M AC4361 ISL103 1934 SEVENTY.NINTH 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. Chief Executive. Tuberculosis Officer; Chief Executive Officer under the Maternity and Child Welfare Act. London: Vail & Co., Ltd., Printers, 170. Farringdon Road, E.C.1. 1934 SEVENTY.NINTH 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. Chief Executive Tuberculosis Officer; Chief Executive Officer under the Maternity and Child Welfare Act. London: Vail & Co., Ltd., Printers, 170, Farringdon Road, E.C. 1. ii MEMBERS OF THE PUBLIC HEALTH COMMITTRE. (November, 1934, to November, 1935) Mayor. Councillor HENRY GEORGE COLEMAN, J.P. Deputy Mayor. Alderman DUNCAN McARTHUR JACKSON, J.P. Aldermen. HERBERT SAMUEL JORDAN EDWARD HENRY TOMKINS, J.P. HERBERT JAMES LOWTON LYGOE. Councillors. JOHN BRUCE HENRY JAMES EDWIN CARTER. STANLEY BENJAMIN FIDOE. WILLIAM HERBERT GALE. FREDERICK THOMAS HERRINGTON. Miss ETHEL MARGARET LITTMAN JAMES HENRY MANLEY. LEONARD McCLANE. WILLIAM JOHN MITCHELL. FRANK LEYDEN SARGENT. WILLIAM GEORGE SCOTT. MATILDA SOUTHGATE, J.P. EDWARD ALBERT WILLIS. Chairman Alderman LYGOE. Vice-Chairman Councillor BRUCE MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE (November, 1934, to November, 1935) Aldermen. HERBERT JAMES LOWTON LYGOE Councillors. Miss ELEANOR MARION ADAMS JOHN DAVID AUBREY Mrs. JESSIE LEONIE BLYTHE STANLEY CECIL BOWERMAN JOHN BRUCE Mrs. FLORENCE HILDA CANTWELL EDWARD NORMAN CARTER Mrs. MIRIAM PRICE COLEMAN Mrs. ROSA ESSEX WILLIAM HERBERT GALE WALTER HARPER WILLIAM JOHN MITCHELL Mrs. MARGARET SUMMERS EDWARD ALBERT WILLIS Members appointed by the Council from outside their own body. Mrs. M. R. JENNER, 46. Milner Square. N.I. Mrs. J. J. JONES, 88, Addington Mansions, Highbury Grange, N 5. Mrs. H. L. REES, 28, Manchester Mansions, Sunnyside Road, N.19. Mrs. C. STONHAM, 135, Highbury New Park, N,5. Chairman.. Councillor Mrs. MIRIAM PRICE COLEMAN. Vice.Chairman: Councillor Mrs. FLORENCE HILDA CANTWELL iii SUMMARY of Vital Statistics in the Registration Year 1934 Population (Enumerated at Census, 1931) 321,795 persons ,, Estimated Mid-year 1933 and 1934 314,200 persons Decrease on Census population, 1931 7,595 persons Mean Population, ten years (1924-1933) 327,520 persons Area 3,092 acres Density (Mid-year 1934) 101 persons per acre Births Males 2,436 ) Females 2188 Persons 4,624 Birth rate 14.72 per 1,000 inhabitants Deaths from All Causes Males 1794 Females 1,749 } Persons 3,723 Death rate 11.85 per 1,000 inhabitants Males 82 Deathsfrom Principal Epidemic Diseases Females 62 } 144 persons Death rate 0.46 per 1,000 inhabitants Deaths from All Tuberculosis Males 185 Females 95 } 280 persons Death rate 0.89 per 1,000 inhabitants Males 169 ) Deaths from Respiratory Tuberculosis. . Femals 84 } 253 persons Death rate 0.81 per 1,000 inhabitants Infantile Deaths under 1 year Males 180 Females 109 1 Total 289 Infantile mortality rate 62 per 1,000 births Excess of Births over Deaths 901 Rateable value of Borough of Islington £2,134,607 Sum represented by a penny rate £8,665 iv Public Health Department, Town Hall, 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 Condition of the Borough for the year 1934. The death.rate (11.85) is 0.55 below that in the previous year (12.40). (In 1923 the rate was 11.60 and in 1863 a similar figure, 11.60 was recorded.) The infantile mortality rate was 62, as against 63 in the previous year. (In the year 1927 an infantile mortality rate of 53 was recorded.) Smallpox cases of the mild (Variola Minor) type were prevalent during the first half of the year, 69 cases being confirmed of the 70 notified. Under the Housing Act 1930 the Borough Council upon the representation of the Medical Officer of Health initiated its first Municipal Slum Clearance and Re.Housing Scheme—the Church Lane Clearance Area. (Georges Road and Brand Street Areas, which were represented by the Borough Medical Officer of Health in August 1923 under the Housing Acts of 1890.1923, were undertaken by the London County Council.) Among other work initiated during the year was the commencement of a survey of underground rooms illegally occupied for sleeping purposes, which necessitated the employment of four Temporary Sanitary Inspectors. A summary of the Minister of Health's observations on the Survey of the of the Health Services of the Borough by his officials, is given. A highly esteemed old servant of the Council, Mr. John Metcalf, Sanitary Inspector under the late Vestry and the Borough Council for 39 years, who was superannuated in 1931, passed away during the year. To the Chairmen of the Committees, Public Health, Maternity and Child Welfare, and Housing, both old and new, and to the members of both Councils, my thanks are due for the sustained interest they took in the work of my department during the year, and to the Superintendent and members of my staff generally for their assistance unstintedly given during an extremely busy year. I am, Your obedient servant, Medical Officer of Health. REPORT OF THE Medical Officer of Health FOR THE YEAR 1934. SPECIAL REPORTS (OTHER THAN THE HEALTH OF THE BOROUGH) AND OUTSTANDING MATTERS BROUGHT BEFORE THE PUBLIC HEALTH, MATERNITY AND CHILD WELFARE, OR HOUSING COMMITTEES DURING THE YEAR. 1. Extract of Vital Statistics and Population, Births and Deaths, pages 3, 4, 5. 2. Infectious Diseases, etc., pages 32.40. Smallpox, page 33. Tuberculosis, pages 41.48. 3. Bacteriological Work, etc., page 50. "Toy Pistol—Tetanus," page 52 . 4. Municipal Health Visitation and Work of Voluntary Welfare Centres, pages 14.24. Infant Life Protection, page 21. 5. Sanitary Work, page 60. Workshops, page 55. 6. Housing, pages 67.71. Underground Rooms, page 69. Clearance Areas, page 67. 7. Meat, Food and Drugs, pages 74.79. Inspection of places where Food is prepared, page 74. Food Poisoning, page 77. 8. Survey of Health Services, page 83. Health Propaganda, page 83. 9. Index to Report, page 92. References, page 90. 1984] 2 Public health Staff. The staff of the Medical Officer of Health (G. CLARK TROTTER, M.D. ; D.P.H. ; F.R.S.E.) is constituted as follows:— Superintendent of Public Health Department and Chief Sanitary Inspector. GEORGE JAMES BRlDEL. †Cort. Sanit. fnsp. Ex. Bd., Cert. San. fnst. Inspector of Meat. Abraham Warren Haydock, Cert. Sanit. Inst., Ex. Joint Bd.† Inspector of Workshops and Bakehouses and Senior Inspector. Harry John James Watson, Cert. Sanit. Inst. Inspectors of Workshops, &.c., in which Females are Employed. Miss Elbanor H. Daniell, Cort. Sanit. Insp. Ex. Bd. ; C.M.B. ; Cert. H.V. Mrs. Susannah Undery, Cert. Sanit. Insp. Ex. Bd. ; C.M.B. ; Cert. H.V. Inspectors of Houses Let in Lodgings. DonaliJ V. Watkins, Cert. Sanit. Insp. Ex. Joint Bd.† Norman Lightowlers, Cert. Sanit. Insp. Ex. Joint Bd. Inspector of Food and Drugs, S.c. Gilbert Stanley Green, Cert. Sanit. Insp. Ex. Bd.† Sanitary Inspectors. District 1. Thos. Wallace Agar, Cert. Sanit. Inst. „ 2. Thomas H. Hancock, Cert. Sanit. Insp. Ex. Bd.† „ 3. Allem Bagshaw, Cert. Sanit. Inst.† „ 4. Colin W. S. Lewis, Cert. Sanit. Insp. Ex. Bd.† „ 5. Stanley P. Marks, Cert. Sanit. Insp. Ex. Bd.† „ 6. William Charles Bartlett, Cert. Sanit. Inst. Ex. Joint Bd.† 7. Leonard H. Pearson, Cert. Sanit. Insp. Ex. Bd. 8. Harry Raymond Homewood, Cert. Sanit. Insp. Ex. Bd.† 9. Arthur Moxon, Cert. Sanit. Insp. Ex. Joint Bd. 10. Alfred E. Wood, Cert. Sanit. Insp. Ex. Bd.† „ 11. Harold H Uren, Cert. Sanit. Insp. Ex. Bd. „ 12. John William Aikbn, Cert. Sanit. Insp. Ex. Joint Bd. 13. Edward G Holmes, Cert. Sanit. Insp. Ex. Bd. ,, 14. James Stephenson Ashworth, Cert. Sanit. Insp. Ex. Joint Bd. Also Meat Inspector's Certificate. Vaccination Officers. J. Jennings, L. Stevens (Temporary). Tuberculosis Visiting Nurse. Miss Emily McGor.txticK, State Regd. Nurse, Cert. General Training. Health Visitors. Mrs. Amy Main, Cert. C.M.B.; Cert. H.V. ; S R.N. Miss Rosina Palmer, Cert. C.M.B.; Cert. H.V.; S.R.N. Miss Ellen Oliver, Cert. C.M.B.; S.R.N. Miss Julia Devine, Cert. C.M.B.; Cert. H.V.; S.R.N. Miss Hilda Frances Harris, Cert. C.M.B.; Cert. H.V.; S.R.N. Miss May Ritson, Cert. C.M.B.; Cert. H.V.; S.R.N. Miss Lily Flower, Cert. C.M.B.; Cert. H.V.; S.R.N. Health Visitor and Infant Life Protection Visitor. Miss Gwenyth Sarah Lewis, Cert. C.M.B.; Cert. H.V.; Cert. Sanit. Inspr. Ex. Bd. Clerical Staff. Henry Angel (Chief Clerk), Edward A. Abbott, Walter J. Wolfe, William G. Bunch, Clement M. Wheble, Arthur R. Wittrick, William R. Causton, Laurence W. Edis, Alfred E. Vanstone, Charles J. Cridland, Leslie P. J. Regan, George F. Kimmis, (Fredk. C. Green, S. A. Brown, Daisy Francis) (Milk Grants). Disinfecting Station. A. Lewis (Engineer), W. G. Jollie (Handyman Stoker), Mrs. Lewis (Caretaker, Shelter House), Mrs. Reid (Cleansing Station Attendant), G. Cooper (Motor Driver), E. Norman (Assistant Driver). Disinfectors. W. Hardwick, J. Brown, A. Taylor, C. Holcombe. Mortuary Keeper. S. Maxwell. Public Vaccinators (See page 52). Public Analyst. ALAN W. STEWART, D.Sc., 23, Queen's Square, W.C.I. Solicitor. NORMAN ROBERTSON, 7, King Street, Cheapside, E.C.2. 3 [1934 EXTRACT OF VITAL STATISTICS. Total. M. F. Live Births. Legitimate 4,450 2,345 2,105 Birth Rate per 1,000 of the estimated Illegitimate 174 91 83 resident population, 14 72 Stillbirths 125 Rate per 1,000 total (live and still) births, 26.32 Deaths 3,723 Death Rate per 1,000 of the estimated resident population, 11.85 Deaths from puerperal causes (Headings 29 and 30 of the Registrar.General s Short List):— Deaths Rate per 1,000 total (live and still) births. No. 29. Puerperal sepsis 3 0.63 No. 30. Other puerperal causes 9 1.89 Total 12 2.52 Death rate of infants under one year of age:— All infants per 1,000 live births 62 Legitimate infants per 1,000 legitimate live births 61 Illegitimate infants per 1,000 illegitimate live births 104 Deaths from Measles (all ages) 39 ,, Whooping Cough (all ages) 15 ,, Diarrhoea (under 2 years of age) 47 POPULATION (ESTIMATED). The population at mid.year 1934, is estimated at 314,200* persons. A decrease in the population of 7,595, when compared with the number of inhabitants ascertained at the census in 1931. MARRIAGES. Marriages, 2,879; Marriage Rate, 18.3.—There were 5,758 persons married, or 2,879 marriages in 1934, and the marriage rate, that is to say, the number of persons married per 1,000 of the population was 18 3. Compared with the previous year these figures show an increase of 786 in the number of persons married, or of 393 marriages , and of 2.7 per 1,000 in the rate. The following statement shows the figures for the previous ten years, 1924.1933. Years. Marriages. Marriage Rate. Years. Marriages. Marriage Rate. 1924 2,872 17.03 1929 2,967 18.56 1925 2,788 16.44 1930 3,063 18.80 1926 2,749 16.21 1931 2,957 18.21 1927 2,844 17.01 1932 2,857 17.60 1928 2,883 17.80 1933 2,486 15.60 *M.O.H. figure as used during year. 1934] 4 BIRTHS. During the year there was 4,624 live births registered, of which 2,436 were boys and 2,188 girls. Of this number, however, 940 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 14.72 per 1,000 of the population, as compared with a mean birth.rate of 17.63 in the preceding ten years. In 1933 the lowest birth.rate (14.35) was recorded. Showing the Births (distinguishing Males and Females) and Birth.rates of Islington in 1934, 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 1933; together with the mean Borough Birth.rates for the 10 years 1924.33. Quarter. Males. Females. Total. Birth Rates. Islington, 1934. Islington, 1924.33. London, 1934. 118 Great Towns, 1934. First 643 564 1,207 15.37 18.24 13.3 14.9 Second 649 583 1,232 15.68 1815 14. 1 156 Third 577 550 1,127 14.35 17.70 13 2 14.8 Fourth 567 491 1,058 1347 16.50 12.3 13.8 The Year 1934 2,436 2,188 4,624 14.72 17.63 13.2 14.8 1933 2,362 2,219 4.581 14.35 18.27 13.2 14.4 Increase or decrease +74 — 31 + 33 +0.37 —0.64 +0.4 N.B.—The total registered births given by the Registrar-General for the Calendar year, 1934, will be found at the foot of table on p. 87. Showing the Births of Males and Females and the Birth.rates in each quarter and for the year, 1934, and in the several Sub.Registration Districts.  Tufnell. Upper Holloway. Tollington. Lower Holloway. Males. Females Total. Birth rates. j Males. Females Total. Birth rates. Males. Females Total. Birth rates. Males. Females Total. Birth rates. 1st Quarter 97 88 185 23.29 64 63 130 17.41 47 43 95 13.07 72 55 127 13.02 2nd ,, 110 104 214 26.94 70 51 121 16.20 50 40 90 12.38 74 64 138 14.15 3rd ,, 103 98 201 25.30 69 56 125 16.74 39 48 87 11.97 58 46 104 10.66 4th ,, 110 98 208 26.19 60 41 101 13.52 46 34 80 11.00 57 63 120 12.30 Year 420 388 808 25.43 263 214 477 15.97 182 170 352 12.10 261 228 489 12.53 Showing the Births of Males and Females and the Birth.rates in each quarter and for the year 1934, 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 111 77 188 13.16 113 88 201 15.51 139 142 281 14.90 643 564 1,207 15.37 2nd ,, 98 99 197 13.79 122 104 226 17.44 125 121 246 13.04 649 583 1,232 15.68 3rd ,, 90 103 193 13.51 99 82 181 13.97 119 117 236 12.51 577 550 1,127 14.35 4th ,, 84 72 156 10.92 97 82 179 13.81 113 101 214 11.34 567 491 1,058 13.47 Year 383 351 734 12.84 431 356 787 15.18 496 481 977 12.95 2,436 2,188 4,624 14.72 5 [1934 Illegitimate Births (174).—The illegitimate births numbered 174 and show a decrease of 12 on the return of the year 1933. They were equal to a rate of 3.7 per cent. of the total registered births. Notification of Births Act, 1907.—3,617 live births were notified (exclusive of 96 stillborn), or 78 per cent. of the total number that were registered during the year. Notified by: Doctors. Midwives. Parents and other Persons. Total. Alive. Still born. Alive. Still born. Alive. Still born. Alive. Still born. 1933. 1st Quarter 261 16 549 9 162 4 972 29 2nd ,, 228 12 515 12 142 1 885 25 3rd ,, 230 10 550 10 124 - 904 20 4th „ 230 9 491 9 135 4 856 22 Year 949 47 2,105 40 563 9 3,617 96 REGISTERED STILL-BIRTHS. Period. Certified by Doctor. Certified by Midwife. By Other Persons. Total. Registered. Per 1,000 of Total Births (including still.born). 1934. 1st Quarter 31 6 — 37 30.65 2nd ,, 27 4 — 31 25.16 3rd ,, 26 1 — 27 23.96 4th ,, 26 4 — 30 28.36 Year 110 15 — 125 2703 DEATHS. The deaths registered during the year numbered 3,723 (exclusive of stillbirths), while the death-rate was equal to 11.85 per 1,000 of the estimated population, or 0.55 below that of the previous year (12.40), and 0.83 below the mean of the preceding ten years; whilst the death-rate of England and Wales was 11.8 and the 121 Great Towns 11.8. 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 108 13.60 78 9.82 73 9 19 80 10.07 339 10.67 Upper Holloway 134 17.94 95 12.72 79 10.58 89 11.92 397 13.29 Tollington 140 19.26 82 11.28 72 10.00 89 12.24 383 13.17 Lower Holloway 164 16.81 99 10.15 76 7.79 95 9.74 434 11.12 Highbury 224 15.68 173 1211 116 8.12 145 10.15 658 11.51 Barnsbury 212 16 36 151 11.65 104 8.02 137 10.57 604 11 65 Islington (South. East) 306 16.22 218 11.56 176 9.33 208 11.03 908 12.03 The Borough 1,288 16.40 896 11.41 696 8.85 843 10.73 3,723 11.85 1934] 6 Showing the Deaths and Death Rates of Islington in 1934, 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 1924.33 and the deaths and death.rates in the year 1933. Quarter. Males. Females. Total. Death Rates. Islington, 1934. Islington, 1924-33. London, 1934. 121 Great Towns, 1934. First 669 619 1,288 16.40 17.44 15.8 14.5 Second 463 433 896 11.41 11.20 11.4 11.5 Third 356 340 696 8.85 9.39 8.9 9.3 Fourth 441 402 843 10.73 12.69 11.0 10 8 The Year 1934 1,929 1,794 3,723 11.85 12.68 11.8 118 1933 1,992 1,965 3,957 12.40 12.57 12.2 12.2 Increase or Decrease -63 -171 -234 -0 55 + 011 -04 -0.4 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, 1934. Mean Deaths (10 years, 1924-33.) Increase or Decrease on mean. 0-1 year 289 375 — 86 1-5 years 119 209 — 90 Under 5 years 408 584 — 176 5-15 years 72 97 — 25 15-25 „ 126 149 — 23 25-35 „ 174 182 — 8 35-45 „ 177 253 — 76 45-55 „ 372 441 — 69 55-65 „ 679 669 + 10 65-75 ,, 856 849 + 7 75-85 661 726 — 65 85 upwards 198 202 — 4 All Ages. 3,723 4,152 — 429 There was a decrease of 176 deaths in the number of deaths under 5 years of age when compared with the average deaths at those ages during the preceding ten years; whilst the number of registered deaths at the several age periods up to between 5.55 years, were also below the decennial average. The deaths of aged people between the age period 65 years and upwards showed a decrease of 99 in the number of deaths when contrasted with the previous year 1933, and 62 below the ten years' average (1924.33). INFANTILE MORTALITY. Infant Deaths, 289; Mortality Rate, 62.—The deaths oF 289 infants under twelve months old were registered during the year, or 86 below the decennial average (375), and they were equal to the infantile rate of 62 per 1,000 births. The lowest rate on record, however, is 53 per thousand births in the year 7 [1934 1927. The rate was 3 per 1,000 births below the mean annual record of the preceding ten years, and is 1 per 1,000 below the rate of last year (1933). In the quarters the mortality ranged from 90 per 1,000 births in the first quarter, 57 in the second, 42 in the third, and 59 in the fourth. In the sub.registration districts the infant mortality was as follows:— Sub.District. Infant Deaths. Mortality per 1,000 Births. Tufnell 25 31 Upper Holloway 25 52 Tollington 28 78 Lower Holloway 40 81 Highbury 43 58 Barnsbury 60 76 Islington South East 68 69 In London the infantile mortality was 67 per 1,000 births. The rate for England and Wales was 59 per 1,000 births. Infantile Mortality during each of the Ten Years 1924.33 and 1934. 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. 4 weeks and under 3 mths. 3-6 6-9 9-12 1-2 2-3 3-4 1924 110 33 23 21 187 59 61 64 76 447 66 1925 105 25 20 20 170 70 72 58 44 414 63 1926 98 19 16 10 143 63 96 56 69 427 66 1927 90 19 13 9 131 46 56 38 53 324 53 1928 108 10 14 9 141 60 73 58 42 374 64 1929 103 18 15 11 147 64 68 73 51 403 73 1930 115 13 11 11 150 60 68 66 55 399 70 1931 93 17 10 19 139 50 51 62 35 337 64 1932 92 15 9 8 124 66 66 49 35 340 68 1933 88 10 18 15 131 54 32 41 30 288 63 Mean 10 years 100 18 15 13 146 59 64 57 49 375 65 1934 85 7 14 8 114 61 53 36 25 289 62 increase or decrease on mean — 15 —11 -1 — 5 — 32 + 2 — 11 -21 — 24 — 86 — 3 Showing the Deaths among Infants per 1,000 Births during the Year 1934. and also the mortality rates for the Years 1924-1933. Sub.Districts. 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Mean 10 years 1934 Increase or decrease on mean Tufnell 54 47 64 52 65 75 78 43 48 26 55 31 —24 Up. Holloway 70 57 30 31 44 42 26 35 30 54 42 52 + 10 Tollington 60 65 92 63 85 71 106 90 88 101 82 78 — 4 Lr. Holloway 85 78 82 74 77 95 57 84 77 68 78 81 + 3 Highbury 60 54 48 52 47 60 58 64 83 51 58 58 ... Barnsbury 77 75 90 59 75 87 95 66 76 80 78 76 — 2 Islington, S.E. 55 58 64 49 67 78 76 68 72 72 66 69 + 3 The Borough 66 63 66 53 64 73 70 64 68 63 65 62 — 3 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. 1934] 8 Showing the Mortality per 1,000 Births among Infants under one year of age in the ten years 1924.33: and in 1934 from certain specified causes. Causes of death. 1934. Rate per 1,000 Births. Mean rate 10 years 1924.33 per 1,000 Births. Difference. Premature Birth and Congenital Defects 16.65 19.92 — 3 27 Bronchitis and Pneumonia 16.44 14.03 + 2.41 Atrophy and Marasmus 3.89 3.64 + 0.25 Diarrhoeal Disease (all forms) 8.87 5.02 + 385 Convulsions 0.43 0 87 — 0.44 Whooping Cough 1.30 3.29 — 1.99 Measles 1.51 2.60 — 1.09 Diphtheria 0.43 0.35 + 0.08 Phthisis 0.43 0.17 + 0.26 Other forms of Tuberculosis 0.43 0.69 — 0.26 Total of above 50.38 50.58 — 0.20 All other causes 5.19 14.37 — 918 Total 55.57 64.95 — 9.38 INFANTILE MORTALITY during. the Year 1934. 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 Death? under 1 year 1-2 2-3 3-4 3-6 6-9 9-12 All Causes. Certified - - - - - - - - - - Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken.pox - - - - - - - - - - Measles — — - - - - - 2 5 7 Scarlet Fever - - - - - - - 1 — 1 Whooping.Cough — — - - — — 2 1 3 6 Diphtheria, Croup - - - - — 1 — 1 — 2 Erysipelas — — - 1 1 2 - 1 — 4 Tuberculous Meningitis - - - - - - - 1 - 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - 2 - 1 3 Meningitis (not Tuberculous) 1 1 - - 2 2 - 1 - 5 Convulsions — - - - — — 1 1 — 2 Laryngitis — - - - — — — — — — Bronchitis 1 - - - 1 5 7 2 — 15 Pneumonia (all forms) 5 1 6 3 15 10 15 10 11 61 Diarrhoea — - — — — — — — — — Enteritis — - 1 1 2 12 13 12 2 41 Gastritis — - — — — — — — - — Syphilis — - — — — 2 1 — — 3 Rickets — - — — - — — - — — Suffocation, overlying - - - - - - - - - - Injury at birth 9 - — — 9 — — — - 9 Atelectasis 10 - — — 10 — — — — 10 Congenital Malformations 5 1 1 1 8 6 1 1 - 16 Premature birth 48 3 2 2 55 5 1 — — 61 Atrophy. Debility and Marasmus 1 - 2 - 3 11 3 - 1 18 Other causes 5 1 2 — 8 5 7 2 2 24 Totals 85 7 14 8 114 61 53 36 25 289 BIRTHS. Nett Births legitimate 4,450 in the year illegitimate 174 4,624 Nett Deaths in legitimate infants 271 289 the year illegitimate infants 18 9 [1934 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. 60 cases of Ophthalmia Neonatorum were notified, compared with 87 cases last year. 131 cases of Ophthalmia were reported by the London County Council and Health Visitors as against 126 cases during the previous year. 10 out of the 60 cases of Ophthalmia Neonatorum were attended at birth by midwives. The cases occurred in the sub.registration districts as follows:— Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South East. The Borough Ophthalmia Neonatorum. 10 4 2 9 7 11 17 60 Ophthalmia. Cases reported by L.C.C. 7 6 6 13 8 33 47 120 Cases reported by Health Visitors 1 — — — - 4 6 11 Of the 60 cases investigated, both of the infants' eyes were affected in 45 instances, whilst in 5 the right eye was involved, and in 10 the left. Treatment.—17 of the 60 Ophthalmia Neonatorum cases were admitted to St. Margaret's Hospital, 26 being treated at other Hospitals. 17 cases were treated at home by private Doctors. 26 cases of inflammatory disease of infants' eyes were nursed by the North London Nursing Association for the Council at a cost of £34 17s. 0d. In 1933 23 cases were nursed at the cost of £20 18s. 0d. Results.—Of the 60 Ophthalmia Neonatorum cases, vision was unimpaired in all cases. Ophthalmia Neonatorum Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified, Treated. At home. In hospital. 60 17 43 60 Nil Nil Nil MATERNAL DEATHS. The number of women dying, pregnancy being a factor, during the year 1934 was 20. Of these 20, 12 have been classified by the Registrar-General as "puerperal causes." This would give a "Registrar-General" Maternal Mortality of 2.5 per 1,000 registered (live and "Still") births. Of these twelve deaths, the Registrar-General has 3 classified as " sepsis." 1934] 10 Taking the gross figure of 20 would give a rate of 4.2. It has been our practice for some years back to record all deaths of women in which, as a result of our investigations, pregnancy was found to be a complication. A Table showing such investigations from 1911 is given. For details of the Maternal Deaths for the year 1934 see page 11. The deaths for the preceding year numbered 25, and were equal to the proportion of 5.3 per 1,000 births. MATERNAL DEATH RATES FOR ISLINGTON. Year. No. of Live Births. No. of Maternal Deaths. Rate. 1911 8,113 17 2.1 1912 8,211 11 1.3 1913 8,359 26 3.1 1914 8,177 22 2.7 1915 7,537 17 2.3 1916 7,262 21 2.9 1917 5,837 12 2.1 1918 5,197 7 1.3 1919 6,278 23 3.7 1920 9,404 22 2.3 1921 7,886 17 3.2 1922 7,506 20 2.7 1923 7,100 15 2.1 1924 6,799 17 2.5 1925 6,580 18 2.7 1926 6,455 20 3.1 1927 6,108 24 3.9 1928 5,790 25 4.3 1929 5,509 27 4.9 1930 5,685 22 3.9 1931 5,281 28 5.3 1932 4,950 16 3.2 1933 4,581 25 5.3* 1934 4,624 20 4.2* *Rate per 1,000 registered live births and still births. 11 [1934 Classifications:—(a) As Intestinal obstruction. (b) As Acute Yellow Atrophy of Liver. (c) As Homicide, (d) As Cerebral haemorrhage. (e) As Rheumatic fever. (f), (g) and (h) As Violent death—Open verdict. (x) Sepsis found P.M. (Classified as "Other accidents of child.birth because of Caesarean Section etc.) (*) Classified as Induced abortion. 1st Quarter 6 = 4.8 2nd Quarter 6 = 4.8 Rate per 1,000 3rd Quarter 5 = 4.3 registered live 4th Quarter 3 = 2.7 and still births. Total (Year) 20 = 4.2 METROPOLITAN BOROUGH OF ISLINGTON MATERNAL DEATHS, 1934. (For those in 1933, see p. 11 of the Medical Officer of Health's Annual Report for that year) 1934. Month. Cause of Death. Ages at Death. Totals. 15 to 25 25 to 35 35 to 45 45 and upwd. Total. From Puerperal Sepsis. From other Diseases of Childbirth. Jan. la. Eclampsia following child birth. P.M ... 1 ... ... 1 ... 1 Feb. la. Peritonitis and Pyaemia Abscess on liver. Puerperal Sepsis following miscarriage. 8 mos. ... 1 ... ... 1 1 ... ,, Haemorrhage. Laceration of vagina due to application of forceps. Instrumental interference with prolonged labour. Misadventure. P.M. Inquest ... ... 1 ... 1 ... 1 ,, Rupture of Ectopic gestation. Natural. P.M. Inquest ... ... ... 1 1 ... 1 Mar. Strangulation of small intestine through diaphragm. Coroner. P.M. Without inquest. (Delivered by P.M. Caesarean Section. Child dead.) ... ... 1 ... 1 ... 1 (a) ,, Acute yellow atrophy of liver following normal full term delivery. No P.M 1 ... ... ... 1 ... 1 (b) 1st Qr. 1 2 2 1 6 1 5 April la. Post-partum Hemorrhage ... ... ......... ... ... ... ... b. Retained placenta No P.M. ... 1 ... ... 1 ... 1 „ la. Puerperal septicaemia ... ... ... ... ... ... ... b. Child-birth. No P M. ... 1 ... ... 1 1 ... ,, Pyaemia & Septic miscarriage. Perforation of vaginal wall by instrument. P.M. Inquest. Open Verdict ... l ... ... 1 1 ... May Haemorrhage from placenta praevia accelerated by Ether (anaesthetic) during delivery at term. P.M. Inquest. Misadventure ... l ... ... 1 ... 1 ,, la. Melaena. b. Enteritis. c. Pelvic sepsis following Caesarean section. PM ... l ... ... 1 lx ... " Peritonitis. Injection of Carbolic Acid into womb. Criminal abortion. Murder P.M. Inquest 1 ... ... ... 1 ... 1 (c) 2nd Qr. 1 5 ... ... 6 3 3 July Cerebral haemorrhage. Hyperpiesis. (8 months pregnant.) Coroner. P.M. Without Inquest. ... 1 ... ... 1 ... 1 (d) ,, Urjemia. Eclampsia. Chronic nephritis. Coroner. P.M. Without Inquest ... ... 1 ... 1 ... 1 Aug. Haemorrhage from Uterus consequent on abortion. P.M. Inquest. 1 ... ... ... 1 ... 1 ,, Ulcerative endocarditis following Rheumatic endocarditis. 2. Pregnancy. No P.M. 1 ... ... ... 1 ... 1 (e) Sept. Infective endocarditis. Septic abortion. Self-produced. Miscarriage. P.M. Inquest. ... ... 1 ... 1 1* ... 3rd Qr. 2 1 2 ... 5 1 4 Oct. General peritonitis. Abortion (about 2 months pregnant). Unknown cause. P.M Inquest. Open verdict. ... 1 ... ... 1 ... 1 (f) Nov. Acute infective endocarditis. Acute or chronic mastoiditis, Septic metritis following abortion. Cause unknown. Openverdict. P.M, Inquest. ... 1 ... ... 1 1 (g) ... Dec. Injection of fluid into pregnant uterus (6 months pregnant). Circumstances unknown. Open verdict. P.M. Inquest. ... ... 1 ... 1 ... 1 (h) 4th Qr. ... 2 1 ... 3 1 2 1934] 12 PUERPERAL FEVER. Of the 54 cases coming to the knowledge of the Medical Officer of Health during 1934, 16 were notified by Medical Practitioners. The proportion of total cases to births was 11.69 per thousand. The notifications were 20 above the average (34) of the preceding ten years and showed an increase of 3.9 in the proportion of attacks to 1,000 births. Cases of Puerperal Fever notified and inquired into during the year 1934. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast. The Borough Cases notified 5 8 4 4 11 12 10 54 Private Practitioners' Cases 2 1 1 2 5 3 2 16 Hospital Cases 3 7 1 — 4 9 6 30 Certified Midwives' Cases — — 2 2 2 — 2 8 Cases inquired into 5 8 4 4 11 12 10 54 Cases treated in Hospital 5 8 4 4 10 11 10 52 Cases treated at Home - - - - 1 1 — 2 52 of the 54 cases were treated in Hospitals. 30 of these contracted the disease in Hospital; 28 cases were removed to London County Council Hospitals; and 24 cases were removed to the St. Mary's Islington Hospital and other London Hospitals. Deaths.—3 deaths were registered as being due to Puerperal Fever. PUERPERAL PYREXIA. Notification of Puerperal Pyrexia Regulations, 1926.—There were 67 cases notified, as against 74 last year. Of these, 15 were Private Medical Practitioners' cases; 47 occurred in Hospital, while 5 were certified Midwives' cases. The notifications were in the proportion of 14.5 per 1,000 births. Cases of Puerperal Pyrexia notified and inquired into during the year 1934. Tufnell. Upper Holloway. Tollington. Lower Holloway, Highbury. Barnsbury. South. East. The Borough Cases notified 7 5 6 4 13 13 19 67 Private Practitioners'Cases 4 1 — 1 2 2 5 15 Hospital Cases 2 4 4 3 11 11 12 47 Certified Midwives' Cases 1 - 2 - - - 2 5 Cases inquired into 7 5 6 4 13 13 14 67 Cases treated in Hospital 7 5 6 3 12 12 18 63 Cases treated at Home — — — 1 1 1 1 4 The services of the Consultant were sought on two occasions during the year. One bacteriological examination was made in a case of suspected Puerperal Sepsis, with negative result. PEMPHIGUS NEONATORUM. During the year 1934, one case which died in Hospital came to the knowledge of the Medical Officer of Health (after death), and the circumstances were investigated. 13 [1934 THE MILK SCHEME FOR NECESSITOUS EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER FIVE YEARS OF AGE. During the year 1934, 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 £1,887 19s. 5d., as against £2,609 17s. 2d. in 1933. The total arrount expended since the Order came into operation in 1918 is £64,195 3s. 9d. The total recipients during the year numbered 7,239, and the quantity of milk supplied to them w as equal to 143,284 pints (17,910 gallons). DISTRIBUTION OF MILK TO NECESSITOUS MOTHERS AND CHILDREN. Scale of Income adopted by the Council, 17th June, 1932:— Per head. 5/- a week and under, after allowance for rent, Free. 5/1 to 6/5 a week, after allowance for rent, Quarter Cost. 6/6 to 7/- a week, after allowance for rent, Half Cost. Children living at home and earning not to be counted as members of the family for the purpose of the scale. The Milk Sub.Committee to have discretionary powers to deal with any particular case which may arise. 1934] 14 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1934. District No 1 2 3 4 5 6 7 I.L.P. Not included in totals Totals. I. Births, First Visits, Infants under 1 Year 592 513 540 754 670 799 354 10 4,222 II. Births, Re-Visits, Infants under 1 Year 289 350 573 604 508 985 458 19 3,767 III. Visits to Children, between 1st and 2nd Years 289 274 549 469 495 953 338 13 3,367 IV. Visits to Children, between 2nd and 5th Years 874 1,230 1,480 1,333 1,193 1,537 1,297 22 8,949 V. Visits re Still Births 13 17 23 27 19 30 8 - 137 VI. Deaths, Visits, re Infants under 1 Year 12 8 12 5 13 15 8 - 73 VII. Deaths, Visits, re Children 1 to 5 years 2 2 5 - 1 1 5 - 16 VIII. †Ante.Natal, Home Visits F/226 239 F/219 250 f/213 266 F/245 258 F/174 186 F/219 263 F/5 7 F/5 7 f/1,438 1,640 IX. †Puerperal Fever, Home Visits f/6 8 F/6 11 f/5 7 F/8 19 F/8 14 F/10 16 F/1 3 F/1 3 F/44 78 Pyrexia, do. f 1 — - - F 1 F/2 4 F 1 - F/5 7 Totals 2,319 2,655 3,455 3,474 3,100 4,603 2,650 74 22,256 X. Attendances at Welfare Centre* 50 25 49 39 47 47 42 23 299 XI. Other Work by Direction 1,352 524 1,191 644 572 1,008 1,473 19 6,764 XII. Visits Declined — - 3 - 1 - - - 4 XIII Visits, House Shut 643 1,076 721 931 1,141 588 466 7 5,566 XIV. Visits, Inopportune 80 12 - 26 8 11 2 - 139 Grand Total of Visits 4,444 4,292 5,419 5,114 4,869 6,257 4,633 123 35,028 *Specify nature of work—e.g., M.O. Consultation, Weighing babies, Dressings, Temperature taking, Selling of Dried Milk. Talk to Mothers, subject dealt with and time occupied. 15 [1934 SUMMARY OF WORK OF MUNICIPAL HEALTH VISITORS FOR YEAR ENDING 1934—Continued, District No. 1 2 3 4 a 6 7 I.L.P. Not included in totals s. Analysis of Visits included in I.-IX. relating to (aa) †Reported Ophthalmia f/8 16 f/6 11 f/14 24 f/7 17 F/28 64 f/39 79 F/8 15 — f/110 226 (a) †Ophthalmia Neonatorum F/10 25 f/4 6 F/9 18 f/6 12 f/12 18 F/10 34 f/4 9 — F/55 122 (b) †Epidemic (Summer) Diarrhoea - - - - - - - - - (c) Other Digestive Diseases 1 - - - - 2 - — 3 (d) Pneumonia and Bronchitis 6 9 12 - 6 5 12 — 50 (e) Rickets 20 4 3 10 6 6 - - 49 (f) †Measles and German Measles f 8 F/14 15 f/16 18 - F 7 f 11 F 12 - f/68 71 (g) †Whooping Cough F 7 - F 20 - F 6 F 10 F 15 - f 58 (h) Tuberculous Disease—P=Pulmonary; O= Other - - - - - - - - — (i) Convulsions - - - - - - - - - (j) †Polio-myelitis — - - - - - - - - (k) Premature Birth 18 3 16 7 11 24 17 - 96 (l) Atrophy, Debility and Marasmus - - - - - - - - - (m) All other investigations (**Specify) 24 9 8 - 9 6 4 — 60 (n) Routine Visits included in I. to IX. and not included in (aa) to (m) 2,194 2,598 3,336 3,428 2,973 4,426 2,566 74 21,521 ***Totals (aa) to (n) 2,319 2,655 3,455 3,474 3,100 4,603 2,650 74 22,256 Total Families Visited 1,746 1,891 2,623 2,691 2,247 3,610 2,066 67 16,874 Registered Births. New Cases Handed to H.Vs. for Visitation. Infant Mortality. Maternal Mortality. Puerperal Fever. Puerperal Pyrexia. Ophthalmia Neonatorum. No. Rate. Notified Births. Non-Notified Births. Transfers In. No. Rate. No. Rate. Cases. Removals. Cases. Removals. Cases. Removals. 4624 14.72 4,663 58 785 289 62 12 2.53 54 . 47 67 60 60 38 **e.g.—Infectious Diseases other than Measles, Whooping Cough, Epidemic Diarrhcea, Polio-myelitis, etc. Syphilis, Rheumatism, N.N.B. Illegit., etc. ***Totals (aa) to (n) should correspond with Totals I. to IX. †F. in front of figures denotes a ''First Visit.'' 1934] 16 VOLUNTARY WELFARE CENTRES. Each year for comparative purposes a Table is given which summarises as far as possible the work of the Voluntary Welfare Centres. The Table is compiled from the reports provided bv the Centres of information which the Medical Officer of Health has to supply to the Ministry of Health for the calendar year. The Centres themselves for the year 1934 for the first time through their Conjoint Committee supplied for each Centre what they considered a proper report of their activities. This report, of course, is on the nature of the work, and is not intended to be a statistical review. This latter is covered by the Table just referred to and the other Table, given at the end of this Section, which covers the activities up to the end of the Centre year, March 31st, 1934, and is compiled from the Annual Reports of the four Centres. Table—Calendar Year, 1934. North. South. East. West. Total. 1. Ante.Natal Clinics. Number held weekly 3 { 1 Ctr. 1* †1 7 1 Rose „ of Expectant Mothers who attend 660 Br'ch. 255 82 1,183 180 „ of attendances 2,099 556 675 276 3,606 2. Consultations for Children up to 5 Years of Age. Total No. of children attending for First time during year, and who, on the date of their First attendance, were:— i. Under 1 year 899 642 467 511 2,519 ii. 1—5 years 163 122 103 67 455 Number of attendances:— i. Children under 1 year 11,335 11,003 7,660 6 442 36,440 ii. 1—5 years 5,736 8,306 7,446 4,779 26,267 3. Home Visiting. Number of visits made to:— i. Expectant mothers:— (a) First Visits 185 106 219 48 558 (b) Total Visits 2,275 259 1,037 234 3,806 ii. Children under 1 year:— Total Visits 5,068 6,904 4,014 2,457 18,443 iii. Children 1—5 years 7,372 7,475 6,309 4,322 25,478 4. Wards and Homes. Number of beds 18 12 - 8 38 Number of patients received:— i. Mothers and Babies:— (a) Mothers 41 72 - — 113 (b) Babies 41 79 - - 120 ii. Babies only 89 — — 87 176 5. Number of Children who attended at the Centres during the Year, and who, at end of Year, were:— i. Under 1 year 694 448 324 415 1,881 ii. 1—5 years 1,058 1,018 826 637 4,139 6. Convalescence. Number of cases:— i. Mothers 28 10 93 26 167 ii. Children 39 80 164 38 321 *Plus one extra Clinic per month. †Since May, 1933, one Birth Control Clinic a month has taken the place of one weekly Ante-Natal Clinic. 17 [1934 WORK OF THE FOUR VOLUNTARY WELFARE CENTRES. (Compiled by the Secretaries.) The four Voluntary Islington Welfare Centres (North, South, East and West) have carried out a large amount of work during the past year, and the Voluntary Committees that govern these Centres have expressed their great appreciation of the encouragement, co-operation and financial support that has been given to them by the Islington Borough Council. The Grants from the Borough Council to the four Centres cover about half their expenditure and the Centres have to raise the remaining half by means of subscriptions, donations, grants from cinemas and entertainments, etc. The work of the Centres is carried out by a staff of doctors and nurses (and in some instances by a clerical staff) aided by a large band of voluntary helpers. The Committee work in close co.operation with:— The Medical Officer of Health for Islington, and the staff of the Health Department, with each other by means of a Conjoint Committee, the Islington Committee of Co.operation for the Welfare of Mother and Child, doctors, hospitals, midwives, the Child Guidance Clinic, the North London District Nursing Association, the Women's Holiday Fund, the Charity Organization Society, schools, day nurseries, churches, missions, Invalid Children's Aid Association, all other agencies working for the health of little children. The principle that actuates every department of the work carried out at the Centres is the establishment of health and the prevention of disease, damage and death by the education of the mother, before the birth of her child and until it reaches school age. The method adopted by the Centres to carry out their objective is to establish clinics for mothers before and after their babies are born and for children from infancy until school age. The mothers are given medical advice as to the best methods of maintaining themselves and their children in good health. This advice is endorsed and amplified by the Centres' nurses. Cases of illness are referred to family doctors or to hospitals. When necessity arises both mothers and children are referred to certain consultative clinics at hospitals or to specialists. The health records of the children are passed on to the School Medical Officer of the London County Council for his information. The mothers have opportunities at the Centres of seeing suitable clothes for the children and of being taught how to make them. Many health talks are given and mothercraft classes on various subjects are provided. Nurses visit the mothers in their homes, to help them to carry out the doctor's directions. These visits give opportunities for getting into close and intimate touch with the mothers, and thereby help them to overcome individual difficulties. A mother needing advice between consultations may consult the Superintendent any morning. She can also be shown how to do simple dressings and to carry out test feeds. 1934] 18 A number of other benefits are secured for the mothers and children, either by the Centres themselves or by arrangement with other institutions, i.e.:— Convalescent Treatment. Dental Treatment. " Light " Treatment. Massage Treatment. When the Centre doctors consider that certain necessitous nursing or expectant mothers need extra nourishment, the Centres arc able to provide or procure dinners, with the assistance of grants, donations and the aid of various institutions. His Worship the Mayor of Islington has kindly given grants for this purpose. He also provided Christmas Dinners for necessitous families attending the four Islington Infant Welfare Centres. The details following show the activities by which all the Centres have provided help and guidance to mothers, for themselves and their children during the past year, with the addition of certain special activities undertaken by individual Centres. Activities Provided or Procured by all the Four Centres. 1. Ante.Natal and Post.Natal Clinics. 2. Children's Clinics. 3. Visiting in the homes. 4. Morning Callers. (Mothers that attend for help and advice between sultations.) 5. Health Talks. Various classes. 6. Convalescence for mothers and children. 7. Dental Clinics. 8. Light Clinics. Additional Benefits Provided or Procured by the Centres. Provided by:— North South East West 1. Convalescent Homes (a) Mothers and Infants — + — — (b) Toddlers — + — - 2. Residential Observation Wards + — — + 3. Massage Clinics + + + — 4. Savings Clubs (Thiift or National Savings Association) + + - - 5. The training of Infant Welfare Students + + + + 6. The training of Infant Welfare Pupils + + — — 7. Home Helps + — — - 8. Mothers' and Fathers' Committees + — — — 9. Exercise Clinics + + — — Special Points in the Working of Each of the Four Centres. North:—6 and 7, Manor Gardens, N.7. Observation Wards provided at the North Centre take into residence three mothers (with their tiny babies) to improve lactation. Three wards for children tinder two years of age who are admitted for diatetic troubles. 19 [1934 The mothers while in residence obtain a practical demonstration in mother. craft night and day. Before the children are discharged their mothers are shown the errors they have made in diet and management. When physical defects are discovered the children are transferred to hospitals. Mothers.—Number admitted during 1934: 41 with 41 babies plus 31 daily cases. Babies.—Number admitted during 1934 : 89 plus 9 daily cases. Five Home Helps.—Women are employed to go into the homes and do the work of the mother while she is in bed after her confinement. Mothers pay into a club to entitle them to the services of a Home Help. Number of members, 94. Number of homes attended, 146. Mothers and Fathers Committees.—These Committees assist the Centre to spread its teaching. They act as a liaison between those who provide the information and benefits obtainable at the Centre and those who receive them. The fathers raised a considerable sum for the Mayor's Christmas Dinner Fund. Exercise Clinics are provided for certain children attending the "Light" Department. The mothers are referred to this Clinic from the post.natal and " Light " Departments. Post.Natal Clinics are held for mothers to attend six weeks after confinement to ascertain that normal conditions have been restored and that the general health is satisfactory. This clinic is becoming overcrowded. 1934. Number of clinics held, 50. Number of mothers who attended, 255. Number of attendances, 656. South. Centre.—6, Clephanc Road, N.l. Rose Branch.—15, Popham Road, N.l. Canonbury Branch.—Held at 100, Canonbury Road, N.l. The policy of the Committee has been to enable every mother to be within easy reach of a Centre and for this purpose, as the district is a large and varied one, the work is carried out at one main Centre and two Branches. One of the Branches is held in a converted public house, which was purchased by the Centre from voluntary funds. The Centre sends a large number of mothers and children to the Almeric Paget Massage Corps in Britannia Row for massage, artificial sunlight and remedial exercises. The weekly dental clinic is well attended. The mothers are urged to bring their children for dental inspection and they themselves can have their teeth stopped or extracted under gas and obtain dentures when necessary. They pay for them gradually to the extent of their ability, the balance being provided from a special Samaritan Fund, and other sources. This Centre owns a Convalescent Cottage at Flamstead, near St. Albans, for six mothers and babies. The mothers go for a fortnight and pay according to their means. The Centre also sends seven children at a time between the ages of 3 and 5 years old to Miss Fleetwood's Home at the seaside, where they stay for a month. Last year the Centre sent away 82 mothers, 89 babies and 70 children. 1934 20 East. Centre.— 32, Drayton Park, N.5. Branch.—At Highbury Quadrant Mission Hall, Hurlock Street, N.5. 1.—Two observation clinics are held weekly, to which mothers are invited if their babies are not gaining weight. The child is fed at the Centre and remains all day for observation. As a result of the advice given the difficulties are usually overcome and breast feeding maintained. 2.—Great attention is paid to the teeth of mothers and children. Those needing treatment are sent to the Eastman Clinic or to the British Dental Hospital. Help is given towards dentures. 3.—Real sunlight treatment is given in the garden (luring the summer to those children selected by the doctor. Cases needing artificial sunlight during the winter are sent to the Almeric Paget Massage Corps or to the Institute of Ray Therapy. 4.—During the summer the garden playground generously provided by the late Lord Riddell was used every morning for sunlight treatment and in the afternoons for massage and for the needlework class. 5.—An important feature of the work is the provision of holidays for mothers and children. During the year 90 mothers and 171 children were sent away—each mother paying according to her means. 6.—Nearly 800 volumes were borrowed from the library, a privilege much appreciated by the mothers. West.—44, Richmond Road, N.l. An Observation Ward is provided at the West Centre for children up to 5 years who are suffering from dietetic disorders. Sometimes a baby who is troublesome to wean is admitted for training in diet and sleep habits, and if the mother of a delicate child has to go into hospital for treatment they try to take the child nto the ward during her absence. The ward has eight cots, and on fine days the children live on a balcony room fitted with vita.glass. A weekly ante.natal and post.natal clinic is held at the Centre. On one morning in the month women whose state of health makes a further pregnancy undesirable are given advice on the best methods of preventing pregnancy. Women are not seen at this clinic unless they are directly referred to it by their doctor. The aforesaid facilities have brought knowledge into the homes, have prevented damage and death, and have had a beneficial effect on the health of the mothers and children in the Borough of Islington. NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN. During the year much assistance was obtained from the Inspectors of the Society in regard to ameliorating the conditions of children (and incidentally 21 [1934 Mothers also) where it w as thought their services could be utilised and there was a possibility of the cases coming within the scope of their work. 34 families came within this category, some being cases which had had to receive such attention in previous years and were again found to need it. The co-operation of the Society's three local Inspectors (including one Lady Inspector for " medical" cases—into which division one quarter of the cases fell) has been particularly useful on the Maternity and Child Welfare side of the work of the Public Health Department in promoting better conditions in the homes for the children and also in compelling parents and guardians to secure medical attention for them. The Inspectors of the Society were specifically incorporated in the Children and Young Persons Act of 1933 as " Authorised Persons " to deal with cases under the Children Act, 1908, as amended by the Children and Young Persons Act, 1932, and the help afforded to my Department by these Inspectors has been noteworthy, lor, of the thirty-four cases mentioned above, six were in connection with these Acts (Infant Life Protection) and one of them developed into a Court case—see section on " Infant Life Protection." In some instances cases were brought to the notice of the Society by my Department and in others the Society called in our services. In one such latter case, when the District Sanitary Inspector visited the premises (to make an ordinary inspection for nuisances), accompanied by the Society's Inspector, an imbecile paralysed boy of 15 years of age was found in filthy surroundings and rescued from further " ill-treatment." In a case of the former type (i.e., children under 5 referred to the Society) in addition a child ever that age, viz., 14 years, was found to need drastic attention for eyes, and eventually had an operation. It is said that his eyes will be quite normal in consequence, and thus he will have a better chance of getting employment. It is therefore in instances of this character that the excellent work of the Society in Islington is apparent and appreciation is due from the Borough for the persistent efforts of the Society's officers to lessen in this area the number of cases of ill-treatment of children—members of the community who are incapable of defending themselves—and for their becoming, as it were, our " social ' policemen.' " INFANT LIFE PROTECTION.—CHILDREN AND YOUNG PERSONS ACTS, 1908-1932. This duty is undertaken by one of the Council's Health Visitors who has been appointed Infant Protection Visitor and whose time is mainly occupied by interviews with mothers who are anxious to obtain homes for their babies, fostermothers who call at the Tow n Hall respecting- the children under their care, and by regularly visiting the homes w here nurse-children are being fostered, together with the clerical work which such duties necessitate. Assistance is rendered where necessary by the Superintendent of the Department, and surveys of the homes of the foster-mothers, previous to registration, are made by the District Sanitary Inspectors. In addition to the individual calls there are, of course, a number of children in particular institutions who come within the purview of the Acts, and are 1934] 22 technically " fostcr-i hilrlren,'' such as Residential Schools taking children under nine years of aye, and institutions such as Children's Homes, " Guest Houses," ctc. Number of foster-mothers on the Register who were receiving- children on the 1st January, 1934 162 Do. do. on the 31st December, 1934 168 Number of foster-mothers added to the Register during the year 49 Number of foster-mothers removed from the Register during the year 43 Number of foster-children on the Register at 31st December, 1934 224* Number of foster-children attending Child Welfare Clinics 86 Visits paid to homes 1,802 Children removed compulsorily 8 Children removed to hospital 11 Deaths reported (Inquests—Nil) 2 Cases recommended for prosecution 8 Other cases of serious complain 2 *Includes those in institutions, etc. The following cases in which action was taken, either by prosecution or otherwise, and where warnings were unheeded, are of interest :—A foster-mother was summonsed for undertaking the nursing and maintenance of an infant for reward without first giving notice to the Local Authority. In this case we received a message from an Inspector of the National Society for Prevention of Cruelty to Children that he had discovered in a house in the district a woman fostering an illegitimate child, age 4i years, and requested that an officer from my Department should visit and see the unsatisfactory manner in which the child was being fostered, with the result that this officer immediately advised that the child be taken to hospital for treatment. Further enquiries by the Infant Protection Visitor disclosed that the woman was not a registered foster-mother and was in the habit of receiving regularly 6/- a week payment from the mother for the child's care and maintenance. Upon the reports on the case being submitted to the appropriate Committee, proceedings were authorised by them, and the case duly came before the Court. The woman pleaded " Guilty," and was fined £2 2s. and £2 2s. costs. The Magistrate in delivering judgment expressed a very strong view, and stated that if similar cases came before them the Court would seriously have to consider sending the delinquent to prison. It is a common defence where cases are taken for failing to give notice for the foster-mother to allege that the notice was sent. Two cases were considered sufficiently serious for us to initiate proceedings. In one case the Court did not accept the foster-mother's statement, and she was ordered to pay a fine of 5/-; in the other case the Magistrate gave the foster-mother the " benefit of the doubt." Other action taken; in one case where there was failure to notify reception of a nurse-child, the foster-mother was warned and she again failed to notify the removal of the same child. This foster-mother was removed from the Register. In another case, where there was obstruction to the Council's officer, no fireguard provision, and indifferent methods of feeding, the case was brought before the Council's solicitor, but, as there was considerable improvement subsequently, legal action was not taken. 23 [1934 Two deaths of foster-children occurred during the year. One was an inmate of an institution and died from a congenital heart defect; another was delicate and under weight when brought to the foster-mother, attended one of our local Welfare Centres, and on the advice of the Medical Officer was removed to St. Mary's Islington Hospital, where he died. Both these came under the review of the Coroner, who did not in either case hold an inquest. We were also satisfied that everything possible had been clone for the children. We also made enquiries into a third death of a child who had been under an Islington foster-mother and had also attended one of our Welfare Centres. This child was treated locally and was progressing well, but the mother who resided in another Borough, removed him. He w as admitted to a Public Assistance Hospital, where he died. Technically, this child, having been removed, was not at the time of his death a foster-child, but in this case also while under the foster-mother's care everything possible was done for the child. The various Departments of the Four Voluntary Centres, with the attendances ending March 31st 1934, may be summarised thus :— North. South. East. West. Total. 1. Ante-Natal Clinics and Ailing Mother Clinics. Number held weekly „ of attendances 4 2,567 2 859 † 620 §1 *273 8 4,319 2. Consultations for Children up to 5 Years of Age. Number held weekly ,, of attendances 10 20,695 11 18,096 **11 15,782 7 11,416 39 65,989 3. Home Visiting. No. of visits made 15,083 12,179 11,418 8,156 46,836 4. Dental clinics. Number attending 673 166 116 62 1,017 ,, of attending or rangements made for attending 1,805 369 - - 2,174 5. Morning Callers. Number of attendances 1,270 827 + + 1,184 3,281 6. Massage Clinics. No. of cases given massage or sent for massage 78 64 (& Sunlight treatment) 128 23 293 7. wards. Number of beds 18 - - 8 26 ,, of patients recieved 166 - - 87 253 8. Number of Children on Books 2,000 1,544 1,211 925 5,680 § Birth Control Clinic takes the place of one Ante-natal Clinic on 2nd Tuesday in month, †Extra Clinic held 2nd Thursday in month. * Attendances of Expectant mothers only. ** Including 2 Observation Clinics. ‡{ Not recorded. 1934] 24 REPORT ON THE WORK OF THE DAY NURSERIES RECEIVING GRANTS FROM THE BOROUGH COUNCIL. There are three Day Nurseries in the Borough. No. of places provided No. of attendances during 1934 i. Lower Holloway Day Nursery, 547, Liverpool Road, N. 50 9,936 ii. South Islington Pro Patria Day Nursery, 9, Canonbury Lane, N.l 55 9,707 iii. St. Luke's Day Nursery, 29 and 30, Penn Road, N.7 30 4,711* Total *Guest House. 135 24,354 The " Guest House " in connection w ith St. Luke's Day Nursery has accommodation lor 12 {and two extra in an emergency). During the year ending March 31st, 1934, (he admissions numbered GO. The accommodation has always been fully taken up, and there were many demands for admission which could not be complied with. MATERNITY AND CHILD WELFARE. Contributions by the Borough Council. Year ending 31st March, 1935. Voluntary Welfare Centres. Day Nurseries. £. £. North Centre 5,428 Lower Holloway 244† South Centre 2,469 St. Luke's ... 229 East Centre 1,859 South Islington 600 West Centre 1,932 Total £1,078† Total £11,688 * This Nursery is a municipally owned building. (No rent charged for its use), f To this amount must be added £150 for recent alterations. INVALID CHILDREN'S AID ASSOCIATION. The Borough Council contributes £25 per annum to the Local Bianch of this Association. During the year, 66 Islington children under five years were given periods of convalescence either in the country or by the sea, and 22 children of like ages, crippled, were provided with surgical appliances, splints, special boots, etc. Contributions for Maternity and Child Welfare Wokk per Case in Respect of Work Done. The Islington Borough Council has an arrangement with the North London Nursing Association for the attendance, by visitation, in cases of Ophthalmia Neonatorum, Acute Primary Pneumonia, Acute Influenzal Pneumonia, Measles, Whooping Cough and Epidemic Diarrhoea. The payments made to this Association, at the rate of one shilling per visit, were :— Under Maternity and Child Welfare £48 5 0 Under Public Health £16 II Of Total £64 16 0 25 [1934 Contributions under arrangements for maternity cases admitted to beds at Maternity Hospitals, the contributions being; a grant of 10s. per case, were : City of London,Maternity Hospital, £69 10s. Od. ; Royal Free Hospital, £14 0s. 0d.. In addition to these, cases of Ophthalmia Neonatorum and Marasmus are admitted to the London County Council's Hospital (St. Margaret's), Camden Town, N.W. and Queen Mary's Hospital, Carshalton. † Includes also nursing of pneumonia (adult). SURVEY OF MATERNITY AND CHILD WELFARE SERVICES. The Maternity and Child Welfare services in the Borough were comprised in a survey made bv officers of the Ministry of Health during the year. A precis of the matters reported on for the Council's consideration is given on page 83. DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—2,350 persons died in the Public Institutions located in Islington, of whom 1,536 belonged to this Borough, the remaining 814 having come here for treatment or relief. Of this latter, 425 died in the Archway Hospital, 200 in the Royal Northern Hospital, 44 in the London Fever Hospital, 08 in the St. Mary's Islington Hospital and Islington Institution, and 13 in the Mildmay Hospital. Of the 2,350 deaths of inhabitants, 1,058 occurred in the St. Mary's Islington Hospital, 192 in the Islington Institution, 118 in the Royal Northern Hospital, and 131 in the Archway Hospital. The proportion which the 2,350 deaths in the Public Institutions bore to the Borough mortality was 63.1 per cent. Without the Borough.—1,293 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, 28 in the North-Western Fever Hospital, 21 in the Children's Hospital, Great Ormond Street, 64 in St. Bartholomew's Hospital, 16 in the Infirmary, Friern Barnet, 48 in the Royal Free Hospital, 68 in the University College Hospital, 34 in the North-Eastern Hospital, 5 in the Eastern Fever Hospital, 35 in the Middlesex Hospital, 7 in the City of London Maternity Hospital, 15 in the Metropolitan Hospital, 11 at la, Manor Road, Ilford (Claybury), and 24 in Tooting Bee Hospital. These 1,293 deaths represented 34.7 per cent, of all the deaths registered in the year. Within and Without the Borough.—The deaths of Islingtonians numbered 2,829, and were equal to 76.0 per cent, of the total deaths registered during the year. Fatal Accidents or Sudden Deaths outside the Borough.— 30 inhabitants died from accidental deaths, or suddenly, in places outside Islington. During the previous year (1933) the total deaths in Local Institutions numbered 2,335, being 1,604 inhabitants of Islington in Local Institutions, plus 731 non-inhabitants of Islington in Local Institutions, the number in Islington Hospital being 1,365, the number in the Royal Northern Hospital 108. The 1934] 26 deaths of inhabitants of Islington in Institutions outside the Borough were 917. The total deaths of Islingtonians in all Institutions were 2,521, and the proportion per 100 deaths from all causes equalled 63.7. Transferable Deaths. —During the year 52 deaths of residents that had occurred in outlying Institutions and other places in Provincial Boroughs were transferred by the Registrar-General to Islington. MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, Fevers— Typhus, Enteric and Continued—and Diarrhoeal Diseases. During the year 145 persons died from these diseases, the death-rate being 0.46 per 1,000 inhabitants, as contrasted with 0.49 in the corresponding period last year, and a decennial average mortality of 172 and a death-rate of 0.53 per 1,000. In London the death-rate from epidemic disease was 0.40. Locally the deaths in the Sub-Registration Districts and Wards were as follows :— Showing the Deaths from eac!i of the principal Epidemic Diseases in the several Wards and Sub-Registration Districts during the Year 1934. SubRegistration Districts. Wards Enteric Fever. Small Pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Enteritis and Diarrhoea. Totals. Tufnell Tufnell 2 1 4 8 15 Up. Holloway Up. Holloway - - 3 2 - 5 10 Tollington Tollington - — 5 — - 9 3 17 Lr. Holloway Lr. Holloway - — 6 1 1 3 10 21 Highbury Highbury - - 6 1 4 2 5 18 Mildmav 1 — 2 2 1 1 5 12 Barnsbury Thornhill - - 7 - 1 3 2 13 Barnsbury - — 2 — — 3 3 8 Islington South East St. Mary's - - 2 - 1 - - 3 Canonbury - — 2 1 - 3 5 11 St. Peter's - — 2 — 4 4 7 17 The Borough 1 — 39 5 15 32 53 146 Total Death Rates 0.00 — 0.12 0.02 0.05 0.10 0.17 0.46 27 [1934 Showing the Deaths and Death-Rates from the Principal Epidemic Diseases during the ten years 1924-33 and for the Year 1934. 1924 1925 1926 1927 1928 1929 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths Rates. Enteric Fever 4 001 4 0.01 1 0.00 — — 2 0.00 2 0.01 Small Pox — — — — — — — — — — — Measles 103 0.30 22 0.06 69 0.20 29 0.09 156 0.48 11 0.03 Scarlet Fever 10 0.03 8 0.02 12 003 8 0.02 8 0.03 8 0.03 Whooping Cough 57 0.17 61 0.20 29 0.09 45 0.14 21 0.06 126 0.39 Diphtheria 33 0.09 21 0.06 31 0.09 25 0.07 25 0.08 32 0.10 Diarrhoea and Enteritis (under 2 years) 52 7.65 per 1000 births 69 10.54 per 1,000 births 69 10.68 per 1,000 births 48 7.79 per 1,000 births 67 11.57 per 1,000 births 68 12.34 per 1,000 births 1930 1931 1932 1933 Mean 10 years 1934 Deaths. Death Rates. Deaths. Death Rates Deaths. Death Rates. Deaths. Death Rates, | Deaths. Death Rates. Deaths. Death Rates. Enteric Fever - - - - 4 0.01 2 0.00 1 0.01 Small Pox 1 0.00 — — — — — — — — — — Measles 140 0.43 7 0.02 52 0.16 14 0.04 60 0.18 39 0.12 Scarlet Fever 14 0.04 4 0.01 7 0.02 4 0.01 8 0.02 5 0.02 Whooping Cough 10 0.03 32 0.10 23 0.07 23 0.07 43 0.13 15 0.05 Diphtheria 42 0.13 15 0.04 20 0.06 33 0.10 28 0.08 32 0.10 Diarrhoea and Enteritis (under 2 years) 97 17.1 per 1,000 births 67 12.7 per 1,000 births 73 14.7 per 1,000 births 63 13.7 per 1,000 births 67 11.6 per 1,000 births 47 10.2 per 1,000 births 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. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Under 1 year 1 7 8 - 10 10 - 15 15 1 7 8 2 39 41 1 to 5 years — — — - 2 2 - 2 2 - 2 2 — 6 6 Over 5 years 3 — 3 3 — 3 - — — - - - 6 - 6 Totals 4 7 11 3 12 15 — 17 17 1 9 10 8 45 53 INFLUENZA. Influenza caused 39 deaths during the year and showed a decrease of 131 on the return for the year 1933, and were G2 below the average of the preceding ten years 1924-33. The death-rate was equal to 0.12 per 1,000 inhabitants, 1934] 28 Showing the Deaths from Influenza in the Quarters of the Year 1934, together with the averages of the corresponding periods, 1924-33. Years. First. Quarters. Fourth. Totals. Second. Third. 1924 70 15 4 15 104 1925 47 3 1 21 72 1926 15 24 3 9 51 1927 118 15 7 12 152 1928 18 12 3 8 41 1929 190 13 1 3 207 1930 5 4 3 4 16 1931 68 4 4 14 90 1932 82 9 4 8 103 1933 162 1 — 7 170 Average 78 10 3 10 101 1934 17 12 1 9 39 Increase or Decrease — 61 + 2 — 2 — 1 — 62 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 1934. Ages. 1924 1925 1926 1927 1926 1929 1930 1931 1932 1933 Mean 10 yrs 1934 Difference. 0- 5 11 6 - 8 3 5 1 4 5 4 5 - 5 5-10 1 2 1 4 1 1 — — — — 1 1 10-15 2 — — 1 — — — — — - - - - 15-25 10 2 2 3 3 2 — 4 3 3 3 - 3 25-35 7 1 4 13 1 9 — 4 9 10 6 2 4 35-45 10 3 8 21 6 19 — 14 4 24 11 I 10 45-55 12 11 6 22 4 38 5 16 10 27 15 6 9 55-65 19 11 12 28 6 43 3 16 18 32 19 5 14 65-75 16 19 8 34 7 52 2 15 25 33 21 11 10 75 & upwards 16 17 10 18 10 38 5 17 29 37 20 13 7 All Ages 104 72 51 152 41 207 16 90 103 170 101 39 62 SEPTIC DISEASES. Erysipelas and Puerperal Septicaemia are the notifiable diseases of this class. Erysipelas—24 deaths were returned from this disease, or 4 more than in the year 1933, and 10 above the average of the preceding ten years 1924-33. Puerperal Diseases.—These comprise Puerperal Pyaemia, Septicaemia, Septic Intoxication and Puerperal Fever, and they caused 12 deaths, being one less than in 1933, and were 3 above the average of the ten years 1924-33. The deathrate was equal to 2.G per 1,000 births. Septicaemia (non-notifiable purulent infections) deaths numbered 10. Anthrax, Glanders, Farcy, Tetanus, etc.—No death was recorded during 1934. INDUSTRIAL DISEASES. Lead Poisoning, Chrome, etc.— No death from any of these causes was recorded. CANCER. Cancer—577 deaths were registered from this malignant disease during the year compared with 509 in 1933, and with an average of 492 in the previous decennium. The deaths represent a death-rate of 1,84 per 1,000 of the civil 29 [1934 population and is 0.34 above the average rate (1.50) of the last ten years; 270 deaths occurred among males and 307 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 1934 :— Ages. 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Mean l0yrs 1934 Difference 0- 5 1 1 1 - 3 2 - 2 2 1 1 - 5-15 1 2 — — — 1 - 3 1 1 1 1 — 15-25 4 3 3 1 3 1 1 1 2 3 o — - 2 25-35 9 5 6 5 14 10 6 10 12 9 9 11 + 2 35-45 38 40 27 24 36 22 26 25 19 23 28 24 — 4 45-55 77 93 73 74 83 84 72 85 78 84 80 83 + 3 55-65 131 168 142 137 147 153 123 138 157 160 146 160 + 14 65-75 149 144 144 135 155 106 139 167 158 146 144 200 + 56 75-85 52 71 51 65 71 81 90 83 92 70 72 87 + 15 85 & upwards 8 7 7 7 9 10 8 7 13 11 9 10 + 1 Totals 470 534 453 449 518 471 467 519 534 509 492 577 + 85 Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the year 1934. Quarters. Tufnell, Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. The Borough First 15 18 11 19 28 21 40 152 Second 11 21 15 20 20 19 44 150 Third 18 13 9 13 27 20 29 129 Fourth 16 12 13 19 22 19 45 146 The Year 60 64 48 71 97 79 158 577 TUBERCULOSIS. Tuberculosis caused 280 deaths, which were 70 below the average of the last decennium, and were 32 below the number registered in 1933. The deathrate resulting from them was equal to 0.89 per 1,000 of the civil population, and represented 7.5 per cent, of the deaths from all causes during the year. Tuberculosis of the Respiratory System (Phthisis or Pulmonary Tuberculosis), caused 253 deaths, as contrasted with the decennial average of 305, while the death-rate was 0.81 per 1,000 of the civil population as against the decennial rate of 0.93 per 1,000. There was a decreaseof 52 on the ten years average number of deaths, and of 0.12 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 1924 340 0.99 8.05 12.3 1925 382 1.13 9.18 12.3 1926 289 0.85 7.06 12.0 1927 314 0.94 7.61 12.3 1928 309 0.95 7.43 12.8 1929 314 0.98 6.59 14.8 1930 280 0.86 7 .03 12.1 1931 281 0.87 6.85 12.6 1932 264 0.81 6.58 12.4 1933 274 0.86 6.92 12.4 Average 10 years 305 0.93 7.35 12.6 1934 253 0.81 6.80 11.8 1934] 30 The following return gives the deaths at each age period :— Age Periods. Males. Females. Total. 0-5 2 - 2 5-15 4 1 5 15-25 22 30 52 25-35 33 19 52 35-45 28 14 42 45-55 39 13 52 55-65 23 4 27 65 upwards 18 3 21 Total 169 84 253 Showing the Deaths from Tuberculosis of Respiratory System in the Sub-Districts during the Four Quarters of the Year 1934. Quarters. Tufnell. Upper way. Tollington. Lower way. Highbury. Barnsbury. Islington, South East. The Borough First 8 3 11 8 8 19 22 79 Second 10 6 3 6 9 12 21 67 Third 3 4 4 7 5 6 15 44 Fourth 1 6 8 7 8 9 24 63 The Year 22 19 26 28 30 46 82 253 Showing the Deaths from all forms of Tuberculosis during 1934. Form. Ages. Sex. Districts Total Deaths. 0-1 1-5 over 5 M. F. Tuf. U.H. Toll. L.H. H. B. S.E. Respiratory 2 - 251 169 84 22 19 26 28 30 46 82 253 Meningeal 1 4 3 5 3 — — — 2 — 4 2 8 Abdominal - — 9 2 1 1 — 1 — 1 — — 3 General — 1 1 1 1 _ 1 — — — 1 — 2 Other forms 1 1 12 8 6 3 1 2 — 3 3 2 14 All Tuberculosis 4 6 270 185 95 26 21 29 30 34 54 86 280 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 547 deaths, 18 below that of 1933. They were equal to a death-rate of 1.74 per 1,000 of the civil population, and represented 14.7 per cent. of the total deaths registered in the Borough. Acute Bronchitis.— There were 59 deaths as compared with 87 in the previous year, 24 occurred among males, and 35 among females. The deaths of 8 infants under 12 months were registered. Chronic Bronchitis.—121 deaths were ascribed to it, 75 being males and 40 females. This return is 38 above that of 1933. Pneumonia (All forms).—337 deaths were registered, of which 192 were males and 145 females, and were 31 above the year 1933. 62 infants under a year old died from this disease, while between the ages of 1 and 5 years 25 died from it. Above 5 years of age the deaths numbered 250. 167 deaths occurred in Public Institutions, chiefly the Islington Hospitals. 31 [1934 Pleurisy.—There were 6 deaths registered from this disease; 3 deaths occurred in Public Institutions. Asthma and Emphysema.—1 death was recorded from Asthma. Other Diseases of the Respiratory System.—23 deaths were registered, as contrasted with 20 in 1933. VENEREAL DISEASES. Fourteen deaths were ascribed to these diseases, 5 less than last year. Of these, 8 were males and 6 females. They were equal to the mean deaths (14) of the preceding ten years 1924-33. The three groups of ages at death were as follows :—Under 1 year, 3 deaths; 1-5 years, no death ; and over 5 years, 11 deaths. The nearest treatment centres of these diseases are the Royal Northern Hospital, Holloway Road, N., and the Royal Free Hospital, Gray's Inn Road, W.C.I. A complete list is exhibited in the public conveniences under the control of the Council. Information and leaflets are distributed on application by letter or otherwise by the Medical Officer ot Health, and if desiied, he personally advises applicants as to what they should do to secure the necessary confidential treatment. Applicants of both sexes have taken advantage of these facilities for information. Mr. George Jewsbury, 39, Kelvin Road, N.5, the Secretary of the local branch of the British Social Hygiene Council, has kindly reported to me on the work of the Local Branch in 1934. As in previous years, open-air addresses were given fortnightly at Highbury Corner. The meetings were well attended, the lectures being followed attentively by audiences of 100 to 200. Meetings were also arranged at the Central Library Hall on October 10th, 17th and 24th for girls, and on October 12th, 19th and 26th for young men. Six talks were given on the subject of " Sex—its place in Life," with special film showings; the average attendance was forty. No charge was made for admission, and there was some evident desire, both of girls and young men, to learn the facts. DEATHS FROM COAL-GAS POISONING. During the year 28 deaths were registered from asphyxia caused by the inhalation of carbon monoxide gas. (The same number of deaths from this cause occurred in 1933.) Twenty-five of these deaths, ivere attributable to suicide, while the cause of the remaining three deaths were accidental. Of the 28 deaths, 20 were males and 8 females, the ages ranging from under 20 to 75 years. ACCIDENTAL DEATHS. The deaths of Islington residents due to accident numbered 124. Of this number 77 deaths were ascribed to vehicular traffic and may be summarised as follows :— Motor Car Other or Lorry. Bus or Tram. Taxi-cab. Vehicles. Total. 67 11 — 9 77 Of this number, 30 deaths occurred to Islington residents when in outlying districts. 1934[ 32 In addition to these, 20 non-residents were also killed by vehicles within the borough. CORONER'S COURT, INQUESTS, AND MORTUARY. During' the year 31 bodies were received into the Mortuary, as compared with an average of 236 in the preceding 10 years. The daily average number of bodies received was 0.08, whilst in 1933 the average was 0.09. No inquests were held, as contrasted with an average of 186 in the ten years 1924-33. Year. Bodies received into Mortuary. Inquests. 1924 294 317 1925 275 306 1926 308 305 1927 309 240 1928 274 206 1929 306 246 1930 279 177 1931 230 65 1932 52 Nil 1933 35 Nil Average 236 186 1934 31 Nil The bulk of the Islington cases are enquired into at the St. Pancras Coroner's Court, and it is understood that there has been a growing tendency to make use of the mortuary and post-mortem room and accommodation in St. Pancras in connection with cases occurring outside that Borough, particularly from Islington and Hampstead. The matter is under the consideration of the Metropolitan Boroughs' Standing Joint Committee. PREVENTION OF INFECTION. Notification, Isolation, Fatality, or Specified Diseases under the Provisions of the Public Health (London) Act, 1891. The Principal Diseases Include :•— Small Pox, Diphtheria, Scarlet Fever, Enteric Fever, Typhus, Continued Fever, Puerperal Fever and Erysipelas. 2,227 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 00. No case of either Typhus or of Continued Fever was notified. The total cases notified are 211 more than those of the previous year (2,016), and 96 above the average (2,131) of the preceding ten years. The increases when contrasted with the decennial averages are to be found in the returns from Diphtheria, Erysipelas and Puerperal Fever, which were respectively 7, 47 and 20 above the average, while Scarlet Fever and Enteric Fever showed decreases of 36 and 12 respectively on the ten years' average. The 2,227 cases were equal to an attack-rate of 7.08 per 1,000 of the civil population. 33 [1934 The returns for the preceding ten years are given in the following statements :— Year. Cases. Attack-rates per 1,000 civil population. 1924 2,085 6.06 J 926 2,194 6.47 1926 1,918 5.65 1927 1,813 5.42 1928 2,260 6.96 1929 2,439 7.62 1930 3,057 9.38 1931 2,111 6.50 1932 1,962 6.04 1933 2,016 0.32 10 years average 2,131 6 49 1934 2,227 7.08 Registration Sub-Districts—The total number of cases notified in these disti icts was as follows :— Total cases notified. Tufnell 223 Upper Holloway 193 Tollington 227 Lower Holloway 291 Highbury 300 Barnsbury 470 Islington South-East 523 Total 2,227 SMALL POX. There were 70 cases notified during the year, of which number 1 was unconfirmed. Of the 69 confirmed cases, 61 were unvaccinated, and 8 (adults) were vaccinated in infancy. The unconfirmed case was an adult vaccinated in infancy. The type of Smallpox was as usual Variola Minor. The first case was notified on the 1st January, 1934, the patient being a scholar at Tollinglon Park Central School. The second case notified was a married woman, aged 23 years, and the source of the disease was obscure. It was, however, discovered that she had been in contact with a case which had been considered to be Chicken-pox, and this appeared to be the source of the infection, inasmuch as the father of this alleged case of Chicken-pox, aged 62 years, developed Smallpox. Luckily as far as our knowledge goes, from this " missed " case there were only three persons infected, cases Nos. 2, 6 and 8. The difficulty in tracing the source of infection of case No. 2, that is, the first case infected from the alleged " Chicken-pox," was that the patient and her husband, being in the theatrical profession, were known to the contacts only by their professional names. Cases Nos. 3, 9, 10, 20, 21, 22 and 24 were associated by visitation or residence, and thus the source of infection was clear. Case No. 7 was a known contact of No. 4, and No. 19 with No. 7. The next serious outbreak developed from a school connection. Two children sickened on the 21st January; one attended St. Mary Magdalene School and the other Westbourne Road School. The source of infection of these children was not traced, but the scholar at Westbourne Road School was evidently the primary cause of the subsequent cases. There were at Westbourne Road School 11 scholars in all affected. In collaboration with the School Authorities it was arranged that our Public Vaccinator should attend at Westbourne Road School and vaccinate the children whose parents had given consent. 183 consented ; 168 of these were successfully vaccinated, 14 appeared to be immune, and 1 could not 1934] 34 be traced afterwards. In a number of cases the source of infection was traced to contact with a fellow worker, and in one group three cases were workers who w ere dealing with paper. Subsequent cases to the number of 4 or 5 frequently occur owing to the refusal of vaccination, or delay in having it done, on the part of contacts. In one instance the husband, although quite well, appears to have carried the infection from his workplace to the home, as his wife contracted the disease. Classification as to source of infection. Infection from previous cases 38 Infection from common lodging houses — Infection from school 8 Smallpox in the neighbourhood 1 Infection from workplace 4 Infection not traced 15 Contact with cases in other Boroughs — Infection in hop fields — Infection from hospital — Infection possibly from " missed " case 3 Unverified cases 1 Total 70 State of vaccination of persons notified to be suffering from Smallpox during the year 1934. Age. Unvaccinated. Vaccinated in Infancy. Doubtful. 0-5 7 — — 5-10 12 — — 10-15 15 — — 15-20 12 — — 20-30 11 1* — 30-40 3 1 — 40-50 1 2 — 50-60 — 2 — 60 and upwards — 3 — 61 9 — * 1 unconfirmed. Diphtheria was responsible for 811 cases of illness, which were 7 above the average (804) of the preceding ten years. The attack rate was equal to 2.58 per 1,000 of the civil population annually, and was 0.13 above the mean rate (2.45) of the decennial period. In London the attack-rate was 2.5 per 1,000. DIPHTHERIA ANTI-TOXIN; IMMUNISATION. Under the Special Order of 15th August, 1910, the then Local Government Board sanctioned the provision by the Sanitary Authority, in pursuance of section 77 of the Public Health (London) Act, 1891, of a temporary supply of Dip htheria Anti-toxin " for the poorer inhabitants of the district, subject to the fol jwing conditions, that is to say, the arrangements with respect to the keeping, distribution and use of the Diphtheria Anti-toxin shall be made in accordance with the advice of the Medical Officer of Health." 35 U934 The section of the Public Health Act referred to is that which enables the authority,with the sanction of the Local Government Board,to provide a temporary supply of medicine, etc., for the poorer inhabitants of their district. (See also page 40.) Applications in respect of 8 children were received for Diphtheria immunisation (Schick Test) during the year. Cost, £4 0s. Od. ANTI-TOXIN TREATMENT. During the year 34,000 units of Diphtheria Anti-toxin serum were issued to Medical Practitioners in the Borough. Of this quantity 30,000 units were sold, the total amount received by the Council being £1 9s. 9d. The remaining 4,000 units were given free, owing to the patients' limited means. Scarlet Fever.—1,089 cases were notified, and they showed a decrease of 30 on the average (1,125) of the ten years 1924-33. The attack-rate was equal to 3.47 per 1,000 of the civil population annually, which is an increase of 0.04 per 1,000 of the mean rate (3.43) of the preceding ten years. In London the attackrate was 4.3 per 1,000 of the civil population. As will be seen by the Table, page 00, 79 cases of Scarlet Fever were treated at home. A proportion of these of course were due to the London County Council circular stating that the accommodation for Scarlet Fever was limited in view of the increased treatment of Measles. Cases of Scarlet Fever were only admitted to Hospital on the recommendation of the Medical Officer of Health from 11th January until 9th July inclusive. Enteric Fever.—A total of 6 cases of Enteric Fever were notified. This is a decrease of 12 on the average (18) that obtained during the ten years 1924-33. The attack-rate was 0.02 per 1,000 annually, a decrease of 0.03 on the mean rate, 0.05, of the last ten years. In London the rate was 0.03. A detailed investigation was made in regard to a case of Enteric Fever occurring in an institution. This occurrence in itself would not have been thought out of the ordinal) except for the fact that in occasional years in this same institution an odd case of Enteric Fever had occurred, and the Superintendent of the Institution approached me to see if I could explain why, when a case of Enteric Fever did occur in the institution, it so happened that it was always the inmate of a particular room. A careful examination of the room itself, even to the extent of lifting a portion of the flooring revealed nothing ; the water supply and the cistern likewise. Attention was then directed to the outside of the building to ascertain the possibility of anything having entered by the window of the particular room. A small distance to the side of the particular window was the entrance to the stoke-hole of the heating apparatus of the institution. It was noticed that one of the flagstones was damp. This w as removed, and underneath was found a drain which had been broken into, evidently to provide a surface water drain for any water which may accumulate in the stoke-hole. This w as followed up, and it was found to enter a three-way junction channel. The manhole cover at the spot where the three-way junction existed was removed, and a careful examination showed that the channel had sunk since its construction and had approximately 2 inches of an adverse fall, that is, the channel sloped in the wrong direction. There appeared sufficient evidence that foul gases could go back along the drain to the stoke-hole flag floor, and in certain conditions might be wafted towards the window ; there was also the question of the carriage of infection by flies and other means. The reason there 1934] 36 was just an occasional case of Enteric Fever was due to the fact that infection is largely a matter of chance ; for instance, the fly may not have carried infection, the particular individual occupying the room may not have been in a receptive condition, may have been immune, etc., but it showed a commendable degree of observation that my attention should have been drawn to the curious fact that these occasional Enteric Fever cases occurred in the case of inmates of a particular room. The necessary reconstruction of the drainage was carried out. Puerperal Fever.—See page 12. Erysipelas.—193 cases were notified, and were 47 above the average of the preceding ten years, the attack-rate being 0.61 per 1,000 of the civil population. FATALITY FROM THE 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 2,227 cases notified, 65 deaths occurred, or 2.9 per cent., which contrasts with an average percentage of 2.7 in the preceding ten years 1924-33. Years. Cases. Deaths. Fatality. 1924 2,087* 66 3.2 1925 2,194 61 2.3 1926 1.919‡ 63 3.3 1927 1,813 55 3.0 1928 2,260 60 2.7 1929 2,439 57 2.3 J 930 3,057 80 2.6 1931 2,111 43 2.0 1932 1.962 50 2.7 1933 2,016 67 3.3 Mean 2,186 59 2.7 1934 2,227 65 2.9 * Including 2 cases not notified. ‡ Includes 1 cass not notified Hospital Isolation.—Of the 2,227 cases of infectious disease notified, 2,064 were isolated in hospital, equal to a percentage of 92.6, while only 7.4 per cent, of the patients were nursed at home. The following tabular statement shows the number of cases treated in the various public institutions :— Year. Cases treated in Hospital. Percentage of cases treated. 1924 1,975 94.6 1925 2,105 96.9 1926 1,852 96.5 1927 1,722 95.0 1928 2,153 95.3 1929 2,337 95.8 1930 2,879 94.2 1931 2,015 95.4 1932 1,879 95.7 1933 1,911 94.3 1934 2,227 92.6 37 [1934 DISEASES TREATED IN HOSPITAL. Disease. Total cases. Cases isolated in Hospital. Percentage of known cases Small-pox 70 70 100.0 Scarlet Fever 1,189 1,010 92.7 Diphtheria 815 806 99.1 Enteric Fever 6 5 83.3 Erysipelas 193 126 65.3 Puerperal Fever 54 47 87.0 2,227 2,064 92.6 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 1934. 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 70 - 70 100.0 - - - - - - - Scarlet Fever 1,010 79 1,089 92.7 7.3 5 - 5 0.4 0.4 Diphtheria 806 9 815 99.1 0.9 29 3 32 3 4 0 .4 3.8 Enteric (Typhoid Fever) 5 1 6 83.3 16.7 1 - 1 16.6 - 16.6 Erysipelas 126 67 193 65.3 34.7 21 3 24 10.8 1.6 12.4 Puerperal Fever 47 7 54 87.0 13.0 1 2 3 1.9 3.8 5.6 Continued Fever - - - - - - - - - - - Total 2,064 163 2,227 92.6 7.4 57 8 65 2.6 0.3 2.9 Showing the number of Cases and Attack Rates of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1924-33 and in 1934. DISEASES. YEARS. Average number of cases, 1924-33 1934 Increase or Decrease 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Small-pox Cases - - 1 - 4 71 244 66 162 11 †— 70 — Rate — — 0.00 — 0.01 0.22 0.75 0.21 0.50 0.03 — 0.22 — Diphtheria Cases 854 911 743 716 756 1004 1242 710 598 547 804 811 † 7 Rate 2.48 2.69 2.19 2.14 2.33 3.14 3.81 2.19 1.84 1.72 2.45 2.58 + 0.13 Membranous Croup Cases 2 2 — 4 4 4 6 4 3 4 4 4 — Rate 0.00 0.00 — 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 — Scarlet Fever Cases 1077 1139 1010 909 1305 1155 1310 1093 983 1220 1125 1089 — 36 Rate 3.13 3.36 2.98 2.72 4.02 3.61 4.02 3.37 3.03 3.82 3.43 3.47 + 0.04 Enteric Fever Cases 14 10 18 12 19 18 31 16 15 15 18 6 — 12 Rate 0.04 0.03 0.05 0.03 0.06 0.06 0.09 0.05 0.04 0.05 0.05 0.02 — 0. 03 Continued Fever Cases 3 — 1 — — 1 — — 1 — — — — Rate 0.01 — 0.00 — — 0.00 0.00 — 0.00 — — — — Puerperal Fever* Cases 19 23 27 33 38 38 36 45 35 36 34 54 + 20 Rate 2.79 3.50 4.18 5.40 6.56 6.89 6.3 8.52 7.07 7.86 5.89 11.68 + 579 Erysipelas Cases 116 109 118 139 134 148 188 177 165 183 146 193 + 47 Rate 0.34 0.32 0.35 0.42 0.41 0.46 0.58 0.54 0.51 0.57 0.45 0.61 + 0 16 Totals Cases 2085 2194 1918 1813 2260 2439 3057 2111 1962 2016 2131 2227 + 96 Rate 6.06 6.47 5.65 5.42 6.96 7.62 9.38 6.50 6.04 6.32 6.49 7.08 + 0-59 * Per 1,000 Registered Births. †Average where there has been continuance of disease during 10 years. 1934] 38 Showing the Cases of the Notifiable Infectious Diseases notified in the SubRegistration Districts and the Wards during the Year 1934. SubRegistration Districts. Wards. Small pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. 1 Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total. Tufnell Tufnell - 116 80 1 - 20 6 - - - 223 Up. Holloway Up. Holloway 4 99 56 - 1 - 25 8 — - - 193 Tollington Tollington 3 115 84 - - - 21 4 — - - 227 Lr. Holloway Lr. Holloway 41 139 87 - 1 - 20 3 — - - 291 Highbury . Highbury 11 62 48 1 — - 9 10 - - - 141 Mildmay 1 87 60 - 2 - 8 1 - - - 159 Barnsbury Thornbill — 126 107 3 — - 25 7 — - - 268 Barnsbury 2 105 78 — — - 12 5 — - - 202 Islington, S.E. St. Mary's 2 72 63 — — - 17 4 — - - 158 Canonbury 1 91 83 1 — 16 2 — - — 194 St. Peter's 5 77 65 — — - 20 4 — — - 171 Totals 70 1,089 811 4 6 — 193 54 — — — 2,227 Attack-Rates per 1,000 population 0.22 3.47 2.58 0.01 0.02 — 0.61 0.17 - - — 7.08 other notifiable: diseases. The diseases which are notifiable in Islington include those which have si/ice 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 Poliomyelitis, Acute Encephalitis Lethargica, Acute Polio-Encephalitis, Acute Primary Pneumonia, Acute Influenzal-Pneumonia, Cerebro-spinal fever or Epidemic Cerebro-spinal Meningitis, Dysentery, Glanders or Farcy, Hydrophobia or Rabies, Malaria, Ophthalmia Neonatorum, Plague, Tuberculosis, Puerperal Pyrexia, and Chicken-pox (except in the vaccinated under 10 years of age). Acute Poliomyelitis. Four cases were notified from this disease during the year, as contrasted with eight in 1933, and four in 1932. 1934 1933 Cases. Deaths. Cases. Deaths. 1st Quarter Nil Nil Nil Nil 2nd „ 1 ,, 3 ,, 3rd ,, 2 ,, 3 ,, 4th „ 1 ,, 2 ,, 4 Nil 8 Nil Epidemic Cerebro-Spinal Meningitis. Eleven cases came to the knowledge of the Medical Officer of Health as against 12 in 1933. During the ten years 1924-33 the cases averaged 11 per annum. 39 [1934 A return of attacks o( the disease during the past ten years is given in the following statement :— 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Average 10 yrs. 1924-33 1934 Total Deaths, 1924-33. 1st Quarter - 2 3 3 1 o 4 4 7 1 3 3 21 2nd ,, ; - 1 3 3 4 2 5 9 3 6 4 4 26 3rd „ 2 2 3 — 2 2 2 1 3 3 2 2 14 4th „ 4 1 2 1 1 3 2 2 6 2 2 2 14 Year 6 6 11 7 8 9 13 16 19 12 11 11 75 The deaths during the year numbered 4, and were equal to a rate of 3G per cent. of the cases notified. INFECTIOUS DISEASES (LONDON) REGULATIONS, 1927. Malaria, Dysentery, Acute Primary Pneumonia and Acute Influenzal Pneumonia. Schedule dealing with Typhus, Relapsing and Enteric Fevers. Regulations dealing- with these diseases came into force on the 7th January, 1919. Dysentery , and the alterations of the Regulations, to suit London, were fully dealt with in the Annual Report for 1927, pages 34 and 35. During the past five years the following cases were notified by medical practitioners to the Medical Officer of Health. 1930 1931 1932 1933 1934 Malaria Nil 1 2 Nil Nil Dysentery Nil 6 15 5 5 Acute Primary Pneumonia 323 370 254 179 189 Acute Influenzal Pneumonia 36 115 87 125 71 Total 359 492 358 309 265 ISLINGTON (CHICKEN-POX) REGULATIONS, 1930. The regulations came into operation on the 24th March, 1930, and from that time to the end of this year 2,351 cases had been notified. In 1934 the notifications were 423. DYSENTERY. Five cases were notified during the year, but there was no common source of infection. They were isolated cases occurring throughout the year. GLANDERS, ANTHRAX AND HYDROPHOBIA IN MAN. Order under Section 55 of the Public Health (London) Act, 1921, by the London County Council. (Came into operation on the 26th April, 1909.) No case w as recorded during the year. Acute Encephalitis Lethargica and Acute Polio-Encephalitis. These diseases became notifiable under an Order of the Local Government Board on the 1st January, 1919. During the year 2 cases of Acute Encephalitis Lethargica were known, and were notified ; no deaths were registered. No cases of Polio-encephalitis were notified, and no deaths were registered. 1934] 40 The following summary shows the number of cases, and also the fatality of recent years :— Acute Encephalitis Lethakgioa. Years. 1924 19*25 19-26 1927 1928 1929 1930 1931 1932 1933 Average (10 years). 1934 Cases 39 17 '21 7 5 8 4 4 4 4 11 2 Deaths 4 6 9 4 3 3 - 2 1 3 3 - Ophthalmia Neonatorum. Purulent Disease of the Eyes of Newly-born Children. See page 9 SUPPLY OF INSULIN TO NON-INSURED PERSONS. Under Section 77 of the Public Health (London) Act, 1891, a temporary supply of medicine, etc., for the poorer inhabitants of a district may with the sanction of the Minister of Health, be made. Under this section, the Minister on the 9th December, 1929, granted authority to the Islington Borough Council to make such provision for the poorer inhabitants. The sanction was given provisionally for a period of twelve months, and was extended for a further period of 12 months. It is laid down by the Minister that practitioners applying for supplies of Insulin should state :— (a) the name and address, age and sex of each patient for whom it is wanted, and (b) to furnish a quarterly report in respect of each patient treated, giving the following information :— (1) The number of doses of Insulin administered ; (2) Whether any tests were made of the urine or of the blood of the patient, and, if so, by whom and with what results. The Minister of Health has to be furnished with a quarterly report by the Medical Officer of Health giving an abstract of the reports forwarded by the medical practitioners, the cost of the Insulin supplied by the Borough Council, and any ge neral remarks as to the working of the arrangements. So far the demand for such assistance for patients comes through the Almoners of three of the largest hospitals. During the year under review 11 cases have received this assistance from the Borough Council, the cost of the Insulin supplied being £26 17s. 6d. BLIND PERSONS ACT, 1920. Under this heading the number of " Totally Blind " and " Partially Blind '' children under 5 years of age coining to the knowledge of the Medical Officer of Health, and under supervision either of the Health Visitors or Voluntary Welfare Centres in the Borough, w ere as follows :— Totally Partially & ' Blind Blind No. of cases at the end of year 1933 1 10 No. of cases coming to the knowledge of M.O.H. during the year 1934 2 2 No. of cases which left during the year 1934— e.g., reached 5 years of age Nil 3 No. of cases under supervision at the end of the year 1934 3 9 PREVENTION OF DEAFNESS. Circular 1337a, Ministry of Health, dated 22nd May, 1933, on " Prevention ot Deafness." 41 [1934 The Islington Voluntary Welfare Centres dealt with cases coming under their supervision; some are treated at Centres, others are sent to hospitals. The Borough Council's and Centres' Health Visitors are instructed to visit such cases and see that the prescribed treatment is being followed. Discharging ears after Scarlet Fever, coming to the knowledge of the Medical Officer of Health—5 cases, after Diphtheria—3 cases. In addition, 32 from other causes were visited by the Health Visitors and the Centres, and 2 of these latter died (one with complication of cerebral abscess following mastoid abscess and one with complication of otitis media). tuberculosis. 534 cases of Tuberculosis in its different forms were notified during" the year. The attack-rate was equal to 1.70 per 1,000 of the civil population. This number was a decrease of 31 on the return of the previous year, and of 0.07 per 1,000 on the attack-rate. Respiratory (Pulmonary) Tuberculosis—455 notifications were received, of which 2g6 referred to males and 189 to females, and represented an attack-rate of 1.45 per 1,000 inhabitants. Showing the Notified Cases of Tuberculosis in the Wards during 1934 Registration Sub-Districts. Wards. Respiratory Tuberculosis. Other Forms of Tuberculosis. Grand Totals T uber- culosis Rate per 1,000 of Population. Malees Females Total Males Females Total Tufnell Tufnell 23 17 40 3 7 10 50 1.57 Up. Holloway Up. Holloway 22 19 41 2 5 7 48 1.61 Tollington Tollington 18 17 35 2 6 8 43 1.48 It. Holloway Lr. Holloway 23 19 42 4 6 10 52 1.33 Highbury Highbury 17 14 31 1 3 4 35 1.16 Mildmay 22 14 36 5 5 10 46 1.70 Barnsbury Thornhill 27 15 42 6 3 9 51 1.79 Barnsbury 26 24 50 2 3 5 55 2.35 Islington. S.E. St. Mary's 20 16 36 4 2 6 42 2.45 Canonbury 32 20 52 3 2 5 57 1.88 St. Peter's 36 14 50 2 3 5 55 1.96 Totals 266 189 455 34 45 79 531 1-70 THE PERIOD OF LIFE AT WHICH TUBERCULOSIS ATTACKED THE PERSONS NOTIFIED DURING 1934. Tubercular Diseases. Sex. Cases Notified in Whole District. At all ages. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up. Respiratory Tuberculosis M. 266 1 5 8 58 116 71 7 F. 189 — 2 12 65 74 30 6 Tubercular Meningitis M. 1 - 1 - - - - — F. - - - - - - - - Tabes Mesenterica M. - - - - - - - F. 1 - — - 1 — - — General Tuberculosis M. - - - - - - - - F. - - - - - - - Other forms of Tuberculosis M. 33 - 7 8 10 6 2 - F. 44 — 6 9 9 14 4 2 All Tubercular Diseases M 300 1 13 16 68 122 73 7 F. 234 - 8 21 75 88 34 8 Totals 534 1 21 37 143 210 107 15 Percentages at each life period to total cases 0.18 3.93 6.93 26.78 39.33 20.04 2.81 1934] 42 From the above statement it will be seen how the disease attacked people at the various ages, viz. : In every hundred eases 3.93 were aged 1 to 5 years. „ „ 6.93 were aged 5 to 15 years. Prime „ ,, 26.78 j were aged 15 to 25 years.* of „ „ 39.33 were aged 25 to 45 years. Life „ ,, 20.04 j were aged 45 to 65 years. ,, ,, 2.81 were aged 65 and upwards. Referring to the first Table above, it will be seen under " Respiratory Tuberculosis " that between the ages of 15 and 25, the males attacked number 58, while the females reached 65. TUBERCULOSIS. Year. Notified Cases. Coming to knowledge. Total. Deaths. 1925 885 287 Ph. 881 1172 Ph. 382 438 O.F. 291 O.F. 56 1926 704 186 Ph. 654 890 Ph. 289 351 O.F. 236 O.F. 62 1927 640 161 Ph. 657 801 Ph. 314 348 O.F. 144 O.F. 34 1928 694 140 Ph. 659 834 Ph. 309 358 O.F. 175 O.F. 49 1929 616 105 Ph. 592 721 Ph. 314 345 O.F. 129 O.F. 31 1930 590 111 Ph. 567 701 Ph. 280 315 O.F. 134 O.F. 35 1931 588 133 Ph. 590 721 Ph. 281 332 O.F. 131 O.F. 51 1932 577 140 Ph. 578 717 Ph. 264 308 O.F. 139 O.F. 44 1933 565 157 Ph. 572 722 Ph. 274 312 O.F. 150 O.F. 38 1934 534 122 Ph. 544 656 Ph. 253 280 O.F. 112 O.F. 27 Showing decrease Notified Cases also Deaths in the case of Pulmonary Disease. " Other forms," while lower since 1926 fluctuated (see above table). PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. These Regulations provide that no person suffering from respiratory tuberculosis who is in an infective condition shall be engaged in any form of dairv work involving the milking of cows, the treatment of milk, or the handling o; containers. No case came to the notice of the Medical Officer of Health during the year which called for action. ISLINGTON TUBERCULOSIS CARE COMMITTEE. I have received from Miss Threlfall, the Secretary of the Committee, the report for the year 1934, as follows - 43 [1934 Report for the year 1934. The year 1934 has been a propitious one for the Tuberculosis Care Committee in that from April 1st it came under the purview of the Borough Council, who appointed a paid Secretary and five of their own members to serve on it. When the existing" tenancy of the office at 19, Compton Terrace came to an end, accommodation was found in the Town Hall. This meant that the work could be carried on there every day of the week, and therefore much more efficiently. The fact that a hundred more cases have passed through the Committee's hands than during the previous year is perhaps proof of this. The Secretary is able to be in close touch with all Public Health officials, and it is felt that more intensive work is now being carried on. The Committee are indebted to the Borough Council for enabling this advance in their work to be made. The decision of the London County Council to abolish the assessment and collection of contributions for residential treatment from the beginning of August was met with approval by the Committee, who felt that where a member of a family had contracted tuberculosis extra money was needed for the better care of the family and patient, thus putting these contacts in a better state of resistance to prevent the spread of the disease. Incidentally, the abolition of the duty of collecting contributions has left more time for care work. The Handicraft Class had to be suspended for a time, much to the disappointment of its members, owing to lack of funds, but through the kindness of the Borough Council it was re-started later in the year, and is now being carried on successfully. The allotment plot is also still being maintained. The following are some examples of constructive care-work carried out during the year :— A.B. was a young boy away in Sanatorium. His father, a widower, was unemployed, and another son was also away ill. He was provided with clothes before admission to Sanatorium and whenever he needed them during his stay there. A small brother appeared in poor health, so it was arranged he should have convalescent treatment by the sea. He returned very much Improved in health and has continued to keep well. C.D. and E.D. were husband and wife, both in Sanatorium. Their income during sickness did not suffice to pay the rent to keep the home going. The help of the Charity Organisation was solicited and the balance needed was paid as long as necessary, and temporary assistance was afforded to E.D. when she first returned home. G.H. was a married woman suffering from pulmonary tuberculosis. She discharged herself from hospital on account of domestic difficulties, and once home w as unwilling to return, at any rate for the time being. Sleeping conditions were unsatisfactory and domestic duties too heavy. A folding bedstead and bedding were provided and the two younger children were boarded out. Later on G.H. was persuaded to accept further hospital treatment. I.J. was a single woman, aged 52, who was recommended Sanatorium treatment. Her Sickness Benefit was sufficient to pay her rent whilst away, but she had taken out certain insurance policies for benefit when she should retire from w ork, and these she could not keep up. The help of the Friends of the Poor was solicited and a weekly grant was made to her during her stay in Sanatorium to enable her to continue her insurance contributions. Temporary help was also given on her discharge. 1934] 44 K.L. was a married woman undergoing hospital treatment. Her husband died under tragic circumstances, and she was prepared to give up her treatment and return home. The home was visited and K.L. assured that matters there were as satisfactory as possible, so that there was no need for her to return. The youngest child was then boarded out and K.L. agreed to continue with her treatment. M.N. was a married man, without family, who had to undergo Sanatorium treatment. His wife carried 011 during his absence by doing needlework, but during a slack period a weekly grant w as obtained from the United Services Fund, which helped her a great deal. She herself needed medical advice, but neglected to seek it, but after friendly relations were established she was persuaded to do so, and later was very grateful for the persuasion used. ft is felt that mention should be made of the very kind co-operation and help which has been given by the Public Assistance Committees throughout the year. During the year there have been 505 New Cases. 1,583 Visits paid. 1,911 Letters written. 708 Interviews. Contributions (assessments) collected (Jan.-Aug.) £314 18 9 Contributions (voluntary) collected (Aug.-Dec.) ... £13 10 0 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. The provisions of these Regulations continue to be systematically carried out with regard to the Register of Notified Cases of Tuberculosis. A quarterly revision of Ihe Register is made 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 following is a statistical statement showing 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 1934. Lungs. Other Forms. Total. M. F. M. F. Numbers on register at the commencement of the year 1934 1,348 1,108 437 411 3,304 Notified cases added during the year 1934.. 266 189 34 45 534 Cases coming to the knowledge of the Medical Officer of Health (other than by notification) during the year 1934.. No. of cases removed from the register during the year 193i 54 35 17 16 122 1.668 417 1,332 323 488 98 472 97 3,960 965 1,221 1,009 390 375 2,995 45 [1934 Showing the Notified Cases of Tuberculosis in the Quarters during 1934. 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 60 52 112 73 60 133 74 45 119 59 32 91 266 189 455 Tubercular Meningitis 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Tabes Mesenterica ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 General Tuberculosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 7 12 19 7 14 21 7 6 13 12 12 24 33 44 77 Totals 68 64 132 80 74 154 81 52 133 71 44 115 300 234 534 Disinfection of Houses and Rooms after Tuberculosis.—The following- statement gives the particulars for the year :— Houses. Rooms. 1st quarter 86 110 2nd „ 88 110 3rd „ 83 106 4th „ 63 79 Total 320 405 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from 1st January, 1934, to the 31st December, 1934, in the Metropolitan Borough of Islington. Age-periods Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. 0 to 1 1 to 5 6 to 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 1 5 3 5 27 31 72 44 42 29 7 266 441 „ Females 2 7 5 21 44 53 21 15 15 6 189 308 Non-pulmonary Males - 8 4 4 4 6 4 2 1 1 — 34 58 „ „ Females - 6 5 4 5 5 11 3 2 2 2 45 58 Showing New Cases of Tuberculosis and all Deaths during 1934. Age Periods. New Cases. Deaths, Pulmonary. Non-Pulmonarv. Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year 3 _ 1 2 1 1 1-5 6 2 9 9 — — 4 2 5-10 6 7 6 5 2 — 1 — 10-15 6 6 9 4 2 1 — 1 15 20 29 24 6 6 3 9 1 2 20-25 35 49 6 11 19 21 — 2 25-35 83 66 5 13 33 19 4 — 35-45 55 26 5 4 28 14 2 — 45 55 51 20 2 3 39 13 1 — 55-65 35 15 2 3 23 4 2 1 65 and upwards 12 9 1 2 18 3 - 2 Totals 3 0 224 51 61 169 84 16 11 65 Deaths not notified or 20.0 per cent, of Total Deaths. 1934] 46 TUBERCULOSIS DISPENSARIES. RETURN SHOWING THE WORK OF THE NORTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1934. Diagnosis. Pulmonary. Non-pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): (a) Definitely tuberculous 92 63 5 2 14 8 6 7 l06 71 11 9 197 (b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous - - - - - - - - 101 81 25 12 219 B.— Contacts examined during the year:— (a) Definitely tuberculous 1 4 - 4 - - - - 1 4 4 9 (b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous - - - - - - - - 34 89 78 90 291 C.—Cases written ott the Dispensary Register as (a) Recovered 5 8 - - 2 1 1 1 7 9 1 1 18 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 135 170 103 102 510 D—Number of Cases on Dispensary Register on December 31st:— («) Definitely tuberculous 262 238 16 13 31 30 34 18 293 268 50 31 642 (b) Diagnosis not completed - - - - - - - - - - - - - 1. Number of cases on Dispensary Register on January 1st 649 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 200 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 20 9. Number of visits by Dispensary Nurses or Health Visitors to 1,229 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme and cases " lost sight of '' 141 Municipal Tuberculosis Visiting Nurse 1,620 10. Number of (a) Specimens of sputum, &c., examined 303 4. Cases written off during the year as dead (all causes) 74 (b) X-ray examinations made in connection with Dispensary work 320 5. Number of attendances at the Dispensary (including contacts) 3,775 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above - 6. Number of Insured persons under Domiciliary Treatment on the 31st December — 7. Number of consultations with medical practitioners*:— (a) Personal 11 12. Number of " T.B. plus " cases on Dispensary Register on the 31st December 347 (b) Other 411 * Hospital staff 114. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) provided by the Council—One in the Northern part of Borough. G. CLARK TROTTER, Chief Tuberculosis Officer. 47 [1934 RETURN SHOWING THE WORK OF THE SOUTH ISLINGTON TUBERCULOSIS DISPENSARY FOR THE YEAR 1934. Diagnosis. Pulmonary. Non-pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M, F. M. F. M. F. A.—New Cases examined during the year (excluding contacts) : (a) Definitely tuberculous 75 50 3 2 10 7 6 2 85 57 9 4 155 (b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 73 68 32 40 213 B.—Contacts examined during the year: — (a) Definitely tuberculous 9 11 3 2 - - - 9 11 3 2 25 (6) Diagnosis not completed .. - - - - - - - - 2 2 1 2 7 (c) Non-tuberculous -— - — — — — — — 24 51 39 39 153 C.—Cases written off the Dispensary Register as:— (a) Recovered - 6 2 1 3 2 1 4 3 8 3 5 19 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 100 119 72 79 370 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 273 193 27 19 40 20 22 36 313 213 49 55 630 (b) Diagnosis not completed — — — — - — — — 2 2 1 2 7 1. Number of cases on Dispensary Register on January 1st 646 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 203 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 57 9. Number of visits by Dispensary Nurses or Health Visitors to homes for Dispensary purposes Municipal Tuberculosis Visiting Nurse 2,137 1332 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases ''lost sight of " 127 10. Number of (a) Specimens of sputum, &c., 586 4. Cases written off during the year as dead (all causes) 103 (b) X-Ray examinations made in connection with Dispensary work 178 5. Number of attendances at the Dispensary (including Contacts) 4,264 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 1 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 205 7. Number of consultations with medical practitioners:— (a) Personal 5 12. Number of " T.B. plus" cases on Dispensary Register on the 31st December 327 (b) Other 152 Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) provided by the Council—One in Southern part of Borough. G. CLARK TROTTER, Chief Tuberculosis Officer. 1934] 48 At the Northern Dispensary there were 742 new cases, and at the Southern 554, while the attendances at the former were 3,775 and at the latter 4,294. The examination of contacts with tuberculous cases showed that 31 were suffering from tuberculosis, 28 were suspects, and 457 were not suffering. The nurses of the Northern Dispensary paid 1,247 visits, and those of the Southern 2,141, to the homes of the patients, while the Tuberculosis Officer of the Northern Dispensary made 200 visits, and of the Southern 203 visits to the patients' homes for the purpose of examining them. Pneumothorax Treatment was also administered to thirty-nine patients at a cost of £232 5s. 6d. Finsen Light Treatment.—Nil. *Artificial Sunlight Treatment.—One case under treatment in the year under review at a cost of £2 9s. 0d. *Kromeyer Lamp. TUBERCULOSIS. The number of persons in attendance at the Dispensaries in each year was as follows :— 1930 1931 1932 1933 1934 North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy North Dispy South Dispy New Cases 563 585 641 609 601 568 668 469 742 554 Actual Number of Attendances 2910 5443 3153 5001 3041 4545 3426 4091 3775 4294 Totals 3473 6028 3794 5610 3642 5113 4094 4560 4517 4848 A summary of the combined dispensaries is given for the following years :- Cases. Attendances. 1930 1,148 8,353 1931 1.250 8,154 1932 1,169 7,586 1933 1,137 7,517 1934 1,296 8,069 Totals 6,000 39,679 Table showing the number of Persons attending the Borough Tuberculosis Dispensaries and the New Cases during 1934. Date. Dispensary Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Year. Total. Attendances ^ Northern 368 325 339 348 321 322 316 261 235 328 303 309 3,775 8,069 Southern 412 379 418 346 403 352 340 334 284 353 380 293 4,294 New Cases Including Contacts Northern 69 62 44 60 51 55 57 35 51 70 41 147 742 1,296 Southern 61 51 58 49 57 43 33 44 27 48 49 34 554 Contacts. Tuberculous Northern 3 - 1 - 2 2 - 2 - - - - 10 31 Southern 1 1 2 2 4 3 2 1 1 - 3 1 21 Suspects Northern 2 3 4 - 1 1 1 - 3 1 - - 16 28 Southern 1 —- 1 1 3 1 1 - - - 4 - 12 Non-Tuberculous Northern 26 26 11 20 18 20 15 8 19 34 18 66 281 457 Southern 13 16 24 19 17 8 8 12 11 21 14 13 176 Nurses' Visits Northern 98 92 107 122 124 123 108 59 109 102 131 72 1,247 3,388 Southern 164 183 176 170 205 183 209 187 180 180 158 146 2,141 Tuberculosis Officers' Visits Northern 29 16 16 14 17 19 19 19 8 14 15 14 200 403 Southern 11 22 31 25 14 23 11 11 10 13 18 14 203 Cases of TUBERCULOSIS in ISLINGTON During 1934 BLACK denotes Pulmonary Tuberculosis WHITE " Other Forms of Tuberculosis 49 [1934 HOME VISITATION—TUBERCULOSIS. Visits paid by Municipal Tuberculosis Visiting Nurse during the period 1st January, 1934, to the 31st December, 1934. Month. North Dispensary. South Dispensary. Total. January 171 136 307 February 158 110 268 March 151 112 263 April 149 120 269 May 144 123 267 June 138 109 247 July 121 105 226 August 143 114 257 September 48 64 112 October 156 131 287 November 119 120 239 December 122 88 210 Totals 1,620 1,332 2,952 TUBERCULOSIS—HOUSING. During the year 534 premises were dealt with in which resided a person notified during 1934 as suffering from Tuberculosis. 431 visits were made to premises with a view to ascertaining the sanitary condition generally of the residences of tuberculous patients and the following statement gives some idea of the conditions which were found to exist. It is satisfactory to note the large proportion of houses in a good sanitary condition; in no case could it be said that the home conditions were very bad. House in a bad sanitary condition 1 Houses in good sanitary condition 299 Houses in which minor defects were discovered 24 Patient removed to another address 107 Patient deceased (no visit paid to house) 89 Patient in Mental Hospital 5 Patient in L.C.C. Hospital (Nursing Staff) or Government Building Staff 1 Duplicate notifications 7 No visitation by request 1 534 THE INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. 1,867 cases of the notifiable infectious diseases occurred in the Public Elementary Schools of the Borough, of which 660 were Scarlet Fever and 453 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 25 - + 25 Scarlet Fever 660 669 — 9 Diphtheria 453 370 + 83 Enteric Fever 2 2 — Chicken-pox 227 — + 227 Total 1,367 1,041 + 326 1934] 50 Non - Notifiable Diseases.—4,651 cases came to the knowledge of the Medical Officer of Health during the year, viz., 2,258 cases of Measles, 792 cases of Chicken-pox, 292 of Whooping Cough, and 1,309 of other diseases. The information respecting these cases was received from the teachers of schools within the borough. Exclusion of Scholars from Schools.—3,440 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 2,258 1,871 + 387 Chicken-pox 792 1,059 — 267 Whooping Cough 292 654 — 362 * Other Diseases 1,309 1,874 — 565 Total 4,651 5,458 — 807 *Note.—"Other Diseases" include Mumps, Scabies, Ophthalmia, Itch, etc. BACTERIOLOGICAL EXAMINATIONS. 2,755 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 47 on that of the preceding year and 45 below the decennial average. Of the total examinations, 366, or 13.3 per cent., gave positive results. Diphtheria.—2,114 specimens were examined for Diphtheria, of which 268, or 12.7 per cent., were found to be " positive." Enteric Fever.—22 specimens of blood were examined, 1 of which gave positive result. Tuberculosis.—619 specimens of sputum were examined, 97, or 15.7 per cent., of which showed that the patients were suffering from pulmonary tuberculosis. These are in addition to routine examinations at the two Tuberculosis Dispensaries. DIPHTHERIA— PATHOGENICITY TESTS. 1934. No. of Swabs Submitted for Examination. Negative Result. (Bacilli) Positive Result. (Bacilli) Non-Virulent. Virulent. 27 19 *8 3 3 * 2 not tested for Pathogenicity. 51 [1934 Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Pulmonary Tuberculosis, 1924-83, and in 1934. Periods. Diphtheria. Enteric Fever. Pulmonary Tuberculosis Total Positive Results Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. 1924 180 1,333 1,513 - 17 17 127 650 777 2,307 1925 232 1,018 1,850 2 12 14 160 762 922 2,786 1926 183 1,501 1,634 3 9 12 148 691 839 2,535 1927 260 1,573 1,833 3 21 24 111 661 772 2,629 1928 276 1,478 1,754 4 32 36 137 723 860 2,650 1929 412 1,888 2.300 2 15 17 119 693 812 3,129 1930 492 2,274 2,766 1 18 19 127 652 779 3,564 1931 280 1,663 1,943 2 8 10 131 727 858 2,811 1932 238 1,746 1,984 5 9 14 111 684 795 2,793 1933 186 1,865 2,051 5 19 24 93 634 727 2,802 Average 10 years 274 1,694 1,968 3 16 19 126 688 814 2,801 1934 268 1,846 2,114 1 21 22 97 522 619 2,755 BACTERIOLOGICAL EXAMINATION OF MILK. During the year 1934 8 samples of milk in various parts of the Borough as supplied to the consumers were tested bacteriologically. In addition to the usual bacterial count, 4 of these were tested for bacillus abortus and also for tubercle bacillus, and 3 were graded milks tested to see if the pasteurisation was efficient; the other sample, an ordinary milk, was tested generally. In the case of the pasteurised milks tested, one was in connection with a case of Enteritis reported, and this particular pasteurised milk was found not to comply with the prescribed conditions, that is, it was a " dirty " milk. As regards the other samples, the bacterial counts were satisfactory, and bacillus abortus or tubercle were not found. BACTERIOLOGICAL EXAMINATION IN CASES OF PUERPERAL SEPSIS. During the year one swab was submitted, which was examined with a negative result. SPECIAL BACTERIOLOGICAL OR CHEMICAL EXAMINATIONS. The only examinations that were necessary during the year were those which came to us owing to complaints regarding Cordials bottled in premises in this Borough. The complaint came through another Borough, the purchaser and the place of purchase were outside Islington, but we were asked to look into the conditions at the place where the article was bottled. The bottler, who also diluted the material with water, complained regarding the water, and there was some little difficulty before the exact water supply was ascertained, as the particular premises at one time did not get the supply direct from the main, but indirectly from adjoining premises. Two samples having been procured by Mr. Haydock, Inspector of Meat and Food, the chemical examination of the cordial as diluted and sold revealed a mould visible to the eye. This particular mould, although it produced fermentation, was not pathogenic. The investigation, although non-conclusive, was a necessary one, and it was noted that during the same month a partner of the firm responsible for the cordial, charged for selling adulterated lemon squash, was fined £10 when summoned at the instance of the Surrey County Council. 1934] 52 Tetanus in Toy Pistol Cartridges,— It is appropriate here to refer to page 43 of the Medical Officer of Health's Report for 1932, where a full account is given regarding an investigation of a search for Tetanus in toy pistol cartridges purchased in the Borough. Subsequently H.M. Inspector of Explosives wrote me from the Home Office, and I submitted to him one of the wads from which Professor James Mcintosh, M.D., of the Bland Sutton Institute, had obtained the Tetanus Bacilli after cultivation, and the opinion was expressed that in view of the wide-spread distribution of Tetanus, evidence was not strong enough to incriminate the cartridges; I, however, demurred, while I had to admit that we had meanwhile only the one finding. During the year, however, confirmation of the infected cartridges has come quite independently in another way. A child was admitted to the Middlesex Hospital after a toy pistol injury suffering from Tetanus, and Professor Mcintosh was able to obtain from the mother the actual box of cartridges used with the pistol, and again in this case he was able to obtain the Tetanus Bacillus from the wads of these foreign cartridges. VACCINATION. Dr. C. V. Spark was appointed in place of Dr. Clay (East Lower Holloway Ward) resigned, and Dr. B. Kessel in place of Dr. Leventon (Barnsbury Ward) resigned, and commenced their duties in November and October respectively. No vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917, as it was possible to refereach case immediately to the Public Vaccinator of the district or institution. Vaccinations.—Of the 3,571 births registered in 1933, the returns of vaccina tion show that only 1,589 infants were successfully vaccinated, while 9 were found to be insusceptible. There were also 174 who died unvaccinated, and 1,198 statutory declarations of conscientious objection to vaccination were obtained by the parents or guardians ; 68 vaccinations were postponed under medical authority. 243 were removed to other districts or places unknown, thus leaving 65 unaccounted for. The return of certificates of exemption, therefore, represents 33 per cent, of the registered births. Vaccination per 100 Years, births, less infants who died unvaccinated. 1924 54.0 1925 50.4 1926 51.5 1927 49.9 1928 46.6 1929 49.5 1930 51.2 1931 50.0 1932 50.0 1933 47.0 Certificates of Exemption.—The following tabular statement shows the decrease in number of these certificates in recent years:— 1923 1,751 1924 1,755 1925 1,973 1926 1,896 1927 1,845 1928 1,755 1929 1,642 1930 1,584 1931 1,477 1932 1,299 1933 1,213 A statement is given of the prosecutions by the Vaccination Officers since the transfer from the Guardians in 1930. 53 [1934 Prosecutions. Year. Northern Islington (No. 1 District) Southern Islington . (No. 2 District) Total. 1930 (from 1st April) 4 3 7 1931 2 - 2 1932 7 4 11 1933 Nil. Nil. Nil. 1934 Nil. Nil. Nil. 13 7 20 Return furnished, by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during, the previous year 1933. Registration Sub-Districts. Number of Births registered in 1933. 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 1934. Number of Statutory Declarations of Conscientious Objection received during year 1934. 1 2 3 4 5 6 7 8 9 10 11 12 Tufnell 572 251 4 - 132 47 3 77 53 5 - 146 Up. Holloway 647 294 1 — 206 24 2 90 29 1 1,308 234 Tollington 246 111 — — 78 19 6 3 21 7 84 Highbury 619 295 3 — 213 17 7 27 46 11 217 Lr. Holloway 380 169 1 — 153 11 8 10 20 8 1,217 109 Barnsbury 471 227 — - 158 25 18 8 26 9 212 Islington, S.E. 637 242 — — 258 31 24 10 48 24 211 The Borough 3671 1589 9 — 1198 174 68 225 243 65 2,525 1,213 Return showing the numbers of persons successfully vaccinated and re-vaccinated at the cost of the rates by the Public Vaccinators during the year ended 30th September, 1934 :— Name of the Institution or Vaccination District. Name of the Medical Officer or Public Vaccinator. Number of successful primary vaccinations of persons, Number of successful re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Under one year. One year and upwards. Total. Tollington Dr. M. J. Healy 176 21 200 18 Upper Holloway Dr. P. Inwald 158 17 175 17 Tufnell .. .. Dr. D. W. F. Latham 183 13 196 5 E. Lower Holloway Dr. F. E. Clay 132 179 311 109 W. Lower Holloway Dr. S. N. Forbes 162 33 195 19 Highbury and W. Mildmay Dr. T. Galbraith 192 34 226 30 Canonbury, E Mildmay, E. St. Mary and E. St. Peter Dr. J. Lynch 242 45 287 11 Thornhill Dr. H. D Christie 139 17 156 2 Barnsbury and W. St. Mary Dr. L. M. Leventon 144 26 170 17 S. St. Mary and W. St. Peter Dr. G. Madden 89 21 110 6 St. Mary, Islington, Hospital* Dr. W. R, Turtle 2 3 5 - St. John's Road L.C.C. Institution* Dr. K. A. Anklesaria 1 — 1 - L.C.C. Schools, Andover Row* Dr. P.J. C. MacDonnell - — — - L.C.C. Children's Homes, Hornsey Rise* Dr. P. J. C. MacDonnell - - - - Total 1,620 412 2032 234 *Institutions. 1934] 54 Vaccinations and re-vaccinations performed by the Public Vaccinators of the Council during the year 1934 :— Successful vaccinations performed at the surgery or elsewhere than at the homes of the persons vaccinated . 115 Successful re-vaccinations performed at surgery or elsewhere than at the homes of the persons vaccinated 105 Successful vaccinations or re-vaccinations performed at the homes of the persons vaccinated or re-vaccinated 2,036* The above figures represent actual vaccinations or re-vaccinations performed by the Public Vaccinators during the year. The Vaccination Officers in the course of their duties forwarded the names of 1,707 children to the Public Vaccinators on Form " H." Other 475 children were vaccinated at the " request " of parents or guardians before Form " H. " was issued. *168 of these vaccinations or re-vaccinations were done at a school. DISINFECTION. Disinfection of Rooms.—2,975 rooms were disinfected, as contrasted with 3,265 in 1933. For this purpose formaldehyde in solution was employed, although it was sometimes augmented by sulphur fumigation, when it was necessary to kill vermin, for which purpose sulphur has been found effective. For the extermination of bugs, in addition all the architrave mouldings and skirting boards behind which they breed are removed, and the walls washed with hot lime, and in certain cases special insecticide fluids or sulphur dioxide were employed. The above figures also include the disinfection of houses and rooms after Tuberculosis, vide p. 45. Rooms Disinfected. 1934 1933 1st Quarter 787 655 2nd „ 661 876 3rd „ 573 769 4th „ 954 965 The Year 2,975 3,265 Work at the Disinfecting Station.—39,708 large articles of bedding, etc., as detailed below, were disinfected by the steam disinfectors, at the Council's Disinfecting Station, compared with 36,647 similar articles disinfected during the previous year. In addition to the above articles, 177,082 second-hand garments were disinfected for clothing contractors trading in the Borough, who paid the Council for the work, amounting to the sum of £75 15s. 0d. Altogether 216,790 articles described in the two paragraphs preceding were disinfected. Since the disinfection station was established 2,911,797 large articles have been disinfected. 55 [1934 Summary of the chief articles of Clothing, Bedding, etc., disinfected during the year 1934, and also in the preceding year 1933. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1934 1933 Beds „ 410 315 342 629 1,696 1,614 Blankets 1198 974 859 1,672 4,703 3,912 Bolsters 281 322 225 422 1,250 988 Carpets 5 — — — 5 — Cushions 134 98 77 154 463 346 Mattresses 436 403 392 577 1,808 1,530 Pillows 1115 959 921 1,632 4,627 3,731 Pillow and Bolster Cases 809 632 584 1,052 3,077 2,438 Quilts 552 445 443 776 2,216 1,881 Sheets 1,025 917 836 1,441 4,219 3,517 Other Articles 4,377 3,965 2,831 4,471 15,614 16,680 Totals 10,312 9,030 7,510 12,826 39,708 36,647 The nature of the articles disinfected for the clothing contractors is shown below:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Blankets 1,525 1,250 4,550 900 8,225 Garments 13,201 24,670 79,496 46,257 163,624 Other Articles 1,672 1,574 1,085 902 5,233 Total .. 16,398 27,494 85,131 48,059 177,082 Disinfectants Distributed and Used.—The following statement gives the quantity of disinfectants distributed by the Sanitary Authority, or used in disinfecting and cleansing rooms:— To householders:—Carbolic powder, 10 cwts. *Disinfectant fluid, 90 galls. *Strong disinfectant is diluted before distribution in place of the former weaker disinfectant used The figure given is as distributed. Disinfection of premises by Formaldehyde Solution, 40 galls. The total cost of disinfectant was £12 12s. 1d., together with £2 10s. 0d., the cost of sulphur candles used in the process of disinfestation of rooms. Shelter House.—The Shelter House was not occupied during the year ; baths were given to 12 verminous persons, while their clothing was disinfected, five of whom were sent from a Common Lodging House. One handywoman attended for the purpose of disinfection after attendance on a case of Puerperal Fever, and 48 other persons who had been in contact with cases of infectious diseases also had their clothing disinfected. Baths were provided for 25 persons who were suffering from Scabies (a series of 3 baths in each case), making a total of 75 baths. Disinfestation of Rooms.—276 rooms were specially disinfested during the year. The method of dealing with such rooms is that upon the Sanitary Inspector becoming aware of bug infestation of rooms, he serves a notice under the London County Council (General Powers) Act, 1922, on the owner requiring the paper to be stripped from the walls, removal of the architrave mouldings and skirtings, and suitable treatment of the walls. It is advised that a plumber's blow lamp be used 1934] 66 on the infested surfaces which are exposed. The occupier is also required to rid infested articles of furniture, etc., of bugs by washing with paraffin or using insecticide, and in some cases it is recommended that the articles be burned. In certain cases where application is made by either the owner or the tenant for the assistance of the local authority, a fee of five shillings per room is asked for. Prior to the room with the furniture remaining therein being sealed at the doors, fireplaces and windows, the walls, etc., are sprayed with an insecticide and sulphur candles in receptacles placed about two feet above the floor level are burned while the air and the surroundings are moist. This process is repeated after a lapse of fourteen clays, in order that the bugs from eggs which have hatched out may not be missed. Disinfestation of School Children (Cleansing from lice and other vermin)—During the year 6,087 (including 1,881 for Scabies) 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 amount paid during the year by the London County Council for the baths given to the children was £514 13s. Od. There was a decrease in the number of children treated for head lice, but an increase in the number of scabies cases treated. The rate paid by the London County Council is two shillings for head cases and one shilling for scabies. Proceedings were instituted by the London County Council under Section 122 of the Children Act, 1908, during the year in 102 instances. In 17 cases no fines were imposed and in the remainder the fines ranged from 1s. to 10s. The total fines amounted to £22 6s. 6d. FACTORY AND WORKSHOP ADMINISTRATION. The Medical Officer of Health submits the annua! report on the manner in which the provisions of the Factory and Workshops Acts, 1901, were carried out in his district during the year 1934. Inspections and Visits.—The inspections and visits made by the three Inspectors were as under :— Factories, including Factory Laundries 948 Workshops, including Workshop Laundries 740 Workplaces, other than outworkers' homes 411 Domestic Workshops 101 Bakehouses 308 Restaurant Kitchens (see also p. 77) 693 Outworkers' premises 1,341 Miscellaneous re-inspections and calls 5,036 Total 9,578 Notices Served —In consequence of the 1,124 sanitary defects discovered as the result of the inspections above, 382 intimation and 24 statutory notices were served. Of these notices 150 were served on the owners of factories, 165 on the owners of the workshops and workplaces, and 22 on the owners of bakehouses and 64 of restaurant kitchens. In addition to these nuisances, 50 were discovered on Outworkers' premises, necessitating the service of 10 notices. Most of these defects were remedied and it was not found necessary to resort to legal proceedings. 57 [1934 Registers. —There were 2,695 workshops on the Registers as contrasted with 2,658 in 1933, while the total number of workrooms were 3,804, as compared with 3,756 in the previous year; 118 workshops were added to the Registers, while 80 were removed from them. The various workshops and workplaces are tabulated as below:— Workshops and Workplaces. 1934. Total Workshops on Register. Total Workrooms on Register. Number added during Year. r removed during Year, Workshops where Men are employed 1.286 2,015 42 29 Workshops where Women are employed 506 797 29 29 Laundries 36 46 — 1 Bakehouses 234 250 1 1 Restaurant Kitchens 537 600 40 19 Other Workplaces 96 96 6 1 Total 2,695 3,804 118 80 Outworkers' Premises 3,471 - 399 388 Workshops Notified to Home Office during Year 1934. Trade. Number of Workshops. Women. Male Young Persons. Totals. Dressmaking 15 40 - 40 Chemists' Sundries 1 17 - 17 Tailoring 5 - 5 Printing 1 4 - 4 Surgical Glass 1 2 — 2 Millinery 1 1 - 1 Artificial Florists 1 2 — 2 Toys 1 1 — 1 Handbags 9 — 9 Mica Goods 1 52 - 52 Blouses 1 1 - 1 Quilts 1 1 — 1 Ties 1 6 - 6 Total 30 141 — 141 INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Inspections. (2) Number of WrittenNotices (3) Prosecutions. (4) Factories (Including Factory Laundries) 948 150 2 Workshops (Including Workshop Laundries) 740 111 ~~ Workplaces 1,412 118 — (Other than Outworkers' premises) Miscellaneous Re-Inspections and calls 6,478 27 - Total 9,578 406 2 1934] 58 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts*— Want of cleanliness 269 267 - - Want of ventilation 28 26 - - Overcrowding 5 5 - - Want of drainage of floors 25 25 - - Other nuisances 411 398 - 2 Sanitary insufficient 48 44 - - Accommodation unsuitable, foul or defective 322 323 - - not separate for sexes 6 5 - - Offences under the Factory and Workshops Arts— Illegal occupation of underground bakehouse (s.101) - - - - Other offences (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 1,124 1,093 - 2 * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Acts, 1901 as remediable under the Public Health Acts. 29 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) Outwork in infected premises (s. 109, 110) 48 2 10 48 2 Nil Total 50 10 50 Nil OUTWORKERS' LISTS (s. 107) : Lists received from Employers 988 Addresses received from Other Councils 1,489 Addresses forwarded to Other Councils 470 Firms failing to send in lists (No. letters sent) 319 OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories : Failure to affix Abstract of the Factory and Workshop Act (s. 133, 1901) 1 Action taken in matters referred by H.M. Inspector as remediable under the Notified by H.M. Inspector 3 Public Health Acts, but not under the Factory and Workshop Act (s. 5, 1901). Reports (of action taken) sent to H.M Inspector 3 Other (New Factories reported under Home Office Memorandum, 1912) 89 Underground Bakehouses (s. 101) in use at the end of the year. 69 59 [1934 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Nature of Work. (1) Instances. (2) Notices served. (3) Prosecutions. (4) Wearing Apparel— Making, &c. 32 5 - Cleaning and washing - - - Household linen - - - Lace, lace curtains and nets - - - Curtains and furniture hangings ... 1 - - Furniture and upholstery - - - Electro-plate - - - File making - - - Brass and brass articles - - - Fur pulling - - - Cables and chains - - - Anchors and Grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, &c. 3 - - Artificial flowers 2 - - Nets, other than wire nets — - - Tents — - - Sacks — - - Racquet and tennis balls — - - Paper, &c, boxes, paper bags 12 3 - Brush making 5 — - Pea picking — — - Feather sorting — — - Carding, &c., of buttons, &c. — — - Stuffed Toys 1 — - Basket making — — - Chocolates and sweetmeats — — - Cosaques, Christmas Crackers, Christmas stockings, &c 12 2 - Textile weaving — — - Lampshades — — - Total 68 10 - SCAVENGING. Particulars are required in the Annual Report of any extension or improvement during the year of methods of scavenging or refuse disposal, and a statement as to the character and efficiency of the arrangements for the removal and disposal of house refuse. The Medical Officer of Health visits with the Cleansing Superintendent the dumping grounds where the contractors dispose of Islington refuse. A special visit was made while the Survey of the Public Health Services was being made by the Ministry of Health representatives during the summer. The visit occurred just before the August holiday with Dr. Parsons to Holwell Hyde, Cole Green, Herts., one of the dumping places, and conditions were found to be very lax. The contractors subsequently admitted that the complaint was justified, and that the laxity was due to the inefficient supervision by a foreman who had been temporarily appointed. They took immediate action, dismissed the man, and ensured proper supervision. As will be seen from a summary given of the recent Survey of the Public Health Services by Ministry of Health Officers, page 83, it is suggested that further efforts should be made (1) to increase the supply of satisfactory dustbins at houses in the Borough, (2) means of preventing, by use of screens and other equipment, the scattering of refuse during loading at the Ashburton Grove Siding, and (3) the matter referred to above which concerns the covering of refuse at Holwell Hyde Tip, and similar action with respect to Wheathampstead. 1934] 60 Mr. Browning, the Cleansing Superintendent, has kindly supplied me with the following statement regarding the work during the year:— (1) Street Sweeping.—The " Beat " system is now in operation throughout the Borough, all roads and streets receiving attention daily. The contents of galvanized sanitary containers installed in orderly trucks are emptied into three hygienic " Bedford " lorries and horse vans. The full scheme to be completed at the end of 1935 allows for four lorries. When these four lorries are all in service the vans will cease to be used. (2) House and Trade Refuse Collection.—On the 1st October, 1934, all old type mechanical vehicles were permanently taken out of commission and replaced by low-loading hygienic " S.D." Freighters. Ten low-loading hygienic horse-drawn vans, built to own design, and by Council's own staff of mechanics, also brought into service, thus eliminating the majority of the old type vans, six only of which are now used on refuse collection work. These vans will also be taken out of commission as soon as the remaining new hygienic vans are built. During the year 1934 86% of refuse was collected by mechanical vehicles and 14% by horses and vans. (3) Disposal.—Both house and trade refuse and road sweepings are sent by rail to contractors' dumps at Blackbridge and Holwell Hyde, Herts., where the material is deposited in jayers of approximately 6 ft. in depth, each layer being covered with 9 in. of soil and otherwise treated in accordance with the requirements of the Ministry of Health. The dumps are frequently inspected by the Cleansing Committee and myself and the Local Sanitary Authority. REMOVAL OF DUST. 23 applications were received during the year by the Public Health Department for the removal of dust. The applications received for the previous ten years were as follows:— 1924 33 1929 21 1925 21 1930 40 1926 20 1931 36 1927 25 1932 44 1928 25 1933 21 Dust Receptacles Provided.—During the year 1,062 dust receptacles were provided by owners of property under notice. DISTRICT INSPECTORS' WORK. During the year the fourteen District Inspectors made a total of 50,238 inspections and calls, an increase of 490 inspections on the corresponding period of 1933; while 15,262 improvements were effected in 6,168 premises; as against 15,040 improvements in 6,424 premises for the preceding year. Synopsis of Inspectors' Work.—The following statement gives a brief synopsis of the district inspectors' work in 1934:— House to house inspections 3,395 Other inspections of dwelling houses 4,119 Re-inspections and calls made 40 971 Visits of inquiry re notifiable infectious diseases 2,227 Butchers' shops, stalls, etc. (Saturday nights) 93 Ice cream shops and factories 199 Dairies and Milkshops 628 Stables and yards 310 Urinals attached to Public Houses 141 Smoke observations 83 61 [1934 Notices Served.—There were 4,895 intimation notices served by the inspectors with respect to nuisances. In 548 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.—276 rooms which were found to be in a verminous condition were fumigated. In 27 instances it was necessary to remove the bedding and clothing to the Disinfecting Station for purification or destruction. Rag Flock Acts. 1911 and 1928.—In the routine inspection, the Sanitary Inspectors found no cause for action to be taken. In two instances it was considered necessary to take samples of rag flock for analysis to be certain that they came within the standard. Smoke Nuisances.—30 complaints of smoke issuing from factory chimneys in the Borough were investigated, and as a result 83 observations were made by the District Inspectors, and 14 notices served upon the owners of the businesses requiring the abatement of the nuisance. Water Certificates.—16 water certificates were granted in accordance with the provisions of sec. 48 (2) Public Health (London) Act, 1921, in respect of 329 separate tenements newly erected or rebuilt during the year. AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT, 1928. MERCHANDISE MARKS ACT, 1926. All the District Sanitary Inspectors are officially appointed for this work. Special inspections for this particular duty under the Merchandise Marks Act and under the Agricultural Produce (Grading and Marking) Act, by these and by the Food Inspector numbered 1,092. 7 prosecutions were taken under the Merchandise Marks Act, 1926, all of which were successful. No premises have been registered for the cold storage or chemical storage of eggs. WIDOWS', ORPHANS' AND OLD AGE (CONTRIBUTORY) PENSIONS ACT, 1925. Since these powers were delegated by the London County Council, no case has arisen so far under Section 6, so none falls to be reported on in 1934. The Section deals with the special provisions as to additional allowances and Orphans' Pensions, and in certain cases the Orphan's Pension payable in respect of a child would in the interest of the child be administered by the local authority or some other person for the benefit of the child, where a representation is made to the Minister by the local authority, or otherwise. 1934] 62 Summary of Sanitary Work from Inspectors' Reports for the year 1934 Districts. Totals 1 2 3 4 5 6 7 8 9 10 11 12 13 14 House to House Inspections 237 391 227 208 219 125 185 257 387 236 185 343 165 230 3395 Other premises inspected 223 281 209 459 232 374 190 425 253 278 293 385 284 233 4119 Re-inspections, Calls made, etc. 2566 3678 3090 3543 3245 3083 1923 2786 2965 2874 3073 2483 3006 2656 40971 Ice Cream Premises inspected. — 47 36 13 15 24 6 5 7 14 14 1 3 14 199 Dairies and Milk Purveyors inspected 13 108 103 43 43 53 42 18 16 66 13 32 16 62 628 Stables „ 18 24 46 13 2 6 2 2 3 l5 3 10 1 44 189 Yards „ 29 15 51 2 1 1 2 5 1 4 1 7 1 1 121 Agricultural Produce (Grading - - - - - - - - - - - - - - - Merchandise Marks Act, 1926 4 73 17 14 7 10 5 4 3 7 4 6 4 2 160 Urinals attached to P.H.'s inspected 14 78 8 5 4 4 20 - 8 - 141 Children and Young Persons Acts 11 5 6 4 6 5 1 12 2 3 - 5 4 1 65 Premises (re Water Certificates) inspected - 3 2 3 7 1 - - - - - - - 48 64 Rag and Bone Dealers — 1 — — — 1 1 — — 1 — 1 — 5 10 Rag and Flock Act - - - - - - - - - - - - - - - Smoke observations — 10 — 2 4 2 30 14 — 5 — 3 13 — 83 Shops, Stalls and Markets (Saturday evening) 7 7 7 7 7 7 4 6 6 6 7 7 8 7 93 Total Inspections and Calls 3108 4657 3872 4319 3793 3696 2391 3538 3643 3529 3593 3291 3505 3303 50238 Notices Served. Intimation Public Health (London) Act, 1891 129 479 252 524 310 432 200 474 491 368 324 363 197 242 4785 Housing Acts 5 30 4 4 2 18 1 3 8 — 3 — 3 3 84 Ice Cream Shops — 1 — — — 3 1 — 2 1 — — — — 8 Dairies, etc. — 2 1 6 — 5 — 2 1 — — 1 — — 18 Statutory Public Health (London) Act, 1891 11 54 13 48 20 81 26 57 60 65 16 30 21 25 527 Housing Acts - - - - - - - - - - - - - - - L.C.C. (General Power) Acts - - - - - - - - - - - - - 2 21 Improvements. Drains— Constructed - - - - - - - - - - - - - - - Re-constructed 7 11 3 6 7 2 3 3 10 - 15 4 1 5 - 71 Repaired 20 12 21 15 2 5 14 2 15 16 2 1 2 133 Ventilated 13 10 6 8 2 1 3 13 2 14 3 - — - 75 Gully and other traps fixed 35 28 5 8 13 1 4 12 — 32 10 1 — - 149 Urinals— Water supply—cleansed - 2 2 2 1 - - 1 - 3 - - - - 11 Water Closets— W.C. erected with pan, trap and water supply 3 - - 5 4 5 - 2 - 2 1 1 1 1 25 Pan and trap only provided 55 61 39 52 28 11 25 68 15 74 53 16 12 11 520 Flushing apparatus repaired 19 32 22 26 25 28 9 26 18 15 24 7 14 11 276 Ventilated 3 3 4 — 3 7 — 3 1 2 1 — — - 27 Walls, etc , cleansed 27 65 19 54 17 71 18 41 27 95 52 16 12 11 525 Position altered — 1 2 — 1 — 1 - - - - — - - 5 Dust Bins provided 22 111 87 169 69 55 41 105 82 90 84 69 26 52 1062 Areas paved 2 10 1 12 1 8 2 2 - 11 1 5 1 1 57 Yards paved or repaved 16 45 16 43 26 32 9 13 21 31 12 7 1 1 273 Provided 51 126 28 56 25 19 21 56 20 92 26 15 5 4 544 waste pipe repaired 42 52 17 66 58 81 27 72 34 47 15 7 6 9 533 Domestic Water Supply— "Cisterns repaired and cleansed 4 13 14 21 3 8 4 3 7 1 2 - 1 3 84 Water supply provided to dwelling house - - - - - - - - - - - - - - - Water supply provided to tenement house 11 39 8 36 11 14 5 1 10 40 8 12 1 4 200 Walls and ceilings of Rooms cleansed and redecorated 135 422 161 451 247 531 127 392 339 326 332 323 75 205 4066 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 30 73 20 80 32 88 30 115 58 57 74 82 20 50 809 Floor space ventilated 1 33 2 5 3 6 1 4 4 1 9 — 1 4 74 Floors repaired 36 74 17 57 17 61 13 68 51 55 33 29 8 31 550 Guttering and rain water pipes repaired 29 28 7 55 67 45 21 66 16 47 18 2 4 11 416 Roofs repaired 36 70 17 129 23 82 16 104 66 63 49 26 20 16 717 Overcrowding abated — 4 — 13 1 8 — 5 6 — 3 18 1 2 61 Illegal use of underground rooms for sleeping discontinued 1 8 - - - 9 1 3 27 - 13 36 7 4 109 Other improvements, or Nuisances abated 141 255 60 241 114 280 84 222 114 150 189 106 41 84 2081 Rooms Disinfected 243 79 165 123 65 88 44 120 179 136 144 145 153 125 1809 Total improvements 982 1667 728 1740 873 1544 514 1541 1099 1414 1176 926 416 642 15262 Total premises improved 401 577 424 674 322 412 225 534 491 505 529 461 305 308 6168 HOUSES LET IN LODGINGS. The houses which come under the operation of the bye-laws received 1,001 inspections during the year, followed by 3,851 subsequent re-inspections and calls, so that the total visits amounted to 4,852 in addition to which 344 visits were made to Common Lodging Houses. These inspections resulted in 818 intimations being served on the persons responsible, which were followed by 140 statutory notices to demand the abatement of the nuisance discovered by the Inspectors especially engaged upon this work. 1 summons was issued for non-compliance with Statutory Notice. The amount of costs in this case was:—£2 2s. 0d. Altogether 2,359 improvements were effected in 633 premises. Synopsis of Inspector's Work:— Improvements. Drains : Constructed — Reconstructed 1 Repaired 13 Ventilated 1 Gully and other traps fixed 4 Water Closets : W.C. erected with pan, trap and water supply 2 Pan and trap only provided 19 Flushing apparatus repaired 88 Ventilated — Walls, etc., cleansed 128 Position altered — Dust Bins : Provided 124 Areas : Paved — Yards : Repaved. 16 63 [1934 1934] 64 Sinks : Provided 15 Waste pipe repaired 35 Domestic Water Supply: Cisterns repaired and cleansed 1 Water supply provided to tenement house 3 Walls and Ceilings of Rooms cleansed and redecorated 583 Other Improvements : Staircase and passages repaired, cleansed and redecorated 150 Floor space ventilated 2 Floors repaired 112 Guttering and rain water pipes repaired 63 Hoofs Repaired 137 Overcrowding abated 17 Illegal use of underground Rooms for sleeping discontinued 4 Other Improvements, or Nuisances abated 841 Rooms Disinfected — Total Improvements 2359 Total Premises Improyed 533 COMMON LODGING HOUSES. Another transferred power delegated to the Public Health Committee on the 17th March, 1933, was the registration of common lodging houses, taking over the duties under the Transfer of Powers (London) Order, 1933, of the registration, licensing, inspection and regulation of common lodging houses. The Committee considered the applications and renewed licences in respect of the under-mentioned premises:— 14 and 16, Barnsbury Street, beds for 51 men. 18, 20 and 22, Barnsbury Street, beds for 78 men. 10 and 12, Campbell Road, beds for 45 men. 13 and 14, Duncan Terrace, beds for 63 women. 155, Englefield Road, beds for 62 men. 87, Essex Road, beds for 52 men. 89, Essex Road, beds for 35 men. 8, Flowers Mews, beds for 30 men. 104 to 106, Georges Road, beds for 34 men. 1, Gordon Place, beds for 4 men. 2, Gordon Place, beds for 4 men. 3, Gordon Place, beds for 8 men. 4, Gordon Place, beds for 8 men. 5, Gordon Place, beds for 8 men. 6, Gordon Place, beds for 6 men. 7, Gordon Place, beds for 6 men. 13, Gordon Place, beds for 9 men. 29, Hornsey Road, beds for 76 men. 47, 49 and 51, Wharfdale Road, beds for 65 women. The total licences granted was 19; during the year 1933 one was vacated, leaving 27 on the register. Visits of inspection.—344 visits were paid by male Inspectors and 52 by women Inspectors, a total of 396 visits. 65 [1934 INFIRM PERSONS. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928. During the year 12 cases, 3 males and 9 females, were investigated owing to complaints received. In the case of two of the women the Medical Officer of Health considered after thorough investigation that the complaints were not entirely justified, and that the individuals were really capable of looking after themselves. One man on persuasion voluntarily entered a hospital, and another man was removed to hospital before action was taken. The third man was removed by our taking action and obtaining an Order of the Court. Of the remaining women, two died within a short time of the complaints being received and looked into ; one on persuasion voluntarily entered an institution, another removed out of the Borough to the care of relatives, another changed to better accommodation in the same building, one taken more seriously ill was removed on medical certificate, and the remaining woman we had removed after action taken by us and an Order of the Court obtained. It will thus be seen that out of the 12 cases, only 2 were actually taken to Court and removed by order. SEWER EMANATIONS. The matter of sewer emanations has been before the Borough Council owing to continued complaints being received, especially in the summer months, since 1929. The matter was reported on page 60 of the Annual Report of the Medical Officer of Health for that year, and on page 70 of the Report for 1930. In 1931, 1932 and 1933 the London County Council were reported to be still continuing experiments to find a feasible method of sewer ventilation. In 1933 the matter had to be seriously reported on in respect of a manhole opposite Pleasant Place. In July, 1934, a petition was received signed by 47 persons who complained regarding this same sewer, the Middle Level Sewer No. 2, in the vicinity of Spencer Street and Sebbon Street, and the matter was reported to the Public Health Committee in September, 1934. Since then there has been a real calm as regards this particular neighbourhood, and no complaints have been received, due to the London County Council having, in place of ventilating the sewer from the open street manhole, closed this down and ventilated the sewer in another district of the Borough by erecting a shaft on the railway bank in the vicinity of Lyon Street. It remains to be seen whether this experiment in ventilation in this position will be effective and not merely be transferring the complaints to another neighbourhood. SCHOOLS. The medical inspection of school children in this, as a Metropolitan Borough, comes under the administration of the London County Council. School premises, however, come under the general sanitary inspection of the department. A school is defined in the interpretation section (141) of the Public Health (London) Act, 1891, thus:—The expression " house " includes schools, also factories and other buildings in which persons are employed. There are in Islington 15 private schools, the number of scholars taken varying from 6 to 83. A number of these take boarders under the age of nine years, and thus come under our purview as regards Infant Life Protection. Some others, although under the London County Council inspection as grant receiving schools, take boarders under nine years of age and are under our inspection for Infant Life Protection. 1934] 66 One of the private schools was found on inspection to be far from satisfactory as regards sanitary standard, and a number of visits had to be made and a notice served before effectual improvement was obtained. This school will probably require supervision for a while to ensure that effective cleanliness is maintained. RATS AND MICE (DESTRUCTION) ACT, 1919. (9 and 10 Geo. 5, Ch. 72.) From the 10th to 15th November in Islington, 2,000 handbills were distributed through the medium of the Sanitary Inspectors in the course of the district visitation, by the Health Visitors, and from the Enquiry Office, Public Health Department, at the Town Hall. This year the Rat Week poster used was varied, inasmuch as the one issued by the Ministry of Agriculture and Fisheries was adopted, being overprinted with the address from which information could be obtained, viz.:—Public Health Department, Islington Town Hall, Upper Street, N.l. It was considered best to use the large poster, as it is the best size for our notice boards. The various boards which the department possess, which are attached to the railings of the open spaces and gardens in the borough, were utilised for the propaganda. As a consequence of the propaganda this year, it was noticed that immediately after Rat Week there was an increase of callers for information—even above the week itself, and an increased sale of Rat Poison. As has been done in former years transparencies announcing Rat Week were exhibited at the Town Hall. At this time a problem in the tracing of rats of more than usual difficulty was before the Public Health Department. A complaint had been received of a basement being infected by rats in October. This resulted in inspection being made and evidence of rats being found, rugs and food eaten, floor boards and plaster gnawed through in places. The owner, when communicated with, issued instructions to a builder to carry out necessary work. Tests were put down to trace the runs but these proved unsuccessful as the runs were so numerous, and owing to the vast floor space under the floors were lost. The stone floor was opened up and an old six inch drain was found. This old disused drain was filled with concrete to a depth of three feet. An interesting feature in the work at these particular premises was the fact that they were occupied by a retired professional photographer, and when the problem of tracing the rats was eventually solved, being proved to be due to the old drain referred to and which had never been properly closed in and which allowed rats to enter from the sewer, he, of his own accord, took photographs of the actual conditions found. The ultimate solving of the problem in this case was arrived at by the wellknown method of a bait attached to twine on a spool, the food being carried into the nest. During the year 1934 the number of notices served was 101. The following Table summarises the work under the Act during the years 1927 to 1934. 67 [1934  1927 1928 1929 1930 1931 1932 1933 1934 Number of Streets visited 235 203 144 166 223 250 244 236 Number of Private Houses visited 368 349 223 387 385 391 388 364 Number of Shops and Factories visited 81 56 36 37 48 17 38 46 Total Premises inspected 449 405 259 424 433 408 426 410 Found Rat Infested 191 154 101 142 178 169 168 178 Found Mice Infested 8 2 4 3 10 9 8 6 Defective Drains Repaired (Cause of Rat trouble) 48 49 23 45 50 63 37 55 Number of Complaints received 202 150 124 176 216 203 194 212 RAG AND BONE DEALERS. Reviewing the report given on this subject last year, it has been found that conditions are generally satisfactory. There is one business less in No. 3 district and one less in No. 4. In No. 6 district one dealer has changed to new premises, but remains in the same district, and there is one less in No. 11 district. The total number of Rag and Bone Dealers in the Borough is 34. Ten official calls were made under the Regulations ; in addition, 38 visits were made to deal with the premises apart from the trade carried on. HOUSING. Housing Schemes Undertaken by the Borough Council.—The Borough Council appointed a Housing Committee in May, 1919, to exercise the powers and duties conferred upon the Council by the Housing and Town Planning, etc., Act, 1919, and subsequent Housing Acts. From that date up to the end of 1934, the following Housing Schemes have been carried out :— Properties. No. of Flats. Total Cost. £ Halton Mansions 160 192,546 Addington Mansions 107 175,262 City and Queens Mansions 92 92,094 Warltersville Mansions 46 45,948 Manchester Mansions and 88, Hazellville Road 41 57,484 Avenell Mansions 40 25,638 Tyndale Mansions 102 83,914 Laycock Mansions 132 88,135 Leyden Mansions 111 73,890 " The Highlands," Crouch Hill 71 35,550 Wakelin House, Sebbon Street 109 50,800 Miscellaneous 64 35,180 1,075 £956,441 CHURCH LANE CLEARANCE AREA. REPRESENTATION BY THE MEDICAL OFFICER OF HEALTH. This area was represented by the Medical Officer of Health on the 1st May, 1933. See Annual Report, 1933 (p. 68). The representation was under the provisions of the Housing Act 1930, and dealt with 53 dwelling houses and shop premises in Church Grove, Church Lane, Rothery Place and Rothery Street. The 1934] 68 Borough Council made an Order requiring clearance in March 1934, and the Ministry of Health Local Enquiry was held in April. Confirmation of the Order (subject to minor modifications) was received in July, and 391 persons displaced were offered accommodation in the Borough's Housing Scheme provided for the decanted persons, that is, Wakelin House. WAKELIN HOUSE. An area approximately 61,200 square feet in Sehbon Street (occupied originally by 26 dwelling houses, 19 of which were vacant) was purchased in July, 1933, from the Marquess of Northampton's Trust for £8,000. On this were erected two blocks of buildings five storeys in height—comprising 109 " balcony type " flats—with brick modern Georgian elevations, relieved by white plaster panels, stone cornices and strings, all resting upon a rusticated red brick base; the street aspect matches the Borough Council's Tyndale Mansions. The elevations to the inner courtyards are of sand lime bricks. The North Block consists of 18 three-bedroom and 56 twobedroom flats, while the South has 13 three-bedroom and 22 two-bedroom fiats. The accommodation has been reserved for families from the Church Lane Clearance Area, and in selected cases from other property dealt with by Order under the Housing Acts, and underground rooms illegally occupied. DECANTATION OF FAMILIES FROM THE CLEARANCE AREA TO THE NEW PREMISES PROVIDED. It is of the utmost importance that every care should be taken to avoid the transference from the clearance area to the new houses provided of anything detrimental, such as bug-infested furniture, pictures, wood, clothing, bedding, etc. If this work is carefully done at least a period of comparative immunity in the new houses may be secured. The tendency of people to buy old articles of furniture or clothing, or to allow infestation through visitors, etc., is always a constant danger and, of course, is not covered by the precautions taken at the decantation, but if these are not taken, it is obvious that matters would be very bad indeed. After seriously considering the matter, the Housing Committee were advised that the best system was treatment of the bedding and clothing by steam under pressure (which was done at the Council'sDisinfectingStation), and with regard to the furniture of the individual tenants removing into the new premises, the disinfestation of this by cyanide gas. This was arranged for by contract, and the consent of all the tenants previously obtained. During the actual process the van in which the treatment was carried out was left at the Council's Cleansing Department's Depot in Liverpool Road in an isolated position, and guarded. To ensure that there was co-operation between the tenants, the removal contractor and the disinfestation contractor, the work was supervised by the District Sanitary Inspector of the Medical Officer of Health's Department, the total time devoted by him to this work being 56 hours, distributed over fifteen days, the time varying from one hour to six hours per day, the general average being about four hours per day. As regards the articles, bedding, etc., treated by steam under pressure, 335 bundles, comprising 1768 articles, were treated. OTHER REPRESENTATIONS. In November the Medical Officer of Health represented to the Housing Committee 10 small clearance areas under Part 1 of the Housing Act 1930, one of these representations, being in two parts. These representations, with the exception of one which if forming part of a larger London County Council Scheme, come up for consideration in 1935. 69 [1934 RECONDITIONING OF HOUSES. Thirty-nine informal notices were served during the year under Section 17 of the Housing Act, 1930, requiring owners to effect repairs, and in no instance was it necessary for the authority of the Housing Committee to be obtained for the issue of a statutory notice. All the notices were complied with. The premises repaired were:—3, Brunswick Road; 8, 9, 10, 11, Gordon Place; 29 and 37, Ashbrook Road ; 38, Salterton Road ; 15, Grove Road ; 4, Fortnam Road ; 14,20,22, Mitford Road; 45,Mulkern Road; 20, 26, Marlboro Road; 167, 171*, Fairbridge Road; 49, St. John's Road; 12,Langdon Road ; 452,Hornsey Road; 13,Sparshlt Road; 15,Alsen Road ; 4,Charteris Road ; 4,Conewood Place ; 135,Boleyn Road ; 46, Canning Road; 69, Poet's Road; 40, Cumberland Street; 350, York Road; 14Rheidol Terrace; 13,Newhall Street; 11,Rheidol Terrace; 449, Liverpool Road; 311, Liverpool Road; 33,Parkfield Street; 4, Remington Street; 2, Almeida Street. * 2 Notices UNDERGROUND ROOMS. On the 1st October four temporary sanitary inspectors who had been appointed commenced a survey of underground rooms illegally occupied for sleeping purposes, and at the end of December these men had made 2,601 inspections, during which were discovered 900 rooms illegally occupied, and 120 rooms overcrowded. Premises. Occupants. Accommodation provided at. 62, Cloudesley Road 5 82, Flaxmere Road, Tottenham. 105, Caledonian Road 6 192, Peterborough Road, St. Helier's Estate, Morden. 87, Northdown Street 9 Removed to unknown address. 57, Roman Road 4 12, Bruce Buildings, Islington. 16, Half Moon Crescent 4 Removed to unknown address. 110, High Street 2 Duncan Terrace, Islington. 91, Barnsbury Road 6 Wessex Buildings, Islington. 58, Wellington Road 7 Removed to unknown address. 6, St. Peter's Street 4 98, Wakelin House. 50, Hanover Street 6 30, Methley House, Andover Road, Islington. Closing Orders made in above cases. 54, Arlington Street. 37, St. Peter's Street. Undertakings given in above cases. 1, 2 and 3, Victoria Mews. Closing Orders made in respect of these premises (not in category of underground rooms). 11, 13, 15, 17 and 19, Dorset Street. 8, 9, 10 and 11, Gordon Place. Demolition Orders made in above cases. Premises. Summary. Closing Orders (Underground rooms) 10 Undertakings given do. do. 2 Closing Orders (not underground rooms) 3 Demolition Orders 9 Summary of Housing from 1919 to 1934 (inclusive):— The number of houses or flats provided by the Islington Borough Council, the London County Council and by private enterprise in the Borough, was as follows:— 1919 to 1933 Total since 1934 1919. Number of houses or flats provided by the Islington Borough Council 893 180 1,073 Number of flats provided by the London County Council 405 50 455 Number of houses or flats provided by private enterprise 580 73 653 1,878 303 2,181 Particulars of houses or flats provided under the Council's Housing Schemes 1919 to 1933. 1934. Total since 1919. 1919 Act. "Halton Mansions (8 more flats are being erected on site of 27 and 28, Canonbury Villas (demolished)., 160 - 160 City Mansions 47 — 47 Queen's Mansions 45 — 45 Warltersville Mansions 46 — 46 Manchester Mansions 31 — 31 Addington Mansions 107 — 107 Comprising* 16 houses 57 dwellings— 57 493 — 493 1924 Act. Tyndale Mansions 102 — 102 Laycock Mansions 132 — 132 Houses, etc., Highbury Station Road 15 — 15 Avenell Mansions 40 — 40 Leyden Mansions 111 - 111 1925 Act. The Highlands, Crouch Hill — 71 71 1930 Act. Wakelin House — 109 109 893 — 1,073 * Includes:—27, Rupert Road 8, Barnsbury Street †27 and 28 Canonbury Villas Not converted 2, Highbury Grange †Since demolished. 1934] 70 71 [1934 The number of overcrowding cases recorded as dealt with by service of notice during the years 1924 to 1934 was :- 1924 13 1925 19 1926 26 1927 24 1928 37 1929 21 1930 32 1931 59 1932 72 1933 42 1934 61 Total 406 Others were dealt with by housing recommendations to L.C.C. HOUSING RECOMMENDATIONS FROM THE PUBLIC HEALTH DEPARTMENT. During the year 1934, recommendations were made to the London County Council regarding housing accommodation for "special hardship" cases. In all, 119 were recommended for special consideration. The basis on which these recommendations were made consisted of families living under overcrowded conditions, but in a number of cases ill-health of members of the family was the main reason for the support given to enable them to receive favourable consideration of their efforts to secure better housing conditions. Of the 119 cases recommended by the Medical Officer of Health, 52 of which were given on account of overcrowding, during the year :— 21 were provided with accommodation by the London County Council. 37 removed to an unknown address. 18 secured better accommodation in Islington. 41 still remained in their Islington occupation. 2 removed to addresses outside Islington. These 119 recommendations can be classified under the following headings :— 52 were on account of overcrowding; 45 ill-health (including 8 tuberculous sufferers); 18 insufficient accommodation for the sexes; 2 damp rooms; and 2 special circumstances. In addition to these 119 cases in which a "special hardship" recommendation was given, several investigations were made into cases brought to the notice of the Medical Officer of Health which called for much sympathy, but which fell short of the standard of "hardship" laid down, namely, gross overcrowding, ill-health of members of the family, and the difficulty of the separation of the sexes. In some of these cases a recommendation was given for consideration should there be any spare accommodation apart from that allocated for "special hardship " cases. 1934] 72 WATER SUPPLY. Number of houses which have not an adequate internal water supply, i.e., water supply from taps only, in yard, 130. Premises on which notices have been served under the London County Council (General Powers) Act, 1907 (Additional Water Supply), 200. DEMOLITION OF HABITABLE DWELLINGS. During the year 31 houses have been demolished, having been taken for new business premises. METROPOLITAN BOROUGH OF ISLINGTON. Housing Statistics for the Year, Ministry of Health Table. 1.—Inspection of Dwelling-houses during the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,514 (b) Number of inspections made for the purpose 7,514 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,669 (b) Number of inspections made for the purpose 1,669 (3) Number of dwelling-houses found to be in such state so dangerous or injurious to health so as to be unfit for human habitation 78 (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 1,298 2.—Remedy for Defects during the Year without Service of Formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by Local Authority or their officers 1,273 3.—Action under Statutory Powers during the Year:- (a) Proceedings under sections 17, 18 and 23 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 39 (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) By owners 39 (b) By local authority in default of owners Nil (b) Proceedings under Public Health Acts— (1) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied 4,785 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 4,785 (b) By local authority in default of owners Nil 73 [1934 (c) Proceedings under sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demolition Orders were made 9 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 5 (d) Proceedings under section 20 of the Housing Act, 1930— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 15 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil NUMBER OF HOUSES OWNED BY THE LOCAL AUTHORITY, DISTINGUISHING THOSE BUILT IN THE LAST TWO YEARS, AND HELD UNDER:— (1) Part III. of the Housing Act, 1925. (2) Part II. of the Housing Act, 1925, and (3) Other powers. Held under Total at 31st Dec., 1931 Erected in 1933 & 1934 Total Part III. of Housing Act 1925 Nil. 71 71 Part II. of Housing Act 1925 Nil. Nil. Nil. Other Powers 893 109 1002 Total 893 180 1073 74 1934] 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 1927 67 7 19 2 95 1928 53 6 15 6 80 1929 59 Nil 17 3 79 1930 68 2 27 2 99 1931 35 4 22 1 62 1932 26 4 11 - 41 1933 25 2 10 1 38 1934 39 - 19 4 62 Totals 1,227 153 224 34 1,638 INSPECTION AND EXAMINATION OF FOOD AND PLACES WHERE FOOD IS PREPARED. Slaughter Houses.—Inspector Haydock reports in respect of the inspection of meat and other foods that the premises visited which were licensed comprised 8 private slaughterhouses and 1 slaughterhouse for the slaughter of horses for export, and 1 knacker's yard. The visits numbered 504. During the year 1 slaughterhouse licence was refused by the Council. The following is the tabulated report :— Number of animals slaughtered for human food :— Oxen. Sheep and Lambs. Horses (for export). 218 4,743 1,532 75 [1934 No. of Cases. Description of Animal affected. Nature of Disease. Extent of Disease. How disposed of. 38 Oxen Distomatosis Liver (whole or part) Destructor or on 1 Ox Tuberculosis Head and Lungs premises. Destructor 2 Oxen „ Head and Tongue „ 3 „ „ Lunch „ 3 „ „ Lungs, Liver and Mesentery „ 1 Ox „ Ribs „ 2 Oxen „ Brisket „ 1 Ox Actinobacillosis Tongue and Head „ 5 Oxen Pleurisy Lungs „ 2 „ Abscess Livers „ 1 Ox Pericarditis Heart „ 1 Lamb Peritonitis Liver On premises. 1 „ Pleurisy Lung „ UNSOUND FOOD DESTROYED. The food destroyed or otherwise disposed of so as to prevent its use for human consumption was as follows :— Tons. cwts. qrs. lbs. Diseased meat including organs from slaughter-houses (surrendered) - 8 2 23½ Meat and Tinned Foods from shops and stalls (seized) - - 3 8 Various Meats & Tinned Foods from shops & stalls (surrendered) - 7 - 16 Fish from shops, fryers and wholesale dealers (surrendered) - 6 - 5 Fruit and Vegetables 7 14 2 23 Total 8 17 1 19½ The total amount of unsound or diseased meat, fish, fruit, and other food destroyed was 8 ton 17 cwt. 1 qr. and 19½ lbs. The diseases which affected animal food are set out in detail above. Shops, etc., Inspection of.—The number of visits made to shops, etc., by Inspector Haydock are as follows :— Total Butchers, Provision Dealers, etc., Shops 2,170 Meat, etc., Preparation Factories 74 Fish, Shops 440 Fruit, Shops 1,444 Markets 241 Stalls 617 Offensive Trades 130 Grand total ... 5,116 1934] 76 Under the London County Council (General Powers) Act, 1932, Part 2, Section 5, a Register of Premises used for the Manufacture or Preparation of Preserved Food is kept. This register practically takes in all butchers with few exceptions, as in the summer months a limited quantity of preservative in the form of Sulphur is allowed in sausages. For this purpose and for the boiling and smoking of hams, the premises come under the Act referred to. Although the main business in the register is that of butcher, others preparing or making articles of preserved food have also to register, thus grocers, provision and other shops are registered as well. (See Preserved Food and Ice Cream, p. 78.). During the year 105 warning letters were sent to various shopkeepers and stallholders who omitted to mark certain commodities with the country of origin. Warnings were also issued in respect of non-compliance with the Meat Regulations. Three fruit hawkers were prosecuted for selling foreign tomatoes without labels indicating the country of origin (these were actually being sold as "English")' one of these being summoned three times in respect of offences committed on different days, and penalties were imposed in each case. The habit of giving a false address is very prevalent amongst street traders in the Borough; on one occasion three costermongers, who were selling imported tomatoes as "English," all gave false addresses in the presence of a police constable. One, however, was recognised at a later date, and thus action could be taken against him. He was summoned and fined. A stall holder was proceeded against for offering for sale a number of fowls in an unsound condition. They were being offered at Is. each, which would have been an attractive price had not their green hue been prominent. The defendant stated in Court that this colour was due to their being " Irish " birds. Offensive Trades include 2 tripe dressers, 5 gut scrapers, 4 fur skin dressers, and Knacker's Yard, which received a total of 142 visits. There was no cause for complaint in the conduct of these businesses. PROSECUTIONS FOR EXPOSING FOR SALE UNSOUND FOOD. In addition to the prosecution for unsound fowls referred to in Mr. Haydock's report, in which the vendor was fined £2 2s. Od. and £2 2s. Od. costs for each offence, a prosecution was taken in respect of unsound chocolates where a fine of 40s. Od. and £2 2s. Od. costs were imposed. In a further case taken in respect of unsound tinned fruit the summons was dismissed, the magistrate not being satisfied that the unsound fruit was deposited on the premises for the purposes of sale. SLAUGHTER OF ANIMALS ACT, 1933. This Act became operative on the 1st January, 1934, and under it it is possible by resolution of the Local Authority to exempt sheep from stunning. The matter was still under consideration of the Borough Council during the year. Under this Act also the Local Authority grant the licences to slaughtermen; 45 applications for licences were received, and after investigation all of these were granted. DISEASES OF ANIMALS ACT. ORDERS OF THE MINISTRY OF AGRICULTURE. No special Order came under purview during the year. A case of Anthrax, found outside the Borough, was dealt with under suitable precautions at our local knackery under supervision. 77 [1934 MARKING OF IMPORTED MEAT. During the year 1931 the marking of imported meat was still regulated by the Sale of Food Order, 1921. SALE OF FOOD ORDER, 1921. No prosecution was taken under this Order during the year. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. No prosecutions were taken under these Regulations during the year. A certain laxity was found in a particular district in Islington, and the traders were warned. The Meat Trades Federation, through their Society, made an independent inspection and agreed with the Medical Officer of Health that matters could be considerably improved. Their co-operation and the pressure they brought to bear on their members resulted in the laxity being remedied. CERTIFICATION OF MEAT FOOD PRODUCTS FOR SHIPMENT ABROAD. The Medical Officer of Health, as Designated Officer for Food Certification, issued 7 certificates in respect of foods prepared in Islington and exported abroad and to the Dominions. LICENSED STREET TRADERS IN THE BOROUGH OF ISLINGTON FOR THE YEAR 1934. Meat, etc., 53; Fish, Poultry, Rabbits, 37; flee Cream, 62; Confectionery, Minerals, etc., 25; *Grocery, Provisions, Tinned Food, etc., 77; Coffee Stalls, etc., 8 ; Fruit, Vegetables, Greengrocery, etc., 270. †e also sell confectionery and minerals. * One tinned food only. Restaurant Kitchens,—The work of inspecting restaurant kitchens is tabulated under Workshops, and is done by the two women inspectors, whose work was reviewed fully in the Report of 1926, p. 58. 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 Number found Inspected. Unsatisfactory. Hotel and Restaurant Kitchens 07 2 Coffee and Dining Rooms 47 8 Refreshment Rooms 203 7 Provision (Cooked Meats, cooked but not consumed on premises) 136 32 693 209 NOTIFICATION OF FOOD POISONING. During the year 5 cases of food poisoning were notified, the alleged poisoning foods being Meat Pie, Tinned Crab, Tinned Peas, Ice Cream, Anchovy Paste, 19341 78 PRESERVED FOOD AND ICE CREAM. On page 67 of the Annual Report for 1932 the registration of premises in respect of these articles was fully dealt with. In 1933 158 premises were on the register for preserved food; 8 were registered during the course of the year. The total on the register at the end of the year, therefore, was 166. The number of ice cream premises in 1933 was 408. All of these continued in 1934; 40 additional were registered, so that the ice cream premises on the register totalled 448 at the end of the year. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. During the year 3 informal samples were taken under the above Regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 and 1927. Seven informal samples were taken and found in order. MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. For prosecutions under this Act see page 82. MILK AND DAIRIES ORDER, 1926. Milk Purveyors and Dairies.—At the close of the year there were on the register : 401 dairies. There were also in the borough 360 premises, from which milk in sealed containers was being purveyed. The latter premises are not subject to the provisions of the Milk & Dairies Order 1926, in view of the definition of the word "dairy" in Art. 19 of the Milk & Dairies (Consolidation) Act, 1915. The person occupying the premises is, however, registered as a purveyor of milk. During the year, five premises were added to, and seven premises removed from, the Register of dairies, while 30 purveyors' names were added to, and one name removed from, the Register of the purveyors of milk. The occupiers of the dairies are ipso facto registered purveyors of milk. The number of dairies in the Borough has been appreciably reduced by the fact that two of the largest businesses have ceased to sell loose milk over the counters of their various premises, the milk being now sold in sealed bottles as delivered from the bottling depot. The United Dairies (London), Ltd., have made this alteration in 18 premises in Islington, and the Express Dairy Co., Ltd., in 7 ; the latter firm, also, has closed two premises entirely. Where a change of occupation of a milkshop or dairy has been effected, or where it is proposed to open a new business, each has been visited by the Superintendent, the total number of visits for the year being 48. For prosecution under the Milk & Dairies Order, see p. 82, 79 [1934 THE MILK AND DAIRIES (AMENDMENT) ACT, 1922; THE MILK (SPECIAL DESIGNATIONS) ORDER, 1923. During the year 1934 the following applications 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, 1923. Designation. No. of applications Number granted. Amount of Fees received. £ s. d. Certified 10 10 2 10 0 Grade A (Tuberculin tested) 29 29 7 5 0 Grade A (T.T.) (Bottling) 1 1 2 2 0 „ (Pasteurized) 3 3 2 12 0 Grade A 5 5 1 5 0 „ (Bottling Licence) - - - Pasteurized (Dealer) 24 24 5 17 6 „ (Pasteurizer) 5 5 5 10 0 Supplementary :— Pasteurized 5 5 10 0 Grade A (Tuberculin Tested) 3 3 6 0 86 86 £27 17 6 ADULTERATION OF FOOD AND DRUGS—FOOD AND DRUGS (ADULTERATION) ACT, 1928. During the year the number of Samples of Food and Drugs taken for Analysis were 1,152, including 615 informal samples ; with but two exceptions all the purchases were made by the Food and Drugs Inspector or his Agent and were submitted to the Islington Public Analyst, Dr. Alan W. Stewart. Of the total samples 1,114 were reported to be genuine and 38 adulterated, or 3.0 per cent. This percentage is 0.3 above the previous year and 3.2 below the average rate for the preceding 10 years. There were 19 prosecutions under the Food and Drugs (Adulteration) Act, 1928, 14 of which were successful. Eight samples of milk were submitted by the Inspector for bacteriological examination, see page 51. Three informal samples were taken under the Public Health (Condensed Milk) Regulations, 1923 and 1927; and seven informal samples under the Public Health (Dried Milk) Regulations, 1923 and 1927, all of which were found to be satisfactory. In addition to this work, Inspector Green made 932 visits under the Merchandise Marks Act. Prosecutions are included in the complete list (p. 82). In connection with the food and drug work 25 warnings were given, 10 warnings under the Milk and Dairies (Consolidation) Act, and 59 warnings under the Marking Orders, 1934] 80 During the year 1934, 3 formal and 20 informal samples of cream were taken ; all proved to be genuine. A wide selection (the varieties numbering 161) of informal samples were taken during the year, as these form the basis upon which information is obtained to enable us to buy formal samples with a view to prosecution. The informal samples of butter numbered 79, cheese 25, pepper 23, honey 17, sausages 17, and olive oil 14. During the year 1934 in addition to the samples taken and submitted to the Public Analyst there was a total of 123 informal samples, which were examined by the Food and Drugs Inspector. These informal samples comprised a number of varied articles. The greatest amount of detected adulteration occurred in the first and second quarters of the year, as shown by the figures given in the statement below. Examined. Genuine. Adulterated. Per Cent. Forma] Informal Formal Informal Formal Informal Adulterated. 1st Quarter 115 296 104 291 11 5 3.9 2nd „ 100 142 100 139 6 3 3.0 3rd „ 138 93 134 93 4 - 1.7 4th „ 178 84 172 81 6 3 3.4 The Year . 537 615 510 604 27 11 3.0 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 122 8.74 3.59 12.33 Milk purchased on Week-days 316 8.73 3.56 12.29 Milk procured in transit at Finsbury Park Station 77 8.84 3.69 12.53 Official Standard 8.50 300 11 50 Sophistication of Milk.—The particulars as to the genuineness or otherwise of the samples procured or purchased on Sundays, Weekdays, and at Finsbury Park Railway Station are as follows :— Percentage Number taken. Genuine. Adulterated. Adulterated. On Sundays 122 119 3 2.4 On Week-days 316 313 3 0 9 At Railway Stations 77 73 4 5.2 (Farmers' Milks) 515 505 10 2.0 81 [1934 Giving the particulars of the Milks taken during each quarter of 1934 on Sundays, Week-days, and at the Railway Stations. 1934. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Week- days. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks. Sundays. Weekdays. Railway Stations. All Milks, 1st Quarter 32 30 46 108 29 30 42 101 3 - 4 7 94 - 8.7 6.5 2nd „ 30 57 14 101 30 55 14 99 - 2 - 2 - 35 - 2.0 3rd „ 20 99 15 134 20 98 15 133 - 1 - 1 - 1.0 - 0 7 4 th 40 130 2 172 40 130 2 172 - - - - - - - - The Year 122 316 77 515 119 313 73 505 3 3 4 10 2.4 0.9 5.2 2.0 The number of samples of milk purchased was 515, of which 505 were genuine, and 10, or 2.0 per cent., were adulterated. Showing the samples of milk reported as genuine or adulterated during the past 10 years and in 1934:— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated Per cent. Adulterated. 1924 681 646 35 5.1 1925 684 652 32 4.7 1926 586 565 21 36 1927 740 710 30 4.0 192S 664 638 26 3.9 1929 539 523 16 3.0 1930 672 661 11 1.6 1931 610 595 15 2.5 1932 596 579 17 2.8 1933 546 524 22 4.0 Average 10 yrs. 632 609 23 3.6 1934 515 505 10 2.0 1934 82 Showing the analysis of 6,218 milks examined in Islington during the 10 years 1924-33 and 1934, 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. 1924 120 8.74 3.42 399 8.78 3.48 162 8.87 3.65 1925 10S 8.71 3.41 384 8.71 3.37 192 8.79 3..67 1926 83 8.81 3.65 409 8.78 3.63 94 8.88 3.62 1927 129 8.87 3.49 378 8.86 3 .73 233 8.84 3.69 1928 124 8.95 3.52 362 8.93 3.40 178 8.90 3.67 1929 142 9.02 3.50 236 8.99 3.41 161 9.01 3.80 1930 110 8.86 3.69 439 8.85 3.61 123 8.90 3.90 1931 95 8.82 3.63 329 8.83 3.64 186 8.93 3.79 1932 111 8.83 356 306 8.82 3.60 179 8.89 3.72 1933 114 8.79 3.46 263 8.80 3.54 169 8.85 3.67 Total samples and average constituents (to years) 1.136 8.84 3.53 3,505 8.84 3.55 1,677 8.89 3.72 1934 122 8-74 3-59 316 8-73 3-56 77 8-84 3.69 Summary of Prosecutions during the year 1934. Statute. Total Prosecutions Successful. Dismissed. Withdrawn. Amount of Penalties Costs Received. £ s. d. £ s. d. Public Health (London) Act, 1891 15 14 1 - 17 10 0 29 6 0 Food and Drugs (Adulteration) Act, 1928 *21 14 5 1 20 11 0 53 0 0 Milk and Dairies (Consolidation) Act, 1915 5 4 - 1 6 0 0 7 5 0 Milk and Dairies Order, 1926 1 1 - - 110 1 1 0 Merchandise Marks Act, 1926 7 7 - - 4 12 6 3 12 6 London County Council Byelaws London County Council (General 9 7 2 - 2 0 0 9 9 0 Powers) Act, 1902 1 - 1 - - - London County Council (General Powers) Act, 1932 2 1 - 1 0 10 0 1 1 0 Children's Act, 1908 and Children's and Young Persons Act, 1932 3 2 - 1 2 7 0 2 2 0 Housing Act, 1930 1 - - 1 - - Totals *65 50 9 5 £54 11 6 £106 16 0 * 1 summons adjourned, sine die. ISLINGTON HOSPITALS, CLINICS, Etc. Beds. St. Mary's (Islington) Hospital 858 Archway Hospital, Archway Road... ... ... 568 Royal Northern Hospital 371 Mildmay Memorial Hospital 30 Mildmay Maternity Home 17 London Fever Hospital 200 In addition, all the Central and North London Hospitals are used by Islington residents. 83 1934 OTHER INSTITUTIONS. Islington Institution, St. John's Road, N.—Accommodation for 1,546 (including those for "Petty Officers," that is, those inmates who are employed in the Institution). In "Sick" Ward: Males, 197 beds; females, 312; and 2 cots. In "Infirm" Ward: Males, 120 beds; females, 183. In Main body of the Institution (including the "Petty Officers" accommodation) for the able-bodied cases and Receiving Ward : Males, 485 beds ; females, 213 ; and 34 cots. Duchess of York Centre (Maternity), Essex Road.—No "beds," but clinic, and receives cases for Royal Free Hospital. North Islington Nursery School, 110, Tollington Park, N.4.—Opened 28th May, 1930. 50 children under 5 years. Islington Dispensary, 303, Upper Street. Islington Medical Mission, Britannia Row. The Almeric Paget Massage Corps, Islington Centre, Britannia Row, N.l (Light treatment, Massage, etc.). Child Guidance Clinic, Tudor House, Canonbury Place, N.l. Clinics, etc., not including Public Assistance, were enumerated on page 79 of the Report for 1931. SUMMARY OF SURVEY OF THE PUBLIC HEALTH SERVICES OF THE BOROUGH COUNCIL. The Minister of Health received during the year a report made by his officers on the Public Health work in Islington, and he has reported that "as far as can be judged by a general survey a reasonable standard of efficiency and progress is being maintained by the Council in the discharge of their functions relating to Public Health." "An important part is played by Voluntary Agencies, particularly as regards Maternity and Child Welfare and Tuberculosis services." "The responsibility for general administrative control which devolves on the Medical Officer of Health" is noted. The following points were brought forward for the Borough Council's consideration: (i) Payment of compensation to Midwives whose patients attend an ante-natal clinic and are, on the advice of the Medical Officer of the Clinic, admitted to hospital; (ii) the extension of the Consultant Services to include assistance, on any doctor requiring same, in difficult and complicated cases during pregnancy or at or after confinement; (iii) the importance of Artificial "Sunlight" treatment being a personal responsibility of a Medical Officer who should be satisfied that the staff who carry out the treatment have a competent knowledge of the technique of administration; (iv) the desirability of increasing the number of visits to milkshops and dairies and also the examination of "ungraded milk" for tubercle bacilli; (v) the better supply of satisfactory dust bins at houses in the Borough ; (vi) the better control to prevent the scattering of refuse at the Council's siding; (vii) the better covering of the refuse dumps in the country by the contractors; (viii) a wider exercise of the powers as regards Health Propaganda is suggested. 1934 84 PROPAGANDA WORK. Under this heading mention may be made of the "Health Talks" and Mothercraft Classes on various subjects provided by the four Voluntary Welfare Centres (p. 17). A large amount of literature is issued from the Public Health Department, Town Hall, comprising:—Hints on the Care and Feeding of Infants, with addresses of Welfare Centres; Advice to Expectant Mothers, Instructions to Foster-parents; Tuberculosis Dispensaries; Registrars; Public Vaccinators, etc.; Smallpox and Vaccination; Notes on Tuberculosis; Flies and Gnats; Measles; Whooping Cough; Diphtheria; Scarlet Fever; Infectious Diseases—Law. There is now issued a leaflet on the Bed Bug. An important addition was the issue of the booklet, "The Islington Child— The Citizen of the Future," dealing with the welfare of little children. This was originally contributed by the Medical Officer of Health, by request, to the local press, and was reprinted by direction of the Maternity and Child Welfare Committee for circulation. A large number of copies were distributed through the Maternity and Child Welfare Centres. The booklet includes a general summary of Welfare Centre work. The Medical Officer of Health, as in previous years, gave "Health Talks" at the request of several social organisations. The activities of the Department are tabulated in poster form, these posters being exhibited prominently on boards in the more populous parts of the Borough. APPENDIX. Vital and Sanitary Statistics, 1934 TOGETHER WITH THE PRESCRIBED RETURNS OF THE MINISTRY OF HEALTH. 86 STATISTICAL APPENDIX)IX Deaths registered in the Borough of Islington during the year ending 1934. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. CAUSE OF DEATH. Sex All ages AGES. DISTRICTS. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85& up Tuf. U.H. Toll. L.H H. B. S.E. AI,L CAUSES M. F. 1,929 1,794 180 109 68 51 24 21 15 12 23 24 37 42 103 71 91 86 219 153 383 296 438 418 295 366 53 145 170 169 214 183 171 212 248 186 326 332 335 269 465 443 Typhoid and paratyphoid fevers (1-2) M. 1 — — — — — — — — 1 — — — — — — - - 1 - - I-. — Measles (7) M. 22 7 32 - - - - - - - - - - - 2 3 5 6 8 9 6 1- 17 Scarlet Fever (8) M. 2 1 1 1 1 — 1 - - - - - - - - - - 1 3 — 1 F. 3 W hooping Cough (9) M. 6 6 8 1 - - - - - - - -- - - 1 2 — 1 5 1 5 F. 9 Diphtheria (10) M. 19 2 16 9 2 1 1 - 1 — — — — — 4 — 9 3 3 6 7 F. 13 Influenza (11) M. 20 — — 1 — — — 2 1 6 5 11 9 4 3 5 2 8 11 4 6 F. 19 Encephalitis lethargica (17) M. - - - - - - - — — — — — — — — — — — — — - F. — Cerebro-spinal Fever . (18) M. 3 — — — 1 — 2 — — 1 — - — — - — 2 — — 2 - F. 1 Tuberculosis of Respiratory .System (23) M. 169 2 — 2 3 12 40 52 42 52 27 16 4 1 22 19 26 28 30 46 82 F. 84 Other Tuberculous diseases (24) M. 16 2 6 1 1 3 2 4 2 1 3 1 1 — 4 2 3 2 4 8 4 F. 11 Syphilis (34) M. 8 3 — — — — — 3 — 2 4 2 - - - - - 5 3 2 4 F. 6 General Paralysis of the Iusane— tabes dorsalis. (83) M. 11 - - - - - - — 2 4 7 — — — — 1 1 1 3 2 5 F. 2 Cancer Malignant disease (45, 46) M. 270 — 1 1 — - — 11 24 83 160 200 87 10 60 64 48 71 97 79 158 F. 307 Diabetes (59) M. 8 - - - - - — 1 — 2 2 8 6 — 1 3 3 1 3 4 4 F. 11 Cerebral haemorrhage, &c. (82) M. 102 5 — — — - - 3 8 17 44 67 45 13 16 24 23 28 30 31 50 F. 100 Heart disease (90-95) M. 380 1 1 6 - 4 9 17 20 55 149 237 212 67 77 74 86 83 152 113 198 F. 403 Aneurysm (96) M. 6 - - - - - — — — 1 2 5 3 — — 1 — 1 2 4 3 F. 5 Other circulatory diseases (97-103) M. 63 - - - - - - — 2 6 27 4 50 16 19 15 16 9 28 30 33 F. 87 Bronchitis (106) M. 99 13 3 — — 1 - 6 3 11 39 44 44 16 14 23 14 17 30 46 30 F. 81 Pneumonia (all forms) (107-108) M. 192 62 25 2 2 4 1 9 24 35 58 60 48 7 21 30 29 53 52 79 73 F. 145 Other respiratory diseases (110-114) M. 14 1 — — — 1 1 4 3 4 3 3 8 2 2 1 3 3 8 7 6 F. 16 Ulcer of Stomach and duodenum (117) M. 32 - - - - - — 1 5 14 16 10 2 — 3 4 4 4 10 13 10 F. 16 Diarrhoea, etc (119-120) M. 33 41 6 — — — — 1 2 - 1 2 — - 8 5 3 10 10 5 12 F. 20 Appendicitis (121) M. 7 — 1 2 — 2 3 — 2 - 1 5 1 — 2 5 - 1 3 2 4 F. 10 Cirrhosis of liver (124) M. 3 — — — — — — — — 1 2 1 — — — — - 1 2 1 - F. 1 Other diseases of Liver, &c. (125) M. 1 — 1 — — — 1 - — — — — 3 — — — — — 1 2 2 F. 4 Other digestive diseases (115, 116, 122, 123, 126-129) M. 26 4 — 2 — 2 1 1 4 11 20 11 9 1 8 13 5 4 16 10 10 F. 40 Acute and Chronic Nephritis (130-132) M. 54 - - 2 - 1 2 3 5. 10 33 36 18 5 9 15 14 11 26 14. 26 F. 61 Puerperal sepsis ("0-145) F. 3 - - - - - 1 3 4 2 2 - - - - - 4 1 - 3 - 2 2 Other puerperal causes (141-150) F. 9 Congenital debility, Premature birth, Malformations, &c. (157-159) M. 68 95 1 3 - - - - - - - - - - 11 9 17 9 16 12 25 F. 31 Senility 102) M. 35 - - - - - — — — - — 14 48 45 8 24 19 9 16 14 17 F. 72 Suicide (163-171) M. 32 — — — — 2 3 10 4 10 12 3 4 — 2 3 8 8 9 6 12 F. 16 Other Violence (172-198) M. 65 1 4 6 2 9 5 13 5 13 18 17 21 10 10 13 11 22 21 14 33 F. 59 Other defined diseases M. F. 159 130 43 13 6 10 5 6 26 16 30 44 51 38 1 32 35 28 32 52 38 32 Causes ill-defined or unknown M. F. 3 2 — — — — — — — — — 2 3 — - — — 3 2 - - - 1934 87 1934 (Ministry of health Return.} Metropolitan Borough of Islington. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING THE CALENDAR YEAR 1934- Causes of Death. Sex All ages 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- AH Causes M 1937 182 35 33 39 61 104 91 221 381 442 348 F 1819 111 32 20 34 67 69 87 155 296 428 520 Typhoid and paratyphoid M 1 — — — — — — — 1 — — — fever F - - - - - - - - - - - - Measles M 21 2 13 6 — — — — — — — - F 17 6 8 3 - - - - - - - - Scarlet Fever M 2 — — — 2 — — — — — — — F 2 — — 1 — 1 — — — — -- — Whooping Cough M 8 3 2 3 — — — — — — — — F 10 4 4 1 1 - - - - - - - Diphtheria M 19 1 3 8 5 2 - - - - - - F 13 1 1 4 6 — — 1 - — — — Influenza M 20 - - - 1 — 2 — 3 1 6 7 F 22 - - - — — —. 2 3 4 7 6 Encephalitis Lethargica M - - - — — — — — — — — — F - - - - - - - - - - - - Cerebro-spinal fever M 2 — — — 1 1 — — — — — — F 1 - — —. — 1 — - - - - — Tuberculosis of respiratory M 169 2 — — 4 23 34 28 38 24 13 - system F 85 — — — 1 31 17 14 12 a 3 2 Other Tuberculous M 16 1 3 1 1 2 3 2 1 2 _ — -- eases F 1) 1 1 1 — 3 1 — 1 1 1 1 Syphilis M 4 1 - - - - - - 1 — 2 — F 7 2 — — — — 2 1 — 1 1 — General paralysis of the insane, tabes dorsalis M 19 - - - - - - 1 7 7 1 3 F 6 - - - - - - 2 - 2 1 1 Cancer, malignant disease M 276 - - - - - 8 7 32 75 115 39 F 309 1 1 — 1 — 3 16 54 85 91 57 Diabetes M 15 - - - - - - 1 1 3 5 5 F 16 - - - - - 1 — 1 2 7 5 Cerebral haemorrhage, &c. M 81 - - - - - - 2 3 24 37 15 F 77 - - - - - - 2 11 11 17 36 Heart Disease M 355 - - — 4 4 5 11 32 74 105 120 F 405 - - - 4 9 9 9 18 62 127 167 Aneurysm M 16 - - - - - 1 - 3 8 3 1 F 13 - - — — - — 1 — 1 9 2 Other circulatory diseases M 62 — — — — - — 2 4 12 21 23 F 80 - - - — - — — 2 18 26 34 Bronchitis M 105 7 2 1 2 3 4 4 11 25 24 22 F 83 4 - — — — 3 1 2 7 25 41 Pneumonia (all forms) M 188 38 9 6 3 4 3 12 24 37 28 24 F 141 22 9 4 2 — 5 8 8 26 25 32 Other respiratory diseases M 40 — —. — — - 2 1 4 1 6 26 F 51 - - - - - - 2 3 2 6 38 Peptic ulcer M 31 - - - - - 1 3 12 9 4 2 F 15 - - - - - - 1 4 5 5 — Diarrhoea, &c M 28 24 1 — — — 1 — — 1 — 1 F 20 12 5 — — — - 1 — 1 — 1 Appendicitis M 7 - - — — 3 — 1 1 — 2 — F 10 - - 1 2 2 — — — 1 3 1 Cirrhosis of Liver M 4 - - - - - - - 1 1 2 — F 1 - — — — — — — — 1 — — Other diseases of liver, etc. M 4 - - 1 — — — — 1 — 2 — F 11 - - — —. 1 1 .—. 2 3 2 2 Other digestive diseases M 33 5 — — 2 — 2 2 7 8 4 3 F 41 1 1 — 1 3 1 5 2 10 9 8 Acute and Chronic Nephritis M 69 — — — 1 2 2 3 7 18 15 11 F 68 — — — 1 2 1 4 5 16 23 16 Puerperal Sepsis F 4 — — — — — 4 — — — — — Other puerperal causes ... F 7 - - - - - 5 1 1 — — — Congenital Debility and Premature Birth. Malformations, etc M 84 82 — — 1 — 1 — — — — — F 44 43 — 1 - - - - - - - - Senility M 7 - - - — — — — - - 2 5 F 29 - - - - - - - - - 4 25 Suicide M 32 - - - — 3 8 3 5 9 1 3 F 17 — — — — 2 1 3 5 3 2 1 Other violence M 71 1 — 5 4 9 10 4 9 10 11 8 F 64 2 — 1 4 6 2 2 5 7 9 26 Other Defined Diseases M 158 15 2 2 8 5 17 4 13 32 33 27 F 138 12 2 3 11 6 13 11 16 22 24 18 Causes Ill-defined or unknown M - - — — — — — — - — — — F 1 - - - - - - - - - 1 — Legitimate. Illegitimate. Deaths under 1 year CM. IF- .. 171 103 ... 11 8 Registered Births M F 2456 2205 0c 00 (Ministry of Health Return.) V Notifiable Infectious Diseases during the Year 1934. Disease. Ages. Totals Total Cases removed to Hospital Under 1. 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and upwds Small Pox Notifications 1 .. .. 4 2 13 14 11 16 3 5 1 70 70 Deaths .. .. .. ... .. .. .. .. .. .. .. .. .. .. Scarlet Fever Notifications 51 62 96 106 403 181 61 93 17 11 .. 1089 1010 Deaths 1 .. 1 .. .. 1 1 .. 1 .. .. .. 5 5 Diphtheria Notifications 17 30 77 93 65 330 100 31 50 14 7 1 815 806 Deaths 2 6 2 4 3 9 1 1 1 1 .. .. 31 28 Enteric Fever Notifications .. .. .. .. .. 1 .. 1 1 1 2 .. 6 5 Deaths .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 Puerperal Fever Notifications .. .. .. .. .. .. .. 3 43 8 .. .. 54 47 Deaths .. .. .. .. .. .. .. .. 3 .. .. .. 3 60 Puerperal Pyrexia Notifications .. .. .. .. .. .. .. 2 58 7 .. .. 67 60 Deaths .. .. .. .. .. .. .. .. .. ... .. .. Acute Primary and Influenzal Pneumonia Notifications 9 14 14 7 9 26 18 16 52 32 47 16 260 123 Deaths 5 1 2 .. • • .. 1 3 3 13 29 20 77 34 Ophthalmia Neonatorum Notifications 60 .. .. .. • • .. .. .. .. .. .. .. 60 38 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica Notifications .. .. .. .. .. .. .. ... 1 .. .. .. 2 1 Deaths .. .. .. .. • • .. .. .. .. .. .. .. .. 1 Cerebrospinal Fever Notifications 3 .. .. .. .. .. 2 1 2 .. .. .. .. .. Deaths .. .. .. .. .. .. 1 .. 2 .. 1 .. 11 11 Acute Poliomyelitis Notifications .. .. .. 2 .. 1 .. .. 1 .. .. .. 4 4 Deaths .. .. .. .. .. .. .. .. 1 .. .. .. 1 4 Anthrax Notifications .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Deaths .. .. .. .. .. .. .. ..* .. .. .. .. .. .. Dysentery Notifications .. .. .. 1 .. 1 2 1 .. .. .. .. .. .. Deaths 1 .. .. .. .. .. .. .. .. .. .. .. 5 5 Malaria Notifications .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas Notifications 4 2 .. .. .. 5 4 8 32 31 79 28 193 126 Deaths 3 1 .. .. .. .. .. .. 1 2 11 24 21 Continued Fever Notifications .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox (except in the vaccinated under 10 years) Notifications 15 25 34 34 33 211 48 8 14 1 .. .. 423 56 Deaths .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cfcr.i 89 1934 (London County Council Return.) Metropolitan Borough of Islington. SUMMARY OF PROCEEDINGS DURING 1934. Premises. No. on Register at end of 1934 No. Added in 1934 No. Removed in 1934 Number of Inspections 1934 Number of Notices 1934 Number of Prosecutions 1934 †Milk Premises †401 5 7 628 18 Nil Cowsheds Nil Nil Nil Nil — „ *Slaughter Houses 8 „ 2 504 — „ Other Offensive Trade Premises 12 „ Nil 142 - „ Ice Cream Premises 448 40 Nil 199 8 1 Registered Houses Let in Lodgings 988 - 2 1,001 818 I * Including the Knackers Yard. † Excluding Bottle Milk Purveyors. Housing of the Working Classes— Number of houses inspected — (a) On account of complaints or illness (P.H. Act) 7,514 (b) House-to-house (Housing Consolidated Regulations, 1925) 1,689 Number of notices served— (a Under P.H. Act :— (i) Intimation 4,785 (ii) Statutory 548 (b) Under Housing Act 84 Number of houses repaired or nuisances remedied under P.H. Act 8,168 Number of houses repaired under Section 3 of Housing Act— (a) By owners 84 (b) By L.A. in default of owners Nil Number of houses closed on notice by owner that they could not be made fit Nil Number of houses for the working classes— (a) Erected during year 180 (b) In course of erection Number of representations by Medical Officer or other person 11 Number of houses included in such representations 78 Number of Closing Orders made Nil Number of Closing Orders determined {i.e. Houses made fit) Nil Number of Demolition Orders 9 Number of houses demolished — (a) In pursuance of Orders 5 (b) Voluntarily 1 Total number of houses in the Borough about 46,000 Number of houses occupied by the working classes about 30,000 U nderground Rooms— Number illegally occupied 109 Number closed or illegal occupation discontinued 109 Overcrowding— Number of cases of overcrowding found 61 Number remedied 61 Number of prosecutions Nil 1934 90 Smoke nuisances— Number of observations 88 Number of complaints 30 Number of notices served14 Number of legal proceedings Nil Cleansing and Disinfection— Number of adults cleansed 41 Number of children cleansed 6,087 Number of premises cleansed;— (a) After infectious diseases 1,924 (b) For vermin 276 Water supply to tenement houses— Number of premises supplied 200 Number of prosecutions 1 Sanitary officers— Chief Sanitary Inspector (Whole time Number of Sanitary Inspectors (Whole time) Male, 20 Female 2 „ „ (Part time) Male, 4 Female Nil Number of Health Visitors (Whole Time) 7 & 1 Infant Life Protection Visitor „ „ (Part time) 1 Infant Life Protection Visitor Tuberculosis Visiting Nurse (Whole time) 1 References—Former M.O. H. Reports. Tables and Reports have appeared in previous Annual Reports of the Medical Officer of Health. See reference page 91, report 1929, for years 1921-1929. Annual Report 1930. Page 10 Public Health Congress. Royal Agricultural Hall. Pages 34, 35 and 36 Smallpox. Page 41 Islington (Chicken-Pox) Regulations, 1930. Page 52 Local Government Act, 1929. Page 57 Cleansing (Disinfection) of School Children. L.C.C. Agreement, p. 57. Pages 60, 61, 62, 63, 64 Shops—General Investigation Regarding Conditions, Etc. and 65. Page 66 Nuisances by Dogs. Rag Flock Acts. Page 67 Agricultural Produce (Grading and Marking) Act, 1928. Merchandise Marks Act, 1926. Pages 70 and 71 Rats and Mice (Destruction) Act, 1919. Pages 71, 72, 73, 74 and 75 Housing. Page 75 Rent and Mortgage Interest (Restrictions) Acts. Page 76 Unsound Chocolates given as Prizes. Page 78 The Grading of Milk—Bacteriological Examination. Pages 78 and 79 The Milk and Dairies (Amendment) Act, 1922; The Milk (Specia Designations) Order, 1923. Annual Report 1931. Page 9 Report on Maternity and Child Welfare Work. Page 17 Work of the Day Nurseries. Pages 17, 18 and 19 Report of the Work of Voluntary Centres. Page 30 Prosecution non-notification of Infectious Disease. Pages 39 and 40 Islington Interim Tuberculosis Care Committee. Pages 60, 61, 62, 63, 65, Housing. 66 and 67. Pages 63 and 64 Basement Rooms. Pages 69 and 70 Census. Page 75 Cheese Sandwiches, Black Currant Pastilles. 91 1934 Annual Report 1932. Page 17 Work of the Day Nurseries. Page 25 Coroner's Court and Mortuary. Page 32 Dysentery. Page 43 Tetanus. Page 44 Sterility of Maternity Outfits. Pages 59-61 Housing. Page 67 Unsound Food as Prizes ; Preserved Food. Pages 67 and 68 Notification of Food Poisoning. Page 68 Food Poisoning—Definition. Page 72 Migratory Vendors—Warning. Misleading Descriptions—Wine and Spirit Mixtures. Page 74 The Almeric Paget Corps Child Guidance Clinic. Open Spaces. Annual Report 1933. Page 17 Work of the Voluntary Centres. Page 20 Day Nurseries. Page 21 Invalid Children's Aid Association. Page 21 National Society for the prevention of Cruelty to Children. Page 22 Infant Life Protection. Page 29 Death from Copying Ink Pencil. Page 32 Typhoid Fever at Camp. Pages 39 and 40 Interim Tuberculosis Care Committee. Page 48 Food Poisoning. Pages 49 and 50 Water Softening. Page 58 Scavenging. Page 64 Non-compliance with Statutory Notice. Page 65 Rat & Mice Act, 1919. Page 67 Housing. Page 68 Church Lane Clearance Area. Page 71 Housing Recommendations. Page 76 Unsound Food Prosecution. Page 77 Pickled Horse Flesh. Page 78 Foot and Mouth Disease Order. 92 1934 INDEX Page Accidental Deaths 25, 31 Acreage iii Acute Poliomyelitis 38 Adulteration of Food 79 Ages at Death 6, 7, 8 Agricultural Produce (Grading & Marking) Act, 1928 61 Anti-toxin treatment 34, 35 Anthrax 28 Appendix 85 Area iii Areas—Clearance 67 Artificial Sunlight Treatment 48 Attack Rates—Infectious Diseases 37 Bacteriological Examinations 50, 51 „ Diphtheria50, 51 Bakehouses 56, 57 Basement Rooms 69 Births iii, 4, 5 „ Illegitimate 5 „ Notification of 5 „ Stillborn 5 Blind Persons Act, 1920 40 Cancer 28, 29, 86, 87 Certification of Meat Food Products 77 Census Information iii Chicken Pox Regulations 39 Children and Young Persons Acts 21-23 Church Lane Clearance Area 67 Cleansing of Verminous School Children 56 Clearance Areas 67 Clinics 82 Coal gas Poisoning 31 Common Lodging Houses 64 Condensed Milk Regulations 78 Consumption (see Tuberculosis) iii, 29, 30, 41, 42, 44 Contributions to Voluntary Welfare Centres 24 Coroner's Court, &c 32 Cream 80 Day Nurseries 24 Dairies and Milkshops (Inspection of) 62,78 Deaths from all causes during the year iii, 5, 86, 87 Deaths from Epidemic Diseases iii, 26, 27 „ —Infants iii, 6, 7,8 „ „ Respiratory Diseases iii, 29, 30, 31, 86, 87 „ in Public Institutions 25, 26 „ and Death Rates 5,6 „ Maternal 9, 10, 11 „ Age at 6, 7, 8, 86, 87 Decantation of Families 68 93 Page Demolition of Habitable Dwellings 72 Density iii Diarrhœal Diseases 27, 86 Diphtheria 34, 86,87 „ Ani-toxin treatment immunisation 34, 35 Diphtheria Bacteriological 50, 51 Diseases Treated in Hospital 36, 37 Disinfectants distributed and used 55 Disinfecting Station 54 Disinfection Work 45, 54, 55 Disinfestation of School Children 56 Distribution of Milk 13 District Inspectors' Work 61-62 Dried Milk Regulations 78 Dust, removal of 60 Dust receptacles provided 60 Dysentery 39 Emanations, Sewer 65 Encephalitis Lethargica 39, 40 Enteric Fever (Typhoid) 35, 50, 51 Epidemic Diseases iii, 26, 27 „ Cerebro-Spinal Meningitis 38, 39, 86, 87 Exemption Certificates 52 Extract of Vital Statistics 3 Erysipelas 28, 36, 37 Factories and Workshops Administration 56-59 Fatality from Notifiable Infectious Diseases 37 Finsen Light Treatment 48 Food, Inspection of, Unsound, Adulteration of 74-77 Food Licensed Street Traders 77 Food Order 77 Food Poisoning 77 Gas (Coal) Poisoning 31 Glanders, Anthrax and Hydrophobia in Man 28,39 Health Propaganda 84 Health Service Survey 83 Health Visitors (Municipal) 14, 15 Home Visitations—Tuberculosis 49 Hospitals—Clinics 82 Hospital Isolation of Infectious Diseases 36, 37 Housing 67-73 „ Accommodation and Recommendations 71 Housing—Tuberculosis 49 Houses Let in Lodgings 63 Ice Cream Premises 62, 78 Illegitimate Births 5 Increase of Rent (Restrictions) Acts 74 Industrial Diseases 28 Infant Life Protection 21, 22, 23 Infantile Mortality iii, 6, 7, 8 Infant Welfare Work 14-24 Infection, Prevention of 32 Infectious Diseases (London) Regulations, 1927 39 Infectious Disease (Notifiable) 38 Infectious Diseases in Schools 49 „ „ (Non-Notifiable) in Schools 50 Infirm Persons 65 Informal Sampling 79, 80 Influenza 27, 28, 86, 87 1934 94 page Inspection of Food 74, 75 „ „ Houses 60, 62, 63 „ ,, Kitchens of Restaurants 57, 77 „ „ Milkshops and Dairies 62, 78 „ „ Slaughter Houses 74, 76 „ „ Workshops 56-59 Institutions 83 Institutions (Deaths in) 25 Inquests 32 Insulin (Supply of) 40 Invalid Children's Aid Association 24, 25 Isolation of Infectious Diseases 36, 37 Islington Chickenpox Regulations 39 Islington Interim Tuberculosis Care Committee 42-44 Kitchens and Restaurants 57, 77 Lead Poisoning 28 Legal Proceedings 82 L.C.C. Bylaws 82 London County Council (General Powers) Act 1902-1932 82 Public Health (Lond.) Act, 1891 82 Food and Drugs (Adulteration) Act, 1928 79, 82 Sale of Food Order, 1921 77,82 Meat Regulations, 1924 77 Milk and Dairies Order, 1926 79, 82 Merchandise Marks Act, 1926 61,79,82 Milk and Dairies (Consolidation) Act, 1915 78, 82 Light Treatment—Artificial Sunlight and "Finsen" 48 London County Council Return of Sanitary Work 89 Malaria 39 Malignant Diseases 28, 29 Marriages 3 Maternity and Child Welfare Committee ii Maternity and Child Welfare Work 9, 14, 15 Maternal Deaths 9, 10, 11 Measles (Deaths) 8, 50, 86, 87 Measles, Notifications by School Teachers 50 Meat Inspection 75-77 Meat, labelling of 77 Medicines, Provision of 40 Merchandise Marks Act, 1926 61, 79, 82 Ministry of Health Returns 87,88 Milk and Dairies (Consolidation) Act, 1915 78, 82 Milk and Dairies Order, 1926 78, 82 Milk, Bacteriological Analyses 51 Milk Scheme 13 „ Adulteration 80-82 Milk Purveyors and Dairies 78 „ Special Designations Order—Licences 79 Mortuary and Coroner's Court 32 National Society for the Prevention of Cruelty to Children 20,21 Notification of Infectious Diseases 32-38 „ „ Tuberculosis 41-42 „ „ Births Act 5 „ „ Still-births 5 Non-notifiable Infectious Diseases in Schools 50 Notices served 61 Nursery School 83 Offensive Trades 76 Ophthalmia Neonatorum 9 1934 95 rage Outworkers' Premises 56-59 Other Notifiable Diseases 38 Pathogenicity Tests (Diphtheria) 50 Pemphigus Neonatorum 12 Phthisis 29, 30, 41, 42, 86, 87 „ Notification of 41,42 Pistol (Toy)—Tetanus 52 Places where Food is Prepared 74, 77 Pneumonia 30, 39, 86, 87 Pneumothorax treatment 48 Poisoning (Gas) 31 (Lead) 28 Polioencephalitis 39 Population at the Census, 1931 iii „ estimated, 1932 iii, 3 Preserved Food (a) Inspectors'Visits 74,75 (6) Registration of Premises 78,79,89 (c) London County Council Table 89 Prevention of Deafness 40, 41 Prevention of Infection 32 Propaganda 84 Prosecutions, Summary of 82 Prosecutions—Unsound Food 79, 82 Public Health Committee ii Public Health (Meat) Regulations, 1924 77 „ „ (Tuberculosis) Regulations, 1930 42-44 Public Institution Deaths 25, 26 Public Vaccinators 53 Puerperal Diseases 11, 12,28 Puerperal Fever and Pyrexia 12 Polio-Myelitis, Acute 35 Pulmonary Tuberculosis 29, 30, 41-42 Rag and Bone Dealers 67 Rag and Flock Act (1911-1928) 61 Rats and Mice (Destruction) Act, 1919 66 Rateable Value iii Recommendations—Housing 71 Reconditioning of Houses 69 References—M.O.H. Reports 90, 91 Regulations, Chickenpox Notification 39 Removal of Dust 60 Rent and Mortgage Interest (Restrictions) Acts 74 Report on Housing 67 Report on Maternity and Child Welfare 9 Report on Work of Day Nurseries 24 Representations of Medical Officer of Health 67, 68 Respiratory Diseases iii, 29, 30, 41, 42 „ Tuberculosis 29-42 Restaurant Kitchens 57, 77 Rooms Disinfected 45,54 Sale of food Order—Labelling of Meat 77 Samples Analysed in 1934 79 Sanitary Inspectors' Work 60, 62, 63 Scavenging 59 Scarlet Fever 35 Schools 49, 50, 56, 65 Septic Diseases 28 Sewer Emanations 65 Shelter House 55 1934 96 1934 Page Shop Inspections 75 Slaughterhouses 74, 76, 89 Slaughter of Animals Act, 1933 76 Small Pox 33 Smoke Nuisances 61 Sophistication of Milk 80 Specialist Consultations 12 Staff 2 Statistics 85 Still-Births, Registration 5 Street Accidents 31 Street Traders 77 Summary of Housing 70 Summary of Vital Statistics iii Survey of Maternity and Child Welfare and Health Services 25,83 Synopsis of Inspectors'Work 60,63 Tetanus 28, 52 Toy Pistol—Tetanus 28 Tuberculous Diseases iii, 29. 30, 41, 42, 44 Tuberculous Meat 75 Tuberculosis (Interim Care Committee) 42—44 Tuberculosis Dispensaries 46—48 Tuberculosis—Housing 49 „ Notification of 41, 42 „ Respiratory, All forms. Deaths iii, 29-31 „ (Public Health) Regulations, 1930 42, 44 „ Visiting Nurse 49 Typhoid Fever (see Enteric) 35, 50, 51 Underground Rooms and Basements 69 Unsound Food, Destroyed 75 Unsound Food-Prosecutions 76 Vaccination 52-54 Vaccination Officers 53 Venereal Diseases 31 Verminous Children, Disinfestation of 56 „ Premises 55,61 Vital Statistics—Summary iii „ „ Extract3 Voluntary Maternity and Child Welfare Centres 16-19, 20, 24, 25, 83 Wakelin House 68 Water Certificates 61 Water Supply 62, 72 Welfare Work by Health Visitors 14, 15 Whooping Cough 8,50 „(Deaths) 86, 87 Widows', Orphans' and Old Age (Contributory) Pensions Act, 1925 61 Workshops and Factories, Inspection of 56-59