1 SL 24 1926 SEVENTY-FIRST ANNUAL REPORT on the Health and Sanitary Condition OF THE METROPOLITAN Borough of Islington. G. CLARK TROTTER, M.D., D.P.H., F.R.S.E. MEDICAL OFFICER OF HEALTH. London: Vail & Co., Printers, 170, Farringdon Road, E.C. 1. • • II MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1926, to November, 1927.) Mayor. Councillor THOMAS LEWIS HARROLD, J.P. A Idermen. HERBERT SAMUEL JORDAN EDWARD HENRY TOMKINS, J.P. Councillors. LESLIE BOYNE CHARLES BUNDOCK LUCY ELLIOTT GEORGE L. W. FRANKS WILLIAM H. GALE WALTER HARPER LEONARD McCLANE WILLIAM J. MITCHELL WALTER FREDERICK NOKES HENRY PENN WILLIAM T. RICKETTS harry i. rolf FRANK L. SARGENT HERBERT TICE WILLIAM T .SMITH Chairman Cooncillor JORDAN Vice-Chairman Councillor SMITH MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1926, to November, 1927.) Councilltrs. PHILIP R. BEECH CHARLES BUNDOCK WILLIAM HY. BURGESS LUCY ELLIOTT WILLIAM H. GALE ALBERT H. JACKSON GEORGE P. JARRETT HENRY JOHNSON SARAH JOHNSON Mrs. MANCHESTER WILLIAM J. MITCHELL Mrs PANNELI. ALBERT E. PETTET GEORGE RUST Mrs. M. SOUTHGATE, J.P. GRACE WATSON Members appointed by the Council Jrom outside their own body. Lady ANDREWS, "Windy Gap," Merton Lane, Highgate, N.6 Dr. ALICE VANCE KNOX, 15, South Grove, Highgate, N.6 Dr. ELEANOR PULLEINE, 5, Hamilton Terrace, N.W. 8. Mrs. WATT, 60, Highbury New Park, N.5 Chairman Councillor Mrs. M. SOUTHGATE, J.P. Vice-Chairman Councillor Mrs. M. A. MANCHESTER. iii SUMMARY of Vital Statistics in the Registration Year 1926. Population (Enumerated at Census, 1921) 380,787 persons „ Estimated Mid Year 1926 839,200 persons Increase on Census population, 1921 8,463 persons Mean Population, ten years (1916-1925) 823,190 persons Area 8,092 acres Density (Mid-year 1926) no persons per acre Births Males 8,283 persons 6,455 Females 3,172 Birth rate 19.0 per 1,000 inhabitants Deaths from All Causes Males 2,065 persons 4,090 Females 2,025 Death rate12.0 per 1,000 inhabitants Deaths from Principal Epidemic Diseases Males 90 171 persons Females 81 Death rate 0.50 per 1,000 inhabitants Deaths from All Tuberculosis Males 223 851 persons Females 128 Death rate 1.03 per 1,000 inhabitants Deaths from Respiratory Tuberculosis Males 180 289 persons Females 109 Death rate 0.85 per 1,000 inhabitants Infantile deaths under 1 year Males 248 Total 427 Females 179 Infantile mortality rate 66 per 1,000 births Excess of Births over Deaths 2,365 Rateable value of Borough of Islington £2,114,443 Sum represented by a penny rate £8,810 iv Public Health Department Municipal Buildings, Upper Street, N.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the Health and Sanitary Conditions of the Borough for the year 1926. The death-rate for 1926 was equal to 12 per 1,000 of the population, and .3 below that of the preceding year. It is the lowest death-rate since 1923, when the exceptional figure of 11.6 was recorded. The infantile mortality rate of 66 is only 3 per 1,000 births above the rate of last year, 1925 (which was the lowest ever recorded in Islington). Reference is made in this Report to the developement in a patient under treatment at the Royal Northern Hospital of Smallpox, contracted on the continent. This case infected one other only. Although the home addresses of both patients were outside Islington, one being in another Metropolitan Borough is statistically transferred to that district; the other home address being outside the Metropolitan Area is not so transferred. The occurrence involved much work in tracing and keeping under observation contacts, the visitors to the hospital being many, while until the safe period was passed, much supervision and care devolved upon the hospital authorities and the Public Health Department. I am, Your obedient Servant, Medical Officer of Health. REPORT OF THE Medical Officer of Health FOR THE YEAR 1926, SPECIAL REPORTS (OTHER THAN THE HEALTH OF THE BOROUGHi AND OUTSTANDING MATTERS BROUGHT BEFORE THE PUBLIC HEALTH OR MATERNITY AND CHILD WELFARE COMMITTEES DURING THE YEAR. SUMMARY. 1. Health Week.—As regards educational propaganda, special efforts wer made to arouse the interest of the citizens in Child Welfare and Health matters generally during Health Week. See pages 9, 10. 2. Infectious Disease.—(a) Occurence of Smallpox—Disease introduced to Royal Northern Hospital, p. 26 (b) Other diseases; secondary infections, p. 29. 8. Dust Nuisance, grinding of bricks and rubble, etc. p. 49. 4. Meat, Food and Drugs.—(a) The Labelling of meat and eggs (Food Order 1921) page 60. (b) Unsound Food, page 56. (c) Arsenic in Apples, page 64. (d) Sophistication of Milk, p. 65. (e) Deputation received re Public Health (Meat) Regulations, p. 59. (/) Restaurant Kitchens, p. 58. 5. Health Visitation and work of Voluntary Centres, Artificial Sunlight installations, etc. pp. 11-18. 6. Index to Report.—Pages 76-78, 1926] 2 POPULATION. According to the Registrar General the population of the Borough at 30th June, 1926, is estimated at 339,200, and equals the number of inhabitants at the corresponding period of the previous year. The figure given is believed to provide as true a measure of the estimate :n June last as the data permit. It is therefore to be presumed that the population of Islington has remained practically stationary. The following tables give the distribution of the population of the several sub-registration districts and wards, together with particulars of their areas and densities. Showing the Areas, Densities and Estimated Populations of the Subregistration Districts at the Middle of year 1926, also the Populations at the Census 1921. Sub-Districts. Area. Acres. Estimated Acres to a person. Estimated Persons to an Acre. 1926 Estimated Population Mid-year 1926. Enumerated Population at Census 1921. Tufnell 411 0.0120 83 34,317 33,750 Upper Holloway 299 0.0093 108 32,180 35,721 Tollington 315 0.0100 100 31,399 30,832 Lower Holloway 406 0.0096 104 42,136 40,139 Highbury 749 0.0121 82 61,700 58,850 Barnsbury 316 0.0056 177 55,987 53,859 South East Islington 0.0013 137 81,481 77,586 The Borough 3,092 0.0091 110 339,200 330,737 Shewing the Areas Densities and Estimated Populations of the Wards at the Middle of the year 1926, also the Populations at the Census 1921. WARDS. Area in Acres. Estimated Persons to an Acre or Density of Population. Estimated Population Mid-year, 1926. Enumerated Population Census, 1921 No. 1—Tufnell 411 83 34,317 33,750 2—Upper Holloway 299 108 32,180 35,721 3—Tollington 315 100 31,399 30,832 4—Lower Holloway 406 104 42,136 40,139 6—Highbury 417 78 32,434 33,417 6—Mildmav 332 88 29,266 25,433 7—Thornhill 178 173 30,741 31,301 8—Barnsbury 138 183 25,246 22,558 9—St. Mary's 150 123 18,519 17,363 10—Canonbury 290 113 32,727 29,997 11—St. Peter's 156 194 30,235 30,226 The Borough 3,092 110 339,200 330,737 3 [1926 Showing the Estimated Number of Persons living in Islington at the Mid-year 1926, at Nine Age Periods, and distinguishing Males and Females. Ages. Males. Females. Persons. 0—5 14,930 14,578 29,508 6—15 31,213 30,522 61,735 15—25 26,124 31,878 58,002 25—35 25,106 30,524 55,630 35—45 21,714 26,116 47,830 45—55 18,999 20,688 39,687 55—65 12,214 13,904 26,118 65—75 6,445 8,480 14,925 75 and upwards 2,035 3,730 5,765 A11 ages 158,780 180,420 339,200 MARRIAGES. Marriages, 2,749; Marriage Rate, 16.2.—The number of persons married was 5,749, as contrasted with 5,576 in the preceding year, which is an increase of 173. The marriage rate was 16.2 per thousand inhabitants, as compared with 16.4 in 1925. The following statement shows the figures for the previous ten years 1916-25. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 1916 3,080 18.30 1921 3,141 18.86 1917 2,689 16.23 1922 2,877 17.23 1918 2,971 18.51 1923 2,764 16.42 1919 3,306 19.28 1924 2,872 17.03 1920 3,370 20.05 1925 2,788 16.44 BIRTHS. There were 6,455 births registered, of which 3,283 were boys, and 3,172 girls. Of this number, however, 1,098 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 19.0 per 1,000 of the population, as compared with a mean birth-rate of 20.9 in the preceding ten years. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1926, 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 1925 ; together with the mean Borough Birth-rates for the 10 years 1916-1925. Quarter. Males. Females. Total. Birth Rates. Islington, 1926. Islington, 1916-25. London, 1926. 105 Great Towns, 1926. First 888 817 1,705 20.1 2105 18.0 18.7 Second 829 870 1,699 20.0 21.4 18.5 19.4 Third 813 782 1,595 18.8 20.3 17.3 18.3 Fourth 753 703 1,456 17.2 20.2 16.7 17.1 The Year 1926 3,283 3,172 *6,455 19.0 20.9 17.1 18.2 1925 3,397 3,183 6,580 19.4 19.0 180 18.8 Increase or decrease -114 -11 -125 -0.4 -1.9 -0.9 -0.6 * These include births which occurred in Lying-in Institutions, etc., outside the Borough. N.B.—The total registered births given by the Registrar-General for the Calendar year, 1926, will be found at the foot of table on p. 8. 4 1926] Showing the Births of Males and Females and the Birth-rates in each quarter and for the year, 1926. and in the several Sub-Registration Districts. Tufnell. Upper Holloway. Tollington. Lower Holloway. Males, Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. 1st Quarter 82 68 150 17.5 118 107 225 128.0 85 63 148 18.9 124 106 230 21.8 2nd ,, 66 79 145 16.9 107 118 225 28.0 69 58 127 16.2 88 134 222 21.1 3rd „ 70 64 134 15.6 113 107 220 27.3 70 78 148 18.9 105 108 213 20.2 4th 59 60 119 13.9 103 100 203 25.2 56 51 107 13.6 97 90 187 17.8 Year 277 271 548 15.9 441 432 873 27.1 280 250 530 16.9 414 438 852 20-2 Showing the Births of Males and Feirales and the Birth-rates in each quarter and for the year 1926, and in the several Sub-Registration Districts.—centd. Highbury. Barnsbury. Islington South-East. The Borough. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. 1st Quarter 130 133 263 17.0 160 157 317 22.6 189 183 372 18.3 888 817 1,705 20.1 2nd „ 146 123 269 17.4 160 150 310 22.1 193 208 401 19.7 829 870 1,699 20.0 3rd 136 121 257 16.7 138 128 266 19.0 181 176 357 17.5 813 782 1,595 18.8 4th 112 120 232 15.0 133 127 260 18.6 193 155 348 17.1 753 703 1,456 17.2 Year 524 497 1,021 16.5 591 562 1,153 20.6 756 722 1,478 18.1 3,283 3,172 6,465 19.0 Illegitimate Births (208).— The illegitimate births numbered 208 and show ail increase of 12 on the return of the year 1925. They were equal to a rate of 3.2 per 100 registered births. Notification of Births Act, 1907.—4,891 births were notified, exclusive of 134 stillborn, or 76 per cent, of the total number that was registered during the year. As years go on the general public would appear to be forgetful regarding their obligations under this Act, an advertisement and notices which were sent out at its initiation being forgotten. Increased efforts will require to be made to keep the primary requirement of the Act before the public, which is " Within THIRTY-SIX HOURS after the birth, it shall be the duty of the FATHER of the child, if he is actually residing in the house where the birth takes place at the time of its occurrence, and of ANY PERSON IN ATTENDANCE upon the mother at the time of, or within six hours after, the birth, to give notice in writing of the birth to the Medical Officer of Health." The year 1927 would appear to be an appropriate time, as then the Registration of Stillbirths will be in force. At present, although notifiable, there is no check, as they are as yet not compulsorily registrable. Notified by Doctors. Midwives. Parents and other Persons. Total. Alive. Still born. Alive. Still born. Alive. Still born. Alive. Still born. 1926. 1st Quarter 306 8 713 13 302 6 1,321 27 2nd „ 270 14 678 22 285 7 1,233 43 3rd „ 267 10 669 20 263 3 1,199 33 4th „ 261 15 656 15 221 1 1,138 31 Year 1,104 47 2,716 70 1,071 17 4,891 j 134 6 [1926 DEATHS. The deaths registered during the year numbered 4,090, while the death-rate was equal to 12.0 per 1,000 of the population, or 0.3 below that of the preceding year (12.3), and was the lowest since 1923, when it was 11.6 per 1,000 inhabitants. The death-rate was also 2.1 less than the average of the previous ten years. The Deaths and Death-rates from All Causes in the Sub-Registration Districts were as follows:— Sub-Districts. Quarters. The Year. 1 2 3 4 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Tufnell 124 14.4 77 8.9 77 8.8 102 11.9 380 11.1 Upper Holloway 140 17.4 73 9.1 71 8.8 119 14.8 403 12.5 Tollington 121 15.4 101 12.9 77 9.8 100 12.7 399 12.7 Lower Holloway 180 17.1 117 11.1 113 10.7 121 11.5 531 12.3 Highbury 201 13.0 173 11.2 140 9.1 196 12.7 710 11.5 Barnsbury 202 14.4 160 11.4 141 10.1 201 14.4 704 12.6 Islington (SouthEast) 305 16.0 220 10.8 197 9.7 241 11.8 963 11.8 The Borough 1,273 15.0 921 10.9 816 9.6 1,080 12.7 4,090 12.0 Showing the Deaths and Death Rates of Islington in 1926, 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 10 years 1916 25 and the deaths and death-rates in the year 1925. Quarter. Males. Females. Total. Death Rates. Islington, 1926. Islington, 1916-25. London, 1926. 105 Great Towns. 1926. First 610 663 1,273 15.0 17.8 13.5 13.7 Second 482 439 921 10.9 12.7 11.1 11.5 Third 424 392 816 9.6 10.4 8.8 9.1 Fourth 549 531 1,080 12.7 15.5 12.4 12.3 The Year 1926 2,065 2,025 4,090 12.0 14.1 11.6 11.6 1925 2,127 2,033 4,160 12.3 12.0 11.7 12.2 Increase or Decrease -62 -8 -70 -0.3 -2.1 -0.1 -0.6 6 1926] Causes of Death (Classified).—The following' table shows the deaths arranged in classes of Disease from All Causes during the ten years 1916-25 and in 1926:— Classified Causes of Death. Years. Mean 10 Yrs. 1926 Difference. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 I. Specific or Febrile Causes 380 391 1361 579 552 464 639 273 391 286 532 285 -247 1. Miasmatic Diseases 268 293 1258 466 437 301 546 155 316 191 423 204 -219 2. Diarrhoeal „ 56 56 51 36 28 85 29 40 20 15 42 29 -13 3. Malarial „ — — 2 2 2 — — — — — 1 — -1 4. Zoogenous „ 3 2 — 1 2 1 — — 2 3 1 — -1 5. Venereal „ 15 15 15 13 13 17 17 20 9 8 14 5 -9 6. Septic „ 38 25 35 61 70 60 47 58 44 69 51 47 -4 II. Parasitic Diseases 1 1 — 1 1 — 3 1 2 1 1 1 — III. Dietetic 3 3 4 2 2 4 7 2 3 3 3 2 -1 IV. Constitutional Diseases 1095 1114 1101 973 918 985 935 945 945 1054 1006 882 -124 V. Developmental 522 486 520 657 556 486 477 377 396 404 488 467 -21 VI. Local 2457 2344 2596 2177 2172 2203 2362 2106 2290 2211 2292 2255 -37 1. Diseases of Nervous System 339 351 330 322 341 345 330 294 290 291 323 307 -16 2. „ Organs of Special Sense 12 14 10 11 20 13 9 16 14 10 13 16 +3 3. ,, Circulatory System 669 681 691 654 592 651 734 745 822 740 698 802 +104 4. „ Respiratory „ 1006 887 1156 770 822 717 903 598 797 756 841 709 -132 5. „ Digestive „ 233 243 246 215 224 260 204 259 192 225 230 223 -7 6. ,, Lymphatic „ 16 9 3 11 10 14 11 11 8 7 10 19 +9 7. „ Urinary „ 149 130 137 151 129 168 134 157 136 142 143 142 -1 8. „ Reproductive „ 24 18 8 17 20 13 20 10 15 20 17 19 +2 a „ Orgs, of Generation 12 12 2 7 7 8 5 4 6 10 7 3 -4 b „ of Parturition 12 6 6 10 13 5 15 6 9 10 10 16 +6 9. „ Bones and Joints 9 5 9 12 5 3 8 8 10 10 8 11 +3 10. „ Integumentary System — 6 6 14 9 19 9 8 6 10 9 7 -2 VII. Violence 183 159 156 162 179 142 137 151 156 169 159 169 +10 1. Accident or Negligence 156 122 115 132 140 99 94 105 115 124 120 124 +4 2. Homicide 4 1 3 2 2 3 3 8 2 2 3 3 — 3. Suicide 23 11 27 28 37 40 39 38 39 42 32 42 +10 4. Execution — — — — — — 1 — — 1 — — — 5. By Bombs (Enemy Aircraft) — 25 11 — — — — — — — 4 — - 4 VIII. Ill-Defined Causes 111 102 103 89 95 84 54 47 39 32 76 29 -47 All Causes 4752 4600 5841 4640 4475 4368 4614 3902 4222 4160 4557 4090 -467 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, 1926. Mean Deaths (10 years, 1916-25.) Increase or Decrease on mean. 0-1 year 427 552 -125 1-5 years 214 348 -134 Under 5 years 641 900 -259 5-15 years 102 161 -59 15-25 „ 132 190 -68 25-35 „ 174 256 -82 35-45 „ 273 325 -62 45-55 „ 430 498 -68 55-65 „ 628 636 -8 65-75 „ 815 805 +10 75-85 „ 686 619 +67 85 upwards 209 167 +42 All Ages. 4,090 4,557 -467 7 [1926 INFANTILE MORTALITY. Infant Deaths, 427; Mortality Rate, 66.—During the year 427 deaths among infants urjder twelve months old were registered, or 125 below the decennial average (552), and they were equal to an infant mortality rate of 66 per 1,000 births. This rate is 13 per 1,000 births below the mean annual record of the preceding ten years, and is 3 per 1,000 above the rate of last year (1925), which was the lowest ever recorded in Islington. In the quarters the mortality ranged from 86 per 1,000 births in the first quarter, 51 in the second, 57 in the third, and 71 in the fourth. In the sub-regfistration districts the infant mortality was as follows: Sub-District. Infant Deaths. Mortality per 1,000 Births. Tufnell 35 64 Upper Holloway 26 30 Tollington 49 92 Lower Holloway 70 82 Highbury 49 48 Barnsbury 104 90 Islington South East 94 64 In London the infant mortality was 64 per 1,000 births, while in the six boroughs encircling Islington it was 65. The rate for England and Wales was 70 per 1,000 births. Infantile Mortality during each of the Ten Years 1916-25 and 1926. Deaths at various ages under One Year of Age. Years. Under one week. Weeks. Total under four weeks. Months. Total Deaths under one year. Deaths per 1,000 Births. 1-2 2-3 3-4 4 weeks and under 3 mths. 3-6 6-9 9-12 1916 129 32 27 21 209 128 116 92 89 634 87 1917 93 38 23 7 161 106 108 99 91 565 97 1918 123 31 19 14 187 87 112 78 107 571 110 1919 158 32 22 21 233 95 92 60 45 525 83 1920 142 54 37 22 255 141 120 79 81 676 72 1921 131 34 35 22 222 104 148 96 71 641 81 1922 125 37 29 22 213 80 97 96 93 579 77 1923 128 35 20 11 194 72 104 54 49 473 66 1924 110 33 23 21 187 59 61 64 76 447 66 1925 105 25 20 20 170 70 72 58 44 414 63 Mean 10 years 124 35 26 18 203 94 103 78 75 553 79 1926 98 19 16 10 143 63 96 56 69 427 66 Increase or decrease on mean -26 -16 -10 -8 -60 -31 -7 -22 -6 -126 -13 Showing the Deaths among Infants per 1,000 Births during the Year 1926. and also the mortality rates for the Years 1916-1925. Sub-Districts. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 Mean 10 years 1926 Increase or decrease on mean Tufnell 84 99 93 50 41 53 83 46 54 47 65 64 -1 Up. Holloway 67 68 83 79 69 76 59 64 70 57 69 30 -39 Tollington 93 102 135 98 58 83 58 55 60 65 81 92 11 Lr. Holloway 107 121 130 101 66 93 81 81 85 78 94 82 -12 Highbury 74 83 99 83 67 93 64 61 60 54 74 48 -26 Barnsbury 103 114 122 91 89 87 86 59 77 75 90 90 - Islington, S.E. 91 89 107 81 79 77 88 82 55 58 81 64 -17 The Borough 87 97 110 83 72 81 77 66 66 63 79 66 -13 8 1926] 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 1916-25 : and in 1926 from certain specified caus's. Causes of death. 1926. Rate per 1,000 Births. Mean rate 10 years 1916-25 per 1,000 Births. Difference. Premature Birth and Congenital Defects 19 20 -1 Bronchitis and Pneumonia 15 17 -2 Atrophy and Marasmus 4 9 -5 Diarrhoeal Disease (all forms) 4 4 - Convulsions 1 2 -1 Whooping Cough 2 3 -1 Measles 3 3 - Diphtheria - - - Phthisis - 1 -1 Other forms of Tuberculosis ... 1 1 - Total of above 49 60 -11 All other causes ... 17 19 -2 Total 66 79 -13 INFANTILE MORTALITY during the Calendar Year 1926. Nett Deaths from stated causes at various Ages under One Year of Age. Cause of Death. Under 1 week Weeks. Total under 4 weeks 4 weeks and under 3 months Months. Total Deaths under 1 year 1-2 2-3 3-4 3-6 6-9 9-12 All Certified 98 19 16 10 143 63 96 56 69 427 Causes, Uncertified Nil — — — — — — — — Nil Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — 5 15 20 Scarlet Fever — — — — — — — — — — Whooping-Cough — — — — — 1 3 3 5 12 Diphtheria, Croup — — — — — 1 — 1 1 3 Erysipelas — — — — — — — 1 — 1 Tuberculous Meningitis — — — — — — — 2 4 6 Abdominal Tuberculosis — — — — — — 1 — — 1 Other Tuberculous Diseases — — — — — — 1 — — 1 Meningitis (not Tuberculous) — 1 — — 1 3* 7* 5* 1* 17 Convulsions 4 — — — 4 — — — — 4 Laryngitis — — — — — — — — — — Bronchitis. — 1 — 2 3 2 3 4 4 16 Pneumonia (all forms) 1 2 5 1 9 10 27 16 21 83 Diarrhoea — — — — — 6 15 4 4 29 Enteritis — 3 — 1 4 7 18 8 5 42 Gastritis — — — 1 1 1 — — — 2 Syphilis 1 — — — 1 — — — — 1 Rickets — — — — — — — — — — Suffocation, overlying — — — — — — 2 — — 2 Injury at birth 3 — — — 3 — — — — 3 Atelectasis 4 — — — 4 1 — — 1 6 Congenital Malformations 15 2 — — 17 6 6 1 1 31 Premature birth 57 7 6 3 73 12 3 — — 88 Atrophy, Debility and Marasmus 6 2 2 1 11 9 5 2 2 29 Other causes 7 1 3 1 12 4 5 4 5 30 Totals 98 19 16 10 143 63 96 56 69 427 Nett Births in the year legitimate6,037 illegitimate246 6,283 Nett Deaths in the year of legitimate infants 394 illegitimate infants 33 * Cerebro-Spinal Fever (b) 9 [1926 EDUCATIONAL PROPAGANDA. A special Committee, composed of members of both the Public Health and Maternity and Child Welfare Committees, was formed to consider propaganda :/i relation to Health and Baby Week. In former years the Town Hall was used, but last year considerable difficulty was experienced as it had ceased to be used for Town Hall purposes, and chairs had to be hired. The condition of the hall after standing empty also precluded its being used without considerable expense for cleaning, etc. The Committee, therefore, formed the opinion that it would be better to have an outstanding lecturer and a special lecture to inaugurate the propaganda. Professor H. R. Kenwood, C.M.G., M.B., F.R.S.E., Medical Officer of Health of the County of Bedfordshire and the Metropolitan Borough of Stoke Newington, gave the inaugural lecture entitled, "The First Law of Health." The special subject chosen, after consultation with the Welfare Centres, for the week was "Cleanliness and its Relation to the Home and Health." A leaflet giving a list of the Public Health Departments, the Tuberculosis Dispensaries, and the Welfare Centres, addresses and hours, was prepared, and the Medical Officer of Health supplied introductory notes as follows:— "Health and good estate of body are above all gold." (Ecclesiasticus, 30, 15) METROPOLITAN BOROUGH OF ISLINGTON. While a large proportion of the work of a public health department is inspections in which questions of cleanliness of premises and of food supplies enter largely, the citizens in their homes must also play their part in the campaign for cleanliness and health. It is well known that exposure to infection accounts for much ill-heath, but by the observance of scrupulous cleanliness, infection is very materially diminished, and in the absence of dirt and contamination, the resistance of the individual to infection is greatly increased. The Surroundings of the Home. The back yard and garden should contain nothing to attract flies. The dustbin should have a closely-fitting cover to keep out flies and cats. With care—for example, lining with paper, and omission of wet things—the metal does not readily rust. Decaying matter, besides smelling offensively, attracts flies, if unable to burn this wrap well in paper. Cardboard boxes and waste paper should be burnt. Use water freely to flush the sink waste and drains, as well as soap and water for the floor. Ventilate the house by opening the windows. Sunlight and fresh air are necessary for health. "Water, Air, and Cleanliness, are the Chief Articles in My Pharmacopeia." (Napoleon I.) The Food Supply for the Household. Choose nourishing food, children require a varied diet to be healthy. Milk is one of the cheapest foods considering its body-building value. Eat some fresh fruit daily. Brown bread is better than white. Fish is a valuable diet. 10 1926] Fresh food is better than tinned, or re-cooked food. Is your food cupboard ventilated and fly-proof? The cleanliness of the food supply is a matter which the individual citizen could do much to improve. Many cases of ill-defined illness have an origin in food contamination, adulteration, or neglect. If the housewife would not buy where she has reason to believe that food is exposed to contamination by dust, flies, etc., the vendors would, through loss of custom, have to take steps to protect their wares. The citizens have thus the matter of the purity of their food supply largely in their own hands. If you find dirt at the bottom of your milk jug, write to the Medical Officer of Health, and complain to your milkman. The Workplace and its Surroundings. What has been stated) as an improvement in the home itself, also applies to the workplace, and the shop. Fully half an individual's time is not spent in repose—indeed it might be said half the life of the worker is generally spent amidst entirely different surroundings from what is called his home. These surroundings — where he works — must leave their imprint upon him. The cleanliness of the workplace and its surroundings is therefore of equal importance with that of the home. The Beginnings of Disease. There is Always Danger in Delay. Most diseases are easily cured if they are discovered early. For persistent cough, loss of weight, shortness of breath, unusual weariness, early medical advice should be sought. There are two municipally supported dispensaries for the early detection of tuberculosis, and the aim of the Welfare Centres is the education of the mother in the maintenance of good health—prevention is better than cure. Florence Nightingale to her Nurses. "Think nothing too small to be attended to in this respect, cleanliness and fresh air—there can be no fresh air without cleanliness. Cleanliness is the only true disinfectant." Health Week had been well advertised in the Borough, both by posters and the distribution of leaflets which had been approved by the Committee. Owing to the Press notices, the Medical Officer of Health received quite a number of requests for the leaflet from other districts. A gratifying feature of the propaganda was the considerable help received from the Local Press, particularly the Islington Gazette. Notices also appeared in the Islington and Hollo-way Press, the Hornsey Journal and the Westminster Gazette, which last also published three special articles by the Medical Officer of Health on "Food Storage in the Home "Education and Hygiene," and "Clean Shops." The work of the Welfare Centres as regards Health and Baby Week is summarised under the report on Maternity and Child Welfare work. 11 [1926 REPORT ON MATERNITY AND CHILD WELFARE WORK. Municipal Health Visitors. OPHTHALMIA NEONATORUM AND OPHTHALMIA. Ophthalmia Neonatorum is an inflammatory disease with purulent discharge occurring- in the eyes of infants within three weeks of birth. 107 cases of Ophthalmia Neonatorum were notified. 33 cases of Ophthalmia were reported by the London County Council. 46 out of the 107 cases of Ophthalmia Neonatorum were attended at birth by midwives. The cases occurred in the sub-registration districts as follows: Tufnelt. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East. The Borough Ophthalmia Neonatorum. 15 19 14 11 3 16 29 107 Cases notified by Doctor 12 17 11 11 3 16 29 99 Cases notified by Certified Midwives 3 2 3 — — — — 8 Ophthalmia. 4 2 2 12 3 10 13 46 Cases reported by L.C.C. — 1 2 9 1 8 12 33 Cases reported by Health Visitors 2 — — — — 2 — 4 Reported by others 2 1 — 3 2 — 1 9 Of the 153 cases investigated, both of the infants' eyes were affected in 125 instances, whilst in, 18, the right eye was. involved, and in 10 the left. Treatment.—13 of 107 Ophthalmia Neonatorum cases were admitted to St. Margaret's Hospital. 34 of 107 Ophthalmia Neonatorum cases were treated at home by private Doctors. 54 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at the cost of £47 14s. (In 1925, 28 cases were nursed at the cost of £28 3s. Results.—.The Ophthalmia Neonatorum cases were with one exception cleared up, a baby girl having left eye impaired by opacities. There was no fatal case during the year. 12 1926] PUERPERAL FEVER. Definition.—The Royal College of Physicians' definition of Puerperal Wvef is : Septicaemia, Pyaemia, Septic Peritonitis, Septic Metritis, and other acute septic inflammation in the pelvis occurring- as the direct result of child-birth. Of the 32 cases coming to the knowledge of the Medical Officer of Health during 1926, 27 were notified by Medical Practitioners. The proportion of total cases to births was 4.9 per thousand. The notifications were five above the average (22) of the preceding ten years and showed an increase of 1.03 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1926. Tufnell. Upper HoUoway. Tollington. Lower Holloway. Highbury. Barnsbury. South East. The Borough Cases notified 2 2 2 2 10 3 6 27 Private Practitioners' Cases 3 2 2 2 4 2 4 19 Hospital Cases — — 1 — 5 2 — 8 Certified Midwives* Cases — 1 — — 2 — 2 5 Cases inquired into 3 3 3 2 11 4 6 32 Cases treated in Hospital 3 3 3 2 9 3 5 28 Cases treated at Home — — — — 2 1 1 4 Of the 32 cases, 28 were treated in Hospitals. Four of these contractedi the disease in Hospital; 13 cases were removed to Metropolitan Asylums Board Hospitals; and 11 cases were removed to other London Hospitals. Deaths.—Eleven deaths were registered as being due to Puerperal Fever, but two of these were notified as Puerperal Pyrexia. PUERPERAL PYREXIA. The Notification of Puerperal Pyrexia Regulations, 1926; made by the Ministry of Health, which came into operation on the 1st October, 1926, resulted in 26 cases being notified. Of these, 12 were Private Medical Practitioners' cases; 8 occurred' in Hospital, while 6 were Certified Midwives' cases. The notifications were in the proportion of 4 per 1,000 births. Two patients subsequently died from Puerperal Fever. Cases of Puerperal Pyrexia notified and inquired into during the year 1926. Tufnell. Upper Hollo way. Tollington. Lower Holloway, Highbury. Barnsbury. SouthEast. The Borough Cases noiified 1 3 3 5 1 6 7 26 Private Praclitioners'Cases — — 1 2 — 4 5 12 Hospital Cases 1 2 2 — 2 1 8 Certified Midwives' Ca^es — 1 — 3 1 — 1 6 Cases Inquired into 1 3 3 5 1 6 7 26 Caies treated in Hospital 1 2 3 2 1 5 5 19 Cases treated at Home — — — 4 — 1 2 7 13 [1926 PEMPHIGUS NEONATORUM. In May, 1925, the Ministry of Health issued a memorandum on Pemphigus Neonatorum, a rare disease which is met with in two types, a mild form in which the large blisters with watery fluid are few, and a grave type in which the skin eruption continues to spread and gives rise to fever, this second form frequently becoming rapidly fatal. The disease is believed to be of the same nature as the pustular contagious disease common in older children and adults, and known as impetigo contagiosa. The importance of care is the more apparent as it is quite obvious than an older person suffering from a skin disease might carry infection which could be transferred to the mother or to the infant, and an infant smitten with this disease may be the cause of a painful illness in the mother, even to the extent of Puerperal Fever. A number of such cases have been investigated in Islington during 1926, and fairly definite information was obtained pointing to the disease in seven cases; three cases were reported primarily from the Royal Free Hospital, where there had been an outbreak of the disease; one was reportec from St. Bartholomew's Hospital; two were reported by general practitioners, and one by a midwife, confirmed by the Medical Inspector of the London County Council. In one of the cases intimated by a private practitioner, a sister of the baby, one year 5 months old, was suffering from impetigo contagiosa, as was also another child at the same address. THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. During the year 1926, the sum expended in the provision of fresh and dried milk for necessitous, expectant and nursing mothers, and children under five years of age, amounted to £3,253 14 3d., as against £3,140 Is. lid. in 1925. The total amount expended since the Order came into operation in 1918, is £46,108 9s. 8d. The total recipients during the year numbered 11,397, and the quantity of milk supplied to them was equal to 259,359 pints (32,420 gallons). The amended scheme for the distribution of milk adopted by resolution of the Council, on the 26th October, 1922, is given below:— No. in family Free. Half-cost. 1 13/- after deduction of rent 15/- after deduction of rent 2 10/6 per head after deduction of ent 12/6 per head after deduction of rent 3 8/6 „ „ 10/- „ „ 4 7/6 „ „ 8/6 „ „ 5 7/- „ „ 8/- „ „ 6 6/6 „ „ 7/6 ,, ,, 14 1926] SUMMARY OF VISITS BY MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1926. District 1 2 3 4 5 6 7 8 Totals. I. Births, First Visits, Infants under 1 Year 539 740 726 811 1,052 701 792 174 5,535 II. Births, Re-Visits, Infants under 1 Year 812 582 610 510 817 1,069 501 329 5,230 III. Visits to Children, between 1st and 2nd Years 631 314 649 580 815 676 453 203 4,621 IV. Visits to Children, between 2nd and 5th Years 1,799 1,514 1,807 1,032 1,935 1,382 1,275 436 11,180 V. Visits re Still Births 18 22 26 19 25 15 28 2 155 VI. Deaths, Visits, re Infants under 1 Year 14 20 16 5 25 9 4 5 98 VII. Deaths, Visits, re Children 1 to 6 years 2 7 4 3 4 - 3 - 23 VIII. IAnte-Natal, Home Visits f/112 182 f/178 240 f/169 220 f/117 126 f/147 190 f/176 218 f/80 87 f/27 28 f/1,006 1,291 IX. f Puerperal Fever, Home Visits f/1 4 f/2 3 f/2 4 f/3 4 f/4 6 f/1 2 f/3 6 - f/16 29 Totals 4,001 3,742 4,062 3,090 4,869 4,072 3,149 1,177 28,162 X. Attendances at Welfare Centre 23 24 50 47 49 55 42 16 306 XI. Other Work by Direction 417 706 914 483 319 697 724 160 4,402 XII. Visits Declined 7 8 9 6 5 - 6 1 42 XIIIj Visits, House Shut 473 907 570 864 507 885 783 345 5,334 XIV. Visits, Inopportune 32 163 25 51 46 35 59 2 413 Grand Total of Visits 4,953 5,550 5,630 4,541 5,795 5,744 4,763 1,701 38,677 15 SUMMARY OF VISITS BY MUNICIPAL HEALTH VISITORS—Continued. District 1 2 3 4 6 6 7 8 Totals. Analysis of Visits included in I.-IX. relating to (a) fOphthalmia Neonatorum f/19 47 f/18 54 f/ll 21 f/3 4 f/10 17 f/19 25 f/9 20 F/3 11 f/92 199 (6) {Epidemic (Summer) Diarrhoea f/3 6 f 2 — f/2 f 7 — — f 2 f/16 19 (c) Other Digestive Diseases 3 7 5 1 — — 7 1 24 (d) Pneumonia and Bronchitis 30 40 10 19 40 — 26 2 167 (e) Rickets 1 68 26 60 105 99 161 4 524 (f ) †Measles and German Measles f/38 51 f/55 58 f/44 f/8 F 14 f/5 f/6 — f/170 186 (g) †Whooping Cough f/12 31 f 14 f/28 29 f/11 f/14 19 f/2 F, 14 f/7 f/101 127 (h) Tubeiculous Disease—P=Pulmonary; O=Other 1 — — 3 — — — 1 5 (i) Convulsions 1 — — — 1 — — — 2 (j) †Polio-myelitis — — — — — — — — (k) Premature Birth 1 59 39 15 20 11 25 — 170 (l) Atrophy, Debility and Marasmus 1 21 9 1 42 — — 1 75 (m) All other investigations (**Specify) 62 66 89 93 57 23 74 9 473 (n) Routine Visits included in I. to IX. and not included in (a) to (m) 3,766 3,353 3,790 2,873 4,547 3,907 2,816 1,139 26,191 ***Totals (a) to (n) 4,001 3,742 4,062 3,090 4,869 4,072 3,146 1,177 28,162 Total Families Visited 2,429 2,665 2,719 2,114 3,158 3,255 2,244 830 19,414 Registered Births. New Cases Handed to Infant H.V.'s for Visitation. Mortality. Puerperal Fever. Puerperal Pyrexia. Ophthalmia Neonatorium, No. Rate. Notified Births. Non-Notified Births. Transfers In. No. Rate. Cases. Removals Cases. Removals. Cases. Removals. 6455 19.0 5930 438 306 427 66 32 28 27 17 107 14 **e.g.—Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhoea, Polio-myelitis, etc. Syphilis, Rheumatism, N.N.B. Illegit, etc. ***Totals (a) to (n) should correspond with Totals I. to IX. †F. in front of figures denotes a "First Visit." [1926 16 1926] REPORT OF WORK OF VOLUNTARY CENTRES. A table is given summarising briefly the work of the Centres for the year ending 31st March, 1927. North Centre.—The Artificial Sunlight clinic continues its excellent work. An additional mercury vapour lamp, the gift of Miss Isabel Harvey, has been installed and extra preventive solarium facilities can be provided for the prevention of rickets. The system of providing "Light" generally in the clinic is as follows:—Children are treated at this clinic in order to increase their power of resistance to disease, and mothers are treated for failing lactation. Both children and mothers receive three treatments a week from a carbon arc lamp, the exposure beginning with two or three minutes and being gradually increased to twenty minutes. A few cases have had longer treatment varying from half an hour to an hour. Whenever the weather is suitable, the children are exposed to the rays of the real sun, instead of those of the lamp, and their bodies become much browner. Very good results have been obtained with rickety children who are treated by the carbon arc lamp twice weekly before exposure to the newly presented mercury lamp. Generally speaking the effect of the light treatment on children has been that their appetites, vitality and contentedness have improved and they have had a general look of well-being. The Centre reports that fathers are taking increasing interest in the children and the Centre's work. Two Massage Clinics held per week by the Almeric Paget Corps have had to be discontinued, but the Corps will provide the services of a masseuse. There are four Wards in connection with this Welfare Centre; three are used for children under two years of age, the other being reserved for three mothers with their infants. Children are admitted for dietetic trouble, and while they are in residence before discharged restored to health, the mothers are shown where they have made mistakes and how to carry on for the future. After discharge a degree of home supervision is exercised to see that the mothers have really understood the teaching given. An interesting item of work at this Centre has been carried on for some years, that is the lending of scales to mothers for a week in order that their babies may be weighed at home before and after every feed. This was originally done as it was found that a single test feed was not a sufficient guide to the Centre doctor in regard to the mother's capacity for infant feeding. During the Municipal "Health Week," lectures were given to the mothers attending this Centre under various titles connected especially with the different aspects of the subject chosen, that is, "Cleanliness and its relation to the Home and Health." The total attendances were 499, giving an average of 83 per lecture. Forty of the mothers from this Centre attended the inaugural lecture, given by Professor Kenwood, at the Central Library, and as an outcome of this an "essay competition" was held, and some of the essays submitted showed very marked ability and powers of observation. South Centre.—During the year a cottage, purchased by the Centre at Flamstead, Bedfordshire—now known as Clephane Cottage—was opened for the reception of six mothers and babies for convalescence. The provision of "Home Helps" was discontinued during this year by the Centre. 17 [1926 The Centre continued to co-operate with the Britannia Row "Light" Clinic, emphasising the fact, however, that the sending a child to this clinic was not ;n substitution for the daily outing which every child should receive. The crowded condition of some of the Clinics at this Centre led to rooms being obtained at the South Islington Pro Patria Day Nursery, 15, Ahvyne Place, N., where an extra clinic once a week hasi been held since February, 1927. An extra day was also arranged for at 28, Duncan Terrace, N., and the use of one more room obtained there. It is reported that these improvements have done much to relieve congestion at the Branch, and enable the work to be carried on more efficiently. At the South Centre preliminary talks were given in advance of "Health Week"—six in number, the average number of mothers present being 19. These preliminary talks were followed by short lectures on "Health and Cleanliness," the subject of the week. The attendances at these totalled 303, and an average of 38 per lecture. East Centre.—The Medical Officer's report states that they are gaining the confidence of the mothers in attendance and that it would appear that this confidence is much greater than it was some years ago, resulting in attendance at the Centre rather than the Hospital Out-Patients' Department. This makes it important that it should be realised that the work of the Welfare Centres is primarily preventive work. They are not for the purpose of treating disease, but for guidance in regard to infant welfare. The markedly preventive nature of the work is especially apparent in the work of the Ante-natal Clinics. Three lectures were given at this Centre during "Health Week" and two at the Branch Centre. The total attendances were 170, being an average of 34. West Centre.—Through the agency of this Centre many mothers and children have been sent away for convalescent treatment, the convalescence being obtained through the generosity of several agencies and the donations towards a special fund for the purpose. This Centre, like the Northern, has its own "artificial light" clinic, and it is reported that this has been of the greatest possible benefit. During "Health Week" the Sisters gave "Health Talks" every afternoon, on the lines of the inaugural lecture, to the various groups of mothers waiting to see the doctors. In addition, two "Health Talks" were given to mothers at the Centre. The attendance at the first was 26, and the second, which was given in the garden, was attended by over 50 mothers. 18 1926] The various Department of the Four Voluntary Centres, with the attendances for 1926, may be summarised thus:— North. South. East. West. Total. 1. Ante-Natal Clinics and Ailing Mothers Clinics. Number held weekly 3 1½* 1 1 6½ Number of attendances 1,539 698 402 337 2,976 2. Consultations for Children up to 5 Years of Age. Number held weekly 10 †10 7 7 34 Number of attendances ‡20,865 17,804 13,522 19,101 71,292 3. Home Visiting. Number of visits made 13,645 10,626 10 548 7,572 42,291 4. Dental Clinics. Number attending 499 147 51 43 740 Number of attendances or arrangements made for attendances 1,455 254 124 92 1,925 5. Morning Callers. Number of attendances 976 653 157 1,315 3,101 6. Massage Clinics. Number of cases given massage or sent for massage 52 (& Sunlight treatment) 81 88 33 254 7. Wards. Number of beds 18 — — 8 26 Number of patients received 169 — — 106 275 8. Number of Children on Books 1,848 1,580 1,181 1,083 5,692 2 Clinics one week, one following week = 1½ weekly. ‡20,865 Total attendances = 14,263 ordinary, 137 Special enquiry re Health of pre-School Children, 6,277 *' Light" Clinic, and 188 "Eye" Clinic. †Two Ministry of Health Special Consultations per month to be added. § Attendances of Expectant Mothers only. WELFARE CENTRES' DISTRICTS. POPULATION. NORTH. Wards 1. 2, 3. SOUTH. Wards 9, 10, 11 and Part of 6. EAST. Ward 5 and Parts of 4 and 6. WEST. Ward 7, 8 and Par of 4. Total. 1926 (Approximate Estimate) 97,900 97,440 53,920 89,940 339 200 29,508 up to 5 years old. BIRTHS. 1925 1,851 (Actual) 1,526 (Approximate) 1,121 (Approximate) 2,082 (Approximate) 6,580 1926 1,951 (Actual) 1,478 (Approximate) 1,021 (Approximate) 2,005 (Approximate) 6,455 Number on Books 1st April, 1927, i.e., Record Cards of Children to be visited. Exclusive of Record Cards marked 'Attending Centre," and "Above Standard," "Visits declined," and " Visits not necessary" 20,146 DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—2,075 persons died in the Public Institutions located in Islington, of whom 1,385 belonged to this Borough, the remaining 690 having come here for treatment or relief. Of these, 433 died in the Archway House, 122 in the Royal Northern Central Hospital and 59 in the London Fever Hospital. Of the 1,385 deaths of inhabitants, 974 occurred in the Islington Infirmary, 247 in the Islington Institution, and 118 in the Royal Northern Central Hospital. The proportion which the 1,385 deaths in the Public Institutions bore to the Borough mortality was 33.8 per cent. 19 [1926 Without the Borough.— 755 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, 27 in the North.Western Fever Hospitlal, 35 in the Children's Hospital, Great Ormond' Street, 101 in St. Bartholomew's Hospital, 32 in the Colney Hatch Mental Hospital, 58 in the Royal Free Hospital, 43 in the University College Hospital, 18 in the North.Eastern Fever Hospital, 25 in the Eastern Fever Hospital, 17 in the Middlesex Hospital, 7 in the City of London Maternity Hospital, and 23 in the Claybury Mental Hospital. These 755 deaths represented 18.5 per cent, of all the deaths registered in the year. Within and Without the Borough.—The deaths of Islingtonians numbered 2,140 and were equal to 52.3 per cent, of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough.— Eighty.five inhabitants diedi from accidental deaths, or suddenly, in places outside Islington. During the previous year (1925) the total deaths in Local Institutions numbered 2,006, being 1,364 inhabitants of Islington in Local Institutions, plus 642 non.inhabitants of Islington in Local Institutions, the number in Islington Infirmary being 962, the number in the Royal Northern Hospital 128. The deaths of inhabitants of Islington in Institutions outside the Borough were 777. The tortal deaths in all Institutions, 2,141 ; and the proportion per 100 deaths from all causes, 51.5. Transferable Deaths.—During the year 47 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 Couch, Fevers—Typhus, Enteric and Continued—and Diarrhceal Diseases. During the year 171 persons died from these diseases, the death.rate being 0.50 per 1,000 inhabitants, as contrasted with 0.39 in the corresponding period' last year, and a decennial average mortality of 253 and a death.rate of 0.78 per 1,000. In London the death.rate from the epidemic diseases was 0.59, while in the six Boroughs encircling Islington the death.rate was 0.54. Locally the deaths in the Sub.Registration Districts and Wards were as follows:— Shewing the Deaths from each of the principal Epidemic Diseases in the several Wards and Sub Registration Districts during the Year 1926. Sub. Registration Districts. Wards Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea. Totals. Deaths Deaths Deaths Deaths Deaths Deaths Deaths Deaths Tufnell Tufnell 3 1 2 2 8 Up. Holloway Up. Holloway — — 8 1 1 2 1 13 Tollington Tollington — — 8 2 2 5 — 17 Lr. Holloway Lr. Holloway — — 11 — 12 5 4 32 Highbury Highbury — — 11 2 1 3 5 22 Mildmav — — 4 — 1 2 1 8 Barnsbury Thornhill — — 8 2 4 2 7 23 Barnsbury — — 5 — 1 2 4 12 Islington South East St. Mary's — — 6 1 3 1 3 14 Canonbury — — 1 1 — 3 1 6 St. Peter's 1 — 4 2 2 4 3 16 The Borough 1 — 69 12 29 31 29 171 Total Death Kates 0.00 — 0.20 0.03 0.09 0.09 0.09 0.50 20 1926] Showing the Deaths and Death.Rates from the Principal Epidemic Diseases during the ten years 1916.25 and for the Year 1926. 1916 1917 1918 1919 1920 1921 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever 9 003 4 0.01 7 0.02 5* 0.02 3* 0.01 1 0.00 Small Pox . . . . . . 1 0.00 . . . . Measles 80 0.26 149 0.50 114 0.39 12 0.04 92 0.27 27 0.08 Scarlet Fever 18 0.06 4 0.01 8 0.03 14 0.04 12 0.04 19 0.06 Whooping Cough 60 0.19 45 0.15 147 0.51 17 0.05 70 0.21 43 0.13 Diphtheria 45 0.14 33 0.11 45 0.16 51 0.16 135 0.40 110 0.33 Diarrhoea and Enteritis (under 2 years) 117 16.11 per 1,000 births 106 18.16 per 1,000 births 82 15.78 per 1,000 births 85 13.53 per 1,000 births 77 8.19 per 1,000 births 156 19.78 per 1,000 births 1922 1923 1924 1925 Mean 10 years 1926 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Enteric Fever — — — — 4 0.01 4 0.01 4 0.01 1 0.00 Small pox — — — — — —— — — — — — — Measles 134 0.40 16 0.05 103 0.30 22 0.06 75 0.23 69 0.20 Scarlet Fever 29 0.09 13 0.04 10 0.03 8 0.02 13 0.04 12 0.03 Whooping Cough 98 0.29 38 0.11 57 0.17 61 0.20 64 0.20 29 0.09 Diphtheria 59 0.18 21 0.06 33 0.09 21 0.06 55 0.17 31 0.09 Diarrhoea and Enteritis (under 2 years) 71 9.46 per 1,000 births 103 14.51 per 1,000 births 52 7.65 per 1,000 births 69 10.54 per 1,000 births 92j 13.16 per 1,000 births 69 10.68 per 1,000 births * Including 2 Malarial Fever. Showing the Deaths from Diarrhoeal 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. Diarrha. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Under 1 year 4 12 16 5 8 13 11 15 26 8 10 18 28 45 73 1 to 5 years — — — — — — — 1 1 — — 1 1 2 2 2 2 — 2 2 1 1 2 1 7 8 Totals 4 14 18 5 10 15 11 18 29 9 11 20 29 53 82 21 [1926 INFLUENZA. Influenza caused 51 deaths during' the year and showed a decrease of 21 on the return for the year 1925, and they were 151 below the average of the preceding ten years 1916.25. The death.rate was equal to 0.10 per 1,000 inhabitants. Showing the Deaths from Influenza in the Quarters of the Year 1926, together with the averages of the corresponding periods, 1916.25. Years. First. Quarters. Fourth. Totals. Second. Third. 1916 9 7 2 18 36 1917 22 8 1 5 36 1918 14 8 60 849 931 1919 294 35 6 21 356 1920 56 43 7 12 118 1921 33 17 2 41 93 1922 200 10 3 8 221 1923 21 22 7 8 58 1924 70 15 4 15 104 1925 47 3 1 21 72 Average 77 17 9 99 202 1926 15 24 3 9 51 ncrease or Decrease —62 + 7 — 6 — 90 —151 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 1926 :— Ages. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 Mean 10 yrs 1926 Difference. 0. 5 1 106 19 10 5 22 5 11 6 17 — 17 5.10 — — 52 5 3 — 1 — 1 2 6 1 — 5 10.15 — — 32 8 3 1 — 2 2 5 — 5 15.25 — — 141 48 12 5 11 — 10 2 23 2 — 21 25.35 — 2 252 82 21 9 14 6 7 1 39 4 — 35 35.45 1 2 109 47 18 15 18 4 10 3 23 8 — 15 45.55 6 7 93 48 17 18 42 12 12 11 27 6 — 21 55.65 6 8 69 42 17 13 37 5 19 11 23 12 — 11 65.75 10 10 50 36 13 14 43 16 16 19 23 8 — 15 75 & upwards 13 6 27 21 4 13 33 8 16 17 16 10 — 6 All Ages 36 36 931 356 118 93 221 58 104 72 202 51 —161 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the principal diseases of this class. Erysipelas.—8 deaths were returned from, this disease, or 3 less than in the year 1925, and 1 below the average of the preceding ten years 1916.25. Puerperal Diseases.—.These comprise Puerperal Pyaemia, Septicaemia, Septic Intoxication and Puerperal Fever, and they caused 11 deaths, which is 3 above the return of 1925, and 3 below the average of the ten years 1916.25. The death.rate was equal to 1.70 per 1,000 births. CANCER. Cancer.—453 deaths were registered from this malignant disease during the year compared with 534 in 1925, and with an average of 445 in the previous decen. nium. The deaths represent a death.rate of 1.34 per 1,000 of the civil population and is 0.04 below the average rate (1.38) of the last ten years; 200 deaths occurred 22 1926] among males and 253 among females. The following statement shows the ages at death of the persons attacked during the past ten years, and the return for the year 1926 :— Ages. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 Mean 10yrs 1926 Difference. 0. 5 2 2 3 2 1 1 1 1 — 1 5.16 3 2 1 — 1 — — 1 2 1 — — 1 15.25 5 4 1 1 4 6 4 3 3 3 — 25.35 4 8 8 5 10 10 8 10 9 6 8 6 — 2 35.45 30 31 27 36 32 34 34 27 38 40 33 27 — 6 45.55 86 73 75 101 74 98 88 88 77 93 85 73 — 12 55.65 124 131 99 120 110 140 124 138 131 168 128 142 + 14 65.75 114 120 126 123 124 131 110 125 149 144 127 144 + 17 75.85 48 55 52 39 43 52 47 68 52 71 53 51 — 2 85 & upwards 3 5 6 7 5 6 6 9 8 7 6 7 + 1 Totals 412 432 393 438 402 475 421 472 470 534 445 453 8 Showing the Deaths from Cancer or Malignant Disease in the several Sub.Districts during the Quarters and the year 1926. Quarters. Tufnell. Upper Hollo. way. Tolling. ton. Lower Hollo. way. Highbury. Barns. bury. Islington, South East. The Borough First 11 12 6 15 22 19 27 112 Second 14 7 12 12 18 15 24 102 Third 7 11 11 19 27 15 31 121 Fourth 14 13 9 14 17 22 29 118 The Year 46 43 38 60 84 71 111 453 TUBERCULOSIS. Tuberculosis caused 351 deaths, which were 119 below the average of the last decennium, but were 31 below the number registered in 1925. The death. rate resulting. from them was equal to 1.03 per 1,000 of the civil population, and represented 8.6 per cent, of the details from all causes during the year. Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 289 deaths, as contrasted with the decennial average of 399, while the death.rate was 0.85 per 1,000 of the vicil population as against the decennial rate of 1.23 per 1,000. There was a decrease of 110 on the ten years' average number of deaths, and of 0.38 on the mean death.rate. Tuberculosis (Respiratory System). Proportion of Deaths from Tuberculosis per 100 Deaths from All Causes. Death rates from All Causes per 1,000 inhabitants. Years. Deaths. Death rates per 1,000 inhabitants. 1916 458 1.48 9.64 15.3 1917 485 1.63 10.54 15.5 1918 516 1.80 8.83 20.4 1919 388 1.18 8.56 14.1 1920 349 1.04 7.80 13.3 1921 355 1.07 8.13 13.1 1922 378 1.13 8.19 13.8 1923 337 1.00 8.64 11.6 1924 340 0.99 8.05 12.3 1925 382 1.13 9.18 12.3 Average 10 years 399 1.23 8.75 14.1 1926 289 0.85 7.06 12.0 23 [1926 The following return gives the deaths at each age period : Age Periods. Males. Females. Total. 0.5 3 3 5.15 2 4 6 15.25 22 23 45 25.35 31 36 67 35.45 38 16 54 45.55 52 22 74 55.65 25 8 33 65 upwards 7 — 7 Total 180 109 289 Showing the Deaths from Tuberculosis of Respiratory System in the Sub.Districts during the Four Quarters of the Year 1926. Quarters. Tufnell. Upper Hollo. way. Tolling. ton. Lower Hollo. way. Highbury. Barns. bury. Islington, South East. The Borough First 12 10 6 10 14 8 22 82 Second e 5 5 8 14 14 16 68 Third 4 6 4 13 10 10 16 63 Fourth 10 5 5 6 17 11 22 76 The Year 32 26 20 37 55 43 76 289 Showing the Deaths from Tuberculosis during 1926. Form. Ages. Sex. Districts. Total Deaths 0.1 1.6 over 5 M. F. Tuf. U.H. Toll. L.H. H. B. S.E. Respiratory 1 2 286 180 109 32 26 20 37 55 43 76 289 Meningeal 6 16 11 22 11 2 2 2 3 6 3 15 33 Abdominal 1 — 11 8 4 1 1 2 3 1 3 1 12 General — — 5 5 — 1 1 2 1 5 Other forms — 1 11 8 4 1 1 2 1 4 3 12 All Tuberculosis 8 19 324 223 128 37 30 27 43 63 55 96 351 DEATHS FROM THE DISEASES OF THE RESPIRATORY SYSTEM. (Exclusive of Tuberculosis and Influenza.) These diseases, which include Chronic and Acute Bronchitis, Pneumonia, Pleurisy and Asthma, caused 709 deaths, or 47 less than in 1925. They were equal to a death.rate of 2.1 per 1,000 of the civil population, and represented 17 per cent, of the total deaths registered in the Borough. Acute Bronohitis.—There were 78 deaths as compared with 80 in the previous year. 41 occurred among males, and 37 among females. The deaths of 9 infants under 12 months were registered. Chronic Bronchitis.—188 deaths were ascribed to it, 94 being males and 94 females. This return is 52 below that for 1925. 24 1926] Pneumonia (All forms).—384 deaths were registered, of which 201 were males and 183 females. 5 more died than in the year 1925. It was very fatal to infants under a year old, among whom it caused 83 deaths, while between the ages of 1 and 5 years 64 died from it. Above 5 years of age the deaths numbered 237. 164 Deaths occurred in Public institutions, chiefly the Islington Infirmaries. Pleurisy.—There were 15 deaths registered from this disease, 5 deaths occurred in Public Institutions. Asthma and Emphysema.—Twenty.one deaths were recorded from these diseases, all of which were adults. Other Diseases of the Respiratory System.—Twenty.three deaths were registered, as contrasted with 27 ini 1925. VENEREAL DISEASES. Only five deaths were ascribed to these diseases, as compared with 8 :n 1925. Of these 4 were males and 1 female. The mean deaths of the preceding ten years, 1916.25, were 14. The annual average number of deaths recorded during ten years from them at three groups of ages has been as follows : Under 1 year, 7 deaths; 1.5 years, 0 deaths; and over 5 years, 7 deaths, making an average toal of 14 per annum. The nearest treatment centres for these diseases are the Royal Northern Hospital, Hollo way Road, N., and the Royal Free Hospital, Gray's Inn Road, W.C. DEATHS FROM COAL.GAS POISONING. During the year 23 deaths were registered from asphyxia caused by the inhalation of carbon.monoxide gas. Thirteen deaths from the same cause occurred in 1925. Twenty.two of these deaths were attributable to suicide, while the cause of the remaining death was accidental. Of the 23 deaths, 16 were males and 7 females the ages ranging from, 23 to 81 years. ACCIDENTAL DEATHS. The deaths due to accident numbered 124. Of this number 52 deaths were ascribed to vehicular traffic, and 31 to accidental falls, including 24 agedi people. The 52 deaths due to accidents in vehicular traffic may be summarised as fallow:— Motor Car Other or Lorry. Bus or Tram. Taxi.cab. Vehicles. Total 28 10 2 12 52 Of this number, 24 deaths occurred to Islington residents when in outlying districts. In addition to these, 17 non.residents were also killed by vehicles within the borough. 25 [1926 INQUESTS AND MORTUARY. During the year 308 bodies were received into the Mortuary, as compared with an average of 372 in the preceding 10 years. Only two infectious bodies were received during the year. The daily average number of bodies received was 0.8 as aerainst 0.7 in 1925. In 305 cases inquests were held, as contrasted with an average of 324 in the ten years 1916.25. Bodies received into Mortuary. Inquests. 1916 507 394 1917 479 359 1918 476 348 1919 429 321 1920 340 312 1921 313 299 1922 316 307 1923 288 279 1924 294 317 1925 275 306 Average 372 324 1926 308 305 The following Table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1926 and 1925 :— 1926 No. of bodies received. Daily Average. No. of Inquests held. 1925 No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 78 0.8 84 1st Quarter 79 0.8 100 2nd „ 60 0.6 54 2nd „ 58 0.6 60 3rd 89 0.9 76 3rd 65 0.7 65 4th „ 81 0.9 91 4th „ 73 0.8 81 Total for year 308 0.8 305* Total for year 275 0.7 306* * Inclusive of Inquests held by the Coroner upon bodies of deceased persons who died in Public Institutions in the borough. PREVENTION OF INFECTION. Notification, Isolation, Fatality, of Specified Diseases under the Provisions of the Public Health (London) Act, 1891. The Principal Diseases Include : Small Pox, Diphtheria, Scarlet Fever, Enteric Fever, Typhus Fever, Puerperal Fever and Erysipelas. 1,918 cases of the principal diseases which are notifiable under the Public Health (London) Act, 1891, came to the knowledge of the Medical Officer of Health. This number does not include other communicable ailments, which are also notifiable. The complete list of infectious diseases which are notifiable in Islington will be found on page 32. 26 1926] The total cases notified are 276 less than those of the previous year (2,194), and 299 below the average (2,217) of the preceding ten years. The decreases when contrasted with the decennial averages are to be found in the returns from Diphtheria, Scarlet Fever and Erysipelas, which were respectively 153, 125 and 24 below the average, while the other diseases all showed a slight increase. The 1,918 cases were equal to an attack.rate of 5.65 per 1,000 of the civil population. The returns for the preceding ten years are given in the following statements :— Year. Cases. Attack.rates per 1,000 civil population. 1916 1,439 4.65 1917 1,251 4.21 1918 1,127 3.93 1919 1,993 6.05 1920 2,853 8.49 1921 4,344 13.05 1922 2,787 8.34 1923 2,096 6.22 1924 2,085 6.06 1925 2,194 6.47 10 years average 2,217 6.86 1926 1,918 5.65 Registration Sub.Districts.—The total number of cases notified in these districts was as follows : Tufnell Total cases notified. 127 Upper Holloway 174 Tollington 228 Lower Holloway 267 Highbury 284 Barnsbury 371 Islington South.East 467 Total 1,918 SMALLPOX. One of two cases occurring in the Borough was allocated to Islington. The primary case was that of a woman who had been admitted to the Royal Northern Hospital on account of abdominal pain and the possibility of an operation, as the symptoms pointed to possible infection of the gall bladder. She also suffered from an old.standing chronic skin disease, psoriasis. These facts naturally made diagnosis difficult, as also the particular type of smallpox which showed itself, which was of the low, flat type preceding the ushering in of the confluent type. The history of the probable source of infection is also interesting, as the patient was in Paris on a visit from the 11th to the 24th September, and the probable date of infection would appear to be there in Paris about the 22nd to the 24th September. It is interesting to note that the origin of cases in the same year at Willesden which infected persons in London was also considered to be in Paris. The case was a severe one, as I have stated, but it was at first hoped that owing to the prompt action taken there might be no one infected. However, a patient in the ward who occupied the next bed, and who like the others had been carefully watched was isolated owing to a rise of temperature, which might have been due to vaccination, which had taken well. On the 21st October a rash appeared in this second patient, modified by vaccination, but considered undoubtedly to be smallpox. This second case was also removed to hospital. 27 [1926 It is this second case which has been allocated to Islington, the first having been allocated to St. Pancras, where the woman's ordinary residence was. The home address of the second case, that is, the one allocated to Islington, was in the Borough of Hornsey, where the woman resided with her husband, but she had been many months in hospital, and for a short interval at " Grovelands," The Hospital " Home," in the Urban District of Southgate. The system adopted in the primary case at the Royal Northern Hospital was to isolate the patient in a side ward at once until a definite diagnosis was made. The history of the Paris visit was not known until the case was being particularly enquired into. When smallpox was definitely diagnosed, in addition to the side room, the ward the patient occupied was immediately placed under quarantine and kept isolated from the rest of the hospital. The Public Vaccinator was the same evening called upon to vaccinate every case in this ward and members of the staff and others particularly selected in the hospital on the following days. It was fortunate that the particular ward was practically self.contained, and this isolation of a portion of the hospital could be carried out. The hospital, of course, suffered by the necessary restrictions which had to be imposed, as it would have been unwise to have admitted any fresh cases that could be avoided, and a very careful watch had to be kept on all patients while there was still any risk of these showing symptoms. The occurrence of only a single case from the infected" patient introduced into a large hospital is, I think, a matter for congratulation, for notwithstanding the great care of the hospital authorities, their extra work, and that which devolved upon the Public Health Department, it would be difficult to ensure that even the great precautions would have such an excellent result in view of the number of visitors to such a large institution and the risk that some infected person might escape detection. Although there were a few false alarms and some cases kept under very persistent supervision, there was not any person infected but the one. The Ministry of Health, when the complicated illness of the first case was under consideration, very kindly lent the assistance of Dr. Sturdee, and the London County Council, Dr. Wanklyn, and these experts continued to attend until the only infected case occurred and the safe period had passed. I need hardly add that the assistance the Medical Officer of Health received from the Public Vaccinator, Dr. Fagan, from the Resident Medical Officer in charge of the ward, Dr. Innes, his assistants, and the staff of the hospital, enabled the good results to be obtained, while the great extra work which was thrown on my department was done ungrudgingly by the inspectors, clerks and staff generally, who gave much overtime and worked hard to round up the contacts and keep in touch with them. In the large number of vaccinations done by the Public Vaccinator, a point arose which is of considerable scientific interest. During the War, as may be known, the practice of the use of iodine solution for sterilizing the skin became fairly common. Such is the routine method of sterlizing the skin before the injection of vaccines, for instance those used for protection against typhoid and cholera, but for ordinary vaccination done by scarification one of the best methods of cleansing the skin; is to wash the part with ether soap solution. Inadvertently in some cases prepared for vaccination the nurse had used the iodine method, and it was found that the effect of the iodiine in destroying the efficiency of the vaccine lymph is marked. These cases, when the effect was discovered, were re.vaccinated. 28 1926] Diphtheria was responsible for 743 cases of illness, which were (153) below the average (896) of the preceding ten years. The attack rate was equal to 2.19 per 1,000 of the civil population annually, and was 0.58 below the mean rate (2.77) of the decennial period. In London the attack.rate was 2. 97 per 1,000, and the Encircling Boroughs 2.56. Scarlet Fever.—1,010 cases were notified, and they showed a decrease of 125 on the average (1,135) of the ten years 1916.1925. The attack.rate was equal to 2.98 per 1,000 of the civil population annually, which is a decrease of 0.52 per 1,000 of the mean rate (3.51) of the preceding ten years. In London the attack. rate was 2.69 per 1,000 of the civil population, while in the Encircling Boroughs it was 2.81. Enteric Fever.—Only 18 cases were notified, which equalled the average that obtained during the ten years 1916.1925. The attack rate was 0.05 per 1,000 annually, or 0.01 per 1,000 below the mean rate (0.06) of the last ten years In London the rate was 0.06, and in the Encircling Boroughs 0.05 per 1,000 of the civil population. Typhus Fever—No case was notified. Puerperal Fever.—See page 12. Erysipelas.—'118 cases were notified, or 24 below the average 142 of the preceding ten years, the attack.rate being 0.35 per 1,000 of the civil population. FATALITY FROM THE EIGHT PRINCIPAL NOTIFIABLE INFECTIOUS DISEASES. By "Fatality" is meant the percentage proportion of deaths to attacks of sickness. During the year it was found that of the 1,919 cases notified, 63 deaths occurred, or 3.3 per cent., which contrasts with an average percentage of 4.0 in the preceding ten years 1916.25. Years. Cases. Deaths. Fatality. 1916 1,439 87 6.0 1917 1.261 66 4.4 1918 1,127 67 6.0 1919 1,993 96 4.8 1920 2,833 173 6.0 1921 4,344 146 3.3 1922 2,787 102 3.7 1923 2,096 48 2.3 1924 2,087* 66 3.2 1925 2,194 51 2.3 Mean 2,217 89 4.0 1926 †l,919 63 3.3 * Including 2 cases not notified, † Includes 1 case not notified. 29 [1926 HOSPITAL ISOLATION. Secondary Infections.—An effort has been made as far as practicable when a case of infection occurs in a household after the return of a case from hospital, and presumably the discharged case is the infecting cause of the new case, to communicate with the hospital from which the first case was discharged. This gives the Medical Superintendent of the particular hospital the knowledge that such an event has happened, otherwise he may be ignorant of it, for very frequently the second case may be sent to another hospital altogether. In our work in this connection, and also from enquiries by parents regarding. the long" detention of some children inj hospital, it was discovered that when a child took a fresh infection in hospital — for instance, Scarlet Fever case contracting Diphtheria; a Diphtheria case contracting Scarlet Fever—it was not the practice of some hospitals to notify the Medical Officer of Health. Thus a child going into hospital as Scarlet Fever might contract Diphtheria in hospital, there was no knowledge that it had had Diphtheria, and yet such a child when sent home might be the cause of a case of Diphtheria arising in the household, having. previously gone to hospital with Scarlet Fever, the connecting. link might not be thought of. Upon enquiry into the matter it was found that in onel at least of the Metropolitan Asylums Board's hospitals, outside the London Area, the Superintendent held that according. to the Infectious Diseases (Notification) Act, 1889, which is the Act in force outside the metropolitan area, he was exempted from notifying a case which occurred within the hospital. The matter having been brought before the Public Health Committee, the following communication was addressed to the Metropolitan Asylums Board :— " The Public Health Committee have recently had1 under consideration in the monthly report of the borough Medical Officer of Health cases of infectious disease classified1 as ' probable return cases.' It transpired that cases of secondary infection in the hospitals of the Metropolitan Asylums Board' were, as a rule, duly intimated: to the Medical Officer of Health, and thus he had knowledge thereof, and was in a position to notice ' return cases ' due to a particular secondary infection, but this applied' when the Board's hospital was within the London Area. " Where the Board's hospital is without the London area, section 3 of the Infectious Disease (Notification) Act, 1889, exempts notification of infectious disease occurring within the hospital, and consequently intimation may not be given. " The Committee think it is exceedingly desirable, and even necessary, that intimation of all cases of infection occurring in Islington patients should be sent to the borough Medical Officer of Health by the Medical Officers of Hospitals under the control of the Board, whether within the London Area or not, and I am accordingly requested to ask whether the Board can see their way to arrange for this to be done." On the 18th February, 1926, the Clerk to the Metropolitan Asylums Board replied' as follows :— "1 am directed to inform you that the question raised' in your letter of the 31st December with regard to the notification of cases of secondary infection which occur in the Board's infectious hospitals outside the metropolitan area has been carefully considered by the committee concerned', and that, as a result, instructions are being issued that the procedure which is followed at the hospitals in the metropolitan area shall be put in force at those outside that area." 30 1926] Hospital Isolation.—Of the 1,918 cases of infectious diseases notified, 1,852 were isolated in hospital, or a percentage of 96.5 while only 3.5 per cent, of the patients, therefore, were nursed at home. With two exceptions this is the highest number on record. The following tabular statement shows the number of cases treated in the various public institutions : Year. Cases treated in Hospital. Percentage of cases treated. 1916 1,269 90.0 1917 1,099 87.8 1918 982 87.1 1919 1.772 88.9 1920 2,642 92.0 1921 4,117 94.8 1922 2,621 94.0 1923 1,996 95.2 1924 1,975 94.6 1925 2,105 95.9 1926 1,852 96.5 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated. Percentage of known cases. Small Pox 1 1 100.0 Scarlet Fever 1,010 992 98.2 Diphtheria 743 739 99.5 Enteric Fever 18 17 94.4 Erysipelas 118 76 64.4 Puerperal Fever 27 26 96.3 Conti nued Fever 1 1 100.0 1,918 1,852 96.5 Summary of Infectious Sickness and of Deaths arising therefrom, distinguishing the Cases treated, at Home and in Hospitals ; and showing the .percentage of notified Cases removed to Hospitals, together with the Fatality among cases treated at Home and in Hospitals during the year 1926. Notified Cases Treated. Percentage 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 1 . 1 100.0 . . . . . . . Scarlet Fever 992 18 1,010 98.2 1.8 11 1 12 1.1 6.0 1.2 Diphtheria Enteric 739 4 743 99.5 0.5 30 1 31 4.1 25.0 4.2 (Typhoid Fever) 17 1 18 94.4 5.6 1 . 1 6.5 . 6.0 Typhus Fever . . . . . . . . . . . Erysipelas Puerperal 76 42 118 64.4 35.6 6 2 8 8.0 5.0 6.8 Fever 26 2† 28 92.9 7.1 9* 2† 11 34.6 100.0 40.8 Continued Fever 1 . 1 100.0 . . . . . . . Relapsing Fever . . . . . . . . . . . Cholera . . . . . . . . . . . Total 1,852 67 1,919 96.5 3.5 57 6 63 3.0 9.0 3.3 * Puerperal Pyrexia (1) † Including 1 case not notified. 31 [1926 Showing the number of Cases and, Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1916.25 and in 1926. DISEASES. 191fl 1917 1918 1919 YEARS. 1922 1923 1924 1925 Average number of cases, 1916.25 1926 Increase or Decrease 1920 1921 Small Pox Cases — — 2 2 — — — — — — — 1 + 1 Rate — — 0.00 0.00 — — — — — — 0.00 — Diphtheria Cases 587 556 514 645 1324 1548 1126 889 854 911 896 743 — 153 Rate 1.90 1.87 1.80 1.96 3.94 4.65 3.37 2.64 2.48 2.69 2.77 2.19 — 0.58 Membranous Croup Cases 6 5 4 4 4 6 4 2 2 2 4 — — 4 Rate 0.02 0.02 0.01 0.01 0.01 0.02 0.01 0.00 0.00 0.00 0.01 — — 0.01 Scarlet Fever Cases 638 478 432 1084 1307 2622 1496 1080 1077 1139 1135 1010 — 125 Rate 2.06 1.61 1.51 3.29 3.89 7.87 4.48 3.21 313 3.36 3.51 2.98 — 0. 52 Enteric Fever Cases 32 23 30 16 24 10 9 16 14 10 18 18 — Rate 0.10 0.08 0.10 0.05 0.07 0.03 0.03 0.05 0.04 0.03 0.06 0.05 — Continued Fever Cases — 1 — — — — 3 — — 1 + 1 Rate 0.00 — — — 0.01 — — 0.00 — Puerperal Fever* Cases 21 16 4 29 29 34 20 22 19 23 22 27 + 5 Rate 2.89 2.74 0.77 0.46 3.08 4.31 2.68 3.10 2.79 3.50 3.15 4.18 + 1.03 Erysipelas Cases 155 173 141 212 165 125 132 87 116 109 142 118 — 24 Rate 0.50 0.58 0.49 0.64 0.49 0.38 0.39 0.26 0.34 0.32 0.44 0.35 — 0.09 Totals Cases 1439 1251 1127 1993 2853 4344 2787 2096 2085 2194 2217 1918 — 299 Rate 4.65 4.21 3.93 6.05 8.49 13.05 8.34 6.22 6.06 6.47 6.86 5.65 .1.21 * Per 1,000 Registered Births. Showing the Cases of the Notifiable Infectious Diseases notified in the Sub_ Registration Districts and the Wards during the Year 1926. 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 — 63 51 — 1 — 10 2 — — — 127 Up. Holloway Tollington Up. Holloway 1 73 83 — 2 — 13 2 — — — 174 Tollington — 116 98 — 2 — 10 2 — — 228 Lr. Holloway Lr. Holloway — 142 111 — 2 — 10 2 — — 267 Highbury — 87 62 1 — 9 6 — — — 165 Highbury Mildmay 69 40 — — 6 4 — — — 119 Thornhill 152 66 — 2 — 22 1 — — — 243 Barnsbury Barnsbury — 59 50 — 3 — 13 2 1 — — 128 St. Mary's — 66 51 — 1 — 6 2 — — 126 Islington, S.E. Canonbury — 108 49 — 3 — 10 3 — — 173 St. Peter's — 75 82 — 1 — 9 1 — — — 168 Totals 1 1010 743 — 18 — 118 27 1 — — 1918 Attack_Rates per 1.000 population 0.00 2.98 2.19 — 0.05 — 0.35 0.08 0.00 — — 5.65 32 1926] OTHER NOTIFIABLE DISEASES. The diseases which are notifiable in Islington include those which have since been added by Order, and the complete list is as follows : Small Pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, the disease known as Scarlatina or Scarlet Fever, the fevers known by any of the following names : Typhus, Typhoid, Enteric, Relapsing, Continued or Puerperal, and also the following infectious diseases : Anthrax, Acute Encephalitis Lethargica, Acute Polio.Encephalitis, Acute Poliomyelitis, Acute Primary Pneumonia, Acute Influenzal Pneumonia, Cerebrospinal fever or Epidemic Cerebro.spinal Meningitis, Dysentery, Glanders or Farcy, Hydrophobia or Rabies, Malaria, Ophthalmia Neonatorum, Plague, Trench Fever, and Tuberculosis. Acute Poliomyelitis. Twelve cases were notified from this disease during the year, as contrasted with 1 in 1925, and 7 in 1924. 1926 1925 Cases. Deaths. Cases. Deaths. 1st Quarter 2 Nil Nil Nil 2nd „ 1 „ 1 „ 3rd „ 3 „ Nil „ 4th 6 „ „ „ 12 Nil 1 Nil Epidemic Cerebro.Spinal Meningitis. Eleven cases were notified, being as against six in 1925. During the ten years 1916.25, the cases averaged 14 per annum. A return of attacks of the disease during the past ten years is given in the following statement: 1916 1917 1918 1919 1920 1921 1922 1923 1924 1926 Average 10 yrs. 1916.25 1926 Total Deattis, 1916.26. 1st Quarter 7 15 7 8 5 3 1 3 — 2 5 3 38 2nd 17 11 4 7 6 3 2 2 — 1 5 3 36 3rd 8 1 1 1 2 — — 2 2 2 2 3 9 4th 7 3 4 — 2 1 — 1 4 1 2 2 11 Year 39 30 16 16 14 7 3 8 6 6 14 11 94 The deaths during the year numbered 11 and were equal to the very high rate of 100 per cent, of the cases notified. 88 [1926 Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919. These Regulations came into force on the 7th January, 1919, and during the past 5 years the following cases were notified by medical practitioners to the Medical Officer of Health : 1922 1923 1924 1925 1926 Malaria 2 2 1 Nil Nil Dysentery 1 3 Nil Nil Nil Acute Primary Pneumonia 77 120 119 93 190 Acute Influenza! Pneumonia 67 58 65 41 55 Pneumonia — — — — Total 147 183 185 134 245 Acute Encephalitis Lethargica and Acute Polio.Encephalitis. These diseases became notifiable under an Order of the Local Government I Boardl on the 1st January, 1919. During the year 21 cases of Acute Encephalitis Lethargica were notified, which is an increase of 4 cases on the return of the previous year, whilst 9 deaths were registered; or 43 per cent, of the notified cases. The following summary indicates a marked increase in the number of cases, and also in the fatality of recent years :— Acute Encephalitis Lethargica, Years. 1919 1920 1921 1922 1923 1924 1925 1926 Average (8 years). Cases 5 8 11 3 10 39 17 21 14 Deaths 1 4 2 3 5 4 6 9 4 No case of Acute Polioencephalitis was known in the Borough. Ophthalmia Neonatorium. Purulent Disease of the Eyes of Newly.born Children. See p. 11. Tuberculosis. During the year 704 cases of Tuberculosis in its different forms were notified. The attack.rate was equal to 2.08 per 1,000 of the civil population. This number shows a decrease of 181 on the return of the previous year, and of 0.53 per 1,000 on the attack.rate. It was, however, 38 above the number in 1924. 84 1926] Respiratory (Pulmonary) Tuberculosis.—542 notifications were received, of which 304 referred to males and 238 to females, and represented an attack.rate of 1.6 per 1,000 inhabitants. The return was an increase of 2 on that of 1924 and a decrease of 154 on 1925. Showing the Notified Cases of Tuberculosis in the Wards during 1926. Registration Sub.Districts. Wards. Respiratory Tuberculosis. Other Forms of Tuberculosis. Grand Totals Tuberculosis Rate per 1,000 of Population. Males Females Total Males Females Total Tufnell Tufnell 23 28 51 6 5 11 62 1.81 Up. Holloway Up. Holloway 25 19 44 12 5 17 61 1.90 Tollington Tollington 20 21 41 2 4 6 47 1.50 Lr. Holloway Lr. Holloway 29 22 51 8 5 13 64 1.52 Highbury Highbury 24 15 39 10 7 17 56 1.73 Mildraay 28 22 50 8 8 16 66 2.25 Barnsbury ThornhUl 32 21 53 9 10 19 72 2.34 Barnsbury 30 23 53 8 10 18 71 2.81 Islington, S.E. St. Mary's 26 14 40 10 1 11 51 2.75 Canonbury 38 23 61 11 5 16 77 2.35 St. Peter's 29 30 59 11 7 18 77 2.55 Totals 304 238 542 95 67 162 704 208 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1926. Tubercular Diseases. Sex. At all ages. Cases Notified in Whole District. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up. Respiratory Tuberculosis M. 304 - 4 11 51 134 96 8 F. 238 1 13 57 103 60 4 Tubercular Meningitis M. 5 2 2 1 F. 1 1 Tabes Mesenterica M. 13 1 2 5 3 1 1 F. 15 2 4 4 3 2 General Tuberculosis M. F. Other forms of Tuberculosis M. 77 1 17 27 14 10 8 - F. 51 — 4 18 13 12 4 - All Tubercular Diseases M. 399 4 25 43 69 145 105 8 F. 305 — 7 36 74 118 66 4 Totals 704 4 32 79 143 263 171 12 Percentages at each life period to total cases 0.57 4.55 11.22 20.31 37.36 24.29 1.70 35 [1926 From the above statement it will be seen how the disease attacked people at the various ages, viz. : In every hundred cases 0.57 were under 1 year of age ,, ,, 4.55 were aged 1 to 5 years. ,, ,, 11.22 were aged 5 to 15 years. Prime of Life ,, ,, 20.31 \ were aged 15 to 25 years ,, ,, 37.36 were aged 25 to 45 years ,, ,, 24.29 J were aged 45 to 65 years ,, ,, 1.70 were aged 65 and upwards. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. The provisions of these Regulations are being- systematically carried out with regard to the Register of Notified Cases of Tuberculosis. This work entails a quarterly revision of the Register by the removal of the names of patients who have died, left the district, and those, who in the opinion of the Tuberculosis Officer, confirmed by the L.C.C. Medical Officer, should be denotified. The reports of the Tuberculosis Officers received for transmission to the L.C.C., and those of the Municipal Tuberculosis Visiting Nurse, afford valuable information with regard to removals from the district, and enable us to a considerable extent to keep our register up-to-date. The following is a statistical statement shewing the number of cases of Notified Tuberculosis on the register at the commencement of the year, the numbers, removed during that period, and the actual number remaining at the close of the year, 1926 (i.e., ending 1st January, 1927) :— Lungs. Other Forms. Total. M. F. M. F. Numbers on register at the commencement of the year 1926. 868 681 254 223 2,026 Notified cases added during the year 1926 304 238 95 67 704 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1926 72 40 42 32 186 No. of cases removed from the register during the year 1926 1,244 959 391 322 2,916 278 172 78 53 581 966 787 313 269 2,335 86 1926] Showing the Notified Cases of Tuberculosis in the Quarters during 1926. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Males Females Total Males Females Total Males Females Total Males Females Total Males Females Total Respiratory Tuberculosis 95 57 152 85 63 148 55 67 122 69 51 120 304 238 542 Tubercular Meningitis 4 ... 4 ... 1 1 1 ... 1 ... ... ... 6 1 6 Tabes Mesenterica 3 3 6 5 2 7 3 ... 10 2 3 6 13 15 28 General Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 19 10 29 21 19 40 21 11 32 16 11 27 77 51 128 Totais 121 70 191 111 85 196 80 85 165 87 65 152 399 305 704 Disinfection of Houses and Rooms after Tuberculosis.—The following statement gives the particulars for the year : 1st quarter Houses. Rooms. 151 204 2nd 146 196 3rd „ 129 161 4th „ 138 175 Total 564 736 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 3rd January, 1926, to the 1st January, 1927, in the Metropolitan Borough of Islington. Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. Age-periods 0 to 1 1 to ! 5 ,5 :o 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and up. Total Primary Notifications. Pulmonary Males — 4 5 6 19 32 73 61 58 38 8 304 453 ,, Females — 1 6 7 21 36 68 36 48 12 4 238 381 Non-pulmonary Males 4 21 18 14 6 12 5 6 7 2 — 95 110 „ „ Females — 6 12 11 7 10 8 7 3 3 — 67 92 Age-periods Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Under 5 5 to 10 10 to 15 Total Primary Notifications Pulmonary Males — — — — — 83 270 Females — — — — 1 50 146 Non-pulmonary Males — — — — — 8 55 „ „ Females — — — — — 7 49 CASES of TUBERCUiOSISin ISLINGTON duringI926 BLACK denotesPuLMOMwTuBERCuLOsis WHITE " Other Forms ofTuberculosis 87 [1926 TUBERCULOSIS DISPENSARIES. The work of the Tuberculosis Dispensaries still progresses very satisfactorily. Dr. Leitch, the Tuberculosis Officer for the southern portion of Islington, and Dr. Comyn, the Tuberculosis Officer for the northern portion, have been constantly in touch with the Public Health Department, and co-ordination has thus been most satisfactorily maintained. I have to congratulate these two Assistant Medical Officers (Tuberculosis) upon the good results which they have obtained. During the year 1,212 persons were examined by the Tuberculosis Officers, and the patients made 10,038 attendances. At the Northern Dispensary there were 542 new cases, and at the Southern 670, while the attendances at the former were 3,366 and at the latter 6,672. The examination of contacts with tuberculous cases showed that 25 were suffering" from tuberculosis, 17 were suspect, and 428 were not suffering. The nurses of the Northern Dispensary paid 916 visits, and those of the Southern 1,400, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 166 visits, a'nd of the Southern 422 visits to the patients' homes for the purpose of examining them. Finsen Light Treatment.—One patient received treatment by the Finsen Light at the London Hospital at a cost to the Council of £3 15s. Pneumothorax Treatment was also administered to five patients at a cost of £23 2s. The number of persons in attendance at them in each year is as follows :— TUBERCULOSIS. 1919 1920 1921 1922 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy New Cases 585 756 655 760 615 758 600 581 Actual number of Attendances 4057 6782 3921 6895 3212 7030 3297 6659 Totals 4642 7538 4576 7655 3827 7788 3897 7240 1923 1924 1925 1926 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy New Cases ... 721 562 502 549 543 656 542 670 Actual Number of Attendances 4001 6825 3374 6122 3394 6176 3366 6672 Totals 4722 7387 3876 6671 3937 6832 3908 7342 A summary of the combined dispensaries is given for the following- years : 1919 Cases. Attendances. Cases. Attendances. 1,341 10,839 1923 1,283 10,826 1920 1,415 10,816 1924 1,051 9,496 1921 1,373 10,242 1925 1,199 9,570 1922 1,181 9,956 1926 1,212 10,038 Totals 10,055 81.783 88 1926] Table showing the number of Tuberculous Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1926. Date. Dispensary Jan. Feb. Mar. Apr. May. June July Aug. Sept. Oct. Nov. Dec. Year. Total. Attendances Northern 318 332 356 265 232 281 237 290 236 290 285 244 3,366 10,038 Southern 567 575 663 536 491 530 554 507 562 586 591 510 6,672 New Cases Including Contacts Northern 66 53 67 37 37 39 41 46 42 51 35 28 542 1,212 Southern 52 60 80 54 51 37 55 53 54 63 69 42 670 Contacts. Tuberculosis Northern — 4 — — — — — — — — — — 4 25 Southern 5 2 2 1 1 1 1 1 5 1 1 — 21 Suspects Northern 3 — 1 1 — 1 2 8 17 Southern 1 1 — — — 1 1 3 1 — 1 9 Non-Tuberculous Northern 30 19 39 8 9 10 13 19 18 24 12 7 208 428 Southern 19 24 20 16 17 8 20 22 13 27 27 7 220 Nurses'Visits Northern 61 53 74 61 72 76 57 100 100 72 98 92 916 2,316 Southern 103 32 142 84 90 126 80 26 118 219 193 187 1,400 Tuberculosis Officers' Visits Northern 10 11 25 17 12 15 16 15 1 12 17 15 166 | 588 Southern 33 30 38 36 31 29 27 20 37 36 34 71 422 HOME VISITATION—TUBERCULOSIS. A Municipal Tuberculosis Visiting- Nurse. Miss Emilv McGoldrick, commenced duties 3rd June, 1925, this is in addition to the visitation work of the dispensary nurses. Duties of Municipal Tuberculosis Visiting Nurse. The Special Tuberculosis Visiting- Nurse shall visit " Tuberculosis Dispensary " cases in their homes, contacts of any tuberculous case or cases, suspects, or contacts which the Tuberculosis Officers desire to attend for examination or require any information about. She shall report regularly to, and take her instructions from, the Tuberculosis Officers at the Dispensaries, and if required shall by arrangement attend at either Dispensary at other times. Her duties shall commence at 9 a.m. (at which hour she shall report at the Public Health Department, where office accommodation will be provided for her) and terminate at 5 p.m. with an interval for luncheon of one hour, Saturdays 9 a.m. to 1 p.m. Her time will be, as far as possible, equally divided between the work of the Southern and Northern Dispensaries. She shall not be under the control of the Matron of either hospital at which the Dispensaries are established, and shall not be used as locum tenens for the tuberculosis nurses. She shall hold office as provided in the Agreement of the Council with the Royal Northern Hospital Corporation, but her main duties will be visitation in the homes as set out above, and will differ from the other Tuberculosis Dispensary Nurses inasmuch as she will not attend the Dispensary Sessions (unless for some special reason as required by the Tuberculosis Officers), and as her time will be allocated between work for both Dispensaries, she will be provided with a central place for starting equi-distant between the two Dispensaries, that is, at the Municipal Offices, and can thus form a link between the work of both Dispensaries and the Public Health Department. 39 [1926 VISITS PAID BY TUBERCULOSIS VISITING NURSE DURING THE PERIOD 3rd JUNE, 1925, to 31st DEC., 1925. Northern Tuberculosis Dispensary Southern Tuberculosis Dispensary Total 908 795 1,703 Visits Paid During Year Ending 31st Dec., 1926. North Dispensary South Dispensary Total January 151 123 274 February 116 111 — 227 March 133 140 273 April 131 94 225 May 136 123 259 June 139 156 295 July 153 117 270 August 138 130 268 September 66 84 150 October 138 120 258 November 134 148 282 December 156 138 294 1,591 1,484 3,075 The Municipal Tuberculosis Visiting- Nurse works under the direction of the Tuberculosis Officers of the North and South Islington Tuberculosis Dispensaries in accordance with the arrangements made in Conference with the Chief Executive Tuberculosis Officer, Dr. G. Clark Trotter. Her visits are made in regard to the "treatment'' of patients notified to be suffering from the disease; patients attending the Dispensaries; Ex-Service Tuberculous War Pensioners, etc. 40 1926] THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 952 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 592 were Scarlet Fever and 359 Diphtheria. 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 Scarlet Fever 592 667 — 76 Diphtheria 359 414 — 55 Enteric Fever 1 1 — Other Diseases — — — Total 952 1,082 — 130 Non-Notifiable Diseases.—5,891 cases came to the knowledge of the Medical Officer of Health during the year, viz : 2,059 cases of Measles, 1,184 cases of Chicken Pox, 409 of Whooping Couch, and 2,239 of other diseases. The information respecting these cases was received from the teachers of schools within the borough. Exclusion of Scholars from Schools.—3,077 children were excluded from classrooms of various schools owing to the presence of an infectious disease, chiefly Diphtheria and Scarlet Fever, in the houses wherein they lived. The non-notifiable diseases among children attending the Public Elementary Schools were:— Disease. Notifications by Teachers. Average of preceding 10 years. Increase or Decrease. Measles 2,059 1,679 + 380 Chicken Pox 1,184 787 + 397 Whooping Cough 409 577 — 168 •Other Diseases 2,239 2,343 — 104 6,891 5,386 + 505 * Note.—" Other Diseases " include Mumps, Scabies, Ophthalmia, Itch, etc. BACTERIOLOGICAL EXAMINATIONS. 2,535 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 Tuberculosis, Diphtheria and Enteric Fever, respectively. The number is a decrease of 251 on that of the preceding year. It is, however, 909 above the decennial average. Of the total examinations, 334 or 13.2 per cent. gave positive results. Diphtheria.—1,684 specimens were examined for Diphtheria, of which 183, or 10.9 per cent., were found to contain Diphtheria bacilli" Enteric Fever.—12 specimens of blood were examined, 9 of which gave negative results. Tuberculosis —839 specimens of sputum were examined', 148, or 17.6 per cent. of which showed that the patients were suffering from pulmonary tuberculosis. 41 [1926 DIPHTHERIA—PATHOGENICITY TESTS. 1926. No. Submitted for Examination. Negative Result. (Bacilli) Positive Result. (Bacilli) Non-Virulent. Virulent. 8 8 Nil Nil Nil Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1916-26. Periods. Diphtheria. Enteric Fever. Pulmonary Tuberculosis. Positive Results. Negative Results. Total Examined Positive Results. Negative Results. Total Examined Positive Results. Negative Results Total Examined Totals. 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 1919 116 352 468 5 15 20 92 348 440 928 1920 261 677 938 3 20 23 83 375 458 1,419 1921 238 969 1,207 3 19 22 127 421 548 1,777 1922 291 953 1,244 — 9 9 139 472 611 1,864 1923 306 1,371 1,677 5 15 20 152 719 871 2,568 1924 180 1,333 1,513 — 17 17 127 650 777 2,307 1925 232 1,618 1,850 2 12 14 160 762 922 2,786 Average 10 years 192 794 986 4 15 19 129 492 621 1,626 1926 183 1,501 1,684 3 9 12 148 691 839 2,535 VACCINATION. Of the 5,490 births registered in 1925, the returns of vaccination show that only 2,633 infants were successfully vaccinated, while 14 were found to be insusceptible. There were also 266 who died unvaccinated, and 1,973 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians; 44 vaccinations were postponed under medical authority, 294 were removed to other districts or place unknown, thus leaving 266 unaccounted for. The return of certificates of exemption, therefore, represents 36 per cent. of the registered births. Years. Vaccination per 100 births, less infants who died unvaccinated. 1921 44.9 1922 46.3 1923 54.8 1924 54.0 1925 50.4 Certificates of Exemption.—The following tabular statement shows the decrease in number of these certificates in recent years :— 1921 2,506 1922 2,347 1923 1,751 1924 1,755 1925 1,973 1926 1,951 42 1926] Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the previous year 1925. Registration Sub-Districts. Number of Births registered in 1925 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 remaining Unvaccinated. or not accounted for (Defaulters). Total Number of Certificates of Primary Vaccination of children under 14 years received during year 1926. Number of Statutory Declarations of Conscientious Objection received during year 1926. 1 2 3 4 6 6 7 8 9 10 11 12 Tufnell 481 277 1 - 133 22 5 18 13 12 129 Up. Holloway 621 306 — — 207 40 3 26 29 10 1.629 248 Tollington 443 211 1 — 150 16 5 6 20 34 138 Highbury 890 434 7 — 316 35 8 20 38 32 324 Lr. Holloway 742 335 — — 255 47 4 3 20 78 272 Barnsbury 1061 542 4 — 363 56 10 6 40 40 1.955 339 Islington, S.E. 1252 528 1 — 549 50 9 10 45 60 601 The Borough 5490 2633 14 — 1973 266 44 89 205 266 3.584 1,951 DISINFECTION. Disinfection of Rooms.—3,533 rooms were disinfected, as contrasted with 3,767 in 1925., For this purpose formaldehyde 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 removed, and the walls washed with hot lime. The above figures also include the disinfection of houses and rooms after Tuberculosis, vide p. 86. Rooms Disinfected. 1926 1925 1st Quarter 921 915 2nd „ 807 922 3rd „ 736 995 4th „ 1,069 935 The Year 3,533 3,767 Work at the Disinfecting Station.—42,950 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 35,076 similar articles disinfected during the previous year. In addition to the above articles, 25,503 second-hand garments, mostly overcoats, jackets, tunics and British warms were disinfected for clothing contractors trading in the Borough, who paid the Council for the work, amounting to the sum of £68 15s. 0d. Altogether, 68,453 articles described in the two paragraphs preceding were disinfected. Since the disinfecting station was established 2,159,245 large articles have been disinfected. 43 [1926 Summary of the chief articles of Clothing, Bedding, etc., disinfected during the year 1926, and also in the preceding year 1925. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1926 1925 Beds 476 376 426 615 1,893 2,034 Blankets 1,417 1,040 1,082 1,754 5,293 4,810 Bolsters 385 310 337 563 1,595 1,722 Carpets 11 2 - 1 14 12 Chair Bed Cushions 30 45 32 62 169 153 Mattresses 441 403 405 685 1,934 1,536 Palliasses 3 0 6 2 17 8 Pillows 1,374 1,247 1,274 1,808 5,703 4,910 Quilts 496 428 462 645 2,031 2,134 Sheets 933 854 868 1,576 4,231 3,766 Other Articles 4,054 3,107 3,559 9,350 20,070 13,991 Totals 9,620 7,818 8,451 17,061 42,950 35,076 The nature of the articles disinfected for the clothing contractors is shown below : 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Overcoats 2,582 3,602 1,441 1,419 9,044 Jackets 725 978 425 648 2,776 Tunics 112 87 — 325 524 British Warms 877 662 150 1 1.690 Other Articles 3025 201 27 8,216 11,469 Total 7,321 5,530 2,043 10,609 25,503 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 Solution Ordinary. Special. Tons. cwts. Gallons. Gallons. Gallons. To Householders 1 10 150 - - Disinfection of Premises Ashburton Grove Refuse — - — 46 Dump — — 140 — Cost = £60 0s. 6d. Shelter House.—The Shelter House was not occupied during the year, but baths were given to 5 verminous persons, and one person suffering from scabies, while their clothing was disinfected'. Three midwives attended for the purpose of disinfection after attendance on cases of Puerperal Fever; and 6 other persons who had been in contact with cases of infectious diseases also had their clothing disinfected. 44 1926] Disinfestation of School Children (Cleansing from lice and other vermin.—During the year 4,634 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 disinfestation. The daily attendance ranged from 2 to' 72. The agreement entered into between the London County Council and the Borough Council from the 1st January, 1921, for the cleansing of verminous children, is a payment at the rate of 2s. for each attendance of each child at Cleansing Station, except when such child is, or is suspected to be, suffering from Scabies, in which case payment by the London County Council will be at the rate of ls. for each bath given. The minimum payment to be paid to the Borough Council in respect of such cleansing shall be not less than £100 per annum. The amount paid during the year by the London County Council for the baths given to the children was £440 7s. Proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, in 29 instances during the year, when fines ranging from 3s. to 10s. were inflicted. The total fines received amounted to £ 10 4s. FACTORY AND WORKSHOP ADMINISTRATION. The Medical Officer of Health submits the annual report on the manner in which the provisions of the Factory and Workshops Act, 1901, were carried out in his district during the year 1926. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under:— Factories, including Factory Laundries 753 Workshops, including Workshop Laundries 1,094 Workplaces, other than outworkers' homes 397 Bakehouses 328 Restaurant Kitchens (see also p. 58) 467 Outworkers' premises 1,222 Miscellaneous re-inspection and calls 5,093 Total 9,354 Notices Served.— In consequence of the 1,337 sanitary defects discovered as the result of the inspections above; 251 intimations and 24 statutory notices were served. Of these notices 96 were served on the owners of factories, 124 on the owners of the workshops and workplaces, and 21 on the owners of bakehouses and 34 of restaurant kitchens. In addition to these nuisances, 108 were discovered on Outworkers' premises, necessitating the service of 44 notices. Most of these defects were remedied so that it was not found necessary to resort to legal proceedings. Registers.—There were 2,280 workshops on the Register, as contrasted with 2,194 in 1925, while the total number of workrooms were 3,089, as compared with 2,993 in the previous year; 195 workshops were added to the Register, while 109 were removed from it. 45 [1926 The various workshops and workplaces are tabulated as below : Workshops and Workplaces. 1926. Total Workshops on Register. Total Workrooms on Register. Number added during Year. Number removed during Year. Workshops where Men are employed 1.001 1,509 112 66 Workshops where Women are employed 527 811 58 38 Laundries 42 53 — — Bakehouses 234 243 1 2 Restaurant Kitchens 429 473 19 2 Other Workplaces 47 — 5 1 Total 2,280 3,089 195 109 Outworkers' Premises 3,057 — 428 239 Workshops Notified to Home Office during Year 1926. Trade. Number of Workshops. Women. Male Young Persons. Totals. Dressmaking 13 87 — 87 Artificial Wreaths I 9 — 9 Mantles 3 7 — 7 Costumes 4 17 — 17 Underclothing 1 1 — 1 Boudoir Caps 1 7 — 7 Tailoring 9 41 — 41 Artificial Florist 1 6 — 6 Pattern Cards 1 12 — 12 Millinery 2 2 — 2 Leather Goods 4 7 — 7 Furriers 3 6 — 6 Picture Mouldings 1 5 — 5 Art Needlework 1 5 — 5 Basket Work 1 5 — 5 Dress Stands 1 4 — 4 Rag Sorting 1 2 — 2 Tie Making 1 3 — 3 Packing Case Making 1 — 1 1 Glass Sign Making 1 — 1 1 Bakehouse 1 — 1 1 Upholstering 2 4 2 6 Wood Carving 1 I 1 o Total 55 231 6 237 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. WrittenNotices Prosecutions. (1) (2) (3) (4) Factories 753 96 Nil. (Including Factory Laundries) Workshops 1,094 108 „ (Including Workshop Laundries) Workplaces 1,192 71 „ (Other than Outworkers' premises) Miscellaneous Re-Inspections and calls 5,093 — - Total 8,132 275 Nil. 46 1926] DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (6) Nuisances under the Public Health Acts*— Want of cleanliness 404 410 Nil. Nil. Want of ventilation 35 35 1 „ Overcrowding 13 13 „ „ Want of drainage of floors 13 13 „ „ Other nuisances 460 448 „ „ Sanitary insufficient 56 53 „ „ Accommodation {unsuitable, foul or defective ... 343 337 „ „ J not separate for sexes 12 9 „ „ Offences under the Factory and Workshop Arts— Illegal occupation of underground bakehouse (s.101) Nil — — — Other offences 1 — (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) Total 1,337 1,318 1† Nil. * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 55 Workshops were also notified H.M. Inspector, of failing to affix Abstract of Factory and Workshop Act (s. 133). OUTWORKERS' PREMISES. Instances. Notices Served. Remedied. Prosecutions. Outwork in unwholesome premises (s. 108) 108 44 108 Nil Outwork in infected premises (s. 109, 110) 26 — — — Total 134 44 108 Nil OUTWORKERS' LISTS (s. 107) : Lists received from Employers 1,836 Addresses received from Other Councils 1,946 Addresses forwarded to Other Councils 912 Firms failing to send in lists (No. letters sent) 323 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories : Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 55 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 12 Reports (of action taken) sent to H.M Inspector 12 Other (New Factories reported under Home Office Memorandum, 1912) Nil Underground Bakehouses (s. 101) in use at the end of the year. 79 47 [1926 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) Wearing Apparel— Making, &c. 64 22 Nil Cleaning and washing — — — Household linen — — — Lace, lace curtains and nets — — — Curtains and furniture hangings — — — Furniture and upholstery 4 — — Electro-plate — — — File making — — — Brass and brass articles — — — Fur pulling — — — Cables and chains — — — Anchors and Grapnels — — — Cart gear — — — Locks, latches and keys — — — Umbrellas, &c. 5 4 - Artificial flowers 12 7 Nets, other than wire nets — — Tents — — - Sacks — — Racquet and tennis balls — — — Paper, &c., boxes, paper bags 17 8 — Brush making 3 3 — Pea picking — — — Feather sorting — — — Carding, &c., of buttons, &c. — — — Stuffed Toys 1 — — Basket making — — — Chocolates and sweetmeats — — Cosaques, Christmas Crackers, Christmas stockings, &c. 2 — Textile weaving - - — Total 108 44 Nil DISTRICT INSPECTORS WORK. The fourteen district inspectors made a total of 56,211 inspections and calls during the year, a decrease of 1,718 inspections on the corresponding period of 1925; while 14,299 improvements were effected in 6,155 premises; as against 15,192 improvements in 6,635 premises for the preceding year. Synopsis of Inspectors' Work,—The following statement gives a brief synopsis of the district inspectors' work in 1926 :—• House to house inspections 3,347 Other inspections of dwelling houses 5,355 Re-inspections and calls made 44,291 Visits of inquiry re notifiable infectious diseases 2,207 Butchers' shops, stalls, etc. (Saturday nights) 53 Ice cream shops and factories 136 Dairies and Milkshops 792 Stables and yards 1,329 Manure depflts 3 Smoke observations 121 48 1926] Notices Served There were 4,803 intimation notices served by the inspectors with respect to nuisances. In 582 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.—74 premises which were found to be in a verminous condition, were cleansed by the owners or occupiers upon receiving the Inspectors' intimations. In 9 instances it was necessary to remove the bedding and clothing to the Disinfecting Station for purification or destruction. Smoke Nuisances.—52 complaints of smoke issuing from factory chimneys in the Borough were investigated, and as a result 121 observations were made by the Districts Inspectors, and 2 notices served upon the owners of the businesses requiring the abatement of the nuisance. In no instance, however, was it found necessary to institute legal proceedings. SPECIAL WORK DURING PERIOD OF GENERAL STRIKE. The period covered was from the 1st May in the afternoon, the dispute ending on the 10th May. During this time, about 220 tons of refuse, house and trade, arrived at the Ashburton Grove Dep6t daily. The accumulation, however, very soon reached large dimensions. Only one, on the 4th May, was there an opportunity of any of the material being got away, and this was but 18 trucks. The Medical Officer of Health suggested that the risk of serious nuisance arising from the accumulation might be temporarily stayed by efficient spraying. Such spraying as a temporary measure keeps down offensive smells and flies. The Superintendent of the Department and one of the Sanitary Inspectors went into the matter. There was no appliance for carrying out work of such dimensions to hand, the usual spray used for disinfection work being too small to make any progress with such large quantities of material. A tar spraying machine was borrowed from the Borough Engineer's Department. It was found, however, in its condition to be useless, and work had to be undertaken of stripping and cleaning the valves and putting the machine in order for use as a disinfecting spray. This was carried out by the Inspector, and subsequently it proved to be efficient for the purpose. When the strike ended there were about 1,600 tons of refuse lying at the depot. The work of spraying was carried out by the disinfectors of the Public Health Department every morning between 8 a.m. and 9 a.m., under the supervision of the Sanitary Inspector deputed for this work, which was continued until the whole of the refuse was completely removed, this being accomplished by the 1st July, 1926. During the whole of this time daily sprayings took place. The amount of disinfectant used was 140 gallons of special liquid disinfectant which was diluted to the strength of one part of disinfectant to 12 parts of water. Forty gallons of this solution was sprayed at each visit. As regards results, during the period no complaints were received of offensive smells which could be attributed to the refuse, and from enquiries and observations it would appear that the number of flies was much less than in previous summers. The potency of the disinfectant used was proved by the fact 49 [1926 that every morning several dead birds were to be seen about the depot and on the heaps of refuse, these birds having eaten the fly larvae which had been saturated with the disinfectant. Another interesting point is that from the 1st May to the 1st July in the immediate neighbourhood there was only one case of notifiable infectious disease, a case of Scarlet Fever, and the infection was not attributable to the dump. The work mentioned is interesting, as it shows what can be done to keep down risks provided the period is not too long, and the accumulations have not in their amount exceeded what can be effectively dealt with by means of extensive spraying. DUST NUISANCE (Grinding of Bricks and Rubble, Etc.). In September considerable consternation was caused in the Tollington Ward by the starting of a business of grinding bricks, rubble, etc., without adequate protection to prevent the dust spreading broadcast. Not only were householders in the neighbourhood seriously annoyed and inconvenienced by the nuisance, but business premises were also invaded by the dust. The residents presented a petition, and the matter was taken up by the Public Health Committee. One difficulty which arises is that the dust which annoyed the householders, etc., came from, but was not on, the premises, and there appeared to be some difficulty as regards the technical wording of the general nuisance section of the Public Health Act. If the Public Health (London) Act, instead of saying " effluvia " in one of its sections said " dust and effluvia " it would cover this matter and also protect the trade interest in a way, as the section (21) in which effluvia is mentioned' sets forth a very definite procedure, and allows " the best practicable means for abating the nuisance." It is thus not too drastic in the restriction of trade or manufacture. There was also the suggestion that the London County Council might take up the matter in their next General Powers Bill. Meanwhile the Medical Officer of Health proceeded as far as he could regarding the premises from which the nuisance was emanating by means of insisting on necessary sanitary accommodation and care for the workpeople employed. When these were remedied the adjacent area would naturally at the same time benefit. REMOVAL OF DUST. 20 applications were received during the year for the removal of dust, which is 1 less than the number recorded last year. The applications received for the previous ten years were as follows:— 1916 31 1921 21 1917 30 1922 15 1918 11 1923 16 1919 19 1924 33 1920 36 1925 21 Dust Receptacles Provided.—During the year 1,388 dust receptacles were provided, while 38 were repaired after the service of sanitary notices, 50 1926] Summary of Sanitary Work from Inspectors' Reports for the year 1926. Districts. | Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 243 249 211 214 239 247 12 3 118 402 25 293 312 197 248 3347 House to House Inspections 235 287 266 642 321 409 157 499 463 400 435 582 307 355 5355 Other premises inspected 2210 2490 3273 3774 2335 3576 2308 3824 4328 3372 3845 2991 3512 2453 44291 Re-inspections, Calls made, etc. — — 26 11 — 22 2 2 37 4 6 13 4 9 136 Ice Cream Factories inspected 38 48 80 57 65 64 92 43 74 45 20 56 49 61 792 Dairies and Milkshops „ 35 1 17 1 16 10 5 1 16 1 2 1 1 — 207 Stables ,, 116 82 201 35 372 7 173 5 52 22 5 28 18 6 1122 Yards „ - — — 3 — - — — — — — - — — 3 Manure Depots „ Vacant land. Passages and Courts inspected 10 7 4 3 76 1 36 1 1 14 1 3 — 5 162 Urinals attached to P.H.'s inspected l 57 61 17 2 72 61 2 7 28 3 - 7 152 472 Premises (re Water Certificates) inspected 6 11 - - 41 77 135 Visits re Sale of Food and Drugs Acts - - 15 - - - - - - - - - - - 15 Smoke observations — 12 21 11 4 3 3 1 24 1 3 10 26 2 121 Shops, Stalls and Markets (Saturday evening^ 4 2 5 3 3 5 2 4 4 4 4 5 4 4 53 Total Inspections and Calls 2892 3235 4180 4771 3533 4416 2970 4511 5408 4142 4614 4001 4166 3372 56211 Notices Intimation Served. | Public Health (Lon: don) Act 1891 202 272 267 589 130 400 180 385 570 397 463 427 226 289 4797 (Milk shop & Dairies — 3 — 1 — — — — 1 1 — — — — 6 Statutory (Public Health (London) Act, 1891 13 18 27 49 9 63 18 42 116 69 24 62 38 33 581 (Housing Act, 1925 - - - - - - - - - - - - 1 — 1 Improvements. Drains— Constructed - - - - - 3 - - - - - - - - 3 Re-constructed 3 15 7 4 — 12 1 11 9 19 3 7 4 2 97 Repaired 23 14 23 34 3 38 9 24 31 31 32 31 7 25 325 Ventilated 3 14 9 9 2 12 2 2 7 17 1 8 3 5 94 Gully and other traps fixed ... Urinals— 20 82 27 22 1 39 16 48 31 71 15 22 3 10 407 Water supply—cleansed — 3 6 2 — 2 5 — 2 4 4 — 1 3 32 - - - - - - - - - - - - - - - Water Closets— W.C. erected with pan, trap and Water Supply 1 2 4 2 - 4 - - 9 2 - - 3 - 27 Pan and trap only provided 19 40 33 53 2 15 17 33 34 71 59 33 8 5 422 Flushing apparatus repaired 24 32 27 77 1 40 22 27 76 36 64 52 23 26 527 Ventilated 1 2 3 3 1 1 1 2 — 2 4 3 2 1 26 Walls, etc . cleansed 8 18 4 47 9 14 11 16 50 61 83 33 28 14 396 Position altered — 7 — — — — — — — — 7 Dust Bins Provided 72 120 55 189 10 89 71 159 64 145 141 128 74 71 1388 Repaired — 2 6 — — 1 2 25 — 2 — 38 Areas Yards Constructed _ - 2 1 ___ 3 Paved 2 4 3 2 4 1 5 2 2 3 1 29 Paved 2 3 2 4 2 1 1 1 16 Repaved 13 31 16 72 5 19 10 21 23 57 22 29 7 10 335 Sinks Provided 10 11 5 6 3 3 6 7 10 10 12 6 1 90 Waste pipe repaired 14 17 11 36 6 15 15 13 26 38 18 17 14 10 250 Domestic Water Supply— i Cisterns Provided - - - - - - 1 1 - - - - - 1 3 Cisterns repaired and cleansed I Water supply provided to ~\ dwelling house Water supply provided to tene' ment house 8 21 29 42 6 16 15 2 14 7 4 10 4 3 181 3 7 2 6 1 2 2 4 4 5 3 1 1 41 1 2 1 6 - 7 5 3 16 3 5 6 2 - 57 Walls and ceilings of Rooms cleansed and redecorated 77 150 167 535 85 258 139 192 502 373 460 288 279 206 3711 Carrried forward 51 [1920  Districts. Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Other improvements— /Staircase and passages repaired, cleansed and redecorated 13 27 24 110 11 49 18 34 87 65 76 50 54 55 673 Floor space ventilated — 2 4 9 — 3 4 1 6 20 11 1 1 62 Floors repaired 21 18 18 60 6 32 9 10 59 28 36 48 19 23 387 Guttering and rain water pipes repaired 21 45 12 65 7 38 17 43 27 48 42 51 37 20 473 Roofs repaired 33 55 61 218 13 87 32 87 122 110 116 124 91 46 1195 Overcrowding abated 1 1 — 7 — 2 1 2 2 1 2 19 Illegal use of underground rooms for sleeping discontinued 1 — 1 — 1 1 — 2 2 2 10 Other improvements, or ances abated 38 56 71 196 15 128 57 83 179 122 192 194 60 78 1469 Rooms Disinfected 166 170 161 221 40 57 55 18 114 43 200 29 107 124 1505 Total improvements 598 962 787 2039 233 986 548 849 1510 1394 1636 1178 836 742 14298 Total premises improved 334 442 412 785 116 380 232 389 617 477 767 420 401 383 6155 HOUSES LET IN LODGINGS. The 1,011 houses which come under the operation of the bye-laws received 317 inspections during the year, followed by 3,163 subsequent re-inspections and calls, so that the total visits amounted to 3,480. These inspections resulted in 398 intimations being served on the persons responsible, which were followed by 52 statutory notices to demand the abatement of the nuisances discovered by the inspector especially engaged upon this work. No prosecutions for non-compliance with the notices served were found necessary. Altogether, 1,221 improvements were effected in 372 premises. Synopsis of Inspectors' Work:— Improvements. Drains : Constructed — Reconstructed 2 Repaired 6 Ventilated — Gully and other traps fixed 1 Urinals : Water supply—cleansed — Cesspools : Abolished — Water Closets : W.C. erected with pan, trap and water supply 4 Pan and trap only provided 10 Flushing apparatus repaired 31 Ventilated 114 52 1926] Walls, etc., cleansed 20 Position altered — Dost Bins : Provided 64 Repaired — Areas : Constructed — Paved — Yards: Paved 2 Repaved 19 Sinks : Provided 4 Waste pipe repaired 9 Domestic Water Supply : Cisterns provided — Cisterns repaired and cleansed 12 Water supply provided to dwelling house — Water supply provided to tenement house — Walls and Ceilings of Rooms cleansed and redecorated 271 Other Improvements : Staircase and passages repaired, cleansed and redecorated 88 Floor space ventilated — Floors repaired 55 Guttering and rain water pipes repaired 7 Roofs repaired 153 Overcrowding abated 7 Illegal use of underground Rooms for sleeping discontinued — Other Improvements, or Nuisances abated 455 Rooms Disinfected — Total Improvements 1221 Total Premises Improved 372 RATS AND MICE (DESTRUCTION) ACT, 1919. (9 and 10 Geo. 5. Ch. 72.) This Act came into operation on the 1st January, 1920, to make further provision for the destruction of rats and mice. Summary of Work under the Rats and Mice (Destruction) Act during the years 1922-26:- 1926 1925 1924 1923 1922 Number of Streets visited 217 96 91 544 711 Number of Private Houses visited 320 133 176 650 1,023 Number of Shops and Factories visited 61 14 19 712 1,009 Total Premises inspected 381 147 195 1,362 2,032 Found Rat Infested 174 66 61 787 1,331 Found Mice Infested 5 2 1 66 72 Defective Drains Repaired (Cause of Rat trouble) 49 51 60 13 52 Number of Complaints received 173 105 118 67 177 53 [1926 Housing. Summary of Housing from 1919 to 1926 (inclusive). The number of houses or flats provided by the Islington Borough Council was 745; the number of houses and flats provided by private enterprise—Sutton 199, Render and others 77, making a total of 276. Particulars of houses or flats provided under the Council's Housing Schemes. Halton Mansions (8 more flats to be erected on lease of two) 160 houses falling-in, during 1932) City Mansions 47 Queen's Mansions 44 Warltersville Mansions 46 Manchester Mansions 31 Addington Mansions 107 435 *Conversion of 16 houses into 61 dwellings Tyndale Mansions102 Laycock Mansions132 Houses, etc., Highbury Station Road 15 Total 745 *Includes :—27, Rupert Road 8, Barnbury Street , Not converted 27 and 25, Canonbury Villas 2, Highbury Grange Eighty houses of the rateable value of over £50 have been converted into 202 flats. The number of overcrowding cases recorded as dealt with during the years 1919 to 1926, was:— 1919 11 1920 7 1921 6 1922 10 1923 17 1924 13 1925 19 1926 26 Total 109 These figures, of course, represent only the number of cases which have been dealt with officially. The number encountered was numerous, but in view of the difficulties of finding other accommodation, proceedings were not instituted in the majority of cases met with, 1926] 54 METROPOLITAN BOROUGH OF ISLINGTON. Housing Statistics for the Year. Number of new houses erected during the year :— (a) Total (including numbers given separately under (b).) 420 (b) With State assistance under the Housing Acts. (i) By the Local Authority 210 (ii) By other bodies or persons 210 1. Unfit dwelling-houses. Inspection— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,702 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 or the Housing Consolidated Regulations, 1925 1,397 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,950 2. Remedy of defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1,358 55 [1926 3. Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 1 (b) By local authority in default of owners Nil (8) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,797 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 4,797 (4) By local authority in default of owners' Nil (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (8) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 56 1926] RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920, 1923 AND 1925. Number of applications for certificates and "reports " under above Acts, Year. House or part of the house not kept in a reasonable state of repair. House or part of the house kept in a reasonable state of repair. " Report " re completion of work mentioned in schedule issued with certificate. Certificates not issued. Total. 1920 25 28 — 1 54 1921 269 52 1 5 327 1922 157 25 11 2 195 1923 123 8 15 2 148 1924 117 6 19 — 142 1925 96 5 12 3 116 1926 68 4 26 2 100 Totals 855 128 84 15 1,082 STATE OF PAUPERISM IN THE BOROUGH. There was a slight increase in the number of paupers relieved during the year for the weekly average was 10,592, compared with 10,583 in 1925 and 11,792 in 1924. Appended is a statement furnished by the Clerk to the Islington Guardians :— Showing the State of Pauperism in the Borough during the year 1926. Quarters. Average number Relieved during each week. Borough Death rates, 1926. Indoor Paupers, Adults and Children. Outdoor Paupers. Totals. Totals corresponding periods 1925. Children Boarded out. Adults. Children under 16. 1 2 3 4 5 6 7 8 1st Quarter 3,032 4,755 2.938 10,725 11,163 35 15.0 2nd „ 2,950 4,985 3,240 11,175 10,562 35 10.9 3rd „ 2,830 4,619 2,614 10.063 9,960 33 9.6 4th „ 2,971 4,700 2 733 10,404 10,650 33 12.7 The Year 2,946 4,765 2,881 10,592 10,583 34 12.1 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Food—Inspection of.—Inspector Wilkinson reports that during the year he has paid 716 visits to the 13 Slaughter Houses now on the register, including one Horse Slaughter House, and that he has ascertained that 9,625 animals were killed therein, namely, 552 oxen and cows, 40 calves, 5,428 sheep and lambs, 60 pigs and 3,545 horses for human consumption, practically the whole of which were exported. These were mostly of good quality and free from disease, but in 49 cases meat and organs found to be diseased were destroyed (vide table on page 62), 57 [1926 Our Food Inspector found tins of Prunes and Loganberries being offered for sale within the Borough which were blown, and on the vendor being remonstrated with, he demurred rather to his being found fault with. On investigation it transpired that these tins came from outside the Borough, and according to the vendor no fault was being found elsewhere. In addition to submitting the tins to the Ministry of Health, the matter was taken up with the Medical Officers of Health of the City of London, Hackney, Bermondsey and Southwark. The results of the investigation in the matter has been dealt with by Dr. Howarth, of the City of London, in his Annual Report. The conclusion arrived at is that loganberries, unless very particular and special treatment and care are taken in the manner of preserving, naturally give rise to gas formation ; on the other hand, similar gas formation may result from real decomposition due to contamination. It is impossible to tell by mere superficial examination that a blown tin is due to either one or the other cause, therefore it is not wise to risk using blown tins of loganberries. While the gas formation may be natural, it might also possibly be due to some noxious cause. The real remedy is for the manufacturers to take the special care necessary and produce tinned loganberries which will not blow out the tins. 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 7 18* Diseased or unsound meat, etc., from shops and factories — 17 1 23 Fish — 12 3 6 Tinned foods 7 Fruit and Vegetables, 3 9 3 22 Total 5 7 1 20 * Of this quantity 68 lbs. was Tuberculous. The total amount of unsound or diseased meat, fish, fruit, and other food destroyed was 5 tons 7 cwts. 1 qr. 20 lbs. The diseases which affected animal food are set out in detail on page 62 Shops, etc., Inspection of.—The 701 shops and places where foodstuffs are sold may be approximated for the year as follows:— Butchers, provision dealers, etc., shops, 250; meat, provisions, rabbits, tinned foods, etc., stalls, 28; food preparation establishments, 15; fish shops, 106; fish stalls, 12; fruit shops, 210; and about 80 fruit, etc., stalls and barrows. To these 18,397 visits were paid, apportioned as follows :— Butchers, Provision Dealers, etc., Shops 8,365 visits Food Preparation Establishments 129 ,, Butcher, Provision, etc., Stalls 1,976 ,, Fish Shops 1,462 ,, Fish Stalls 822 „ Fruit Shops 2,838 ,, Fruit Stalls 6,676 ,, Total 22,268 ,, 58 1926J Meat in a Bedroom.—A summons was taken for depositing for the purpose of sale a quantity of meat in a room used as a sleeping place. Upon inspection of the building (where there were no shop premises), in the front room on the first floor there was a double bed on the floor which was covered with linoleum, there were two packages of meat, one containing three quarters of a hundred-weight, and another a quarter of a hundred-weight of beef. It was cut up into joints —altogether there were about 20 pieces. It was stated on behalf of the Public Health Committee that, according to the evidence, the quantity of meat was in excess of what was reasonable for the consumption of the family, which consisted of the defendant, his wife and son. The defendant stated that a few neighbours asked him to get some meat which he could buy cheaper in the Central Meat Markets, where he worked for a wholesale firm, than they could get it at a local butchers'. He cut it up, and wrapped the joints in an inner cover of white paper and an outer one of brown. In answer to the Magistrate the defendant stated that he usually delivered the meat on his way home from the market. In convicting, the Magistrate stated that it was wrong to keep meat which was intended for the people's food in a bedroom. The excuse of the defendant could not be admitted; it was not a new Act; it was clear that the meat was kept for sale, and the customers paid for it. A fine of 20s. and 20s. costs were imposed. Restaurant Kitchens.—'The work of inspecting restaurant kitchens is tabulated under Workshops. This work is done by the two women inspectors. As will be seen, a very considerable proportion is each year found to be unsatisfactory, proving the great necessity there is for these inspections. It is ulnfortunate in the interests of public health that there is no compulsory registration of these premises. This is the more apparent when it is considered that quite a good proportion are small coffee bars erected in a space behind hoardings and odd corners, whilst some are portable, and capable of being moved from place to place. It is found on the inspection of this class of " kitchen " that strict cleanliness is apt to be neglected owing to the fact that there is no drainage provided, and very frequently no independent water supply. The condition of these places is of very considerable importance, as quite a large trade is done. Should unsatisfactory conditions exist (and it is well known that lack of cleanliness in the preparation and storage of food is of primary importance, as neglect in this may lead to food poisoning), the lack of registration does not help investigation, as many of these temporary movable " kitchens " may have moved on before they can be discovered. In fact, there is no doubt a considerable proportion escape inspection, as it is only by very thoroughly examining each particular district and taking notes that they are located. It has been found that proprietors of some of the very small " provision " shops, and especially those that have a general mixed' trade in poor localities, plead ignorance of the Public Health (Meat) Regulations, 1924, and when questioned, it is discovered that they have no proper portable boiler for boiling hams, etc. ; further questioning may elicit the fact that the ham is boiled in the same copper that is used for the family washing. This, of course, is contrary to the regulations. Needless to say, when attention is drawn to such matters they are remedied. The same remarks apply to this class of trader as the other, one has to discover that they cook provisions; the information is not volunteered; there is no registration. 59 (1926 The following is a tabulated statement of the premises examined, and the results. In each case the unsatisfactory conditions were remedied without having to resort to prosecution. Number Inspected. Number found Unsatisfactory. Hotel and Restaurant Kitchens 54 12 Coffee and Dining Rooms 216 68 Refreshment Rooms 87 31 Provision (Cooked Meats, cooked but not consumed on premises) 110 28 467 139 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. As there was very considerable laxity on the part of some traders in regard to these Regulations, action had to be taken for their enforcement. These prosecutions were taken not in any harsh spirit, but owing to complaints received, some tradesmen complaining that while they were strict in carrying out the regulations, their neighbours acted unfairly in exposing meat and bringing their wares into perhaps closer view of the public. One wet and slushy afternoon, a visit was paid to a busy street to see if precautions were being taken by the tradesmen. Stopping at a shop which had meat exposed beyond the shop front, it was found that the gutter had been swept. There were two large heaps of mud fairly high at each side. The fast traffic passing through this mud splashed it right across the pavement so that the mud was deposited on the meat exposed. To the enquiry of the Medical Officer of Health as to what the trader was doing with regard to the regulations to protect his meat, the shop assistant replied, " Oh, I am sweeping away the mud in front of the shop." Passing on to another shop, a similar question was asked as to what precautions were being taken. The reply was—" I am most careful in wiping the meat when it gets splashed'." This reply was all oblivious of the fact that it is impossible to really wipe a piece of meat clean in this manner. The regulations are to prevent contamination. While this was the attitude of some tradesmen, there were marked contrasts. There was no lack of wishing to discuss the matter with the department, and I am glad to say that some really caught the spirit of the regulations. It is an expensive matter putting in a glass front, but in a case where this was done, enquiry of one of the assistants as to whether the business had been damaged by having to take the exposed meat indoors elicited the reply, " On the contrary, our business has doubled." It was the peculiar and almost defiant attitude of the first category mentioned that made it necessary to take cases to Court. As the regulations were comparatively new, and these were the first legal actions, large penalties were not expected. Fifteen prosecutions were taken; in one a penalty of £2 2s. Od. was obtained with two guineas costs; four cases were withdrawn on payment of costs, and 7 others were withdrawn, four of these last being alterative summonses. Three cases were dismissed. 1926] 60 A section of the traders, through their Associations, sent a deputation to the Public Health Committee to express their views. After hearing the deputation and considering what they had put forward, the Committee decided that, (a) while they appreciated the suggestions which had been made to them by the deputation, after carefully considering the same, the Committee were of opinion that they had no alternative but to administer the Public Health (Meat) Regulations, 1924, and that they would inform the deputations from the Associations accordingly ; (b) that enquiry would be made as to how the regulations were being administered in some of the other Boroughs; (c) that the Cleansing Committee of the Islington Borough Council would be asked to consider what steps could be taken to prevent the blowing of dust from the roads (this being one of the points raised by the Deputation), and (d) that the Medical Officer of Health be authorised to continut to take proceedings for infringements of the regulations. From the observations of my department, I believe that the firm attitude taken by the Public Health Committee in counteracting the growing laxity which was at that time prevalent has fully justified itself, and that there is a decidedly more earnest desire on the part of tradesmen to fulfil the spirit of the regulations. SALE OF FOOD ORDER.—THE LABELLING OF EGGS. The Order, which is a remnant of " Dora," has been renewed each year by the Expiring Laws Acts. Its administration falls upon the Public Health Department. The Order provides regarding eggs that " A person shall not sell or offer or expose for sale, whether by wholesale or retail, as fresh eggs or new laid eggs, or under any description of which the words " fresh " or "new laid " form part, any eggs which have been imported into the United' Kingdom unless the description also includes the word " imported " or word or words disclosing the country of origin. It will be noted that it is no offence under this Order to label foreign eggs simply " English," omitting the words " fresh " or " new laid," and we have known this to be done. The provisions are by no means easy to administer owing to the difficulty of proof, and it would appear as if this Order, as far as it relates to eggs, has been found to be unworkable by most authorities. I say this with all due respect to those who have made some effort in endeavouring to have foreign eggs correctly labelled in their areas. As far as one can judge from cases reported' in the public Press, prosecutions regarding eggs under this Order are very few. A table is appended giving a summary of the egg prosecutions taken in the Borough of Islington from 1922 to the end of the year under review. It will be noted that 69 cases were taken, in 49 of which fines or fines and costs were obtained ; another 17 resulted in costs alone being obtained. In addition there were three cases, two of which were dismissed, and one dismissed but costs allowed. As regards the fines and costs, the fines in the cases to date amounted to "£.100 4s. Od.; the costs awarded £62 3s. 6d., and total fines and cost £162 7s. 6d. Some interesting points have come out through the proceedings taken. Three of the cases were against wholesale dealers, as we refrained from taking action against the retailer who had been misled in his purchases. In another case a purchase was made of eggs which were unticketed, but the Inspector distinctly asked for " new laid eggs," and no mention was made of the fact that the eggs 61 [1926 were imported. The defendant's manager and assistant, both at the time and in Court, maintained that no offence had been committed, as no written label had been used. With the remark that the defendant had been too clever, the Magistrate convicted. In other cases, the word "imported" has been written on the back of the label, or else in small letters at the foot so as to be concealed by the eggs. In Islington this work, with the exception of two prosecutions, has been undertaken with other duties by one Inspector only. In addition to these prosecutions there have been innumerable verbal warnings, and a great many letters written to offenders. It has been found that when a new tradesman moves into Islington, until he is warned, he adopts the slack methods bordering on, if not actually wilfully deceptive which he has utilised, in the place he has come from, without check. We have thus forced upon us in Islington the practical futility of the provisions of this Order if they are not to be generally enforced on our borders. Proof is as I have stated, often a difficult matter, and has to be obtained by indirect means—e.g., the invoicing of the eggs to the retailer as imported, and the knowledge that these same imported eggs have been incorrectly described accordingly to the provisions of the Order. Undoubtedly, not only are eggs misdescribed, but frequently foreign and home eggs are mixed. The difficulty surrounding identification of the foreign egg could be overcome if each foreign egg were required to be marked, before importation, in some simple manner. This would prevent deception, or, at least, provide the means of identification if wrongly labelled, or if mixed with home produce. When one considers the number of warnings that have been issued in Islington and the number of successful prosecutions, one cannot conceive that the tradesmen in other places are more particular in carrying out the provisions of the Order. The effective remedy would appear to be, as I have said, an efficient but simple system of marking before importation. This would be simpler than the method' of distinguishing home produce by marking which was advocated in a letter to "The Times," of February 8th, 1926, from a Sussex writer. During the year 1926 four summonses were taken in respect of eggs improperly labelled. Convictions were obtained in each case, and fines with cost amounting to £16 Os. Od., were imposed. TABLE SUMMARISING RESULTS OF PROSECUTIONS IN REGARD TO EGGS UNDER THE SALE OF FOOD ORDER, 1921. Year. Fines. Costs. Total Fines and Costs. £ s. d. £ s. d. £ s. d. 1922 2 cases dismissed. 1923 17 4 0 13 17 6 31 1 6 1924 35 19 0 17 0 6 52 19 6 1926 35 11 0 26 15 6 62 6 6 1926 11 10 0 4 10 0 16 0 0 100 4 0 62 3 6 162 7 6 62 19261 SUMMARY of results of egg cases. Year. Fined, or fined and costs awarded. Costs only awarded. Dismissed. Total. 1922 — — 2 2 1923 15 6 — 21 1924 12 6 — 18 1925 18 5 1 24 1926 4 — — 4 49 17 3 69 Cowsheds.—The 4 cowsheds within the Borough received 25 visits, and were found generally satisfactory. Offensive Trades include 4 tripe dressers, 2 gut scrapers, 1 fat melter and gut scraper; and the knackers' yard which received a total of 52 visits. The inspector reports that he found no cause for complaint in the conduct of the business carried on in them. Tabulation of meat and organs diseased as found in slaughter-houses during the year 1926:— No. of Cases. Description of Animal Affected. Nature of Disease. Extent of Disease. How disposed of. 1 Ox Tuberculosis Head, tongue and lungs Council's Destructor. 1 Ox Tuberculosis (incipient stage) Lungs and costal pleura ,, ,, 1 Lamb Moribund Carcase and organs ,, ,, 1 Sheep Adipose tissue.primary external violence Flank and diaphragm ,, ,, 2 Oxen Decomposition Tripes not duly collected ,, ,, 36 Oxen Parasitic (Dis. Hep.) Liver ,, ,, 1 Ox Parasitic (Dis. Hep.) Liver and lungs ,, ,, 6 Heifer Abscess (simple, or multiple) Liver ,, ,, Milkshops and Dairies.—At the close of the year there were 496 milkshops and dairies on the register, 15 having been added to it, while 87 were removed. The District Sanitary Inspectors paid 792 visits to them, and served 6 notices for the carrying out of various sanitary improvements and the cleansing of dirty utensils. REPORT OF THE MEDICAL OFFICER OF HEALTH TO THE MINISTRY OF HEALTH UNDER THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 and 1917. During the past year (1926), samples of Milk, Cream and Preserved Cream have been obtained to ascertain the extent to which the provisions of the Regulations are being carried out by the vendors. 63 [1926 (1) Milk and Cream NOT Sold as Preserved Cream : Milk. Milk 586 Separated Milk Nil Total number of samples of milk examined for the presence of preservatives 586 Number in which preservative was found to be present Nil Cream. (2) Cream NOT Sold as Preserved Cream Number of which preservative was found to be present Nil Cream Sold as Preserved Cream: (a) Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservative were correct— Correct statements made Nil Statements incorrect Nil (b) Determination of Milk Fat in cream sold as preserved cream— Above 35 per cent. Nil (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream have not been observed Nil (d) Particulars of each case in which the regulations have not been complied with, and action taken — Note.—A further 23 informal samples of cream were purchased, but not analysed. They had the orthodox preservatives label, or were pure cream. THE MILK AND DAIRIES (AMENDMENT) ACT, 1922; THE MILK (SPECIAL DESIGNATIONS) ORDER, 1922-23. During the year 1926, the following appications were made for licences under the provisions of the above Order to enable the persons to sell Specially Designated Milk:- LICENCES GRANTED UNDER MILK (SPECIAL DESIGNATIONS) ORDER, 1922-23. Designation. No. of applications. Number granted. Amount of Fees received. 1926. 1926. £ s. d. " Certified " 3 3 0 15 0 " Grade A." (Tuberculin tested) 4 4 4 14 0 " Grade A." Nil — — " Pasteurized " (Dealer) Nil — — " Pasteurized " (Pasteurizer) 3 3 3 3 0 "Pasteurized" (Supplementary) 2 2 0 4 0 12 12 8 16 0 1926] 64 ADULTERATION OF FOOD AND DRUGS. During the year 1,244 samples of foods and drugs, including 13 informal samples, were submitted for analysis by Mr. Green, the Food and Drugs Inspector, who purchased the samples for submission to our Analyst, Mr. A. Pinchin, B.Sc. Of the total samples 1,198 were reported to be genuine and 46 adulterated, or 3.7 per cent. This percentage is 6.6 lower than in the previous year, and 4.1 per cent. below the average rate during the preceding 10 years. During the year 1926, in addition to the official samples taken and submitted to the Public Analyst, there was a total of 342 informal samples which were either submitted to the Public Analyst or examined by the Food and Drugs Inspector. These informal samples comprised about two dozen varied articles. As the result of these examinations, official samples were in many cases afterwards taken. The taking of informal samples is necessary to enable the purchase of samples to be concentrated on, such articles as are likely to be adulterated, and also to enable us to pick out the persons who are likely to be contravening the law; otherwise, if samples were only taken haphazard, a lot of analyses might be undertaken needlessly. When informal samples are taken the usual procedure to divide up the sample and leave a portion with the vendor is not gone through, and therefore the delinquent, if there be one, is not aware that he is being tested. Arsenic in Apples.—Early in the year our attention was kindly called by a firm in an adjacent Borough who possessed chemical experts, to the sale of apples at a particular shop in the Borough of Islington. Upon analysis of an informal sample of apples purchased, the Analyst reported that arsenious oxide 1/70 grain per lb. was found, but this was confined to a small portion of the skin surrounding the stalk and calyx. In the bulk of the apple including the rest of the skin and core, arsenic could not be detected. An investigation was made to find out what shops were selling this particular kind of apple, and a warning ietter was also sent to these asking them to at once assure us that they were taking every possible means to eliminate arsenical apples from their stock, and in future that they would avoid any recurrence. adulteration. The greatest amount of detected adulteration occurred in the first quarter of the year, as shown by the figures given in the statement below, when it was 9.2 per cent. and contrasted with 2.5, 1.3 and 0.9 per cent., respectively, in the second, third and fourth quarters. Examined. Genuine. Adulterated. Per Cent. Formal Informal Formal Informal Formal Informal Adulterated 1st Quarter 368 3 326 3 33 Nil 92 2nd ,, 242 1 236 1 6 2.5 3rd „ 303 6 299 6 4 1.3 4th „ 328 3 325 3 3 0.9 The Year 1,231 13 1,185 13 46 Nil 3.7 Prosecutions—25 summonses were issued under the "Sale of Food and Drugs Acts," of which 24 were successfully prosecuted. Altogether penalties and costs to the amount of £60 16s. 6d. were obtained. Two prosecutions were also 65 [1926 taken under the "Milk and Dairies Amendment Act, 1922," resulting in convictions in each case with penalties and costs amounting to £3 3s. 14 other summonses were taken out under the "Milk and Cream Regulations, 1912 and 1917," seven of the defendants being convicted and fined £2 and ordered to pay £15 15s. costs. The other 7 summonses were withdrawn,. Informal Sampling.—The informal samples included 3 samples of Butter, 1 Honey with Comb, 3 Cheshire Cheese, 1 Chicken and ham Roll, 1 Chicken, Ham and Tongue Roll, 1 Puff Paste, 2 Apples and 1 Cherry Jam. None of these were adulterated. Milk.—The qualitative result 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 83 8.81 3.65 12.46 Milk purchased on week-days 409 8.78 3.63 12.41 Milk procured in transit at Finsbury Park Station 94 8.88 3.62 12.50 Official Standard 8.50 3.00 11.50 Sophistication of Milk.—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 83 81 2 2.4 On Week-days 409 397 12 2.9 At Railway Stations 94 87 7 7.4 (Fanners' Milks) 586 565 21 3.6 Giving the particulars of the Milks taken during each quarter of 1926 on Sundays, Week-days, and at the Railway Stations. 1926. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. Sundays. 1 Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. 1st Quarter 13 125 73 211 11 114 69 194 2 11 4 17 15.4 8.8 5.5 8.0 2nd ,, — 66 — 66 — 66 — 66 — — — — — — — — 3rd ,, 35 116 17 168 35 115 14 164 — 1 3 4 — 0.9 18.0 2.4 4th „ 35 102 4 141 35 102 4 141 — — — — — — — — The Year 83 409 94 586 81 397 87 565 2 12 7 21 2.4 2.9 7.4 3.6 The number of samples of milk purchased was 586, of which 565 were genuine and 21, or 3.6 per cent. were adulterated'. 66 1926] Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1926:— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. 1916 699 506 93 15.5 1917 592 526 66 11.1 1918 634 637 97 15.3 1919 638 579 59 9.2 1920 642 605 37 5.7 1921 644 605 39 6.0 1922 638 576 62 9.7 1923 676 644 32 4.7 1924 681 646 35 5.1 1925 684 652 32 4.7 Totals 10 yrs. 643 588 55 8.5 1926 586 665 21 3.6 Showing the analysis of 7,014 milks examined in Islington during the 10 years 1916-25 and 1926, 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 nonfatty solids. Per cent. of fat. No. of Samples Per cent. of nonfatty solids. Per cent. of fat. No. of Samples Per cent. of nonfatty solids. Per cent. of fat. 1916 160 8.60 3.53 319 8.66 3.43 120 8.83 3.63 1917 150 8.63 3.45 322 8.60 3.41 120 8.84 3.59 1918 136 8.39 3.60 377 8.44 3.53 121 8.61 3.65 1919 166 8.56 3.56 331 8.56 3.61 141 8.67 3.68 1920 162 8.71 3.42 338 8.76 3.52 142 8.86 3.66 1921 151 8.83 3.34 371 8.79 3.37 122 8.91 3.73 1922 120 8.78 3.39 356 8.76 3.34 162 8.75 3.60 1923 120 8.82 3.55 388 9.08 3.63 168 8.90 3.63 1924 120 8.74 3.42 399 8.78 3.48 162 8.87 3.65 1926 108 8.71 3.41 384 8.71 3.37 192 8.79 3.67 Total samples and average constituents (10 years) 1,393 8.68 3-47 3,685 8.70 3.47 1,450 8.80 3.65 1926 83 8.81 3.65 • 409 8.78 3.63 94 8.88 3.62 67 [1926 The Public Analyst, during the year reported on the genuineness of the articles examined as follows:— Showing the Samples of Foods and Drugs submittid to the Public Analyst during the Year 1926, Article. Number examined. Number adulterated. Formal Informal Private Total Formal Informal Private Total Milk (a) 586* — — 586 21 — — 21 Butter 340 3 — 343 6 — — 6 Dripping 1 — — 1 — — — — Crushed Linseed 12 — — 12 — — — — Honey (b) (e) 18 — — 18 — — — — Honey with Comb — 1 — 1 — — — — Pepper 45 — — 45 — — — — Arrowroot 17 — — 17 1 — — 1 Mustard 10 — — 10 — — — — Cocoa 26 — — 26 — — — — Ground Ginger 3 — — 3 — — — — Rice (c) 3 — — 3 — — — — Coffee 5 — — 5 — — — — Chicory 1 — — 1 — — — — Cayenne Pepper 2 — — 2 — — — — Lard 81 — — 81 1 — — 1 Lemonade Powder (d) 10 — — 10 — — — — Cheese 7 — — 7 — — — — Cheshire Cheese — 3 — 3 — — — — Butter on Bread 8 — — 8 3 — - 3 Custard Powder (e) 4 — — 4 — — — — Curry Powder (d) 3 — — 3 — — — — Sherbert (d) 2 — — 2 — — — — Strawberry Jam (e) 5 — — 5 — — — — Gelatine 1 — — 1 — — — — Raspberry Jam (e) 1 — — 1 — — — — Raspberry Powder (c) 1 — — 1 — — — — Mixed Cream (Confectionery) 1 — — 1 — — — — Full Cream Dried Milk 6 — — 6 — — — — Full Cream Condensed Milk 6 — — 6 — — — — (sweetened) Ground Almonds 3 — — 3 — — — — Preserved Ginger (b) 3 — — 3 — — — — Olive Oil 1 — — 1 — — — — Malt Extract 1 — — 1 — — — — Wiltshire Roll (b) 1 — — 1 — — — — Chicken and Ham Roll (b) 1 1 — 2 — — — — Chicken, Ham and Tongue 1 1 — 2 — — — — Roll (b) Whiskey 2 — — 2 2 — — 2 Brandy 1 — — 1 — — — Pufl Paste — 1 — 1 — — — — Apples — 2 — 2 — — — — Cherry Jam — 1 — 1 — — — — Margarine 12 — — 12 12 — — 12 Total samples 1,231 13 Nil 1,244 46 Nil Nil 46 = 3 7% (а) All milk samples free from Boric Acid and Formalin. (b) Free from preservatives. (c) Conformed to requirements with regard to extraneous mineral matter. (d) Free from lead or arsenic. (e) Conformed to suggested limits for arsenic and sulphate of lime. (f) Free from arsenic and preservatives. * Including 3 samples from Paddington Station under the Milk and Dairies (Consolidation) Act. 1926] 68 Milk Prosecutions. The summary of prosecutions showed that during the year 15 prosecutions were taken, of which number 14 were successful, and 1 was dismissed. Summary of Prosecutions during year 1926. Total Prosecutions. Successful. Dismissed. Withdrawn. Amount of Penalties and Costs Received. £ s. d. " Public Health (London) Act, 1891 " 17 11 — 6 46 15 0 " Sale of Food and Drugs Acts, 1875-99 " 23 22 1 — 56 12 6 " Margarine Act, 1887 " 2 2 — — 4 4 0 " Sale of Food Order, 1921 " 4 4 — — 16 0 0 " Milk & Cream Regulations, 1912-17 " 14 7 — 7 17 15 0 " Milk & Dairies Amendment Act, 1922 " 2 2 — — 3 3 0 '* Public Health Meat Regulations, 1924" 15 1 3 11 8 5 0 " L.C.C. General Powers Act, 1902 " 2 1 1 — 0 10 0 " L.C.C. By-Laws " — — — — Totals 79 50 5* 24 153 4 6 * 4 Dismissed on points of law and 1 upon the merits of case. PUBLIC HEALTH STAFF. The staff of the Medical Officer of Health is constituted as follows : Chief Sanitary Inspector and Superintendent.—George James Bridel, San it. Insp.Ex.Bd *Senior Sanitary Inspector. Inspector of Workshops and Bakehouses.— H. J. J. Watson. *Inspector of Meat, etc.—H. Wilkinson. *Inspector of Food and Drugs, etc.—G. S. Green. *Inspector of Houses Let in Lodging.—L. H. Pearson. *Sanitary Inspectors.—T. W. Agar, H. J. Bicknell, A. Bagshaw, S. P. Marks, E. I. Fortune, J. Metcalf, T. H. Hancock, C. E. Horsman, A. E. Wood, E. G. Holmes, W. G. Neale, †F. H. Chuter, H. H. Uren, C. W. Lewis, H. Dewhurst. *Inspectors of Workshops, etc., in which Females are Employed.—Eleanor H. Daniell, Mrs. S. Undery. *Health Visitors.—Mrs. A. Main, Miss V. A. Lainton, R. Palmer, L. Flower, E. Foot, E. Neale, N. W. Dudfield, E. O Oliver. *Tuberculosis Visiting Nurse.—Miss E. McGoldrick. Clerical Staff.—G. H. King (First Clerk), H. Angel, A. E. Abbott, W. J. Wolfe, W. G. Bunch, A. R. Wittrick, C. M. Wheble, A. E. Booker, W. R. Causton, *C. J. Cridland, L. W. Edis. Milk Grants.—*F. C. Green, *A. E. Vanstone, *Daisy Francis. Disinfecting Station.—A. Lewis (Engineer), W. G. Jollie (Handyman Stoker), Mrs. Home (Cleansing Station Attendant), Mrs. Lewis (Caretaker, Shelter House), G. Cooper (Motor Driver). Disinfectors.— F. Webb, J. Brown, W. Hardwick, W. Woodley, A. Taylor. Mortuary Keeper.—S. Maxwell. Those marked with an asterisk indicates contribution was expected either under the Public Health Acts or by Exchequer Grants, † Resigned. APPENDIX. Vital and Sanitary Statistics, 1926. together with the PRESCRIBED RETURN OF THE MINISTRY OF HEALTH. 1926] 70 STATISTICAL APPENDIX Showing Deaths from all Causes in Islington during the Year 1926. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. tutions 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. Small Pox — — — — — — — — — — — — — — — — — — — — — — — — (a) Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — (b) Unvaccinated — — — — — — — — — — — — — — — — — — — — — — — — — (c) No Statement — — — — — — — — — — — — — — — — — — — — — — — — — 32 Measles 20 42 7 — — — — — — — — — — 62 7 3 8 8 11 15 13 11 39 30 69 Scarlet Fever — 6 3 2 — — — 1 — — — — — 6 6 1 1 2 — 2 2 4 4 8 12 Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — — 6 Epidemic Influenza — — 1 — 1 1 4 8 6 12 8 7 3 — 51 6 5 3 9 8 9 11 27 24 51 6 Whooping Cough 11 17 1 — — — — — — — — — — 28 1 2 1 2 12 2 5 5 12 17 29 1 Diphtheria 3 16 11 1 — — — — — — — — — 19 12 2 2 5 5 5 4 8 18 13 31 Enteric Fever — — — 1 — — — — — — — — 1 — — — — — — 1 1 — 1 Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — Diarrhoea. Dysentery 7 — — — — — — — — — — — — 7 — — — — 1 1 2 3 4 3 7 10 Epidemic Enteritis 21 — — — — 1 — — — — — — — 21 1 — 1 — 3 5 9 4 12 10 22 2 Other Allied Diseases 7a 2 a 1a — — 1a — — — — — — — 9 2 — 1 2 1 — 2 5 6 5 11 Hydrophobia — — — — — — — — — — — — — — — — — — — — — — — — Glanders — — — — — — — — — — — — — — — — — — — — — — — — — Tetanus — — — — — — — — — — — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — — — — — — — — Cow Pox — — — — — — — — — — — — — — — — — — — — — — — — — 2 Syphilis 1 — — — — — — — — — — — — 1 1 — — — 1 2, — — — 1 — 2 — 2 1 3 Gonorrhoea — — — — — — — — — 1 — 1 — 2 1 — — — — 1 — 2 — 2 Phagedaena — — — — — — — — — — — — — — — — — — — — — — — — 5 Erysipelas 1 — — — — — — — 1 4 1 1 — 1 7 — — — — 3 2 3 1 7 8 4 Puet peral Fever — — — — — 3 2 6 — — — — — — 11 2 2 1 — 2 1 3 — 11 11 2 Pyaemia — 1 1 — — 1 2 1 2 — 1 — — 1 8 — — — 1 2 3 3 7 2 9 4 Infective Endocarditis — — — 1 1 1 3 1 6 2 1 — L — 17 1 — 4 1 4 3 4 G 11 17 Other Allied Diseases — — — — — — — — 1 — — 1 — — 2 1 — — — 1 — — 1 1 2 Malarial Fever — — — — — — — — — — — — — — — — — — — — — — — — — Rheumatic Fever — — — 2 — 1 — 1 — — — — — 4 1 — — — 2 1 — 4 — 4 Rheumatism of Heart — 1 2 6 — — 1 — 1 1 — — — 1 11 1 — — 2 2 2 5 4 8 12 8 Tuberculosis of Brain 6 16 2 3 1 4 — 1 — — — — — 22 11 2 2 2 3 6 3 15 22 11 33 Tuberculosis of Larynx — — — — — — — 1 — — — — —- — 1 — — — — — 1 — 1 — 1 90 Phthisis 1 2 1 5 12 33 G7 53 74 33 6 1 — 3 28ft 32 26 20 37 55 42 76 179 109 288 2 Abdominal Tuberculosis 1 — 1 1 2 1 — 1 2 2 1 — — 1 11 1 1 2 3 1 3 1 8 4 12 2 Genet at Tuberculosis — — 1 1 1 — — — — — — — — — 5 1 — 1 — — 2 1 5 — 5 5 Other forms Tuberculosis — 1 2 — 1 1 2 2 3 — — — — 1 11 1 1 2 3 1 3 1 8 4 12 Other Infective Diseases — — — — — — — — — — — — — — — — — — — — — — — —- — Thrush — — — — — — — — — — — — — — — — — — — — — — — — — Actinomycosis — — — 1 — — — — — — —— — — 1 1 — — — — — — 1 — 1 Hydatid Diseases — — — — — — — — — — — — — — — — — — — — — — — — Scurvy — — — — — — — — — — — — — — — — — — — — — — — — — Other Diseases due to Altered Food — — — — — — — — — — — — — — — — — — — — — — — — — Acute Alcoholism — — — — — — — — — — — — — — — — — — — — — — — — — Chronic Alcoholism — — — — — — — — — 1 1 — — — 2 — — — — 1 — 1 1 1 2 Chronic Industrial Poisonings — — — — — — — — — — — — — — — — — — — — — — — — — Other Chronic Poisonings — — — — — — — — — — — — — — — — — — — — — — — — — Osteo-arthritis — — — — — — — — 2 3 7 4 — — 16 2 1 1 — 2 2 8 — 16 16 Gout — — — — — — — — — — 2 — — — 2 — — — 1 1 — — 1 1 2 143 Cancer — — — — 1 2 6 27 73 142 144 51 7 — 453 46 43 38 60 84 71 111 200 253 453 2 Diabetes Mellitus — — — — — — 2 3 3 2 8 2 — — 20 2 5 2 1 2 3 6 10 10 20 Purpura Haemorrhagica 2 — — — — — — — — — — — — 2 — 1 — — — 1 — — 2 — 2 Haemophilia — — — — — — — — — — — — — — — — — — — — — — — — — Anaemia — 2 — — 1 — — 3 6 2 3 3 — 2 17 2 1 3 4 3 2 4 12 7 19 Lymphadenoma — — — 1 — — — 1 — — 1 — — — 3 — 1 — — 2 — — 2 1 3 Premature Birth 86 — — — — — — — — — — — — 86 — 11 4 12 9 12 20 18 48 38 86 Injury at Birth 3 — — — — — — — — — — — — — — — — — — — 1 1 2 1 3 Debility at Birth 3 — — — — — — — — — — — — 3 — — — — — — 3 — 1 2 3 Atelectasis 5 — — — — — — — — — — — — 5 — 3 1 — — — 1 — 3 2 5 Congenital Defects Want of Breast Milk 35 2 — — — — — — — — — — — 37 — 2 1 5 2 7 9 11 23 14 37 Atrophy, Debility, Marasmus 23 1 — — — — — 1 — — — — — 24 1 2 3 2 7 4 1 6 17 8 25 a Cerebro-Spinal Fever (11). 71 T1926 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. I.H. H. B. S.E. Dentition 1 — — — — — — — — — — — — 1 — — — — — — 1 — — 1 1 Rickets — 2 — — — — — — — — — — — 2 — — — — — — 2 — 2 — 2 Old Age, Senile Decay — — — — — — — — — 2 56 185 93 — 336 35 42 31 46 65 42 75 132 204 336 Convulsions 4 3 — — — — — — — — — — — 7 — — 1 1 1 2 2 — 5 2 7 Meningitis 10 1 1 — 1 — 2 — 1 1 — — — 11 6 3 1 2 2 2 4 3 9 8 17 Encephalitis — 1 1 1 — 1 1 — 1 2 — — — 1 7 — — 2 2 2 2 2 6 8 Apoplexy — — — — 1 — 2 4 11 32 41 46 10 — 147 16 19 17 16 25 25 29 57 90 147 Softening of Brain — — — — — — — — 2 3 — 2 — — 7 1 1 — — 1 1 3 3 4 7 Hemiplegia — — — — — — — — — 3 4 4 1 — 12 2 2 2 — 2 2 2 4 8 12 General Paralysis of Insane — — — — — 1 3 12 4 2 2 — — — 24 1 2 2 2 5 6 6 15 9 24 Other forms of Insanity — — — — — — 1 2 — 2 1 1 2 — 9 — 1 — 2 4 1 1 2 7 9 Chorea — — — — — — — — — — — — — — — — — — — — — — — — — Cerebral Tumour — — — 1 — — 2 2 2 1 1 — — — 9 1 — 1 2 1 2 2 3 6 9 Epilepsy — — — — 1 — 4 1 2. 3 1 — — — 12 1 1 1 1 4 1 3 10 2 12 Laryngismus Stridulus — — — — — — 1 — — — — — — — 1 — — 1 — — 1 — 1 Locomotor Ataxy — — — — — — — — 3 6 2 — — — 11 — 1 — 1 2 5 2 10 1 11 Paraplegia 1 — 2 — — — 3 2 2 4 7 3 1 1 24 1 1 3 3 6 3 8 11 14 25 Other Forms, Brain Diseases — 1 — 1 — — 2 3b 6 b 1 1 3b - 1 17 4 1 2 3 3 2 3 9 9 18 Otitis — — 2 3 — 1 4 1 2 1 — — — — 14 1 — 3 — 4 4 2 7 7 14 Disease of Nose, Epistaxis — — — — — — — — — — — — — — — — — — — — — — — — — 2 Disease of the Eye — 2 — — — — — — — — — — — 2 — 1 — — 1 — — — 1 1 2 1 Pericarditis Endocarditis — 1 — — — — — — — 2 — 1 — 1 3 — 2 — — 1 1 — 1 3 4 Eudocarditis — — 1 — — 2 2 — 2 1 2 1 — 11 — — — — 1 3 7 4 7 11 Hypertrophy of Heart — — — — — — — — — — — — — — — — — — — — — — — — — Angina Pectoris — — — — — — — — — 1 6 5 — — 12 3 — 2 — 6 1 — 7 5 12 2 Aneurism — — — — — — — 1 4 5 4 1 — — 15 2 — — 2 5 2 4 12 3 15 6 Senile Gangrene — — — — — — — — 2 1 6 6 1 — 16 4 3 — 1 3 4 1 7 9 16 51 Embolism, Thrombosis — — 1 — — 1 — — 7 23 30 18 3 — 83 7 10 4 16 18 13 15 44 39 83 1 Phlebitis — — — — — — — — 2 — — — — 2 — — — — 1 — 1 — 2 2 Varicose Veins — — — — — — — — — — — — — — — — — — — — — — — — — 170 Other Diseases, Heart and Vessels 4 2 — 6 5 3 20 29 62 121 214 154 39 6 653 57 74 81 72 114 89 172 302 357 659 2 Laryngitis — 1 — — — — — — — 2 — — — 3 1 — — 2 3 3 Croup — — — — — — — — — — — — — _ Other Diseases, Larnyx and Trachea — — — — — — — — — — — — — — — — — — — — — — — — — 9 Acute Bronchitis 9 6 — — — — 2 1 12 6 13 21 8 15 63 4 9 8 13 13 17 14 41 37 78 40 Chronic Bronchitis 7 1 1 1 — — — 5 17 34 59 52 11 8 180 9 16 16 26 23 54 44 94 94 188 16 Lobar Pneumonia 3 4 — 1 1 3 4 11 12 17 12 5 2 7 68 7 9 7 12 12 10 18 45 30 75 143 Lobular Pneumonia 77 57 2 1 1 3 3 10 18 31 46 30 5 134 150 17 29 37 48 27 60 6(5 145 139 284 6 Pneumonia 3 3 1 — — 1 — 1 — 6 6 2 2 6 19 — 2 5 4 7 3 4 11 14 25 1 Emphysema Asthma — — — — — ~~~ — 4 3 5 5 4 — — 21 3 4 1 3 1 5 4 13 11 21 5 Pleurisy 1 — — — 2 2 1 1 3 5 — — 1 14 1 3 — 4 1 3 3 11 4 15 6 Other Diseases, Respiratory System 1 2 — — — — 1 1 4 5 3 2 1 3 17 4 4 2 1 2 3 4 12 8 20 Diseases of Mouth and Anen.xa — 1 — 1 — 1 — — — 1 2 — — 1 5 2 — — — 1 — 3 2 4 6 Diseases of Pharynx — — — — — — — — — — — — — — 1 1 — — — — — — 1 — 1 Diseases of (Esophagus — — — — — — — — — — — — — — — — — — — — — — 1 — 1 Ulcer of Stomach and Duodenum 1 — — — — — 2 12 10 12 4 1 — 1 41 4 3 3 — 7 16 9 32 10 42 Other Diseases of the Stomach 4 1 — — — — 1 — _ 2 2 1 5 6 2 1 5 3 c 5 11 19 Enteritis 45 1 1 — — — — 1 1 — 3 1 — 46 7 4 4 4 9 5 16 11 32 21 53 4 Appendicitis — 1 1 1 — 2 1 2 2 2 2 2 — 1 15 — 4 3 3 2 4 10 16 Obstruction of Intestines 5 1 — — — 1 2 4 4 4 12 8 1 6 36 3 4 7 4 10 6 8 19 23 42 Other Diseases of Intestines 1 — — — 1 — 1 — 1 — 2 2 — 1 7 1 — 1 — 2 2 2 2 6 8 4 Cirrhosis of Liver — — — — 1 — 1 4 8 6 4 1 — — 25 2 6 2 5 4 1 5 16 9 25 Other Diseases if Liver — — 1 — — — — 1 2 1 2 1 — — 8 1 — — — 1 3 2 6 8 Peritonitis — — 1 1 l — 2 — — 1 1 — — — 7 — 1 2 — 2 1 1 3 4 7 Other Diseases, Digestive System — — — — — — — — — — — — — — — — — — — — 1 1 1 1 2 Diseases, Lymphatic System and Glands — 2 — — — 2 1 1 6 1 5 1 2 17 4 2 3 o 3 1 4 7 12 19 20 Acute Nephritis — — — — — — — — — — — 1 — — 1 — — — — 1 1 1 Bright's Disease — — — — — 3 — 5 12 23 21 10 4 — 78 10 7 9 9 14 12 17 38 40 78 Calculus — — — — — — — 2 2 5 1 1 — — 11 1 — 1 2 2 5 2 9 11 Diseases of Bladder and Prostate — — — — — — — 1 — 4 11 20 3 — 39 3 4 3 5 10 b 11 35 4 39 Other Diseases, Urinary System — — — — — — — 1 2 5 1 3 1 — 13 — — 1 3 3 2 4 5 8 13 Diseases of Testis and Penis — — — — — — — — — — — — — — — — — — — — — — — — — Diseases of Ovaries — — — — — — — — — — — — — — — — — — — — — — — 1 1 Diseases of Uterus and Appendages — — — — — — — — — — — — — — — — — — — 1 — 1 — 2 2 Diseases of Vagina and External Genitals — — — — — — — — — — — — — — — — — — — — — — — — — Diseases of Breast — — — — — — — — — — — — — — — — — — — — — — — — — Abortion. Miscarriage — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Mania — — — — — — — — — — — — — — — — — — — — — — — — 1 Puerperal Convulsions — — — — — 2 2 — — — — — — — 4 1 — — 1 1 — 1 — 4 4 1 Placenta Previa, Flooding — — — — — — 2 4 — — — — — — 6 1 — — 1 1 1 2 — 6 6 b Encephalitis Lethargica (9). 72 1926] 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 Thrombosis — — — — — — 1 — — — — — — — — — — — — — — — — 1 2 Other Diseases, Pregnancy and Childbirth — — — — — 1 2 2 — — — — — — 5 1 2 — — 1 — 1 — 5 5 Arthritis, Ostitis, Peri- — — — — — — — — — — — — — — — — — — — — — — — — — Other Diseases, Osseous System — — 2 1 1 — — 2 1 3 1 — — — 11 1 1 2 3 2 2 — 9 2 11 Ulcer, Bedsore — — — — — — — — — — — — — — — — — — — — — — — — — Eczema — — — — — — — — — — — — — — — — — — — — — — — — — Pemphigus — — — — — — — — — — — — — — — — — — — — — — — — — Other Diseases, Integumentary System 3 1 — — — — — — — 2 — — — 4 2 — — 2 — 3 1 — 4 2 6 Accidents and Negligence. In Mines and Quarries — — — — — — — — — — — — — — — — — — — — — — — — — 16 In Vehicular Traffic — 4 4 — 3 3 4 9 6 8 6 4 1 4 48 8 8 1 9 10 6 10 39 13 52 On Railways — — 1 — — — 1 1 — 1 — — — — 4 — — — — 2 1 — 4 — 4 On Ships, Boats, etc. — — — — — — — — — — — — — — — — — — — — — — — — — In Building Operation — — — — — — — — 2 1 1 — — — 4 — — — 1 — 1 2 4 — 4 1 By Machinery — — — — 1 — — — 1 — — — — — 2 — — — 1 1 — — 2 — 2 1 By Weapons and plements — — — — — 1 — — 1 — — — — — 2 — — — 1 — — 1 1 1 2 3 Burns and ouarries 2 4 — — 1 — — — — — 3 — — 6 4 1 2 1 1 2 2 1 2 8 10 Poisons, Poisonous — — — — — — — — — 1 — — — — 1 1 — — — — — — — 1 1 surgical Narcosis 1 — — — — — — — — 1 — 1 — 1 2 — — — — 1 — 2 2 1 3 Effects of Electric shock — — — — — — — — — — — — — — 1 — — — — — 1 — 1 — 1 Corresiens by chemicals — — — — — — — — — — — — — — — — — — — — — — — — — Drowning — 1 — — 1 — — 1 1 — 1 — — 1 4 — — — 2 1 1 1 5 — 5 Suffocation, Overlaid in Bed 3 — — — — — — — — — — — — 3 — — ___ 1 — 1 1 — 2 1 3 Suffocation otherwise 5 — — — — — — — — — — — — — — 1 — — 1 1 — 2 3 2 5 Falls not specified — — — — 2 — — 2 2 1 9 9 6 — 31 4 3 — 4 5 3 10 13 18 31 Wheather Agencies — — — — —— — — — — — — — — -— — — — — — — — — — — — Otherwise, not stated — — —. — 1 — 1 — — — — — — 2 — 1 — — — 1 — 2 — 2 Homicide suicide 2 — 1 — — — — — — — — — — 2 1 — — 1 — 2 2 1 3 By Poison — — — — 1 1 1 10 6 4 3 1 — — 27 5 1 — 4 8 4 5 18 9 27 By Asphyxia — — — — — — — — — — — — — — — — — — — — — — — — — By Hanging and Stran- gulation — — — — — — — — — 1 2 — 1 — 4 — — 1 1 2 — — 3 1 4 by drowing — — — — — — — — 1 1 1 — — — 3 — — — 2 — — 1 — 3 3 By shooting — — — — — — — — — 1 1 — — — 2 — — — — — — — — 2 By cut or stab — — — — — — — — 1 2 1 — — — 4 2 — 1 — 1 — — 4 — 4 1 By Precipitation from Elevated Places — — — — — — — — — — 1 — — — — — — — — — 1 1 — 1 By Crushing — — — — — — — — — — — — — — 1 — 1 — — — — 1 1 — 1 By other and fied methods — —— — — — — — — — — — — — — — — — — — — — — — — — Execution — — — — — — — — — — — — — — — — — — — — — — — — — Sudden Death, cause not ascertained — — — — — — — — — — — — — — — — — — — — — — — — — Ill-defined and unspecified causes — — — — — — — — — — — 1 — — 1 — — — 1 — — — 1 — 1 Males 248 125 31 20 31 49 84 154 248 338 401 279 57 373 1692 196 210 196 279 32 7 374 483 — — 2065 Females 179 89 27 24 16 36 90 119 182 290 414 407 152 268 1757 184 193 203 252 383 330 480 — — 2025 883 TOTAL DEATHS 427 214 58 44 47 85 174 273 430 628 815 686 209 641 3449 380 403 399 531 710 704 963 2065 2025 4090 73 [1926 Metropolitan Borough of Islington. CAUSES OF, AND AGES AT DEATH DURING THE CALENDAR YEAR 1926. Causes of Death. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without 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 Total Deaths whether of "Residents" or " Non- Residents" in Institutions in the District 1 2 3 4 5 6 7 8 9 10 11 All Causes Certified 4063 427 113 101 95 127 439 1056 1705 1592 Uncertified Nil — — — — — — — — Nil Enteric Fever 1 — — — — 1 — — — 1 Small Pox — — — — — — — — — — Measles 69 20 24 18 7 — — — — 49 Scarlet Fever 12 — 2 4 5 — 1 — — 2 Whooping Cough 31 12 10 8 1 — — — — 7 Diphtheria and Croup 31 3 3 13 12 — — — — 5 Influenza 51 — — — I 2 12 18 18 16 Erysipelas 8 1 — — — — — 5 2 6 Phthisis (Pulmonary Tuberculosis) 280 1 1 1 3 44 116 107 7 188 Tuberculous Meningitis 32 6 7 9 5 4 I — — 10 Other Tuberculous Diseases 26 1 — 1 4 8 4 7 1 10 Cancer, malignant disease 454 — — 3 34 215 202 234 Rheumatic Fever 4 — — 1 2 — 1 — — — Meningitis (a) 27 17 2 1 1 2 2 2 — 4 Organic Heart Disease 717 2 1 1 10 t 9 57 207 430 323 Bronchitis 272 16 5 2 2 — 9 71 167 113 Pneumonia (all forms) 383 83 41 24 5 8 30 89 103 207 Other diseases of respiratory organs 57 1 2 1 2 9 21 21 20 Diarrhoea and Enteritis 79 71 1 — 1 1 — 2 3 37 Appendicitis and Typhlitis 15 — — 1 2 2 3 4 3 10 Cirrhosis of Liver 25 — — — — 1 5 14 5 11 Alcoholism 2 — — — — — — 1 1 — Nephritis and Bright's Disease 76 — — — — 2 5 33 36 42 Puerperal Fever 11 — — — — 3 8 — — 5 Other accidents and diseases of Pregnancy and Parturition 18 — — — — 3 15 — — 6 Congenital Debility and Malformation, including Premature Birth 151 148 3 — — — — — 25 Violent Deaths, excluding Suicide 123 13 3 5 5 12 19 26 40 67 Suicide 40 — — — 2 12 16 10 11 Other Defined Diseases 1067 33 9 10 28 18 *96 •218 655 183 Diseases Ill-defined or unknown 1 — — — — — — — 1 — Totals 4063 427 113 101 95 127 439 1056 1705 1592 Sub-Entries.—Included in above figures : a)Cerebro-spinal Meningitis 11 7 2 — 1 1 1 — — — Poliomyelitis 1 — — — — — A- — — — Encephalitis Lethargica 3 — — — — — — *3 — — 74 1926] LONDON COUNTY COUNCIL RETURN. Borough of Islington. PROCEEDINGS DURING 1926. Premises. Number of Places. Number of Inspections 1926 Number of Notices 1926 Number of Prosecutions 1926 On Register at end of 1925 Added in 1926 Removed in 1926 On Register at end of 1926 Milk Premises 568 15 87 496 792 6 Nil Cowsheds 4 — — 4 25 Nil ,, Slaughter-Houses 13 — — 13 716 ,, ,, Other Offensive Trade ,, Premises 17 2 — 19 60 ,,. ,, Ice Cream Premises 238 — — 238 136 ,, ,, Registered Houses Let in Lodgings 1,011 - — 1,011 3,480 450 ,, * Including the Knacker's Yard, 8 Fur Skin Dressers and 1 Fat Melter. Housing of the Working ClassesNumber of houses inspected— (a) On account of complaints or illness (P.H. Act) 8,702 (b) House-to-house (Housing Consolidated Regulations, 1925) ... 1,897 Number of notices served— (a) Under P.H. Act:— (i) Intimation 4,797 (ii) Statutory 581 b) Under Housing Act 1 Number of houses repaired or nuisances remedied under P.H. Act 4,797 Number of houses repaired under Section 3 of Housing Act— (a) By owners Nil (b) By L.A. in default of owners Nil Number of houses closed on notice by owner that they could not be made fit 1 Number of houses for the working classes— (a) Erected during year 409 (A) In course of erection 24 Number of representations by Medical Officer or other person Nil Number of houses included in such representations Nil Number of Closing Orders made Nil Number of Closing Orders determined (i.e. Houses made fit) Nil Number of Demolition Orders Nil Number of houses demolished— (а) In pursuance of Orders Nil (b) Voluntarily*19 Total number of houses in the Borough about 45,000 Number of houses occupied by the working classes about 28,500 • Including 7 houses in Borough Council Housing Scheme, and 12 houses in Brand Street Area Improvement Scheme (L.C.C.). 75 [1926 Underground Rooms— Number illegally occupied 10 Number closed or illegal occupation discontinued 10 Overcrowding— Number of cases of overcrowding found 26 Number remedied 26 Number of prosecutions Nil Smoke nuisances— Number of observations 121 Number of complaints 52 Number of notices 2 Number of summonses Nil Cleansing and Disinfection— Number of adults cleansed 6 Number of children cleansed 4,634 Number of premises cleansed:— (a) After infectious diseases 3,442 (b) For vermin 91 Water supply to tenement houses— Number of premises supplied 57 Number of prosecutions Nil Sanitary officers— Chief Sanitary Inspector (Whole time) 1 Number of Sanitary Inspectors (Whole time) Male, 19 Female 2 „ ,, (Part time) Male, Nil Female Nil Number of Health Visitors (Whole Time) 9 „ „ (Part time) Nil Tuberculosis Visiting Nurse(Whole time) 1 76 [I926 INDEX Page Accidental Deaths 19, 24 Acreage 2 Adulteration of Food 62-68 Ages at Death 6 Area 2 Arsenic in Apples 64 Bacteriological Examinations 40 Births 3 „ Illegitimate 4 „ Notification of 4 „ Stillborn 4 Cancer 21 Chicken Pox 40 Cleansing of Verminous School Children 44 Coal gas Poisoning 24 Consumption (see Tuberculosis) 22 Cow Sheds 62 Deaths from all causes during the year 5,70 Deaths from Epidemic Diseases 19 „ „ Respiratory Diseases 23 „ in Public Institutions 18 „ from Classified Causes 6 Density 2 Diphtheria19, 28,41 Diseases Treated in Hospital 29, 30 Disinfectants distributed and 43 Disinfecting Station 42 Disinfection Work 42, 43 Disinfestation of School Children 44 District Inspectors' Work 47-60 Drugs 67 Dust Nuisance 49 Dust, removal of 49 Dysentery 33 Education Propaganda 9-10 Eggs, labelling of 60-62 Encephalitis Lethargica 33 Enteric Fever (Typhoid) 19, 20, 28 Epidemic Diseases 19, 25 „ Cerebro-Spinal Meningitis 32 Erysipelas 21, 28 Factories and Workshops Administration 44-47 Fatality from Notifiable Infectious Diseases 28 Food, Adulteration of. Inspection of. Unsound 56-67 Food Order 60 Gas (Coal) Poisoning 24 [1926 77 Page Health Visitors (Municipal) 11-16 Health and Baby Week 9, 16, 17 Home Visitations—Tuberculosis 38, 39 Hospital Isolation of Infectious Diseases 29, 30 Housing 53-55 Houses Let in Lodgings 51, 52 Infantile Mortality 7, 8 Infant Welfare Work 11 Infection, Prevention of 25 Infectious Diseases in Schools 10 „ „ (Non-Notifiable) in Schools 40 Influenza21 Inspection of Food 56 „ „ Houses 50,54 „ „ Kitchens of Restaurants 44,56 „ „ Slaughter Houses and Cow Houses 56, 62 „ „ Workshops 44-47 Institutions 18 Increase of Rent (Restrictions) Acts 56 Inquests 25 Isolation of Infectious Diseases 30 Kitchens and Restaurants 44, 56 Light Treatment—Artificial Sunlight and "Finsen" 16, 37 London County Council Return of Sanitary Work 74, 75 Malaria 33 Malignant Diseases 21 Marriages 3 Maternity and Child Welfare Committee 11 Maternity and Child Welfare Work 11 Measles, Notifications by School Teachers 40 Meat Inspection 56 Meat Regulations, 1924 59 Meat, labelling of 57 Meat in Bedroom 56 Ministry of Health Returns 8,54,73 Milk Scheme 13 „ Adulteration 65 „ Shops and Dairies 62, 74 „ and Cream Regulations 62 „ Special Designations Order—Licences 63 Mortuary and Coroner's Court 25 Notification of Infectious Diseases 25,, „ Tuberculosis 33 ,, „ Births Act 4 Non-notifiable Infectious Diseases in Schools 40 Offensive Trades 62 Ophthalmia Neonatorum IX Outworkers' Premises 46 Other Notifiable Diseases 32 Pauperism 56 Pathogenicity Tests (Diphtheria) 41 Pemphigus Neonatorum 13 Phthisis 22, 23, 34 „ Notification of 34 Places where Food is Prepared 56 Pneumonia 24, 33 Pneumothorax treatment 37 78 [1926 Page Population at the Census, 1921 2 „ estimated, 1926 2 Preservatives 67 Prevention of Infection 26 Prosecutions, Summary of 68 Public Health Committee ii „ „ Milk and Cream Regulations 62 „ „ Meat Regulations 1924 69 „ Staff 68 „ „ (Tuberculosis) Regulations 1924 35 Puerperal Diseases 12, 21 „ Pyrexia 12 Polio-Myelitis, Acute 32 Pulmonary Tuberculosis 22 Rats and Mice (Destruction) Act, 1919 52 Rateable Value iii Rent and Mortgage Interest (Restrictions) Acts 56 Respiratory Diseases 23 „ Tuberculosis 22, 23, 34 Restaurant Kitchens 44, 5 6 Sale of food Order—Labelling of Eggs 60 Samples Analysed in 1926 67 Sanitary Inspectors' Work 47-50 Schools 40 Secondary Infections 29 Septic Diseases 21 Shelter House 43 Slaughterhouses 56 Small Pox 26, 27 Smoke Nuisances 48 Sophistication of Milk 65 Special work during period of General Strike 48 Statistics 70 Street Accidents 24 Tuberculous Diseases 33-35 Tuberculosis Dispensaries 37 „ Notification of 33 „ Deaths from 22 „ (Public Health) Regulations, 1912 36 „ Visiting Nurse 38, 39 Typhoid Fever (see Enteric) 19, 20, 28 Unsound Food 57 Vaccination 41, 42 Venereal Diseases 21 Verminous Children, Disinfestation of 11 „ Premises 18 Voluntary Maternity and Child Welfare Centres 16, 17, 18 Workshops and Factories, Inspection of 11-17 Welfare Work by Health Visitors 11,12, 11,15