursing Association at a cost of £19 3s. to the Council, in accordance with the terms of the agreement entered into with the Association. The Medical Officer of Health has never been in favour of the notification of this disease, because he believes that the good effected by it is not in any way commensurate with the care, trouble and time spent in visiting them, but primarily because little good can be effected. He would not, however, object to measles complicated with pneumonia among children under five years old, or, indeed, of any children similarly afflicted, being notified, because he thinks that by the attendance of nurses on poorer persons, who cannot afford to employ them, a number of lives might be saved. He believes, however, that to prevent much of the measles at present occurring, it would be wise not to allow children under five years of age attending the public elementary schools, and he would welcome the prohibition of the attendance of these children at them. He has had a large experience of this disease in the North of England, and many years ago he, when Medical Officer of Health of Sunderland, had an alarming one, when he was able to compare an epidemic in this borough with its behaviour in a neighbouring town which possessed an Act making the disease notifiable. This was in 1885, when an epidemic occurred in Sunderland and in some of the North-East coast towns which no measures or barriers were able to control. At one time measles was not the prevalent disease it is to-day, and on looking at the past records of the borough of Sunderland at the time when the epidemic occurred, he was surprised with the large increase in its death-rate, which from 1851-1860, with 428 deaths, was 0.41 per 1,000. A similar rate persisted in the next decade, and a slightly decreased one in the ten years following, while in the ten years 1880-1889 it rose one hundred per cent. The writer at that time was much struck with the impossibility of controlling the disease, the deaths from which had so largely increased, and in studying the matter very closely was driven to the conclusion that nothing had occurred from the earlier years to cause the increase in the prevalence of the disease except the establishment of the public elementary schools; for it was then that the children became aggregrated in large numbers unknown to previous generations. It might be mentioned here that some short time before the war, the Rt. Hon. John Burns, M.P., who was then the President of the Local 1919] 46 Government Board, called a conference of the Medical Officers of Health of London to consider the question of the notification of Measles. The members of that Conference voted, with one exception, who was the Medical Officer of Health of Islington, for the adoption of the notification of the disease, and he gave as a reason for his opposition that his experience had taught him that the disease was beyond control, but that if children under five years of age were excluded from school attendance, more good would be effected than by notification. He was then asked by a member of the Conference who would look after the children if they stayed at home, to which he replied, " their mothers who brought them into the world, and whose duty it was to look after their children until they were five years old, at which time thev would be fit to enter school." The disease was not made notifiable then, but almost immediately after Mr. John Burns retired from the Government its notification was made compulsory. The result was a failure, as the Medical Officer of Health had foretold, and consequently during the early days of December last year its notification was cancelled by the Ministry of Health. To-day there is no notification of measles in England and Wales. The disease, however, is still locally notified to the Medical Officer of Health by the teachers of the public elementary schools. Its notification lasted from Tanuary 1st, 1916, to January 1st, 1920. Showing the cases of Measles notified in the Four Quarters of the year 1919. Notifications. District, Area of Borough. Quarters. 1st. 2nd. 3rd. 4th. Year.  Northern 50 91 66 71 278 Southern 111 303 266 311 991 The Borough ... 161 394 332 382 1,269 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,448 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 2 were Small Pox, 701 were Scarlet Fever, 320 Diphtheria, 1 Enteric Fever, 420 Measles, and 4 other diseases. 47 [1919 The number of notifications of the several diseases are given below :— Disease. No. of Notifications. Average of preceding 10 years. Increase or Decrease. Small Pox 2 — + 2 Scarlet Fever 701 524 + 177 Diphtheria ... 320 243 + 77 Enteric Fever 1 7 - 6 Measles 420 — '— Other Diseases 4 — + 4 Total 1,448 Non-Notifiable Diseases.—3,376 cases came to the knowledge of the Medical Officer of Health during the quarter, viz. :—252 cases of Whooping Cough, 608 of Chicken Pox, and 2,516 of other diseases. The information respecting these cases was received from the teachers of 57 schools. Exclusion of Scholars from Schools.—2,818 children were excluded from classrooms of various schools owing to the presence of an infectious disease, chiefly Scarlet Fever, in the houses wherein they lived. The non-notifiable diseases among children attending the Public Elementary Schools were : — Notifications by Teachers. Average of preceding 10 years. Increase or Decrease. Disease. Chicken Pox 608 813 -205 Whooping Cough ... 252 679 -427 +Other Diseases 2,516 2,244 +272 3,376 3,736 -360 + Note.—"Other Diseases" include Mumps, Scabies, Ophthalmia, Itch, &c. BACTERIOLOGICAL EXAMINATIONS. 928 examinations were made for the medical profession of the sputum, of swabs from the throat and of the blood of patients suspected to be suffering from Phthisis, Diphtheria and Enteric Fever. This number is an increase of 190 on that of the preceding year. It is, however, 54 less than the decennial average. Diphtheria.—468 specimens were examined for Diphtheria, of which 110 were found to contain Diphtheritic bacilli. 19191] 48 Enteric Fever.— 20 specimens of blood were examined, of which only five gave positive results. Phthisis.- 440 specimens of sputum were examined, only 92 of which showed that the patients were suffering from this disease. These bacteriological examinations have proved of the greatest utility, and have helped the medical profession in the borough very much. They complain, however, of the delay that is sometimes experienced in obtaining the results of the examinations. This is unavoidable, as the swabs from the throat, the blood from suspected enteric fever patients, and the sputa from the phthisis patients have to be sent to the Lister Institute at Chelsea. In many sanitary authorities in the country it is usual to employ a bacteriologist, and indeed such an official is becoming an absolute necessity in all large boroughs, so that the examinations may be made speedily and delays in the removal of patients to isolation in hospital avoided. Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria Enteric Fever and Phthisis, 1909-19. Periods. Diphtheria. Enteric Fever. Phthisis. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Totals. 1909 64 236 300 20 35 55 60 162 222 577 1910 125 276 401 32 29 61 63 157 220 682 1911 157 327 484 19 33 52 66 186 252 788 1912 137 298 435 23 27 50 119 341 460 945 1913 163 418 581 24 28 52 183 546 729 1362 1914 178 518 696 15 44 59 243 567 810 1565 1915 123 360 483 16 19 35 198 568 766 1284 1916 127 277 404 10 12 22 135 390 525 951 1917 100 216 316 12 8 20 165 420 585 921 1918 74 171 245 3 21 24 111 358 469 738 Average 10 years 125 310 435 17 26 43 134 370 504 982 1919 116 352 468 5 IS 20 92 348 440 928 VACCINATION. Of the 4,749 births registered in 1918, the returns of vaccination show hat only 2,055 infants were successfully vaccinated, while 22 were found to be insusceptible. There were also 320 who died unvaccinated, and 1,027 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians. 86 vaccinations were 149 [1919 postponed under medical authority, thus leaving 1,239 infants unaccounted for. The return of certificates of exemption, therefore represents 21.6 per cent, of the registered births. It is sad to observe that there has been a continual fall in the percentage of infants who have been vaccinated. This is especially noticeable in the last ten years. The decrease was first apparent in 1910, and it has gone on increasing since that year, as may be seen by the figures given in the following Table:— Years. Vaccination per 100 births, less infants who died unvaccinated. Years. Vaccination per 100 births, less infants who died unvaccinated. 1880 89.8 19OO 67.9 1881 90.8 1901 75.8 1882 91.i 1902 80.0 1883 90.4 1903 81.2 1884 90.5 1904 82.3 1885 90.6 1905 80.5 1886 90.8 1906 79.9 1887 90.4 1907 76.9 1888 88.4 1908 72.4 1889 89.0 1909 70.7 1890 89.3 1910 66.7 1891 87.4 1911 62.3 1892 85.5 1912 54.1 1893 85.0 1913 51.1 1894 84.0 1914 46.8 1895 70. 9 1915 49.0 1896 73.9 1916 47.5 1897 73.3 1917 46.7 1898 64.9 1918 46.4 1899 66.4 How serious the matter is will be seen from the following figures In 1897-1901 (five years) there were 451 exemption certificates.[/.###] In 1902-1906 do. 498 do. In 1907-1911 do. 3,992 do. In 1912-1916 do. 9,218 do. The Medical Officer asserts advisedly-and his assertion is based on his intimate knowledge of Small Pox—that such figures are lamentable, nnd that if unfortunately this disease should again attack the borough with any virulence, it will be found that large numbers of people will die, and that the sufferers for the most part will be children, as it was in pre-vaccination days, and that the adult population will be the lesser sufferers by reason of the fact that so many of them were vaccinated in infancy. Only last year a boy was attacked with the disease who had never been vaccinated, for his father was a conscientious objector. The Medical Officer of Health visited the father and strongly advised him to have his other child protected, but he persistently refused, as his conscientious objections could not be overcome. On the second 1919] 50 visit he still persisted, and the last words of the Medical Officer of Health to him as he shook hands at the door were, "take a friend's advice and have your other child vaccinated or you will regret it." He, however, still refused, and would neither get his wife nor himself vaccinated. Indue course another certificate was received stating that the second boy had been attacked. He was removed to hospital, where he died from confluent small pox. The father and mother were called to the institution before the child's death, but on their arrival they were informed that "they had better not see him, because he would not be able to recognise them, and certainly they would not recognise him." It ought to be mentioned that in one of the conversations the Medical Officer of Health had with the father he informed him that he had discussed the matter with a doctor, who was a friend, who stated to him that vaccination was more or less a myth," or words to that effect. The doctor himself had not been re-vaccinated since his infancy, and it is not surprising to find that he contracted the disease in a severe form. Perhaps the myth is truth now. It is much to be regretted that science is permitted to be flouted in the manner in which it has been with respect to this terrible disease. When the Medical Officer of Health had charge of the Small Pox Hospital in Sunderland, an anti-vaccinator, who spoke in the parks on the subject, was attacked with the disease in only a mild form, due to his vaccination in youth. One morning when the Medical Officer of Health visited his ward, this man said to him, "there have been five cases admitted into this ward since yesterday, two of which were vaccinated and three unvaccinated," and on being asked how he knew who were vaccinated patients and who were unvaccinated, he replied, " Sir, it does not require to be a patient in this ward many days before one sees the good vaccination does." It need not be said that this gentleman did not again preach against vaccination. He was convinced of its efficiency as would any honest thinking man be convinced, if he saw the cases in the wards. The Medical Officer of Health knows very well that the views held on this subject by many people are really conscientious, but there are hundreds who oppose vaccination, especially women, only because of the trouble and inconvenience caused by the infant for a short while after vaccination. The evils, and undoubtedly there were evils, that accrued after vaccination have been practically done away with since the greater precautions recommended by the medical profession in the vaccination of children have been practised. Certificates of Exemption.—The following tabular statement shows that the increase of these certificates, more especially during the past eight years. 1906 123 1912 1,646 1907 259 1913 1,942 1908 588 1914 2,124 1909 824 I9I5 1,710 1910 1,080 1916 1,796 1911 1,241 1917 1,341 1918 1,027 Sub-Registration Districts during the year 1918. REGISTRATION SUB-DISTRICTS. Number of Births registered in 1918. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of Statutory Declarations of Conscientious Objection. Died Unvaccinated. Postponement by Medical Certificate. Removed to other Districts. Removed to places Unknown. Number of Children rtmaining Unvaccirated, or not accounted for in Report Book. lotal Number ot Certificates of Piimary Vaccination at All Ages received during year 1919. Number of Statutory Declarat;ons of Conscientious Objection received during year 1919. 1 2 3 4 5 6 7 8 9 10 11 12 Tufnell 514 263 3 ... 118 39 4 30 27 30 1,223 654 Upper Holloway 557 279 2 ... 123 33 4 31 29 56 Tollington 414 185 ... ... 95 29 3 17 38 47 Highbury 688 303 9 ... 160 46 4 19 47 100 Lower Holloway 615 279 5 ... 100 40 8 ... 63 120 1,248 742 Barnsbury 909 361 ... ... 176 69 25 2 101 175 Islington, South East 1052 385 3 ... 255 64 38 4 115 188 The Borough 4,749 2,055 22 ... 1,027 320 86 103 420 716 2,471 1,396 51 [1919 1919] 52 DISINFECTION. Disinfection of Rooms. —1,780 rooms were disinfected, as contrasted with 1,037 in 1918. For this purpose formaldehyde, either in a gaseous form or in solution, was employed, although it was sometimes augmented by sulphur dioxide, when it was necessary to kill vermin, for which purpose it has been found most effective. For the extermination of bugs, however, all the architrave mouldings and skirting boards behind which they breed are renoved, and the walls washed with hot lime. The above figures also include the disinfection of houses and rooms after Phthisis, vide p. 43. The Cleansing and Spraying of Rooms—1,650 rooms, as contrasted with 1,802 in 1918, were cleansed and sprayed. Rooms disinfected. Rooms sprayed. 1919. 1918. 1919. 1918. 1st Quarter 220 311 452 404 2nd „ 293 263 447 403 3rd „ 412 215 333 387 4th „ 855 248 418 608 The Year 1,780 1,037 1,650 1,802 The following class-rooms, etc., were disinfected after the occurrence in them of cases of the diseases mentioned:— 1st Quarter. Nil. 2nd Quarter. Canonbury Road L.C.C. Schools (Scarlet Fever). Newington Green L.C.C. Schools (Diphtheria). 3rd Quarter. Buckingham Street L.C.C. Schools (Scarlet Fever) 4th Quarter. Gifford Street L.C.C. Schools (Scarlet Fever). Work at the Disinfecting Station.—41,336 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 38,659 similar articles disinfected during the previous year. In addition to the above articles 19,777 old or second-hand garments, mostly soldiers' overcoats, jackets, tunics and trousers were disinfected for clothing contractors trading in the borough, who paid the Council for the work, amounting to the sum of £32 16s. 8d. Altogether 61,113 articles described in the two paragraphs preceding were disinfected, which bring the number of large articles disinfected since the disinfecting station was established to 1,497,675. 53 [1919 Summary of the chief articles of Clothing, Bedding, &c, disinfected during the year 1919, and also in the preceling year 1918. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter The Year 1919 1918 Beds 419 369 480 785 2,053 1,642 Blankets 919 750 779 1,794 4,242 3,602 Bolsters 296 271 349 768 1,684 1,325 Carpets 101 23 25 51 200 341 Chair Bed Cushions 47 36 73 151 307 95 Mattresses 353 461 467 738 2,019 1,174 Palliasses 83 83 42 18 226 79 Pillows 908 760 1,003 1,897 4,568 3,899 Quilts 399 276 420 854 1.949 1,922 Sheets 517 489 755 1,606 3,367 2,721 Other Articles 3,592 3,792 3,844 9,493 20,721 21,859 Totals 7,634 7,310 8,237 18,155 41,336 38,659 The nature of the articles disinfected for the clothing contractors is shown below :— 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Year Soldiers' Overcoats 1,051 350 345 1,882 3,628 „ Jackets 2,178 1,704 769 2,392 7,043 „ Tunics — 300 — 952 1,252 „ Haversacks — — — — — Trousers 450 — 247 1,192 1,889 Frock Coats - — 500 62 562 Boots 100 — — — IOO Other Articles 554 6 198 4,545 5,303 4.333 2,360 2,059 11,025 19,777 Disinfectants distributed and used.—The following statement gives the quantity of disinfectants distributed by the Sanitary Authority, or used in disinfecting and cleansing rooms :— How disposed of. Carbolic Powder Disinfecting Fluid. Formaldehyde. Powder. Solution. Tons. cwts. Gallons. cwt. qr- lbs. Gallons. To Householders 1 0 194 — — Disinfection of Premises.. - - — 1 1 22 36 Cost = £128 17s. od. 64 Shelter House.—The Shelter House was occupied by six persons during the disinfection of their homes after infectious diseases. Baths were given to 12 verminous persons ; and 4 to persons who had been in contact with an infectious disease were also afforded bathing facilities, and their clothing was disinfected. Three midwives also attended for the purpose of disinfection after attendance on cases of Puerperal Fever. Verminous School Children.—During the year 4,838 baths were given to children from the London County Council Schools, who attended the Disinfecting Station, and were cleansed by the nurse whom the Borough Council appointed for the work, while their clothing was undergoing disinfection. The daily attendance ranged from 3 to 43. The agreement entered into between the London County Council and the Borough Council, for the cleansing of verminous children, is a payment of Is. for each bath ; upon the understanding that the minimum amount to be paid to the Borough Council in respect of such cleansing shall be £100 per annum. The amount paid during the year by the London County Council for the baths given to the children was j£241 18s. Od. No legal proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, during the year. In the early part of the year the attention of the Public Health Committee was drawn to the unsuitability and the insufficient number of the baths at the Shelter House for the bathing of the London County Council school children, verminous persons, and all persons demanding baths (tramps, and the like), and also of midwives who had been attending puerperal fever cases, but the consideration was deferred until after the November elections. On the formation of the new Public Health Committee the matter was brought before them, and a letter from the Ministry of Health, dated 16th July, 1919, was read to them, and the following report was presented by the Medical Officer of Health. To the Chairman and Members of the Public Health Committee. Mr. Chairman, Ladies and Gentlemen, Baths at Disinfecting Station. In order that this Committee should be aware of the events which preceded their visit to the Disinfecting Station on Saturday afternoon last, I think it would be well if the previous history of the baths were referred to, and I would therefore inform the Committee that on one or two occasions previous to March 17th of this year the question of erecting separate baths for the cleansing of verminous persons, midwives and school children was discussed. Priortothisdate however,the then Local Government Board had issued a Memorandum respecting 55 [1919 lousiness and itch, dated February 27th, 1919, in which they stated that following on complaints of the increased prevalence of lousiness and itch, and the wider realization of the part played by lice in the spread of fevers, inquiries have been made by sanitary authorities about the measures to be taken against the infestation by these parasites. As an outcome of this communication from the Board, I drew the attention of the Public Health Committee to the fact that some time previously I had advised the Committee to erect a proper cleansing station, because the shelter house (which was erected for the housing of persons in whose homes infectious disease had occurred while their homes were being disinfected), was being used for the purpose of cleansing verminous children. As a result of my report, the Committee thought it might be well for me to view the baths at the Workhouse and ascertain if they could be utilised for the bathing of the children and verminous persons. On the 12th May I reported to the Committee that I had seen Mr. Davey, the Clerk to the Guardians, and that the Master had shown me the baths, near the gateway of the Receiving House, through which the poor pass on entering the house, and where he or she receives a bath. There are separate baths for men and women, and as they are very dark require artificial light during the daytime; the water closets open immediately from them, and I came to the conclusion that they were not baths such as respectable men and women should be required to use, and that I was certain they would be little used by the general public. I also pointed out that there was an urgency for these baths, for it had gone abroad that the Council were providing them. I added that I was strongly of opinion that the Council should provide their own baths for this special purpose in the disinfecting station grounds, apart from which baths were required for the bathing of school children, especially as the present temporary arrangement was likely at any time to be upset through the outbreak of such a disease as small pox, when every apartment of the shelter house would be required. I am, Your faithful Servant, A. E. HARRIS, Medical Officer of Health. Previously on the 19th May, the Medical Officer of Health reviewed the circumstances of the baths, and pointed out that the Council is expected to provide baths for verminous persons who may apply for them, that they are also under an agreement with the London County Council to provide accommodation for the bathing of at least 30 school children per diem ; and that it is their duty to provide accommodation for the bathing of midwives who have been in attendance on cases of puerperal fever or any other fever into which they may 1919] 56 have been brought into contact, that applications are also made by soldiers who are sent by the medical men in attendance on them for scabies, and finally that the Local Government Board's Circular asks for provision to be made for the treatment of persons suffering from scabies and itch. He also pointed out that recently when a case of Small Pox made its appearance he was compelled to forego the use of the shelter house for the isolation of contacts, with the result that daily visits had to be paid to the house to inquire as to the health of its inmates, and to carry out the disinfection of the house while the contacts were still there, and as the critical period was approached he himself had to visit at the home very frequently. At this time he also recommended the erection of baths for cleansing. Again in June the Medical Officer of Health reported to the Committee that the Ministry of Health was of opinion that something might be done at the Islington Institution, but that he strongly objected to the proposal, as the baths were not suitable. Later on, Dr. Manby, of the Ministry visited the baths at the disinfecting station and also those at the Islington Institution, with the result that on the 17th July, the following letter was received from the Ministry:— Ministry of Health, Whitehall, S.W., 16th July, 1919. Sir, I am directed by the Ministry of Health to advert to your letter of the 17th ultimo, and to state that they have had under consideration a report by their Inspector Dr. E. P. Manby, after his recent visit to Islington in connection with the arrangements made by the Borough Council for the bathing of verminous children. The Ministry are advised that the suggested arrangements for the disinfection at the St. John's Road Institution would not be suitable for tne use of persons other than those about to be admitted to the Institution, and they would urge the Borough Council to provide at an early date a suitable cleansing station of their own. The Ministry are further advised that the use of the Borough Council's small pox shelter as a cleansing station is open to objection except as a temporary expedient, as it is desirable that the shelter should always be ready for the reception of contact cases, etc. I am, Your obedient servant, H. O. Stutchbury. The Town Clerk. 57 [1919 The Medical Officer of Health therefore once more advised the Public Health Committee to recommend the Council to build baths for the bathing of verminous children, midwives who have been in contact with puerperal fever or other infectious disease, as well as for the bathing of verminous persons. Tt is not necessary to labour this point, for something had to be done to relieve the pressure on the Shelter House, which was built wholly and solely for temporary sheltering persons while their homes were being disinfected after an infectious disease, and also for the accommodation of persons who have been in contact with small pox, which in the past had proved of enormlous value, and had undoubtedly prevented the spread of infectious disease, especially of small pox. At a meeting of the Public Health Committee at the disinfecting station on December 20th, 1919, it was the general opinion that suitable baths should be erected in the cottage occupied by the caretaker, while a new cottage should be erected for him. Plans and specifications have been passed and the sanction of the Ministry of Health has been obtained for the erection of the necessary buildings, so that it is expected that in a short time the borough will be provided with suitable baths for the persons requiring them. In compliance with the requirements of the Factory and Workshops Act, it is the duty of the Medical Officer of Health to submit an annual report on the manner in which its provisions are carried out in his ^district, and accordingly he herewith submits it for the year 1919. FACTORY AND WORKSHOP ADMINISTRATION. Inspections and Visits.—The inspections and visits made by the Inspectors were as under:— Factories, including Factory Laundries 431 Workshops, including Workshop Laundries 615 Workplaces, other than outworkers' homes 310 Bakehouses 611 Restaurant Kitchens 378 Outworkers' premises 943 Miscellaneous re-inspections and calls 5,622 Total 8,910 1919] 58 Notices served.—In consequence of the 1,113 sanitary defects discovered as the result of the inspections above ; 194 intimations and 8 statutory notices were served. Of these notices 31 were served on the owners of factories, 135 on the owners of workshops and workplaces, and 33 on the owners of restaurant kitchens. Fn addition to these nuisances, 69 were discovered on Outworkers' premises, necessitating the service of 48 notices. Registers.—There were 1,719 workshops on the Register, as contrasted with 1,887 in 1918, while the total number of workrooms was 2,319, as contrasted with 2,707 in the previous year. 121 workshops were added to the Register while 289 were removed from it. The various workshops and workplaces are tabulated as below:— Workshops and Workplaces. 1918. 1919. Workshops on Register. Workrooms on Register. Number added during Year. Number removed during Year. Total number of Workshops on Register. Total Number of Workrooms on Register. Workshops where Men are employed 392 516 103 15 480 674 Workshops where Women are employed 862 1,375 .. 228 634 925 Laundries 69 180 .. 38 31 93 Bakehouses 238 248 .. 1 237 246 Restaurant Kitchens 326 388 18 7 337 381 Total 1,887 2,707 121 289 1,719 2,319 Outworkers' Premises — 2,276 548 415 — 2,341 Workshops notified to Home Office, 1919. Trade. Number of Workshops. Protected Employed Persons. Women. Male Young Persons. Total Blouses 2 31 .. 31 Millinery 2 4 .. 4 Ties 5 6 .. 6 Furrier 1 1 .. 1 Tailoring. 4 7 .. 7 French polishing 1 1 .. 1 Dress 9 36 .. 36 Leather 4 12 .. 12 Embroidery 2 4 .. 4 Bead Embroidery 1 1 .. 1 Chemists (manufacturing) 1 2 .. 2 Brush Making 1 10 .. 10 Gold Leaf Beater 1 2 .. 2 Total 34 117 .. 117 59 [1919 SECRETARY OF STATE'S RETURNS on the administration of the Factory and Workshop Act. 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspec'ions made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of (1) Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories .. .. (Including Factory Laundries) 431 34 Nil Workshops (Including Workshop Laundries) 615 110 " Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 1,299 58 " Miscellaneous Re-inspections 5,622 Total 7,967 202 Nil 2 -DEFECTS F< )UND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred to H.M. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :—* Want of cleanliness 381 366 Nil Want of ventilation • • 11 Overcrowding 1 1 * > Want of drainage of floors 29 29 I I Other nuisances 252 211 l 1 Sanitary Accommodation i insufficient 11 9 l t -( unsuitable, foul or defective.. 431 447 l * * not separate for sexes 8 4 I 1 0fences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) ,, Breach of Special sanitary requirements for bakehouses (ss. 97 to 100) J • Other offences (Excluding offences relating to outwork which are included in Part 3 of this report) • • * * II Total 1,113 1,097 Nil Nil * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act 1901, as remediable under the Public Health Acts. 3. HOME WORK. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises. (Secs. 109, 110). NATURE OF WORK Lists received from Employers Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served under Public Health (London) Act, 1891. Prosecutions Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Outworkers. Sending once in the year Outworkers. Failing to keep or permit inspection of lists. Failing to send lists. Lists, f Contractors. Workmen. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— a (1) making, &c. 148 62 1,578 19 .. 97 122 .. .. 37 23 .. 5 (2) cleaning and washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Household linen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. Curtains and furniture hangings 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Electro-plate .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. File making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur pulling .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cables and chains .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, laches and keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. Artficial Flowers 10 .. 109 4 .. 17 4 .. .. 13 5 .. 4 .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sacks .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Racquet and Tennis Balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper, etc., Boxes, Paper Bags 18 .. 199 2 .. 44 16 .. .. 14 11 .. 4 .. .. Brush making 4 .. 100 .. .. .. .. .. .. 4 2 .. .. .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Stuffed toys 2 .. 9 .. .. .. 1 .. .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chocolates and Sweetmeats .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cosaques, Christmas Crackers, Christmas Stockings, &.c. 2 .. 52 .. .. .. .. .. .. .. 2 .. .. .. .. Textile weaving .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 186 62 2,054 25 Nil 158 116 Nil Nil 69 48 Nil 13 Nil Nil 60 [1919 * When an occupier gives out work cf more than one of the classes specified in column 1, and subdivides his 1st in such a way as to show the number df workers in each class of work, the list is included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers are assigned in columns 3 and 4 (or 6 and 7) into their respective classes. : The figures in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lisis each yea. and of the entries of names 2 Umbrellas, 5 Furniture, 1 Brass, and i File Making are included in lists of wearing Apparel Makers. [1919 61 4—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Workshops where men are employed 480 Workshops where women are employed 634 Laundries 31 Bakehouses 237 Restaurant kitchens 337 Total Number of Workshops on Register 1,719 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 34 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5, 1901). Notified by H.M. Inspector 21 Reports (of action taken) sent to H.M. Inspector. 21 Other (New Factories reported under Home Office Memorandum, 1912) nil Underground Bakehouses (s. 101) in use at the end of the year.. 85 DISTRICT INSPECTORS' WORK. The fourteen district inspectors made a total of 48,533 inspections and calls during the year, an increase of 11,269 inspections on the corresponding period of 1918; while 8,270 improvements were effected in 3,861 premises; as against 4,537 improvements in 2,526 premises for the preceding year. The increase must be ascribed to the return to duty of those Inspectors who had been away on War Service, and to the filling up of the vacancies in the Inspectorial Staff, 1919] 62 Synopsis of the Inspectors' Work.—The following statement gives a brief synopsis of the district inspector's work in 1919 :— House to house inspections 160 Other inspections of dwelling houses 5,578 Re-inspections and calls, made 38,622 Visits of inquiry re notifiable infectious diseases ,, school cases of infectious 1,993 diseases 1,448 Butchers' shops, stalls, etc. (Saturday nights) 47 Ice cream shops and factories 98 Dairies and Milkshops 693 Stables and yards 1,501 Manure depôts 82 Smoke observations 52 Notices Served.—There were 1,896 intimation notices served by the inspectors with respect to nuisances, of which 857 were delivered personally, and 1,039 by post. In 263 instances it became necessary, as the intimations to owners or occupiers of the properties had been ignored, to report the nuisances to the Public Health Committee, who ordered statutory notices to be served. Verminous Premises—Bedding and Clothing.—80 premises which were found to be in a verminous condition, were cleansed by the owners or occupiers upon receiving the Inspectors' intimations. In 45 instances it was necessary to remove the bedding and clothing to the Disinfecting Station for purification or destruction. Smoke Nuisances.—Black smoke was observed to be issuing from the chimneys of the undermentioned premises, and consequently notices were served on the owners of the following businesses requiring the abatement of the nuisance:— Western's Laundry, 160, Holloway Road. Handisyde Ltd., 166-168, Holloway Road. REMOVAL OF DUST. Nineteen applications were received during the year for the removal of du it, which is 8 above the number recorded last year. The applications received for the previous ten years were as follows:— 1909 67 1914 - 26 1910 44 1915 - 28 1911 52 1916 - 21 1912 47 1917 - 30 1913 32 1918 - 11 Dust Receptacles Provided.—During the year 727 dust receptacles were provided, while 15 were repaired after the service of sanitary notices. 63 [1919 Showing summary of Sanitary Work from Inspectors' Reports for the year 1919. DISTRICTS. Totals. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 House to House Inspections .. .. .. .. .. 34 .. .. .. 14 .. 42 20 50 160 Other premises inspected 340 377 300 544 354 478 351 491 323 206 429 464 475 443 5578 Re-inspections, Calls made, &c. •2698 2632 3300 2419 3866 2844 2641 3575 1864 1268 2261 2830 2785 3639 38622 Ice Cream Factories inspected .. .. 8 44 .. .. 12 .. 5 2 10 5 6 6 98 Dairies and Milkshops do. 76 23 186 144 15 14 35 79 30 7 17 32 22 13 693 Stables do. 36 19 27 66 34 14 52 6 11 7 .. 1 31 5 309 Yards do. 95 110 317 111 34 241 92 8 22 5 .. 22 68 37 1192 Manure Dep6ts do. 58 .. .. 17 1 •• .. .. .. .. .. .. 6 .. 82 Vacant land, Passages and Courts inspected 11 2 3 7 2 40 25 1 .. .. .. 1 52 5 149 Urinals attached to P.H.'sinspected 43 94 102 18 150 89 13 .. 5 4 8 2 10 21 559 Premises (re Certificate Customs and Inland Revenue Acts) inspected.. .. .. .. .. .. .. .. 9 .. .. 1 .. 3 .. 13 Premises (re Water Certificates) inspected .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Visits re Sale of Food and Drugs Acts. 121 109 109 52 109 54 99 92 1 .. .. .. 116 117 979 Smoke observations .. 2 3 20 .. 1 .. 1 11 .. .. 10 4 .. 52 Shops, Stalls and Markets (Saturday evening) 3 4 5 2 5 3 6 5 1 .. 3 2 4 4 47 Total Inspections and Calls .. 3481 3372 4360 3474 4570 3812 3329 4267 2273 1513 2729 3416 6602 4340 48533 Notices Served. Intimation—Personally 126 6 8 89 91 24 31 52 90 43 58 49 41 149 857 By Post .. 179 46 198 .. 1 96 168 .. 2 .. 117 79 153 1039 Statutory — Personally 7 6 .. 2 8 .. 6 4 4 2 1 2 3 16 61 By Post 17 27 6 32 19 3 7 11 11 3 7 11 19 29 202 Improvements. Drains— Constructed .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Re-constructed 7 7 2 4 2 1 4 6 3 1 1 1 9 1 49 Repaired 17 11 9 16 9 10 11 9 9 9 19 16 19 22 186 Ventilated 8 9 3 8 2 .. 2 5 1 1 2 2 10 1 54 Gully and other traps fixed 65 32 23 28 11 6 23 32 11 7 11 3 35 12 299 Urinals—Water supplied, cleansed .. .. 2 4 .. .. 2 .. .. .. 1 1 2 1 13 Cesspools—Abolished .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Water Closet— W.C. erected with pan, trap and water supply 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Pan and trap only provided 20 22 13 27 8 1 18 22 9 4 5 6 25 16 198 Water supply provided 13 39 11 36 30 12 21 24 27 7 38 35 32 55 380 Ventilated .. 1 1 1 .. .. .. .. 1 .. .. .. 2 .. 6 Position altered 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 2 Dust Bins—Provided 48 38 43 94 47 24 38 74 63 39 63 50 20 86 727 Repaired .. .. .. .. 2 1 .. .. .. 1 7 . . .. 4 15 Areas—Constructed .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 2 Yards—Paved .. .. 1 2 .. .. .. 2 .. .. .. .. .. 1 6 Repaved 20 15 8 19 10 6 15 8 8 4 18 19 14 22 186 Sinks—Provided 4 6 1 2 .. 1 5 .. 3 2 .. .. 4 1 31 Domestic Water Supply— Cisterns provided .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Cisterns repaired and cleansed .. 8 16 13 25 7 11 10 6 12 3 8 7 5 22 153 Water supply provided to dwelling house 8 10 4 10 11 .. 7 7 3 .. 5 9 5 11 90 Water supply provided to tenement house 2 1 .. 1 .. .. .. 1 11 4 .. 1 1 .. 22 Other improvements— Rooms cleaned and limewashed 52 53 65 154 91 122 71 32 198 61 218 364 96 259 1836 Walls and passages repaired, cleansed and limewashed 22 15 12 51 17 17 16 15 44 14 66 75 37 97 498 Floor space ventilated 1 1 1 5 .. .. 1 1 2 2 .. .. 2 1 17 Floors repaired 6 8 7 24 7 6 9 5 9 11 15 21 17 19 164 Roofs repaired 52 47 37 78 54 31 41 44 54 15 66 66 50 75 710 Overcrowding abated .. .. .. .. 1 .. .. 1 .. .. .. 1 1 7 11 Illegal use of underground Rooms for sleeping discontinued .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 3 Other Improvements, or Nuisances abated 60 78 39 121 60 35 61 59 90 37 127 111 84 219 1184 Rooms Disinfected 120 105 125 159 153 41 109 165 20 25 80 9 156 158 1425 Total Improvements 536 514 421 869 522 325 467 520 579 247 754 799 626 1091 8270 Total Premises Improved .. 273 269 255 422 290 117 255 367 207 130 335 222 286 433 3861 19191 64 HOUSES LET IN LODGINGS. There are 1,070 houses under the operation of the by-laws. I,7fi7 inspections were made during the year, followed by 8,520 subsequent reinspections and calls, so that the total visits amounted to 10 287. These inspections resulted in 1,024 intimations being forwarded to the persons responsible, which were followed by 218 statutory notices to demand the abatement of the nuisances discovered by the two inspectors especially engaged upon this work. Altogether 3,880 improvements were effected in 1,338 premises. Synopsis of Inspectors' Work:— Improvements. Drains Constructed — Reconstructed 2 Repaired 30 Ventilated — Gully and other traps fixed 2 Water Closets W.C. erected with pan, trap and water supply 4 Pan and trap only provided 29 Water supply provided 80 Ventilated — Position altered — Dust Bins Provided 202 Repaired 2 Areas Constructed — Yards Paved 4 Repaved 27 Sinks Provided 4 Domestic Water Supply Cisterns provided 1 Cisterns repaired and cleansed... 17 Water supply provided to dwelling house 4 Water supply provided to tenement house 6 Other Improvements Rooms cleansed and limewashed 1646 Walls and passages repaired, cleansed and limewashed 852 Floor space ventilated 1 Floors repaired 48 Roofs repaired 214 65 [1919 Overcrowding abated 8 Illegal use of underground rooms for sleeping discontinued 1 Other Improvements, or Nuisances abated 694 Rooms disinfected 2 Total Improvements 3,880 Total Premises Improved 1,338 STATE OF PAUPERISM IN THE BOROUGH. During the year the decrease in Pauperism was maintained, for the number of paupers relieved weekly averaged only 4,872, as contrasted with 5,078 in 1918 and 8,629 in 1914. Appended is a statement furnished by the Clerk to the Islington Guardians Showing the State o) Pauperism in the Borough during the year 1919. Average number Relieved during each week. Quarters. Indoor Paupers, Adults and Children. Outdoor Paupers. Totals. Totals corresponding periods 1918 Vagrants] Relieved. Children Boarded out. Borough Death rates, 1919. Adults. Children 1 2 3 4 5 6 7 8 9 1st Qr. 2,680 1,350 930 4 960 5,330 No Wards. 65 20.58 2nd „ 2,619 1,300 884 4,803 5,086 57 11.88 3rd „ 2,555 1,276 948 4,779 4 929 57 10.20 4th „ 2,621 1,306 1,020 4,947 4,971 55 13.73 The Year 2,619 1,308 945 4,872 5,078 58 14.09 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Food—Inspection of.—Inspector Wilkinson reports that during the year he has paid 1,015 visits to the 20 Slaughter Houses now on the register, including one Horse Slaughter House, and that he has ascertained that 16,114 animals were killed therein, namely :—1,371 oxen and cows, 26 calves, 14,268 sheep and lambs, 41 pigs and 408 horses for human consumption. These were mostly found of good quality and free from disease. 1919] 66 The food destroyed or otherwise disposed of (chiefly for pigs' food) so as to prevent its use for human food was as follows:— Tons cwts. qrs. lbs. Diseased meat and organs from slaughter-houses 2 1 0 23* Diseased or unsound meat, etc., from other sources 3 3 i 19 Bacon 2 3 1 Fish 1 4 1 1 Bread 1 2 0 Cheese 5 0 12 Condensed Milk 15 Butter 3 0 8 Eggs 1 2 2 Rabbits 11 3 4 Fruit, Vegetables, etc. 7 8 2 14 Dried Fruits (principally Dates) 25 2 1 22 Fowls and Ducks 1 5 Total Tons 40 6 0 14 The total amount of unsound or diseased meat, fish, fruit, and other food destroyed was 40 tons 6 cwts. 0 qr. 14 lbs. The diseases which affected animal food are set out in detail on p. 67. Shops, etc., Inspection of.—The number of shops, etc., when foodstuffs are sold varies somewhat from time to time, but may be approximated for the year as follows : — Butchers, provision dealers, etc., 186, meat and rabbit stalls 6, food preparation establishments 16, fish shops 84, fish stalls 6, fruit shops 175, and about 18 fruit stalls and barrows. To these 491 shops, etc. a total of 10,177 visits were made, apportioned as under, viz.:— Butchers, Provision Dealers, etc., Shops .. 5,126 visits. Food Preparation Establishments 189 „ Butcher and Provision Stalls, 158 „ Fish Shops 1,287 „ „ Stalls 271 „ Fruit Shops 1,933 „ „ Stalls 1213 „ Total 10,177 Visits. Cowhouses.— There are 4 cowhouses in the borough, and these were visited upon 25 occasions. They were generally found to be satisfactory. * Of this quantity 1 ton, 9 cwts. 1 qr. 14 lbs. was Tuberculous. Of this quantity 27 lbs. was Tuberculous. Milkshops and Dairies—At the close of the year there were 594 milkshops and dairies on the register, 9 having been added, and 1 removed from it. They received 693 visits from the District Sanitary Inspectors, who Served 32 notices for the execution of various sanitary improvements and the cleansing of dirty utensils. List of diseased or unsound meat and organs discovered in slaughter houses during the year 1919 :— No. of Cases Description of Animal Affected. Nature of Disease or Affection. Extent of Disease. How disposed of. 3 2 Cows and 1 Bull Tuberculosis (generalised) Carcase and all organs N.B. —On the ground of National economy the bulk of the meat and organs found unfit for human food was disposed of to Pig Keepers' for Pigs' food; and in other cases it was destroyed by fire. 1 Cow Tuberculosis (localised) Part Carcase and all organs 3 2 Cows and 1 Bull do. do. Part Carcase and part organs 2 1 Ox and 1 Heifer do. do. All organs 6 3 Cows and 3 Oxen do. do. Part organs 2 2 Pigs do. do. Heads and Throat glands 2 Sheep Moribund condition Carcase and all organs 5 Oxen and Cows Bruised-ante mortum Parts of Carcase 2 Fœ tus of Ewes Unwholesome Entire 1 Sheep Abscess Part of Carcase and Lungs 2 do. do. Liver, Lungs and diaphragm 5 do. do. Livers 43 Oxen, including Heifers, Cows and Bulls Parasitic (Dis. Hep.) do. 32 Sheep Parasitic (various) do. 4 Horses Hydatid Cysts do. Offensive Trades.—The 4 tripe dressers, 2 gut scrapers and the knacker's yard received 42 visits during the year. 67 [1919 19j.yj 68 ADULTERATION OF FOOD AND DRUGS. One thousand two hundred and twenty-nine samples of foods and drugs were submitted for analysis by the District Inspectors, for since Mr. Tom Leonard Burrell was loaned to the Food Control Committee, these Inspectors have procured the samples for submission to our Analyst, Dr. F. L. Teed and to the additional Analyst, Mr. A. Pinchin, B.Sc., who reported that 1,100 were genuine and G3 were adulterated, or 5-6 per cent. This percentage is the lowest hitherto recorded, and compares with 9-6 per cent, in the preceding year. It is, therefore, 4-5 per cent, lower than obtained then, and is 5-3 per cent, below the average rate during the preceding 29 years The greatest amount of adulteration occurred in the first and second quarters of the year, as is seen by the statement given below, when it was 0 3 and 7-3 per cent, respectively, and contrasted with 5-3 and 1-9 per cent, respectively in the third and fourth quarters. This falling off in the last two quarters of the year is due to the decreased amount of adulteration in milk. Indeed, in the last quarter the adulteration of this article of food fell as low as 3-7 per cent. Examined, Genuine. Adulterated. Per cent.[/### 1st Quarter 302 283 19 6.3 2nd „ 303 281 22 7.3 3rd „ 304 288 16 5.3 4th „ 320 314 6 1.9 The Year 1,229 1,166 63 5.6 - — - - Prosecutions.—40 summonses were issued under the Sale of Food and Drugs Acts, 20 of which were successfully prosecuted. Altogether penalties and costs to the amount of £158 7s. Od. were obtained. The Public Analysts, in the quarterly reports during the year, reported on the genuineness of the articles examined as follows :— Milk.—The qualitative results of the Analyses of the Milk samples, which have now been published for many years, are as follows :— No. of Samples. Solids not Fat. Fat. Total solids. Milk purchased on Sundays 166 8.56 .3.56 12.12 Milk purchased on week-days 331 8.56 3.6l . 12.17 Milk procured in transit at Finsbury Park Station 141 8.67 3.68 . 12.35 Official Standard — 8 50 300 1150 69 [1919 The particulars as to the genuineness or otherwise of the samples procured or purchased on Sundays, Week-days, and at Finsbury Park Railway Station are as follows:— Number taken. Genuine. Adulterated. Percentage Adulterated On Sundays 166 152 14 8.4 On Week-days 331 295 36 10.9 At Railway Stations (Farmers' Milks) 141 132 9 6.4 638 579 59 9.2 iving the particulars of the Milks taken during each quarter of 1919 on Sundays, Week-days, and at the Railway Stations. 1919. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Week-days. Railway Stations. All Milks. Sundays. Week-days. Railway Station. All Milks. Sundays. Week-days. Railway Stations. All Milks. Sundays. Week-days. Railway Stations. All Milks. 1st Quarter 41 79 39 159 37 68 36 141 4 11 3 18 9.7 13.9 7.7 11. 3 2nd ,, 42 81 33 156 38 69 30 137 4 12 3 19 9.5 14.8 9.1 12.2 3rd „ 40 88 36 162 36 76 34 146 4 10 2 16 10.0 11.5 5.5 9.9 4th „ 43 85 33 161 41 82 32 155 2 3 1 6 4.6 3.5 3.0 3.7 The Year 160 331 141 638 152 295 132 579 14 36 9 59 8.4 10.9 6.4 9.2 The number of samples of milk purchased was 638, of which 579 were genuine and 59, or 9.2 per cent, were adulterated. As a rule it may be stated that the milk sold in Islington is of good quality, but last year it was not quite so good as that generally sold. There is, however, very little to complain about, for a study of the table on p. 71 showing the adulteration of milk that is sold in the borough and of milk arriving at the railway stations indicates that the average milk sold in the borough showed it to contain 3.56 per cent, of fat on Sundays, 3-61 per cent, on weekdays, as contrasted with 3.68 per cent, of fat in the milk delivered at the railway stations. It will be seen from this that there is a slight diminution in the amount of fat sold on weekdays and Sundays when contrasted with the milk arriving from the country. The amount, however, is very slight, and hardly noticeable. It is satisfactory, therefore, to note that our milk supply has not materially deteriorated, although as a matter of fact the milk arriving in London from the farmers is not quite so good as it used to be in days gone by. For 21 years the fat content of the farmers' milks averaged 3.83 per cent., 70 1919] whereas last year it was 3.68 per cent., which is practically the same amount as that of the milks of the preceding four years. During the last few years, probably owing to the increased price of milk, the roundsmen unfortunately got into the habit of giving short measure, with the result that there were several prosecutions for this offence undertaken by the Food Control Committee, and it is satisfactory to note that a number of convictions were obtained, although the penalties were not nearly so heavy as they should have been. The number of these offences is not known to the Medical Officer of Health, as they did not come within his official cognisance, it being no part of the duty of the Public Health Department to prosecute for their commission. It is to be hoped, however, that in the new Milk Regulations some especial power will be given to sanitary authorities to take proceedings against persons who practise this fraud, but this may not occur for it is rumoured that the Ministry of Health hold the opinion that the public can protect themselves against this fraud by measuring their milk. The return of the samples of milk reported as adulterated by the Public Analyst, is given in the following tabular statement:— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adultered. 1892 171 139 32 18.7 1893 213 173 40 18.7 1894 206 169 37 17.9 1895 413 343 70 16.9 1896 468 418 50 10.6 1897 513 464 49 9.5 1898 543 492 51 9.4 1899 532 477 55 10.3 1900 54i 485 56 10.3 I90I 632 556 76 I2.0 1902 586 528 58 9.9 1903 508 458 50 9.8 1904 600 553 47 7.8 1905 594 549 45 7.6 1906 634 560 74 11.8 1907 597 557 40 6.7 1908 604 552 52 8.6 1909 605 563 42 6.9 1910 621 563 58 9.3 1911 601 542 59 9.8 1912 606 573 33 5.4 1913 600 555 45 7.5 1914 595 539 56 9.4 1915 605 531 74 12.2 1916 599 506 93 I5.5 1917 592 526 66 11.1 1918 634 537 97 15.3 Totals 14.413 12,908 1.505 10.4 1919 638 579 59 9.2 71 [1919 Showing the analyses of 12,402 milks examined in Islington during the twenty one years 1898-1918 and 1919, and distinguishing those purchased on Sundays, on Week-days, and procured at the Railway Stations whilst in transit from the Farmer to the London Milk Purveyor. Years. Sunday Milks. Week-day Milks. Railway Milks (Farmers). No. of Samples. Per cent. of non-fatty solids. Per cent. of fat. No. of Samples. Per cent. of non-fatty solids. Per cent. of fat. No. of Samples. Per cent. 0 non-fatty solids. Per cent. of fat. 1898 193 8.50 3.50 230 8.56 3.69 120 8.84 4.04 1899 181 8.49 3.50 231 8.53 3.58 120 8.82 4.23 1900 196 8.64 3.62 224 8.55 3.53 121 8.75 3.93 1901 196 8.56 3.64 295 8.60 3.49 141 8.77 3.69 1902 192 8.59 3.60 274 8.64 3.51 90 8.76 3.85 1603 167 8.42 3.86 218 8.47 3.74 120 8.66 3.90 1904 164 8.52 3.78 317 8.48 3.74 120 8.62 3.97 1905 _ .. 161 8.55 3.68 323 8.51 3.72 112 8.66 3.87 1906 195 8.49 3.58 332 8.52 3.59 110 8.75 3.69 1907 150 8.64 3.63 327 8.65 3.76 120 8.77 3.96 1908 160 8.58 3.69 324 8.58 3.52 120 8.73 3.88 1909 159 8.66 3.67 326 8.85 3.62 120 8.74 3.86 1910 160 8.57 3.55 336 8.50 3.44 125 8.76 3.74 1911 160 8.57 3.63 320 8.54 3.65 121 8.71 3.92 1912 160 8.70 3.67 32b 8.76 3.61 120 8.84 3.86 1913 162 8.74 3.56 318 8.72 3.52 120 8.92 3.80 1914 155 8.60 3.42 320 8.71 3.52 120 8.88 3.78 1915 165 8.64 3.43 320 8.76 3.49 120 8.86 3.67 1916 160 8.60 3.53 319 8.56 3.43 120 8.83 3.63 1917 150 8.63 3.45 322 8.60 3.41 120 8.84 3.59 1919 136 8.39 3.60 377 8.44 3.53 121 8.61 3.65 Total samples and average constituents(21 years) 3,522 8.58 3.60 6.379 8.60 3.57 2,501 8.77 3.83 1919 166 8.56 3.56 331 8.56 3.61 111 8.67 3.68 1919] 72 Showing the Samples of Foods and Drugs submitted to the Public Analyst during the year 1919. Description. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Genuine. Adulterated. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals let Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Milk 159 156 162 161 638 141a 137a 146a 155d 579 18a 19a 16a 6a 59 Butter 48 49 49 51 197 48 49 49 51 197 .. .. .. .. .. Lard 10 10 11 10 41 10 10 11 10 41 .. .. .. .. .. Dripping 18 19 20 20 77 18 19 20 20 77 .. .. .. .. .. Coffee 18 9 10 10 47 18 9 10 10 47 .. .. .. .. .. Coffee (French) .. .. 1 .. 1 .. .. 1 .. 1 .. .. .. .. Coffee & Chicory 1 .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. Cocoa 10 20 20 21 71 10 20 20 21 71 .. .. .. .. .. Mustard .. 9 8 8 25 .. 6 8 8 22 .. 3 .. .. 3 Pepper .. .. .. 9 9 .. .. .. 9 9 .. .. .. .. .. Baking Powder 10 .. .. .. 10 10b .. .. .. 10 .. .. .. .. .. Malt Vinegar 9 .. 1 7 17 9 .. 1 7 17 .. .. .. .. .. Mustard Mixture .. 1 .. 2 3 .. 1 .. 2 3 .. .. .. .. .. Mustard Condiment .. .. 1 .. 1 .. .. 1 .. 1 .. .. .. .. .. Iron Pills .. 10 .. .. 10 .. 10 .. .. 10 .. .. .. .. .. 283 283 283 299 1,148 265 261 267 293 1,086 18 22 16 6 62 Margarine 19 20 21 21 81 18 20 21 21 80 1 .. .. .. 1 Totals 302 303 304 320 1,229 283 281 288 314 1,166 19 22 16 6 63 a All free from Boric Acid and Formalin. b Conformed with the Local Government Board recommendations. 73 [1919 Milk Prosecutions. The summary of prosecutions showed that during the year 47 prosecutions were taken, of which number 24 were successful and 22 were dismissed, while one was withdrawn. The large number of cases dismissed was due to the fact that in 19 cases warranties were pleaded in defence. The warranty defence, especially in the case of milk, is a public scandal, for as is seen in the tables showing the composition of the several milks, the farmers send to the borough milk containing, on an average, 3.83 per cent. of fat. It is hoped that we have nearly come to the end of the days when such a defence can be pleaded, for undoubtedly the offence was for the most part due to adulteration by dishonest distributors or by the abstraction of fat in the course of transit. But here again it must be said that such abstraction could not occur if the milk purveyors insisted that this important food, especially for invalids and children, should be forwarded in locked or fastened churns. There has always been unwillingness both on the part of the London purveyors and the farmers to send their milk or to receive it in protected churns, and it is astonishing to find that a plea has been put forward by purveyors that the railway companies would not allow the conveyance of milk and churns thus protected, although as a matter of fact it has been allowed by them for nearly twenty years. SUMMARY OF PROSECUTIONS.—During year 1919. Total Prosecutions. Successful. Dismissed. Withdrawn. Amount Penalties Received. "Public Health (London) Act, 1891" 7 4 3* ... £ s. d. 29 13 0 "Sale of Food and Drugs Acts, 1875-99 " 40 20 19† 1§ 158 7 0 "Margarine Act, 1887" Nil. ... ... ... ... Total 47 24 22 1 188 0 0 * 2 summonses were dismissed on technical objections, while the other was an alternative summons. † Warranties established. Withdrawn upon payment of costs. APPENDIX. VITAL AND SANITARY STATISTICS, 1919. together with the PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH AND Abstracts for Previous Years. 1919] 76 Table A. Showing the Deaths from All Causes in Islington during the Year (53 Weeks) ending 3rd January, 1920. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. Deaths in Institutions within Borough. DISEASES. AGES. Under 5 Over 5 DISTRICTS. Males. Females. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H. B. S.E. Small Pox (a) Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 (b) Unvaccinated .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 (c) No Statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles .. 10 2 .. .. .. .. .. .. .. .. .. .. 10 2 1 .. .. 4 1 .. 6 3 9 Scarlet Fever .. 7 7 2 .. 1 2 .. .. .. .. .. .. 7 7 .. .. 1 ? 2 4 .. 7 .. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 90 Epidemic Influenza 4 15 5 8 21 27 82 47 48 42 36 18 3 19 337 40 38 30 19 61 75 93 172 184 2 Whooping Cough 2 12 3 .. .. .. .. .. .. .. .. .. .. 14 3 .. 2 1 1 3 8 2 7 10 3 Diphtheria 1 18 28 3 1 .. .. .. .. .. .. .. .. 19 32 3 3 4 4 15 3 10 23 28 Enteric Fever .. .. .. .. 1 1 .. .. 1 .. .. .. .. .. 3 .. 1 1 .. .. .. 1 1 2 Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Diarrhœa, Dysentery 11 3 1 .. .. .. .. .. 2 4 2 1 .. 14 10 1 .. 1 4 2 8 3 14 10 1 Epidemic Enteritis 9 .. 1 .. .. .. .. .. .. .. .. 1 1 9 3 1 3 .. 2 1 .. 5 2 10 Other Allied Diseases †§§ §§3 §4 .. .. .. .. .. §2 .. .. .. .. 6 6 .. 1 .. 3 ? 1 5 6 6 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tetanus 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 1 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Syphilis 5 .. .. 1 .. 1 .. 1 1 .. 1 .. .. 5 5 2 1 1 1 1 1 3 3 7 Gonorrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. 2 .. .. .. .. 1 .. 3 .. Phagedaena .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9 Erysipelas .. .. .. .. .. 1 3 3 1 2 3 1 .. 13 2 2 2 .. 1 3 3 6 7 8 Puerperal Fever .. .. .. .. .. 1 10 .. .. .. .. .... .. .. 13 .. .. .. .. 3 .. .. .. .. 8 Pyaemia 2 .. 1 .. .. .. 1 .. 3 2 3 1 .. .. 11 .. 1 1 2 6 ?, 2 9 5 7 Infective Endocarditis .. .. .. 1 3 4 5 2 3 .. .. 1 .. .. 19 1 1 1 2 2 6 6 8 11 1 Other Allied Diseases .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 2 .. .. 1 .. .. .. 1 1 1 Malarial Fever .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 2 1 .. .. .. .. 1 .. 2 .. Rheumatic Fever .. .. 3 1 1 .. 1 .. 1 .. .. .. .. .. 7 1 2 1 2 .. .. 1 1 6 Rheumatism of Heart .. .. 1 1 .. .. .. .. .. .. 1 .. .. .. 3 1 1 .. .. .. 1 .. 1 1 5 Tuberculosis of Brain 6 23 6 8 2 1 .. 1 .. .. .. .. .. 29 15 .. .. .. .. 3 8 17 18 26 1 Tuberculosis of Laryanx .. .. .. .. .. .. .. 2 2 .. .. .. .. .. 4 2 .. .. .. .. 1 1 3 1 106 Phthisis 2 16 3 11 23 44 72 87 67 58 11 .. .. 18 .. 34 48 37 45 53 58 109 215 169 6 Abdominal Tuberculosis 4 5 2 1 .. 5 1 3 1 1 .. .. 4 19 1 5 1 3 2 5 6 13 10 General Tuberculosis 1 .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. 1 .. .. 1 .. 1 .. 2 Other forms Tuberculosis 1 3 .. 2 1 .. .. .. .. 2 .. 1 .. 4 6 1 .. .. .. 3 2 4 5 .. Other Infective Disease .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Actinomycosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydatid Diseases .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. Scurvy 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. Other Diseases due to Altered Food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chronic Industrial Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Osteo-arthritis .. .. 1 .. .. .. .. .. .. 3 8 2 1 .. 15 .. 2 2 .. 4 2 3 10 Gout .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 128 Cancer 1 1 .. 1 1 3 5 36 101 120 123 39 7 2 436 57 48 .. 60 83 60 92 211 227 Diabetes Mellitus .. .. .. .. 1 2 6 2 5 6 6 .. .. .. 28 .. 2 3 2 5 5 11 12 16 Purpura Hasmorrhagica 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. 1 .. 1 .. Haemophilia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anaemia .. .. .. .. .. .. .. 2 .. 2 3 .. .. .. 7 .. 1 .. 1 4 .. 1 3 4.. Lymphadenoma .. .. .. 1 .. 1 .. .. .. 1 . .. .. .. 3 2 .. .. 1 .. .. .. 1 2 Premature Birth 108 .. .. .. .. .. .. .. .. .. .. .. .. 108 .. 8 11 15 15 10 24 25 61 47 Injury at Birth 4 .. .. .. .. .. .. .. .. .. .. .. .. 4 .. 1 1 .. 2 .. .. .. 2 2 Debility at Birth 14 .. .. .. .. .. .. .. .. .. .. .. .. 14 .. .. .. 1 5 1 2 5 8 6 Atelectasis 7 .. .. .. .. .. .. .. .. .. .. .. .. 7 .. 1 1 .. .. 1 .. 1 .. .. Congenital Defects 62 1 .. .. .. .. .. .. .. .. .. .. .. 63 .. 3 6 6 10 11 12 15 .. 25 Want of Breast Milk 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. 1 •• 1 Atrophy, Debility, Marasmus 74 1 .. .. .. .. .. .. .. .. .. .. .. 75 .. 5 11 7 9 15 13 15 40 35 † Chicken Pox (1). § Cerebro Spinal Meningitis (9). !! Post-basic Meningitis (1). * Ophthalmia Neonatorum (3). 77 [1919 Table A.—Continued. Deaths in Institutions within Borough. DISEASES. AGES. Under 5. Over 5. DISTRICTS. Males. Females. Totals 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. | U.H. Toll. L.H. H. B. S.E. Dentition 1 1 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. 1 .. 1 .. .. 1 1 2 Rickets .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. 1 1 .. .. .. 1 1 2 Old Age, Senile Decay .. .. .. .. .. .. .. .. .. 4 104 258 109 .. 475 39 77 30 52 89 80 108 185 390 175 Convulsions 5 1 .. .. .. .. .. 1 .. .. .. .. .. 6 1 .. 1 1 .. 3 .. .. .. 3 7 Meningitis 5 2 4 2 1 .. .. 3 1 .. .. .. .. 7 11 2 1 1 3 1 4 5 7 11 18 Encephalitis 2 .. †1 2 .. .. 1 2 1 .. .. 1 .. 2 8 1 3 .. 1 2 1 2 5 5 10 Apoplexy .. .. .. .. .. .. 5 5 19 33 43 41 4 .. 148 17 16 16 16 37 20 26 61 .. 148 Softening of Brain .. .. .. .. .. .. .. .. .. 2 1 .. .. .. 3 .. .. 2 .. 1 .. .. 1 2 3 Hemiplegia .. .. .. .. .. .. .. .. 1 5 5 2 3 .. 16 1 2 .. 2 .. 5 3 7 9 16 General Paralysis of the Insane .. .. .. .. .. .. 2 7 10 2 .. .. .. .. 21 l 5 1 3 3 4 4 l6 5 21 Other forms of Insanity .. .. 1 1 .. 1 1 1 3 5 8 2 .. .. 23 2 5 3 2 5 3 3 10 13 23 Chorea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebral Tumour .. .. 2 .. 1 .. 2 1 1 .. .. .. .. .. 7 .. 2 1 .. 3 .. 1 .. 5 7 Epilepsy .. .. 1 .. 2 .. .. 2 3 .. 3 .. .. .. 12 1 2 .. 3 2 .. 4 5 7 12 Laryngismus Stridulus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 Locomotor Ataxy .. .. .. .. .. .. .. 2 4 8 2 .. .. .. 16 3 .. .. 1 3 3 5 16 .. 16 Paraplegia .. .. .. .. .. .. .. 3 3 15 6 5 1 .. 33 5 .. 4 1 11 4 8 .. 13 33 Other forms, Brain Diseases .. .. .. 1 .. .. 1 2 1 **1 1 .. .. .. 7 .. .. .. 1 4 2 .. 3 4 7 Otitis .. .. .. 2 1 .. 2 .. .. .. .. 1 .. .. 6 1 3 1 1 .. .. 3 .. 5 9 Disease of Nose, Epistaxis .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 1 Disease of Eye .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 1 1 Pericarditis .. .. .. 1 1 .. 2 .. .. .. 1 .. .. .. 5 1 1 .. 1 2 1 .. 4 2 6 Endocarditis .. .. .. 1 2 .. .. 1 1 2 1 .. .. .. 9 .. 1 .. 2 .. 3 3 .. 3 9 Hypertrophy of Heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Angina Pectoris .. .. .. .. .. .. .. .. .. 1 1 1 .. .. 3 .. .. .. .. 1 .. 2 3 .. 3 3 Aneurism .. .. .. .. .. .. .. 1 7 4 .. 2 .. .. 14 3 4 .. 3 1 1 2 9 5 14 4 Senile Gangrene .. .... .. .. .. .. .. .. .. 5 5 1 .. 11 2 3 1 1 2 l 1 6 5 11 10 Embolism, Thrombosis .. .. .. .. .. .. .. 5 6 5 7 6 1 .. 33 2 4 2 3 11 4 7 10 23 33 Phlebitis .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 .. 1 1 Varicose Veins .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. 1 .. .. .. 1 .. 1 Other Diseases, Heart and Vessels .. 2 2 4 5 4 21 44 68 127 179 96 24 2 b74 58 59 57 50 90 99 163 296 280 376 Laryngitis .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 1 1 .. 1 1 2 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases, Larynx and Trachea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 18 Acute Bronchitis 30 6 1 .. .. 1 2 3 13 20 31 33 9 36 113 20 21 13 18 26 14 39 76 73 149 60 Chronic Bronchitis 6 6 .. .. .. 1 .. 9 14 45 91 56 9 12 233 21 SS 19 39 34 46 53 102 143 145 8 Lobar Pneumonia 2 2 .. .. 1 2 5 9 5 8 6 3 .. 4 37 4 4 4 7 8 8 6 28 13 41 29 Lobular Pneumonia 55 52 12 2 .. .. 7 13 7 11 16 8 1 107 77 19 10 19 27 33 32 44 104 80 184 23 Pneumonia 8 9 .. .. 3 4 15 11 17 13 14 3 2 17 82 10 12 10 12 8 23 24 59 40 99 2 Emphysema, Asthma .. .. 1 .. .. .. 1 1 6 9 9 .. .. .. 27 2 1 4 3 7 2 8 16 11 27 4 Pleurisy .. 1 .. 1 .. .. 5 ? 3 1 2 1 .. 1 15 5 1 .. 3 2 2 3 9 7 16 1 Other Diseases, Respiratory .. .. .. .. .. .. 1 1 1 2 1 1 .. .. 7 .. 2 .. 3 .. .. 2 3 4 7 Diseases of Mouth and Annexa 1 1 2 .. .. .. 1 .. .. 1 .. .. .. 2 4 .. 1 .. 2 2 .. 1 3 3 6 Diseases of Pharynx .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 1 Diseases of (Esophagus .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 1 .. .. 1 4 Ulcer of Stomach and Duodenum .. .. .. .. 2 3 10 11 7 4 2 .. .. 39 8 3 4 6 5 7 6 27 12 39 Other Disease of Stomach 7 1 .. .. .. .. .. 1 .. .. 1 1 1 8 4 .. .. 2 ,3 1 3 3 6 6 12 32 Enteritis 53 8 .. 1 .. .. .. .. 2 2 .. 1 .. 61 6 2 7 8 7 7 18 18 40 27 67 5 Appendicitis .. 1 2 3 .. .. 1 3 3 2 2 .. .. 1 17 1 4 .. 1 4 4 4 .. 10 18 Obstruction of Intestine .. 2 .. .. .. .. 2 1 3 9 7 6 .. 2 28 4 1 5 3 5 4 8 11 19 30 Other Diseases of Intestine 2 1 .. 1 .. .. .. 1 .. 1 .. .. .. 3 3 .. 1 1 1 .. 1 2 4 2 6 Cirrhosis of Liver .. .. .. .. .. .. .. 1 3 6 5 1 .. .. 16 2 1 3 1 3 2 4 7 9 16 Other Disease of Liver 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 5 2 1 .. .. 1 .. 2 2 4 6 Peritonitis . .. .. 2 .. .. 1 .. 1 .. 2 .. .. .. .. 6 .. .. .. 1 2 1 2 3 3 6 Other Diseases, Digestive System 1 .. .. .. .. .. .. .. 2 .. 1 1 .. 1 4 .. 1 .. .. 2 2 .. 2 3 5 Diseases, Lymphatic System and Glands .. 2 .. .. .. 1 l 1 1 1 1 3 .. 2 9 3 1 .. 1 2 2 2 1 10 11 4 Acute Nephritis .. .. .. .. 1 .. 1 .. 1 1 .. .. .. .. 4 .. .. 2 1 1 .. .. 4 .. 4 17 Bright's Disease .. .. .. 1 .. 2 3 8 15 30 24 11 3 .. 97 7 13 10 10 16 10 31 57 40 97 Calculus .. .. .. .. .. .. .. .. 1 1 2 .. .. .. 4 1 .. .. .. .. 3 .. 2 2 4 3 Diseases of Bladder and Prostate .. .. .. .. 1 .. 2 3 4 3 13 5 .. .. 31 3 4 4 5 6 4 5 27 4 31 Other Diseases, Urinary System 1 1 .. .. .. 1 l 1 3 3 1 2 1 2 13 3 1 1 1 2 3 4 8 7 l5 Diseases of Testis and Penis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diseases of Ovaries .. .. .. .. .. .. 2 1 .. .. .. .. .. .. 3 .. .. 1 1 .. .. 1 .. 3 3 Diseases of Uterus and Appendages .. .. .. .. .. .. .. 1 1 1 .. 1 .. .. 4 .. 1 1 .. 1 .. 1 .. 4 4 Diseases of Vagina and External Genitals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diseases of Breast .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Abortion, Miscarriage .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 1 Puerperal Mania .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Convulsions .. .. .. .. .. .. l 1 .. .. .. .. .. .. 2 .. 1 .. 1 .. .. .. .. .. 2 Placenta Praevia, Flooding .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 2 .. .. .. 2 .. .. .. .. 2 2 † Acute Poliomyelitis. ** Encephalitis Lethargica. 78 1919] Table A.—Continued. Deaths in Institutions within Borough DISEASES. AGES. Under 5. Over 5. DISTRICTS. Males. Females. Totals. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H. B. S.E. Puerperal Tromhosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Other Diseases, Pregnancy and Childbirth .. .. .. .. 1 .. 1 3 .. .. .. .. .. .. 5 1 .. 1 1 1 1 .. .. 5 5 Arthritis, Ostitis, Periostitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases, Osseous System 1 2 3 3 1 1 1 .. .. .. .. .. .. 3 9 1 2 2 3 .. 2 2 9 3 Ulcer, Bedsore .. .. .. .. .. .. .. .. 1 .. 2 1 .. .. 4 .. 3 .. .. .. .. 1 2 2 4 Eczema .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pemphigus 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 .. .. Other Diseases, Integumentary System .. .. 2 1 .. .. 1 2 .. 2 1 .. .. .. 9 .. 2 1 3 2 .. 1 5 4 9 Accidents and Negligence. In Mines and Quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 In Vehicular Traffic .. 4 5 1 2 .. 3 2 2 2 9 5 .. 4 31 4 2 4 3 2 11 9 15 20 35 On Railways .. .. .. .. 1 .. .. .. 1 .. 2 .. .. .. 4 .. 1 1 1 .. 1 .. 3 1 4 On Ships, Boats, etc. (not drowning) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. In Building Operations .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Machinery .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. 2 By Weapons and Implements .. .. .. .. 1 .. 1 .. 1 .. .. .. .. .. 3 .. .. 1 .. .. 1 1 3 .. .. 15 Burns and Scalds 1 8 1 2 3 1 2 .. 1 2 1 1 1 9 15 1 1 3 4 5 4 6 5 19 24 Poisons, Poisonous Vapours .. 1 .. .. .. 1 .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. .. 1 .. 2 2 Surgical Narcosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Effects of Electric Shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Corrosions by Chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Drowning .. .. 2 1 .. .. .. 1 .. 1 .. .. .. .. 5 1 .. 1 .. .. 3 .. 3 2 5 Suffocation, Overlaid in Bed 7 .. .. .. .. .. .. .. .. .. .. .. .. 7 .. 1 .. .. 1 1 1 3 4 3 7 ,, Otherwise 5 2 1 .. .. .. .. 1 .. 1 .. .. .. 7 3 1 .. 1 1 3 2 2 6 4 10 21 Falls not specified .. .. .. .. .. .. .. 1 2 5 8 13 7 .. .. 1 3 4 4 8 3 8 14 23 26 Weather Agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Otherwise, not stated 1 .. .. 2 .. .. .. .. 1 .. 1 .. .. 1 4 .. 2 .. .. 1 2 .. 3 2 5 Homicide 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. 1 1 .. 1 1 2 Suicide. By Poison .. .. .. .. .. .. 1 2 .. 3 2 .. .. .. 8 .. 1 .. 1 1 1 4 6 2 4 By Asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Hanging and Strangulation .. .. .. .. .. .. 1 1 2 .. .. .. .. 4 .. .. 1 1 1 .. 1 2 2 4 By Drowning .. .. .. .. .. .. 1 1 2 .. .. .. .. .. 4 .. .. .. .. 3 .. 1 2 3 4 By Shooting .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. 2 By Cut or Stab .. .. .. .. .. .. .. .. 1 5 .. .. .. .. 6 .. 1 2 .. .. 1 2 6 .. 6 By Precipitation from Elevated Places .. .. .. .. .. .. .. .. 3 .. 1 .. .. .. 4 1 .. .. .. .. 1 2 3 1 4 By Crushing .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. By other and unspecified methods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Execution .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sudden Death, cause not ascertained .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ill-defined and unspecified causes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Bombs (enemy . ircratt .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Males 299 117 49 33 40 44 133 191 279 386 434 253 47 416 1889 202 262 203 274 377 417 570 ... ... 2305 Females 226 122 66 40 45 70 163 178 220 274 394 394 143 348 1987 241 278 217 271 404 360 564 ... ... 2335 792 TOTAL DEATHS 525 239 115 73 85 114 296 369 499 660 828 647 190 764 3876 443 540 420 545 781 777 1134 2305 2335 4640 79 [1919 TABLE B. Showing the Births and Birth Rates of Islington from 1841 to 1919. Year. Births. Birth Rates. Year. Births. Birth Rates. Year. Births. Birth Rates. Year. Births. Birth Rates. 1841 1446 25.58 1861 5530 35.31 1881 9894 34.87 1901 9264 27.62 1842* 1508 25.28 1862 5619 34.76 1882 9991 34.79 1902* 9214 27.06 1813 1627 25.86 1863 6094 36.51 1883 9940 34.19 1903 8983 26.95 1844 1804 27.18 1864 6349 36.84 1884* 9872 33.54 1904 8890 26.73 1845 1838 26.20 1865 6743 37.90 1885 9667 32.45 1905 8756 26.39 1846 2152 29.13 1866* 6983 38.02 1886 9849 32.66 1906 8659 26.16 1847 2318 29.75 1867 7391 38.97 1887 9740 31.92 1907 8531 25.83 1848* 2529 30.76 1868 7608 38.86 1888 9609 31.10 1908* 8665 25.80 1849 2613 30.13 1869 7529 37.24 1889 9628 30.79 1909 8198 24.93 1850 3015 32.96 1870 7674 36.77 1890* 9230 29.16 1910 8201 25.01 1841-50 20850 28.65 1861-70 67520 37.20 1881 90 97420 32.49 1901-10 87361 26.36 1851 3033 31.46 1871 7671 35.63 1891 9797 30.61 1911 8113 24.79 1852 3462 34.19 1872* 8048 36.36 1892 9743 30.12 1912 8211 25.15 1853 3701 34.81 1873 8398 36.89 1893 9749 29.81 1913* 8359 25.19 1851* 3964 35.50 1874 8697 37.16 1894 9678 29.28 1914 8177 25.12 1855 4148 35.37 1875 9068 37.67 1895 10183 30.48 1915 7537 23.16 185G 4306 34.97 1876 9225 37.26 1896* 9921 29.38 1916 7262 21.57 1857 4512 34.89 1877 9380 36.85 1897 9842 29.19 1917 5837 17.62 1858 4560 33.57 1878* 9498 36.28 1898 9453 28.07 1918 5197 16.20 1859 5011 35.13 1879 9714 36.08 1899 9658 28.72 1919* 6278 18.30 1860* 5218 34.84 1880 9928 35.86 1900 9254 27.55 1851-60 41915 34.54 1871-80 89627 36.60 1891-190C 97278 29.31 1911-19 (9 years) 64971 21.90 * These years contained 53 weeks. 1919] 80 Table C. Showing the Illegitimate Births in Islington from 1841 to 1919. Years. Births. Years. Births. Years. Births. Years. Births. Years. Births. Years. Births Years Births. Years. Births. 1841 * 1851 100 1861 184 1871 280 1881 380 1891 265 1901 228 1911 248 1842 33 1852 100 1862 207 1872 346 1882 353 1892 298 1902 248 1912 303 1843 * 1853 95 1863 224 1873 335 1883 370 1893 267 1903 242 1913 297 1844 * 1854 125 1864 248 1874 344 1884 341 1894 290 1904 273 1914 304 1845 43 1855 126 1865 291 1875 363 1885 327 1895 286 1905 227 1915 271 1846 53 1856 149 1866 272 1876 361 1886 331 1896 242 1906 244 1916 289 1847 64 1857 151 1867 306 1877 337 1887 350 1897 269 1907 230 1917 297 1848 85 1858 140 1868 317 1878 303 1888 345 1898 262 1908 231 1918 239 1849 74 1859 174 1869 284 1879 401 1889 350 1899 279 1909 250 1919 215 1850 97 1860 175 1870 318 1880 359 1890 328 1900 261 1910 240 7 yrs 449 1851 to 1860 1335 1861 to 1870 2651 1871 to 1880 3429 1881 to 1890 3475 1891 to 1900 2719 1901 to 1910 2413 1911 to 1919 9 yrs. 2463 * The births in these years cannot be ascertained. 81 [1919 TABLE D. Showing the Deaths and Death Rates of Islington from 1841 to 1919. Years. Deaths. Death rates. Years. Deaths. Death rates. Years. Deaths. Death rates. Years. Deaths. Death rates. 1841 1013 17.91 1861 3123 19.94 1881 5617 19.79 1901 5361 15.98 1842* 1101 18.46 1862 3496 21.62 1882 5643 19.65 1902* 5635 16.55 1843 1115 17.72 1863 4340 26.00 1883 5561 19.12 1903 4839 14.52 1844 1294 19.49 1864 4594 26.65 1884* 5515 18.74 1904 5236 15.74 1845 1258 17.96 1865 4617 25.94 1885 5740 19.27 1905 4955 14 93 1846 1383 18.72 1866* 5154 28.06 1886 5434 18.02 1906 5050 15.26 1847 1624 20.83 1867 4509 24.55 1887 5699 18.67 1907 5079 15.38 1848* 1745 21.22 1868 4886 24.95 1888 5197 16.82 1908* 4679 13.93 1849 1891 21.80 1869 4937 24.42 1889 5035 16.10 1909 4918 14.96 1850 1609 17.58 1870 5078 24.33 1890* 6152 19.43 1910 4523 13.79 1841-50 14033 19.28 1861-70 44734 24.64 1881-90 55593 18.55 1901-10 50275 15.17 1851 2082 21.59 1871 5048 23.44 1891 6326 19.77 1911 4866 14.87 1852 2086 20.60 1872* 4196 18.95 1892 6075 18.78 1912 4682 14.34 1853 2395 22.52 1873 4156 18.25 1893 6391 19.55 1913* 5028 15.15 1854* 2800 25.07 1874 4816 20.57 1894 5263 15.92 1914 4938 15.20 1855 2680 22.85 1875 4833 20.07 1895 5760 17.24 1915 5546 1704 1856 2677 21.74 1876 4969 20.07 1896* 5884 17.42 1916 4751 15 35 1857 2586 20.00 1877 5111 20.07 1897 5395 16.00 1917 4600 15.48 1858 2777 20.44 1878* 5376 20.53 1898 5705 16.94 1918 5841 20.40 1859 2898 20.32 1879 5456 20.27 1899 6293 18.71 1919* 4640 14.09 1860* 3028 21.21 1880 5716 20.65 1900 5721 17.03 1851-60 26009 21.43 1871-80 49677 20.28 1891-1900 58813 17.72 1911 19 9 years. 44892 15.77 * These years contained 53 Weeks. 1919] 82 TABLE E. Infantile Mortality Returns, extracted from the Annual Reports of the Registrar-General, 1841-55, and from the Annual Reports of the Medical Officer of Health of Islingon, 1856 to 1919. Years. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. 1841 190 131 1861 748 135 1881 1,400 140 1901 1,290 139 1842* 224 149 1862 725 130 1882 1.403 140 1902* 1,219 132 1843 — — 1863 906 147 1883 I.312 133 1903 1.136 126 1844 — — 1864 969 153 1884* 1,506 150 1904 1,140 128 1845 267 164 1865 1,088 161 1885 1.387 143 1905 1,074 "3 1846 330 153 1866' 1,170 169 1886 1.517 54 1906 1,083 125 1847 348 150 1867 1,119 152 1887 1.557 160 1907 995 117 1848* 386 152 1868 1,266 164 1888 1,271 132 1908* 894 103 1849 441 168 1869 1.234 165 1889 1,261 131 1909 841 103 1850 360 119 1870 1.135 149 1890* 1,488 161 1910 777 95 1841-50 (8 years) 2.546 146 1861-70 10,360 153 1881-90 14,102 145 1901-10 10,450 120 1851 457 151 1871 1,179 154 1891 1,481. 151 1911 1,040 128 1852 457 132 1872* 1, 200 150 1892 1,417 145 1912 710 86 1853 571 154 1873 1,172 138 1893 1.595 164 1913* 898 107 1854* 604 152 1874 1,278 147 1894 1,229 127 1914 849 104 1855 605 146 1875 1,306 145 1895 1,416 139 1915 805 107 1856 612 142 1876 1,397 152 1896 1,490 150 1916 634 87 1857 642 140 1877 1,302 140 1897 1,338 136 1917 565 97 1858 648 142 1878* 1,453 154 1898 1,504 159 1918 571 110 1859 665 133 1879 1,340 135 1899 1.548 160 1919* 525 83 1860* 747 144 1880 1.517 154 1900 1.344 145 1851-60 6.008 143 1871-80. 13.144 147 1891-00 14,362 148 1911-19 (9 years ) 6,597 101 * These years contained 53 weeks. 83 [1919 Table F. Showing the Cases of Infectious Diseases in Islington in Quinquennial Periods, 1891—1910 and in 1919. Year Smallpox. Scarlet Fever. Diphtheria and Menibranous Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever Relapsing Fever. Cholera. Total Notifications. Attack rates per 1,000 Population. 1691 1 728 756 189 2 313 33 6 1 .. 2059 6.43 1892 42 1709 738 219 .. 550 51 6 .. 3 3318 10.26 1893 118 2880 885 251 1 672 38 7 .. 1 4853 14.34 1894 90 1493 867 245 1 395 23 7 .. .. 3121 9.44 1895 25 1692 582 184 5 320 22 9 .. .. 2839 8.50 1891-5 276 8502 3828 1088 9 2280 167 35 1 4 16,190 9.90 1896* 50 2031 1091 229 .. 385 30 6 2 .. 3824 11.32 1897 3 1577 729 256 .. 312 27 1 .. 1 2906 8.62 1898 .. 1336 544 237 2 279 19 1 .. ... 2418 7.18 1899 3 1494 705 353 ... 350 33 2 .. 3 2943 8.75 1900 2 1074 633 259 1 285 16 6 .. .. 2276 6.78 1896-00 58 7512 3762 1334 8 1611 125 16 2 4 .14,367 8.53 1901 50 1286 911 281 2 285 34 3 .. .. 2852 8.51 1902* 276 1372 878 257 .. 357 19 5 .. .. 3164 9.29 1903 9 865 455 130 .. 227 19 2 .. .. 1707 5.12 1904 17 1146 347 126 1 280 24 .. .. .. 1941 5.84 1905 3 1198 351 100 .. 252 24 .. .. .. 1928 5.81 1901-05 355 5867 2942 894 3 1401 120 10 .. .. 11,592 6 .96 1906 1 1386 439 149 1 274 24 1 .. .. 2275 6.87 1907 1216 481 92 252 21 1 2063 6.25 1908* 1409 530 97 235 17 1 2289 6.82 1909 3 1285 430 95 1 221 14 2049 6.23 1910 1 730 471 89 1 212 20 1 .. .. 1525 4.65 1906-10 5 6026 2351 522 3 1194 96 4 .. .. 10,201 6.19 1911 .. 804 593 73 .. 275 14 .. .. .. 1759 5.37 1912 .. 811 516 49 .. 185 16 .. .. .. 1577 4.83 1913* .. 1317 550 50 .. 226 28 .. .. .. 2171 6.54 1914 .. 1853 659 76 .. 334 25 .. .. 2947 9.08 1915 1332 624 28 .. 203 23 .. .. .. 2210 6.98 1911-15 .. 6117 2942 276 .. 1223 106 .. .. .. 10,664 6.58 1916 .. 1633 593 32 .. 155 21 .. .. .. 1439 4.65 1917 .. 478 561 23 .. 173 16 .. .. .. 1251 4.21 1918 2 432 518 30 .. 141 4 .. .. .. 1127 3.93 1919* 2 1081 649 16 .. 22 29 1 .. .. 1993 6.05 * These years contained 53 weeks. 1919] 84 MINISTRY OF HEALTH RETURN.—TABLE III. Metropolitan Borough of Islington. CAUSES OF, AND AGES AT DEATH DURING THE CALENDAR YEAR, 1919. Causes of Death Nett Deaths at the subjoined Ages of " Residence " whether occurring within or without the District. Total Deaths whether of "Residents" or "Nonresidents" in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 yrs 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All Causes. Certified 4506 506 93 137 1S5 193 643 1127 1622 1381 Uncertified .. .. •• .. .. .. .. .. .. .. Enteric Fever 3 .. .. .. ,. 2 .. 1 .. 1 Small-pox 1 .. .. .. 1 .. .. .. .. 1 Measles 10 .. 2 6 2 .. .. .. .. 6 Scarlet Fever 15 .. 2 5 5 1 2 .. .. 1 Whooping Cough 17 3 5 6 3 .. .. .. .. 2 Diphtheria and Croup 49 .. 1 16 31 1 .. .. .. 11 Influenza 351 4 6 9 14 46 127 90 55 129 Erysipelas 13 .. .. .. .. .. 5 4 4 11 Phthisis (Pulmonary Tuberculosis) 362 2 5 11 14 63 146 111 10 177 Tuberculous Meningitis 43 6 4 18 11 3 1 .. .. 11 Other Tuberculous Diseases 35 1 3 5 9 2 7 6 2 13 Cancer, Malignant Disease 426 1 .. 1 1 4 40 213 166 199 Rheumatic Fever 8 .. .. .. 5 1 1 1 .. 2 Meningitis 28 7 3 1 10 1 3 3 .. 3 Organic Heart Disease 476 .. .. 1 6 10 54 164 241 204 Bronchitis 389 35 5 7 1 3 18 96 224 145 Pneumonia (all forms) 314 60 37 23 13 8 60 60 53 69 Other Diseases of Respira tory Organs 51 .. .. 3 2 .. 10 21 15 13 Diarrhoea and Enteritis . 100 72 7 4 3 .. .. 9 5 46 Appendicitis and Typhlitis 16 .. .. .. 5 1 4 4 2 11 Cirrhosis of Liver 16 .. .. .. .. .. 1 8 7 8 Alcoholism .. .. .. . .. .. .. .. .. 1 Nephritis and Bright's Disease 91 .. .. .. 1 4 12 39 35 31 Puerperal Fever 13 .. .. .. .. 1 12 .. .. 11 Other accidents and diseases of Pregnancy and Parturition 11 .. .. .. .. 1 9 1 .. 5 Congenital Debility and Malformation, including Premature Birth 252 250 1 1 .. .. .. .. .. 20 Violent Deaths, excluding Suicide 127 14 4 10 15 9 13 18 44 69 Suicide 28 .. .. .. .. .. 7 18 3 8 Other Defined Diseases 1261 51 8 10 33* 32 111 260 756 173 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. • • Totals 4506 506 93 137 185 193 643 1127 1622 1381 Sub-Entries — included in above figures;— Cerebro-spinal Meningitis 9 2 2 .. 3 .. .. 2 .. .. Poliomyelitis 1 .. .. •• 1* .. .. .. .. .. 85 [1919 MINISTRY OF HEALTH RETURN.—TABLE IV. Metropolitan Borough of Islington. INFANTILE MORTALITY DURING THE CALENDAR YEAR 1919. Nett Deaths from stated Causes at Various Ages wider Out Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under four Weeks. 4 Weeks and under 3 Months 3-6 Months. 6-9 Months. 19-12 Months. Total Deaths under One Year. All Causes Certified 155 32 19 19 225 92 I 89 57 43 506 Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. 1 .. .. 1 Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 1 1 1 3 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. (Tuberculous Meningitis .. .. .. .. .. .. .. 3 3 6 . Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. 1 .. 1 1 3 Meningitis (not Tuberculous) 1 .. .. .. I 1 .. 2 †3 7 Convulsions 2 .. 1 .. 4 1 .. .. .. 5 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 4 .. 6 9 8 6 6 35 Pneumonia (all forms) .. 1 2 .. 3 8 17 18 14 60 Diarrhœa .. 1 .. .. 1 6 6 5 2 20 Enteritis 1 1 .. .. 3 10 22 13 4 52 Gastritis .. .. 1 .. 1 1 2 1 .. 5 Syphilis 1 I 1 .. 3 1 1 .. .. 5 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 1 .. .. .. 1 3 2 .. .. 6 Injury at Birth 4 .. .. .. 4 .. .. .. .. 4 Atelectasis 6 1 .. .. 7 .. .. .. .. 7 Congenital Malformations 33 7 2 3 45 13 3 .. .. 61 Premature Birth 79 14 3 4 100 5 1 1 .. 107 Atrophy, Debility and Marasmus 20 3 4 9 36 22 19 3 2 82 Other Causes 7 2 1 .. 10 511 *6 **3 *7 37 Totals 155 32 19 19 225 92 89 57 43 506 Nett Births in the year legitimate 5,774 Nett Deaths in the year of legitimate infants 465 illegitimate 293 illegitimate infants 41 * Influenza (4). § Ophthalmia Neonatorum (3). † Cerebro-Spinal Meningitis (2). 1919] 86 LONDON COUNTY COUNCIL RETURN. Borough of Islington. PROCEEDINGS DURING 1919. PREMISES. Number of Places— Number of inspections, 1919. Number of Notices. 1919. Number of Prosecutions 1919. On Register at end of 1918. Added in 1919 Removed in 1919. On Register at end of 1919. Milk premises 586 9 1 594 693 32 Nil Cowsheds 4 Nil Nil 4 25 Nil ,, Slaughter-houses 21 Nil 1 20 1,015 ,, ,, Other offensive trade premises 7 Nil Nil 7 189 ,, ,, Ice cream premises 235 7 Nil 242 98 15 ,, Registered houses let in lodgings ... ... ... 1,070 10,287 1,242 ,, Total number of intimation notices served for all purposes 3,114 Insanitary houses— Number closed under the Public Health (London) Act, 1891 Nil Number of premises cleansed under section 20 of the L.C.C. (General Powers) Act, 1904 80 Housing of the Working Classes— Number of houses inspected 496 Number of representations by householders Nil Number of representations by Medical Officer 2 Number of houses included in such representations 287 Number of houses remedied without Closing Orders Nil Number of Demolition Orders Nil Number of houses dealt with under section 15 of the Housing, Town Planning, etc., Act, 1909 Nil Number of Closing Orders Nil Number of houses included in such Closing Orders Nil Number of Closing Orders determined Nil Number of houses demolished—(a) in pursuance of Orders Nil (b) voluntarily Nil Obstructive buildings— Number of representations under section 38 of the Housing Act, 1890 Nil Number of representations still under consideration Nil 87 [1919 Number of buildings demolished Nil Number of Orders for repairs issued under section 28 of the Housing Act, 1919 1 Number of houses repaired by local authorities Nil Number of houses closed on notice by owner that they could not be made fit Nil Total number of houses in the borough 39,938 Number of houses for the working classes— (a) Erected during year Nil (b) In course of erection Nil Number of houses occupied by the working classes Fully two-thirds of the dwelling houses in the borough. Smoke nuisances— Number of observations 52 Number of notices 2 Number of nuisances and complaints 10 Number of summonses 1 Underground Rooms— Number illegally occupied 3 Number closed or illegal occupation discontinued 3 Overcrowding— Number of rooms overcrowded 11 Number remedied 11 Prosecutions Nil Cleansing— Number of adults cleansed 19 Number of children cleansed 4,838 Cleansing— Number of rooms or premises cleansed 4,832 Water supply to tenement houses— Premises supplied 28 Prosecutions Nil Sale of Food— Number of premises used other than ice cream premises, milk shops and cowsheds 491 Number of inspections 10,177 1919] 88 Disinfection shelter— Persons accommodated 25 Ophthalmia neonatorum regulations— Number of notifications received during the year from certified midwives 23 Sanitary officers— Number of Sanitary Inspectors (Whole-time) Male 20 Female 2 ,, „ (Part-time) Male, Nil Female, Nil Number of Health Visitors Whole-time, 2 Part-time, Nil Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 6 Revenue Acts— Number of houses for which applications were received during year Nil Number of tenements comprised therein Nil Number of tenements for which certificates were (a) granted Nil (6) refused Nil (c) deferred Nil Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. Nil (b) For prevention of nuisance arising from offensive matter ning out of any manufactory, etc. Nil (c) For the prevention of keeping of animals in such a manner as to be injurious to health Nil (d) As to paving of yards, etc., of dwelling houses Nil (e) In connection with the removal of offensive matter, etc. Nil (/) As to cesspools and privies, removal and disposal of refuse, etc. Nil (g) For securing the cleanliness of tanks, cisterns, etc. Nil (h) With respect to water closets, earth closets, etc. Nil (i) With respect to sufficiency of water supply to water closets Nil (j) With respect to drainage, etc. (Metropolis Management Act, section 202) Nil (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) Nil Number of prosecutions under L.C.C. General Powers Act, 1907— (1) With respect to water supply to tenement houses Nil Mortuaries— Total number of bodies removed 429 Total number of infectious bodies removed 10