ISL 58 London1910 I-P. FIFTY-FIFTH ANNUAL REPORT ON THE HEALTH & SANITARY CONDITION OF THE METROPOLITAN Borough of Islington ALFRED EDWIN HARRIS, MEDICAL OFFICER OF HEALTH London: Vail & Co , Printers to the Council, 170, Farringdon Road, E C. 1911. MEMBERS OF THE PUBLIC HEALTH COMMITTEE (November, 1909, to November, 1910) Mayor Councillor HENRY JAMES CLARKE, J P A1dermen CHARLES CROLE-REES WM EDWIN MANCHESTER ROBERT STEPHENS CUFFLIN Councillors Ward Ward 1. ROBERT JAMES GANN. 5. THOS LUKE HARWOOD. 1. REUBEN LOOMES. 6. WM MASON BRADBEAR. 2. FRANK EDWD WIDDOWSON. 7. HENRY MARK KINGSTON . 2. HAROLD E BUTCHER. 7. HENRY MILLS, J.P . 2. ROBERT WM HILL. 9. WM THORESBY COOKSEY J.P. 3. WILLIAM J SMITH. 10. FRANCIS BANNING. 4. FRANK HALLAM. 11. WALTER E MARKHAM. Chairman Councillor THOMAS LUKE HARWOOD Vice-Chairman Councillor WM J SMITH OFFICERS OF THE public Healtlh Department Medical Officer of Health ALFRED EDWIN HARRIS, L R C S , L R C P Edin Solicitor ARTHUR MELLOR BRAMALL Public Analyst FRANK LITHERLAND TEED, D Sc , F I C , F C S Superintendent of Public Health Depaitment and Chief Sanitary Inspector JAMES RICHARD LEGGATT Inspector of Meat HARGREAVES WILKINSON, Cert Sanit Inst Inspector of Workshops and Bakehouses GEORGE WEST Inspectors of Workshops &c , in which Females are employed JOSEPHINE JANE BROWN * B A , Cert Sanit Insp Ex Bd ANNIE CATHERINE YOUNG, Cert Sanit Insp Ex Bd MARIAN GWYNETH PARKER DAVIES, † Cert Sanit Insp Ex Bd Inspectors of Houses let in Lodgings WILLIAM WALTER WARD THOMAS HENRY HANCOCK, Cert Sanit Insp Ex Bd Inspector appointed under the Sale of Food and Drugs Acts TOM LEONARD BURREl L, Cert Sanit Inst Inspectors of Nuisances and Sanitary Inspectors District 1 WILLIAM COOK, Cert Sanit Inst „ 2 HARRY JAMES BICKNELL, Cert Sanit Inst „3 ALLEN BAGSHAW, Cert Sanit Inst „4 GEORGE JAMES BRIDEL Cert Sanit Insp Ex lid „ 5 WILLIAM HOLSGROVE FLOOD, Cert Sanit Inst ,, 6 CHARLES EDWIN HORSMAN, Cert Sanit Ins* „7 EDWARD ISAAC FORTUNE, Cert Sanit Inst „8 JOHN METCALF, Cert Sanit Inst „9 WILLIAM IRVING, Cert Sanit Inst „ 10 HARRY JOHN JAMES WATSON, Cert Sanit Inst „11 SAMUEL JEFFERY, Cert Sanit Inst ,, 12 THOMAS WALLACE AGAR, Cert Sanit Inst „13 JAMES JARVIS JORDAN § „14 HARRY CALLOW, Cert Sanit Inst Engineer in charge of Steam Disinfectors ARTHUR DEAN Caretaker of Shelter House Mrs DEAN Mortuary Keeper ALFRED GEORGE SPRAGUE ‡ Distributor of Disinfectants JOHN REDDY Disinfectors JOHN WRIGHT and THOMAS DIXON Clerical Staff Chief Clerk GEORGE HAROLD KING Second Clerk HENRY ANGEL ThirdClerk GEORGE JAMES ELDRIDGE Fourth Clerk EDWARD ALBERT ABBOTT Fifth Clerk WALTER JOSEPH WOLFE Sixth Clerk WILLIAM GEORGE BUNCH Seventh Clerk ARTHUR R WI TTRICK Junior Clerk CLEMENT MARSTONE WHEBLE Messenger ALEXANDER SANSON * Miss Brown resigned 4th March, 1910 † Appointed 9th May, 1910 § Inspector Jordan resigned, 15th July, 1910 ‡ Appointed 29th August, 1910 iv. INDEX. Page Adulteration of Food 272 Ages at Death 21, 29 Alcoholism 96 Analyst's quarterly reports 299-305 Annual Birth and Death rates, and Death-rates of Children 321 Anti-toxin Serum, free distribution of 342 Appendicitis 79 Area of Borough 6 Artizans'and other Dwellings 246 Bacteriological Diagnoses 185 Bakehouses 203-207 Baths and Washhouses 335 Births 14 „ in Decennial periods from 1841 323 Births, notification of 16 Butcher's Shops and Shops where food is sold 252, 261 Butchers' open window stalls 252 Butter and Margarine 286 Cancer 83 Canned Salmon 269 Chicken Pox, Notification of 161 Common Lodging Houses 245 Constitutional Diseases 83, 94 Continued Fever 69, 129 Cow Houses 256-265 Deaths 21 „ from Classified Causes 32, 33 „ at different age periods 21, 29 „ in the Quarters 23, 28, 30, 31 ,, ,, Sub-Districts 22 „ „ Wards 23, 26 „ „ Encircling Boroughs 73, 74 ,, from Epidemic Diseases 52-75 Deaths registered from all causes during the Year 314 Deaths registered from all causes in each Quarter 317 Deaths in Decennial periods from 1841 325 Deaths in Public Institutions 97 Death-rates of Populous Towns 75 Density of Borough 7 Diabetes Mellitus 93 Diarrhœa 69 Dirty Milk Vessels 271 Diphtheria 65 „ Fatality from 119, 122, 123 „ Notification of 117 Diphtheria and Croup 122 Disinfectants distributed and used 196 Disinfecting Station 194 Disinfection Work 192 District Inspection 229 Dust, removal of 235 Enteric Fever 68 „ Notification of 124 „ Fatality from 124, 126 v. Page Epidemic Diseases 52-75 ,, Cerebro-Spinal Meningitis 141 Erysipelas, Notification 126 „ Fatality from 126,128 Factories and Workshops 200 Fatality, from Infectious Diseases 110, 165 • Food, Adulteration of 272 ,, Informal sampling of 306 Food Inspection 250 Golden Syrup 290 Health Visitors 17, 38, 67, 81 Hospital Isolation of Infectious Diseases 164-166 Houses Let in Lodgings 227 Housing, Town Planning, &c , Act, 1909 237 Ice Creams 268, 272 Illegitimate Births 16 ,, „ in Decennial periods from 1841 324 Infantile Mortality 35-52 ,, „ in Decennial periods from 1841 326 Infectious Diseases on Business Premises 170 Infectious Diseases in Streets 171 Infectious Diseases in Schools 146 „ (Non-notifiable) in Schools 149, 163 Infectious Sickness in the several Wards from 1891 328, 333 „ in Quinquennial periods from 1891 327 Informal Sampling of Foods 306 Influenza 76 Inspection of Food 250 „ Kitchens of Restaurants 208, 216 ,, Slaughter Houses and Cow Houses 253-258, 265 Houses let in Lodgings 227 Inquests 104 Isolation of Infectious Diseases 164 Lamb and Veal, blowing of 252 Local Government Board Returns 336-339 London County Council Return of Sanitary Work 340 341 Margarine Act 286 Marriages 12 Measles 59 ,, Notification of 150-161 Meat Inspection 250 Midwives attending Disinfecting Station 198 Milkshops, Registration of 265 Milk, Quality of 281 Milkshops and Dairies 265 Mortality in Sub-Registration Districts 22 Mortuary and Coroner's Court 104 Notification of Infectious Diseases 106, 130, 131 „ „ „ in Registration Sub-Districts 108,132,133 „ „ „ in the Sanitary Inspectors' Districts 136 „ „ „ „in the Wards 109, 134, 135 „ „ „ „ during the several Months 137 „ „ „ in the Encircling Boroughs 138, 139 „ „ „ „ in Metropolitan Boroughs 140 „ „Phthisis 141 ,, ,, Births Act 16 Non-notifiable Infectious Diseases in Schools 149, 153 vi. Page Occupation of persons attacked with Infectious Disease 166 Offensive Trades 265 Outworkers' Premises 208, 218 Pauperism 242 Persons to an Acre 8 Phthisis 88 „ Prevention of 145 „ Notification of 141 .. Voluntary Notification of 144 Places where Food is prepared 216 Population—Estimated in 1910 3 „ in Sub-Districts 7 „ and Density of Wards 9 Population, Inhabited Houses, Marriages, Births, and Deaths 320 Pork Sausages 293 Prosecutions, Summary of 310 Puerperal Septic Diseases 81 Puerperal Fever 81 „ „ Notification of 128 „ „ Fatality from 129 Pulmonary Consumption 88, 141-146 Registered Lodging Houses 227 Respiratory Diseases 94 Restaurant Kitchens 208, 216 Salmon canned 269 Samples analysed in 1910 273 Sanitary Inspectors' Work 232 Sauces adulterated 292 Scarlet Fever 64 „ Notification o† 112 „ Fatality from 114 Seasonal Mortality 23 Septic Diseases 80 Shelter House 197 Slaughter Houses 253 Small Pox 59 „ Notification of 112 Smoke Nuisances 231 Street Markets 250 Streets where Infectious Diseases occurred 171 Summary of Sanitary Work in fourteen Districts 232 Summary of Applications for Removal of Dust 235 Trades carried on in Houses where Infectious Diseases have occurred 170 Tubercular Diseases 88-92 Typhus Fever 69, 126 Unsound Food 250 Unsound Fish 250 Vaccination 186 Venereal Diseases 97 Verminous Persons 197 Water Certificates 229 Water Supply 311 ,, to Tenement Houses 232 Whooping Cough 66, 162 Workshops and Factories, Inspection of 200 Work of Public Health Department, Summary of 334 REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1910 To the Worshipful the Mayor, Aldermen and Councillors of the Borough of Islington Gentlemen, I have pleasure herewith in presenting to you my report on the health and sanitary condition of your Borough during 1910 Its issue has been somewhat delayed owing to the fact that the recent Census showed that the population had been over-estimated by 25,933 When these figures were published the report had been prepared Indeed, a considerable portion of it had been in the printer's hands for some time I felt, however, that its issue would be a mistake, because not a single mortality rate, based, of course, on erroneous figures, relating to the year under consideration, or to any year between 1901 and 1909, would have been correct The report was, therefore, revised, and every statistic corrected, so that the actual state of health of the large district over which you preside might be shown It has been suggested that the good health of the Borough had been too highly lauded of late, because the population had been largely over-estimated, and that when the death-rates were re-calculated on the revised population, they would be found to be not nearly so satisfactory In these circumstances, I am glad to be able to report that the death-rate for 1910, based on the revised population, was the lowest on record, which may be seen on reference to Table H in the Appendix I, therefore, heartily congratulate the Borough on its good health viii. The birth-rate, however, continues to be low, and although it showed an improvement on that of the preceding year, yet it must be considered unsatisfactory I have deemed it my duty in two or three places in this report to strongly advocate the appointment of Health Visitors The Public Health Committee are aware of my views on this subject, but your attention as a Council so far has not been directly called to them I would, therefore, urge on you the consideration of my recommendations respecting such appointments A detailed report on this subject was submitted to the last Council (190(5-1909), who, however, did not adopt my proposals Nevertheless, the need for appointing these Health Visitors is greater to-day than ever, wherefore I earnestly hope that you will at an early date consider this pressing question The Notification of Births Act, 1907, the Public Health (Tuberculosis) Regulations, 1908, and the Public Health (Tuberculosis in Hospitals) Regulations, 1911, make the employment of Health Visitors more than ever necessary, if the work, which this Act of Parliament and these Regulations involve, is to be efficiently performed by the Council I trust that you will pardon my insistence on this matter, but as these appointments are very necessary, duty has compelled me to impress their importance on you Were I to do otherwise I would be false to the position I hold, and to the public whose health interests are so largely committed to my charge A great preacher has said that " he who is false to piesent duty breaks a thread in the loom, and will find the flaw when he may have forgotten the cause " I have no desire to find that flaw in the later years of a long professional career ; nor would I wish that when you and I have gone from here that others, who shall succeed us in our respective official spheres, should do so, and say of me that I stood silent when the more modern methods of saving human life were urgently inviting attention, and that I was, therefore, responsible for the deaths of those adults and children whose lives might have been saved if suitable instruction and advice had been given to them or to their guardians I desire to offer my sincere thanks to the Chairman of the Public Health Committee (Councillor Harwood) for the general support he has given to the important matters that I have from time to time brought before the Committee, and also to the Committee themselves for their invariable kindness and courtesy to myself . ix In conclusion I have to thank all the members of the staff of my department for the excellent way they have worked during the year, and especially Mr J R Leggatt (the Superintendent and Chief Inspector) and Mr George King (Chief Clerk), to both of whom I am greatly indebted for the manner in which they have performed their duties and for the assistance they have given me in the discharge of mine I am, Your faithful servant, Alexfarries Medical Officer of Health Town Hall, Islington, lsi August, 1911 X SUMMARY of Vital Statistics, 1910 Population (Estimated) 1910 Persons 327,985 Estimated decrease on population, 1909 750 persons Mean Population, ten years (1900-1909) Persons 331,434 Area 3,092 acres Density 114 persons per acre Marriages 2,870 Persons married 5,740 Persons married rate 17.50 per 1,000 inhabitants Births Males 4,196 Persons 8,201 females 4,005 Birth rate 25.01 per 1,000 inhabitants Deaths from All Causes Males 2,313 Persons 4,523 Females 2,210 ) Death rate ,, ,, I3.79 per 1,000 inhabitants Deaths from principal Epidemic Diseases Males 209 Females 219 428 persons Death rate 1.30 oer 1,000 inhabitants Infantile Deaths under 1 year Males 439 Females 338 Total 777 Infantile mortality rate 95 per 1,000 birihs Excess of Births over Deaths 3,678 PART I THE POPULATIONS, AREAS AND DENSITIES OF THE SUB-REGISTRATION DISTRICTS, THE WARDS AND THE BOROUGH B 3 1910 REPORT of the Medical Officer of Health FOR THE YEAR 1910 POPULATIONS, SUB-DISTRICTS, AREAS AND DENSITIES Population —The population, as estimated by the Registrar General, for the year 1910 was 353,356, of which 167,999 are males, and 185,357 females Thus for every 100 males there were 110 females He based this calculation on the increase of the borough between 1891 and 1901, as shown by the census taken in the last mentioned year How far he has been correct it is now possible to say The Medical Officer of Health had very little doubt in his own mind, although of course he might have been wrong, that the population had not increased to this extent He had arrived at this conclusion for the following reasons From 1801 to 1851 there had been a continuous rise in the percentage increase from decennium to decennium Thus from 1801 to 1811 it was 39.7 per cent; from 1811 to 1821 40.5 percent; from 1821 to 1831 66.4 percent; from 1841 to 1851 70.7 percent So far there had been an increase in the percentage, but thence onwards to 1901 there was a steady diminution in it Thus from 1851 to 1861 it was 63 1 per cent; from 1861 to 1871 37.1; from 1871 to 1881 32.3 per cent; and then there was a great drop from 1881 to 1891, when it was only 12.8 per cent, while from 1891 to 1901 there was still a further great diminution in the percentage increase, viz , from 12. 8 to 4.9 per cent Since 1901 it had been very apparent to the Medical b 2 1910] 4 Officer of Health that this small increase had not been maintained, because he could not help noticing that private houses, especially those for the wealthy and upper middle classes, had not been fully occupied, so that there were many vacant houses in the borough, while in the lower class dwellings there had been a great decrease in overcrowding On the other hand it was stated, by persons who do not think as the Medical Officer of Health did, that there had been no falling off, for although they admitted that the number of vacant residences was large, yet they said that many houses had been turned into flats, and also that there had been many blocks of dwellings, intended for the working classes, built He was not in a position to assert that their contention was wrong, although he had very grave doubts on the point; indeed, he thought that when the census returns were published, it would be found that Islington, instead of exhibiting an increase would show either none at all or a slight decrease The question of population is of course very important Those who have studied the reports of the Medical Officer of Health during the last few years will have noticed that he has been in great doubt as to the reliability of the estimates of the Registrar General, but that notwithstanding this he has considered that the error in the calculations of the birth-rates and death-rates based upon them would not be very great We now know what the actual population is, for the census returns have been published, and it has been found that it has actually fallen from 334,991 in 1901 to 327,423 in 1911, which is a decrease of 7,568 persons Of course, this will make a difference in the mortality rates, and other calculations based on the estimated population Thus the 4,523 deaths which were registered during 1910 are now found to be equal to a deathrate of 13.79 instead of 12.80, or a difference of 0.99, almost 1 per 1,000 of the population It is extremely unsatisfactory that there should have been any doubt in a matter of such moment as the mortality rate of the borough, apart altogether from the mercenary consideration that the distribution of the Equalisation of Rates grant is based on the estimated population of the Registrar General Mortality figures, to be of any real service, should be very accurate, and, therefore, it is essential that if this accuracy is to be obtained, a quinquennial census should be made If such a census were taken, it need not be a full one, such as that taken every ten years, but only one to ascertain the numbers of males and females and their ages If this were done, and the expense could not be great, then not only London, but the whole of England would have a satisfactory basis for the calculation of their vital statistics, 5 [1910 The following are the figures that were ascertained at the several census periods from 1801 to 1911 :— Census Years Enumerated Populations Actual Decennial Increase or Decrease Percentage Increase + or Decrease— 1801 10,212 — — 1801 15,065 4 853 +39.7 1821 22,417 7,352 +40.5 1831 37,3l6 14,899 +66.4 1841 55,776 18,460 +49.4 1851 95,329 39,553 +70.7 1861 155,341 60,012 +63.1 1871 213,749 58,408 +37.1 1881 282,865 69,116 +32.3 1891 319,155 36,290 +12.8 1901 334,991 15,836 + 4.9 1911 327,423 -7,568 - 2. 2 In view of the fact that the census had not been taken when most of this report had been prepared, the calculations had been based on the estimate of the population by the Registrar-General It is not possible in every instance to eliminate these errors, but they have been corrected as far as possible, while many statistical tables have been entirely omitted, as the Medical Officer of Health considers that they would have been entirely misleading Sub-Districts —The Borough is divided into seven sub-districts for the purpose of registration At one time there were only two such sub-districts in the parish of Islington, but from time to time as the borough grew the subdivisions were increased, the last being made on the ist August 1901, when the sub-district of Upper Holloway was divided into the three sub-districts of Tufnell, Upper Holloway and Tollington Prior to this change, the sub-district of Islington South East had been apportioned Part of it was added to the sub-districts now known as Lower Holloway and Barnsbury, and the remainder to the sub-district of Islington South East The more numerous the sub-districts of the borough are, the more easily is the exact health of the population gauged, for it is then possible to ascertain accurately the state of the health of comparatively small populations contained in them Wards —The wards are 11 in number, and vary considerably in size Thus Tufnell and Highbury each contain 417 acres, while Barnsbury extends over 137 (vide Table II) 1910] 6 Area—The area of Islington is 3,092 acres, or nearly five square miles, and although it is very large, it is exceeded in size by seven other Metropolitan Boroughs, for Wandsworth has within its boundaries 9,129 acres; Woolwich, 8,276; Lesvisham, 7,014; Camberwell, 4,480; Lambeth, 4,180; and Hackney, 3,288 None of these, too, have been entirely built on, so that there is much room for a considerable increase of their populations On the other hand Islington possesses little or no spare building land and has been practically covered with houses It has already been pointed out in previous reports that although the gross area of the Borough is 3,092 acres, yet over 291 acres are devoted to parks or similar open spaces, railways, canals and markets How these affect the Borough may be seen in the following table:— Sub-Districts Gross Area (Acres) Water Railways Markets Parks and Open Spaces Total Unavailable Space Net Area Tufnell 417 7. 4 20.8 .... 6.2 34.4 382.6 Upper Holloway 290 .... 7.3 .... .... 7.3 2827 Tollington 320 .... 21.9 ..... .... 219 298.1 Lower Holloway 413 .... 33.0 14.9 11.0 58.9 354.1 Highbury 798 ... 76.1 ... 32.4 108.5 689.5 Barnsbury 309 5.1 22.0 .... 4.7 31.8 277.2 South-East Islington 545 4.7 15.8 .... 8.5 29.0 516.0 The Borough 3,092 I7.2 196.9 14.9 62.8 291.8 2,800.2 In the subjoined Tables (pp 8 and 9) the figures there given have been calculated on an estimate of the population based on the census returns of this year, and, therefore, they may be taken to be as nearly correct as it is possible to get them . 7 [1910 The following figures were ascertained at the census taken, on April 1st, 1911:— Areas in Acres Families or Separate Occupiers, 1911 Populations Increase or Decrease 1901 1911 Increase Decrease  Islington 3,092 80,025 334,991 327,423 — 7,568 Sub-Districts Tufnell 411 8,203 31,995 33,528 1,533 — Upper Holloway 299 8,318 33,978 37,127 3,149 — Tollington 315 7,246 33,922 30,615 — 3,307 Lower Holloway 413 9,080 41,424 39,364 — 2,060 Highbury 799 15,229 63,797 61,992 — 1,805 Barnsbury 310 13,350 54,478 53,015 — 1,463 Islington, South-East 545 18,599 75,397 71,782 — 3,615 Parliamentary Divisions North 23,767 99,895 101,270 1,375 — West 16,720 74,171 70,336 — 3,835 3,108 East 21,641 89,349 86,602 — 2,747 South 17,943 71,823 69 300 — 2,523 Density of Population—The actual area on which the people live is 2,800 acres; consequently there are 117 persons living on each acre, while if the gross acreage be considered the number will be 106. It has frequently been pointed out that the density of the population in Islington is very high, and far above that of London, in which it is 60 . Whether we compare Islington with the great majority of the London Boroughs or with the provincial towns, it is found that very few of the former and none of the latter show a greater crowding of the people. 8 1910] Table I. showing the Areas, Densities, and Estimated Populations of the Sub-registration Districts at the middle of the year 1910. Sub-Districts. Area in Acres. Acres to a person. Persons to an Acre. Estimated Population Mid-year 1910. Tufnell ... 417 0.0125 80 33,414 Upper Holloway 290 0.0078 127 36,894 Tollington 320 0.0104 96 30,860 Lower Holloway 413 0.0104 96 39,517 Highbury 798 0.0128 78 62,126 Barnsbury 309 0.0058 172 53,123 South-East Islington ... 545 0.0075 132 72,051 The Borough 3,092 0.0094 106 327,985 9 [1910 Table II Showing the Areas, Densities and Estimated Populations of the Wards at the middle of the year 1910 wards Area in Acres Persons to an Acre, or Density of Population Estimated Population Mid-year, 1910 No 1—Tufnell 417 80 33,414 2—Upper Holloway 290 127 36,894 3—Tollington 320 96 30,860 4—Lower Holloway 413 96 39,517 5—Highbury* 417 ... ... 6—Mildmay* 337 ... ... 7—Thornhill* 172 ... ... 8—Barnsbury* 137 ... ... 9—St Mary's* 148 ... ... 10—Canonbury* 286 ... ... 11—St Peter's* 155 ... ... The Borough 3,092 106 327,985 Populations not available for these districts until the full census returns are published. PART II MARRIAGES, BIRTHS AND DEATHS 1910 12 MARRIAGES There were 5,740 persons married during the year, as compared with an average of 5,906 in the ten years preceding The marriage rate was equal to 17.50 per 1,000 of the estimated population, as against 1778 in the period just mentioned Thus there is a decrease of 166 on the mean of the decennium and in the number of persons married of 0.28 on the persons married rate The marriage rate varied during the year from 14.12 persons per 1,000 inhabitants in the first quarter to 21.31 in the third quarter. The number of persons who were married and the rate in the second quarter were 1,256 and 15.31 per 1,000 respectively, and in the fourth quarter 1,578 persons married, and a rate of 19.24 per 1,000 The year 1910 brought to a conclusion the decennial period, in which it will be noticed in Table IV that there were 29,433 marriages, or 58,866 persons married, and the rate, therefore was 17.76 per 1,000 of the population In Table IV will be found a statement which gives the marriage rates for the Borough since 1841 in decennial periods, in which it is noteworthy that in the decennial periods 1851 to 1860, 1861 to 1870, 1871 to 1880 and 1891 to 1900 the marriage rate was practically fixed, only varying from 17.06 to 17.96 Curiously enough, for reasons which it is difficult to explain, from 1881 to 1890 the rate fell to 15.55, while in the ten years just completed, 1901-1910, it rose to 17.76 It is puzzling to understand how an increase in the marriage rate is coincident with a decline which is considered to have taken place in the trade and commerce of the borough, and with a decrease which has actually occurred in the population TABLE III showing the number of Persons Married and the Marriage Rates in the Borough in 1910 No persons married Persons married per 1,000 inhabitants 1st quarter 1,158 14.12 2nd „ 1,256 15.31 3rd „ 1,748 21.31 4th „ 1,578 19.24 The year 5,740 I7.50 18 [1910 The record of marriages in Islington since 1841, given in decades and as abstracted and collected from the Registrar-General's annual reports is as follows :— Table IV Showing the Marriages and Marriage Rates in Seven Decennial Periods, 1841-1910, and in 1910 Periods Marriages Persons married per 1,000 of the Population 1841-50 6,109 16'81 1851-60 10,901 17.96 1861-70 16,194 I7.84 1871-80 20,889 17.06 1881-90 23,322 15.55 1891-1900 28,947 17.44 1901-10 29,433 17.76 1910 2,870 17.50 1910] 14 Table V showing the Marriages and the Marriage Rates m the Borough during 1910 and in the preceding ten years Years No persons married Persons married per 1000 inhabitants I900 5,936 17.67 I90I 5,988 17.88 I902 6,216 18.26 1903 6,106 18.32 1904 5,896 17.73 1905 5,968 17.99 1906 5,928 17.91 1907 5,924 17.94 1908 5,562 16.88 1909 5,538 16.84 Average of 10 years 5 906 17.78 1910 5,740 17.50 Decrease on mean l66 0.28 BIRTHS There were 8,201 births registered during the year, which is an increase of 103 on the return for 1909 It is, therefore, so far satisfactory The return is, however, less than that which obtained in any of the years from 1901 to 1908 or in any year as far back as 1872 A statement such as this emphasises the fact that the fertility of the population is not what it used to 15 [1910 be in former years This question has been discussed in many of these reports, and, therefore, it is not necessary to go into the matter more fully now Suffice it to say that there are few people who do not believe that such a decrease is due solely to a deliberate intention on the part of married women to avoid childbearing, in which they are encouraged by their husbands Whether such action on their part is right or wrong is one that has been argued, for and against, by moralists and social economists, but whatever may be their opinion on the subject, it is certain that the decay of nearly all nations has followed the diminution of their birth-rates The birth-rate of the year, calculated on the basis of the recent census, was 25.01 per 1,000 of the population Sexes of the Infants.- 4,196 of the infants that were born were males and 4,005 were females The females were, therefore, in proportion of 100 to every 105 males In the Quarters —In the first quarter there were 2,221 births; in the second 2,088 ; in the third 2,043 ; and in the fourth 1,949 In the Sub-Districts —In Tufnell there were 741 births, of which 378 were males and 363 were females. In Upper Holloway 985 births were registered, 495 being males and 490 females; in Tollington 724, of which 377 were males and 347 were females; in Lower Holloway 1,050 births, of which males and females were equal in number, viz 525 Highbury was credited with 1,271 births, of which 673 were males and 598 females In Barnsbury there were 1,545 births, of which 783 were males and 762 females And lastly in Islington South-East there were 1,885 births registered, of which 965 were males and 920 were females It may be noted that the births in Tufnell sub-district were fewer than in any year since 1903, when 740 were registered Again, in Upper Holloway the return of births was the lowest since it became a separate sub-registration district In Tollington the 724 births, although above the number registered in 1909, were below those of the preceding seven years In Lower Holloway the 1,050 births were the fewest in number recorded since 1902 In Highbury the 1,271 births present a similar tale, while in Barnsbury the 1,545 births, although 52 above the return of the preceding year, were below the returns from 1902 to 1908 In South-East Islington the 1,885 births, although 22 above the the return for 1909, were nevertheless below that of the preceding years 16 1910] The following Table gives the number of births registered in the several sub-registration districts from 1902 to 1910:— TABLE VI Births registered in Sub-Registration Districts, 1902-1910 Sub-District 1902 1903 1904 1905 1906 1907 I908 1909 I9IO Tufnell 745 740 799 758 746 745 816 759 741 Upper Holloway 1,131 1,108 1,066 1,067 1,061 1,023 1,027 993 985 Tollington 849 850 815 809 747 755 728 705 724 Lower Holloway 1,122 1,126 1,114 1,118 1,118 1,094 1,067 1,084 1,050 Highbury 1,488 1,460 1,423 1,303 1,348 1,278 1,416 1,301 1,271 Barnsbury 1,757 1,648 1,672 1,706 1,679 1,709 1,625 1,493 1,545 Islington South-East 2,122 2,051 2,001 1,995 1,960 1,927 1,986 1,863 1,885 Borough 9,2I4 8,983 8,890 8,756 8,659 8 531 8,665 8,198 8,201 Illegitimate Births.- There were 240 illegitimate births registered during the year, or 10 fewer than in 1909 It is interesting to note that from 1851 to 1860 the average number of illegitimate births in Islington was 133; in the succeeding decade, 1861 to 1870, it was 265; from 1871 to 1880 342, from 1881 to 1890 347, and from 1891 to 1900 271 There has, therefore, been a very considerable decrease in the last decennial period, indeed it amounted to 756 Table G in the Appendix gives a return of the illegitimate births registered in Islington during the last 70 years Notification of Births.—The Notification of Births Act was primarily passed with a view to the prevention of the deaths of newly born children, which has been for many years a blot on our boasted civilization It is true that the infantile mortality in England and Wales, and, indeed, in the United Kingdom, is not nearly so high as that experienced in other countries, but nevertheless in view of the fact that the birth rate was an ever decreasing 17 [1910 quantity, it becomes a matter of great moment to the nation In these circumstances it was no wonder that the Notification of Births Act, 1907, was passed by Parliament Its object, and its sole object, was to save lives by enabling Sanitary Authorities to get into immediate touch with the mothers so that they might receive early instruction as to the care of their young progeny. It was felt that if this were done many of the lives now lost would be saved. For some years prior to the passing of this Act, several sanitary authorities throughout the country had appointed trained women, mostly nurses, to visit mothers on the occasion of the birth of their children, and to instruct them as to the best means of rearing their infants. Their usefulness was at once recognised, and, therefore, their success was immediate. These women were soon known as health visitors, and have now become a recognised weapon in the armoury of public health authorities for the prevention of premature deaths among infants. They have been recognised by Parliament, by the Local Government Board, by the London County Council, and by every great authority in the country as being not only a useful, but a necessary instrument for such zvork ; and, indeed, the London County Council in order to encourage the appointment of health visitors in the county which it governs, obtained powers from Parliament in their General Powers Act of 1908 (Section 6) to allow any Sanitary Authority in London to appoint suitable women to be known as Health Visitors for the purpose of giving to persons advice as to the proper nurture, care and management of young children, and the promotion of cleanliness, and of discharging such other duties, if any, as may be assigned to them in accordance with the provisions of this section They also obtained power at the same time to pay out of the county funds any sum or sums by way of contribution towards the salaries of any persons so appointed, not exceeding in the case of any one such person one half of her salary . Owing to the fact that the majority of the Council pledged themselves at the last election not to appoint health visitors, not one of the mothers in Islington has been visited during the last two years on the birth of their children and no words of comfort or advice have been given to them. It is true that a card of instructions has been sent to each mother, but everyone with experience knows that documents, especially official documents, are for the most part thrown on one side Fortunately this is not true in every case, for in several instances that have come to the knowledge of the Medical Officer of Health the advice given on these cards of instruction has been highly appreciated, and has been passed on to others, but he also knows that in most cases it has been almost entirely neglected. He, therefore, again advises the Council, as strongly as he can, to appoint a sufficient number of Health Visitors to carry out the intentions of the tj c 18 1910 Notifications of Births Act, 1907, which was the instruction of mothers through the means of Health Visitors. The number of notifications received during the year was 7,407, of which number 1,011 were notified by doctors, 3,271 by midwives, and 3,125 by parents and other persons . It may be recollected that in 1908, 0,983 such notifications were received, of which 988 came from medical practitioners, 2,312 from midwives, and 3,683 from parents and other persons. It is to be regretted that there was a deficiency in the number of notifications to the amount of 794 births, or 9.68 per cent, of the total number registered during the year. Of this large number inquiry has shown that in 524 cases the mothers were attended by doctors, in 38 by midwives, and in 12 by other persons In 220 cases no information could be obtained owing to incorrect addresses, removals, or to the fact that the children had died before registration . Table VII Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1910, and in the four quarters of the year, also in the year 1909 ; together with the mean Borough Birth-rates for the years 1900-1909. Quarter Males Females Total Birth Rates Islington, 1910 Islington 1900-09 1st 1,098 1,023 2,121 25.87 27.74 2nd 1,045 1,043 2,088 25.46 26.62 3rd 1,070 973 2,043 2491 26.26 4th 983 966 1,949 23.77 25.87 The Year 1910 4,196 4,005 8,201 25.01 26.61 1909 4,238 3,960 8,198 24.94 25.01 Increase or decrease -42 +45 +3 +0.07 —1.60 19 Table VIII. Showing the Births 0} Males and Females in each quarter and for the year, 1910, tit the several Subregistration Districts. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. SouthEast Islington. The Borough Males. Females. Total. Males. Females. Tota'. Males. Females. Total. Males Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Qr. 90 89 179 129 132 261 106 81 187 134 133 267 175 149 324 205 203 408 259 236 495 1,098 1,023 2,121 2nd „ 85 104 189 135 123 258 90 100 190 136 122 258 169 175 344 179 188 367 251 231 482 1,045 1,043 2,088 3rd „ 113 87 200 119 132 251 82 82 164 136 153 289 173 136 309 209 184 393 238 199 437 1,070 973 2,043 4th ,, 90 83 173 112 103 215 99 84 183 119 117 236 156 138 294 190 187 377 217 254 471 983 966 1,949 Year 378 363 741 495 490 985 377 347 724 525 525 1,050 673 598 1,271 783 762 1,545 965 920 1,885 4,196 4,005 8,201 C 2 1910 20 1910] Table IX. Showing the Birth-rates for each quarter and for the year 1910. of Islington. Sub-Districts. I St Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Tufnell 21.43 22.62 23.94 20.71 22.17 Upper Holloway 28.30 27.97 27.21 23.31 26.70 Tollington 24.24 24.62 21.25 23.72 23.46 Lower Holloway 27.02 26.11 29.25 23.88 26.57 Highbury 20.86 22.15 19.89 18.93 20.46 Barnsbury 30.72 27.63 29.59 28.39 29.08 Islington, S. East 27.48 26.76 24.26 26.14 26.16 The Borough 25.87 25.46 24.91 2377 25.01 Table X. Showing the Population, Births, and Birth.rates in Seven Decennial Periods, 1841 to 1910, and in 1910. Periods. Mean Population in each Decade. Number of Births in each Period. Birth-rates. Average Yearly Number of Births, corrected on the basis of the population of 1910. 1 2 3 4 5 1841-50 72,767 20,850 28 .65 9,397 1851-60 121,353 41.915 31.54 11,329 1861-70 181,529 67,520 37. 20 12,199 1871-80 244,884 89,627 36.60 12,004 1881-90 299,857 97,420 32. 49 10,656 1891-1900 331,868 97,278 29. 31 9,614 1901-10 331,381 87.361 26.36 8.647 1910 327,985 8,201 25. 01 8,201 21 |1910 DEATHS. 1 he Medical Officer of Health is afforded much satisfaction through being able to report that the number of deaths, 4,523, registered in the borough in 1910, was less than at any time since 1873, notwithstanding the fact that the population has increased since then from 227,000 to 327,985. The deaths were 395 below those registered in the precedmg year, and 559 below the corrected average of the ten years 19001909. This is extremely satisfactory, for it shows that there has been on the whole a steady decrease in the number registered from year to year. In 1900, 5,721 deaths occurred, or 1,198 more than were registered last year. The deathrate, based on the recent census, was 13.79 per 1,000, which was the lowest deathrate recorded in Islington since civil registration came in/o vogue. This may be seen from the facts that from 1841 to 1850 the mean deathrate was 19.28 per 1,000, while the lowest deathrate in that decade was 17.58 in the year 1850. In the ten years 18511860 the mean deathrate was 21.43 per 1,000, while the lowest deathrate in these years was 20.0 per 1,000 in 1857. From 1861 to 1870 the deathrate averaged 24.6 per 1,000, while the lowest deathrate in this period was 19.94 in 1861. In the succeeding decade, 18711880, there was a considerable fall in the deathrate, which averaged 20.4 per 1,000, while the lowest rate registered was 18.25 in 1873. From 1881 to 1890 the average deathrate was 18.60, while the lowest rate recorded was 16.10 in 1889. From 1891 to 1900 the mortality was at the rate of 17.72 per 1,000 of the population, while the lowest rate that obtained was 15.92 in 1894. Then we come to the new century, in which the population for the first time showed a decrease, where we find that in the ten years 19011910 the mean mortality was 15.17 per 1,000. Thus the deathrate for the decennium, calculated on the population ascertained at the recent census, stands very low, viz:—15.17 per 1,000. These figures are given so that it may not be thought that the health conditions that undoubtedly obtain in Islington have been exaggerated. Such is not the case, for, even taking the average deathrate of a borough such as Islington, with its large artizan population, at 15.17, the health conditions axe most satisfactory. Ages at Death. ——With the exception of the two age periods 75 to 85 and 85 and upwards, there was a decrease in the number of deaths when compared with the preceding ten years at the various periods of life as specified in Table XV. There are one or two of the age periods to which special 1910] 22 attention might be drawn. Thus for instance there were only 777 deaths among infants under one year old, as compared with an average of 1,102 in the preceding ten years. Here then is a decrease of 325 deaths, which is a very substantial falling off in the mortality at this age. Again, between 1 year and 5 years the 515 deaths registered in 1910 are 61 below the average of 576 that obtained from 1900 to 1909; while in the age period of 515 years there is a decrease of 8, the number of deaths registered last year being 150. In the age period 1525 years, 146 deaths were registered, as against 190 in the preceding ten years, so that there is a decrease of 44. In the next ten years of life, 2535, 235 deaths were registered, or 66 less than the average (301) in the preceding decennium. In the age period 3545, 341 deaths were registered, which shows the satisfactory decrease of 79 from the average of 420. Again a further decrease is to be noted in the age period 4555, wherein 479 deaths were registered as contrasted with 525 in the preceding decennium, so that here was a decrease of 46 deaths. Thus we see that in the principal working period of life, viz., from 15 to 55 years, there was a decrease of no less than 235 deaths. This is, indeed, very good, and shows that the health of the workers has been much better than the average for the Borough. Full particulars as to ages at death may be found in Table XV. The Mortality in the SubDistricts.—The seven subregistration districts into which Islington is divided showed a mortality rate that varied from 12.21 in Highbury to 15.16 in Lower Holloway. Tufnell.—In Tufnell there were 424 deaths, as compared with an average of 470 in the preceding eight years. This number curiously enough is only one less than the number of deaths registered in 1908. The death rate was 12.69 per 1,000 of its population. Upper Holloway.—Upper Holloway also showed a decreased mortality, as the 535 deaths that were registered are 10 below the average of the preceding eight years, and 23 below the figure for 1909. The deaths for the year gave a mortality rate of 14.56 per 1,000 of its population. Tollington.—In this subdistrict there were 392 deaths, as compared with an average of 450 in the preceding eight years The deaths were also fewer than any registered since 1902. The deathrate was equal to 12.70 per 1,000 of its inhabitants. 28 1910] Lower Holloway.—This subdistrict showed a diminished mortality, for the deaths, which were 599 in number, were 19 below the return for 1909, and 59 below the average of the preceding eight years. The mortality was at the rate of 15*16 per 1,000 of its population. Highbury.—Highbury likewise showed a decreased mortality, the deaths numbering 759, as compared with 793 in the preceding year, and an average of 820 in the years 19021909. The deathrate for this subdistrict was only 12.21 per 1,000. It may be stated that in a very considerable portion of Highbury the mortality was exceptionally small, but as exact figures cannot be arrived at, it is deemed better not to depend on mere guesswork. The Medical Officer of Health, however, has no hesitation in saying that the health of the residential portion of Highbury is equal, if not superior, to any similar residential district in any part of London. The mortality is less than in any year since 1902. Barnsbury.—In this subdistrict 802 deaths were registered as contrasted with 872 in 1909, and an average of 934 in the preceding eight years. The return is the smallest known since 1902. The deathrate, based on the estimated population, was 15*09 per 1,000. Islington SouthEast. — Here 1,012 deaths were registered, as com trasted with 1,208 in the preceding year, and an average of 1,177 in the eight years 19021909. The mortality was at the rate of 14.04 per 1,000. It may be remarked that the deaths were fewer than in any year since 1902. Further particulars as to the mortality in the subregistration districts are given in the Local Government Board return in Table II. of the Appendix. Mortality in the Wards.—The number of deaths are set out in the several wards as given in Table XII. SEASONAL MORTALITY. First Quarter.— The deaths numbered 1,237, or 269 below the corrected average of the ten years 19001909, and were equal to the low annual death rate of 15.08, as contrasted with a mean deccnnial rate of 18.36 per 1,000. The mortality was lower in proportion to population than any experienced 1910] 24 in the borough during the first quarters of the twenty-four years 1886-1909, and probably during any first quarter of the last century. Second Quarter.—In this quarter there were 974 deaths registered, which were equal to the very low annual deathrate of 11.88 per 1,000, and represented a decrease of 199 on the corrected annual average, which was 1,173 in the' 10 years 1900-1909. The mortality in proportion to population was lower than any experienced in the second quarters of the year 1886-1900, and in all probability is the lowest that has occurred since registration became compulsory. Third Quarter.—In this quarter the health of the district was again exceedingly good, for the deaths numbered only 882, or 201 less than the average of 1,083 which obtained in the preceding ten years, while they were equal to the low annual death-rate of 10.75 per 1,000 of the estimated population, as compared with a mean decennial rate at this period of the year of 13.21 per 1,000. The proportional mortality was below any hitherto experienced in the Borough in the third quarter, and so far as can be seen by the returns, was lower than any during the last 110 years. Fourth Quarter.—This quarter did not show a decrease in the number of deaths when compared with the preceding ten years. Indeed, the 1,430 registered were 111 above the corrected average of 1,319 that obtained from 1900 to 1909, and were equal to an annual deathrate of 17.44 per 1,000 of the population, and contrasted with a mean decennial rate of 16.08 per 1,000. The mortality was the largest experienced in the Borough since the 4th quarter of 1904. The deaths varied from 91 in the first week in October to 164 in the first week in December. 25 [1910 Table XI. Showing the Deaths and Death Rates from All Causes in the several SubRegistration Districts. subdistricts Males. Females. Totals. Death Rates. Tufnell ... 204 220 424 i2'69 Upper Holloway 29i 24.4 535 14^0 Tollington l86 206 392 1270 Lower Holloway 323 276 599 i5i6 Highbury 345 4r4 759 12*21 Barnsbury 429 373 802 i509 SouthEast Islington ... 535 477 1,012 I4'°4 The Borough... 2,313 2,210 4,523 1379 Previous year 1909 2,487 2,43i 4,918 1496 1910] 26 Table XII. Showing the Deaths from All Causes in the Wards during the Four Quarters of 1910. Wards First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Year. Deaths. Deaths. Deaths. Deaths. Deaths. Tufnell 111 86 73 154 424 Upper Holloway 140 111 101 I«3 535 Tollington 108 80 87 117 392 Lower Holloway 151 128 123 197 599 Highbury 135 89 79 134 437 Mildmay 78 73 61 54 266 Thornhill 128 117 102 178 525 Barnsbury 69 61 60 87 2 77 St. Mary's 53 47 48 63 211 Canonbury 130 72 57 120 379 St. Peter's 134 110 9i 143 478 The Borough 1.237 974 882 1,429 4,523 27 [1910 TABLE XIII. Showing the Deaths and Death Rates together with the mean Mortality of the SubDiscricts for the Seven Years, 19039 and during the Year, 1910 DEATHS. DEATHRATES. 1903. 1904 1905. 1906. 1907. 1908. 1909. Average 19039. 1910 1903. 1904 1905. 1906 1907. 1908. 1909. Average 1903-9. 1910 Tufnell 440 571 483 432 482 425 44O 467 424 13.60 17.57 14.79 13.17 14.62 12.59 13.23 14.23 12.69 Upper Holloway 535 523 550 542 559 485 558 536 535 15.42 14.94 15.57 15.20 15.54 13.12 I5.25 I5.04 14.50 Tollington 437 475 428 425 480 396 430 439 392 13.17 14.46 13.16 13.21 15.07 12.32 13.79 13.64 12.70 Lower Holloway 618 693 644 721 644 571 617 644 599 15.09 17.00 15.88 1787 16.04 14.03 15.53 15.96 15.16 Highbury 796 775 837 779 816 816 793 802 759 12.56 12.26 13.28 12.39 13.02 12.81 1273 12.76 12.21 Barnshury 899 963 897 967 949 885 872 919 802 16.60 17.83 16.65 18.oo 17.72 16.25 16.37 I7.11 15.09 Islington, S. East 1,114 1,236 1,116 1,184 1,149 1,1o1 1,208 1,158 1,012 14.94 16.65 15.11 i6.11 15.71 14.84 16.68 15.76 1404 The Borough 4,839 5,236 4,955 5,050 5,079 4,679 4,918 4,965 4,523 14.52 15.74 14.93 15 .25 15.37 13.93 14.96 15.00 1379 1910] 28 Table XIV, Showing the Deaths and DeathRates of Islington in 1910, and in the four quarters of the year, the mean Borough DeathRates for the years igooog and the deaths and deathrates in the year igog. Quarter. Death Rates. Males Females. Total. Islington, 1910'. Islington, 1900-09. First 624 613 1,237 15. 08 18 .36 Second 489 485 974 11 .88 14 .31 Third 486 396 882 10. 75 13.21 Fourth 714 716 1,430 17. 44 16 .08 The Year 1910 2 313 2,210 4 523 13. 79 15.49 1909 2,487 2,431 4,918 14 .96 13.79 Decrease 174 —221 395 —1. 17 —1.70 * These rates have been calculated upon the population as corrected on the basis of the recent census of ign. 29 [1910 Table XV. Showing the Ages at Death during the Years 1900—1909 and in 1910. Years. AGES. 0—1 1—5 All under 5yrs. 5—15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85 upwards All above 5yrs. Totals. 1900 1,344 612 1,956 183 233 339 480 605 664 678 469 114 3,765 5,721 1901 1,290 638 1,928 176 210 315 444 511 631 592 451 103 3,433 5,361 1902 1,219 687 1,906 198 222 339 470 571 664 656 468 141 3,729 5,635 1903 1,136 538 1,674 139 201 299 390 491 533 577 423 112 3,165 4,839 1904 1,140 603 1,743 165 197 295 439 521 603 666 496 111 3,493 5,236 1905 1,074 565 1.639 116 188 318 380 527 590 648 396 153 3,316 4,955 1906 1,083 589 1,672 141 167 273 377 528 611 654 490 137 3,378 5,050 1907 996 545 1,541 162 167 310 398 492 659 730 463 157 3,538 5,079 1908 894 426 1,320 161 170 257 408 47i 597 637 510 148 3,359 4,679 1909 841 560 1,401 140 144 271 415 539 600 692 544 172 3,517 4,918 Mean. 1,102 576 1,678 158 190 301 420 525 615 654 471 135 3,469 5,147 1910 777 515 1,292 150 146 235 341 479 607 636 495 142 3,231 4,523 Increase or Decrease -325 — 61 -386 -8 -44 -66 -79 -46 -8 1-8 + 24 + 7 - 238 — 624 19101 8O Table XVI. Showing tin Deaths and Deathrates from All Causes in the Four Quarters and in the Subdistricts, together with the Deathrates of the Borough during the same periods. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Bamsbury. Southeast Islington. The Borough. Deaths Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. First Quarter 111 13. 29 140 15.18 108 14.00 151 15. 28 231 14.87 197 14.83 299 16 .60 1,237 15.08 Second Quarter .. 86 10. 29 111 12. 03 80 10 .37 128 12 .95 176 11.33 178 13.40 215 11 .93 974 11 .88 Third Quarter 73 8. 74 101 10.95 87 11 .27 123 12 .45 149 9 .59 162 12 .20 187 10.38 882 10.75 Fourth Quarter .. 154 1.844 183 19. 84 117 15 .1 197 19 .94 203 13.07 265 19 .95 311 17.26 1,430 17 .44 The Year 124 12.69 535 14. 50 392 12.70 599 15 .16 759 12 .21 802 15 09 1,012 14.04 4,523 13.79 N.b.—The heavy figures show which was the healthiest mbdistrict in the quarters to which they refer. 81 [1910 Table XVII. Showing the Deaths and DeathRates from All Causes for each Quarter since 1888. (The Lowest Death Rates are printed in heavy type.) QUARTERS. Years. First. Second. Third. Fourth. Year. Deaths Death Rates. Deaths Death Rates. Deaths Death Rates. Deaths Death Rates. Deaths Death Rates. 1888 1,029 21.09 1,163 15. 05 1,072 13.88 1,333 17 .25 5,197 16 .82 1889 1,440 18 .42 1,186 15 .17 1,101 14 .07 1,308 16 .73 5,035 16.10 1890 1,789 22.60 1,359 17 .16 1282 16 .20 1,722 20 .20 6,152 19 .43 1891 1,698 21 .22 1,725 21.56 1,299 16.23 1,604 20 .05 6,326 19 .77 1892 2,193 27 .13 1,260 15 .57 1,231 15 .22 1,391 17 .20 6,075 18.78 1893 1,597 19.53 1,485 18.16 1,558 19.06 1,751 21 .42 6,391 19 .55 1894 1,613 19.52 1,284 15.54 1,131 13.68 1,235 14. 94 5,263 15 .92 1895 1,936 23 .18 1,210 14.48 1,292 15 .47 1,322 15.83 5,760 17.24 1896 1,664 19. 71 1,382 16 .37 1,336 15.82 1,502 16.52 5,884 17.42 1897 ] ,421 16.85 1,081 12 .82 1,335 15 .83 1,558 18.48 5,395 16.00 1898 1,744 20. 71 1,246 14.80 1,439 17 .09 1,276 15 .15 5,705 16.94 1899 1,681 19.99 1,281 15.23 1,572 18.70 1,759 20.92 6,293 18.71 1900 1,819 21. 66 1,390 16. 55 1,221 14.54 1,291 15. 37 5,721 17 .03 1901 1,411 16.86 1,253 14.97 1,216 14.53 1,481 17 .69 5,361 16.01 1902 1,796 21. 50 1,220 14. 60 1,149 13.76 1,470 16.34 5,635 16 .55 1903 1.393 16.59 1,226 14 .71 1,031 12 .37 1,199 14.39 4,839 14.52 1904 1,430 17. 27 1,106 13. 36 1,284 15 .44 1,410 16.96 5,236 15 .74 1905 1,316 15.86 1,178 14. 20 1,076 12.97 1,385 16.70 4 955 14.93 1906 1,391 16. 80 1,151 13. 94 1,163 14.05 1,345 16 .25 5,050 15 .25 1907 1,640 19. 86 1,224 14. 82 939 11.37 1,276 15 .45 5,079 15 .37 1908 1,387 16. 83 1,010 12. 26 984 11 .94 1,298 14.63 4,679 13.93 1909 1,676 20. 39 1,136 13.82 903 10.98 1,203 14.63 4,918 14 .96 Corrected Mean 22 years 1,615 19 .69 1,247 15.21 1.205 14 .69 1,409 17.18 5,476 16.70 1910 1,237 15.08 974 11.88 882 10.75 1,430 17. 44 4,523 13. 79 Increase or Decrease -378 -4.61 -273 -3. 33 -323 -394 + 21 + 0. 26 -953 -2. 91 N.B-The Deathrates for the years 1901-10 have been recalculated on the basis of the Censuses of 1901 and 1911, as published by the Registrar General, May 25th, 1911. 1910] 32 Table XVIII. Showing the Deaths and Death-rates from eleven Classified Diseases in the Sub-Districts and in the Borough. Classified Diseases. T ufnell Upper . Holfoway. Tollington. Lower Holloway. Highbury. Barnsbury. South-East Islington. The Borough. Deaths. Death Rates Deaths. Death 1 Rates. 1 Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Miasmatic 31 0 ..93 53 1 44 45 1.46 68 1.72 55 0.88 93 1.75 58 0 .80 403 1. 23 Diarrhoeal 7 0.21 10 0.27 6 0. 19 16 0.40 6 0.10 19 0 36 12 0 .16 76 0.23 Constitutional 100 2. 99 118 3.20 77 2.49 122 3 09 191 3.07 163 3 07 218 3 02 989 3 01 Developmental 34 1. 02 51 1 38 29 0. 94 50 1.26 52 0. 84 83 1 56 83 1.15 382 1 16 Nervous 21 0. 63 46 1.25 n 0. 68 33 0.83 51 0. 82 40 0 75 70 0.97 282 0 86 Circulation 72 2.15 86 2.33 56 1. 81 74 1.87 136 2.19 94 1.77 127 1 .76 645 1 .97 Respiration 89 2. 66 72 1 .95 76 2. 46 116 2 93 129 2.07 157 2.96 231 3.21 870 2.65 Digestive Organs .. 17 0. 51 29 0.78 20 0. 65 39 0.99 50 0. 80 56 1.05 69 0.96 280 0 .85 Urinary System .. 13 0.39 19 0.51 20 0. 65 26 0.66 33 0. 53 28 0 53 38 0.53 177 0 .54 Violence 18 0. 64 15 0 .41 13 0.42 31 0.78 28 0.45 36 0.68 53 0.73 194 0 .59 Ill.defined .. 6 0. 18 19 0. 51 16 0.52 14 0 .35 10 0.16 18 0 .34 21 0.29 104 0.32 The heavy figures denote that these death-rates were the highest experienced in the several districts during the year from the diseases mentioned. 33 [1910 Table XIX. Showing the Deaths (arranged in Classes) from All Causes, in the Four Quarters. Classified Causes of Death. Quarters. Year. 1st. 2nd, 3rd. 4th. I. Specific or Febrile Causes.. 121 9G 94 228 539 1. Miasmatic Diseases 101 70 53 179 403 2. Diarrhoeal ,, 9 7 28 32 76 3. Malarial ,, .. .. .. 1 1 4. Zoogenous ,, .. .. 1 .. 1 5. Venereal „ 4 6 4 1 15 6. Septic ,, 7 13 8 15 43 II. Parasitic Diseases .. .. 1 .. 1 III. Dietic 2 2 5 2 11 IV. Constitutional Diseases 243 263 218 265 989 V. Developmental 112 80 65 125 382 VI. Local . 672 473 430 728 2,303 1. Diseases of Nervous System 84 64 62 72 282 2. „ Organs of Special Sense 1 2 4 7 3. „ Circulatory System 177 132 153 183 645 4. ,, Respiratory „ 282 169 92 327 870 5 ,, Digestive „ 59 66 65 90 280 6. ,, Lymphatic „ 1 2 2 4 9 7. ,, Urinary „ 55 35 46 41 177 8 „ Reproductive ,, 8 2 3 4 17 9. ,, Bones and Joints.. 3 1 1 5 10 10. ,, Integumentary System 2 .. 2 2 6 VII. Violence 59 44 49 42 194 1. Accident or Negligence 43 29 37 29 138 2. Homicide. 3 1 2 6 3 Suicide 16 12 11 9 48 4. Execution .. .. .. 2 2 VIII. Ill-defined Causes . 28 16 20 40 104 All Causes 1,237 974 882 1,430 4,523 Note—The heavy figures denote that the diseases to which they are applied were most fatal in the Quarter to which they refer. D 1910] 84 Table XX. Showing the Death-rates* from All Causes in the several undermentioned places during the Four Quarters and the Year. Places First Quarter. Second Quarter Third Quarter. Fourth Quarter, The Year 1910. England and Wales 15 .3 12.8 11.4 13 .9 13. 4 77 Great Towns 14.8 12.6 11.6 14 .6 13 .4 136 Smaller Towns 14 .5 11.7 10 6 12.9 12. 4 England and Wales less the 213 Towns 16.1 13.5 11, 13 .5 13. 6 County of London 14 3 11.6 10.3 14.7 12. 7 Bristol 13 .1 10 9 9 5 12 .6 11. 5 Birmingham 16 .3 12.4 11 2 14 .8 13.7 Liverpool 19 .4 17 .7 16 4 17 .5 17. 7 M anchester 16.9 16 .2 14 1 16.9 16. 1 Leeds 14 .2 13 .3 12.4 14.8 13. 7 Sheffield 14 .0 12 .3 13 0 14.4 13 .4 The Encircling Boroughs 14.6 12 .1 10 3 14 .9 13.0 St. Pancras 14.6 13.5 11.2 15.8 13 .7 Stoke Newington 13 .3 10 .0 83 12. 2 10. 9 Hackney 14 .1 10 .6 9 0 13. 1 11. 6 Hornsey 8.6 7.4 5.2 9 .6 7.'7 Finsbury 19.3 16.4 13. 7 20.7 17.5 Shoreditch 18. 1 14 8 14.8 19 .1 16. 7 Islington 15 .08 11.88 10.75 17.43 13.79 • All the Death-rates in this Table, except those of Islington, have been calculated ou the populations as given by the Registrar-General. 35 [1910 INFANTILE MORTALITY. Islington has good reason to rejoice at the low mortality among its infants which obtained during the year, for only 777 died out of the 8,201 bom during the year, which is to say that the infantile mortality rate was 95 per 1,000 births. This is by far the lowest proportion hitherto chronicled in the borough, or at all events, since the compulsory registration of births and deaths came into force, as may be seen by a reference to Table I. in the Appendix, which gives the infantile deaths and mortality rates since 1841. The infantile mortality rate of 95 per 1,000 is 8 below that of the preceding year, and 29 below that of the ten years 1900-1909, while it is 48 below the mean rate of the years 1841 to 1909. During this long period of sixty-nine years, 490,339 children were born, of whom 70,148 died before they had reached the age of one year, so that the proportion of deaths per 1,000 births was 143. Deaths under Proportion of deaths Period. Births. 1 year. per 1,000 births. 1841-1909 490,339 70,148 143. These figures indicate what a heavy toll has been laid on infant life in Islington, which is only one district of our great metropolis. They are so enormous that it is difficult to grasp them; and yet as they occurred from year to year no very special heed was taken of them; in fact, nobody seemed to care about them, and, therefore, little or nothing was done to prevent them. Happily of late there has been a tendency for the mortality to decrease, for it will be seen in the Table already mentioned that since 1899, when it was 11>0 per 1,000 births, there has been a steady fall in it, so that five years later (1904) it was 128, and at the end of another quinquennium (1909) 103, while it is now only 95. Compared with other places, Islington never exhibited a very high deathrate among its infants, although so long ago as 1866 it reached the figure of 169 per 1,000 births, which is the highest rate ever chronicled here. That was forty-five years ago, and yet last year, a very favourable one for infants, owing to the meteorological conditions which prevailed, at least five of the Smaller Towns and one of the Greater Towns showed nearly as high a mortality. D 2 1910] 36 The gradual decrease in the local infantile mortality during the last few years has been due to the very favourable meteorological conditions, cool air and occasional rains, and in a lesser degree to the decrease in overcrowding, to the educational influences of the Press, and to the general awakening of the popular conscience to the fact that innumerable and unnecessary deaths were daily occurring. The consequence of this awakening has been felt in most of the large towns, which have nearly, if not all, shown a lessened mortality, while the country as a whole has not lagged behind, for there the rate has been 106, as compared with 121 in the preceding five years. In the Great Towns the fall has been from 132 to 115. A few figures arranged in tabular form will better show what has been happening in England and Wales. Infant deaths per Period. Birth-rate. Death-rate. 1,000 births. 1851-60 34.1 22.2 154 1861-70 35.2 22.5 154 1871-80 34.4 21.4 149 1881-90 32.5 19.1 142 1891-00 29.9 18.2 154 1901-05 28.4 16.0 138 1906-10 26.0 14.6 117 Here it is very apparent that from 1851 to 1900 there had been no decrease in the proportion of deaths among infants to the number of births, although in the same period the death-rate from all causes steadily decreased, notwithstanding the great growths of the towns and the greater density of their populations, from 22.2 per 1,000 of the population to 18.2, or nearly 20 per cent. It is, therefore, exceedingly gratifying to find that coincidentally with the movement, instituted by thoughtful men and women during the last ten years, to prevent the great waste of human life that was occurring, there has been so great a decrease; indeed, so great has it been that whereas formerly 154 infants died during their first year of life, out of every 1,000 that were born in the last quinquennium only 117 died, or a saving of 37 lives in every 1,000 births. But great though the improvement has been, the mortality is still far and away too high ; nor will those who take an interest in the protection of infantile health be satisfied until it has been reduced to the narrowest limits. What that limit is it is impossible to gauge accurately, but it must certainly be thirty to forty per cent, lower than the latest returns for the country show. That the Insurance Bill introduced into Parliament by the Chancellor of the Exchequer, if it should become law, will reduce the mortality among infants is a certainty, 37 [1910 for nothing has been more fatal to young children than the early resumption of work by mothers who have recently been confined. It is bound to have farreaching effects. But while the Government are thus about to do their part, it also behoves the local authorities who control the administration of local affairs, and who, therefore, have the management of the health interests of the people, by far the greatest of all interests which they direct, to do their part; and particularly to see that the wives of the labouring classes, who enter upon matrimony in absolute ignorance of all matters appertaining to maternity, shall receive adequate instruction after, as well as just prior to, their lyingin. Happily most authorities in the country have determined to do their duty, and not a few in the County of London also, but unfortunately we in Islington still remain passive. We are not doing our duty. The trouble and difficulties of the poorer classes have not yet appealed to us. We are allowing children to die without affording them that assistance which the Government say is necessary, and which they are desirous we should give; which the collective wisdom of those engaged in public health work in this country say is necessary; which Parliament so approved that it passed the Notification of Births Act, 1907, in order that the authorities should be supplied with the requisite information at the earliest moment; which the InterDepartmental Committee on Physical Deterioration has altogether blessed; which the National Conferences on Infantile Mortality of 1906 and 1908 have strongly urged; and which everyone who has studied this question is convinced is absolutely essential to stay the sacrifice of infant life that is taking place, so that these children live but a handful of days. Are we in Islington more wise than these authorities? Do we understand this subject better than those persons who have so carefully inquired into the best methods for the prevention of these deaths ? Certainly not! Then why delay ? " Delays have dangerous ends " and in this case, contrary to what Shakespeare says that " In delay lies no plenty," there does lie plenty—plenty of pain, plenty of suffering, plenty of anguish, and plenty of deaths. Truly delays have dangerous ends. Then why delay? The duty is manifest, the means to be adopted obvious, the results — the saving of life, the amelioration of pain, the sturdier growth of the child, and the prevention of much illness in the later life of the child—certain, for the child is father to the man in a very literal sense, because as the frame work, the bony structure, the nervous centres are well 1910] 38 and properly nourished, so too will the man be strong and robust and brave. Duty plainly indicates to the Council that health visitors should be appointed, and appointed immediately, just as it goads the Medical Officer of Health to make these strong representations to a body of men, so many of whom axe his friends. He, however, prefers to warn them against their aimless drift rather than conceal from them what they ought to do, and so bring on them and on himself a charge of grave neglect, believing that never can any advice be wrong or misunderstood when duty tenders it. It has been frequently said that if Health Visitors were appointed they would not be received by the mothers; that they would be turned away ; and would even run a grave risk of being illtreated. The records of the very many places where they have been appointed afford no support for such a surmise—and surmise it is—for as a matter of fact they have been invariably well received. Indeed, at a conference held not long since in London it was emphatically stated that not only were they welcomed, but they were frequently sent for by mothers anxious to receive instruction at their hands. Let us glance a moment at the mortality from diarrhoea in Islington, for it has a considerable bearing on this subject. During the last four years inquiries were made as to the feeding of the infants, the occupation and the health of the mothers, and other matters, which will be found in detail in Table XXIII. It was discovered from these inquiries that only 12.7 per cent, of the infants thus dying were reared on the breast alone, whereas 87.3 per cent, were artificially fed. Was not this, it may be asked, the result of maternal occupation, or forced employment? The answer is, no! for it was found that of these infants' mothers only 37.7 per cent, were employed, while (>2.3 per cent, were unemployed. When we analyse the figures more closely we find that whereas only 18.2 per cent, of the mothers of the infants who died under three months old were at work, there were 81.8 per cent, unemployed. This is the most critical period of an infant's life, as then it most requires breast milk, together with proper care and nurture ; and it is also the time when the mother, and especially the young mother, requires instruction and aid in the nursing of her offspring. It may be pleaded that possibly they could not nurse because their health was bad. The returns disprove it, for whereas 73 per cent, were in good health, only 27 per cent, were in moderate or bad health. It was, therefore, not because of the state of their health that they did not nurse their infants. 89 [1910 Again, the returns show that among the infants aged between 3 and 6 months, only 11.8 were breastfed, whereas 88.2 were fed otherwise; and in their case 58.8 per cent, of the mothers were in good health, and 41.2 per cent, in moderate or bad health, while 56.9 per cent, were unemployed, and 58.8 employed. In the next threemonthly period (69) only 6.3 per cent, of the infants were breastfed, while 93.7 per cent, were fed otherwise. Of their mothers 66.7 were not in employment, and 33.3 were, while 72.9 were in good health and only 27.1 per cent, in moderate or bad. Lastly, in the fourth threemonthly period (912) 13.3 per cent, of the infants were fed at the breast and 86.7 per cent, otherwise, and of their mothers 73.3 per cent, were in good health; and 26.7 per cent, in moderate or bad, while 40 per cent, were not employed, and 60 per cent, were employed Trimonthly periods. How fed. Health of mother. Employed. Breast. Otherwise. Good. Moderate or Bad. Yes. No. 0-3 21.2 788 72.7 27.3 18.2 81.8 3-6 11.8 88.2 58.8 41.2 56.9 58.8 6-9 6.3 93.7 72.9 27.1 33.3 66.7 9-12 13.3 86.7 73.3 26.7 60.0 40.0 0-12 12.3 87.7 68.5 31.5 37.7 62.3 Now nearly, if not all, these mothers received instructions by post as soon as their infants were born as to the best methods of feeding their offspring, in which they were strongly advised to feed them on the breast alone, and yet we find that 87.7 per cent, of the cases inquired into were not so fed. The fact is, and it cannot be blinked, that in the words of the great Lord Derby, " Sanitary instruction is even more important than sanitary legislation." Instruction is everything. What do these women—so many of them a lasting monument to the failure of the public elementary schools to turn out girls with a knowledge that may be of assistance to them 1910] 40 as mothers—so many of whom have never had the advantage of a training as a child's maid in a respectable family, but on the contrary have gone to a laundry or other workshop or workplace, where they learn nothing that can be of the least advantage to them as wives or mothers—what do these women know of the physiology of the breast and its milk? Do they understand the injustice they are doing their progeny? Are they aware that for one child, who is fed on the breast that dies, fully 10 w ho are not so fed die ? They know absolutely nothing of these things, and the only way they can obtain that knowledge is by instruction by properly qualified persons. Neither the midwives nor the parish doctors nor the cheap doctors have time in their busy lives to give it, aind, therefore, these mothers go without it. Only the well-to-do and the rich receive it, and they as a rule practice it, and consequently the mortality among their infants is small. The poor have no chance. They should get it, and the time is coming when they will demand it. This by some people will be called Socialism, but they who say so do not know what is Socialism and what is not Socialism. It is not Socialism, it is public health administration for the preservation of human life, which takes no heed of politics, and which should not, and certainly in England, does not, know anything about them. These mothers need instruction. Last year " The Bulletin of the Chicago School of Sanitary Instruction," which is devoted to the dissemination of advice and information of the Department of Health of the City of Chicago, published an article by Dr. Effa V. Davis, which was considered so valuable and timely that they have been re-printed this year. " The feeding of a baby at its mother's breast is not so simple a matter that it can be done properly without some study and care by those in charge. More mothers could, and would, furnish breast milk to their babies with greater ease and comfort to themselves and to their babies if their medical attendants took moie pains to teach them the facts about the physiology of lactation. "Some facts to be borne in mind are the followingIn Chicago last summer fifteen bottle-fed babies died to every one that was breast-fed. Mothers should be made to appreciate this fact when bottle feeding is contemplated. You can dry up a mother's milk by putting the baby to her breast only at long intervals, say morning and evening, or only at night. Such habits will spoil the best wet nurse ever created. 41 [1910 " You can check a mother's milk by constant or too many night feedings, or by disturbing the woman's hours of sleep in any other way. " You can spoil the best breast milk in the world by feeding the woman with too rich food, giving her alcoholic tonics and checking normal exercise. " You can ' upset' the baby by putting it to the breast too frequently, loading a halfempty stomach with a fresh meal. Vomiting, colic, green stools and diarrhoea are some of the results. " You can get the best results by first knowing what the wet nurse yields to her baby by a system of weighing the child before and after nursing Every baby doctor should keep suitable scales to rent or lend for this purpose until he is satisfied on the matter. " The interval between nursings can best be regulated when you know how much milk the baby gets in twentyfour hours. An ordinary baby will thrive best on not more than seven meals in twentyfour hours during the first three months of life, and often will do as well or better on six feedings. An effort should be made early to cut down night feedings, as it favours the welfare of both the mother and child. " When the yield of breast milk is scanty and the child not gaining, give an ounce or two of artificial food just after its nursing, rather than omit a breast feeding altogether, if the child is under six months or even older, and if the time be midsummer, as such a method keeps the breasts up to their best yielding capacity. The old way of substituting a bottle for one or two feedings only checks the yield of milk all the more. " Mixed feeding, when properly conducted, may be begun with benefit to the nursling in its eighth or ninth month, but the physician must instruct the mother what, when and how much she shall give. The following will do no harm, but will greatly help nourish breastfed babies when eight or nine months old if properly prepared, given at the proper time, and in proper quantities. "' Pap' (stale bread) soaked in boiling water and cooked with cow's milk for a few minutes. " Vegetable soup, strained, with a little toasted bread. " Farina, or other similar cereal, boiled and served with clean cow's milk. 1910] 42 " Teach mothers the value of a drink of pure water to the nursling. Thirst is often mistaken for hunger, especially in summer time." Such instructions as these are indeed most excellent, but how can they be instilled into the mind of the ordinary working man's wife without oral instructions and explanations ? In them it is laid down that " the physician must instruct the mother." That would be impossible in this country. Perhaps they are better off in Chicago than we in Islington, for there are no physicians available here for the purpose who will give the advice to the poor, and, therefore, the instruction must be given by Health Visitors, women who are trained nurses, who have passed examinations in physiology, and whose ex perience is such as would justify their employment. Does anyone believe for a moment that if the mothers were visited and instructed it would be found that 78 per cent, of the mothers of infants who died from diarrhoea before they had reached the end of their thiid month would have failed to nurse their infants at the breast? Certainly not, for it is the negation of all motherly feeling and instinct, which only requires to be roused and encouraged to ensure that these mothers to do their duty to their infants. But it will never be done by sending them leaflets, or printed instructions, which only the very few value, and whose ultimate fate is either to light the fire or a pipe. It was not only in order that we might send these leaflets to lying in mothers or to enter their names in carefully kept ledgers that Parliament passed the Notification of Births Act, but also for a more excellent purpose, to enable sanitary authorities to give oral advice to those people who so sadly need it, and through whose want of knowledge so many infants meet a premature, and, therefore, an unnatural death. It behoves us, therefore, to be up and doing, for procrastination means much unnecessary illness and many similar deaths. One has only to study the mortality returns to see that this statement is borne out by facts. During the last ten years 23 infants under a year old out of every thousand born died from bronchitis and pneumonia, in many instances as the result of exposure to unsuitable weather conditions, and from other causes that are absolutely preventable; 18 infants in every thousand born died from marasmus and atrophy, diseases frequently associated with malnutrition due to improper food, and therefore in a great part preventable. Twenty-one infants out of every thousand born died from various forms of diarrhoea, which was due for the most part to various causes which were 48 [1910 preventable. Five out of every thousand infants born died from tuberculosis, mainly induced by feeding or conditions that were preventable. But they have not been pi evented because there is nobody to instruct the poor unfortunate mothers to whom a baby is as great a puzzle as a complicated piece of mechanism is to a child. It is in the poorer class neighbourhoods, where education is lacking, where illiteracy most abounds, that we find the greatest infant mortality. Investigations everywhere have proved this beyond doubt, and it is, therefoie, in such districts that the instruction of mothers is most urgently necessary. If we ask ourselves which are the worst districts in this respect in Islington, the answer will be at once forthcoming:—Lower Holloway and Barnsbury. And if we examine the records we will find that they are the two districts in which the infantile mortality rate is at its highest, 1415 per 1,000 births in Lower Holloway, and 130 in Barnsbury, as compared with 120 in the rest of the borough during the eight years 1902-1909. Of course there are more factors at work than the ill-feeding of the infants to cause these differences in the mortality, but if enquiry be made they will be found to arise from ignorance—ignorance of that elementary principle of sanitation, the need of cleanliness, which is next to Godliness, and Order, Heaven's first law. It is not too much to say that if the necessity for practising these two vital doctrines were instilled into the minds of mothers, apart altogether from methods of feeding and of suitable foods, much good would result. The mothers, and the young mothers especially, want to be reached by some agency, which all thoughtful persons consider should be trained visitors under the control of a public authority. There is one point that is too often forgotten by persons who have the management of infant children, and by those holding public positions such as memberships in local sanitary authorities, which is that the prevention of infantile mortality and the feeding and rearing of infant children are inextricably united, for it is unfortunately a fact that improper feeding leads to many of the ills which are made very visible in the later life of the child. Malnutrition, it is quite true, frequently kills children, but not always, and when it does not, it too often leaves them so damaged and so deformed as to be life-long burdens to society, and who, if they are not able to do som - kind of light work—they never can perform any of a heavy nature—are left to be taken care of either by the charitably disposed or by the Poor Law Authorities of the country. Let us take only one example, that of Rickets, which is frequently produced by insufficient and improper food, i.e., which does not afford the proper and necessary 1910] 44 nourishment for the structure of the body. Here is a disease that is neithef caused by heredity nor, so far as is known, by a microbe, and yet it is an entirely preventable disease, and can be avoided by feeding the children with proper food, at the proper time. This disease is not fatal, yet it is the means of crippling thousands of children every year, and so causes a serious economic loss to the nation. In such cases as these, medical advice, or indeed such advice as health visitors could give, and might give, would with a certainty have caused a large diminution of the disease, and would thus have prevented the crippled condition to which so many persons are subjected as the result of malnutrition at the very threshold of their lives. This reason, even if there were no others, ought to be quite sufficient to cause sanitary authorities to provide teachers for the young mothers of the working classes. The deaths among infants and the infantile mortality rates in each district during 1909 and 1910 were as follows:— Deaths per 1,000 Births. Sub-Districts. Deaths. 1910. 1909. Tufnell 58 78 107 Upper Holloway 87 88 77 Tollington 64 88 96 Lower Holloway 114 108 101 Highbury 105 82 93 Barnsbury - 171 111 111 South-East Islington - 178 94 117 The Borough - 777 95 103 45 [1910 TABLE XXI. Showing the Deaths among Infants per 1,000 Births during the year 1910, and also the mortality rates for the years 1902-9. Sub-Districts. 1902. 1903. 1904. 1905 1906. 1907. 1908 1909. Mean 1902 9. 1910. Decrease. Tufnell - 123 112 141 127 122 127 81 107 117 78 39 Upper Hollo- 103 138 92 101 105 88 74 77 96 88 8 way Tollington 144 105 128 117 127 132 117 96 124 88 36 Lower Hollo- 156 159 161 151 i55 148 125 101 143 108 35 way Highbury 114 178 98 117 95 107 101 93 , 106 82 24 Barnsbury 151 210 142 124 138 123 119 111 130 111 19 South East Islington 130 263 134 121 129 104 99 117 121 94 27 The Borough 132 126 128 123 125 117 103 103 120 95 25 TABLE XXII. Showing the Mortality per 1,000 Births among Infants under one year of age in the three years 1901-03; in the ten years 1900-09; and in 1910 from certain specified causes. Causes of Death Mean rate of 3 years 1901-2-3 per 1,000 Births. 1910. Mean rate 10 years 1900-09 per 1,000 Births. Premature Birth and Congenital Defects 24 .25 18. 65 24 .10 Bronchitis and Pneumonia 25.67 19 .51 22.62 Atrophy and Marasmus .. 20.54 11. 46 18 .55 Diarrhceal Diseases (all forms) 19 .01 10. 49 21. 03 Convulsions. 6.66, 2.68 4 41 Whooping Cough 6.44 7.80 5. 32 Measles 3.27 2.56 3 .73 Phthisis 1 .85 0.37 1 .24 Other forms of Tuberculosis 5 68 5 .24 5 20 Diphtheria 0.43 0 12 0 34 Total of above 113.80 78. 88 106. 54 All other causes 18.91 15. 85 18 .10 Total 132. 71 94 73 124 .64 1910] 46 TABLE XXIII. Particulars of Investigations into the Deaths of Infants from Diarrhoea during the four years 1907-10. Ages of Infants in three monthly periods Total und r twelve months. Total for 4 years. 0-3. 3—6. 6—9. 9-12. 1907 1908| 1 909j 1910 1907 908 1909 1910 1907 1908 1909 1910 1907 1908 1909 1910 1907 1908' 1909 1910 1907 -10 Food of Infants. Breast milk only 3 3 .. 1 1 2 1 2 .. .. .. 3 1 1 1 1 5 6 2 7 20 Cows' milk only 4 9 3 1 6 14 5 3 7 11 6 3 6 • • 1 2 23 34 15 9 81 Condensed milk only .. 2 1 2 1 4 .. 1 3 2 .. 1 .. 2 2 4 6 9 2 21 Artificial foods only .. .. 1 .. .. .. .. .. .. 3 .. .. 3 .. .. .. 3 3 1 .. 7 Breast and cows' milk 1 3 .. .. 2 1 .. 3 .. 2 1 .. 2 .. .. 1 5 6 1 4 16 ,, condensed milk .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 .. 2 ,, artificial foods . .. .. .. .. .. 1 .. 1 .. 1 1 .. .. .. 1 .. .. 2 2 1 5 Mixed foods .. .. .. .. 1 1 .. .. .. .. 1 .. .. 3 .. .. 1 4 1 .. 6 Not stated .. .. .. .. .. .. .. .. .. 1 1 1 .. .. .. 1 .. 1 1 2 4 8 18 5 2 12 20 10 9 8 21 12 7 13 4 6 7 41 63 33 25 162 State of Mother's Health. Good health 3 16 4 1 7 11 5 7 8 13 9 5 10 3 5 4 28 43 23 17 111 Moderate 3 1 1 .. 2 4 1 1 .. 4 2 1 .. 1 .. 1 5 10 4 3 22 Bad 2 1 .. 1 3 5 4 1 .. 3 .. 1 3 .. 1 1 8 9 5 4 26 Not stated .. •• .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 .. 1 1 1 3 8 18 5 2 12 20 10 9 8 21 12 7 13 4 6 7 41 63 33 25 162 Mother s State as to Occupation. No occupation 6 15 4 .. 6 16 7 .. 7 15 6 1 5 .. 5 24 46 22 1 93 Occupied 2 3 1 .. 6 4 3 8 I 5 5 5 7 4 1 6 16 16 10 19 61 t Unknown .. .. .. 2 .. .. .. 1 .. 1 1 1 1 .. .. 1 1 1 1 5 8 8 18 5 2 12 20 10 9 8 21 12 7 13 4 6 1 7 41 63 33 25 162 Breast 3 3 .. 1 1 0 1 2 .. .. .. 3 1 1 1 1 5 6 2 7 20 Method of Feeding. Bottle with tube . 2 7 2 .. 5 9 5 3 3 13 7 2 8 .. 4 3 18 29 18 8 73 Bottle (boat shape) withoi tube.. 2 7 2 1 6 8 4 4 5 6 3 1 3 1 2 16 21 10 8 55 Spoon . 1 1 1 .. .. .. .. .. .. 1 .. .. 1 2 .. .. 2 4 1 .. 7 Otherwise .. .. .. .. .. 1 .. .. .. .. 1 .. .. 1 .. .. .. 2 1 .. 3 V Not stated .. •• .. .. .. .. .. .. .. 1 1 1 •• .. .. 1 .. 1 1 2 4 8 18 5 2 12 20 10 1 9 8 21 12 7 13 4 6 7 41 63 33 25 162 47 [1910 Table XXIII.—continued, Ages of Infants in three monthly periods. Total under twelve months. 1 Total for 4 | years. 0—3. 3—6. 6—9. 9—12. 1907 1908 1909 1910 1907 1908 1909 1910 1907 1908 1909 1910 1907 1908 1909 1910 1907 1908 1909 1910 1907 -10 Method used to cleanse Feeding Apparatus. Scalding water 2 2 .. .. 6 3 3 2 1 5 3 .. 5 .. 1 1 14 10 7 3 34 Hot 1 4 .. .. .. 1 3 .. 1 3 1 1 .. .. 1 .. 2 8 5 1 16 Hot water and soda.. 1 3 2 2 9 2 2 3 6 2 2 .. .. 2 1 6 18 8 5 37 Cold water .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. 1 Brush and hot water .. 3 2 1 3 4 1 2 3 4 4 .. 6 .. 1 3 12 11 8 6 37 Otherwise 1 .. 1 .. .. 1 .. .. .. .. 1 .. 1 .. .. .. 2 1 2 .. 5 Not stated (including 20 at breast) 3 6 .. 1 1 2 1 3 .. 2 1 4 1 4 1 2 5 14 3 10 32 8 18 5 2 12 20 10 9 8 21 12 7 13 4 6 7 41 63 33 25 162 1 No of Rooms occupied by Family. 1 room .. 3 .. .. .. 5 1 3 .. 2 4 .. .. 1 2 1 11 7 4 22 2 rooms .. 6 2 1 .. 8 6 2 .. 8 5 2 .. 1 2 2 .. 23 15 7 45 3 ,, 7 2 .. .. 3 1 3 .. 5 2 5 .. .. 2 2 .. 15 7 10 32 4 ,, .. .. .. 1 .. .. .. .. .. 2 .. .. .. 1 .. 1 .. 3 .. 2 5 5 ,, or more 2 1 .. .. 1 2 1 .. 1 .. .. .. .. .. .. .. 4 3 1 .. , Not stated .. .. .. .. .. 3 .. .. .. 2 .. .. .. 1 .. .. .. 6 .. .. 6 Unknown .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 .. 1 1 1 3 .. 18 5 2 .. 20 10 9 .. 21 12 7 .. 4 6 7 .. 63 33 25 121 State of Rooms as to Cleanliness. Clean 8 13 5 2 12 15 8 7 8 16 6 S 12 2 3 6 40 46 22 20 128 Dirty .. 4 .. .. .. 3 1 1 .. 3 3 .. 1 2 2 .. 1 12 6 1 20 Unwholesome .. .. .. .. .. 1 .. 1 .. .. .. 1 .. .. 1 .. .. 1 1 2 4 Not stated .. 1 .. .. .. 1 1 .. .. 1 2 1 .. .. .. .. 3 3 1 7 ^Unknown .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 .. 1 1 1 3 8 18 5 2 12 20 10 9 8 21 12 7 13 4 6 7 41 63 33 25 162 Prevalence of Flies. Numerous .. 2 .. .. .. 3 4 2 .. 5 1 1 .. .. 1 .. .. 10 6 3 19 Moderate .. .. .. .. .. .. 1 .. .. 4 1 .. .. .. .. 1 .. 4 2 1 7 Few .. 2 3 1 .. 6 3 2 .. 3 5 2 .. .. 2 2 .. 11 13 7 31 None noted .. 14 2 1 .. 11 2 5 .. 9 5 4 .. 4 3 4 38 12 14 64 .. 18 5 2 .. 20 10 9 .. 21 12 7 1 .. 4 6 7 63 33 25 121 1910 48 XXIV. Summary of Investigations into the Deaths of Infants from Diarrhoea during the four years [907-10. Ages of Infants in three monthly periods. Total under twelve months. 0-3. 3 6. 6 9. 9 12. 1 Food of Infants. Breast milk only 7 6 3 4 20 Cows' milk only 17 28 27 9 81 Condensed milk only 3 7 6 5 21 Artificial foods only 1 .. 3 3 7 Breast and cows' milk .. 4 6 3 3 16 ,, condensed milk 1 .. .. 1 2 ,, artificial foods .. 2 1 5 Mixed foods .. 2 1 3 6 Not stated .. .. 3 1 4 33 51 48 30 162 State of Mother's Health. Good health 24 30 35 22 111 Moderate 5 8 7 2 22 Bad 4 13 4 5 26 Not stated .. .. 2 1 3 33 51 48 30 162 Mother's state as to occupation. No occupation 25 23 29 10 97 Occupied at work 6 21 16 18 57 Unknown . 2 1 3 2 8 33 51 48 . 30 162 Method of Feeding. Breast 7 6 3 4 20 Bottle with tube .. Bottle (boat shape) without tube 11 12 22 22 25 15 15 6 73 55 Spoon 3 .. 1 3 7 Otherwise .. .. 1 1 1 3 ^Not stated .. .. 3 1 4 33 51 48 30 162 Method used to cleanse Feeding Apparatus. Scalding water 4 14 9 7 34 Hot 5 4 6 1 16 Hot water and soda 6 15 13 3 37 Cold water .. 1 .. 1 Brush and hot water 6 10 11 10 37 Otherwise 2 1 1 1 5 Not stated (including 20 at breast) 10 7 7 8 32 33 51 48 30 162 No. of Rooms Occupied by the Family. 1 room 3 9 6 4 22 2 rooms 9 16 15 5 45 3 9 7 12 4 32 4 ,, 1 .. 2 2 5 5 ,, or more 3 4 1 8 Not stated .. 3 2 1 6 Unknown .. .. 2 1 3 25 39 40 17 121 State of Rooms as to Cleanliness. Clean 28 42 35 23 128 Dirty 4 5 6 5 20 Unwholesome .. 2 1 1 4 Not stated 1 2 4 .. 7 Unknown .. .. 2 1 3 33 51 48 30 162 Prevalence of Flies. Numerous 2 9 7 1 19 Moderate .. 1 5 1 7 Few 6 11 10 4 31 None noted 17 18 18 11 64 25 39 40 17 121 49 [1910 TABLE XXV. Showing the Ages at Death of Children under one year of age and the Deaths at the several periods per 1,000 Births during years 1905-1910. Ages at Death. Deaths. Deaths per 1,000 B'r hs 1905. 1906 1907 1908. 1909. 1910. Total 6 years. 1905. 1906. 1907. 1908. 1909. 1910. Total 6 years. Under 1 week 185 182 187 186 156 163 1,059 21 .13 21 .01 21.91 21.46 19. 02 19.87 20. 76 1—2 weeks 61 42 58 52 52 45 310 6 .96 4.85 6 80 600 6. 34 5 .49 6. 08 2—3 ,, 54 49 51 33 26 41 254 6.17 5 .66 5.98 3.81 3. 17 5 .00 4 .98 3—4 ,, 36 35 34 39 35 29 208 4 .11 4 .04 3.98 4 .50 4. 27 3 .54 4 .08 Total under a month 336 308 330 310 269 278 1,831 38 .37 35 .56 38 .67 35.77 32. 80 33 .90 35 .90 1—2 months 124 120 105 97 83 69 598 14 .16 13 .85 12 .30 11 .20 10. 12 8 .41 11.72 2—3 „ 91 108 84 83 64 62 492 10 .39 12 .47 9.84 9 .58 7.80 7.56 9.64 Total 1—3 months 215 228 189 180 147 131 1,090 24 55 26 .82 22 .14 20 .78 17 .92 15 .97 21 .36 Total under 3 months 551 536 519 490 416 409 2,921 62 .92 61.88 60 .81 56 .55 50.72 49 .87 57 .26 3 — 4 months 88 96 63 48 44 42 381 10.05 11.08 7 .38 5.54 5 37 5 .12 7.47 4-5 „ 65 67 58 55 58 61 364 7.42 7.74 6 .80 6.35 7.07 7.44 7.14 5—6 43 67 48 48 46 41 293 4 .91 7.74 5.63 5.54 5 .61 5.00 5 .74 Total 3—6 months 196 230 169 151 148 144 1,038 22 .38 26 .56 19 81 17 .43 18 05 17 .56 20 .35 6—7 months 62 56 55 37 55 31 296 7 .08 6.47 6 .44 4 .27 6.71 3.78 5.go 7—8 „ 48 55 44 43 34 30 254 5.48 6.35 5.16 4 .96 4 .15 3.65 4.98 8-9 „ 54 51 68 46 55 45 319 6.17 5.89 7 .97 5.31 6 .71 5.49 6 .25 Total 6—9 months 164 162 167 126 144 106 869 18.73 18.71 19 .57 14 .54 17 .57 1292 17 .03 9—10 months 55 51 45 39 45 38 273 6.28 5 .89 5.27 4.50 5. 49 4 63 5 .35 10—11 ,, 52 54 51 39 40 43 279 5 .94 6.24 5.98 4 .50 4.88 5 .24 5.47 11—12 ,, 56 50 45 49 48 37 285 6 .39 5 .77 5 27 5 .66 5 85 4.51 5.59 Total 9—12 months 163 155 141 127 133 118 837 18 .61 17 .90 16 .52 14.76 16 22 14 38 16 .41 Total under 1 year 1,074 1,083 996 894 841 777 5,665 122. tj4 125 05 116 71 103 .28 102-56 94 73 111 .05 w 1910] 50 Table XXVI. Showing the Deaths of Infants under a year old, the Infantile Mortality Rate in each Quarter and in each Year, since 1885. Years. QUARTERS. annual Deaths & Mortality. First. Second. Third. Fourth. Deaths under 1 year. Deaths per 1,000 Births. Deaths under 1 year. Deaths per 1,000 Births. Deaths under 1 year. Deaths per 1,000 Births. Deaths under 1 year. Deaths per 1,000 Births. Deaths under 1 year. Deaths per 1,000 Births. 1885 322 121 299 128 460 195 306 123 1,387 144 1886 370 144 268 111 577 237 302 126 1,517 154 1887 288 117 323 132 580 239 366 153 1,557 160 1H88 826 132 270 115 359 152 316 132 1,271 133 1889 421 164 162 94 376 164 302 130 1,261 132 1890 356 144 326 142 422 177 384 170 1,488 158 1886-90 1,761 141 1,349 113 2,314 195 1,670 142 7,094 147 1891 1892 338 425 129 171 349 295 144 122 397 384 165 164 397 313 169 136 1,481 1,417 151 148 1893 403 161 393 156 508 212 391 166 1,595 163 1894 313 125 267 113 363 154 286 123 1,229 129 1895 353 134 315 128 427 172 321 138 1,416 143 189J-95 1,832 144 1,619 133 2,079 173 1,708 139 7,138 145 1896 373 151 318 130 449 196 350 128 1,490 150 1897 296 115 216 90 446 183 380 156 1 338 136 1898 362 151 282 122 561 227 299 132 1,504 159 1899 308 123 256 105 622 256 362 157 1,548 160 1900 326 132 291 127 419 175 308 147 1,344 145 1896-00 1,665 134 1,363 115 2,497 208 1,699 143 7,224 150 1901 304 124 255 113 397 172 334 147 1,290 139 1902 311 131 236 109 316 136 356 150 1,219 132 1903 329 145 243 107 262 118 302 136 1,136 126 1904 238 104 215 94 424 192 263 124 1,140 128 1905 226 101 250 109 318 152 280 131 1,074 123 1901-05 1,408 121 1,199 107 1,717 154 1,535 138 5,859 130 1906 271 120 203 90 344 164 265 129 1,083 125 1907 319 145 221 102 106 79 290 140 996 117 1908 247 111 171 80 204 95 272 124 894 103 1909 233 106 221 109 180 90 207 104 841 103 1910 219 103 159 76 138 67 261 134 777 95 1906-10 1,289 117 975 91 1,032 99 1,295 126 4,591 109 Note:—The lowest infantile mortality rates in the periods of the year to Which they refer are printed in heavy type. 51 [1910 tu Table xxvii. Showing the Chief Causes of Infantile Mortality in the fourteen years, 1896-1909 and in 1910. Cause of Death. Years. Mean 14 years 1910 Difference.[/##] 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 | 1908 1909 Small-pox .. 1 .. .. .. 1 4 .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. i. Common ' Measles 67 12 65 •27 42 37 24 29 51 27 36 27 24 31 36 21 -15 Infectious Scarlet Fever 2 1 2 2 2 1 1 1 1 3 1 1 - 1 Diseases. Diphtheria (including 10 6 6 3 5 7 1 4 2 2 3 1 4 1 1 1 - 3 Membranous Croup Whooping Cough 103 58 67 66 68 38 76 63 30 51 30 53 29 36 55 64 + 9 Diarrhoea, all forms 125 138 220 208 148 143 72 83 200 149 171 73 80 46 133 33 -100 ii. Diarrheal Enteritis, Muco-enteritis, (iastrn-pntpnh5 C2 65 105 159 67 70 43 46 20 53 92 49 52 26 65 38 - 27 Diseases enieniis Gastritis, Gastro- lnfpcHnal Catarrh 10 8 9 13 21 21 23 22 18 15 14 9 7 23 15 is .. Premature Birth 169 174 191 187 176 169 194 174 178 163 144 164 167 136 170 121 - 49 Congenital Defects 40 39 30 21 36 48 33 47 43 48 59 47 51 52 42 46 + 4 iii. Wasting Injury at Birth .. .. .. .. .. •• .. 1 .. .. .. .. .. 1 + 1 Diseases. Want of Breast-milk, Starvation 7 3 2 2 1 5 2 7 6 4 5 8 4 4 4 - 4 Atrophy, Debility, Marasmus 242 256 244 285 221 188 192 183 177 138 134 137 138 133 191 94 - 97 /Tuberculous Meningitis .. 28 23 29 30 25 24 20 20 10 19 20 17 13 18 21 24 + 3 , t„, , [ Tuberculous Peritonitis iv. Tuberculous Tabes Mesenterica 64 55 48 30 25 26 25 20 20 24 17 17 14 20 29 14 - 15 Diseases. Qther TubercuIous Diseases 22 20 20 27 28 19 23 30 16 12 12 23 13 8 19 8 - 11 Erysipelas 5 2 6 3 2 3 4 3 1 3 3 4 4 3 3 Syphilis 6 17 12 7 17 10 11 10 11 13 9 5 13 10 11 8 3 Rickets 5 6 4 8 2 5 3 1 4 3 5 2 1 3 - 3 Meningitis (not Tuberculous) 21 27 25 16 19 23 16 18 10 19 18 10 13 11 18 14 - 4 v. Other Convulsions 74 60 46 62 57 68 69 47 47 38 24 16 15 14 46 22 - 24 Causes. Bronchitis 141 129 129 124 119 104 116 90 78 77 82 83 39 55 98 50 - 48 Laryngitis 5 4 5 2 4 5 2 4 1 3 1 1 3 - 3 PneumoDia 129 86 87 112 118 123 134 109 101 107 ios 153 106 106 112 110 - 2 Suffocation, overlying 51 39 48 45 43 39 46 15 25 14 22 23 23 27 33 26 - 7 Other Causes 102 109 110 108 97 113 86 108 88 94 79 77 80 77 95 64 - 31 1 490 1,338 1,504 1,548 1,344 1,290 1,219 1,136 1,140 1,074 1,083 996 894 841 1,207 777 - 430 1910] 52 In England and Wales, in the seven greatest towns, and in the boroughs surrounding Islington, the infantile mortality rates were as follows:— England and Wales 106 per 1,000 births Rural Districts 96 „ 77 Great Towns 115 „ 136 Smaller Towns 104 „ London . 103 „ Birmingham 130 „ Liverpool 140 „ Manchester 131 „ Leeds 132 ,, Bristol go „ Sheffield . 127 „ The Encircling Boroughs. Hornsey 70 „ Stoke Newington 64 „ Hackney 98 „ Shoreditch 146 „ Finsbury - 123 „ St. Pancras 102 „ The Encircling Boroughs - 106 „ Islington 95 MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Fevers (that is to say, Typhus, Enteric and Continued) and Diarrheal Diseases. Deaths.—Once more it is most satisfactory to the Medical Officer of Health to have to report that these diseases were all below the average of the the years 1885-1909, while some of them were so low as to be almost a negligible quantity. Altogether 428 deaths were registered, or over 43 per cent, below the average that obtained from 1885 to 1909. 58 [1910 These 428 deaths are with the exception of 358 registered in 1908 and 418 recorded in 1909, even without any correction for increase of the population, the smallest number known in Islington since 1885, and probably for a considerable period prior to that date ; indeed, one cannot but wonder, when there is so small a number of deaths from Scarlet Fever as 11, how it happened, for the return is not only the smallest on record for this disease, but is also 36, or 77 per cent, below the corrected average of the 25 years before mentioned, while Enteric Fever, although not the lowest return known, is yet 24, or 59 per cent, below the similarly corrected average. Death-rate.—The death-rate from all these diseases, calculated on the estimated population, was 1*30 per 1,000 of the population. This is a very low rate, and was only bettered twice in the 25 years 1885-1909, namely in 1908 and in 1909, when it was respectively 1 09 and T27 per 1,000 of the population. Table XXVIII., which gives the deaths and death-rates from the epidemic diseases since 1885, will show that from the former years down to the present time there has been a steady diminution of the mortality from these diseases, and as it is for their prevention sanitary authorities put forth their greatest efforts, it is very satisfactory to find that they have not been without avail, not only in Islington, but also throughout the country. In the County of London during the year the death-rate was 1*14 per 1,000 of the population, while in the various boroughs immediately encircling Islington it was 1T9. Of these boroughs that of Finsbury had an epidemic death-rate of T92 ; St. Pancras T39 ; Hackney 0"84 ; Stoke Newington 0 58 and Hornsey 0'39. Deaths in the Sub-Districts.—In the sub-districts the deaths from the epidemic diseases ranged from 10(5 in Barnsbury to 33 in Tufnell. Intermediately the death? were 78 in Lower Holloway, 62 in Islington South East, 55 in Upper Holloway, 50 in Highbury and 40 in Tollington. The particulars of the deaths in each sub-district are given on page 56. 1910] 54 Showing the Deaths from the principal Epidemic Diseases for the Twenty-five years 1885-1909 and in 1910, together with Death-rates* for the total deaths. Years. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Simple and Undefined Fevers. Diarrhceal Diseases. Totals. Death-Rate, 1885 129 294 36 167 210 3 63 — 197 1099 3 .69 1886 3 63 26 72 214 2 60 — 320 760 2 .52 1887 — 335 59 46 240 2 45 — 309 1036 3 .39 1888 — 147 64 50 231 1 59 — 162 714 2 .31 1889 - 177 40 62 86 — 61 — 178 604 2 .01 1890 - 202 65 81 204 — 39 - 180 771 2.44 1891 — 224 50 +178 255 1 32 - 159 899 2.81 1892 3 179 53 170 161 - 41 1 189 797 2 .47 1893 2 119 94 200 181 1 48 2 237 884 2 .70 1894 3 199 69 218 188 36 — 95 808 2 .44 1895 1 135 66 144 81 1 30 3 189 650 1 .94 1896 1 288 57 257 234 46 2 153 1038 3 .07 1897 1 97 61 131 130 44 — 174 638 1 .89 1898 — 325 26 93 168 1 36 1 2-3 933 2.77 1899 — 155 33 128 160 — 47 258 781 2.32 1900 1 159 24 106 142 — 46 2 180 660 1.96 1901 8 151 30 134 85 — 47 1 172 628 1.87 1902 53 114 40 104 152 45 1 99 608 1.82 1903 — 120 2i 43 152 — 22 1 109 471 1 .41 1904 1 181 35 28 83 — 18 — 260 606 1 .82 1905 1 123 37 34 111 — 17 — 206 529 1 .59 1906 — 187 37 32 74 — 19 — 213 562 1.70 1907 — 130 24 42 120 13 — 103 432 1 .31 1908 — 78 30 60 55 — 18 — 117 358 1.09 1909 — 197 25 31 86 ... 12 — 67 418 1 .27 1910 .. — 166 11 34 124 — 17 — 76 428 1 .30 "The death-rates from 1901 to 1910 have been calculated on the Census returns of 1911, and are therefore approximately correct. f From this date Membranous Croup was included. 55 [1910 Table XXIX. Showing the Corrected Mean Number of Deaths from the Principal Epidemic Diseases. 1885-1909 and in 1910 Diseases. Corrected Average Number of Deatbs 1885-1909. 1910. Decrease. Small pox 8 .. - 8 Measles 176 166 - 10 Scarlet Fever 44 11 - 33 Diphtheria 105 34 - 71 Whooping Cough 153 124 - 29 Typhus Fever 1 .. -1 Enteric Fever 38 17 - 21 Continued & Ill-defined Fevers 1 .. 1 Diarrhoea 185 76 - 109 The above Diseases 711 428 - 283 The following statement shows the position occupied by Islington with respect to the Epidemic Diseases in the country and in the neighbouring metroDolitan boroughs. Epidemic Epidemic death-rates death-rates per 1,000 per 1,000 inhabitants. inhabitants. England and Wales 0.99 77 Great Towns 1.23 136 Smaller Towns o.88 Rural Districts 0.74 The Encircling Boroughs rig The Encircling Boroughs. St. Pancras 1.39 Stoke Newington 0.58 Hackney . 0.84 Hornsey 0.39 Finsbury 1.92 Shoreditch 1.90 County of London West London Districts 0.90 North „ „ 1.04 Central „ „ 1.45 East fl rr 1 .47 South „ „ 1.15 County of London 1.14 Islington 1.80 Epidemic death-rates per 1,000 inhabitants. West Ham 1.20 Bristol 0.59 Birmingham 1.12 Nottingham 1.10 Liverpool 2.28 Manchester 1.79 Epidemic death-rates per 1,000 inhabitants. Salford 1.70 Bradford 1.25 Leeds 1.28 Sheffield 1.50 Hull 1.76 Islington 1 .30 1910] 56 The number of the deaths in, and the epidemic death-rate of, each subregistration district were as follows :— Deaths. Epidemic Death-rates. Tufnell 33 0.98 Upper Holloway 55 1.49 Tollington 44 1.42 Lower Holloway 78 1.97 Highbury 5o o.8o Barnsbury 106 1 99 Islington, South-East 62 o.86 428 1.30 Table XXX. Deaths from each of the principal Epidemic Diseases during the year 1910, inclusive of the Deaths of Borough Patients in Hospitals outside the Borough. subregistration districts. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric (Typhoid Fever.) Diarrhoea. TOTALS. Tufnell 10 1 2 11 ... 2 7 33 Upper Holloway 11 2 8 17 ... 7 10 55 Tollington 24 2 12 ... ... 6 44 Lower Holloway 36 2 2 20 ... 2 16 78 Highbury 16 2 3 22 ... 1 6 50 Barnsbury 43 4 10 27 ... 3 19 106 S. East Islington 26 ... 7 15 ... 2 12 62 The Borough 166 11 34 124 ... 17 76 428 Preceding year, 1909 197 25 3i 86 ... 12 67 418 57 [1910 Table XXXI. Showing the Deaths from the Principal Epidemic Diseases in the Wards during the Four Quarters of 1910. WARDS. First Quarter. Second Quarter. Third Quirter. Fourth Quarter. Year. Deaths. Deaths. Deaths. Deaths. Deaths. Tufnell 8 5 4 16 33 Upper Holloway 16 8 7 24 55 Tollington 2 7 4 31 44 Lower Holloway 13 11 17 37 78 Highbury 12 7 5 13 37 Mildmay 3 3 3 2 11 Thornhill 15 9 14 43 81 Barnsbury 6 3 6 10 25 St. Mary's ... 2 1 4 7 Canonbury 6 2 2 9 19 St. Peter's 5 7 12 14 38 The Borough ... 86 54 75 203 428 1910] 68 Table XXXII. Showing the Deaths from each of the Principal Epidemic Diseases in the several Wards during the Year 1910. WARDS. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Continued and Ill-defined Fever. Diarrhoea. Total Epidemic Deaths. Tufnell ... 10 1 ... 11 • •• 2 ... 7 1 33 Upper Holloway ... II 2 8 17 ... 7 ... 10 55 Tollington ... 24 2 12 ... ... ... 6 44 Lower Holloway ... 36 2 2 20 ... 2 ... 16 78 Highbury ... 14 2 ... 16 ... ... ... 5 37 Mildmay ... ... 2 ... 2 5 ... 1 ... 1 11 Thornhill ... ... 36 3 10 19 ... 2 ... 11 81 Barnsbury ... 7 1 ... 8 ... 1 ... 8 25 St. Mary's ... 3 ... 2 1 ... 1 ... ... 7 Canonbury ... 7 ... 3 6 ... ... ... 3 19 St. Peter's ... 16 ... 3 9 ... 1 ... 9 38 The Borough ... 166 11 34 124 ... 17 ... 76 428 69 [1910 SMALL POX. No death was registered during the year. MEASLES. There were 166 deaths from measles during the year, as contrasted with 197 in the preceding year, and with a corrected average of 176 during the 25 years 1885 to 1909. There has thus been a decrease of 10 on the mortality that has usually prevailed. In 1908, 78 deaths were registered, and in 1907, 130. In the first quarter of the year only one death was known. In the second, however, the number increased to 8; in the third quarter the deaths were nearly trebled, being 21, while in the fourth quarter they rose to 136, or six times as many as they had been in the third quarter. In the first quarter of the year the only death that was registered occurred in South-East Islington, while in the second quarter there was 1 death in Barnsbury, 3 in South-East Islington, and 4 in Lower Holloway. In the third quarter the deaths in Lower Holloway had increased to 7, in both Barnsbury and South-East Islington to 6, while Highbury for the first time during ihe year contributed to the mortality, 2 deaths being registered there- In the fourth quarter the deaths in Lower Holloway increased to 25, in Highbury to 14, in Barnsbury to 36, and in South-East Islington to 16, while Tufnell and Upper Holloway for the first time during the year were affected to the extent of 10 and 11 deaths respectively. Thus at the end of the year there were 10 deaths registered in Tufnell, 11 in Upper Holloway, 24 in Tollington, 36 in Lower Holloway, 16 in Highbury, 43 in Barnsbury, and 26 in Islington South East. These figures are just what one would have reasonably expected, because the chief factor at work in the case of infantile deaths is very patent in the case of deaths from measles. There is no epidemic disease, with the probable exception of diarrhoea, which contributes so much to the death-rate among young children as it does. It is, however, found that many, or the greater number, of the deaths from it are due to secondary causes which attack a very large percentage of the patients and which, as has been frequently pointed out by the Medical Officer of Health, are chiefly pneumonia and bronchitis, but especially the former. Indeed, in the year just passed, 136 of the registered deaths from measles were probably due to the pneumonia 1910] 60 which supervened on it, and if we inquire into the cause, we will find that it is to be traced to the ignorance of the parents, especially the mothers, as to the necessity of taking precautions for warding off the dangers to which the lungs are so susceptible after an attack of what is in itself so mild a disease, for it is a rare thing indeed for measles alone to kill any person. That this is true is apparent from the fact that out of 166 deaths from measles registered in the borough last year, 160 were contributed by diseases which supervened on the measles itself. Thus pneumonia was a secondary cause in 136 cases, bronchitis in 3, diarrhoea in 4, whooping cough in 1, and other ailments which will be found in Table XXXV. The registers show that 21 deaths occurred among children under 1 year old, and it is notable that all of these had attained the age of 6 months, while 2 of the infants died in their eighth month, 2 in their ninth month, 6 in their tenth month, 6 in their eleventh month, and 5 in their twelfth month. There were also 131 deaths among children 1 to 5 years old. and 14 deaths between 5 and 15 years old. The epidemic of measles which commenced during the fourth quarter received the very anxious attention of the Public Health Committee, to whom full particulars were regularly submitted. There is no disease peculiar to children which has of late years caused so much concern to sanitary authorities and their Medical Officers of Health as measles, because of the modern system of whipping-up young children, who are really under the school age, to the schools, which then become a powerful factor in its spread. The figures which have just been given show that by far the greater number of deaths occur among children under five years of age, and yet very large numbers of little ones are daily exposed to unnecessary danger by their attendance at the schools. Indeed, when we look at the roll of deaths from measles and whooping-cough, we cannot, if we have unbiassed minds, come to any other conclusion than that the lives of many of the little ones who have died from this disease, might have been preserved if they had not been sent to school, where they were brought into contact with the disease. The Medical Officer of Health feels no uncertainty as to what is the best thing to be done with these children. There is one course, and one only possible, which is to keep them at home. There is no reason for their attendance at school; they learn nothing, while at the same time they are kept in confinement and in 61 [1910 sitting postures which are absolutely detrimental to their future development These little children should be retained at home and allowed to play in the fresh air, even that of the streets or their back yards will be found purer than that of the schoolrooms, which soon become contaminated by the large number of children in the class rooms. It may be asked what is to become of them if they do not attend school, and the answer is, let their mothers mind them ! Parents, especially London parents, are far too freely relieved of their responsibility toward their children in these days. They should be made to feel it. It would make them better mothers if they knew that they had a real responsibility respecting their children. But if the State insists on these children being taken daily from their homes, let it not make creches of the schoolrooms, but provide playgrounds in the open air with shelters to protect the children in case of rain, at centres in different parts of our boroughs, where the children, under a suitable and less expensive class of teacher than at present, could be taught to play and to develop their little bodies so as to enable them to successfully resist any attacks of the infectious diseases which may unfortunately come their way. This subject, however, is not one that can be more than alluded to in an annual report. Indeed, it might with advantage be treated of in a special report. The particulars as to measles during the year are fully set out in the following- T ables:— Table XXXIII. Showing the Deaths from Measles in the Sub-Districts for each Quarter Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. .. .. 10 10 Upper Holloway .. .. .. 11 11 Tollington .. .. .. 24 24 Lower Holloway .. 4 7 25 36 Highbury .. • • 2 14 16 Barnsbury .. 1 6 36 43 Islington, South East 1 3 6 16 26 The Borough 1 8 21 136 166 19101 62 Table XXXIV. Showing the Death-Rates of the Encircling Boroughs from Measles in the Four Quarters of 1910. Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. St. Pancras 0.05 0 .52 0. 86 0 .93 0.59 Stoke Newington • • 0 .15 0 .44 0.22 0 .20 Hackney 0.32 0.57 0.07 0.15 0.28 Hornsey • • • • • • 0.04 0.01 Finsbury 0.04 0 .59 0 .25 1.91 0 .70 Shoreditch 1 .53 0.88 0.60 0.95 0 .74 The above Districts 0 .18 0. 50 0 .40 1. 44 0.44 Islington 0.01 0.10 0.25 1.66 0.49 Table XXXV. Showing the Secondary Causes of the Deaths from Measles. Secondary Diseases. Quarters. The Year 1910. 1 2 3 4 Males. Females. Totals. Pneumonia 1 7 16 112 63 73 136 Bronchitis .. .. 1 6 4 3 7 Convulsions .. .. 1 2 2 1 3 Diarrhoea .. .. 1 3 2 2 4 Ophthalmitis .. .. 1 .. .. 1 1 Whooping Cough .. .. .. .. 1 1 .. 1 Suppurative Adenitis .. .. .. 1 .. 1 1 Laryngitis .. .. .. 1 .. 1 1 Cancrum Oris .. .. .. 2 1 1 2 Marasmus .. .. .. 1 1 1 Stomatitis .. .. .. 2 1 1 2 Suppurative Arthritis .. .. .. 1 1 1 Total Secondary Diseases 1 7 20 132 74 86 160 Deaths where no secondary disease was entered 1 1 4 5 1 6 Total Deaths 1 8 21 136 79 87 166 68 [1910 Table XXXVI. Showing the Deaths from Measles during each Week of 1910. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Week. Deaths. Week. Deaths. Week Deaths. Week. Deaths. 1 ... 14 ... 27 1 40 1 2 ... 15 ... 28 5 41 2 b 1 16 ... 29 1 42 6 4 ... 17 ... 30 1 43 7 5 ... 18 ... 31 ... 44 6 6 ... 19 1 32 1 45 10 7 ... 20 1 33 2 46 12 8 ... 21 1 34 1 47 22 9 ... 22 2 35 2 48 15 10 ... 23 ... 36 ... 49 12 11 ... 24 1 37 3 50 16 12 ... 25 ... 38 1 51 18 13 ... 26 2 39 3 52 9 13 weeks 1 13 weeks 8 13 weeks 21 13 weeks 136 1910] 04 Table XXXVII. Showing the deaths from Measles in the Quarters, 1900-09 and 1910 Years. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. Whole Year. 1900 64 75 15 5 159 1901 7 17 27 100 151 1902 53 29 12 20 114 1903 35 64 17 4 120 1904 20 75 56 30 181 1905 26 17 20 60 123 1906 75 11 8 187 1907 4 56 44 26 130 1908 19 12 7 40 78 1909 89 94 10 4 197 Corrected average number of deaths 40 50 22 30 142 1910. 1 8 21 136 166 Increase or Decrease -39 -42 -1 + 106 + 24 SCARLET FEVER. As already stated, the deaths from Scarlet Fever at all ages numbered only 11, of which 7 were those of children under five years old and 4 between 6 and 15. Thus all the deaths occurred among children. The return is the lowest of which there is any record available; at all events since 1856. Indeed no other return has been nearly so low. In the last annual report the behaviour of this disease in Islington was discussed so that it will not be necessary to do so now. It is very satisfactory to find that there has been a steady diminution in the number of deaths from it even when compared with years long passed by when the population was 65 [1910 not a third of that of to-day. Since 1886, if wo analyse the deaths in quinquennial periods, we find that from 1886 to 1890 there were 254 deaths; from 1891 to 1895, 332 ; from 1896 to 1900, 201 ; from 1901 to 1905, 166 ; and from 1906 to 1910, 127. Thus we see that from 1895 to the end of 1910 there has been a persistent decrease in the mortality. The particulars of the disease in the various districts are given in the Table which follows:— Table XXXVIII. Showing the Deaths from Scarlet Fever in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. .. .. 1 1 Upper Holloway .. 1 .. 1 2 Tollington .. .. .. • • .. Lower Holloway 2 .. • • .. 2 Highbury 1 .. 1 .. 2 Barnsbury 2 .. .. 2 4 Islington, South East .. .. •• .. .. The Borough 5 1 1 4 11 DIPHTHERIA. The return of 34 deaths from this disease must be considered satisfactory, particularly as following the low return of 31 in 1909. In 1908, 60 deaths were registered, in 1907 42, and in 1906 32. Thus for some years there has been a very small mortality compared with what it used to be from this formerly very fatal disease. When the return of the past years are examined, we find that from 1886 to 1890, 311 deaths were registered; from 1891 to 1895,842; from 1896 to 1900, 678; from 1901 to 1905, 343; and from 1906 to the end of last year 199. These figures show that ever since the 1891-1895 quinquennium there has been a very steady fall in the number of deaths ; indeed the decrease from the average of that quinquennium to the end of last year was as much as 76'4 per cent, F 1910] 66 Towards the end of the year the Medical Officer of Health felt it his duty to recommend the Council to keep a supply of anti-toxin for the treatment of Diphtheria in families which could not afford to pay for it, and which would also be available for members of the medical profession who required it in times of urgency. The matter was duly considered by the Public Health Committee who brought up a recommendation to the Council to follow the advice tendered to them, especially as under an Order of the Local Government Board, dated August 15th, 1910, the provision of a temporary supply of anti-toxin for the poorer inhabitants in a Metropolitan Borough was sanctioned. The report is attached as an appendix to the present Annual Report. The following Table give particulars as to the deaths from Diphtheria during the year. Table XXXIX. Showing the Deaths from Diphtheria in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year Tufnell .. .. 1 1 2 Upper Holloway 2 .. 2 4 8 Tollington .. •• .. .. 2 2 Lower Holloway .. • • 1 1 2 Highbury 1 1 1 .. 3 Barnsbury 5 2 1 2 10 Islington, South East 1 2 1 3 7 The Borough 9 5 7 13 34 WHOOPING COUGH. One hundred and twenty-four deaths were registered from this disease as compared with 86 in 1909, 55 in 1908, 120 in 1907, and 75 in 1906. Indeed, • the deaths from it have been more numerous than in any year since 1903, when 152 occurred. However unsatisfactory this may be, there is this much to be said that the mortality from whooping cough is declining in 67 [1910 Islington, for when the returns are examined in quinquennial periods from 1886 to the present time, it is found that there has been a very large decrease in the number of deaths, especially during the last two quinquennial periods. The figures for the several quinquennia are as follows:— 1886-1890 975 deaths 1891-1896 866 „ 1896-1900 834 „ 1901-1905 583 „ 1906-1910 ' 459 „ Here we see that there has been the very satisfactory decrease in the mortality from 975 deaths in the 1886-1890 quinquennium to 459 in the 1906-1910 period, so that even this disease, like others of the epidemic class, shows a decreased mortality. It is, however, still far too high. Ages at Death. 64 out of 124 registered deaths occurred among children under 1 year old, and of these five occurred in the second month of life, 6 in the third, 3 in the fourth, 4 in the fifth, 5 in the sixth, 10 in the seventh, 0 in the eighth, 6 in the ninth, 6 in the tenth, 12 in the eleventh and 7 in the twelfth. Between 1 and 5 years of age there were 57 deaths, and only 3 above this age. Thus we find that out of the 124 deaths, all except 3 occurred among children under 5 years old, and of these 53 per cent, had not attained their first year. This is one of the saddest stories that has to be told in connection with public health work, for the deaths are very frequently entirely preventable, and are always preceded by very great suffering on the part of the little patients. There is probably no more distressing sight than that of a little helpless baby struggling for its breath in one of the paroxysms of this disease. Instruction of mothers is truly necessary if the mortality from it is ever to be brought within reasonable bounds. Particulars are given with respect to the deaths in the various districts in the Table which follows:— f 2 1910] 68 Table XL. Showing the Deaths from Whooping Cough in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year Tnfnell 8 2 .. 1 11 Upper Hollo way 10 5 2 .. 17 Tollington 2 7 1 2 12 Lower Holloway 10 6 2 2 20 Highbury 11 9 2 •• 22 Barnsbury 12 7 4 4 27 Islington, South East 7 4 2 2 15 The Borough 60 40 13 11 124 ENTERIC FEVER. Enteric Fever was the cause of 17 deaths, or five more than in the preceding year. Here again the return must be considered favourable, for it is no less than 24 below the corrected average of the years 1885-1909. The close of last year, as it completes the quinquennial period, makes it possible to compare the deaths in the preceding quinquennia with it. From 1886 to 1890 the deaths numbered 264, or an average of 52-8 per annum; from 1891-1895. 187, or 37*4 per annum ; from 1896-1900, 219, or 43 8 per annum ; from 1901-1905, 149, or 29-8 per annum ; and from 1906-1910, 79, or 15-8 per annum. Thus with this disease as with the others already mentioned there has been a steady decrease in the mortality; indeed, since the 1886-1890 quinquennium to that ending last year there has been a decrease of 70 per cent. This is truly an amazing record and speaks volumes for the sanitary conditions of to-day in comparison with those of former times. 69 [1910 Table XLI. Showing the Deaths from Enteric Fever in the Sub-Districts f»r each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell • • • • 1 1 2 Upper Holloway 1 1 2 3 7 Tollington • • • • • • • • .. Lower Holloway .. .. 1 1 2 Highbury .. • • 1 • • 1 Barnsbury 1 1 .. 1 3 Islington, South East •• 1 •• 1 2 The Borough 2 3 5 7 17 TYPHUS FEVER. No death was recorded. CONTINUED AND ILL DEFINED FEVERS. Nil return. DIARRHCEAL DISEASES. Only 76 deaths were registered from diarrhceal diseases during the year This low number is particularly satisfactory, as it followed on the low return of 67 in 1909. 33 deaths however, occurred among children under a year old, and 31 between that age and five years. While there were no deaths between the ages of 5 and 25, there were 12 among persons who had passed that age. Perhaps the most unusual feature of the return was that the deaths in the third quarter, which is usually the most fatal one, were less than those registered in the fourth, whereas the usual state of affairs is that the deaths in the third quarter are from six to ten times more numerous than in the fourth. The actual number of deaths registered in the third quarter of the year was 28, as 1910] 70 contrasted with 32 in the fourth. In 1909 the third quarter was also unusually healthy, yet there were only 12 deaths in the fourth quarter, whereas there were 41 in the third. Taking the records in quinquennial periods, the Medical Officer of Health finds that from 1886 to 1890 there were 917 deaths in the third quarters, and 105 in the fourth; in the quinquennial 1891 to 1895, 616 deaths were registered in the third quarters, and only 83 in the fourth ; in the next period 1896 to 1900 there were 901 deaths in the third quarters and 89 in the fourth; in the 1901 to 1905 period there were 655 deaths in the third quarters and only 107 in the fourth. In the 1906 to 1910 there were 338 in the third quarters and 150 in the fourth. Thus it is seen that the rule has been without exception as regards the quinquennia that the deaths in the third quarters considerably exceed those in the fourth. There has, however, been one other exception besides that of last year to the rule, viz:—in 1907, when the deaths in the third quarter numbered only 30, whereas in the fourth they were 49. The cause of this was no doubt due to the meteorological conditions which prevailed, for the cool third quarter was succeeded by short periods of very hot weather in the month of October. Particulars of the disease are given in the Tables which follow:— Table XLII. Showing the Deaths from Diarrhoea in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. 3 2 2 7 Upper Holloway 3 1 1 5 10 Tollington • • 3 3 6 Lower Holloway 1 1 6 8 16 Highbury 3 • • 2 1 6 Barnsbury 1 1 9 8 19 Islington, South East 1 1 5 5 12 The Borough 9 7 28 32 76 71 [1910 Table XLIII. Shewing the Deaths from Diarrhaeal Diseases together with those classed under Enteritis and its sub-headings, arranged in quarterly periods, and at three groups of ages. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals Diarrhoea Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Under 1 year 2 7 9 4 14 18 13 9 22 14 23 37 33 53 86 1 to 5 years 5 1 6 1 ... 1 11 1 12 14 7 21 31 9 40 Over 5 years 2 6 8 2 4 6 4 3 7 4 6 10 12 19 31 Totals 9 14 2 3 7 18 25 28 13 41 32 36 68 76 81 157 Note.—In this Table the deaths under Enteritis include only those which are not epidemic or zymotic. 1910] 72 TABLE XL1V. Showing the Diarrhceal Deaths including those from Epidemic Enteritis in the Third Quarter, 1910. 1910 Deaths. Meteorology. Temperature of the a;r. Temp, of the earth. Rainfall. Week Ending. Tuf. U.H. Toll. L.H. H. B. S.E. Total. Mean temperature of air in degrees. | Departure | from mean i temperature i of 65 years 1 Temperature of the earth 3 feet below surface. Rainfall in inches. No. of days on which rain fell. July 9th .. 1 .. .. 1 .. 2 g 55 .3 o -6. 9 o 58.21 1 29 5 ,, 16th .. .. .. .. .. .. .. 57.9 -5 .1 5799 0 01 1 ,, 23rd .. .. .. .. 1 .. 1 59 2 -4.0 58.82 1.22 6 ,, 30th 1 .. .. .. .. .. 1 58.8 -3.7 59 06 0 35 6 1 .. 1 .. .. 2 .. 4 578 -4 .9 58.52 2.87 18 August 6th .. .. .. 1 .. .. .. 1 602 -2 .0 60 .12 0. 85 5 ,, 13th .. .. .. .. .. .. 1 1 60.7 -1.6 60 .48 0.18 5 ,, 20th .. .. .. .. .. 1 .. 1 62 7 +0. 6 61 .13 0.19 3 ,, 27th 1 .. 1 1 .. 1 1 5 59.9 -1.0 61 .26 0.80 4 1 .. 1 2 .. 2 2 8 609 -1.0 60 .75 2.02 17 Sept. 3rd.. .. .. 1 .. .. 1 2 58 3 -1.7 60. 59 0 .41 4 ,, 10th.. .. 1 .. 1 .. 1 1 4 54 7 -4.2 5968 0.02 1 ,, 17th.. .. .. .. .. 561 -1.6 58.71 0.66 5 ,, 24th.. .. .. l 1 2 l 5 53.8 -2 .2 58.01 0.00 Oct. 1st .. .. .. .. 2 1 1 l 5 58 6 + 3.8 57 35 0.10 2 .. 1 1 4 2 5 3 16 56 3 -1.2 58.87 1.19 12 3rd Quarter 2 1 3 6 2 9 5 28 58 3 -2.4 59.38 6.08 47 73 [1910 Table XLV. Showing the Deaths occurring in Islington and in the several Encircling Boroughs from All Causes, front the principal Epidemic Diseases, and fnm Phthisis in the year 1910. THE ENCIRCLING BOROUGHS. Estimated Populations, 1910. Total Deaths from all Causes. Total Epidemic Deaths. Deaths from principal Epidemic Diseases. Deaths from Phthisis. Deaths of infants under 1 year of age. Deaths under 1 year to 1,000 Births. Small Pox. Measles. Scarlet Fever. Diptheria. Whooping Cough. Typhus. Enteric Fever. Simple and Undefined Fevers. Diarrhoea. i 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 St. Pancras 237,792 3,261 330 ... 140 17 21 96 ... 4 ... 52 304 582 102 Stoke Newington 54,838 600 31 ... 11 1 2 7 ... 2 ... 8 50 63 64 Hackney 239,979 2,797 202 ... 66 5 8 61 ... 10 ... 52 259 520 98 Hornsey 98,561 758 39 ... 1 4 8 12 ... 3 ... 11 31 92 70 Finsbury 94,578 1,656 182 ... 66 4 21 36 ... 4 1 50 160 347 123 Shoreditch 114,387 1,905 217 ... 84 4 14 46 ... 8 ... 61 170 526 146 The above Boroughs 840,135 10,977 1,001 ... 368 35 74 258 ... 31 1 234 974 2,130 106 Islington 327,985 4,523 428 ... 166 11 34 124 ... 17 ... 76 390 777 95 1910] 74 Table XLVI. Showing the Death Rates of Islington and of the several Encircling Boroughs from All Causes, from the principal Epidemic Diseases, and from Phthisis in the year 1910. THE ENCIRCLING BOROUGHS. Estimated Populations, 1910. Total Deathrates from All Causes. Total Epidemic Death-rates. Death-rates from principal Epidemic Diseases. Death-rates from Phthisis. Deaths under 1 year to 1,000 Births. Small Pox Measles. Scarlet Fever. Diphtheria Whooping Cough. Typhus. Enteric Fever. Simple and Undefined Fevers Diarrhoea. 1 2 3 4 5 6 7 8 9 IO 11 12 13 14 15 St. Pancras 237,792 13.8 1.39 ... 0.59 0.07 0.09 o'4o ... 0.02 ... 0.22 1.28 102 Stoke Newington 54,838 11.0 0.58 ... 0.20 0.02 0.04 0.13 ... 0.04 ... 0.15 0.91 64 Hackney 239,979 11.7 0.84 ... 0.28 0.02 0.03 0 .25 ... 0.04 ... 0.22 1.08 98 Hornsey 98,561 7.7 0.39 ... 0.01 0.04 0.08 0.I2 ... 0.03 ... 0.ll 0.31 70 Finsbury 94,578 17.6 1.92 ... 0.70 0.04 0.22 0.38 ... 0.04 0.01 0.53 1.70 123 Shoreditch 114,387 16.7 1.90 ... 0.74 0.04 0.12 0.40 ... 0.07 ... 0.53 1.49 146 The above Boroughs 840,135 13.0 1.19 ... 0.44 0.04 0.09 O.3O ... 0.04 ... 0.28 1.16 106 Islington 327,985 13.79 1.30 ... 0.51 0.03 0.10 0.38 ... 0.05 ... 0.23 1.19 95 Note.—This Table has been prepared from figures in the Annual Report, 1910, published by the Registrar General, which, with the exception of those for Islington, are, however, uncorrected. 75 [1910 Table XLVII. Showing the Death-rates from All Causes, from the principal Epidemic Diseases, together with the Infantile Mortality, in the Country, in the Populous Towns, in Towns whose Populations exceed 300,000 inhabitants, in the Encircling Boroughs, and in Islington. All Causes. Principal Epidemic Diseases (Cols. 3-9). Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea Deaths under 1 Year to 1,000 Births. Cols. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. England and Wales .. 13.4 0.99 0.00 0.23 0.06 0.12 0.24 0.05 0.29 106 77 Great Towns 13.4 1.23 0.00 0.31 0.08 0.12 0.29 0.05 0.38 115 136 Smaller Towns 12.4 0.88 0.00 0.16 0.06 0.11 0.24 0.05 0.26 104 England and Wales less the 213 Towns 13.6 0.74 0.00 0.15 0.05 0.12 0.17 0.05 0.20 96 London 12.7 1.14 .. 0.41 0.04 0.09 0.28 0.04 0.28 103 Bristol 11.5 0.59 .. 0.08 0.03 0.10 0.17 0.02 0.19 90 Birmingham 13.7 1.12 .. 0.07 0.14 0.11 0.37 0.04 0.39 130 Liverpool 17.7 2.28 .. 0.60 0.22 0.13 0.58 0.05 0.70 140 Manchester 16.1 1.79 .. 0.40 0.11 0.14 0.56 0.09 0.49 131 Leeds 13.7 1.28 .. 0.32 0.08 0.14 0.31 0.04 0.39 132 Sheffield 13.4 1.50 0.00 0.25 0.07 0.08 0.39 0.04 0.67 127 St. Pancras 13.8 1.39 .. 0.59 0.07 0.09 0.40 0.02 0.22 102 Stoke Newington 11.0 0.58 .. 0.20 0.02 0.04 0.13 0.04 0.15 64 Hackney 11.7 0.84 .. 0.28 0.02 0.03 0.25 0.04 0.22 98 Hornsey 7.7 0.39 .. 0.01 0.04 0.08 0.12 0.03 0.11 70 Finsbury 17.6 1.92 .. 0.70 0.04 0.22 0.38 0.05 0.53 123 Shoreditch 16.7 1.90 .. 0.74 0.04 0.12 0.40 0.07 0.53 146 Encircling Boroughs 13.0 1.19 .. 0. 44 0.04 0.09 0.30 0.04 0.28 106 Islington 13.8 1.30 .. 0.51 0.03 0.10 0.38 0.05 0.23 95 * These are the death-rates published by the Registrar-General, and, with the exception of those for Islington, are not corrected for the new Census. 1910] 76 INFLUENZA. This infectious disease caused 36 deaths during the year, as compared with 70 in 1909 and 81 in 1908, and an average of 75 in the twelve years 1898-1909. The return is also the lowest experienced in this period. The following statement, which gives the incidence of the disease at the several ages of life from 1898 to 1909 is reprinted from the report of last year, to which has been added the return for 1910 and the averages for the years 1898-1909. Ages. 1898. 1899. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909 Average. 18981909. 1910. Departure from average 0- 5 8 6 3 4 4 3 4 4 4 5 3 1 4 2 – 2 5-10 2 2 3 1 – 1 – 1 1 1 – 1 1 – –1 10-15 – – – – – 1 – – – – – 15-20 4 4 9 – 3 2 3 – 4 3 5 2 3 2 – I 25-35 4 12 7 2 7 3 2 3 5 10 3 4 5 2 – 3 35-45 5 17 16 5 13 5 7 5 4 19 8 8 10 3 – 7 45-55 9 15 18 5 14 9 7 7 10 5 14 10 10 5 – 5 55-65 15 28 28 12 6 8 6 9 13 6 16 9 13 5 – 8 65-75 11 24 36 12 17 6 11 12 16 12 14 20 16 5 – 11 75-85 6 14 25 5 15 3 7 12 8 12 14 11 11 8 – 3 85 and 1 4 4 – 4 – 1 1 2 1 4 4 2 4 + 2 wards – – – – – – – – – – – – – – – 65 126 149 46 83 40 48 54 67 75 81 70 75 36 – 39 77 [1910 Table XLVIII. Showing the Deaths from Influenza in the Quarters of the Year 1910, together with the corrected averages of the corresponding periods 1900-1909. Years. Quarters. Totals. First. Second. Third. Fourth. 1900 122 17 3 7 149 1901 18 13 4 11 46 1902 45 15 5 18 83 1903 30 3 1 6 40 1904 12 5 2 29 48 1905 26 16 3 9 54 1906 13 21 7 26 67 1907 48 12 4 11 75 1908 52 20 3 6 81 1909 36 19 4 11 70 Corrected Averages 39 14 4 13 70 1910 21 6 2 7 36 Increase or Decrease –18 –8 –2 –6 –34 Table XLIX Showing the Secondary Causes of Death from Influenza in the Four Quarters of the Year 1910. Tufnell. Upper Holloway Tollington Lower Holloway. Highbury. Barnsbury. South-East Islington. Totals for Year. Quarters. Quarters. Quarters. Quarters. Quarters. Quarters Quarters. 1st. 2nd. 3rd 4th. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th. 1st 2nd. 3rd. 4th. 1st. 2nd 3rd. 4th. 1st. 2nd. 3rd. 4th 1st 2nd. 3rd. 4th Pleurisy .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Pneumonia .. .. .. .. 2 1 .. .. 2 1 .. .. 1 .. .. 1 4 .. .. .. 1 1 1 .. 1 .. .. 2 18 Bronchitis 1 .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. 2 1 .. .. .. 1 .. .. 1 9 Heart Disease, etc. 1 .. .. .. 2 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 Convulsions .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Gastric Hermorrhage .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Phthisis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 All Secondary Causes 2 .. 1 .. 4 1 .. 1 3 2 .. .. 2 .. .. 1 5 2 .. 2 2 1 1 .. 2 .. .. 3 35 No Secondary Causes 1 .. •• .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Totals 3 .. 1 .. 4 1 .. 1 3 2 .. •• 2 .. .. 1 5 2 .. 2 2 1 1 .. 2 .. .. 3 36 1910] 78 79 [1910 APPENDICITIS. There were 27 deaths registered from appendicitis, or two more than in each of the preceding years. Altogether 224 deaths have been known since 1902, or an average of 25 per annum. The mortality, as seen by the statement below, seems to become less as age advances, and particularly after the ten years ending with the 45th year, when there is a drop from 26 to 20; in the next decade there is a fall to 14; in the decade succeeding this there is a further fall to 10; while no deaths have been registered among persons above this last-mentioned age. The subjoined tabular statement has been prepared to show the ages at which people died from the disease. Ages. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910 Totals 0-5 — 1 — 1 — 1 2 2 3 10 5-10 2 4 2 4 3 — 7 7 2 31 10-15 7 3 5 1 2 7 1 2 3 31 15-20 1 4 3 6 3 3 3 3 4 30 20-25 1 7 2 3 1 2 3 1 5 25 25-35 3 5 8 3 2 2 2 1 1 27 35-45 2 3 2 4 5 — 4 4 2 26 45-55 3 2 1 4 1 1 2 1 5 20 55-65 — 1 3 2 2 3 1 2 — 14 65-75 1 2 1 1 1 — — 2 2 10 75-85 — — — — — — — — — — 85 and upwards — — — — — — — — — — 20 32 27 29 20 19 25 25 27 224 5 per cent. of these deaths occurred at the age period - 0 5 14 „ „ „ „ 5-10 14 „ „ „ „ 10-15 13 „ „ „ „ 15-20 11 „ „ „ „ 20-25 12 „ „ „ ,, 25-35 12 ,, „ „ „ 35-45 8 „ „ „ „ 45-55 6 „ „ „ „ 55-65 5 „ „ „ 65-75 100 „ „ ,, „ All ages 1910] 80 SEPTIC DISEASES. These include Erysipelas, Pyaemia, Septicæmia and so-called Puerperal Fever, and as a group caused 43 deaths as contrasted with 40 in 1909, and 44 in 1908. Erysipelas.—Nine deaths occurred from Erysipelas, as contrasted with an average of 14 in the preceding 13 years. Of the deaths, 3 were among infants aged from 2 to 7 months old. No deaths occurred in the sub-districts of Tufnell, Upper Holloway and Tollington, while two were registered in Lower Holloway, 1 in Highbury, 4 in Barnsbury, and 2 in Islington South-East. The returns from these diseases during the last fourteen years were as follows:— 1897 11 1898 8 1899 16 1900 17 1901 15 1902 13 1903 9 1904 23 1905 12 1906 16 1907 13 1908 14 1909 12 Average 14 1910 9 Table L Deaths from Erysipelas in the Sub-Districts during the Year 1910. Deaths. Death Rates. Tufnell ... — per1,000 inhabitants. Upper Holloway ... — „ „ Tollington ... — „ „ Lower Holloway 2 0.05 „ „ Highbury 1 0.01 „ „ Barnsbury 4 0.07 „ „ Islington, South-East 2 0.02 „ „ The Borough 9 003 „ „ 81 [1910 Puerperal Septic Diseases.—These diseases of course only occur among women, and are due to infection during labour or after child-birth. They include Puerperal Pyaemia, Septicaemia, Sapræmia, Septic Intoxication, and the so-called Puerperal Fever, which is more or less a generic name for the whole. During 1910 they were 8 in number, or one more than the corrected average in the ten years 1900-1909. They were in the proportion of 9.7 to every 10,000 births, as contrasted with 10.3 in the preceding ten years. The Medical Officer of Health has frequently discussed the cause of these diseases. Sometimes they are accidental, but probably more frequently are due to the want of care exercised by women during their lying-in. Cases would probably be much rarer if women were properly instructed before their lying-in as to the necessity that exists for them to adopt precautions, especially in the direction of cleanliness in their bed and the clothes they wear during their confinement. Health Visitors are proving very useful in this direction. The following is a statement of the deaths for the last decennial period:— Years. Deaths. Deaths per 1,000 births. 1900 6 0.65 1901 15 1.62 1902 12 1.30 1903 9 1.00 1904 14 1.57 1905 6 0.68 1906 11 1.27 1907 8 0.94 1908 4 0.46 1909 7 0.85 Corrected average 9 1.03 1910 8 0.97 g 1910] 82 * Table LI. Showing the Deaths from Puerperal Fever in the Sub-Districts for each Quarter and the Year 1910. Pub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. Whole Year. Tufnell 1 .. .. .. 1 Upper Holloway 1 .. .. .. 1 Tollington .. 1 .. .. 1 Lower Holloway .. .. .. .. .. Highbury .. .. 1 .. 1 Barnsbury .. .. .. 2 2 Islington, South East 1 1 .. •• 2 The Borough 3 2 1 2 8 TABLE LII. Showing the Deaths from Puerperal Fever per 1,000 Births in the Sub Districts for each Quarter and the Year 1910. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 5.58 .. .. .. 1.35 Upper Holloway 3.83 .. .. .. 1.01 Tollington .. 5.26 .. .. 1.38 Lower Holloway .. .. .. .. .. Highbury .. .. 3.23 .. 0.79 Barnsbury .. .. .. 5.30 1.29 Islington, South East 2.02 2. 07 .. .. 1.06 The Borough 1.41 0.96 0.49 1.02 0.97 88 [1910 CONSTITUTIONAL DISEASES. These diseases form a group which are only second in importance to those known as the epidemic diseases. They include Rheumatic Fever, Rheumatism, Rickets, Diabetes, Gout, Anaemia, and above all, Tuberculosis, whether of the lungs or any other part of the body. During the year they caused 989 deaths, as compared with 1,039 in the preceding year, and they were equal to a death-rate of 3.01 per 1,000 of the population. During the last twenty years they have caused 21,538 deaths, which are equal to an annual death-rate of 3.25 during this period. The deaths and death-rates from these diseases are well worth studying year by year, and for the first time they are now given:— Deaths. Death-rates. Deaths. Death-rates. 1891 1,064 3.32 1901 1,080 3.22 1892 1,037 3.21 1902 1,101 3.23 1893 1.093 3.18 1903 1,070 3.21 1894 997 3.02 1904 1,116 3.36 1895 1,314 3.33 1905 1,007 3.03 1896 1,122 3.26 1906 1,042 3.15 1897 1,084 3.21 1907 1,041 3.15 1898 1,067 3.17 1908 1,048 3.12 1899 1,115 3.32 1909 1,032 3.14 1900 1,119 3.33 1910 989 3.01 Cancer and Malignant Diseases.—361 deaths from cancer and malignant diseases were recorded during the year. They were equal to a death-rate of 11.0 per 10,000 of the population, which is 0.03 in excess of the rate recorded in the preceding year, while the actual number of deaths were eight in excess of the same year. When comparison is made with the mean return for the preceding 20 years, it is found that they are GO in excess. This group of diseases continues to show an uninterrupted increase, as was stated in the report for 1909, and, indeed, an examination of the figures proves that whereas there were only 1,180 deaths in the quinquennium 1891 1895, there were 1,792 in the quinquennium 1900-1910, or an increase of nearly 52 per cent. This is indeed a matter of the utmost moment, and it is therefore no wonder that we hear of cancer research funds and endowments of special institutions for inquiry into the cause of this disease. G 2 1910] 84 The following is the return for the several years since 1891:— Years Deaths Deaths per 10,000 Pop. Years Deaths Deaths per 10,000 Pop. 1891 218 6.8 I902 326 9.6 1892 219 6.8 1903 350 10.5 1893 238 7.3 1904 323 9.7 1894 239 7.2 1905 328 9.9 1895 266 7.9 1906 363 11.0 1896 291 8.5 1907 348 10.5 1897 304 9.0 1908 367 10.9 1898 283 8.4 1909 353 10.7 1899 270 8.o Corrected Average 295 8.9 1900 303 9.0 361 11.0 1901 289 8.6 1910 Ages at Death.—The ages of the persons who die from cancer including malignant diseases are given in the statement set out below. From this it will appear that during the ten years 1900-1909, in 3,350 deaths, the greater number occurred at the age periods above 35. Thus between the ages of 35 and 45 there were 344 deaths, or 10.2 per cent. of the total number registered from these diseases. Between the ages of 45 and 55 there were 723 deaths, or 21.6 percent.; between 55 and 65 there were 958 deaths, or 28.6 per cent., and between 65 and 75 there were 831 deaths, or 24.8 per cent.; between 75 and 85 there were 300 deaths, or 8.9 per cent. It is, therefore, very apparent that the most valuable lives in the population, whether among males or females, are annually carried off. In the Tables which follow, very full particulars are given as to the prevalence of this disease in the borough, as well as of the death-rates from them at the different age periods; while full details are given of the several parts of the body which it attacked, differentiating between males and females:— Ages. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Average. 1900-1909. 1910. 0- 5 1 — 3 4 1 2 1 1 1 — 14 2 5-15 2 1 3 3 2 1 3 3 2 3 23 1 15-25 3 2 5 7 5 3 3 3 8 3 42 5 25-35 6 8 8 5 10 11 7 6 6 10 77 6 35-45 32 33 29 43 43 22 35 39 41 27 344 40 45-55 79 63 75 75 61 74 90 64 63 79 723 72 55-65 92 76 103 95 84 95 110 95 112 96 958 100 65-75 58 75 70 83 90 92 74 102 93 94 831 85 75-85 27 27 27 34 22 25 38 27 39 34 300 47 85&upwards 3 4 3 1 5 3 2 8 2 7 38 3 303 289 326 350 323 328 363 348 367 353 3,350 361 85 [1910 Table LIII. Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the Year 1910. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury Islington, South-East. The Borough. 1st 5 14 6 14 20 11 16 86 2nd 12 9 6 9 18 18 16 88 3rd 10 9 9 9 18 15 20 90 4th 11 14 8 14 20 14 16 97 The Year 38 46 29 46 76 58 68 361 Table LIV. Deaths from Cancer or Malignant Disease at seven age periods. Ages. Males. Females. Persons. Deaths. Deaths. Deaths. 0-25 6 2 8 25-35 3 3 6 35-15 14 26 40 45-55 3i 41 72 55-65 46 54 100 65-75 40 45 85 75 & upwards 18 32 50 All Ages 158 203 361 1910] 86 Table LV. Mortality from Cancer or Malignant Disease during the Year 1910. ORGANS AFFECTED. Sex. Age at Death. Males. Females. Totals. 0—5 —15 —26 —35 —45 —55 —65 —75 —75 upwards. Diseases of Nervous System Brain M .. .. .. .. .. .. .. .. .. .. .. .. f. .. .. .. .. .. .. .. .. .. .. .. .. Organs of Special Sense — Ear m. .. .. .. .. .. .. 1 1 .. 2 .. 2 F. .. .. .. .. .. .. .. .. .. .. .. Diseases of Heart, etc.— Endocarditis m. .. .. 1 .. .. .. .. .. .. 1 .. 3 f .. .. 1 .. .. 1 .. .. .. .. 2 Respiratory System— Larynx m. .. .. .. .. .. 1 2 .. .. 3 .. 4 f. .. .. .. .. .. .. .. 1 .. .. 1 Lung m .. .. .. .. .. .. .. .. .. .. .. 2 f. .. .. .. .. .. .. 1 .. 1 .. 2 Digestive System— Rectum m .. .. .. .. 4 3 2 6 .. 15 .. 32 f. .. .. .. 1 3 1 5 4 3 .. 17 Pylorus m .. .. .. .. .. .. 1 1 .. 2 .. 5 F .. .. .. .. .. .. 1 1 1 .. 3 Pancreas M .. .. .. .. .. 1 2 .. .. 3 .. 4 f .. .. .. .. .. .. 1 .. .. .. 1 Liver M. .. .. .. .. 2 3 5 6 3 19 .. 42 F. .. .. .. .. .. 4 6 8 5 .. 23 Appendix M .. .. .. .. .. .. .. .. .. .. .. 1 f. .. .. .. .. .. 1 •• .. .. .. 1 Œsophagus M. .. .. .. 1 1 7 2 4 1 16 .. 20 f. .. .. .. .. .. .. 2 2 .. .. 4 Stomach M. .. .. .. .. 1 3 10 8 2 24 .. 37 f. .. .. .. .. 1 1 6 4 1 .. 13 Peritoneum M. 1 .. .. .. .. .. .. .. .. 1 .. 1 f. .. .. .. .. .. .. .. .. .. .. .. Gall Bladder M. .. .. .. .. .. .. .. 1 1 2 .. 6 f. .. .. .. .. .. 1 .. 2 1 .. 4 Abdomen M .. .. .. .. .. .. .. .. 1 3 .. 7 F. .. .. .. .. .. 2 1 1 .. .. 4 Colon M .. .. .. .. 2 1 1 2 .. 6 .. 13 f. .. .. .. 1 1 .. 1 2 2 .. 7 Jaw M. .. .. .. .. .. 2 .. 2 .. 4 .. 5 f. .. .. .. .. .. .. .. 1 .. .. 1 Intestines (parts not specified) M .. .. .. .. .. 1 .. .. 1 2 .. 6 f. .. .. .. .. .. 2 1 .. 1 .. 4 Omentum M .. .. .. .. .. .. .. .. .. 2. .. 3 f. .. .. .. .. .. .. 1 .. .. .. 1 Tongue M .. .. .. .. 1 1 .. .. 3 12 .. 12 f. .. .. .. .. .. .. .. .. .. .. .. Caecum M .. .. .. .. .. .. .. .. .. .. .. 2 f. .. .. .. .. .. 1 .. .. 1 .. 2 Duodenum M. .. .. .. .. .. .. .. .. 1 1 .. 1 F .. .. .. .. .. .. .. .. .. .. .. Fauces M .. .. .. .. .. .. .. .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Spleen m. .. .. .. .. 1 .. 1 .. .. 2 .. 3 f .. .. .. .. .. 1 .. .. .. .. 1 87 [1910 Table LV.—continued. ORGANS AFFECTED. Sex. Age at Death. Males. Females. Totals. —6 —15 —25 —36 —45 —65 —65 —76 —76 upwards. Digestive System—continued. Mesentery M .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. .. 1 .. .. .. .. Pharynx M. .. .. .. .. .. .. .. 1 1 2 .. 3 F. .. .. .. .. .. 1 .. .. .. .. .. Mouth M .. .. .. .. .. 1 .. .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Tonsils M. .. .. .. .. .. .. .. 1 .. l .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Lymphatic System— Parotid Gland. M .. .. .. .. .. 1 .. .. .. l .. 1 F .. .. .. .. .. .. .. .. .. .. .. Thyroid Gland M .. .. .. .. .. .. 1 .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Mediastinum M. .. .. 1 .. .. 1 .. .. .. 2 .. 2 F. .. .. .. .. .. .. .. .. .. .. .. Inguinal Gland M .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. .. .. .. 1 .. .. Cervical Gland M .. .. .. .. .. 1 .. .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Urinary System— Kidney M. .. 1 .. 1 .. 1 1 .. .. 4 .. 9 F. .. .. .. .. 2 1 1 1 .. .. 5 Bladder M .. .. .. .. .. 1 2 2 2 7 .. 13 ) F. .. .. .. .. .. 1 1 2 2 .. 6 Prostate M. .. .. .. .. .. .. 1 .. .. 1 .. 1 F .. .. .. .. .. .. .. .. .. .. .. Generative System— Breast M .. .. .. .. .. .. 1 1 .. 2 .. 41 F .. .. .. .. 4 9 10 7 9 .. 39 Uterus F .. .. .. .. 10 11 15 8 3 .. 47 47 Ovary F. .. .. .. .. 1 1 •• .. 1 .. 3 .. Pelvis F .. .. .. .. 3 1 .. 1 .. .. 5 .. Testis M. .. .. .. 1 .. .. .. .. .. 1 .. 1 Perineum M .. .. 1 .. .. .. .. .. .. 1 .. 1 Organs of Locomotion— Neck M. .. .. .. .. 2 2 2 l .. 7 .. 8 F. .. .. .. 1 .. .. .. .. .. .. 1 Arm M. .. .. .. .. .. .. 1 .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Leg M .. .. .. .. .. .. .. .. 1 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Bones and Joints— Spine M .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. 1 .. .. .. .. 1 Skull M 1 1 1 F .. .. .. .. .. .. .. .. .. .. .. Sacrum M. .. .. .. .. .. .. .. .. 1 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Vertebrae M. .. .. .. .. .. .. .. .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Integumentary System— Head M. .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. 1 .. .. .. .. .. 1 Unspecified M. .. .. .. .. .. .. .. .. .. .. .. 1 F. 1 .. .. .. .. .. .. .. .. .. .. Total Males and Females for] Year M 1 1 4 3 14 31 46 10 18 158 .. .. F. 1 .. 1 3 26 41 54 45 32 .. 203 .. Total Deaths 2 1 5 6 40 72 100 85 50 158 203 361 1910] 88 Tubercular Diseases. Tuberculosis of the Lungs or Phthisis, Tuberculosis of the Brain or Tubercular Meningitis, Tuberculosis of the Larynx, Tuberculosis of the Abdomen or Tabes Mesenterica, and General Tuberculosis, These diseases caused 539 deaths, as compared with 582 in the preceding year, and with an average of 633 in the ten years 1900-1909. Thus we see that there has been the substantial decrease of 94 deaths on the average of the decennium, of which 93 was due to the decrease in the deaths from phthisis or tuberculosis of the lungs, so that while it has shown a most satisfactory decrease, the deaths from other forms of the disease have remained stationary. If we examine Table LVIII., which shows the mortality from tuberculosis of the lungs and other forms of tuberculosis since 1900, differentiating males from females and from children under five years of age, it will be found that the deaths among children still remain very high ; indeed, as compared with 1900 and 1901 they show a very marked increase, although last year there was certainly an improvement, for the deaths among them were fewer than in any year since 1900. Phthisis or Tuberculosis of the Lungs.—It is very satisfactory to note that the number of deaths recorded from this disease is lower than any of the returns since 1891, when 544 deaths were registered, whereas last year there were only 390, a decrease of 115 on the corrected average. Since that year the number of deaths registered in each year has varied, although as a rule the variations have not been great, but they have nevertheless been mostly in a downward direction. Thus in the quinquennium 1891-1895 there were 2,715 deaths. In the succeeding five years 1895-1900 there were 2,762 deaths; in the next five years 1901-1905, however, they fell to 2,523, and in the last quinquennium 1906-1910 to 2,093. Thus the returns for the last five years show a decrease of 622 when compared with the quinquennium 1891-1895, 669 when compared with the quinquennium 1891-1900, and 430 when compared with the quinquennium 1901-1905. These are very substantial decreases which are specially satisfactory in view of the fact that this disease is the one which is the greatest scourge to adult and more mature life. The reduction in the mortality has chiefly occurred at the wage-earning periods of life. 89 [1910 Phthisis. Years. Deaths Death rates per 1,000 inhabitants. Proportion of Deaths from Phthisis per 100 Deaths from All Causes. Death rates from All Causes per 1,000 inhabitants 1891 544 1.70 8.60 19.8 1892 504 1.56 8.30 18.8 1893 560 1.71 8.76 19.5 1894 539 1.63 10.24 15. 9 1895 568 1.70 9.86 17.2 1896 530 1.54 9.01 17.4 1897 520 1.54 9.64 16.0 1898 527 1.56 9.24 16.9 1899 583 1.73 9.26 18.7 1900 602 1.79 10.52 17.0 1901 545 1.62 10.16 15.9 1902 515 1.51 9.14 16.5 1903 492 1.48 10.16 14.5 1904 533 1.60 10.18 15.7 1905 438 1.32 8.84 14.9 1906 411 1.24 8.14 15.3 1907 436 1.32 8.58 15.4 1908 432 1.29 9.23 13.9 1909 424 1.29 8.62 15.0 Corrected average 505 1.54 9.28 16.6 1910 390 1.19 8.62 13.8 The following return shows the deaths at each age period:— Age periods. Deaths. Age periods. Deaths. 0- 5 11 55-65 48 5-15 8 65-75 l6 15-25 56 75-85 5 25-35 92 35-45 70 Total 390 45-55 84 In London there has been an uninterrupted decrease in the mortality rate since 1881. Per 1,000 inhabitants. Per 1,000 inhabitants. 1881-85 2.22 1906 1.44 1886-90 1.97 1907 1.40 1891-95 1.85 1908 1.32 1896-1900 1.75 1909 1.31 1901-1905 1.57 1910 1.14 1910 ] 90 Table LVI. Showing the Deaths from Phthisis in the Sub Districts during the Hour Quarters of the Year 1910. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South-East. Borough 1st 9 8 7 12 19 14 29 98 2nd 7 14 8 11 18 14 34 106 3rd 8 15 9 7 13 15 14 81 4th 13 15 5 15 17 17 23 105 The Year 37 52 29 45 67 60 100 390 Tabes Mesenterica, or Consumption of the Bowels—This disease caused 36 deaths, 23 of which were those of males and 13 of females. 24 of the deceased were children under five years old, while 12 were above that age, and 3 were between 5 and 15. It is noteworthy that 11 of the deaths from abdominal tuberculosis were registered as occurring among persons between the ages of 25 and 75 years. Tubercular Meningitis.—72 deaths were registered, which number is the same as that recorded in 1909. 24 of these were of infants who had not reached the end of their first year, and 31 of children between 1 and 5 years of age. Out of the remaining number, 7 deaths were of juveniles between 5 and 10 years of age, 6 between 10 and 15, and 4 of persons between 15 and 35 years of age. Tuberculosis of the Larynx.—Only two deaths were registered, both of which occurred among persons aged between 35 and 45 years. General Tuberculosis and Scrofula.—In 23 instances death was ascribed to general tuberculosis. In five cases the deceased had not reached the end of their first year of life. In six instances they were between 1 and ft years of age; in three between 5 and 10; in two between 10 and 15; in two between 25 and 35; in two between 35 and 45; in two between 55 and 65, and in one instance the deceased was between the age of 65 and 75 years. Other forms of Tuberculosis.—16 deaths were registered. Further particulars respecting tuberculosis are to be found in the succeeding Tables:— 91 [1910 Table LVII. Showing the Deaths from the Tubercular Diseases during 1910. Diseases. Ages. Sex. Districts. Totals Deaths. Death Rates* per 1000 Population 0—1 1—5 Over 5 M. F. Tuf. u.h Toll. l.h. h. | B. S.E. 0—5 5—15 All Ages. Phthisis 3 8 379 234 156 37 52 29 45 67 60 100 390 0.29 0.12 1.10 Tabes Mesenterica 14 10 12 23 13 6 3 1 — 8 8 10 36 0.63 0.05 0.10 Tubercular Meningitis 24 31 17 42 30 6 7 4 16 7 17 15 72 1.45 0.19 2.20 Tuberculosis of the Larynx — — 2 1 1 — — — 1 — 1 — 2 — — 0.00 General Tuberculosis 5 6 12 11 12 — 2 3 2 5 5 6 23 0.29 0.05 0.07 Other Forms of Tuberculosis — 3 13 12 4 — 1 2 3 5 2 3 16 0.08 0.02 0.05 All Tubercular Diseases 46 58 435 323 216 49 65 39 67 92 93 134 539 2.74 0.4 1.52 *These death rates have not been revised. 1910] 92 Table LVIII. Mortality from Tuberculosis of the Lung (including Phthisis) and other Forms of Tuberculosis. Years. Number of Deaths. Death Rates. Tuberculosis of Lung (including Phthisis.) Other forms of Tuberculosis. Tuberculosis of Lung (including Phthisis). Other forms of Tuberculosis. Males (all ages). Females (all ages). Males (all ages). Females (all ages). Children (under 5). Males (all ages) Females (all ages). Males (all ages). Females (all ages). Children (under 5). 1900 385 217 57 51 88 2*42 I 22 0.36 0.29 2.12 1901 325 220 82 50 99 2'04 1-25 0.51 0.28 2.74 1902 308 207 84 73 120 1.92 1.17 0.52 0.41 3.31 1903 291 201 80 60 103 1.80 1.13 0.49 0.34 2.82 1904 315 2l8 83 66 104 1.94 1.22 0.51 0.37 2.84 1905 243 195 74 68 107 1.49 1.08 0.45 0.38 2.90 1906 252 159 88 79 112 1.54 0.88 0.54 0.44 3.02 1907 260 176 83 89 110 1.58 0.97 0.45 0.49 2.95 1908 248 184 96 76 109 1.53 0.99 0.59 0.41 2.85 1909 255 169 80 78 116 1.53 0.92 0.48 0.42 3.07 Average 288 195 81 69 107 1.78 1.08 0.49 0.38 2.86 1910 234 156 89 60 93 139 0 84 053 0.32 2.45 98 [1910 DIABETES MELLITUS. The return of 34 deaths in 1910 is only two below that of the preceding year, and compares with an average of 29 in the ten years 1900-1909. It is true that the number of deaths when contrasted with such a disease as phthisis is comparatively small, but inasmuch as they occur mostly among persons of 25 years and over, and, therefore, among the working periods of life, they are important. It is on this account that of late years the Medical Officer of Health has issued a statement similar to that given below. Table LIX. Showing the Deaths from Diabetes Mellitus at ten age periods during the years 1900-1909, and in 1910. Ages at Death. Years. Total 10 years 1910 1900 1901 1902 1903 1904 1905 1900 1907 1908 1909 0- 5 — — — — — — — — — — — — 5-15 — — 1 1 — — — 1 — — 3 1 15-25 2 2 — 1 3 1 1 1 — 4 15 3 25-35 1 3 2 2 2 3 3 1 1 2 20 1 35-45 2 1 7 2 3 2 3 1 2 1 24 3 45-55 7 5 4 2 5 4 3 2 4 10 46 7 55-65 7 10 9 8 11 6 7 7 7 8 80 7 65-75 7 8 2 7 9 11 14 5 5 5 73 1O 75-85 2 3 3 3 1 1 1 2 1 3 20 2 85 upwards — 1 — — 1 — — 1 1 3 7 — All Ages 28 33 28 26 35 28 32 21 21 36 288 34 Males 11 20 12 11 19 15 13 11 11 22 144 20 Females 17 13 16 15 16 13 19 10 11 14 144 14 1910] 94 TABLE LX. Showing the Deaths from the several Constitutional Diseases during the Years 1900- 1909, also the Corrected Mean Number of Deaths for these Years, together with the Deaths in 1910. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908 1909 Corrected Means 19001909. 1910. Increase or Decrease. Rheumatic Fever 16 9 17 16 13 18 15 11 9 10 13 15 + 2 Rheumatism 10 12 15 21 21 11 19 13 14 28 16 15 — 1 Gout 7 7 11 6 11 7 6 13 7 4 8 2 — 6 Rickets 13 19 17 9 11 11 11 5 5 3 10 4 — 6 Cancer 303 289 326 350 323 328 363 348 367 353 331 361 + 30 Tabes Mesenterica 36 38 43 40 40 39 35 26 45 41 39 36 — 3 Tubercular Meningitis 69 80 77 71 74 63 80 74 63 72 71 72 + 1 Phthisis 602 545 515 492 533 438 411 436 432 424 477 390 —87 Other Tubercular and Scrofulous Diseases 3 14 37 29 35 40 52 72 64 45 38 41 + 3 Purpura 2 2 2 1 1 2 1 3 3 2 1 — 1 Anaemia. Chlorosis, Leucocythaemia.. 12 9 7 8 14 15 16 15 14 13 12 16 + 4 Diabetes 28 33 28 26 35 28 32 21 21 36 28 34 + 6 Other Diseases 3 5 2 1 5 7 1 4 4 3 3 2 — 1 Totals 1,104 1.062 1,097 1,070 1 116 1,007 1 042 1,041 1,048 1,032 1,048 989 —59 DISEASES OF THE RESPIRATORY SYSTEM. There were 870 deaths registered from these diseases, which include acute and chronic Bronchitis, Pneumonia, Pleurisy and Asthma. It is satisfactory to find that this return is 217 less than the number registered in 1909. Naturally these diseases are greatly influenced by climatic conditions, and are not so amenable to sanitary efforts as other diseases that have already been considered. Nevertheless, it would be folly to close one's eyes to the fact that some of them, pneumonia especially, are influenced by the environment of the persons whom they attack. It goes without saying that where there is dirty air and dirty surroundings, you will find more cases of pneumonia than where the opposite conditions prevail. 95 [1910 The following Table indicates what a large number of deaths from diseases of the respiratory system occurs from year to year:— Years. Deaths. Years. Deaths. 1891-1895 6,268 1901-1905 5,104 1896-1900 5,479 1906-1910 4,934 It will be noticed that between the first and last quinquennium there is a difference of 1,334, which is a very large saving of human life. Acute Bronchitis.—136 deaths were ascribed to acute bronchitis, of which 59 were those of males and 77 were of females. The return is 46 below that of 1909. No less than 49 out of these 136 deaths occurred among children in their very first year of life, and 25 between 1 and 5 years. Altogether 74 of these children had not reached the end of their fifth year. Ten deaths occurred in the public institutions of the borough. Chronic Bronchitis.—254 deaths from this disease were registered, as compared with 352 in the preceding year. 118 were males and 136 females. In contrast with the ages at death from acute bronchitis, it is noticeable that only one occurred among children under five years old, while 23 were among persons aged from 45 to 55; 45 among persons 55-65; 85 among persons 65-75, and 69 among old people between 76 and 85, while as many as 26 occurred among very old people who had passed their 85th year. 72 deaths, or over one-third of the entire number, occurred in public institutions, chiefly in the Workhouse Infirmaries. Pneumonia—To this disease were ascribed 429 deaths, as contrasted with 476 in the preceding year, of which number 220 were males and 209 females. There were also 110 deaths among infants under one year old, and 112 among young children between 1 and 5 years of age, 6 among children between 5 and 10. 71 deaths, as compared with 75 in the preceding year, occurred in public institutions, generally the Workhouse Infirmaries. Pleurisy. This disease caused 17 deaths, of which only one was under five years old. Three deaths were registered in the public institutions. Asthma and Emphysema.—21 deaths were known, all of which occurred among adults who had passed their 25th year. 1910] 90 Other Diseases of the Respiratory System were credited with 13 deaths, or four less than the number recorded in 1909. The following return, showing the deaths of infants among these diseases, is of interest:— Acute Bronchitis. Pneumonia. Total. 1st quarter 9 42 51 2nd „ 9 16 25 3rd „ 4 12 l6 4th „ 27 40 67 49 110 159 ALCOHOLISM. Since 1907 there has been a considerable decrease in the number of deaths ascribed to alcoholism, for in that year 28 deaths were registered, whereas in 1910 there were only 11. In the intervening years, 1908 and 1909, the figures were respectively 17 and 18. The most gratifying feature of the return is that there has been a most marked falling off in the deaths among females, for, whereas they numbered 18 in 1907, there were only 5 in 1910, and in the intervening years they numbered respectively 9 and 6. The number of deaths during each year since 1901 is as follows:— Acute. Chronic. Total. Males. Females 1901 27 27 7 20 1902 9 29 38 20 18 1903 3 23 26 13 13 1904 4 18 22 12 10 1905 4 21 25 9 l6 1906 3 13 l6 5 11 1907 4 24 28 10 18 1908 3 14 17 8 9 1909 4 14 18 12 6 1910 3 8 11 6 5 22S 102 126 97 [1910 VENEREAL DISEASES. Syphilis and Gonorrhoea are the two chief diseases of this class which prove fatal, and they numbered 15 during the year, as contrasted with a similar number in 1909, and an average of 18 in the ten years 1900-1909. The return shows that the deaths among infants were 2 below the number registered in 1909, and 5 below those registered in 1908. During the year considerable discussion has arisen among the medical profession respecting a new remedy for syphilis, and if only a small proportion of the good results that have been ascribed to it are correct, it follows that a valuable remedy has been placed in the hands of physicians. Let it be hoped that at last a medicine has been discovered which will eradicate so terrible and horrible a disease from the human body. Under 1 year. 1—5 years. Adults. Total. 1901 10 1 6 17 1902 11 — 10 21 1903 10 1 8 19 1904 13 — 5 18 1906 9 1 11 16 1908 13 1 6 20 1909 10 — 5 15 1910 8 — 7 15 Totals 101 6 70 177 DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—1,683 persons died in the Public Institutions located in Islington, of whom 1,120 belonged to this borough, the remaining 563 having come here for treatment or relief. Among the latter were 397 persons who died in the Holborn Infirmary, and 85 in the Great Northern Central Hospital, 10 in the Islington Infirmary, 6 in the London Fever Hospital, 4 in St. Pelagia's Creche, and 12 in the Memorial Cottage Hospital. Of the 1,120 deaths of inhabitants, 839 occurred in the Islington Infirmary, 148 in the Islington Workhouses and Schools, and 97 in the Great Northern Central Hospital. The proportion which the 1,120 deaths bore to the borough mortality was 24.7 per cent. Without the Borough.—681 deaths of persons belonging to Islington were registered as occurring in Public Institutions in districts of London outside the Borough. They included, among others, 41 in the North-Eastern H 1910] 98 Fever Hospital, 58 in the Children's Hospital, Great Ormond Street, 82 in St. Bartholomew's Hospital, 29 in the Colney Hatch Asylum, 55 in the Royal Free Hospital, 68 in the University College Hospital, and 19 in Claybury Asylum. These 681 deaths represented 15.0 per cent. of all the deaths registered in the year. Within and without the Borough.—The deaths of Islingtonians in Public Institutions numbered 1,801, and were equal to 39.8 per cent. of the total deaths registered during the year. Fatal accidents or sudden deaths outside the Borough — Twenty-nine inhabitants died from accidental deaths, or suddenly, in places outside Islington. Table LXI. Showing the Deaths of Inhabitants in Local Institutions and, in Institutions outside the Borough, also the Deaths of Non-Inhabitants in Local Institutions during the ten years 1900-1909 and in 1910. Years, Total Deaths in Local Institutions cols. 3 and 4). Inhabitants of Islington in Local Institutions. NonInhabitants of Islington in Local Institutions. Inhabitants in Islington Infirmary. Inhabitants of Islington in G.N.C. Hospital. Inhabitants of Islington in Institutions outside the Borough. Total Deaths of Inhabitants in all Institutions (cols. 3 and 7). Proportion per 100 deaths from all causes (col. 8). 1 2 3 4 5 6 7 8 9 1900 1,564 990 574 779 124 553 1,543 26.9 1901 1,394 903 491 603 124 630 1,533 28.6 1902 1,531 909 622 587 130 737 1,646 29.2 1903 1,467 912 555 654 122 627 1,539 31.8 1904 1,619 987 632 719 132 589 1,576 30.1 1905 1,526 962 564 680 126 619 1,581 31.9 1906 1.574 955 619 717 I06 648 1,603 31.5 1907 1.675 1,082 593 760 1 656 1,738 34.2 1908 1.565 1,015 550 750 120 684 1,699 36.3 1909 1,672 1,055 617 755 113 735 1,790 36.4 Average 1,559 977 582 700 123 648 1,625 31.6 1910 1,683 1,120 563 839 97 681 1,801 39.8 99 r1910 Table LXII. Showing the Deaths of Inhabitants in Public and Charitable Institutions situated within the Borough distributed to their respective Sub-registration Districts; also the Deaths of Non-Inhabitants in the same Institutions during the Year 1910. PUBLIC INSTITUTION. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. Total Inhabitants. NonInhabitants. Islington Infirmary 70 135 72 112 102 148 200 839 10 Islington Workhouses 11 13 14 21 20 29 39 147 3 Workhouse Schools – – 1 – – – – 1 Gt. Northern Hospital 14 22 17 11 20 7 6 97 85 Holborn Infirmary – – – – – – 1 1 397 Aged Pilgrims' Asylum – 3 – – – 1 – 4 6 St. Pelagia's Creche – – – – 2 – – 2 4 Aged Blind Home – – – – – – – – 9 Medical and Surgical Home – – – – – – – – – Children's Nursing Home – – – – – – – – – St. John's Nursing Institute – – – – – – – – – Kingsdown Orphanage – – – – – – – – – Shoreditch Infirmary – – – – – – – – – Whittington College – – – – – – – – 2 Tufnell Park Nursing Institution – – – – – – 2 2 1 St. Andrew's Nursing Home – – 1 – – – – 1 – Alexandra Nursing Home, Turle Road – 1 1 – – – – 2 1 Highbury Nursing Home – – – – – – – – 4 Nursing Home, Hornsey Lane – – – – – – – – 1 H.M. Prison, Holloway 1 – – – – – – 1 4 H.M. Prison, Pentonville 1 – – – – – 1 2 2 Drovers' Almshouses – – – – – – – – – London Fever Hospital – – – – – – 1 1 6 Memorial Cottage Hospital – – – 1 8 1 4 14 12 Invalid Home, Aubert Park – – 1 – – – 2 – 1 Invalid Home, Highbury Terrace – – – – – – – – 6 Bookbinders' Asylum – – – 1 1 – – 2 1 Metropolitan Benefit Societies' Asylum – – – – – – – – 1 Bricklayers' and Tilers' Almshouses – – – – – – – – 1 Dyers' Almshouses – – – – – – – – 2 Pennefather Memorial Home – – – – – – – – – Clothworkers' Almshouses – – – — – – 1 1 – Totals 97 174 107 146 153 186 257 1,120 563 *There were also 9 deaths at places not mentioned in this list. H 2 1910] 100 Table LXIII. Showing the Deaths of Inhabitants of Islington in Public Institutions and in other places situated outside the Borough distributed to their respective Sub-Registration Districts during the Year 1910. Sub-Registration Districts. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. Males. Females. Total. Males. Females. Total. Males. Females. Total. | Males. Females. Total. Males. Females. Total. Tufnell 6 3 9 5 4 9 6 4 10 8 6 14 25 17 42 Upper Holloway 15 9 24 13 9 22 17 10 27 21 13 34 66 41 107 Tollington 4 2 6 3 4 7 6 6 12 4 7 11 17 19 36 Lower Holloway 9 7 16 13 11 24 16 8 24 17 9 26 55 35 90 Highbury 15 17 32 12 5 17 16 11 27 18 10 28 61 43 104 Barnsbury 19 13 32 12 17 29 16 9 25 33 15 48 80 54 134 South-East Islington 27 24 51 21 19 40 32 16 48 30 28 58 110 87 197 Borough 95 75 170 79 69 148 109 64 173 131 88 219 414 296 710 101 [1910 Table LXIV. Showing the Deaths of Inhabitants in Public and Charitable Institutions situated without the Borough, during the Year 1910. Institutions. 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. Year. Middlesex Hospital 4 3 8 6 21 Friedenheim (Home of Peace), N.W. 1 2 3 5 11 North Western Fever Hospital .. .. 1 2 3 University College Hospital 8 15 16 29 68 Eastern Fever Hospital .. .. .. .. .. Children's Hospital, Gt. Ormond Street 14 16 10 18 58 Banstead Asylum 2 3 7 .. 12 Manor Asylum (Epsom) 1 2 .. 3 6 Darenth Asylum .. 1 1 1 3 Hanwell Asylum 5 2 2 6 15 New Hospital for Women (Euston Road) 2 .. .. 1 3 Metropolitan Hospital 3 5 2 2 12 German Hospital 5 2 2 3 12 St. Bartholomew's Hospital 23 18 17 24 82 Royal Chest Hospital 1 2 .. 2 5 King's College Hospital 2 2 3 .. 7 Guy's Hospital 2 1 .. .. 3 Colney Hatch Asylum 12 6 6 5 29 North Eastern Fever Hospital 14 3 8 16 41 Leavesden Asylum 2 2 3 .. 7 St. Thomas's Hospital 1 1 1 1 4 Cane Hill Asylum .. •• 1 2 3 Royal Free Hospital 9 13 14 19 55 London Temperance Hospital 4 5 4 3 16 Cancer Hospital (Chelsea) 1 3 .. .. 4 London County Asylum (Dartford) 3 .. 2 1 6 London Hospital 3 4 4 2 13 St. Anne's House, Stoke Newington .. 1 .. 1 2 Mildmay Hospital 2 1 .. 2 5 Homœpathic Hospital, Gt. Ormond Street 1 1 1 .. 3 Claybury Asylum 3 4 6 6 19 Children's Hospital (Paddington Green) 1 .. 1 2 4 St. George's Hospital .. .. .. 1 1 Hackney Infirmary 1 .. 2 .. 3 St. Pancras Infirmary 5 3 3 2 13 St. Pancras Workhouse .. .. 1 1 2 City of London Lying-in Hospital 1 .. 4 5 11 Marylebone Infirmary .. .. 1 .. 1 Wesminster Hospital .. .. 1 1 2 Hospital of St. John and St. Elizabeth .. .. 1 .. 1 St. Mary's Hospital .. .. 1 .. 1 Tooting Bec Asylum 1 .. 2 4 10 Charing Cross Hospital .. .. .. .. 1 National Hospital, Queen's Square, W,C. .. .. 1 .. 1 Bethnal House Asylum .. .. 1 1 2 St. Luke's House, Pembridge Square, S.W. .. .. 1 5 8 Chest Hospital, Bethnal Green .. .. .. 1 1 Holborn Workhouse, Hoxton 1 .. .. 1 2 Caterham Asylum 3 .. .. 2 5 Hostel of God (Clapham) 1 .. .. .. 1 Shoreditch Infirmary 3 .. 1 2 6 Horton Asylum .. .. 3 2 6 Heart Hospital, Soho Square 1 .. 1 .. 2 St. Peter's Hospital 1 .. .. .. 1 Long Grove Asylum 3 2 1 2 8 Belmont Workhouse 1 .. .. .. 1 19101 102 Table LXIV.—continued. Institutions. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. East London Hospital .. 1 .. .. 1 Queen's Hospital, Bethnal Green 1 2 2 5 10 Lock Hospital .. 1 1 .. 2 Royal Hospital, Waterloo Road .. 1 .. .. 1 Mount Vernon Hospital .. 1 .. 1 2 4 Home Hospital, 16, Fitzroy Square 1 .. 1 .. 2 Hampstead General Hospital 2 .. 1 .. 4 West London Hospital 1 .. .. .. 1 City of London Asylum, Stone 1 .. .. .. 1 Bethlem House .. .. 1 1 2 South Eastern Fever Hospital .. .. .. .. 1 Samaritan Free Hospital 2 .. .. .. .. Royal National Orthopoedic Hospital .. .. 1 .. 1 Home of Good Shepherd, Shoreditch .. .. .. 1 1 Italian Hospital .. .. 2 1 4 Brompton Hospital .. .. .. 1 1 Chelsea Infirmary .. .. .. 1 1 Ravenswood Nursing Home, Highgate Road .. .. .. .. 1 Kidbrook Nursing Home, Shooter's Hill Road .. .. 1 .. 1 St. Joseph's Hospice, Hackney 1 .. .. .. 2 Camberwell Infirmary .. .. .. 1 1 Children's Infirmary, Carshalton .. .. 2 .. .. Bethnal Green Infirmary .. .. .. 1 1 Sick Asylum, Bromley .. .. 1 .. 1 North London Nursing Institution, Stoke Newington .. .. .. 1 1 Poplar Workhouse .. .. 1 .. 1 The Babies' Home, Brunswick Place, Shoreditch .. .. 1 .. 1 Tooting Home .. .. .. 1 1 City of London Workhouse, Hackney 1 .. .. .. 1 Middlesex Asylum 1 .. 1 .. .. Queen Charlotte Hospital .. .. 1 1 3 Medical and Surgical Home, 14, EndsleighGdns., N.W .. .. .. 1 1 163 142 166 210 681 Accidental and other Deaths:— In Chapel Street, Clerkenwell ..1 .. .. .. 1 At 12, Beaumont Street, W. ..1 .. .. .. 1 In River Thames off Stewart's Wharf, Poplar ..1 .. .. .. 1 In Dalston Lane, Hackney ..1 .. .. 1 .. At 8, Alexandra Road, Stoke Newington ..1 .. .. .. 1 At Wentworth Street. Spitalfields .. ..1 .. .. .. .. At Moorgate Street Station 1 .. .. .. .. In cab in Battle Bridge Road, St. Pancras .. 1 .. .. 1 At 57, Beaumont Street, W. .. 1 .. .. 1 At 43, Gerrard Street, Soho, W. .. 1 .. .. 1 In River Lee, near Middlesex Wharf .. 1 .. .. 1 In Regent's Canal, near New North Road Bridge .. 1 1 .. .. At Hamilton's Cooperage Works, 0laf Street, Hammersmith .. 1 .. .. 1 In Northwold Road, Hackney .. .. 1 .. .. At 10, York Grove, Peckham .. .. 1 .. .. At 153. York Road, St. Pancras .. .. 1 .. .. At 14, Henrietta Street, Marylebone .. .. 1 .. 1 At 5, St. Scholasticus Retreat, Lower Clapton .. .. 1 .. 1 At Covent Garden Tube Station .. .. 1 .. 1 At Camberwell Green .. .. .. 1 1 At 6, The Terrace, St. Pancras .. .. .. 1 1 In Aldermanbury, E.C. .. .. .. 1 1 At 7, The Terrace, St. Pancras .. .. .. 1 .. At 50, Oxford Street, Marylebone .. .. .. 1 1 In No. 3 Pond, Parliament Hill Fields .. .. .. 1 .. In Burghley Road, St. Pancras .. .. .. 1 1 At 2r, Guest Street, St. Luke's .. .. .. 1 1 Total Deaths 170 148 173 219 710 103 [1910 Table LXV. Showing the Deaths of Inhabitants and Non-Inhabitants in Public and Charitable Institutions situated within the Borough during the Four Quarters and in the Year 1910. PUBLIC INSTITUTIONS. Inhabitants. Non-Inhabitants Totals. 1st qr. 2nd qr. 3rd qr. 4th qr. Year. 1st qr. 2nd qr. 3rd qr. 4th qr. Year. 1st qr. 2nd qr. 3rd qr. 4th qr. Year, Islington Infirmary 212 194 170 263 839 1 4 3 2 10 213 198 173 265 849 Islington Workhouses and Schools 39 43 22 44 148 1 .. .. 2 3 40 43 22 46 151 Great Northern Central Hospital 27 25 23 22 97 34 16 15 20 85 61 41 38 42 182 Holborn Infirmary 1 .. .. .. 1 114 80 82 121 397 115 80 82 121 398 St. John's Nursing Institute .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tufnell Park Nursing Institute 1 .. 1 .. 2 1 .. .. .. 1 2 .. 1 .. 3 London Fever Hospital .. .. .. 1 1 4 2 .. .. 6 4 2 .. 1 7 Aged Pilgrims' Asylum 2 1 .. 1 4 .. 1 1 4 6 2 2 1 5 10 St. Pelagia's Creche. .. 1 .. l 2 2 1 .. 1 4 2 2 .. 2 6 Memorial Cottage Hospital 3 6 1 4 14 2 1 3 6 12 5 7 4 10 26 Alexandra NursingHome.Turle Road 1 .. 1 • • 2 .. .. 1 .. 1 1 .. 2 .. 3 Aged Blind Home .. .. .. .. .. 1 2 4 2 9 1 2 1 2 9 Medical and Surgical Home .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Invalid Home, Aubert Park 1 .. 1 1 3 2 1 1 1 5 3 1 2 2 8 H.M. Prison, Holloway .. .. 1 .. 1 2 .. l 1 4 2 .. 2 1 5 H.M. Prison, Pentonville .. .. .. 2 2 2 .. .. .. 2 2 .. .. 2 4 Children's Nursing Home .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Kingsdown Orphanage .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whittington College .. .. .. .. .. .. 1 .. 1 2 .. 1 .. 1 2 Metropltn. Benefit Societies' Asylum .. .. .. .. .. .. .. .. 1 1 .. .. .. 1 1 Shoreditch Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Drovers' Almshouses .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Bookbinder's Asylum .. .. .. 2 2 .. .. 1 .. 1 .. .. 1 2 3 Invalid Home, Highbury Terrace .. .. .. .. .. 1 3 l l 6 1 3 1 1 6 Dyers' Almshouses .. .. .. .. .. .. 1 l 2 .. l 1 .. 2 Highbury Nursing Home .. .. .. .. .. .. 2 l 1 4 .. 2 1 1 4 Bricklayer's and Tiler's Almshouses .. .. .. .. .. 1 .. .. .. 1 1 .. .. .. l Clothworkers' Almhouses .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 l St. Andrew's Nursing Home .. .. 1 .. l .. .. .. .. .. .. .. 1 .. l Nursing Home, Hornsey Lane .. .. .. .. .. 1 .. .. .. 1 1 .. .. l Totals 287 270 221 342 1120 169 115 115 164 563 456 385 336 506 1683 1910] 104 INQUESTS AND MORTUARY. During the year 609 bodies were received into the Mortuary, as compared with an average of 660 in the preceding 10 years. This is, with two exceptions, viz., 563 in 1908, and 592 in 1909, the smallest number recorded in these years. The daily average number of bodies received into the mortuary was 1.7 as compared with 1.6 in 1909. In 385 cases inquests were held, as contrasted with an average of 428 in the years 1900-1909. Bodies received into Mortuary Inquests. 1900 754 475 1901 693 431 1902 745 458 1903 681 393 1904 660 424 1905 625 419 1906 642 433 1907 644 441 1908 563 396 1909 592 407 Average 660 428 1910 609 385 The following table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1909 and 1910. 1909. No. of bodies received. Daily Average. No. of Inquests held. 1910. No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 193 2.1 136 1st Quarter 159 1.7 117 2nd „ 128 1.4 82 2nd ,, 142 1.6 81 3rd ,, 120 1.4 78 3rd ,, 126 1.4 84 4th ,, 151 1.6 111 4th ,, 182 2.0 103 Total for Year 592 1.6 407 Total for Year 609 1.7 385 PART III. THE NOTIFICATION, ISOLATION, FATALITY, AND PREVENTION OF INFECTIOUS DISEASES. INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS AND ON BUSINESS PREMISES, TOGETHER WITH THE OCCUPATIONS OF THE PERSONS ATTACKED. 1910] 106 THE NOTIFICATION OF INFECTIOUS DISEASES. Small Pox, Diphtheria, Membranous Croup, Enteric or Typhoid Fever, Typhus Fever, Erysipelas, Continued Fever, Relapsing Fever, and Cholera. These diseases are all notifiable under the provisions of the Public Health (London) Act, 1891. There are, however, other diseases such as Cerebrospinal Meningitis and Pulmonary Tuberculosis, which are notifiable under the Orders of the London County Council and the Local Government Board, to which reference will be found on page 141 of this report. During the year 1,525 cases were notified, or 524 less than in the preceding year, and 700 below the corrected average of the preceding 10 years. The cases represented an attack rate of 4.65 per 1,000 inhabitants of the Borough, which contrasted most favourably with the mean rate of 6.'79 which obtained from 1900 to 1909 inclusive (ten years), as well as with the mean rate 7.85 per 1,000 recorded since notifications became compulsory twenty years ago. The attack rate was not only low, but was actually the lowest hitherto known in Islington. This is an extremely satisfactory record, the value of which is much enhanced by the fact that each disease exhibited a decreased number of cases as compared with the average which prevailed during the preceding ten years, and, indeed, since notification became established. The nearest approach to the attack rate now recorded was that of the year 1903, when it was 5.12 or 0.47 per 1,000 higher than now. How low it was is well seen in the diagram which faces this page, which graphically depicts the rates that prevailed during the last twenty years. It was pointed out last year that the notifiable infectious diseases were gradually decreasing, and the decrease was shown by arranging the numbers in quinquennial periods. It would be well to do this once more. Quinquennia. Notifications. Decrease on Preceding Periods. 1891-1895 16,190 - 1896-1900 14.367 1,823 1901-1905 11,592 3,775 1906-1910 10,201 1,391 107 [1910 These figures show that these diseases are not nearly so prevalent as formerly; while the enormous decrease of 6989 cases is very significant of the good sanitary work, practical and educational, that has been steadily going on during these twenty years. They, too, give all the more satisfaction because when the records of separate diseases are examined, they indicate that each one is decreasing, not only in proportion to population, but in actual numbers. The returns for the several years are set out below::— Years Cases. Attack-rates per 1,000 inhabitants. Years. Cases. Attack rates per 1,000 inhabitants. 1891 2,059 6.43 1901 2,852 8.52 1892 3,318 10.26 1902 3,164 9.29 1893 4,853 14.84 1903 1,707 5.12 1894 3,121 9.44 1904 1,941 5.84 1895 2,839 8.50 1905 1,928 5.81 1896 3,824 11.32 1906 2,275 6.87 1897 2,906 8.62 1907 2,063 6.25 1898 2,418 7.18 1908 2,289 6.82 1899 2,943 8.75 1909 2,049 6.23 1900 2,276 6.78 1891-1909 50,825 8.06 1910 1.525 4.65 Altogether there have been 52,350 cases notified, which represent a mean attack rate during these twenty years (1891-1910) of 7.85 per 1,000 inhabitants of the Borough. It may be that the attack rates which obtained in some other boroughs, even in some of the six Encircling Boroughs, are lower than that of Islington, but it is very doubtful if any of them are really as good when the large percentage of working-class people who reside in it are taken into consideration. It is this fact which makes the returns so eminently satisfactory. Islington is not what it was as a residential district, for while the proportion of the well-todo classes has decreased, apparently for no reason beyond a desire to live in the outer suburbs of London, or even farther afield in the country, the proportion of labourers and artizans has increased. 1910] 108 The number of cases of infectious diseases notified in the Encircling Boroughs during 1910 was as follows:— Cases. St. Pancras 1,212 Stoke Newington 182 Hackney 927 Hornsey 319 Finsbury 522 Shoreditch 532 Encircling Boroughs 3,694 Islington 1,525 Sub-Registration Districts.— It is satisfactory to find that compared with the preceding year each of these districts, with the exception of Upper Holloway, showed a decrease in the number of notifiable infectious diseases reported, and, even there, there was no increase, for the number was identical with that of 1909. The number of cases and the attack rates are set out in the statement given on opposite page. These satisfactory figures are seen to be even better than they appear at first sight when they are compared with the numbers reported during the preceding eight years, for it is found that in Tufnell they were 46 fewer than the average of 209; in Tollington 48 less than the average of 219; in Lower Holloway 129 less than the average of 301; in Highbury 176 less than the average of 375; in Barnsbury 69 less than the average of 364; in Islington South-East 199 less than the average of 478. In Upper Holloway alone was the number of cases above the average, which they exceeded by 21. This was partly due to an outbreak of Diphtheria which occurred at the Workhouse among very young children. The statement (Table in the Appendix) showing the number for each district, it is satisfactory to note that compared with 1902 there is a very large decrease in the number of cases in each district, and even when compared with each of the preceding years the return is in some instances the lowest hitherto known, as for instance in Lower Holloway and Islington 109 [1910 South-East. In Tufnell, Upper Holloway, Tollington and Barnsbury, the returns have been better on only two occasions; while in Lower Holloway, Highbury and Islington South-East they have never been so good, even without allowing for the increase of population. Cases. Attack-rates. Tufnell 160 4.79 Upper Holloway 249 6.75 Tollington 171 5.54 Lower Holloway 172 4.35 Highbury 199 3.20 Barnsbury 295 5.55 Islington South East 279 3.87 Total 1,525 4.65 These figures are very good, and should encourage the Public Health Committee and the Public Health Department in the efforts that they have been making during the last 19 years. Wards —The following is a statement as to the number of cases notified and the attack-rates in the several wards. Cases. Attack Rates. Tufnell 160 4.79 per 1,000 inhabitants. Upper Holloway 249 6.75 „ „ Tollington 171 5.54 ,, ,, Lower Holloway 172 4.35 „ ,, Highbury 96 - M ild may 83 - Populations not available from Census return as yet. Thornhill 199 - ,, ,, Barnsbury 96 - St. Mary 81 - Canonbury 96 - St. Peter 122 - Total 1,525 4.65 1910] 110 In the Quarters.—In the first quarter 339 cases were notified representing an annual attack-rate of 4.13 per 1,000 of the inhabitants. These cases were 145 below the corrected average (484) which obtained in the first quarters of the preceding 10 years. It is to be remarked that the decrease was due to a diminution of the number of cases of Small Pox, Scarlet Fever, Diphtheria, Enteric or Typhoid Fever and Erysipelas notified. In the second quarter 319 cases, equal to an annual attack-rate of 3.89 per 1,000, were notified. They were 157 below the average of 476 which obtained in the second quarters of the preceding 10 years. The decrease was due to the fewer number of cases of Small Pox, Scarlet Fever, Diphtheria, Enteric Fever, Erysipelas, and Puerperal Fever notified. In the third quarter there were 364 cases notified, which represent an annual attack-rate of 4.44 per 1,000 inhabitants. They were 228 below the corrected average (592) which obtained in the third quarter of the preceding 10 years. The decrease was due to the fewer notifications of Small Pox, Scarlet Fever, Diphtheria, Enteric Fever, and Erysipelas. In the fourth quarter 503 cases were notified, which represents an annual attack-rate of 6.13. The cases are 170 below the corrected average (673) of the fourth quarters of the preceding 10 years, and showed a decrease from the following diseases:-Small Pox, Scarlet Fever, Enteric Fever, and Erysipelas. FATALITY FROM THE NOTIFIABLE INFECTIOUS DISEASES. By the term "fatality" is meant the percentage proportion which the deaths bear to the notified cases of these diseases. The number of deaths registered from, as well as the number of notifications of, these diseases were less than in any year since 1891, the year in which the Notification Act was begun to be enforced in Islington, and, therefore constitute a record. They numbered 79, or 5.2 per cent. of the notifications. It will be noticed in the following figures that there has been an almost uniform diminution in the fatality since 1896, 111 [1910 Years Cases. Deaths. Fatality. 1891 2,059 258 12.5 1892 3,318 291 8.7 1893 4.853 383 7.9 1894 3.121 339 10.8 1895 2,839 266 9.3 1896 3,824 390 10.2 1897 2,906 258 8.8 1898 2,418 173 7.1 1899 2,943 238 8.1 1900 2,276 202 8.8 1901 2,852 250 8.7 1902 3,164 268 8.4 1903 1,707 108 6.3 1904 1,941 119 6.1 1905 1,928 107 5.5 1906 2,275 115 5.0 1907 2,063 100 4.8 1908 2,289 126 5.5 1909 2,049 87 4.2 1910 1,525 79 5.2 Total 52,350 4.157 7.9 In the last annual report allusion was made to the largely decreased fatality from these diseases, and it is, therefore, very satisfactory to find that it continues to be low, for although the proportion now recorded is one per cent. more than that of the preceding year, namely, 4.2, yet it is very low, and is 2.7 below the mean fatality of the twenty years 1891-1910. The decrease, as stated, has been almost uniformly steady, as during the five years 1891-95 it was 9.49 per cent.; in the next five years 1896-1900 it had decreased to 8.77 ; in the next period 1901-05 it had further fallen to 7.34, and in the last five years 1906-10 it was 4.97 per cent. This decrease will be better seen when these figures are tabulated in quinquennial periods. Years. Cases Deaths. Fatality. 1891-1895 16,160 1,537 9.49 1896-1900 14,367 1,261 8.77 1901- 1905 11,592 852 7.34 1906-1910 10,201 507 4.97 1891-1910 52,350 4,157 7.94 1910] 112 Now when the fact that the mortality of the borough has so largely decreased, together with the circumstances that pari passu there has been a large diminution of the cases of infectious diseases, are taken into consideration, a most satisfactory state of health affairs is exhibited. Indeed, it is one at which the borough may well rejoice. One cannot prognosticate that such good health will be always enjoyed in the future, but judging by the steadiness, allowing for the usual slight oscillations, with which it has fallen during the last twenty years, it is perhaps not too much to hope that it will not vary much; unless, indeed, the character of the population alters very much for the worse. Hospital Isolation. —Of the 1,525 persons who w ere notified as suffering from these diseases, 1,247 were treated in hospital, of whom 68, or 5.4 per cent, died; while of the 278 patients who remained at home, 11 or 3.9 per cent, succumbed. SMALL POX. One case only was notified. It was the last of the sequence of cases that had their origin in Russia, whence, as described in the Annual Report for 1909, it was conveyed to Islington by a member of an English Theatrical Troupe, who had been performing there. The patient recovered. It is satisfactory to find that the borough remains practically free from Small Pox, as during the last six years only seven genuine cases were known. On several occasions, however, a false alarm was raised, but the cases, on examination, proved to be Chicken Pox. The failure of medical men to recognise the disease is not to be wondered at considering the few opportunities* they now have of seeing it, thanks to vaccination. The last outbreak of any extent occurred in 1902, when 270 cases were notified. Since then only 3?> have been known. Hospital Isolation.- The case was removed to hospital. Fatality.—The case recovered. Since 1891 there have been 694 cases of Small Pox notified, of which 75 died, so that the fatality has been 10.8 per cent. SCARLET FEVER. There have never been so few cases of this disease in the borough, when the increase of population is taken into consideration, as during the year under discussion, when only 730 were notified. The actual lowest 118 [1910 return was registered in 1891, when 728 cases were entered. At that time, however, notification was in its infancy, and there has been only too much reason to suspect that only a percentage of the cases, although a large one, was made known to the Medical Officer of Health. These 730 cases were equal to an attack-rate of 2.22 per 1,000 of the population, as compared with a corrected average of 1,208 cases, and an attackrate of 3.69 per 1,000 in the preceding 10 years. The reduction in the number of cases notified during the last eight years was common to each of the Subregistration Districts in the borough, thus for instance there were 83 cases notified in Tufnell sub-district, as against an average of 120 in the preceding 10 years; 76 in Tollington as against 132; 91 in Lower Holloway as against 170; 114 in Highbury as against 217 ; 117 in Barnsbury as against 199, and 128 in Islington South-East as against 275. In Upper Holloway, however, the number of cases notified was exactly equal to the average. There has undoubtedly been a tendency for the notifications of this disease to decrease, for it is found that in the 10 years, 1891-1900,16,014 cases were notified, while in the succeeding 10 years, 1901-10, there were only 11,893, or a decrease of 4,121. The movement of the disease as shown in quinquennia is as follows:— 1891-1895 8,502 cases. 1901-1906 5,867 cases. 1896-1900 7,512 „ 1906-1910 6,026 „ It will be seen from these figures that during the last quinquennial period the decrease was not maintained. Still, the return for that period contrasts very favourably with those of the two first mentioned periods. It has been pointed out in previous reports that the bacteriology of Scarlet Fever is uncertain, and it is to be regretted that during the year which has just passed no new light has been thrown on the subject. Bacteriologists differ as to the specific germ, and until they are agreed it is unlikely that much advance will be made in the prevention of the disease. It is very difficult at times to trace the source of a case of Scarlet Fever, but there can be very little doubt that it must frequently be conveyed from one person to another, particularly from one child to another while in attendance at school. The aggregation of children is in itself fraught with danger, but when to this is added the embraces and kisses of these little ones, such danger is immensely increased. It is of course well known that the germ of the disease may be conveyed by clothes. It is evidently very tenacious of life, for every Medical Officer of Health is aware that garments that have been put away for months, when again used, have been the means of starting a fresh outbreak. It is generally recognised I 1910] 114 that the virus is contained in the secretions from the nose, mouth, and ears, while the old belief that it was spread by the desquamating skin has latterly been discarded. Milk supplies have of course from time to time been answerable for outbreaks, and in such cases it has been usually found that the contamination was due to persons handling it while suffering from the disease. It has also been traced to cows who themselves are suffering from inflammatory diseases of the udder. There has been a suggestion that the micro-organism of the disease may be dormant in the mucous membrane of the throat, until inflammation has been set up by some cause. Scarlet Fever. Number of cases occurring in one house. No. of cases. 1 case in one house. 2 cases in one house. 3 cases in one house. 4 cases in one house. 6 cases in one house. 6 cases in one house. No. of houses infected in 1910. No. of houses infected. 499 65 12 5 3 - 584 No. of cases occurring in Public Institutions. Cases. Public Institutions Infected Cornwallis Road Workhouse 10 St. John's Road Workhouse 2 "London Fever Hospital 3 Islington Workhouse Schools 15 30 Hospital Isolation.—As many as 690 cases out of a total of 730 known were isolated. In other words 94.5 per cent, were removed from their homes. The Medical Officer of Health cannot refrain from remarking that many of these cases might reasonably have remained at home to be nursed, and tended by their mothers; but apparently the general desire on the part of the parents seems to be to get their patients removed as quickly as possible. Fatality.—Of the 730 notified cases, only 11, or 1.5 per cent. died, which was the lowest fatality rate hitherto recorded in the borough. It is interesting to note that from 1891 to 1900 the fatality rate was 3.3 per cent., and from 1901 to 1910, 2.4. 115 [1910 Table LXVI. Showing Cases, Deaths and Fatality of Scarlet Fever in age periods 0-5 and over 5 years. Fatality means percentage of Deaths to Cases. Ages. 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 Mean. 18931909 1910 0-1 Cases 38 18 15 19 18 15 13 16 13 11 7 13 20 11 6 9 14 15 2 Deaths 4 2 3 2 1 2 - 2 2 — 1 1 — 1 — 3 1 1 - Fatality 10.5 11.1 20.0 10.5 5.6 13.3 - 12.5 15.4 - 14.3 7.7 - 9.1 - 33.3 7.1 6.6 - 1-2 Cases 98 60 56 55 57 51 39 36 43 51 31 47 31 32 38 47 30 47 16 Deaths 14 9 5 5 7 4 1 3 4 7 1 6 5 2 2 5 4 5 1 Fatality 11.3 15.0 9.0 9.1 12.3 7.8 2.6 8.3 9.3 13.7 3.2 12.8 16.1 6.2 5. 3 10.6 13.3 10.6 6.2 2-3 Cases 125 83 98 132 102 79 102 64 75 95 54 62 88 94 61 82 82 87 53 Deaths 14 13 12 12 5 3 7 4 4 6 4 5 6 10 4 3 3 7 1 Fatality 11.2 15.6 12.2 9.1 4.9 3.8 6.9 6.2 5.3 6.3 7.4 8.1 6.8 10.6 6.6 3.7 3.7 8.0 1.9 3-4 Cases 165 110 126 150 155 102 124 78 105 110 71 108 105 137 107 89 102 114 72 Deaths 14 10 11 8 9 7 6 2 5 7 5 6 11 8 4 2 4 7 4 Fatality 8.5 9.1 8.7 5.3 5.8 6.9 4.8 2.6 4.8 6.4 7.0 5.5 1.5 5.8 3.7 2. 2 3.9 6.1 .5.5 4-5 Cases 229 156 178 183 162 137 152 103 104 161 78 106 125 129 128 125 137 141 71 Deaths 10 14 8 6 12 2 5 4 3 8 2 8 6 2 4 4 8 6 1 Fatality 4.4 9.0 4.5 3.3 7.4 1.5 3.3 3.9 2.9 4.7 7.6 7.6 4.8 1.6 3.1 3.2 5.8 4.3 1.4 Total under 5 Years. Cases 655 427 473 539 494 384 430 297 340 428 241 336 369 403 340 352 365 404 214 Deaths 56 48 39 33 34 18 19 is 18 28 13 26 28 23 14 17 20 26 7 Fatality 8.6 11.2 8.2 6.1 6.9 4.5 4.4 5.1 5.3 6.5 5.4 7.7 7.6 5.7 4.1 4.8 5.5 6.4 3.3 Over 5 Years. Cases 2 225 1,066 1,219 1,492 1,083 952 1,064 777 946 944 624 810 829 983 876 1.057 920 1,051 516 Deaths 38 21 27 24 27 8 14 9 12 12 11 9 9 14 10 13 5 16 4 Fatality 1.7 1.9 2.2 1.6 2.5 0.1 1.3 1.2 1.3 1.3 1.8 1.1 1.1 1.4 1.1 1.2 0.5 1.5 0.7 Totals Cases 2,880 1.493 1,692 2,031 1,577 1,336 1,494 1,074 1,286 1,372 865 1,146 1,198 1,386 1,216 1,409 1,285 1,455 730 Deaths 94 69 66 57 61 26 33 24 30 40 24 35 37 37 24 30 25 42 11 Fatality 3.3 4.6 3.9 2.8 3.8 1.9 2.2 2.2 2.3 2.9 2.7 3.0 3.1 2.7 1.9 2.1 1.9 2.9 1.5 1910] 116 Table LXVII. Showing the Sickness from Scarlet Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 22 14 21 26 83 Upper Holloway 23 36 28 34 121 Tollington 18 18 14 26 76 Lower Holloway 31 19 19 22 91 Highbury 34 25 28 27 114 Barnsbury 24 22 31 40 117 Islington, South East 34 35 26 33 128 The Borough 186 169 167 208 730 Table LXVIII. Showing the Attack-Rates of Scarlet Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 2.64 1.68 2.52 3.12 2.49 Upper Holloway 2.50 3.92 3.05 3.70 3.29 Tollington 2.32 2.32 1.81 3.35 2.45 Lower Holloway 3.14 1.92 1.92 2.23 2.30 Highbury 2.19 1.61 1.80 1.74 1.83 Barnsbury 1.81 1.65 2.33 3.01 2.20 Islington, South East 1.89 1.94 1.44 1.83 1.78 The Borough 2.27 2.06 2.04 2.54 2.22 117 [1910 Table LXIX. Showing the Fatality from Scarlet Fever. (Deaths to 100 cases of Sickness) Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. .. .. 3.8 1.2 Upper Holloway .. 28 .. 2.9 1.6 Tollington .. .. .. .. .. Lower Holloway 6.4 .. .. .. 2.2 Highbury 2.9 .. 3 6 .. 1.7 Garnsbury 8.3 .. •• 5.0 3.4 Islington, South East .. .. .. .. .. The Borough 2.7 0.6 0.6 1.9 1.5 DIPHTHERIA. Diphtheria, which includes Membranous Croup, was notified in 471 instances, as compared with a corrected average of 538 in the preceding 10 years, and the cases were equal to an attack-rate of 1.44 per 1,000 of the population, as against a mean rate of 1.64 in the 10 years mentioned. Although the return was below the corrected average, it has been better on five occasions during the last 10 years, viz.:—in 1903, when 455 cases were notified; in 1904, when there were 347; in 1905, when there were 351; in 1906, when there were 439; and in 1909, when there were 430. Since 1891 there has been a tendency for this disease to decrease, for when the twenty years that have elapsed are split up into quinquennial periods, it is found that there were 3,828 cases notified from 1891 to 1895; 3,702 from 1896 to 1900; 2,942 from 1901-1905; and 2,351 from 1906-1910. Such a state of affairs is exceedingly satisfactory with regard to a disease about which a popular American author* wrote as follows:—" Scarcely more than a " decade ago, as the mother sat by the cradle of her first-born, musing over "his future, one moment fearfully reckoning the gauntlet of risks that his tiny life had to run, and the next building rosy air-castles of his happiness " Hutchinson. "Preventable Diseases," p. 222. 1910] 118 '' and success, there was one shadow that ever fell black and sinister across " his tiny horoscope. Certain risks there were which were almost inevitable" initiation ceremonies into life, mild expiations to be paid to the gods of " the modern underworld, the diseases of infancy and childhood. Most of " these could be passed over with little more than a temporary wrinkle to " break her smile. They were so trivial, so comparatively harmless: measles, " a mere reddening of the eyelids and peppering of the throat, with a head" ache and purplish rash, dangerous only if neglected ; chicken pox, a child's-play " at disease; scarlatina, a little more serious, but still with the chances of " twenty to one in favour of recovery; diphtheria, ah! that drove the smile " from her face and the blood from her lips. Not quite so common, not so " inevitable as a prospect, but, as a possibility, full of terror, once its poison " had passed the gates of the body fortress. The fight between the Angel " of Life and the Angel of Death was waged on almost equal terms, with " none daring to say which would be the victor, and none able to lift a hand " with any certainty to aid. " Nor was the doctor in much happier plight. Even when the life at "stake was not one of his own loved ones—though from the deadly contagious" ness of the disease it sadly often was (I have known more doctors made " childless by diphtheria than by any other disease except tuberculosis)— " he faced his cases by the hundred instead of by twos and threes. The " feeling of helplessness, the sense of foreboding, with which we faced every "case was something appalling. Few of us who have been in practice twenty " years or more, or even fifteen, will ever forget the shock of dismay which " ran through us whenever a case to which we had been summoned revealed " itself to be diphtheria. Of course, there was a fighting chance, and we " made the most of it; for in the milder epidemics only ten to twenty " per cent. of the patients died, and even in the severest a third of them " recovered. But what ' turned our liver to water,' as the graphic Oriental " phrase has it, was the knowledge which, like Banquo's ghost, would not down, " that while many cases would recover of themselves, and in many border-line " ones our skill would turn the balance in favour of recovery, yet if the " disease happened to take a certain sadly familiar, virulent form we could " do little more to stay its fatal course than we could stop an avalanche, and " we never knew when a particular epidemic or a particular case would take " that turn. 'Black' diphtheria was as deadly as the Black Death of the " middle ages." 119 [1910 In the Sub-Registration Districts.-49 cases were notified from Tufnell, 94 in Upper Holloway, 63 in Tollington, 32 in Lower Holloway, 48 in Highbury, 109 in Bamsbury, and 7ti in Islington South-East. In Tufnell, Lower Holloway, Highbury, and Islington South-East, the returns were all below the average of the preceding 8 years, while in Upper Holloway, Tollington and Barnsbury they were above it. Hospital Isolation.—Out of 471 notified cases, 438, or 93.0 per cent., were removed to hospital for isolation and treatment, while only 33, or 7.0 per cent., were kept at home. Of the number treated in hospital, 332 were sent to hospitals belonging to the Metropolitan Asylums Board, 311 of which went to the North-Eastern Hospital, 16 to the North-Western Hospital, 2 to the Eastern Hospital, and 3 to the Grove Hospital. Fatality.—Among the 471 cases there were 34 deaths, so that the fatality was 7.2 per cent., which is exactly the proportion experienced in 1909. At the close of the year a report on the distribution of antitoxin serum for the treatment of Diphtheria was presented to the Public Health Committee and afterwards by their orders to the Council, in which, on page 10, will be found a table showing the fatality year by year from this disease in Islington from 1891. From that table it may be gathered that during the years 1891-1893 the fatality was 23.0 per cent.; that during 1894 to 1900 it was 20.9 per cent.; and that from 1901 to the present time it was 10.5 per cent. These figures represent respectively the pre-antitoxin period, the antitoxin period in which antitoxin serum was used largely, and the period in which the same serum was used very largely. When one considers these figures, especially when taken in conjunction with many other facts stated in that report, it cannot be doubted that a new remedy of great potency has been introduced in the treatment of the disease, a treatment which is chiefly due to Behring and Kitasato. Speaking of the value of this remedy, well may the American author already quoted, say:—" The mass of figures from all parts of the world in " support of its value has become so overwhelming that it is neither possible " nor necessary to specify them in detail. The series of Bayeaux, covering " two hundred and thirty thousand cases of diphtheria, chiefly of hospitals, and " hence of the severest type, showing that the death-rate has been reduced " from over fifty-five per cent. to below sixteen per cent. already, and that this " decrease was still continuing, will serve as a fair sample." 1910] 120 Diphtheria. Number of cases occurring in one house. No. of cases. 1 case in one house. 2 cases in one house. 3 cases in one house. 4 cases in one house. 5 cases in one house. 6 cases in one house. No. of houses infected in 1910. No. of houses infected. 354 26 3 4 - - 387 No. of cases occurring in Public Institutions. Cases. Public Institutions Infected St. John's Road Workhouse 23 Islington Infirmary 16 Islington Workhouse Schools 1 40 Table LXX. Showing the Sickness from Diphtheria in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 14 4 13 18 49 Upper Holloway 16 18 21 39 94 Tollington 10 13 16 24 63 Lower Holloway 6 5 9 12 32 Highbury 15 9 19 5 48 Barnsbury 16 11 18 64 109 Islington, South East 16 16 15 29 76 The Borough 93 76 111 191 471 *(Inclusive of Membranous Croup.) 121 [1910 Table LXXI. Showing the Attack-Rates of Diphtheria (inclusive of Membranous Croup) in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 1.68 0.48 1.56 2.16 1.47 Upper Holloway 1.74 1.96 2.28 4.24 2.56 Tollington 1.29 1.68 2.06 3.10 2.03 Lower Holloway 0.61 0.51 0.91 1.22 0.81 Highbury 0.96 0.58 1.22 0.32 0.77 Barnsbury 1.20 0.83 1.35 4.82 2.05 Islington, South East 0.89 0.89 0.83 1.61 1.05 The Borough 1.13 0.93 1.35 2.33 1.44 Table LXXII. Showing the Fatality from Diphtheria, including Membranous Croup. (Deaths to 100 cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. .. 7.7 5.5 4.1 Upper Holloway 12.5 .. 9.5 10.3 8.5 Tollington .. •• .. 8.3 3.2 Lower Holloway .. .. 11.1 8.3 6.2 Highbury 6.6 11.1 5.2 .. 6.2 Barnsbury 31.2 18.2 5.5 3.1 9.2 Islington, South East 6.2 12.5 6.6 10.3 9.2 The Borough 9.6 6.6 6.3 6.8 7.2 1910] 122 Table LXXIII. Showing the Cases and Deaths from Diphtheria and Membranous Croup, together with the Fatality and the Departure from the Mean Fatality during the ten years1900-1909, and 1910. Year. Cases. Deaths. Fatality Diphtheria. Membranous Croup. Total of Diphtheria and Membranous Croup. Diphtheria. Membranous Croup. Total of Diphtheria and Membranous Croup. Deaths to 100 cases of Diphtheria and Membranous Croup. Departure from Average Fatality of 10 years.* 1900 624 9 633 100 6 106 16.7 - 4.9 1901 902 9 911 124 10 134 14.7 - 6.9 1902 871 7 878 101 3 104 11. 8 - 8.8 1903 452 3 455 41 2 43 9.4 - 10.0 1904 347 .. 347 27 1 28 8.1 - 10.3 1905 351 .. 351 33 1 34 9.7 - 7.3 1906 437 2 439 30 2 32 7.3 - 8.6 1907 480 1 481 41 1 42 8.7 - 5.2 1908 522 8 530 59 1 60 11.3 - 1.6 1909 425 5 430 30 1 31 7.2 - 5.2 1900-09 5,411 44 5,455 586 28 614 11.3 - 1910 463 8 471 34 - 34 7.2 - 4.1 *The last column shows the departure from the average fatality of the ten years preceding year indicated. Table LXXIV. Showing the Cases, Deaths and Fatality from Diphtheria at Home and in Hospital. Quarter. Cases Nursed at Home. Cases Nursed at Hospital. Cases 1 Deaths. 2 Percentage Fatality 3 Cases. 4 Deaths. 5 Percentage Fatality. 6 Ist 6 - - 87 9 10.3 2nd 8 1 12.5 68 4 5.9 3rd 6 - - 105 7 6.6 4th 13 - - 178 13 7.3 Year 33 1 3.3 438 33 7.5 Note —In comparing columns 3 and 6 it must not be forgotten that it is only the mildest cases which as a rule are retained at home. The worst cases are invariably hurried to hospital. 123 [1910 Table LXXV. Showing the Fatality from Diphtheria* at each year of life up to 15 years of age, and at each decennial period after that age. Ages. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. The Year. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. 0-1 4 ... ... ... ... ... 1 ... ... 5 1 20 10 1 10 1-2 8 2 25 8 2 25 10 1 10 12 2 l6 38 7 18 2-3 6 1 l6 4 ... ... 16 1 6 19 2 10 45 4 9 3- 4 13 2 15 10 1 10 9 1 11 11 3 27 43 7 16 4-5 9 2 22 10 ... ... 17 1 6 27 1 4 63 4 6 5-6 12 ... ... 13 ... ... 13 2 15 27 ... ... 65 2 3 6- 7 5 1 20 3 ... 33 16 ... ... 21 ... 5 45 3 7 7-8 7 ... ... 2 ... ... 2 ... ... 11 ... 9 22 1 4 8- 9 7 ... ... 3 ... ... 2 1 50 13 ... ... 25 1 5 9-10 6 1 l6 3 ... ... 1 ... ... 4 ... ... 14 1 7 10-11 4 ... ... 4 ... ... 1 ... ... 5 ... ... 14 ... ... 11-12 3 ... ... ... ... ... 4 ... ... 4 ... 25 11 1 9 12-13 1 ... ... 2 ... ... 1 ... ... 4 ... ... 8 ... ... 13-14 2 ... ... 2 ... ... 2 ... ... 3 ... ... 9 ... ... 14-15 ... ... ... 1 ... ... 1 ... ... 4 1 25 6 1 16 15-25 3 ... ... 6 1 16 8 ... ... 10 ... ... 27 1 4 25-35 1 ... ... 5 ... ... 6 ... ... 4 ... ... 16 ... ... 35-45 1 ... ... ... ... ... ... ... ... 4 ... ... 5 ... ... 45-55 1 ... ... ... ... ... 1 ... ... 2 ... ... 4 ... ... 55-65 ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 65 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 93 9 9 76 5 6 111 7 6 191 13 7 471 34 7 * Inclusive of Membranous Croup. 1910] 124 ENTERIC FEVER. The return was the lowest known since the introduction of the notification of infectious diseases. Only 89 cases were reported, as against a corrected average of 157 in the preceding 10 years, and they were equal to an attack rate of 0.27 per 1,000, as against a mean rate of 0.48. How different this return is to those experienced from 1891 to 1900, when they averaged 242 per annum, and even to the first five years of the new century, when they averaged 179. In 1906, 149 cases were notified, but since then there has been a considerable reduction. Thus, for instance, in 1907, 92 cases were known; in 1908 97, in 1905 95, and last year, as already stated, only 89 cases were notified. Clearly the diminution of this disease has gone on pari passu with the improved sanitary conditions of the borough, although it must not be forgotten that those seasonal influences which usually prevail when the disease is rife were more or less absent during the last four years, and consequently we find not only a diminution in the cases of Enteric Fever, but also of diarrhoea and its allied complaints. In the Sub-Districts.—The number of cases notified in the several sub-registration districts are all below the averages of the preceding 8 years. Thus the cases in Tufnell fell from an average of 9 to 7; in Upper Holloway from 14 to 13 ; in Tollington from 12 to 5; in Lower Holloway from 18 to 13; in Highbury from 23 to 9 ; in Barnsbury from 27 to 20, and in Islington South-East from 27 to 16. From these returns it is seen that all parts of the borough enjoyed a diminished number of attacks. Hospital Isolation.—Altogether 65 cases, or 73.0 per cent., were isolated in hospital. While 24, or 27.0 per cent., remained at home for treatment. Fatality.—As 17 deaths occurred among the 89 cases, the fatality was 19.1 per cent. Unlike diphtheria, there is very little change in the fatality from this disease, for an examination of the returns shows that in the five years, 1891-1895, there were 1,088 cases and 187 deaths, and therefore a fatality of 17.1 per cent. From 1896 to 1900 there were 1,334 cases, and 219 deaths, or a fatality rate of 16.4 per cent., from 1901 to 1905 there were 894 cases and 148 deaths, or a fatality rate of 16.5 per cent.; while from 1900 to 1910 there were 522 cases and 79 deaths, with a fatality rate of 15.1 per cent. CHART Showing the rise and fall of Enteric Fever for each week in 1910, and the averages for the corresponding weeks in the ten years 1900—1909. Red Lines Weekly Notifications. Green Lines=Ten Years' Average Table LXXVI. Showing the Cases of Enteric Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. 1 1 5 7 Upper Holloway 3 4 5 1 13 Tollington 1 1 2 1 5 Lower Holloway 1 3 4 5 13 Highbury •• 2 5 2 9 Barnsbury 3 3 12 8 26 Islington, South East 3 2 6 5 16 The Borough 11 16 35 27 89 Table LXXVII. Showing the Attack-Rates of Enteric Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year Tufnell .. 0.12 0.12 0.60 0.21 Upper Holloway 0.33 0.44 0.54 0.11 0.35 Tollington 0.13 0.13 0.26 0.13 0.16 Lower Holloway 0 .10 0. 30 0 .40 0.51 0.33 Highbury .. 0.13 0.32 0.13 0.14 Barnsbury 0. 23 0.23 0.90 0.60 0.49 Islington, South East 0.17 0.11 0.33 0.28 0.22 The Borough 0.13 0.19 0.43 0.33 0.27 125 [1910 1910] 120 Table LXXVIII. Showing the Fatality from Enteric Fever. (Deaths to 1oo cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter Whole Year. Tufnell .. .. 100.0 20.0 28.6 Upper Holloway 33.3 25.0 40.0 100.0 53.9 Tollington .. .. .. .. .. Lower Holloway .. .. 25.0 20.0 15.4 Highbury .. .. 20.0 .. 11.1 Barnsbury 33.3 33.3 .. 12.5 11.5 Islington, South East .. 50.0 .. 20.0 12.5 The Borough 18.2 18.7 14.3 25.9 19.1 TYPHUS FEVER. One case was notified, but it was afterwards discovered that it was not this disease. ERYSIPELAS. 212 cases were notified, as contrasted with a corrected average of 263 during the preceding 10 years, and the resulting attack-rate was 0.65 per 1,000 of the population, as contrasted with a mean rate of 0.80 in the decemium. Hospital Isolation.—Of the 212 cases, 41, or 19.3 per cent., were treated in hospital, while 171, or 80.7 per cent., remained at home. It must not be forgotten that many of these were Erysipelas in name only, so slight was the disease. Fatality.— Only 9 deaths were registered, so that the fatality rate was 4.2 per cent. CHART Showing the rise and fall of Erysipelas for each week in 1910, and averages for the corresponding weeks in the ten years 1900—1909. Red Lines Weekly Notifications. Green Lines=Ten Years' Average. 127 [1910 Table LXXIX. Showing the Sickness from Erysipelas in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 8 6 3 2 19 Upper Holloway 3 4 3 7 17 Tollington 5 3 8 8 24 Lower Holloway 3 9 10 11 33 Highbury 6 8 5 6 25 Barnsbury 4 11 7 16 38 Islington, South East 13 13 10 20 56 The Borough 42 54 46 70 212 Table LXXX. Showing the Attack-Rates of Erysipelas in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 0.96 0.72 0.36 0.24 0.57 Upper Holloway 0.33 0.44 0.33 0.76 0.46 Tollington 0.64 0.39 1.03 1.03 0.77 Lower Holloway 0.30 0.91 1.01 1.11 0.84 Highbury 0.39 0.51 0.32 0.39 0.40 Barnsbury 0.30 0.83 0.53 1.20 0.71 Islington, South East 0.72 0.72 0.55 1.11 0.78 The Borough 0.51 0.66 0.56 0.85 0.65 1910] 128 Table LXXXI. Showing the Fatality from Erysipelas. (Deaths to 100 cases of Sickness). Sub-Districts. 1st Quarter. '2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. .. .. .. .. Upper Holloway .. .. .. .. .. Tollington .. .. .. .. .. Lower Holloway .. 22.2 .. .. 6.0 Highbury .. 12.5 .. .. 4.0 Barnsbury .. 9.0 14.3 12.5 10. 5 Islington, South East .. 7.7 .. 5. 0 35 The Borough .. 9. 2 2. 1 4. 3 4.2 PUERPERAL FEVER. Twenty cases of this disease were notified, or one less than the corrected average of the preceding 10 years. The cases ane, however, six above the return of the preceding year, when the smallest number hitherto known was entered in the records. Hospital Isolation.—Ten out of the 20 cases were nursed in hospital, or 50 per cent. Fatality. — As many as 8 deaths occurred, so that the fatality was 40 per cent. Table LXXXII. Showing the Sickness from Puerperal Fever in the Sub-Districts for each Quarter and for the Year. Sub- Districts. 1st Quarter 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year Tufnell 2 .. .. .. 2 Upper Holloway 1 2 1 .. 4 Tollington .. 1 .. .. 1 Lower Holloway 1 .. 1 1 3 Highbury 1 .. 2 .. 3 Barnsbury .. 1 .. 3 4 Islington, South East 1 .. .. 2 3 The Borough 6 4 4 6 20 129 [1910 Table LXXXIII. Showing the Attack-Rates of Puerperal Fever per 1,000 registered Births in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 1.12 .. .. .. 2.70 Upper Holloway 3.83 7 .75 3. 98 .. 4 .06 Tollington .. 3. 98 .. .. 1. 38 Lower Holloway 3. 74 .. 3 .40 4. 24 2 .86 Highbury 3.09 .. 6 .47 .. 2 .36 Barnsbury . .. 2 .45 .. 7 .96 2. 59 Islington, South East 2.02 | .. .. 4 .25 1 .59 The Borough 2.83 1.92 1.96 3.08 2. 44 Table LXXXIV. Showing the Fatality from Puerperal Fever. Deaths to 1oo cases of Sickness. [##Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 50.0 .. .. .. 50 .0 Upper Holloway 100.0 .. •• .. 25.0 Tollington .. 100. 0 .. .. 100. 0 Lower Holloway .. .. .. .. .. Highbury .. .. 50 .0 .. 33 .3 Barnsbury .. .. .. 66.6 50. 0 Islington South East 100.0 .. .. .. 66 .6 The Borough 50. 0 50.0 25. 0 33. 3 40. 0 CONTINUED FEVER. One case was notified, as against an average of the preceding 10 years of 2. 1910] Table LXXXV. Showing the number of Cases of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1900-1909 and in 1910. diseases. years. Corrected average number of cases. — Increase or Decrease. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1900-1909. 1910 Small Pox 2 50 276 9 17 3† 1 ... ... 3 35 1 —34 Scarlet Fever 1074 1286 1372 865 1146 1198 1386 1216 i409 1285 1208 730 —478 Diphtheria 624 902 871 452 347 351 437 480 552 425 534 463 —71 Membranous Croup 9 9 7 3 ... ... 2 1 8 5 4 8 +4 Enteric Fever 259 281 257 130 126 100 149 92 97 95 157 89 —68 Typhus Fever 1 2 ... ... 1 ... 1 ... ... 1 1 1 — Erysipelas 285 285 357 227 280 252 274 252 235 221 263 212 —51 Puerperal Fever 16 34 19 19 24 24 24 21 17 14 21 20 -1 Continued Fever 6 3 5 2 ... ... 1 1 1 ... 2 1 -1 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... Cholera . ... ... ... ... ... ... ... ... ... ... ... ... Totals 2276 2852 3164 1707 1941 1928 2275 2063 2289 2049 2225 1525 -700 i Case returned after a few days not Small Pox. 130 181 [1910 Table LXXXVI. Showing the Attack-Rates of the several Notifiable Infectious Diseases during the Ten Years 1900-1909 and in 1910. diseases. years. Mean Attack Kates. Attack Rate. Increase or Decrease 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1900-1909 1910. Small Pox o'oo 0.15 0.81 0.03 o.o5 o.o1 O.OO 0.00 O'OO O'O1 O. 11 0.00 — O. 11 Scarlet Fever 3.20 3.84 4 03 2.6o 3.45 3.61 4. 18 3.68 4.20 3.91 3.69 2.22 1.47 Diphtheria 1.86 2.69 2.56 1.36 1.04 1 06 1.32 1.45 1.64 1.29 1.63 1-41 —0.22 Membranous Croup. 0.03 0.03 0.02 001 ... ... oo-o o'OO 0.02 O'O1 O.OI 0 03 4- 0'02 Enteric Fever °.77 0.84 0.75 0.39 0.38 0.30 °.45 0.28 0.29 0 .29 0.48 0 27 —0.21 Typhus Fever o.oo 0 00 ... ... o.oo ... oo.o ... ... O.OO O'OO 0.00 0.00 Erysipelas 0.85 0.85 1.05 o.68 0.84 0.76 0.83 0.76 0.70 0.67 o.8o 0.65 -0.15 Puerperal Fever 173 3.67 2.06 2.11 2.70 2.74 279 2.46 1.96 1.71 2.41 2.44 -0'03 Continued Fever 0'02 o'oi 0 .01 ... • • ... ... ... ... ... O.OO 0.00 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 678 8.52 9.29 5.12 5.84 5.81 6.25 6.25 6.82 6 .23 6.79 4.65 —2.14 * These figures are calculated as per 1,000 Registered Births. k 2 182 TABLE LXXXVII. Showing the number of Cases of Infectious Diseases notified in the Sub-Registration Districts during 1910. Sub-Registration District. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Totals. Attack-Rate per 1,000 of the Population. Tufnell ... 83 48 1 7 ... 19 2 ... ... ... 160 4.8o Upper Holloway- ... 121 92 2 13 ... 17 4 ... ... ... 249 6.78 Tollington - 1 76 62 1 5 ... 24 1 1 ... ... 171 5.52 Lower Holloway - ... 91 31 1 13 ... 33 ... ... ... ... 172 4.36 Highbury ... 114 47 1 9 ... 25 3 ... ... ... 199 3.20 Barnsbury - ... 117 107 2 26 1 38 4 ... ... 295 5.55 Islington South East ... 128 76 ... 16 ... 56 3 ... ... 279 3.87 The Borough 1 730 463 8 89 1 212 20 1 ... ... 1525 4.65 (All Duplicates have been deducted). 1910] TABLE LXXXVIII. Showing the Attack-rates of Infectious Diseases notified in the Sub-Registration Districts during 1910. Sub-Registration Districts. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (T yphoid) Fever Typhus Fever. Erysipelas. Puerperal* Fever. Continued Fever. Relapsing Fever Cholera. Attack-Rate per 1,000 of the Population. Tufnell - ... 2.49 1.44 0.03 0.2I ... o.57 2.70 ... ... ... 4.8O Upper Holloway - ... 3.3° 2.51 0.05 o.35 ... 0.46 4.06 ... ... ... 6.78 Tollington 0.03 2.46 2.00 0.03 o.i6 ... 0.78 1.38 0.03 ... ... 5.52 Lower Holloway - ... 2.31 0.78 0.03 o.33 ... 0.84 2.86 ... ... ... 4.36 Highbury - ... 1.84 0.76 O.O1 0.14 ... 0.40 2.36 ... ... ... 3.20 Barnsbury ... 2 .20 2.01 O.O4 0.49 0.02 0.72 2.59 ... ... ... 5.55 Islington, South East ... 1.78 1.o6 ... 0.22 ... 0.78 1.59 ... ... ... 3.87 The Borough o.oo 2.22 1.41 0.03 0.27 O'OO 0.65 2.44 0.00 ... ... 4.65 188 [1910 134 CD jO TABLE LXXXIX. Showing the number of Cases of Infectious Disease notified in the Wards during the year 1910. (N.B. Duplicate notifications have been deducted). WARDS. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Totals. Cases Notified per 1,000 of Population. I 2 3 4 5 6 7 8 9 10 11 12 13 14 Tufnell ... 83 48 1 7 ... 19 2 ... ... ... 160 4.8o Upper Holloway ... 121 92 2 13 ... 17 4 ... ... ... 249 6.78 Tollington 1 76 62 1 5 ... 24 1 ... ... ... 171 5.52 Lower Holloway ... 91 31 1 13 ... 33 3 ... ... ... 172 4.36 Highbury - ... 53 18 4 ... 19 2 ... ... ... 96 ... Mildmay - ... 49 22 1 5 ... 5 I ... ... ... 83 ... Thornhill - ... 72 87 2 13 ... 22 3 ... ... ... 199 ... Barnsbury - ... 45 20 ... 13 ... 16 1 ... ... ... 96 ... St. Mary's - ... 32 22 ... 4 ... 22 1 ... ... ... 81 ... Canonbury- ... 45 21 ... 8 ... 21 1 ... ... ... 96 ... St. Peter's - ... 63 40 ... 4 ... 14 1 ... ... ... 122 ... Totals - 1 730 463 8 89 1 212 20 I ... ... 1525 4.65 1908 1409 522 8 97 ... 235 17 I ... ... 2289 6.43 1909 - 3 1285 425 5 95 1 221 14 ... •• ... 2049 5.83 * The Census Populations for these Wards not yet published. 185 [1910 Table XC. Showing the Attack-Rates of the Notifiable Infectious Diseases notified in the Wards during the Year 1910. WARDS. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (T yphoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total AttackRates. Tufnell 2.49 1.44 0.03 0.2I ... 0.57 o.o6 .. .. .. 4'8o Upper Holloway .. 3.30 2.51 0.05 0.35 .. O.46 0.11 ... ... ... 678 Tollington - 0.03 2.46 2.00 0.03 o.i6 ... 0.78 0.03 0.03 ... ... 5.52 Lower Holloway ... 2.31 0.78 0.03 o.33 ... 0.84 o.o7 ... ... ... 4.36 Highbury - ... ... ... ... ... ... ... ... ... ... ... ... Mildmay ... ... ... ... ... ... ... ... ... ... ... ... Thornhill ... ... ... ... ... ... ... ... ... ... ... ... * Barnsbury - ... ... ... ... ... ... ... ... ... ... ... ... St. Mary's - ... ... ... ... ... ... ... ... ... ... ... ... Canonbury - ... ... ... ... ... ... ... ... ... ... ... ... tSt. Peter's - ... ... ... ... ... ... ... ... ... ... ... ... otals ... ... ... ... ... ... ... ... ... ... ... ... * Census Populations for these Wards not yet published. 136 1910] Table XCI. Showing the Number of Cases of Infectious Diseases which were investigated by the District Sanitary Inspectors during the Year 1910. Sanitary Inspectors. Number of the Sanitary District. Small Pox. i Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cerebro Spinal Fever. Total. Mr. Cook 1 ... 62 47 1 6 ... 9 2 ... ... ... 127 ,, Bicknell 2 ... 121 91 2 13 ... 17 4 ... ... ... ... ,, Bagshaw - 3 ... 23 28 1 3 ... 8 ... ... ... 63 ,, Bridel 4 ... 64 42 ... 3 ... 23 2 ... ... ... ... ,, Flood 5 ... 51 9 ... 6 ... 23 ... ... ... ... 89 „ Horsman - 6 ... 46 18 ... 3 ... 10 2 ... ... ... 79 „ fortune 7 ... 35 10 ... 4 ... 12 1 ... ... ... 62 MetClaf — 8 ... 41 16 1 5 ... 5 1 ... ... ... 69 „ Irving 9 ... 75 56 1 13 ... 21 1 ... ... ... 167 ,, Watson 10 ... 36 18 ... 4 ... 14 ... ... ... ... 72 „ Jeffery 11 ... 33 27 ... 2 ... 13 2 ... ... ... 77 ,, Agar 12 ... 46 53 2 13 ... 20 3 ... ... ... 138 „ Jordan 13 ... 28 21 ... 5 ... 14 1 ... ... ... 69 ,, Callow M ... 69 27 ... 9 ... 23 1 ... ... ... 129 Totals 1 730 463 8 89 1 212 20 1 ... 1.525 Table XCII. Shozving the Cases of Infectious Disease which were notified, in the several Months during the Year 1910. N.B.—(Duplicate Notifications have been deducted.) Month. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. . Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total each month January 1 49 25 ... 5 ... 18 2 ... ... ... 100 February ... 84 30 ... 2 ... 16 3 ... ... ... 135 March ... 53 34 4 4 ... 8 1 ... ... ... 104 April ... 59 27 ... 4 ... 19 2 ... ... ... 111 May ... 49 21 ... 3 ... 13 ... ... ... ... 86 June 61 28 ... 9 .... 22 2 ... ... ... 122 July ... 55 28 ... 5 ... 7 3 ... ... ... 98 August ... 43 31 ... 7 1 17 1 ... ... ... 100 September ... 69 52 ... 23 ... 22 ... ... ... ... 166 October ... 70 53 2 13 ... 18 4 ... ... ... 160 November ... 66 70 1 10 ... 26 1 ... ... 174 December ... 72 64 1 4 ... 26 2 ... ... ... 169 Total 1 730 463 8 89 1 212 20 1 ... ... 1.525 137 [1910 1910] 138 Table XCIII. Showing the Cases of Infectious Disease notified during the Year 1910 in Islington and in the Encircling Boroughs. The Encircling Boroughs. Estimated Populations, 1910. Small Pox. Scarlet Fever or Scarlatina. Diphtheria (including Membranous Croup. Enteric (Typhoid) Fever Typhus Fever. " Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total Cases. St. Pancras 237,792 ... 681 263 63 ... 191 13 ... ... 1 1,212 Stoke Newington 54.838 ... 85 53 10 ... 31 3 ... ... ... 182 Hackney 239,979 ... 403 190 64 ... 254 16 ... ... ... 927 Hornsey 98,561 ... 173 104 11 ... 30 1 ... ... ... 319 Finsbury 94.578 ... 165 150 30 ... 170 7 ... ... ... 522 Shoreditch 114,387 2 213 131 48 ... 130 8 ... ... ... 532 The Encircling Boroughs 840,135 2 1,720 891 226 ... 806 48 ... ... 1 3.694 Islington 327,985 1 730 471 89 1 212 20 1 ... ... 1,525 189 [1910 Table XCIV. Showing the Attack-Rates per 1,000 inhabitants of the Infectious Diseases notified, during the Year 1910 in Islington and in the Encircling Boroughs. The Encircling Boroughs. Estimated Populations, 1910. Small Pox. Scarlet Fever or Scarlatina. Diptheria (including Membranous) Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever.* Continued Fever. Relapsing Fever. Cholera. Total Attack-Rates. I 2 3 4 5 6 7 8 9 IO II 12 13 St. Pancras 237.792 ... 2.87 1.11 0.27 ... o.81 0.05 ... ... O'OO 5.11 Stoke Newington 54.838 ... 1.55 0.97 0.18 ... 0.57 0.05 ... ... ... 3.32 Hackney 239.979 ... 1.68 0.79 0.27 ... 1o6 0.07 ... ... ... 3.87 Hornsey 98,561 ... 176 1o6 0.11 ... 0.31 0.01 ... ... ... 3.25 Finsbury 94.578 ... 175 159 0.32 ... 1.8o 0.07 ... ... ... 5.53 Shoreditch 114.387 0.02 1.87 1.15 0.42 ... 1.14 0.07 ... ... ... 4.67 The Encircling) Borough 840,135 O'OO 2.05 1.06 0.27 ... 0.96 o.o6 ... ... o.oo 4.4. Islington 327,985 000 2.22 1.44 0.27 o.oo 0.65 0. 07 o.oo ... ... 4.65 Increase or Decrease ... ... +0.17 + 0.38 ... ... —0.31 +0.01 ... ... ... + 0.25 * Per 1,000 of the population. N.B.—The above rates are, with the exception of Islington calculated on the basis of the estimated population of the Registrar-General. Those for Islington on that of the late Census. 140 191Gt] Table XCV. Showing the Cases of Infectious Disease notified in the several Metropolitan Cities and Boroughs during the year 1910. Cities and Boroughs. Estimated population in the middle of 1910. Notified Cases of Infectious Disease. Small Pox Scarlet Fever. Diphtheria.* Typhus Fever. Enteric Fever. Other continued Fevers. Puerperal Fever. Erysipelas. Cerebro-spinal meningitis. Other Noti6able Infectious Diseases. . LONDON 1 872.702 7 10,509 5,494 3 1,284 16 292 3,982 115 8 21,710 West Districts. Paddington 153,004 .. 261 120 .. 40 .. 9 100 7 1 538 Kensington 184,635 .. 263 155 .. 37 3 10 142 2 .. 612 Hammersmith 127,413 .. 341 165 .. 31 2 9 62 2 .. 612 Fulham 181,282 .. 354 257 .. 18 2 20 112 7 .. 770 Chelsea 75,457 .. 120 83 .. 16 .. 3 20 .. .. 242 City of Westminster 167,233 1 248 149 .. 48 .. 6 61 2 .. 515 North Districts. St. Marylebone 125,195 .. 208 127 1 22 .. 4 117 2 .. 481 Hampstead 96.739 .. 144 51 .. 20 .. 2 32 2 2 253 St Pancras 237,792 .. 681 263 .. 63 .. 13 191 10 1 1,222 Islington 353 356 1 731 473 1 89 1 20 213 16 .. 1,545 Stoke Newington 54.838 .. 85 53 .. 10 .. 3 31 1 .. 183 Hackney 239,979 .. 403 190 .. 64 .. 16 254 6 1 934 Central Districts. Holborn 53,142 .. 68 45 .. 25 .. .. 42 1 .. 181 Finsbury 94,578 .. 165 150 .. 30 .. 7 170 4 .. 526 City of London 17,132 .. 21 20 .. 4 .. 1 16 1 .. 63 East Districts. Shoreditch 114,387 2 213 131 .. 48 .. 8 130 5 .. 537 Bethnal Green 131,579 .. 236 182 .. 108 1 13 174 7 1 722 Stepney 3)4,379 .. 554 404 .. 118 .. 29 381 7 .. 1,493 Poplar 172,432 1 470 175 .. 62 .. 15 209 3 1 937 South Districts. Southwark 211,832 .. 419 284 .. 54 .. 16 244 3 1 1,021 Bermondsey 127,238 1 364 210 .. 39 .. 6 130 5 .. 754 Lambeth 327,074 .. 908 327 .. 78 1 19 193 5 .. 1,531 Battersea 188,222 .. 488 227 .. 45 2 16 170 5 .. 953 Wandsworth 305,838 .. 681 286 .. 54 .. 20 182 5 .. 1,228 Camberwell 286,058 .. 511 272 .. 76 2 7 219 2 .. 1,089 Deptford 119,642 .. 301 130 .. 24 2 2 144 1 .. 604 Greenwich 112,935 171 168 .. 20 .. 5 89 1 .. 454 Lewisham 164,8'J9 573 224 .. 29 .. 5 61 2 .. 894 Woolwich 135,422 l 526 172 .. 10 .. 8 90 1 .. 808 Port of London .. .. .. 1 1 .. 3 .. .. 3 .. .. 8 * Including Membranous Croup. N.B.—All the above notified cases are as published by the Registrar General in his Annual Report, 1910 141 |1910 EPIDEMIC CEREBRO-SPINAL MENINGITIS. This disease, also known as "Spotted Fever," and which at times assumes an epidemic form, has been notifiable in London since 1907. Last year 15 cases were reported, or an increase of five on the return of the preceding year, of eight on that of 1908, and four on 1907. Altogether 43 cases have been reported since the disease became notifiable, and of these 21 died. Thus it will be seen that the fatality has been very high, being as much as 48.9 per cent., so that practically in half the cases death ensued. The following statement shows the cases for each year since 1907, and the total deaths from 1907 to 1910:— Total Total Deaths 1907. 1908. 1909. 1910. Cases. 1907-10. 1st quarter - — - 2- 2- 3- 7- 3 2nd 3-2-3-7-15-4 3rd „ 5 - — - 2 - 1 - 8 - 5 4th 3 • 3 3 - 4 " 13 - 9 11 7 10 r5 43 21 NOTIFICATION OF TUBERCULOSIS. This disease is notified in Islington both voluntarily and under the Order issued by the Local Government Board on December 18th, 1908, which makes it compulsory on the Poor Law Officials to notify cases which came under their observation. Particulars of this Order have already been given in a previous report. Under the Public Health (Tuberculosis) Regulations, 1908. -During the year 1,277 notifications were received, as compared with 1,582 in 1909, so that there was a decrease of 305. The notifications, however, refer to only (696 persons, of whom 478 were Islingtonians. The following is a summary of the notifications:— Form A. (From Medical Officers of Poor Law Institutions) 481 Form B. (From the Medical Officer of a District) 238 Form C. (From the Superintending Officer of an Institution) 557 Form D. (From the Relieving Officer of a District) ... 1 1,277 The Fees in respect to the above certificates amounted to £39 7s. 9d. 142 1910] Of the total number of notifications received (1,277) during the year under the Regulations, 424, or 23.4 per cent., were merely notices of transfer of patients from one institution to another. Thus from Holborn Workhouse, Shepherdess Walk, which is situated without the borough, 311 cases were transferred to Holborn Infirmary, which is situated within the borough, while 93cases were transferred from the Islington Workhouse to the Islington Infirmary, both within this borough, and 20 cases were transferred from Cornwallis Road Workhouse to Islington Infirmary. From these figures it will be seen that a large percentage of the notifications were of little utility from a public health point of view. The following are the particulars as to the persons from whom the certificates were received:— Islington Infirmary Medical Officer 270 Islington Workhouse Medical Officer 26 District Medical Officers 239 Islington Relieving Officers 2 Superintending Officers of Institutio 231 (Within the Borough) Superintending Officers of Institutions 330 (Without the Borough) Holborn Union Workhouse Medical Officer 31 Other sources, principally outside Institutions 47 1,277 As remarked last year, many of the certificates received related to the same individual: thus :— 1 individual was notified 20 times. 1 i, it 14„ 1 11 „ 2 individuals were notified 9 „ 2 „ „ 8 „ 3 „ „ 7 „ 10 „ 6„ 10 I, H 5 „ 27 „ „ 4 „ 65 „ „ 3 „ 166 „ „ twice and 402 „ „ once Total certificates received 1277 Total cases 096 Total Islington cases 478 148 [1910 Last year the case of T.M. was given as an illustration of the way in which these tuberculous people move about from place to place, from the Common Lodging House to the Infirmary, and thence back to their old haunts, only in a few weeks to again return to the Infirmary. Since the end of 1909, however, no further notification has been received respecting this man, and it is reasonable to assume that he has either died or left London. T.M. was notified IT times, but during last year another patient, H.P., who in 1909 was only notified on 3 occasions, has become a regular visitor to the Workhouse and Infirmary, so that no less than 20 notifications have been received respecting him. His record for the year is as follows:— Date Notifica- of By whom notified. Circumstances of Notification. tion Fees Notification incurred. ~ mo. April 13 District Medical Officer ... Consultation at Relief Offices 1s. 26 Medical Officer of Isling- Entered Islington Infirmary 1s. ton Infirmary Mav 19 Superintending Officer of ! Transferred from Islington Infirmary to 10, 3d Islington Infirmary Campbell Road 21 Medical Officer of Isling- , Entered Islington Workhouse 1s. ton Workhouse 27 Medical Officer of Isling- Entered Islington Workhouse 6d. ton Workhouse 30 Superintending Officer of Transferred from Islington Workhouse o 3d. Islington Workhouse Infirmary Aug. 8 Medical Officer of Corn- Entered Cornwallis Road Workhouse, Is wallis Road Workhouse 8 Superintending Officer of Transferred to Islington Infirmary ... 3d. Cornwallis Road Workhouse 13 Medical Officer of Isling- Entered Islington Infirmary 6d. ton Infirmary Sept. 20 Superintending Officer of Left Infirmary 3d. Islington Infirmary 21 Medical Officer of Corn- Entered Cornwallis Road Workhouse 6d. wallis Road Workhouse 21 Superintending Officer of Transferred to Islington Infirmary 3d. Cornwallis Road Workhouse ,, 28 Medical Officer of Corn- Entered Cornwallis Road Workhouse 6d. wallis Road Workhouse ,, 28 Superintending Officer of Transferred to Islington Infirmary 3d. Cornwallis Road Workhouse Oct. 8 Medical Officer of Corn- Entered Cornwallis Road Workhouse 6d. wallis Road Workhouse ,, 8 Superintending Officer of Transferred to Islington Infirmary 3d. Cornwallis Road Workhouse ,, 24 Medical Officer of Corn- Entered Cornwallis Road Workhouse 6d. wallis Road Workhouse 24 Superintending Officer ot Transferred to Islington Infirmary 3d. Cornwallis Road Workhouse Nov. 7 Medical Officer of Corn- Entered Cornwallis Road Workhouse 6d. wallis Road Workhouse 7 Superintending Officer of Transferred to Islington Infirmary 3d. Cornwallis Road Work- house | 144 1910] It may he added that up to this date (June 19th, 1911), this man has been notified an additional 15 times, so that altogether 88 notifications have been received respecting him. From this statement it will be seen that a sum of 9s. 9d. has been paid in notification fees during the year in respect of this one patient. Voluntary Notification ot Phthisis.—Only 57 cases were notified voluntarily by members of the medical profession, of which 23 occurred in their private practice as medical practitioners, and 34 in connection with their official position in public institutions, such as the City Road Chest Hospital and the Brompton Hospital. One of the Relieving Officers also notified a case of the disease, which did not come within the Poor Law regulations. The following are the particulars of the cases notified during the year.— Years. Medical Practitioners Relieving Officers. Totals. Private Practice. Public Practice. 1905 68 13 42 123 1906 30 34 62 126 1907 40 28 69 137 1908 27 32 50 109 1909 32 28 4 64 1910 23 34 1 58 Six years 220 169 228 617 Disinfection of Premises —The disinfection of premises after phthisis has greatly increased since the Tuberculosis Order of 1908 came into force, as may be seen in the Table given below. The numbers have increased from '283 houses and 380 rooms in 1905 to 481 houses and 045 rooms in 1910. The method of disinfection is that of spraying formaldehyde solution on the walls, floors and ceilings, while in nearly every case the bedding and other soft goods are removed to the disinfecting chamber. The following are the particulars:— 145 [1910 The figures for the year contrast with those of the preceding five years, as follows:— Houses. Rooms. 1905 283 - 380 1906 258 - 369 1907 296 - 411 1908 281 - 361 1009 514 - 672 19iO --- - 481 645 Prevention of Phthisis.—The question of the prevention of Phthisis is year by year gaining a greater hold on public attention, as the people more clearly understand that although it is an infectious disease, it is also a very preventable one. Indeed, it was no doubt owing to the firm hold that they have taken of this idea that the Chancellor of the Exchequer has been induced to bring in a Bill which will enable the Government to devote a large sum of money for the erection of Sanatoria and other institutions for the cure of this disease, and the instruction of those persons passing through them as to the best methods to be adopted for its prevention when they leave the institutions. The Government evidently grasped the fact that the instruction of the afflicted is of the first importance if the disease is to be prevented. Everything rests with the patients, because as they are careful or careless so will the disease behave. If there is no spitting, no careless use of handkerchiefs or other infected articles, and no similar acts, there will be little or no phthisis. But this action of the Government will not relieve the local authorities of their duties, one of which is undoubtedly that they should appoint Health Visitors to visit the afflicted to instruct them as to what they should do to prevent the spread of the disease, as well as to the best means to adopt for their own comfort and cure. It is not meant by this that they should advise them as to medicines, but as to how they should obtain the greatest amount of sunshine and pure air, as well as cleanliness in their homes. There are many other matters also Houses. Rooms. 1st quarter 134 . 169 2nd „ . 127 - 191 3rd 96 127 4th „ ... 124 - 158 Total 481 - 645 146 1910] about which such visitors will be able to impart instructions to the sufferers. It is to be regretted that in Islington no Health Visitors have been appointed, and that apparently the Council are determined not to appoint them. It will be noticed that one of the duties of the Health Committee which is to be established in each district under the new Insurance Bill is to see that the various Acts relating to public health are enforced, and, if this become law, it is as certain as night succeeds day that many of the defaulting authorities will be compelled to enforce those Acts which are now allowed to remain passive. It must be clear to everyone who will consider the matter with an unbiassed mind that when the notification of any particular disease is made compulsory, such notification must be followed up by some action on the part of the Sanitary Authority; and that it was not, as already pointed out when discussing the notification of biiths. for the purpose of chronicling the fact that certain persons were afflicted, and of entering their names in a register that the Public Health (Tuberculosis) Regulations, 1908, and the Public Health (Tuberculosis in Hospitals) Regulations. 1911, were passed, for this would be merely throwing useless clerical work on the sanitary authorities. The Medical Officer ol Health feels that the strong opinion which now exists throughout the country must have its effect on those sanitary authorities who will not comply with the intentions of the Local Government Board and Parliament. The days of doing nothing are hastening to an end, and the Medical Officer of Health does not regret it. INFECTIOUS DISEASES IN THE PUBLIC ELEMENTARY SCHOOLS. These diseases consist of two classes, those known as the notifiable infectious diseases (Small Pox, Scarlet Fever, Diphtheria, Enteric Fever, Erysipelas, etc.), which are reported in due course by the Sanitary Authority to the head teachers of the schools, and those other diseases which, though infectious, are not notifiable under the Public Health (London) Act, viz.: Measles, Chicken Pox, Whooping Cough, Mumps, etc. During the year the Inspectors on making inquiry found that 579 of the persons attacked were suffering from one or other of the notifiable infectious diseases, which were equal to 38 per cent, of all the cases notified. Of these diseases none were attributable to Small Pox; 369 were credited to Scarlet Fever, as compared with an average of 653 in the preceding 10 years, so that 347 [1910 here was a decrease of 284 on its decennial average. The cases of this disease formed nearly 64 per cent, of the notifiable infectious diseases attacking scholars. Diphtheria was discovered to have attacked 197 children attending school, or 34 per cent, of the total number of scholars stricken with an infectious disease. The cases were 45 below the decennial average, and 87 below the number known in 1909. Enteric Fever attacked 13 scholars, or 25 below the decennial average. These 13 cases represented 2.2 per cent, of the scholars afflicted by this disease. It is very satisfactory to find that all the diseases when contrasted with the decennial average attacked 370 fewer scholars. Table XCVI. Showing the Scholars attacked by the Notifiable Infectious Diseases in the Public Elementary Schools. Year. By Small Pox. By Scarlet Fever. By Diphtheria. By Enteric Fever. By Other Diseases. Total Scholars attacked. Proportion to every 100 cases notified. 1900 1 542 283 67 13 906 39.8 1901 .. 669 438 72 32 1211 42.5 1902 14 664 405 64 34 1181 37.3 1903 .. 507 216 35 16 774 45.3 1904 .. 571 138 28 20 757 39.0 1905 .. 640 138 31 23 832 43.2 1906 .. 785 177 33 3 998 43.9 1907 .. 608 216 11 1 836 40.5 1908 .. 809 230 19 .. 1058 46 .2 1909 737 184 16 1 938 45.8 Ten years' Average 2 653 242 38 14 949 42 .1 1910 369 197 13 579 38 .O Decrease on Average 2 284 45 25 14 370 41.1 148 1910] Table XCVII. Showing the cases of Notifiable Infectious Diseases occurring in Public Elementary Schools during the Year 1910. NAME OF SCHOOL. Scholars attacked. Scholars excluded from School who lived in houses in which infected children resided. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Other Fevers. Total. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Other Fevers. Total. Yerbury Road .. 5 5 .. .. 10 .. 31 25 11 .. 67 St. John's, Holloway Road .. 5 18 .. .. 23 .. 9 32 1 .. 42 St. Joseph's, Highgate Hill .. 1 .. .. .. 1 .. 9 2 .. .. 11 Hargrpve Park .. I3 1 .. .. 14 .. 27 17 2 .. 46 Burghley Road .. 16 l .. .. 17 .. 34 7 .. .. 41 St. Mark's, Grove Road .. 4 7 .. .. 11 .. 20 19 2 .. 41 Cottenham Road .. 9 8 .. .. 17 .. 67 83 1 .. 151 Grafton Road .. 9 1 .. .. 13 .. 17 17 4 .. 38 Duncombe Road .. 18 6 .. .. 25 .. 151 60 14 .. 228 Whittington, Highgate Hill .. 14 2 .. .. 16 .. 46 3 .. 49 Montem Street .. 9 13 .. .. 22 .. 44 23 5 .. 72 St. Barnabas, Hornsey Road .. 3 1 .. .. 4 .. 8 2 .. .. 10 Forster, Hornsey Road .. 2 1 .. .. 3 .. 12 5 .. .. 17 Poole's Park .. 10 4 .. .. 14 .. 23 11 7 .. 44 Hornsey Road (Upper) .. 13 7 1 .. 21 .. 40 28 3 .. 71 Hungerford Road .. 13 .. 2 .. 15 .. 47 7 2 .. 56 Brecknock, York Road .. 4 .. .. .. 4 .. 24 4 3 .. 31 Pakeman Street .. 5 5 .. .. 10 .. 13 3 .. .. 21 St. Janes', George's Road .. 2 1 .. .. 3 .. 10 .. .. .. 10 Catholic School. Eden Grove .. 5 .. .. .. 5 .. 8 2 .. .. 10 Caledonian Road .. 7 9 2 .. 18 .. 34 23 4 .. 61 Westbourne Road .. 13 4 .. .. 17 .. 33 15 7 .. 55 St. Mary Magdalene, Liverpool Road .. 2 .. 1 .. 3 .. 8 1 .. .. 9 Blackstock Road .. 2 3 .. .. 5 .. 8 9 4 .. 21 Gillespie Road .. 7 4 .. .. 11 .. 11 2 1 .. 14 Drayton Park (Wesleyan) .. 7 .. .. .. 7 .. 10 2 1 .. 13 St. John's, Conewood Street .. 6 1 .. .. 7 .. 9 2 4 .. 15 St. Jude's, King Henry's Walk .. 4 2 .. .. 6 .. 14 3 .. .. 17 Newington Green .. 4 2 .. .. 6 .. 12 6 .. .. 18 Ambler Road .. 4 2 .. .. 6 .. 17 9 .. .. 26 York Road .. 6 4 1 .. 11 .. 30 34 8 .. 72 Gifford Street .. 22 5 2 .. 29 .. 97 25 29 .. 151 St. Thomas, Everilda Street .. 1 3 .. .. 4 .. 5 5 .. .. 10 St. Clement's, Cumberland Street .. 4 1 .. .. 5 .. 5 1 .. .. 6 Blundell Street .. 8 .. .. .. 9 .. 30 6 12 .. 48 St. Paul's, Dorset Street .. 5 1 .. .. 6 .. 11 3 .. .. 14 Ecclesbourne Road .. 5 l .. .. 6 .. 16 4 3 .. 23 Tottenham Road.. .. 2 .. .. .. 2 .. 5 7 .. .. 12 Queen's Head Street .. 21 11 .. .. 32 .. 33 13 4 .. 50 Popham Koad (Angler's Gardens) .. 1 2 .. .. 3 .. 4 8 .. .. 12 St. Philip's, Arlington Square .. 1 2 .. .. 3 .. 11 6 .. .. 17 Shepperton Road .. 2 .. .. .. 2 .. 9 2 2 .. 13 Rotherfield Street .. 2 3 .. .. 5 .. 11 15 .. .. 26 St. Bartholomew, Shepperton Road .. .. .. .. .. .. .. .. 5 1 .. 6 Buckingham Street .. 5 28 .. .. 33 .. 20 81 1 .. 102 Winchester Street .. .. 4 .. .. 4 .. 14 23 .. .. 37 All Saints', Muriel Street .. 2 .. .. .. 2 .. 11 4 .. .. 15 Vittoria Place .. 5 6 .. .. 11 .. 34 32 .. .. 66 Holy Trinity, Cloudesley Street .. .. 1 .. .. 1 .. 1 8 4 .. 13 Richard Street .. 4 2 .. .. 6 .. 10 2 2 .. 14 Station Road .. 4 1 .. .. 6 .. 18 6 4 .. 28 Thornhill Road .. 18 2 .. .. 20 .. 35 5 7 48 Barnsbury Park .. 4 1 .. .. 5 .. 8 2 .. .. 10 St Matthew's, City Road .. 3 2 .. .. 5 .. 6 7 .. .. 13 St. John's, Duncan Terrace .. 9 .. .. .. 10 .. 14 .. 1 .. 15 Hanover Street .. 5 2 .. .. 7 .. 23 29 3 .. 55 Canonbury Road .. 12 1 .. .. 13 .. 29 0 3 .. 38 St. Mary's, Cross Street 2 3 .. 5 4 4 1 .. 9 German School, St. Peter Street .. 1 1 Total __ 369 197 13 •. 579 6 1293 766 61 3 2229 149 [1910 NON-NOTIFIABLE INFECTIOUS DISEASES AMONG CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS. As many as 6,077 cases of these diseases were notified, as contrasted with a decennial average of 3,581. This is the largest number hitherto notified in a single year, the nearest approach to it occurring in 1907, when 5,829 cases were notified. The large jump from 4,605 in 1909 to 6,077 in the year under discussion was almost entirely due to the epidemic of measles which was so prevalent during the later months of the year, although a considerable part of the increase was attributable to the prevalence of Chicken Pox. The particulars respecting the number of cases since 1900 are as follows:— Year. Measles. Chicken Pox. Whooping Cough. Other Diseases. Totals. 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 Totals 10 years Average 1910 1,619 2,772 1,214 1.049 355 999 1,935 2,065 1,095 1,667 14.770 1,477 2,194 365 247 482 206 182 637 425 981 624 491 4,640 464 985 434 161 326 277 1,293 732 300 831 385 708 5,447 545 892 648 215 295 766 595 1,011 i,475 !,952 2,255 1,739 10,951 1,095 2,006 3,066 3,395 2,317 2,298 2,425 3,379 4,*35 5,829 4,359 4,605 35,8o8 3,581 6,077 1910] 150 Measles. — These cases numbered 2,194, as contrasted with 1,667 in 1909, and an average of 1,477 during the ten years 1900-1909. With the exception of the year 1901, in which 2,772 notifications were received from the teachers, the number is the largest hitherto recorded. The cases of the disease known in the borough up to the end of May were considerably below the average for that period of the year, but in the first week of June 60 cases occurred and by the end of the third week of that month they had risen to 66. The disease then commenced to show a decrease, so that in the fourth week only 48 cases were notified, while a fortnight later they had fallen to 28; in the succeeding week they numbered 26, and in the third week they numbered only 17. The schools were then closed for the summer vacation, and of course no further notifications were received until the first week after their opening, when 7 cases were reported to the Medical Officer of Health. In the following week, which was the first week of September, 8 cases were notified, and then followed in the several succeeding weeks 16, 30, 43, 50 and 50. After this period the disease became seriously epidemic, because in the first week of October, 107 cases were notified. This was followed by 93, 106 and 103 cases in the remaining weeks in that month. Then there was a sudden rise to 165 in the first week of November, which was followed in the ensuing week by 168 notifications. There was a drop then to 121 cases, only, however, to be succeeded by a rise to 166 cases, to be again followed by 181. This was the highest point of the curve, for the cases fell in the two following weeks to 155 and 141. This brings the history of the disease down to the end of the third week in December, when the schools were closed for the Christmas vacation. The epidemic was, therefore, in full swing when the year 1911 opened, and without entering into minute details, it may be said that a heavy toll was exacted by it until the end of March, at which period it showed signs of abating, but it was not until the middle of June of the current year that anything like the low returns experienced in the first three months of 1910 were reached. A chart of the disease during last year and up to the middle of June, 1911, is attached. Measles 1910-11. Chart showing course of Epidemic Week by Week as determined by the Notifications received from the Teachers of the Public Elementary Schools in the Borough. 151 [1910 Statement showing number of Children excluded from various Schools on account of Measles in their Homes. Name of School. Dept. 1st Qr. 2nd Qr 3rd Qr 4th Qr. Total in Dept. Total for School. Ambler Road I. ... 3 ... 8 11 13 B. ... ... ... 2 2 All Saints I ... 6 1 18 25 26 Mxd. ... 1 ... ... 1 Angler's Gdns., Popham Road ... I. ... 6 10 26 42 45 B. ... 1 ... 2 3 Barnsbury Park I ... ... ... 33 33 40 Mxd. ... ... ... 7 7 Blackstock Road I. ... ... ... 55 55 60 G. ... ... ... 5 5 Blundell Street I. 2 51 3 11 67 84 B. 1 ... ... ... 1 G. ... 8 4 4 16 Buckingham Street I. ... 20 26 46 92 96 G. ... ... 4 ... 4 Burghley Road T 5 1 1 7 8 B. ... ... ... 1 1 Caledonian Road I. ... 6 9 34 49 49 Canonbury Road I. ... ... 7 7 14 14 Cloudesley Street I. ... 4 4 5 13 18 B. ... ... ... 1 1 G. ... 2 ... 1 3 P.D. ... ... ... 1 l Cottenham Road I. 1 ... 1 15 17 17 Drayton Park I. ... ... 9 9 9 Duncombe Road I. ... 1 ... 24 25 32 J. B. ... 1 5 6 S.M. ... ... 1 l Ecclesbourne Road I. 2 6 1 23 32 36 B. ... ... ... 2 2 G. 1 1 ... ... 2 Eden Grove I. ... ... ... 3 3 7 G. ... ... ... 4 4 Forster I. ... 1 32 25 58 67 B. ... ... ... 9 9 Gifford Street I. ... 26 11 50 87 97 B. ... ... 5 ... 5 G. ... ... ... 5 5 1910] 152 Name of School. Dept. 1st Qr 2nd Qr. 3rd Qr. 4th Qr. Total in Dept. Total for School. Gillespie Road I. ... ... ... 10 10 11 G. ... 1 ... ... 1 Grafton Road I. ... 4 ... 10 14 20 G. ... ... ... 6 6 Hanover Street I. ... 20 3 11 34 34 Hargrave Park I. ... ... 7 11 18 20 G. ... ... 1 1 2 Harvist Road I. ... 5 ... ... 5 6 G. ... 1 ... ... l Hungerford Road I. 1 ... ... 8 9 18 B. ... ... ... 6 6 G. ... 3 ... ... 3 Montera Street I. 1 ... 1 16 18 19 G. ... ... ... 1 1 Newington Green I. ... 5 2 7 14 20 G ... 1 1 4 6 Pakeman Street I. ... 1 3 30 34 34 Poole's Park I. ... ... ... 34 34 40 B. ... ... ... 4 4 G. ... ... ... 2 2 Queen's Head Street I. ... 3 8 17 28 30 G. ... ... ... 2 2 Richard Street I. 3 12 1 22 38 38 Rotherfield Street I. ... 3 ... 28 31 31 St. Clement's Street I. ... ... 1 8 9 9 St. James' 1. ... 1 4 11 16 16 St. John's, Pembenon Road I ... ... ... 5 5 5 ,, Cone wood Street I. ... ... ... 4 4 4 ,, Duncan Place I ... ... ... 1 1 1 St. Mark's I. ... ... ... 2 2 2 St. Mary's, Fowler Road I. ... 1 ... 4 5 5 St. Mary Magdalene I. 1 3 7 24 35 39 G. ... ... ... 4 4 St. Matthew's I. 5 ... ... ... 5 5 St. Philip's I. ... ... ... 3 3 3 Shelburne Road I. ... ... 2 4 6 6 153 [1910 Name of School. Dept. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total in Dppt. Total for School. Shepperton Road I. ... 7 1 15 23 24 G ... ... 1 ... 1 St. Thomas' I. ... 1 ... 7 8 9 G. ... ... ... 1 l Station Road I 1 4 5 20 30 40 G. ... ... 5 5 10 Thornhill Road I. ... ... ... 3 3 3 Upper Hornsey Road I. ... ... 6 28 34 40 B. ... ... 1 1 G. ... ... 2 3 5 Vittoria Place I. 1 18 3 4 26 26 Westbourne Road I. 7 32 14 39 92 98 B. ... 2 ... 4 6 Whittington I. ... 4 ... 15 19 19 Winchester Street I 1 6 ... ... 7 7 Yerbury Road I. ... ... ... 98 98 100 B. ... ... ... 2 2 York Road I. ... 35 2 33 70 G. ... ... ... 1 1 71 33 317 200 1.021 1,571 1,571 SUMMARY. Department 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. Infants 31 296 175 925 1,427 Boys 1 3 7 38 49 Girls 1 17 18 49 85 Mixed 1 •• 9 10 33 317 200 1,021 1,571 1910] 164 The history of the disease during the year, as contained in reports presented by the Medical Officer of Health to the Public Health Committee, is narrated below— On November Tth, the Medical Officer of Health reported as follows:— " You will possibly have noticed that since the resumption of the meetings of your Committee after the vacation I have reported an increasing number of cases of Measles on each successive occasion ; and I have now again to report that during the last fortnight 258 cases have been notified by the teachers of the Public Elementary Schools, compared with 199 in the preceding fourteen days. " Measles is a disease which is always more or less prevalent in the Borough, having its greatest incidence, as judged by the deaths, in the first and second quarters of the year, and its least in the third and fourth. " This year up to the middle of May, the average number of cases notified by the teachers did not exceed 4 per week. They, however, then commenced to increase, so that in the third and fourth weeks of that month 1 received 11 and 43 notifications respectively. "In the following week, which was the first week in June, the number was (JO, in its second week 47, and in its third 70. In its fourth week, the 25th week of the year, the number fell to 38, being followed by 41 in the 26th week. In the first three weeks of the third quarter the number of cases fell to 28, 26 and 17, respectively, which brought the period up to the summer holidays. The schools were then closed until the last week in August, and during this period I heard of no cases. On the week after their opening, however, 7 cases were notified, which was followed from week to week up to the present time by 4, 16, 30, 43, 50, 106, 93, 106, 103 and 155, which brings us to the week ending November 5th. " It is perhaps unfortunate that no particulars as to the number of cases that occurred in former years are available by which to judge the extent of the present outbreak, but this may possibly be measured by contrasting the number of deaths that were registered in the corresponding periods of preceding years. On examining these figures I find that from 1891 to 1900 the number of deaths which occurred in the period extending from the 34th to the end of the 44th weeks, that is to say, the period from the annual holidays up to the 44th week of the year, averaged 12, and in the nine years 155 [1910 11)01 to 1909, 11, whereas during the present epidemic in the same period the number has been 32, or 2.75 times more. It must not, however, be imagined from this that severe outbreaks have not been known previously, for in the third quarter of 1907, 44 deaths were recorded, as against 21 in the third quarter of the present year. The feature, however, that I do not like in the present epidemic is that the deaths at the beginning of the fourth quarter are much more numerous than usual, although here again I find that in previous years they have also been numerous, namely in 1891 and in 1900, when they were respectively 12 and 19, as against 22 in the current quarter. "It is interesting to follow the course of the disease during the present year. In the first quarter I find that it was practically confined to Richard Street Schools, at which 25 cases were known Then in the second quarter Buckingham Street Schools in the King's Cross District became infected, and there 48 cases were known. The infection then spread to Blundell Street Schools, from whch 41 cases were notified, and to Gifford Street, whence there were 35. Thence it passed along to Vittoria Place Schools, from which 25 cases were notified, and to York Road Schools, from which 35 were reported. About the same time further East at Hanover Street Schools 29 cases occurred. "It will be seen that its progress up to this time has been gradually northwards from King's Cross. In the third quarter, still going northwards, it passed to Hargrave Park, from which 17 cases were notified. Thence it seems to have gone to Yerbury Road Schools, from which I find that fully 60 cases have bee; notified. "The East of the Borough up to the present time seems to have escaped, although in the fourth or current quarter the South-East corner around Queen's Head Street and Popham Road appears to have suffered; and,indeed,atPopham Road School, 17 cases were known in the third quarter, and 41 in the current quarter to date. "There is no doubt, however, that the disease is spreading towards the East, for at Drayton Park Schools I find that in the current quarter 23 cases have occurred, and at St John's Schools, Conewood Street, 18. "When one has to deal with figures like these, and with a disease like Measles, it seems almost impossible to discover measures which would effectively stop the epidemic. 1910] 156 "In former years it has been the practice to close the infants' department as soon as this infection made its appearance ; but this practice has not been found to be altogether efficient, for the children, instead of mixing at school, mixed with each other in the streets, in the parks, and in the playgrounds, and thus, although in a much lesser degree, spread the infection. "About 12 months ago the Local Government Board and the Board of Education conferred together and issued a memorandum to the Medical Officers of Health and School Medical Officers on the prevention of the spread of infectious disease among the children attending public elementary schools, and made the following recommendations for the exclusion of individuals suffering from Measles:— ' Children attacked by measles should be kept from school for four weeks. ' In large towns, and in the smaller districts where the majority of ' children over seven years of age who are attending public elementary schools ' have had measles, the practice is frequently adopted, when measles breaks out ' in a household, of excluding from school attendance only those children of ' the same household who attend the infant school, and those older children ' of the same household who have not had measles. These particular children ' of the same household should be excluded from school until 21 days from the ' date of the onset of the illness of the last patient with measles m the ' house. ' The above procedure can be recommended as the result of experience ' in large districts. It is a compromise which is obviously not a counsel of ' perfection, and may need future modification.' "In that Memorandum they point out that school closure has probably more frequently taken place on account of an epidemic of measles than for any other disease, but that as the closure has been commonly deferred until a large proportion of the children are already absent, it has proved useless in populous districts—at least for preventing the spread of the disease. "I quite agree with this statement, because about the yeax 1885 an epidemic of this disease occurred in Sunderland which was so severe that for a considerable time the weekly death-rate ran very high, and finally reached a figure equal to 47 per 1,000 per annum. Such a death-rate, I need hardly say, not only alarmed the people of the Borough, but excited very considerable interest at the Local Government Board, whom I kept acquainted from day to day with the progress of the epidemic. The schools were closed and everything was done that forethought could suggest, but nothing seemed to be of avail, and it ran 157 [1910 its course. About this time the Borough of Jarrow and Tyne Dock applied for and obtained from Parliament power to make the notification of measles compulsory. Notwithstanding this law, however, and although the earlier cases were isolated in hospital, the disease, when it made its appearance at these places, was as unmanageable as before notification ; and, indeed, it was impossible to deal with the notifications when they arrived. It was thought that if the first cases could be got at and isolated, the measles would not spread, but the hope was delusive, as its infectivity starts almost as soon as the patient has been infected, and before it has been recognised. It is this feature of the disease which makes it so difficult to deal with, and also makes Medical Officers of Health and particularly Medical Officers of Schools so loth to close their schools or even classrooms. "In the present epidemic the Medical Officer of the London County Council (Education) and myself are keeping the closest watch on the schools, and the joint recommendatons of the Local Government Board and the Board of Education are being carried out. "Apart from closing the schools, I do not know what else can be done, and with my experience of this disease I would not recommend such a course. The results are problematic, the inconvenience certain, for closure would not merely throw out of gear all school work, but it would also cause very great inconvenience, if not loss of money to the parents of the children attending school, especially of those in the infant classes, for they would in many instances be compelled to give up their employment to look after the children at home, although I hold strongly that these very young children should not be sent to school. "There is one matter, however, which needs improvement, namely, the earlier notification to the Medical Officer of Health of the cases occurring among scholars. The delay is not always, I believe, due to any neglect on the part of the Head Teachers, but of the Attendance Officers, who I believe do not report them early enough. At one time teachers used to send scholars to inquire the cause of the absence of other scholars, but this practice has rightly been put a stop to. The teachers have now to depend solely on the information supplied to them by the Attendance Officers, who, owing to the large number of absentees, and as well as to other matters which require their attention, are not able to report as quickly as is necessary when dealing with Measles. I am afraid, judging by the batch of notifications I often receive at one time from the teachers, that the Attendance Officers do not report the cases each day as they come across them, but wait until they have a number and then report all of them at one time.* * The Medical Officer of Health understands that at this time they were reported only once a week. 1910] 158 "This delay is fatal, for with an early notification, the children who have not been protected by a previous attack, and who have been in contact with the patients, continue to attend school, in course of time form a second crop, and in turn infect others in contact with them, to form a third crop, so that finally nearly all the non-protected children become infected. If then the earlier notification by the Attendance Officers could be obtained, non-protected children could be excluded sooner, and the disease probably checked." On November '21st the Medical Officer of Health again reported as follows:— "In continuance of my observations at the last meeting on the epidemic of Measles in the Borough, I have now to inform the Committee that during the last two weeks there have been respectively 168 and 121 cases notified by the teachers, as compared with 155 and 103 in the preceding two weeks. There were, therefore, 289 cases reported during the fortnight. The cases of the disease in the successive weeks were 103, 155, 168 and 121 ; consequently it is seen that there is at the present time a tendency to a diminution of the cases. "During the fortnight I have had an interview here with Dr. Hogarth, one of the Medical Officers of the Education Department of the London County Council, and the result of that interview was that he expressed himself, on the part of his medical department, as most anxious to act in every way with this Council. "I pointed out to him one or two matters about which I thought an improvement might be effected, and these were agreed to. "During the last 14 days cases of the disease have been notified from the following schools:— Yerbury Road - 32 Hargrave Park 4 Burghley Road 1 Duncombe Road 3 Grafton Road - 8 Forster Road - 1 Whittington - 11 Upper Hornsey Road 8 Pooles Park 17 St. James, Georges Road - 2 Pakeman Street 24 Caledonian Road 5 Catholic Schools, Eden Westbourne Road 15 Grove - 3 Blackstock Road 14 St. Mary Magdalene 4 St. John's, Conewood Street 10 159 [1910 Gillespie Road 15 Ambler Road - 1 Newington Green - 4 Gifford Street - 17 York Road 3 St. Clement's, Cumberland St. Thomas, Everilda St. - 7 Street - 7 Blundell Street 1 Ecclesbourne Road - 4 Popham Road - 2 St. Philip's, Arlington Sq.- 12 Rotherfield Street - 8 Vittoria Place • 1 All Saints, Muriel Street - 7 St. John's, Duncan Terrace 17 Station Road - - - 7 Canonbury Road 8 On December 19th, 1911, the Medical Officer of Health again reported to the Public Health Committee as follows:— "I have to report that the disease, so far as can be judged by the notifications, shows a tendency to fall, as during the last two weeks the teachers of the public elementary schools have reported 155 and 141 cases, making a total of 290 cases, as compared with 346 in the preceding fortnight. The number of schools affected was 33, and the number of cases at each school was as follows:— Yerbury Road - 11 Hargrave Park - 8 St. Mark, Grove Road 5 Cottenham Road 13 Duncombe Road 17 Whittington ... 9 Montem Street 25 Upper Hornsey Road 26 Hungerford Road 8 Pakeman Street 2 St. James', Georges Road 2 Eden Grove, Catholic 3 Caledonian Road 2 Westbourne Road 9 St. Mary Magdalene 2 Blackstock Road 49 Gillespie Road - 6 Drayton Park ... 13 Ambler Road - 6 Gifford Street ... 10 St. Thomas 2 Blundell Street 4 Ecclesbourne Road - 31 Popham Road - 1 Shepperton Road 2 Rotherfield Street 4 All Saints 1 Vittoria Place - 1 Holy Trinity - 3 Richard Street - 6 Station Road - 10 Hanover Street - 1 Canonbury Road 9 160 19101 "The following is a summary of the action taken by the Public Healtl Department with respect to these cases:— Number of schools where disinfection has been carried out 1 Comprising (No. of classrooms so disinfected) 2 Number of schools where exclusion has been adopted ... 19 Comprising (No. of classrooms) 44 Schools where closure has been adopted 1 (partial) Comprising (No. of classrooms) 2 " The number of deaths registered from Measles in the fortnight ending December 10th, which is the last date for which the full return is available, has been 27. This is a decrease of 7 on the number registered in the preceding fortnight, but an increase of 26 on the corresponding period for 1909. " I do not expect that there will be any great decrease in the mortality from the disease until after the beginning of the new year. The Medical Officer of Health reported to his Public Health Committee on January 23rd, 1911, and thus brought the history of the disease to the end of the year:— " The epidemic of measles, I regret to report, still continues. It has now lasted for practically 35 weeks, the first death being registered in the 6th week of the second quarter of last year, from which date, at first gradually, and then more quickly, it increased iin virulence, so that while in the second quarter there were only 8 deaths, in the third there were 21, and in the fourth 136. I might also mention as a remarkable fact that in the first quarter there was only 1 death, which is the best record of the borough since 1891. Now the death return for the first quarter was 52 below the average of 20 years, of the second 48, of the third 22, while that of the fourth quarter was 94 above it. From these figures it will be seen that the mortality during the last quarter of the year was exceptionally heavy. Greater mortality has, however, been experienced in a single quarter, for in the second quarter of 1887 there were 213 deaths registered, in the first quarter of 1896, 170, and in the first quarter of 1898, 183. In this last mentioned case the mortality was preceded in the fourth quarter of 1897 with a return of 72 deaths, and succeeded by one of 183 deaths in the 2nd quarter of 1898. 161 [1910 "I imagine that the present epidemic has now reached its turning point, for an examination of the mortality returns show a fall, which, if not quite steady, have a downward tendency. "Let us follow the course of the epidemic week by week as shown by the deaths, beginning with the sixth week of the second quarter:—They were respectively—1, 1, 1, 2, 0, 1, 0, 2, 1, 5, 1, 1, 0, 1, 2, 1, 2, 3, 1, 3, 1, 2, 6, 7, 6, 10, 12, 22, 15, 12, 16, 18, 9, 8, 11 and last week 8. Now, the fatality from Measles is uncertain, because of the impossibility of obtaining accurate information as to the number of cases. It has, however, been shown by Dr. Theodore Thomson of the Local Government Board that the fatality rate among children under 5 years of 85 per 1,000 of the attacked, and between 5 and 10 years 11 per 1,000 of the attacked. A calculation based on these figures makes it probable that there have bepn 1,776 children under 5 years attacked in the present epidemic, and 1,272 between 5 and 10 years, or a total of 3,048 cases. "During this period there have been 2,400 cases notified by the London County Council School Teachers, so that there is a difference of 648 between the calculated number of cases, and those known among children attending schools. "Since the schools were opened after the Christmas holidays, I have to report that scholars have been excluded from 11 schools and from 18 classrooms for measles. This was due to the fact that 21 infants, 5 girls, and 1 boy who were attacked with measles are found to have been in attendance since vacation. "I may say that never before has such attention been given to measles in Islington as there has been during the present epidemic, and it would be unfair for me not to give much credit of this to the painstaking manner in which Mr. Wheble, the Clerk who keeps the records of this disease, has analysed the cases as they were notified." Chicken Pox.—985 cases of Chicken Pox were notified, as contrasted with an average of 491 in the ten years 1900-1909. The largest number of cases came from Blundell Street Schools, where there were 66, from Canonbury Road 92, Ecclesbourne Road 82, Pooles Park 70, and from Upper Hornsey Road 60. A full statement of the several schools attacked is given in Table XCVIII. M 1910] 162 Whooping Cough.— This disease also showed an increase, for there were 892 cases notified, as contrasted with 708 in the preceding year, and an average of 545 in the ten preceding years. Other Diseases.—These diseases include Mumps and various skin diseases of an infectious character, and were responsible for 2,006 notifications, as contrasted with 1,739 in the preceding year, and with a decennial average of 1,095. A study of the last column of the succeeding Table will show that since 1904 there has been a considerable increase in the number of other diseases notified by the school teachers, and of course there has been a corresponding increase in the amount of work devolving on the Sanitary Inspectors, for each case must be inquired into, however briefly. Such a large increase in the work must necessarily derange the general work of the Public Health Department, and, indeed, it is not too much to say that this derangement would have been very serious indeed had not the sanitary staff put their backs into the work and endeavoured to do their utmost to meet the difficulties of the position. There is no question that owing to the notification of births and tuberculosis, together with the largely increased notification of the non-notifiable infectious diseases by the school teachers, a position has arisen which can only be met by the appointment of trained women to do work which at present devolves on the Sanitary Inspectors, and which would be more satisfactorily performed by females. 168 [1910 Table XCVIII. Showing the Infectious Diseases notified during the year 1910 by the Teachers of Public Elementary Schools under the provisions of Regulation 148, sec. iv., of the London County Council Schools Code. School. Measles. Chicken Pox. Whooping Cough. Other Diseases. Totals. All Saints' 34 1 2 2 39 Ambler Road 10 5 13 14 42 Burghley Road 19 8 6 7 40 Blackstock Road 88 24 5 12 129 Barnsbury Park 38 2 .. 8 48 Blundell Street 54 66 89 112 321 Brecknock, York Road.. 1 3 .. .. 4 Buckingham Street 118 44 9 53 224 Cottenham Road 24 13 33 23 93 Canonbury Road 36 61 23 149 269 Catholic School, Eden Grove 11 2 .. 13 26 Caledonian Road 61 4 12 51 128 Chapel of Ease 58 13 25 31 127 Duncombe Road 47 92 45 106 290 Drayton Park .. 38 7 15 43 103 Ecclesbourne Road 62 82 22 57 223 Forster, Hornsey Road.. 40 9 5 37 91 Grafton Road 48 57 19 15 139 Gillespie Road 41 20 33 25 119 Gifford Street 122 25 20 183 350 Hargrave Park 48 18 17 24 107 Hungerford Road 20 6 7 21 54 Holy Trinity 30 5 .. 7 42 Hanover Street 39 13 3 30 85 Montem Street 46 43 25 58 172 Newington Green 11 15 3 45 74 Poole's Park .. . 60 70 29 69 228 Pakeman Street 44 4 11 56 115 Popham Road 80 .. 13 17 110 Queen's Head Street 49 10 12 64 135 Risinghill Street 1 .. 1 .. 2 Rotherfield Street 39 17 22 56 134 Richard Street 48 14 40 36 138 Shepperton Road 36 4 16 36 92 Station Road .. .. 50 19 12 27 108 St. J ohn's, Holloway Road .. 13 35 17 65 St. Joseph's .. .. 1 1 St. Mark's, Grove Road 5 .. .. 7 12 St. Paul's, Blenheim Road .. .. .. .. .. Shelburne Road 15 16 24 27 82 St. Ann's .. .. .. .. .. St. James' 22 5 4 17 48 St. John's, Conewood Street ,, ,, .. 29 1 23 14 67 St. Jude's.. 3 8 10 21 St. Thomas' 15 7 23 18 63 St. Clement's 33 .. 20 3 56 St. Paul's, Dorset Street 2 .. .. 4 6 St. Bartholomew's .. .. .. .. .. St. Philip's 28 7 16 88 139 St. Matthew's, Rotherfield Street 3 4 .. 1 8 St. Matthew's, City Road 21 11 1 6 39 St. John's, Duncan Terrace 25 .. .. 9 34 St. Mary's 23 .. .. 7 30 Tottenham Road 17 2 7 25 51 Thornhill Road 4 3 .. 13 20 U pper Hornsey Road .. 54 60 29 41 184 11 j Vittoria Place ,, .. 34 12 13 21 80 Whittington 50 5 14 14 83 Westbourne Road 80 24 41 109 254 Winchester Street 8 3 . . 1 12 Yerbury Road 130 27 39 51 247 York Road 45 6 8 15 74 Total 2,194 985 892 2,006 6,077 m 2 1910] 164 ISOLATION OF INFECTIOUS DISEASES. As many as 1,247 cases out of the 1,525 that were notified under the Public Health (London) Act, 1891 were isolated in Hospital, representing 8r8 per cent, of all the notified cases. This percentage is the largest which has been recorded in Islington, with one exception, viz., 83.2 in 1909, as may be judged by the following figures :— 1896 1897 1898 1899 1900 1901 1902 1903 48.4 per cent. 557 58.4 64.6 „ 68.2 „ 69.6 7.9 72.6 „ 1904 1905 1906 1907 1908 1909 1910 75.5 Per cen*76.1 77.1 8o.o „ 80.4 „ 83.2 81.6 The Metopolitan Asylums Board, as usual, isolated the largest number of these cases, and out of 1,247 persons removed from their homes, 1,120 were taken to their hospitals. Scarlet Fever.—690 cases out of 730, or 94-5 per cent., were isolated and treated in hospitals, and of these, 556, or 8o"6 per cent., were removed to one or other of the hospitals of the Metropolitan Asylums Board. Diphtheria.—438 cases, or 93 per cent, of the 471 cases notified, were isolated in hospital, and of these, 332 were treated in the Metropolitan Asylums Board's Hospitals. Only 33, or 7 per cent., remained at home. Enteric Fever.—Of the 89 cases that were notified, 65, or 73 per cent, were removed to hospital, while 24, or 27 per cent., remained at home. Erysipelas.—212 cases were known, of which 41, or 19.3 per cent., were treated in hospitals. Nearly all these occurred in the institutions in which they were treated. Puerperal Fever.—10 cases out of 20 that occurred, or 50 per cent., were treated in hospital, while an equal number was treated at home, [1910 165 Table XCIX. Summary of Infectious Sickness and of the Deaths arising therefrom, distinguishing the Cases treated at Home and in Hospitals; and showing the percentages of notified Cases removed to Hospitals, together with the Fatality among cases treated at Home and in Hospitals during the year 1910. Notified Cases Treated. Percentages of Notified Cases Treated. Deaths Occurring. Percentages of Deaths Occurring. In Hospital. At Home. Total. In Hospital. At Home. In Hospital. At Home. Total. In Hospital. At Home. Total. Small Pox 1 .. 1 100.0 .. .. .. .. .. .. Scarlet Fever 690 40 730 94.5 5.5 11 .. 11 1.6 .. 1.5 Diphtheria 438 33 471 93.0 7.0 33 1 34 7.5 3.0 7.2 Enteric (Typhoid Fever) |65 24 89 73. 0 27.0 10 7 17 15.4 29.1 19.1 Typhus Fever.. 1 •• 1 100.0 .. .. .. .. .. .. .. Erysipelas 41 171 212 19.3 80.7 8 1 9 19.5 0.6 4.2 Puerperal Fever 10 10 20 50.0 50.0 6 2 8 60.0 20.0 40.0 Continued Fever 1 .. 1 1000 .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. Total.. 1,247 278 1,525 81.8 18.2 68 11 79 5.4 3. 9 5 .2 1910] 166 Table C. Showing the Cases of Infectious Disease removed to the Metropolitan Asylums Board's Hospitals for treatment and isolation during 1910 Metropolitan Asylums Board's Hospitals. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Diseases. Total Admissions. Deaths. Eastern .. .. 2 .. .. 13 15 .. North Eastern .. 547 311 18 .. 180 1,056 42 North Western .. 7 16 7 1 12 43 3 Western .. .. .. .. .. .. • • .. South Western .. • • .. .. .. .. .. .. The Grove .. 1 3 .. .. .. 4 .. Brook Hospital .. .. .. .. .. .. .. •• South Eastern .. 1 .. .. .. .. 1 .. Convalescent Hospital .. .. .. .. .. .. .. .. Small Pox 1 .. •• .. .. .. 1 .. Totals 1 556 332 25 1 205 1.120 45 OCCUPATION OF PERSONS ATTACKED WITH INFECTIOUS DISEASES. It has been the rule of the Public Health Department for very many years when making an investigation into the cause of a case of an infectious disease, to ascertain the nature of any employment that was being carried on in the house, if it be a business premises as well as a dwelling house, or by an outworker if it be a dwelling house only. As a consequence much good has been effected, and businesses, which could only be continued with much risk to the public, e.g., dairies, have been stopped until all danger had passed away; while outworkers have been prevented continuing their work, and if necessary, the goods which they have been making were disinfected. Mrs. Young in her interesting report mentions seventeen such cases, which occurred during the year, and specifies two of special importance. One has only to look through the Table CI. to see how important it is to make enquiries into the occupation of persons attacked with an infectious disease, and to understand how necessary it is that their employers should be informed of the fact so that any articles they have received from their employees might be disinfected, if necessary. 167 [1910 Table CI. Showing the Occupations of Patients suffering from the several notifiable Infectious Diseases during the year 1910. Occupations. Small Pox. J Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Cerebro-Spinal Fever. Total. Apprentice ... 1 ... ... ... ... ... ... ... ... 1 Artist ... 1 ... ... ... ... ... ... ... ... 1 Artificial Flower Maker ... ... 1 ... ... ... ... ... ... ... 1 Barmaid ... ... ... ... 2 ... ... ... ... ... 2 Blouse Maker ... ... ... ... ... ... ... ... ... ... 2 Burnisher ... 1 ... ... ... ... ... ... ... ... 1 Butcher ... 1 ... ... ... ... ... ... ...... ... 2 Box Maker ... 1 1 ... ... ... ... ... ... 2 Boxer ... 1 ... ... ... ... ... ... ... ... 1 Butler ... ... 1 ... ... ... ... ... ... ... 1 Baker ... ... 1 ... 1 ... 2 ... ... ... 4 Builder ... ... ... ... ... ... 1 ... ... ... 1 Bookbinder ... ... 1 ... ... ... 2 ... ...... ... 3 Bootmaker ... ... ... ... ... ... 2 ... ... ... 2 Billiard Marker ... 1 ... ... ... ... ... ... ... ... 1 Clerk ... 9 3 ... 3 ... ... ... ... ... 21 Carpenter ... ... ... ... ... ... ... ... ... ... 1 Charwoman ... 2 1 ... 1 ... ... ... ... ... 11 Compositor ... 1 ... ... 1 ... 1 ... ... ... 3 Canvasser ... ... ... ... ... ... 1 ... ... ... 1 Cabinet Maker ... ... ... ... ... ... 1 ... ... ... 1 Carpet Maker ... 1 ... ... ... ... ... ... ... ... 1 Chair Maker ... 1 ... ... ... ... ... ... ... ... 1 Cinematograph Operator ... ... ... ... ... ... 1 ... ... ... 1 Coach Painter ... ... ... ... ... ... 1 ... ... ... 1 Cellarman ... 1 ... ... ... ... ... ... ... ... 1 Cutter ... ... 1 ... ... ... ... ... ... ... ... 1 Coachman ... ... ... ... ... ... 1 ... ... ... i Commission Agent ... 1 ... ... ... ... ... ... ... ... i Cook ... ... 1 ... 2 ... ... ... ... ... 3 Carman ... 1 1 ... ... ... 1 ... ... ... 3 Commercial Traveller ... ... 1 ... 1 ... ... ... ... ... 4 Cab Driver ... ... ... ... ... ... 1 ... ... ... i Camera Maker ... ... ... ... 1 ... ... ... ... ... i Chorus Singer ... ... ... ... ... ... 1 ... ... ... i Chauffeur ... ... ... ... ... ... ... ... ... ... i Chaff Cutter ... ... ... ... ... ... ... ... ... ... 1 Civil Servant ... ... ... ... ... ... 1 ... ... ... i Drapers' Assistant ... 2 ... ... ... ... ... ... ... ... ... Drayman ... ... ••• ... 1 ... ... ... ... ... 1 Dispenser ... ... ... ... 1 ... ... ... ... ... i 1910] 168 Table CI.—continued. Occupations. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Cerebro-Spinal Fever. Total. Dustman ... ... ... ... ... ... 1 ... ... ... 1 Decorator ... ... ... ... ... ... 1 ... ... ... 1 Dressmaker ... 4 1 ... ... ... ... ... ... ... 5 Electric Lamp Maker ... ... ... ... ... ... 1 ... ... ... 1 Engineer ... ... 1 ... 2 ... 4 ... ... ... 7 Factory Hand. ... 1 ... ... ... ... ... ... ... ... 1 Fish Salesman ... ... ... ... ... ... 3 ... ... ... 3 Feather Curler ... 1 ... ... ... ... ... ... ... ... 1 Furrier ... 1 ... ... ... ... ... ... ... ... 1 Grocer ... 1 ... ... 1 ... ... ... ... ... 3 Gardener ... 1 ... ... ... ... ... ... ... ... 1 Goldbeater ... 1 ... ... ... ... ... ... ... ... 1 Housekeeper ... ... 1 ... ... ... 1 ... ... ... 2 Horsekeeper ... ... ... ... ... ... 2 ... ... ... 2 Housewife ... 7 5 ... 10 ... 25 20 ... ... 67 Insurance Agent ... ... ... ... ... ... 1 ... ... ... 1 Jeweller ... ... ... ... ... ... 2 ... ... ... 2 Laundress ... 1 ... ... 1 ... 1 ... ... ... 3 Lead Glazier ... ... ... ... ... ... 1 ... ... ... 1 Law Writer ... ... ... ... ... ... 1 ... ... ... 1 Labourer ... 2 ... ... 3 ... 2 ... ... ... 7 Motor Apprentice ... 1 ... ... ... ... ... ... ... ... 1 Mantle Maker ... 1 ... ... ... ... ... ... ... ... 1 Mother's Help ... ... 1 ... ... ... ... ... ... ... 1 Machinist ... 1 ... ... 3 ... ... ... ... ... 4 Merchant ... ... ... ... ... ... 1 ... ... ... 1 Nurse ... 4 3 ... 1 ... 1 ... ... ... 9 Needlewoman ... 1 ... ... ... ... 2 ... ... ... 3 Office Boy ... 1 ... ... ... ... ... ... ... ... 1 Optician ... ... ... ... ... ... 1 ... ... ... 1 Pawnbroker ... ... ... ... ... ... 3 ... ... ... 3 Plasterer ... ... ... ... ... ... 1 ... ... ... 1 Pianoforte Key Maker ... ... ... ... ... ... 1 ... ... ... 1 Porter • • • ... ... ... 2 ... 5 ... ... ... 7 Postman ... ... ... ... 1 ... ... ... ... ... 1 Packer ... ... 1 ... 2 ... 2 ... ... ... 5 Printer ... ... ... ... 1 ... ... ... ... ... 1 Pianoforte Tuner ... 1 ... ... ... ... ... ... ... ... 1 Pastrycook ... 1 ... ... ... ... ... ... ... ... 1 Programme Seller ... 1 ... ... ... ... ... ... ... ... 1 Photographer ... 1 ... ... ... ... ... ... ... ... 1 Painter ... ... 1 ... 1 ... 4 ... ... ... 6 Policeman ... ... 1 ... ... ... 2 ... ... ... 3 Pointsman ... ... ... ... 1 ... ... ... ... ... 1 Railway Servant ... ... ... ... ... ... 3 ... ... ... 3 Scholar ... 430 213 ... ... ... 17 ... ... ... 675 169 [1910 Table CI.— continued. Occupations. Small Pox. Scarlet Fever. Diphtheria. | Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Cerebro-Spinal Fever. Total. Storekeeper ... 1 ... ... ... ... ... ... ... ... 1 Servant ... 2 3 ... 2 ... ... ... ... ... 11 Shop Assistant ... ... 1 ... 2 ... ... ... ... ... 5 Solicitor ... ... ... ... 1 ... ... ... ... ... 1 Scientific Instrument Maker ... ... ... ... ... ... 1 ... ... ... 1 Tobacconist ... 1 ... ... ... ... ... ... ... ... 1 Typist ... 1 ... ... ... ... ... ... ... ... 1 Telephone Operator ... ... ... ... ... ... ... ... ... ... 1 Teacher ... ... ... ... 1 ... ... ... ... ... 1 Toy Painter ... ... 2 ... ... ... ... ... ... ... 2 Tram Conductor ... ... ... ... 1 ... ... ... ... ... 1 Tailor ... ... ... ... 2 ... ... ... ... ... 2 Time Keeper ... ... ... ... 1 ... ... ... ... ... 1 Veneer Cutter ... ... ... ... ... ... ... ... ... ... 1 Van Guard ... ... ... ... ... ... ... ... ... ... 2 Warehouseman ... 2 ... ... ... ... ... ... ... ... 4 Waiter ... 1 ... ... 1 ... ... ... ... ... 2 Waitress ... ... ... ... ... ... ... ... ... ... 2 Wire Worker ... 1 ... ... ... ... ... ... ... ... 1 Wardrobe Dealer ... ... ... ... ... ... 1 ... ... ... 1 Total ... 500 249 ... 69 ... 141 20 ... ... 979 170 1910-J Table CII. List of Trades and Businesses carried on in Houses wherein Infectious Diseases have occurred during 1910. trades and BUSINESSES. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Memb. Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Artificial Florist ... 3 ... ... ... ... ... 3 Baker ... 1 2 ... ... ... ... 3 Bootmaker ... 3 1 ... 2 ... ... 6 Boarding House ... i ... ... 1 ... ... 3 Builders ... 4 2 ... 1 ... ... 7 Brass Founders ... ... ... ... 1 ... ... i Butchers ... 1 ... ... ... ... ... ... ... 1 Bookseller ... ... ... ... ... ... 1 ... ... 1 Brushmaking ... ... 1 ... ... ... ... ... ... 1 Blind Maker ... 2 ... ... ... ... ... ... ... 2 Common Lodging House ... 1 1 ... ... ... 2 ... ... 4 Card Box Maker ... ... 1 ... ... ... ... ... ... 1 Chimney Sweep ... ... 1 ... ... ... ... ... ... 1 Cornchandler ... 2 ... ... ... ... ... ... ... 2 Cabinet Making ... ... 1 ... ... ... ... ... ... 1 Coffee House ... 2 ... ... ... ... ... ... ... 2 Confectioner ... 4 4 ... ... ... ... ... ... 8 Cycle Repairing ... 2 1 ... ... ... ... ... ... 3 Coal Merchant ... ... ... ... ... ... 1 ... ... 1 Dentist ... ... 1 ... ... ... ... ... ... 1 Dairy ... 3 ... ... ... ... ... ... ... 3 Dressmaking ... 4 4 ... ... ... 3 ... ... 11 Drapers ... 1 4 ... ... ... ... ... ... 5 Electric Shade Making ... ... 1 ... ... ... ... ... ... 1 Embroidery ... ... 1 ... ... ... ... ... ... 1 Feather Trade ... 2 ... ... ... ... ... ... ... 2 Furriers ... 2 1 ... ... ... ... ... ... 3 Furniture Dealer ... ... 1 ... ... ... ... ... ... i Fishmongers ... ... ... ... ... ... 1 ... ... 1 Fried Fish Shop ... 1 ... ... ... ... ... ... ... 1 Fancy Shop ... ... 2 ... ... ... ... ... ... 2 Furniture Remover ... 1 ... ... ... ... ... ... ... I General Dealer ... 6 3 ... ... ... 2 ... ... 11 Grocers ... 2 1 ... 1 ... ... ... ... 4 Greengrocer ... 2 5 ... ... ... 1 ... ... 8 Glass Works ... ... 1 ... ... ... ... ... ... 1 Hairdresser ... 3 2 ... ... ... ... ... ... 5 Ironmongers ... 1 ... ... ... ... 1 ... ... 2 Laundry ... 2 ... ... ... ... 1 ... ... 3 Lady's Outfitter ... ... 1 ... ... ... ... ... ... i Letter Cutting ... ... ... ... ... ... ... ... ... i Mangling ... 1 ... ... ... ... 1 ... ... 2 Milk Shop ... ... 1 ... ... ... 1 ... ... 2 Millinery ... 1 ... ... ... ... ... ... ... 1 Marine Store Dealer ... ... 2 ... ... ... ... ... ... 2 171 [1910 Table CII.—continued. trades and businesses. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Memb.;Croup. Enteric (Typhoid Fever). 1 Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total.  Mantle Maker ... 2 ... ... ... ... 1 ... ... 3 Motor Garage ... 1 ... ... ... ... ... ... ... 1 Money Lender ... ... ... ... 1 ... ... ... ... 1 Nursing Home ... 1 ... ... ... ... 1 ... ... 2 Orphauage ... 1 ... ... ... ... ... ... ... 1 Public House ... 4 ... ... 1 ... 2 ... ... 7 Plumbing ... 1 ... ... ... ... ... ... ... 1 Paper Shop ... 2 ... ... ... ... ... ... ... 2 Photographer ... 1 1 ... ... ... ... ... ... 2 Picture Shop ... ... 1 ... ... ... ... ... ... 1 Paper Bag Making ... ... 1 ... 1 ... ... ... ... 1 Perfumery ... ... ... ... ... ... 1 ... ... 1 Restaurant ... 1 ... ... ... ... ... ... ... 1 School ... ... ... ... 1 ... ... ... ... 1 Stable ... ... ... ... 1 ... 1 ... ... 2 Sign Writer ... 1 1 ... ... ... ... ... ... 2 Shoemaker ... 1 ... ... ... ... ... ... ... 1 Surgery ... ... 1 ... ... ... ... ... ... 1 Stationer ... ... 1 ... ... ... ... ... ... 1 Surgical Instrument Maker ... 1 ... ... ... ... ... ... ... 1 Tutor ... 1 ... ... ... ... ... ... ... 1 Timber Merchant ... 1 ... ... ... ... ... ... ... 1 Tailor ... 1 1 ... ... ... ... ... ... 2 Tin Worker ... ... 1 ... ... ... ... ... ... 1 Tie Making ... ... ... ... ... ... 1 ... ... 1 Undertaker ... 1 ... ... 1 ... ... ... ... 2 Upholstery ... 1 ... ... ... ... ... ... ... 1 Wardrobe Dealer ... 2 1 ... ... ...; ... ... ... 3 Totals ... 82 55 ... 8 ... 27 ... ... 172 ...STREETS AND PUBLIC INSTITUTIONS IN WHICH INFECTIOUS DISEASES OCCURRED. The following Table shows the streets in which the notifiable infectious diseases occurred during the year. It is remarkable to again find that such streets as Campbell Road and Queensland Road, the two worst streets, judged by the character of their inhabitants, in Islington were comparatively free from serious infectious diseases. Thus in Campbell Road there were only 2 cases of Diphtheria and 1 case of Scarlet Fever, while there was no case of Enteric Fever, or Typhus Fever, although there 1910] 172 were 4 cases of Erysipelas. In Queensland Road there was only 1 case of Scarlet Fever, 1 of Diphthenia, and 1 of Erysipelas. In both roads all the cases occurred in separate houses, which is hardly what one would expect in such crowded and low class streets, and speaks volumes for the speed with which the patients were isolated. In George's Road, another crowded street, there were only 4 cases of infectious disease, 2 of Scarlet Fever, and 2 of Diphtheria, and here again the cases occurred in separate houses. It will be noticed that 15 cases of Scarlet Fever and 1 case of Diphtheria were reported from the Islington Workhouse Schools, which, without doubt, were introduced from without. These schools have been unfortunate with respect to Scarlet Fever, which has on several occasions attacked the children. This disease, once it gains access to suitable soil, that is to say children who never had the disease, speedily spreads. It does not always follow that there must be insanitary conditions to have infectious disease. The Board of Guardians might remember this when they attack the Public Health administration of Islington, for their attacks have been as undeserved as would be an attack by the Medical Officer of Health on the cleanliness and general conduct of their schools, which are most excellent. It will be noticed, too, that there were 23 cases of Diphtheria among the young children in the St. John's Workhouse. Dr. James, as soon as he perceived that an outbreak was probable, consulted the Medical Officer of Health, with the result that swabs were obtained from the throats of all the children in the affected ward, and examined bacteriologically, so that it was possible to isolate every child in whose throat the bacillus diphtheria was found. Thus the outbreak was stayed. 178 [1910 Table CIII. Showing the Streets in which the several cases of Infectious Disease occurred during 1910. The large figure denotes the number of cases and the small figure the number of infected houses. name of street. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever Erysipelas Puerperal Fever. Continued Fever. Totals Allen Street ... ... 11 ... ... ... 11 ... ... 22 Arundel House, Halton Road ... ... ... ... ... ... 11 ... ... 11 Avenell Road ... 11 ... ... ... ... ... ... ... 11 Astey's Row ... 11 ... ... ... ... 11 ... ... 22 Andover Road ... 4s 55 ... ... ... 22 ... 11 1211 Anatola Road ... ... ... ... ... ... ... 11 ... 11 Ashbrook Road ... 43 22 ... ... ... ... ... ... 65 Alwyne Villas, Canonbury ... 11 ... ... ... ... ... ... ... 11 Archibald Road ... 11 ... ... ... ... ... ... ... 11 Arthur Road ... 11 11 ... ... ... ... ... ... 22 Arundel Square ... 42 ... ... ... ... ... ... ... 42 Albany Cottages, Popham Street ... ... 11 ... 11 ... ... ... ... 22 Andover Gardens, Andover Road ... ... 11 ... ... ... ... ... ... 11 Alexander Road ... 11 11 ... ... ... 22 ... ... 44 All Saints Street ... 11 21 ... ... ... ... ... ... 32 Athelstane Road ... 41 11 ... 11 ... ... ... ... 63 Aberdeen Road ... 2a ... ... 11 ... ... ... ... 33 Aubert Park ... i1 11 ... ... ... ... ... ... 22 Arlington Street ... 22 11 ... ... ... ... ... ... 33 Alsen Road ... 11 ... ... ... ... ... ... 11 Anchor Dwellings, Brewery Road ... ... 11 ... ... ... ... ... ... 11 Arvon Road ... 11 ... ... ... ... ... ... ... 11 Almington Street ... 11 11 ... 11 ... ... ... ... 32 Alma Grove ... ... ... ... ... ... 11 ... ... 11 Ambler Road ... 11 21 ... ... ... ... ... ... 32 Archway Road ... 11 11 ... ... ... 11 ... ... 33 Alfred Street ... 21 ... ... ... ... ... ... ... 21 Andover Street ... 11 ... ... ... ... ... ... ... 11 Ashburton Grove ... ... ... ... ... ... 11 ... ... 11 Albert Street ... ... ... ... 11 ... ... ... ... 11 Anuesley Road ... ... 11 ... ... ... ... ... ... 11 Arundel Mews, Arundel Square ... ... ... ... ... ... 11 ... ... 11 Ashby Road ... ... ... ... 11 ... ... ... ... 11 Albion Grove ... ... 11 ... ... ... ... ... ... 11 Albion Street ... ... ... ... 11 ... ... ... ... 11 1910] 174 Table CIII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. . Puerperal Fever. Continued Fever. Totals. Anson Road ... 11 ... ... ... ... ... ... ... 11 Arlington Square ... ... 11 ... ... ... ... ... ... 11 Barbara Street ... 21 33 ... ... ... 11 ... ... 65 Bardolph Road ... 2a ... ... ... ... 11 ... ... 33 Beversbrook Road ... 32 ... ... ... ... 11 ... ... 43 Barnsbury Road ... 55 22 ... ... ... 44 ... ... 1110 Bride Street ... 11 11 ... ... ... ... 11 ... 33 Bruce Buildings, Caledonian Road ... 21 ... ... ... ... ... ... ... 24 Baxter Road ... ... 11 ... ... ... 22 ... ... 33 Bickerton Road ... 11 11 ... ... ... ... ... ... 22 Blackstock Road ... 5s ... ... 11 ... ... ... ... 64 Birnam Road ... 21 3s ... ... ... ... ... ... 54 Brunswick Road ... 22 ... ... ... ... 22 ... ... 44 Belper Street ... 11 ... ... ... ... ... ... ... 11 Baring Street ... 11 21 ... ... ... ... ... ... 3a Beresford Road ... 32 ... ... ... ... ... ... ... 33 Bemerton Street ... 65 97 ... 11 ... ... ... ... 1610 Brecknock Road ... 22 11 ... ... ... ... ... ... 33 Benwell Road ... 11 22 ... 11 ... ... ... ... 44 Bracey Street ... 62 22 ... ... ... ... ... ... 9s Beaconsfield Buildings, YorkRoad. ... 119 22 11 ... ... 33 ... ... 1614 Baalbec Road ... ... 11 ... ... ... ... ... ... 11 Bryant wood Road ... 2a ... ... ... ... ... ... ... 22 Bismarck Road ... 62 ... ... ... ... ... ... ... 62 Blundell Street ... ... ... ... 22 ... 2a ... ... 44 Bryan Place ... 11 11 ... ... ... ... ... ... 22 Brewery Road ... 21 ... ... 32 ... 44 ... ... 02 Burns Buildings, Caledonian Road ... 11 ... ... ... ... ... ... ... 11 Barnsbury Street ... 32 ... ... ... ... 11 ... ... 4s Brookside Road ... ... 21 ... ... ... ... ... ... 21 Beale's Mews, Warlters Road ... ... ... ... ... ... 11 ... ... 11 Blenheim Road ... 42 ... ... ... ... ... ... ... 42 Balls Pond Road ... ... 22 ... ... ... ... ... ... 22 Bryan Street ... 11 2s ... ... ... ... ... ... 33 Boleyn Road ... 11 ... ... ... ... ... ... ... 11 Belitha Villas ... 22 ... ... ... ... ... ... ... 22 Balmoral Grove ... 11 ... ... ... ... 11 ... ... 2a Brunswick Street ... 11 11 ... ... ... ... 11 ... 32 Brooksby Street ... ... ... ... 11 ... ... ... ... 11 Barnsbury Grove ... 11 ... ... ... ... ... ... ... 11 Barnsbury Park ... 11 ... ... ... ... 11 ... ... 22 175 [1910 Table CIII—continued. Name of street. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. Buckingham Street ... ... 11 ... 11 ... ... ... ... 22 Barnsbury Square ... ... ... ... ... ... 11 ... ... 11 Bedford Terrace, Durham Road ... 21 ... ... ... ... ... ... ... 21 Beacon Hill ... 11 ... ... ... ... ... ... ... 11 Britannia Row ... 11 11 ... ... ... ... ... ... 21 Bingfield Street ... ... 11 ... ... ... ... 1i ... 22 Baxter Grove ... 11 ... ... ... ... ... ... ... 11 Canonbury Villas ... ... ... ... ... ... 11 ... ... 11 Calabria Road ... 11 11 ... ... ... ... ... ... 22 Canonbury Avenue ... 21 11 ... ... ... ... ... ... 32 Cornwallis Road Workhouse ... 10 ... ... ... ... 1 ... ... 111 Compton Road ... ... ... ... 11 ... ... ... ... 11 Campdale Road ... ... 11 ... ... ... ... ... ... 11 Coleman Street ... ... 11 ... ... ... ... ... ... 11 Coombe Street ... 22 11 ... ... ... ... ... ... 33 City Road ... 22 ... ... ... ... 11 ... ... 33 Cumberland Street ... 22 ... ... ... ... ... ... ... 22 Colebrooke Row ... 22 22 ... ... ... 11 ... ... 55 Church Road ... 11 ... ... ... ... ... ... ... 1l City Garden Row ... 22 ... ... ... ... ... ... ... 22 Copenhagen Street ... 44 76 ... ... ... ... 11 ... I210 Corinne Road ... 33 ... ... ... ... 11 ... ... 44 Canterbury Road ... 22 11 ... ... ... ... ... ... 33 Carlton Terrace, Halton Road ... 11 11 ... ... ... ... ... ... 22 Caledonian Road ... 88 1010 ... 22 ... 11 ... ... 2121 Charlotte Street ... 11 22 ... ... ... ... ... ... 33 Cottenham Road ... 62 22 ... ... ... ... ... ... 84 Crane Grove ... ... ... ... 11 ... 11 ... ... 22 Cromwell Road ... . ... ... ... ... 11 ... ... 11 Corinth Road ... 62 ... ... ... ... 11 ... ... 73 Corporation Street . 11 ... ... ... ... ... ... ... 11 Canonbury Road ... 11 11 ... 22 ... 32 ... ... 75 Camden Buildings, York Road ... ... ... ... ... ... 11 ... ... 11 Corbyn Street ... 22 22 ... ... ... ... ... ... 44 Chalfont Road ... 11 11 ... ... ... ... ... ... 21 Cross Street ... ... 11 ... ... ... ... 11 ... 22 Cloudesley Street ... 11 ... ... 22 ... ... ... ... 33 Canonbury Place ... ... ... ... 11 ... ... ... ... 11 Campbell Road ... 11 22 ... ... ... 44 ... ... 77 Canonbury Park, South ... ... ... ... ... ... 1l ... ... 11 College Street ... 11 ... ... ... ... ... ... ... 11 Crayford Road ... 11 ... ... ... ... 11 ... ... 22 Cheverton Road ... 22 ... ... ... ... ... ... ... 22 Calverley Grove ... 11 ... ... ... ... ... ... ... 11 176 1910] Table CIII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. | Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. Cornwallis Road ... 33 22 ... ... ... 11 ... ... 66 Carlsbad Street ... ... 22 ... 11 ... ... ... ... 33 Conewood Street ... ... ... ... 11 ... 11 ... ... 22 Canal Terrace ... ... 22 ... ... ... ... ... ... 22 Caledonian Crescent ... ... 11 ... ... ... ... 11 ... 22 Cromartie Road ... ... ... ... 11 ... ... ... ... 11 Cottenham Terrace ... 11 ... ... ... ... ... ... ... 11 Compton Terrace ... ... ... ... ... ... 11 ... ... 11 Clayton Street ... 22 ... ... ... ... ... ... ... 22 Canonbury Park, North ... ... ... ... ... ... 11 ... ... 11 Cardwell Terrace ... ... ... ... ... ... 11 ... ... 11 Charteria Road ... 21 ... ... ... ... 11 ... ... 32 Cardale Street ... 22 ... ... ... ... ... ... 22 Crouch Hill ... ... 11 ... ... ... ... ... ... 11 Camden Road ... ... ... ... 11 ... ... ... ... 11 Cloudesley Road ... ... 11 ... ... ... ... ... ... 11 Church Street ... 11 ... ... ... ... ... ... ... 11 Compton Street ... 21 ... ... ... ... ... ... ... 21 Canonbury Lane ... 11 ... ... ... ... ... ... ... 11 Camden Street ... 11 ... ... ... ... ... ... ... 11 Cloudesley Square ... ... ... ... ... ... 11 ... ... l1 Clarence Terrace, York Road ... ... 41 ... ... ... ... ... ... 41 Canonbury Street ... 22 ... ... ... ... ... ... ... 22 Canning Road ... 11 ... ... ... ... ... ... ... 11 Devonshire Road ... 44 33 ... 11 ... ... 11 ... 99 Duncombe Road ... 32 65 ... ... ... ... ... ... 96 Duncan Terrace ... 22 ... ... ... ... 21 ... ... 48 Dennis Street ... 11 11 ... ... ... 11 ... ... 32 Dawlish House, Pleasant Place ... 11 11 ... ... ... ... ... ... 21 Dresden Road ... 22 ... ... ... ... ... ... ... 22 Durham Road ... 11 ... ... ... ... ... ... ... 11 Devonshire Street ... 33 ... ... ... ... 11 ... ... 44 Drovers Hall ... 11 ... ... ... ... ... ... ... 11 Dorset Street ... ... 11 ... ... ... ... ... ... 11 Dagmar Terrace ... 32 ... ... ... ... ... ... ... 32 Despard Road ... 22 ... ... ... ... ... ... ... 22 Dillons Place, Hornsey Road ... ... ... ... ... 11 ... ... 11 Dame Street ... ll ... ... ... ... ... ... ... 11 Drayton Park ... 11 ... ... ... ... 11 ... ... 22 Dunford Road ... 1l 11 ... ... ... ... ... ... 22 Denmark Street ... ... 11 ... ... ... ... ... ... 11 Dean Street ... ... 11 ... ... ... ... ... ... 11 Dorinda Street ... 11 ... ... ... ... ... ... ... 11 Denmark Road ... 11 ... ... ... ... ... ... ... 11 177 [1910 Table CIII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. Denmark Grove ... ... ... ... 21 11 ... ... ... 31 Davenant Road ... ... ... ... 11 ... 11 ... ... 22 Delhi Street ... 11 ... ... ... ... ... ... ... 11 Douglas Road ... ... ... ... ... ... 22 ... ... 22 Denmark Place ... ... 21 ... ... ... ... ... ... 21 Essex Road ... 54 11 ... ... ... 22 ... ... 87 Edinboro' Cottages, Popham Street ... 22 22 ... ... ... ... ... ... 44 Elthorne Road ... 22 11 ... l1 ... ... ... ... 43 Everleigh Street ... 31 ... ... ... ... ... ... ... 31 Elmore Street ... 11 11 ... 11 ... 33 ... ... 66 Elwood Street ... 32 ... ... ... ... ... ... ... 32 Eden Grove ... 32 11 ... ... ... ... ... ... 43 Enkel Street ... 11 ... ... ... ... ... ... ... 11 Ellenborough Road ... 32 22 ... ... ... ... ... ... 54 Englefield Road ... ... ... ... ... ... 11 ... ... 11 Edward Square ... ... 54 ... ... ... ... ... ... 54 Elfort Road ... 11 ... ... ... ... ... ... ... 11 Elliott's Gardens, Essex Road ... 11 ... ... ... ... 11 ... ... 22 Ellington Street ... 22 ... ... ... ... ... ... ... 22 Eaton Grove, Wedmore Street ... ... ... ... 11 ... ... ... ... 11 Eddington Street ... ... 31 ... ... ... ... ... ... 31 Fair bridge Road ... 44 44 ... 1l ... 11 ... ... 1010 Fowler Road ... 21 ... ... ... ... ... ... ... 21 Francis Street ... 11 ... ... ... ... ... ... ... 11 Fort Cottages, Hurlock Street ... 21 ... ... ... ... ... ... ... 21 Freegrove Road ... 22 22 ... ... ... ... ... ... 43 Frederick Street ... 11 ... 1l ... ... 22 ... ... 44 Framfield Road ... ... ... ... ... ... 11 ... ... 11 Freeling Street ... 11 21 ... ... ... 33 ... ... 65 Friends Cottages, Canonbury Road ... ... 11 ... ... ... ... ... ... 11 Francis Terrace ... 11 11 ... ... ... ... ... ... 22 Fortnam Road ... ... 11 ... ... ... ... ... ... 11 Fife Terrace ... ... 11 ... ... ... ... ... ... 11 Fonthill Road ... 22 43 ... ... ... ... ... ... 65 Frome Street ... 21 ... ... 11 ... ... ... ... 32 Fairmead Road ... ... ... 1l ... ... ... ... ... 11 Full brook Road ... 11 ... ... ... ... ... ... ... 11 Foxham Road ... 11 ... ... ... ... ... ... ... 11 Florence Street ... 11 ... ... ... ... ... ... ... 11 George's Road ... 22 22 ... ... ... ... ... ... 44 Grosvenor Road ... 33 11 ... 11 ... ... ... ... 56 Gillespie Road ... 22 22 ... ... ... 22 ... ... 66 N 178 1910] Table CIII.—continued. Name of street. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. Grantbridge Street ... 33 58 85 Grosvenor Street ... ... 2 3 jl 3s Graham Street ... 11 6fi 8' Gifford Street ... 108 55 i5- Gladsmuir Road ... 11 i1 Grove Road ... 54 38 86 Goodinge Road ... 75 i1 32 II' Gravedale Road ... ... jl i1 Goodvwin Street ... ... i1 il Gresley Road ... 11 i> Grenville Road ... ... 22 22 Giesbach Road ... ... i1 i1 George Yard, Blundell Street Great Northern Hospital, ... ... I1 i1 Holloway Road ... ... i1 i1 21 Gloucester Road ... 11 I1 21 Girdlestone Road ... ... i1 i1 22 Green Lanes ... 11 i1 Hanover Street ... 11 i1 i1 3" Hornsey Street ... ... i1 i1 Hampden Road ... 11 11 i1 Holloway Road ... 87 o5 05 T Huntingdon Street ... 32 o° i1 1712 Hornsey Road ... 97 I1 i1 i1 65 Hargrave Park ... 22 87 2» i1 i1 21" Hornsey Rise Gardens ... 12 2a Halton Road ... 22 i1 22 Hargrave Road ... 11 i1 i1 44 Hartham Road ... 11 i1 H.M. Prison, Holloway ... i1 i1 Huddleston Road ... I1 . . . 4 41 i1 Hatchard Road ... 44 32 i1 8s Hargrave Mansions, Hargrave Road ... i1 i1 2a Highbury Terrace ... i1 i1 Highbury Hill ... _ Q ... i1 i1 Harberton Road ... 2 i1 3" Horsell Road ... 4 «2 4a Highgate Hill ... 2 2a High Street ... 2 r 1 2s Hightbury Park ... i i1 ... 22 Hanley Road ... 2 - 2 i1 3s Hamilton Road ... 3 ... ... ... 3a 179 [1910 Table CIII.—continued. Name of street. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals Hope Street ... ... ... ... ... ... 11 ... ... 11 Hemingford Road ... 22 43 ... ... ... ... ... ... 65 Hilldrop Crescent ... ... 11 ... ... ... ... ... ... 11 Hungerford Road ... ... ... ... 11 ... ... ... ... 11 Hurlock Street ... ... ... ... ... ... 11 ... ... 11 Hatley Road ... ... ... ... ... ... 11 ... ... 11 Hatton House, Hornsey Road ... ... ... ... ... ... 11 ... ... 11 Hope Place, Holloway Road ... 11 ... ... ... ... ... ... ... 11 Highbury New Park ... ... ... ... 22 ... ... ... ... 22 Halliford Street ... ... ... ... 11 ... ... ... ... 11 Highbury Quadrant ... 11 32 ... ... ... ... ... ... 43 Havelock Street ... 32 22 ... ... ... 11 ... ... 65 Hillmarton Road ... ... 11 ... ... ... ... ... ... 11 Hornsey Rise ... 21 21 ... ... ... ... ... ... 41 H.M. Prison, Pentonville ... ... ... ... 11 ... ... ... ... 11 Hollingworth Street ... ... 11 ... ... ... ... ... ... 11 Islington Workhouse Schools ... 15 1 ... ... ... ... ... 161 Islington Green ... 22 ... ... ... ... ... ... ... 22 Ingleby Road ... ... ... ... 32 ... ... ... ... 32 Islington Infirmary ... ... l6 ... 1 ... 1 ... ... 18 Islington Workhouse, St. Johns Road ... 2 23 ... ... ... 4 ... ... 291 Isledon Road ... 53 11 ... ... ... 11 ... ... 75 Junction Road ... 65 ... ... ... ... 11 ... ...... 76 Kingsdown Road ... 31 22 ... 22 ... ... ... ... 76 Kelvin Road ... 43 ... ... ... ... ... ... ... 43 King Henry's Walk ... 33 11 ... ... ... ... ... ... 44 King Henry's Street ... ... 11 ... ... ... ... ... ... 11 Kiver Road ... 11 33 ... ... ... ... ... ... 43 King Edward Street ... ... ... ... ... ... 11 ... ... 11 Kingsdown Orphanage, Hornsey Lane ... 11 ... ... ... ... ... ... ... 11 King Edward's Buildings, Brewery Road ... 11 ... ... ... ... ... ... ... 11 Liverpool Buildings, Liverpool Road ... 11 11 ... 11 ... 11 ... ... 44 Lesly Street ... 22 ... ... ... ... ... ... ... 22 Langdon Road ... 53 11 ... ... ... ... ... ... 64 Landseer Road T d 1 ... 11 22 ... ... ... 11 ... ... 44 Lennox Road ... ... 44 ... ... ... ... ... ... 44 Lyon Street ... 22 11 ... 33 ... ... ... ... 64 Lewis Trust Buildings ... ... 32 ... ... ... ... ... ... 32 Liverpool Road ... 76 43 ... 22 ... 22 ... ... I512 Lavina Grove ... ... ... ... ... ... 11 ... ... 11 N 2 180 1910] Table CIII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. Liberia Road ... 22 11 ... ... ... ... ... ... 33 Lofting Road ... 21 ... ... ... ... ... ... ... 21 Lidyard Road ... 62 ... ... ... ... ... ... ... 62 Lucerne Road ... ... ... ... ... ... 11 ... ... 11 Lonsdale Square ... 22 ... ... 1l ... ... ... ... 33 Lysander Grove ... 21 ... ... ... ... ... 11 ... 32 London Street ... 22 ... ... ... ... ... ... 22 London Fever Hospital ... 3 ... ... ... ... ...... ... ... 31 Luard Street ... 11 11 ... ... ... ... 11 ... 33 Little Cumming Street ... 11 22 ... ... ... ...... ... ... 32 Lady Margaret Road ... 22 ... ... ... ... ... ... 22 Linton Street ... 32 22 ... . ... ... ... ... 54 Loraine Road ... 11 ... ... ... ... ... ... ... 11 Lambton Road ... 11 ... ... ... ... ... ... 11 Mercers Road ... 11 11 ... 11 ... ... ... ... 33 Medina Road ... ... ... ... ... 11 ... ... 11 Mattbias Road ... ... 21 11 ... ... ... ... ... 32 Marlborough Road ... 88 11 11 ... ... ... ... ... 109 Mulkern Road ... ... 21 ... ... ... ... 11 ... 32 Matilda Street ... 11 11 ... ... ... ... ... ... 22 Mildmay Grove ... 43 ... ... ... ... ... ... 43 Milton Grove ... ... ... ... ... ... ... 11 ... 11 Monte Cristo Mansions, Newington Green ... ... ... ... ... 11 ... ... 11 Magdala Road ... 22 ... ... .. ... ... ... ... 22 Mildmay Road ... ... 22 ... ... 11 ... ... 33 Market Street ... 11 ... ... ... ... ... ... ... 11 Marquess Road ... 22 ... ... ... ... ... ... ... 22 Milner Square ... 11 ... ... ... ... ... ... 11 Mayton Street ... 21 11 ... ... ... ... ... ... 32 Moray Road ... 44 33 ... ... ... 11 ... ... 88 Mitford Road ... ... 22 ... ... ... ... ... ... 22 Mildmay Nursing Home, Newington Green ... ... ... ... ... ... 11 ... ... 11 Madras Place ... 11 ... ...... ... ... ... ... ... 11 Mildmay Street ... ... 11 ...... ... ... ... ... ... 11 Mayville Street ... ... 11 ... ... ... ... ... 11 Mildmay Avenue ... ... ... ... ... ... 11 ... ... 11 Marriott Road ... ... ... ... ... ... 11 ... ... 11 Milner Street ... 21 ... ... ... ... ... ... 21 Marcellus Road ... 11 11 ... ... ... ... ... ... 21 Muriel Street ... 11 ... ... ... ... ... ... ... 11 Medina Grove ... ... ... ... ... ... 11 ... ... 11 Monsell Road ... 11 ... ... ... ... ... ... ... 11 181 [1910 Table CIII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. Maygood Street ... 11 ... ... ... ... ... ... 11 Nailour Street ... ... ... ... ... ... 11 ... ... 11 New North Road ... 32 11 ... ... ... 11 11 ... 65 North Road ... 43 ... ... ... ... ... ... ... 43 Noel Street ... 11 ... ... ... ... ... ... ... 11 North Avenue ... ... 11 ... ... ... 22 ... ... 33 Northampton Street ... 42 ... ... 11 ... ... ... ... 53 Newington Green ... ... 11 ... ... ... ... ... ... 11 Newington Green Road ... 22 11 ... ... ... ... ... ... 32 Northdown Street ... ... 1l ... ... ... ... ... ... 11 Northampton Park ... 11 ... ... ... ... ... ... 11 Nicholay Road ... 22 ... ... ... ... ... ... 22 Norfolk Street ... 11 ... ... ... ... ... ... l1 Oxford Road ... ... 2 2 ... ... ... 11 ... ... 33 Orchard Street ... 11 11 ... ... ... ... ... ... 22 Offord Road ... 32 11 ... ...... ... 11 ... ... 54 Orpingley Road ... 22 22 ... ... ... ... ... ... 43 Outram Street ... 11 44 ... 2 2 ... ... ... ... 77 Orleans Road ... ... 11 ... ... ... ... ... ... 11 Offord Street ... 11 ... ... ... ... ... ... ... 1l Petherton Road ... ... 11 ... ... ... ... ... 11 Poole's Park ... 44 11 ... ... ... 55 1l ... 110 Payne Street ... 42 41 ... ... ... ... ... ... 83 Parkfield Street ... ... ... ... ... ... l1 ... ... 11 Pembroke Street ... 33 65 ... 1l ... 22 ... ... 1210 Packington Street ... 22 11 ... ... ... 11 ... ... 44 Pentonville Cottages, Market Street ... 11 ... ... ... ... ... ... ... 11 Palmerstone Road ... 11 ... ... ... ... 52 ... ... 62 Pickering Street ... 11 11 ... ... ... ... 11 ... 33 Prebend Street ... ... 11 ... ... ... ... ... ... 1l Pyrland Road ... 11 11 ... ... ... 11 ... ... 33 Pleasant Passage, Holloway Road ... ... 11 ... ... ... ... ... ... l1 Pemberton Gardens ... 21 11 ... ... ... 11 ... ... 43 Pulteney Terrace ... 11 11 ... ... ... ... ... ... 22 Pulteney Street ... ... ... ... ... ... 11 ... ... l1 Prospero Road ... ... ... ... ... ... l1 ... ... l1 Park Street ... ... 21 ... ... ... 11 ... ... 32 Pleasant Place, Essex Road ... 22 11 ... ... ... ... ... ... 32 Popham Road Palmerston Buildings, City ... 33 ... ... ... ... l1 ... ... 44 Garden Row ... 31 11 ... ... ... ... ... ... 42 Poynings Road ... ... 11 ... ... ...... l1 ... ... 22 182 1910] Table CIII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. Prospect Row ... 11 31 ... ... ... ... ... ... 42 Plimsoll Road ... ... ... ... ... ... 11 ... ... 11 Parolles Road ... 21 ... ... ... ... ... ... ... 21 Peabody Buildings, Greenman Street ... 11 ... ... ... ... ... ... ... 11 Popham Street ... ... ... ... ... ... 11 ... ... 11 Queen Margaret's Grove ... 1l ... ... ... ... ... ... ... 11 Queensland Road ... 11 11 ... ... ... 11 ... ... 33 Queen Head Street ... 32 ... ... ... ... ... ... ... 32 Queen's Place ... ... ... ... ... ... 11 ... ... 11 Queensbury Street ... ... 22 ... ... ... 22 ... ... 44 Queen's Cottages, Popham Street ... ... 11 ... ... ... ... ... ... 11 Quinn Buildings, Popham St. ... ... 11 ... ... ... ... ... ... 11 Rufford Street ... 11 ... ... 11 ... ... ... ... 22 Rocliffe Street ... 2l ... ... ... ... ... ... ... 21 Rupert Road ... 33 ... ... ... ... ... ... ... 33 Richmond Road ... 32 ... ... 11 ... 11 ... ... 54 Roman Road ... 54 22 ... 11 ... ... ... ... 86 Richmond Crescent ... ... 11 ... ... ... 11 ... ... 22 Rhodes Street ... 22 ... ... ... ... ... ... ... 22 Riversdale Road ... 42 11 ... ... ... 11 ... ... 65 River Street ... ... ... ... ... ... 11 ... ... 11 Romilly Road ... 1l ... ... ... ... 11 ... ... 22 Runton Street ... 22 ... ... ... ... ... ... ... 22 Ronald's Road ... 11 ... ... ... ... ... ... ... 11 Ringcroft Street ... ... 11 ... ... ... ... ... ... 11 Russell Road ... ... 11 ... ... ... ... 11 ... 22 Regina Road ... 11 ... ... ... ... ... ... ... 11 Rosemary Street ... 11 ... ... ... ... ... ... ... 11 Rheidol Terrace ... ... 11 ... ... ... ... ... ... 11 Rock Street ... ... 11 ... ... ... ... ... ... 11 Rothery Street ... ... ... ... 11 ... ... ... ... 11 Scholefield Road ... 22 11 ... ... ... ... ... ... 33 Sotheby Road ... 41 ... ... ... ... ... ... ... 41 Sheen Grove ... 11 ... 1l 11 ... ... ... ... 32 Station Road ... ... 11 ... ... ... ... ... ... 1l Sonning Street ... 22 11 ... 11 ... ... ... ... 44 Spencer Street ... 11 ... ... ... ... 32 ... ... 43 St. George's Avenue ... 33 ... ... ... ... 22 ... ... 55 St. James Road ... 43 11 ... ... ... 33 11 ... 98 Stock Orchard Street ... ... 11 ... ... ... ... ... ... 11 Sudeley Street ... 11 ... ... ... ... ... ... ... 11 St. Thomas' Road ... 33 ... ... ... ... ... ... ... 38 183 [1910 Table CIII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Menb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. St. Paul's Road ... 33 ... ... ... ... 11 ... ... 44 Southgate Road ... 22 ... ... ... ... ... ... ... 22 St. Jude Street ... 52 ... ... 11 ... ... 11 ... 74 Salisbury Road ... 44 ... ... ... ... ... ... ... 44 St. Paul's Place ... 22 11 ... ... ... ... ... ... 33 Stanmore Street ... 11 22 ... ... ... ... ... ... 33 Seven Sisters' Road ... 22 21 ... ... ... ... ... ... 43 St. John's Road ... 88 55 ... 11 ... 11 ... ... 1514 Shaftesbury Road ... ... ... ... 11 ... ... ... ... 11 Stroud Green Road ... ... 11 ... ... ... ... ... ... 11 St. Paul Street ... 11 ... ... ... ... ... ... ... 11 Shepperton Road ... 1l 11 ... ... ... 11 ... ... 33 Shelburne Road ... 32 11 ... ... ... ... ... ... 42 Sussex Road ... 11 22 ... ... ... ... ... ... 33 Sebbon Street ... 11 ... ... ... ... ... ... ... 11 St. Peter Street ... 32 11 ... ... ... 11 ... ... 54 St. John's Villas ... ... 11 ... 11 ... ... ... ... 22 St. Mary's Road ... 1l ... ... ... ... ... ... ... 11 Sheringham Road ... ... ... ... ... ... ... 11 ... 11 Sutterton Street ... 31 ... ... ... ... ... ... ... 31 Stanley Road ... ... 11 ... ... ... ... ... ... 11 South Street ... ... 11 ... ... ... ... ... ... 11 St. Clement's Street ... ... 11 ... ... ... ... ... ... 11 Stonefield Street ... 1l ... ... 11 ... 11 ... ... 33 Sherbourne Street ... 22 ... ... 22 ... 11 ... ... 55 St. Philip Street ... ... ... ... ... ... 11 ... ... l1 Southcote Road ... 22 ... ... ... ... ... ... ... 22 Tavistock Terrace ... ... 32 ... ... ... ... ... ... 32 Tollington Park ... ... 22 ... ... ... 44 ... ... 66 Tufnell House, Pleasant Place ... 11 ... ... ... ... ... ... ... 11 Tufnell Park Road ... 55 22 ... ... ... ... ... ... 76 Twyford Street ... 11 ... ... ... ... ... ... ... 11 Thane Villas ... ... 21 ... ... ... ... ... ... 21 Thornhill Crescent ... ... ... ... ... ... 11 ... ... 11 Tiber Street ... ... 33 ... ... ... ... ... ... 33 Thatched House Buildings, Essex Road ... ... ... ... ... ... 11 ... ... 11 Theberton Street Thornhill Houses, Barnsbury ... 22 22 ... ... ... ... ... ... 44 Park ... 22 ... ... ... ... 11 ... ... 33 Torrens Buildings, City Road ... ... 11 ... ... ... ... ... 11 Thorpedale Road ... 22 22 ... ... ... 11 ... ... 55 Tabley Road ... ... 11 ... ... ... ... ... ... 11 Tremlett Grove ... 53 11 ... ... ... ... ... ... 64 Tyndale Place ... ... 11 ... ... ... ... ... ... 11 184 1910] Table CIII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Totals. Tufnell Park Mews ... ... ... ... 11 ... ... ... ... 11 Thornhill Square ... 11 ... ... ... ... ... ... ... 11 Union Road ... 11 ... ... ... ... 11 ... ... 22 Upper Street ... 33 22 ... 11 ... ... ... ... 66 Union Square ... 11 ... ... ... ... ... ... ... 11 Upper Park Street ... ... ... ... ... ... 1l ... ... 11 Victor Road ... 22 ... ... ... ... ... ... ... 33 Vittoria Place ... 21 ... ... ... ... ... ... ... 21 Vittoria Street ... 11 11 ... ... ... 21 ... ... 42 Victoria Villas, Sonderberg Road ... 11 ... ... ... ... ... ... ... 11 Victoria Place, Queensland Road ... 11 ... ... ... ... ... ... ... 11 Vorley Road ... 53 22 ... ... ... ... ... ... 75 Vincent Terrace ... 21 ... ... ... ... ... ... ... 21 Victoria Road ... 11 ... ... ... ... 22 ... ... 33 Wallace Buildings, Caledonian Road ... 11 32 ... ... ... ... ... ... 43 Wall Street ... 11 ... ... ... ... 11 ... ... 22 Westbourne Road ... 54 11 ... ... ... ... ... ... 65 Woodville Grove ... 21 ... ... ... ... ... ... ... 21 Wyatt Road ... ... 1l ... ... ... ... ... ... 11 Ward Road ... 11 11 ... ... ... ... ... ... 22 Wessex Buildings, Wedmore Street ... 11 22 ... ... ... ... ... ... 33 Witherington Road ... 32 ... ... ... ... ... ... ... 32 William Street, St. Peter's Street ... 22 ... ... ... ... ... ... ... 22 Windsor Road ... ... 11 ... ... ... ... ... ... 11 Wynford Road ... 11 11 ... ... ... ... ... ... 22 Wharfdale Road ... 22 ... ... ... ... 11 ... ... 33 Wedmore Gardens, Upper Holloway ... 11 21 ... ... ... ... ... ... 31 Wellington Road ... 11 ... ... 11 ... 11 ... ... 33 Winchester Street ... 11 11 11 ... ... 22 ... ... 54 Witley Road ... ... ... ... 11 ... ... ... ... 11 Williamson Street ... ... 11 ... ... ... 1l ... ... 11 Warrender Road ... 43 11 ... ... ... ... ... ... 43 Wallace Road ... 21 i1 ... ... ... ... ... ... 32 Windsor Street ... 11 11 ... ... ... ... ... ... 22 Whistler Street ... 11 ... ... ... ... ... ... ... 11 Warner Street ... 32 11 ... ... ... ... ... ... 42 Whewell Road ... ... 11 ... ... ... ... ... ... 11 Yerbury Road ... ... 11 ... 11 ... ... ... ... 22 York Road ... 11 ... ... ... ... 33 ... ... 41 185 [1910 BACTERIOLOGICAL EXAMINATIONS. During the year 682 specimens were examined for the medical profession practising in Islington (to enable them to diagnose suspicious cases of Diphtheria, Enteric Fever, and Phthisis with certainty) as compared with 577 in the preceding year, and 545 in 1908. A full statement for each year since 1898 is given in Table CIV. Diphtheria.—401 specimens were examined, as contrasted with 300 in 1909 and 281 in 1908. This is the largest number hitherto forwarded for examination. In 125 instances the Lister Institute returned certificates showing positive results, and in 276 giving negative results. Enteric Fever.—Specimens of blood were examined in 61 instances, of which number 32 gave positive results, and 29 negative. Phthisis.—The sputum of 220 patients was examined, and the reports showed that 63 persons were suffering from the disease, and that 157 were not. All these examinations were made by the Lister Institute, who during the last eleven and a half years have examined 4,933 specimens for the Borough Council, namely:—2,208 Diphtheria, 896 Enteric Fever, and 1,829 Phthisis, and enabling the medical profession of Islington to diagnose diseases in 1,803 instances, or in 36.5 per cent. of the doubtful cases which they had under treatment. The following Tables show the results of the examinations that have been made:— Diseases. Total Examinations. Positive Results. Negative Results. Percentage of Positive Results. Diphtheria 2,208 774 1,434 35.0 Enteric Fever 896 401 495 44.7 Phthisis 1,829 628 1,201 34.3 Total 4,933 1,803 3,130 36.5 186 1910] Table CIV. Showing the result oj the Bacteriological Examinations made for th* Diagnosis of Diphtheria, Enteric Fever and Phthisis, 1898-1910. Periods. Diphtheria. Enteric Fever. Phthisis. Totals. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Positive j Results. Negative ! Results. | Total Examined. 1898 (6 months) 11 20 31 31 17 48 ... ... ... 79 1899 47 50 97 25 51 76 36 43 79 252 1900 43 62 105 33 45 78 35 44 79 262 1901 80 90 170 66 46 112 28 43 71 353 1902 52 70 122 45 69 114 39 83 122 358 1903 14 64 78 15 54 69 40 96 136 283 1904 28 58 86 14 39 53 46 89 135 274 1905 61 86 147 34 22 56 87 131 218 421 1906 68 99 167 27 29 56 57 96 153 376 1907 88 135 223 25 34 59 68 121 189 471 1908 93 188 281 34 25 59 69 136 205 545 1909 64 236 300 20 35 55 60 162 222 577 1910 125 276 401 32 29 61 63 157 220 682 Totals (for 11½ years) 774 1434 2208 401 495 896 628 1201 1829 4933 VACCINATION—OR THE STATE OF PREPAREDNESS TO MEET SMALL POX. There can be no doubt that the ability of any community to resist an invasion of Small Pox, is to be judged mainly by its condition as to vaccination Facts prove it, statistics show it, and experience teaches it. But for all that the clamour of the anti-vaccinator is great, and doubtless has its effect on ignorant, uneducated, thoughtless, and timorous people. In no other way can the continued fall in the proportion of children vaccinated be accounted for. 187 [1910 The returns of the vaccination officers for 1909, the latest complete return available, is sad reading, for it shows that only 70.7 per cent. of the infants (less those who died unvaccinated) were vaccinated. This, with the exception of the three years, 1898, 1899, and 1900, is the lowest percentage hitherto reached. During the last ten years the highest percentage of vaccinations was attained in 1904, when it was 82.3 per cent. Since then there has been a steady fall, 1905, 80.5 per cent.; 1906, 79.9 per cent.; 1907, 76.9 per cent.; 1908, 72.4 per cent., and 1909, 70.7 per cent. No doubt, in addition to the outcry of the anti-vaccinators, the comparative freedom of this country from Small Pox has had something to do with the decrease in the vaccinations. The young parents of to-day know nothing of the terrible nature of the disease against which so many of them are refusing to adopt precautions. They know nothing of the disfiguration and blindness and baldness which, in its uncontrolled state, it causes; and above all they know nothing of the enormous mortality that occurs among the unvaccinated when they are attacked. It is to be feared that nothing but sad experience will teach them their lesson. It seems very little use for men like the writer, who has had a very large experience of the disease, to tell them. They think they know better than they do, or else they rely on misleading literature, which does all it can " to make the worse appear the better reason," and which, undoubtedly, has had a large measure of success. The people are misled. They will only discover their error when it is too late. When some one near and dear to them is taken away, or hopelessly disfigured for life. Then they will believe that there is a virtue, and a potent virtue, in vaccination. The Medical Officer of Health has known such persons among his own personal friends, of whom at least one has paid the forfeit of his life through his disbelief. It is an unfortunate circumstance that the Government of this country do not, like other countries, insist on vaccination. They know full well through their advisers that vaccination is the sheet anchor to withstand the stress of an epidemic of Small Pox, and yet they refrain from insisting on it. The writer does not refer to one particular political party—all are more or less alike. One may be a little weaker than the other. That is all. 188 1910] Years. Vaccinations per 100 births, less infants who died unvaccinated. Years Vaccinations per 100 births, less infants who died unvaccinated. 1880 89.8 1895 70.9 1881 90.8 1896 73. 9 1882 91.1 1897 73.3 1883 90.4 1898 64.9 1884 90.5 1899 66.4 1885 90.6 1900 679 1886 90.8 1901 75.8 1887 90.4 1902 8o.o 1888 88.4 1903 8l.2 1889 89.0 1904 82.3 1890 89.3 1905 80.5 1891 87.4 1906 79.9 1892 85.5 1907 76.9 1893 85.0 1908 72.4 1894 84.0 T9°9 70.7 The returns for 1909 show that out of 8,044 births, 507 of the infants died before they were vaccinated, so that 7,537 were liable to the operation, of whom 5,332, or 70.7 per cent. were vaccinated. Insusceptibility.—35 infants were insusceptible to vaccination, that is to say that having undergone the operation, probably more than once, the vaccination, in popular language, "did not take." Died Unvaccinated.—507 children died before vaccination was effected, as compared with 595 in 1908, and G09 in 1907. Exemption Certificates.—There was a very large increase in the number of Exemption Certificates granted to parents or guardians to enable them to forego vaccination for their infants. They numbered 824, as compared with 588 in 1908, 259 in 1907 and 123 in 1906. The great increase in the number of these certificates has been undoubtedly due to the legislation of 1907, which enabled a parent, on making a statutory declaration within four months of the birth of the child, that he conscientiously believes that vaccination would be prejudicial to his child, to obtain a certificate of exemption. 1897 1898 1899 1900 1901 1902 14 103 101 127 106 73 1903 1904 1905 1906 1907 1908 1909 103 89 110 123 259 588 824 189 [1910 Table CV. Showing the State of Vaccination in Islington, 1880-1910, also in London and in England and Wales, 1880-1908. Years. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Died Unvaccinated. No. of exemption certificates. Postponed by medical certificate. Remaining. Cases (cols. 6, 7, & 8), not finally vaccinated per 100 births.† Ditto in London. Ditto in Rest of England. 1 2 3 4 5 6 7 8 9 10 11 1880 9,931 8,123 26 885 Not granted for years previous to 1897. 118 779 9.0 7.0 4.5 1881 9,993 8,339 21 812 89 730 8.2 5.7 4.3 1882 10,000 8,360 22 819 155 644 8.0 6.6 4.5 1883 9,950 8,192 25 890 194 644 84 6.5 4.9 1884 9,892 8,121 47 924 191 601 8.0 6.8 53 1885 9,083 7, 874 41 991 157 617 8.0 7 0 5.5 1886 9,844 7,944 39 1,091 148 622 7.8 7 8 6.1 1887 9,732 7,769 44 1,133 171 615 8.1 90 6.7 1888 9,620 7,522 39 1,112 219 728 9.8 10.3 8.2 1889 9,638 7,581 22 1,120 198 717 95 11.6 9.6 1890 9,239 7,250 19 1,117 122 731 9.2 13.9 10.9 1891 9,823 7,584 33 1,145 131 930 10.8 16.4 12.9 1892 9,626 7,221 28 1,183 127 1,048 12.2 18.4 14.3 1893 9,757 7, 251 38 1,222 132 1,114 12 .7 18.2 15.7 1894 9,574 7,151 39 1,067 101 1.216 13 7 20.6 19.0 1895 9,959 7,079 50 975 237 1,618 18.7 24.9 19.8 1896 9,752 6,575 46 854 223 2 ,054 23.4 26.4 22.3 1897 9,878 6,539 30 954 14 220 2,121 23.8 29.1 21.6 1898 9,478 5,422 44 1,068 103 251 2,590 31.1 34.4 26.6 1899 9,631 5,698 81 1,048 101 333 2,370 29.1 28.7 20.8 1900 9,316 5,777 30 812 127 298 2,272 28 .9 26.8 19.9 1901 9,266 6,382 29 852 106 107 1,790 21. 6 25.2 17.3 1902 9,055 6,593 39 818 73 98 1,434 17.7 22.1 15.2 1903 8,959 6,673 23 739 103 62 1,359 17.0 21.7 14.7 1904 8,956 6,774 26 729 89 50 1,288 15.9 20.2 14.5 1905 8,603 6,360 28 709 110 66 1,330 17.5 20.1 14.8 1906 8,534 6,260 22 696 123 100 1,333 18. 2 22.7 16.8 1907 8,372 5,976 15 609 259 65 1,448 21.2 25.8 20.3 1908 8,317 5,595 31 595 588 89 1,419 25. 2 28.8 27.9 1909 8,044 5,332 35 507 824 59 1,287 26. 9 Not available. Not avail1able. 1910 (6 m'ths) 4,073 2,500 7 230 510 57 769 32.8 *The figures in Column 8 are obtained by adding together the numbers given in Columns 3, 4, 5, 6 and 7 and deducting the total from the number in Column 2. †The figures in Column 9 are percentage statements, obtained by adding together the numbers given in Columns 6, 7 and 8 and applying them to the numbers in Column 2. 190 1910] Table CVI. Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the year 1909. REGISTRATION SUB-DISTRICTS. Number of Births registered in 1909. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of Conscientious Objections received. Died Unvaccinated. Postponement'by Medical Certificate. Removed to other Districts. Removed to places Unknown. Number of Children remaining Unvaccinated, or not accounted for in Report Book Total Number of Certificates of Primary Vaccination at All Ages received during year 1910. 1 2 3 4 5 6 7 8 9 10 11 Tufnell 755 515 2 ... 77 50 11 27 64 9 2,804 Upper Holloway 990 700 4 ... 79 64 3 13 116 11 Tollington 697 479 4 ... 80 36 2 10 64 22 Highbury 1,287 816 3 ... 218 69 5 23 125 28 Lower Holloway 1,073 756 2 ... 89 64 16 9 111 26 2,877 Barnsbury 1,447 965 3 ... 103 94 7 11 223 41 Islington, South East 1,795 1,101 17 ... 178 130 15 10 280 64 The Borough 8,044 5,332 35 ... 824 507 59 103 983 201 5,681 191 [1910 Table CVII. Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the period, January to June, 1910. registration sub-district. Number of Births registered from 1st January to 30th June, 1910. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of Conscientious Objections received. Died Unvaccinated. Postponement by Medical Certificate. Removed to other districts. Removed to places unknown. Number of children remaining unvaccinated or not accounted for in Report Book. Number of Exemption Certificates received during the year 1910. 1 2 3 4 5 6 7 3 9 10 11 Tufnell 364 223 ... ... 54 18 13 14 34 8 557 Upper Holloway 507 356 ... ... 56 25 7 14 36 13 Tollington 369 241 ... 59 15 5 2 25 22 Highbury 651 408 4 ... 110 37 3 18 47 24 Lower Holloway 512 309 1 ... 53 32 10 6 60 41 543 Barnsbury 743 415 ... 58 49 7 4 112 98 Islington, South East 927 548 2 ... 120 54 12 5 122 64 The Borough 4,073 2,500 7 ... 510 230 57 63 436 270 1,120 192 [1910 DISINFECTION.* The work of disinfection continues to be considerable. It includes the disinfection, as well as the stripping of the walls of rooms in houses, wherein an infectious disease has occurred, and also the class-rooms of schools. It also embraces the disinfection of infected clothing, bedding, furniture, and the like as well as verminous articles, such as furniture or clothing. Disinfection of Rooms.—There were 1,777 rooms disinfected after infectious diseases, or for other causes, as compared with 2,334 in the preceding year. As usual the disinfectant used was for the most part formaldehyde in gas or in solution, and, where circumstances demanded, sulphur dioxide, especially where there were vermin to be destroyed. The Cleansing and Stripping of Rooms.-As many as 1,093 rooms, as contrasted with 947 in 1909, were cleansed, sprayed or stripped. 1909. 1910. 1st Quarter 209 - 232 2nd,, 234 - 284 3rd ,, 175 - 224 4th ,, 329 - 353 Disinfection of Schools— Class rooms in 34 public elementary schools, including the Guardians' Schools, Hornsey Road, also the St. John's Road and Corinwallis Road Workhouses and the Relief Station, St. John's Road, were disinfected after Measles, Whooping Cough, Scarlet Fever or Diphtheria. The following statement shows the Schools, etc., disinfected:— 1st Quarter. Thornhill Road L.C.C. Schools (Whooping Cough). St. Clement's L.C.C. Schools (Whooping Cough). St. John's School, Holloway (Whooping Cough). Wesleyan School, Drayton Park (Measles). Guardians Schools, Hornsey Road (Scarlet Fever). 2nd Quarter. Duncombe Road L.C.C. Schools (Scarlet Fever). All Saints, Muriel Street, Schools (Measles). St. John's School, Holloway (Diphtheria). Cornwallis Road Workhouse (Scarlet Fever). York Road L.C.C. Schools (Measles). Buckingham Street L.C.C. Schools (Measles). Gifford Street L.C.C. Schools (Measles). Hanover Street L.C.C. Schools (Measles). * See also disinfection after phthisis p. 144. 193 [1910 3rd Quarter. Gillespie Road L.C.C. Schools (Diphtheria). Barnsbury Park L.C.C. Schools (Scarlet Fever). Shepperton Road L.C.C. Schools (Scarlet Fever). Buckingham Street L.C.C. Schools (Measles). Rooms or Wards in the following places were also disinfected:— St. John's Road Workhouse (Diphtheria) 2 wards. Islington Infirmary (Diphtheria). Relief Station, St. John's Road (Scarlet Fever). Kingsdown Orphanage (Scarlet Fever). 4th Quarter. Upper Hornsey Road L.C.C. Schools (Measles). Montem Street L.C.C. Schools (Measles and Diphtheria). Buckingham Street L.C.C. Schools (Diphtheria). Westbourne Road L.C.C. Schools (Measles). Thornhill Road L.C.C. Schools (Measles). Ecclesbourne Road L.C.C. Schools (Measles). Drayton Park Schools (Measles). Gifford Street L.C.C. Schools (Scarlet Fever). St. John's, Conewood Street (Measles). Poole's Park L.C.C. Schools (Measles). St. Thomas', Everilda Street (Measles). Pakeman Street L.C.C. Schools (Measles). Duncombe Road L.C.C. Schools (Measles). Station Road L.C.C. Schools (Measles). Gillespie Road L.C.C. Schools (Measles). Eden Grove Catholic Schools (Measles). The following places were also disinfected:— St. John's Road Workhouse (Diphtheria) 3 wards. Guardians' Schools, Hornsey Road (Scarlet Fever and Measles). O 194 1910] Table CVIII. Showing the Disinfection of Rooms by Formaldehyde Gas after Infectious Disease, in the Sanitary Inspectors' Districts, during the year 1910. Sanitary Inspectors' Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total 1910. 1909 1st Q'rter 28 45 7 24 25 23 14 24 30 13 13 28 6 41 321 589 2nd do. 24 50 14 34 23 31 14 18 24 19 24 41 13 44 373 594 3rd do. 30 51 9 39 25 31 29 20 44 22 23 36 20 30 409 608 4th do. 49 75 27 69 34 34 27 24 83 26 48 70 57 51 674 543 Year 131 221 57 166 107 119 84 86 181 80 108 175 96 166 1777 2834 Table CIX. Showing the Cleansing, Spraying or Stripping of Rooms after Infectious Disease, in the Sanitary Inspectors' Districts, during the year 1910. Sanitary Inspectors Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total 1910. 1909 1st Q'rter 12 11 1 57 14 5 14 8 16 13 18 32 10 21 232 209 2nd do. 8 76 4 19 14 11 11 21 29 9 16 19 19 18 284 234 3rd do. 21 30 11 14 24 4 13 19 11 7 23 26 13 8 224 175 4th do. 13 46 17 43 17 17 23 12 31 9 7 48 50 20 353 329 Year 54 163 33 133 69 37 61 60 87 38 64 125 92 77 1093 947 Disinfecting Station.— The amount of work done at the Disinfecting Station was the heaviest on record, for no less than 83,786 large articles were disinfected, as compared with 68,860 in 1909, 62,455 in 1908, and 30,083 in J 907. The large increase in recent years is due to the fact that during the last three, a firm which exports second-hand garments or condemned military uniforms, mostly the latter, have had their goods disinfected by the Council, paying for the work, to entitle them to a certificate, required by foreign or Dominion Governments, that they have been disinfected. 195 [1910 The actual number of garments or other articles, bedding, etc., disinfected after exposure to infectious disease or contamination by vermin was 27,168, as compared with 37,273 in 1909, and 36,106 in 1908. This decrease is entirely due to the lesser number of cases of the notifiable infectious diseases that have been notified. TABLE CX. Summary of the chief articles of Clothing, Bedding, &c., disinfected during the year 1910, and also in the preceding year 1909. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1910 1909. Beds 426 371 434 702 1,933 2,859 Blankets 883 886 801 1,391 3,961 4,810 Bolsters 392 377 408 630 1,807 2,716 Carpets 114 55 73 92 334 633 Chair Bed Cushions 50 68 58 100 276 383 Mattresses 420 412 427 651 1,910 1,725 Palliasses 163 107 102 211 583 1,458 Pillows 940 925 1,026 1,444 4,335 5,577 Quilts 420 413 432 734 1,999 2,857 Sheets 530 549 647 1,076 2,802 4,876 Other Articles 1,544 1,483 1,650 2,551 7,228 9,379 Totals 5,882 5,646 6,058 9,582 27,168 37,273 The ensuing statement shows the nature of the articles disinfected for the clothing contractors. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Soldiers' Tunics 1,887 837 550 1,157 4,431 „ Overcoats 7,888 2,158 7,037 4,972 22,055 „ Jackets 4,385 1,933 5,690 4,429 16,437 T rousers 1,112 292 172 176 1,752 Other Articles 2,164 1,562 7,311 906 11,943 17,436 6,782 20,760 11,640 56,618 O 2 196 1910] The following is a record of the work performed by the Steam Disinfectors during the past sixteen years:— 1895 17,240 articles 1896. 42,258 „ 1897 28,302 ,, 1898 20,172 „ 1899 25,378 ,, 1900 19,136 ,, 1901 27,050 ,, 1902 36,772 ,, 1903 23,748 ,, 1904 21,868 „ 1905 25,463 ,, 1906 28,629 „ 1907 30,083 ,, 1908 62,455 ,, 1909 68,860 ,, 1910 83,786,, Total for sixteen years 561,200 „ Disinfectants distributed and used.—The following statement gives the quantity of disinfectants distributed by the Sanitary Authority, and used in disinfecting and cleansing rooms:— How disposed of. Carbolic Powder. Disinfecting Fluid. Formaldehyde. Powder. Solution. Tons. cwts. Gallons. cwt. qr lb. Gallons. To Householders 3 0 680 — — Disinfection of Premises.. — — 1 2 0 41 Cost = £51 4s. l1d. 197 [1910 SHELTER HOUSE. During the year the Shelter House was used by only four families, pending the disinfection of their homes. It was also used to give baths to verminous persons, a practice of which the Medical Officer of Health does not approve, as he is of opinion that baths which are used for people who come to the shelter house while their homes are undergoing disinfection should not be used by people afflicted with vermin. Neither does he approve of the bathing of nurses after attendance on puerperal fever patients, in baths used by verminous persons or by persons who might possibly be suffering from an infectious disease. He has long since pointed out the necessity there is for separate baths. He can, however, state that every possible precaution is taken to prevent a mishap. Midwives.— Ten midwives or nurses were afforded baths after attendance on cases of Puerperal Fever. Verminous persons cleansed, at the Shelter House under the "Cleansing of Persons Act, 1897." Date of Admittance. Address. Number of Persons. Cause. 1910. 18th Jan. 16, Barnsbury Street 1 Verminous. 4th Feb. 8 do. 1 Do. 14th Mar. 92, Thorpedale Road 1 Do. 14th April 29, Eden Grove 1 Do. 20th „ Albert Home, Essex Road 1 Do. 22nd „ Unknown 1 Do. 12th May 47, Fonthill Road I Do. 4th June 6, Osnaburgh Cottages 2 Do. 12th July 87, Essex Road 2 Do. 20th „ Halton House, Halton Road 1 Do. 10th Aug. 47, Campbell Road 1 Do. 12th Sept. 29, Halton Road 1 Do. 16th „ 148, Thorpedale Road 1 Do. 7th Dec. 15, Campbell Road 1 Do. 9th „ 20, Barnsbury Street 1 Do. 20th „ do. do. 1 Do. 29th „ 155, Englefield Road 1 Do. 198 1910] Persons using Shelter House pending the disinfection of their homes. Date of Admittance. Address. Number in Family. Cause. 1910. 23rd Aug. 9, Denmark Grove 7 Typhus Fever. 14th Oct. 29E, Beaconsfield Buildings 5 Scarlet Fever. 14th Nov. 74, Gifford Street 1 Measles. 14th „ 48, Lofting Road 1 ,, Midwives attending Shelter House for the pur' ose of disinfection after attendance on cases of Puerperal Fever. Date of Attendance. Name. Address. 1910 14th April Mrs. A. 4, Victoria Place. 28th July Nurse L. 7, Cumberland Terrace. 28th ,, Nurse H. 29, Ambler Road. 13th Aug. Nurse M. 96, Bingfield Street. 19th Sept. Mrs. W. 107, St. James' Road. 11th Oct. Mrs. L. 18, Sonning Street. 28th „ Nurse B. 28, New North Road. 4th Nov. Mrs. J. 23, Canonbury Street. 8th Dec. Nurse A. 96, Bingfield Street. 13th „ Nurse D. Do. do. PART IV. SANITATION. ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1910. INSPECTION OF WORKSHOPS, WORKPLACES, LAUNDRIES AND BAKEHOUSES. HOUSES LET IN LODGINGS. DISTRICT INSPECTIONS. STATE OF PAUPERISM. COMMON LODGING HOUSES. DUST REMOVAL. 200 1910] FACTORY AND WORKSHOP ADMINISTRATION. The 133rd section of the Factory and Workshop Act, 1901, provides that the Medical Officer of Health of every District Council shall report specifically in his annual report on the administration of the Act so far as it refers to workshops and workplaces, and that he shall send a copy of his report, or such part of it as deals with such administration to the Secretary of State. Inspectors.—The work of administration is carried on by three inspectors, one male and two females. To the male inspector is delegated the inspection of factories, workshops, and workplaces where males are employed, and to the females similar places, including the homes of outworkers, where females are employed. One of these ladies confines her attention to factories and workshops, which include laundries and workplaces, while the second inspects the homes of outworkers, the kitchens of restaurants, and all places where food is prepared. Hence it will be seen that the work of the three inspectors is of considerable importance, not only to the workpeople, but to the community. Inspections and Visits.—There were 11,004 inspections and visits made to the various premises, as compared with 11,476 in the preceding year, with 11,505 in 1908, with 10,727 in 1907, and with 0,908 in 1906. To factories, which include factory laundries, were paid 429 visits, as compared with 447 in the preceding year; to workshops, which include workshop laundries, 1,870 visits were made, as against 1,820; to workplaces other than outworkers' premises, 259, as against 311; to kitchens and restaurants 477, as against 822; to outworkers' premises, 1,114, as against 1,328, while miscellaneous re-inspections and calls amounted to 0,381, as against 0,748. The slight decrease was due to the ill health which compelled the male Inspector's absence from duty for some time, as well as to the want of a female inspector for a time, after the retirement of Miss Brown, and before the appointment of her successor. Notices served.—608 intimations and 9 statutory notices were served on the owners of premises of proprietors of businesses, relating to 1,638 sanitary defects, of which 1,600 had been remedied at the close of the year. In addition to these notices, 70 relating to 70 sanitary defects were served at the homes of outworkers. All these notices compare with 780 in the preceding year. 201 [1910 Registers.— There were at the end of the year 4,542 workshops on the registers, as against 4,370 in 1909. They include 530 workshops where men, and 785 workshops where women are employed, and also 114 laundries, 253 bakehouses, 746 kitchens of restaurants, eating houses, or of places where food is prepared, and 2,114 outworkers' premises, which have increased considerably, and at the end of the year showed an increase of 264 on the return for 1909. The following tabular statement gives the figures for the year as well as for 1909. Workshops and Workplaces. 1909. 1910. Workshops on Register. Workrooms on Register. Number added during Year. Number removed during Year. Total number of Workshops on Register Total Number of Workrooms on Register. Workshops where Men are employed 544 804 68 82 530 769 Workshops where Women are employed 857 1,598 113 185 785 1,448 Laundries 128 9 23 114 Bakehouses 253 263 253 263 Restaurant Kitchens 738 1,018 16 8 746 1,030 Outworkers' Premises 1,850 2,035 681 417 2,114 2,114 Total 4,370 5,718 887 715 4,542 5,624 Sanitation.— The sanitary defects or nuisances discovered were 1,638 in number, of which 4,490 were due to want of cleanliness, 19 to insufficient ventilation.'26 to overcrowding, 113 to insufficient or want of surface drainage, and 418 to other nuisances. Dustbins were wanting in eight instances, and defective in 23. In 31 cases the w.c. accommodation was insufficient, in 302 it was foul, in 200 it was unsuitable or defective, and in 8 separate accommodation had not been provided for the separate sexes. At the close of the year 1,600 of these defects had been remedied. There were also 70 defects discovered in the homes of outworkers, as compared with 119 in 1909. In the subjoined statement the number of nuisances dealt with since 1896 is to be seen. 202 1910] 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 Total Overcrowding 26 12 15 14 22 14 4 13 4 13 30 9 8 9 24 217 Ventilation 14 13 2 5 4 3 5 8 11 4 8 31 12 29 20 169 Dirty Premises 311 195 109 99 217 218 231 423 630 412 448 970 719 425 505 5,912 Drains 554 458 375 313 216 177 90 50 19 15 4 19 261 61 87 2,699 W.C.'s 420 325 341 355 411 375 154 161 165 151 190 620 573 677 522 5,440 Water supplies 79 41 35 20 19 13 83 54 18 38 17 23 45 40 43 568 Surface drains 79 109 87 51 78 81 2 53 40 34 39 45 72 99 116 985 Cleanliness.— 490 premises were found in an uncleanly state, and 505 were put into proper order. These figures exceed the defects found, but this is explained by the fact that they include the premises about which notices had been served in 1909, but which had not been cleansed at its close. The numbers of the preceding years have been 425, 970, 448, 412, and 719. Effluvium Nuisances—None was found. Ventilation.— Insufficient ventilation was discovered in 19 instances, and 20 were remedied before the close of the year. Overcrowding.— 26 instances of overcrowding came under the observation of the Inspectors, and 24 of these had been abated before the close of the year. In the preceding years the numbers were 13 in 1905, 30 in 1906, 9 in 1907, 8 in 1908, and 9 in 1909. Overcrowding in the workshops of Islington is not of a serious character. Want of Drainage of Floors.— In 113 instances the floors of workshops, chiefly laundries, were found to be insufficiently drained, and consequently a notice was served in each instance, and the notices respecting 116, which includes some remaining over from 1909, had been complied with at the close of the year. Sanitary Accommodation.— Special attention was as usual given to the provision of this class of accommodation in workplaces, particularly to that provided for the sexes, and resulted in separate accommodation being 203 [ 1910 required in 8 instances, in 5 of which it had been provided before the close of the year. Thirty-one nuisances due to insufficient accommodation were abated, and 304 foul w.c. pans were cleansed, and 187 that were unsuitable or defective were remedied. Bakehouses.— At the close of the year there were 253 bakehouses on the register, and of these Inspector West made 474 inspections in addition to a number of other visits. The Chief Inspector (Mr. J. R. Leggatt) also carefully inspected, and reported on the bakehouses as follows:— Town Hall, Upper Street, Islington, N , 20th April, igio. To the Medical Officer of Health. Dear Sir,— Having completed my annual inspection of the bakehouses in use, above and below ground in the Borough, which number 202; it affords me very great pleasure to report that I found them in a most satisfactory state. This improvement is largely due to the fact that Mr. West, Workshops Inspector, has been able, after his illness some time ago, to systematically inspect the bakehouses, which is, as you are aware, most essential if good results are to be achieved. It is gratifying to note that the drying of articles of various kinds in bakehouses is very much on the decrease, and the occupiers are beginning to realise that a bakehouse is intended solely for the baking of bread. I have, however, had to call attention on several occasions to the inlet and outlet ventilators being blocked up with sacking, which is done in order to keep the bakehouse warm, but upon my pointing out the importance of an exchange of air being effected by the process of ventilation, which was provided by direction of the Public Health Committee prior to the certificates being issued, the obstacles were at once removed. The only other matter that I wish to refer to is the practice in some of the bakehouses to allow the sweepings from the floor to be placed under the troughs for some days, and then for them to be removed later. I have drawn the attention of those responsible to what appears to me to be not only a waste of time in doing work twice over, but also a very objectionable habit. I have every reason to believe that in time a permanent improvement will be effected. I am, Yours faithfully, JAMES R. LEGGATT, Superintendent and Chief Sanitary Inspector. 204 1910] LIST OF BAKEHOUSES. Upper Holloway District. Bakehouses aboveground. 104, Andover Road 88, Andover Road 19, Archway Road 16, Brecknock Road 62, Cottenham Road 29, Cottenham Road 49, Campbell Road 67, Durham Road 103, Elchorne Road (Factory) 57, Elthorne Road 75, Elthorne Road 166, Fairbridge Road 103, Fairbridge Road 81, Fonthill Road 114, Fonthill Road 90, Grove Road 24, Hampden Road 125, Hanley Road 58, Hazelville Road 12, Hercules Road 582, Holloway Road 634, Holloway Road 626, Holloway Road 679, Holloway Road 484, Hornsey Road 346, Hornsey Road 420, Hornsey Road 9, Highgate Hill 81, Junction Road 25, Lennox Road 127, Marlborough Road no, Marlborough Road 47, Palmerston Road 163, Seven Sisters Road 131, Stroud Green Road 51, Stroud Green Road 144, Tollington Park 5, Tollington Park (Factory) Certified underground Bakehouses. 54, Archway Road 84, Ashbrook Road 33, Bedford Terrace 26, Blenheim Road 10, Campdale Road 3, Card well Terrace 144, Elthorne Road 87, Hazelville Road 676, Holloway Road 575, Holloway Road 487, Hornsey Road 264, Hornsey Road 27, Hornsey Rise 239, Junction Road 104, Junction Road 167, Junction Road 7, Junction Road 59, Junction Road 47, Landseer Road 57, Marlborough Road 32, Milton Grove 31, Salisbury Road 1, Stapleton Hall Road 212, Tufnell Park Road 84, Yerbury Road 205 [1910 Bakehouses not in use. 5, Andover Road (underground) 44, Cheverton Road (aboveground) 23, Girdlestone Road (underground) 60, Grove Road (aboveground) 102, Highgate Hill „ 599, Holloway Road (underground) 33, Milton Grove 53, Poole's Park (aboveground) Crisp & Co., Seven Sisters Road (aboveground) Lower Holloway District. Bakehouses aboveground. V.V. Bakery, Brewery Road (Factory) Kemp's Bakery, Brewery Road (Factory) 421a, Caledonian Road 261, Holloway Road 251, Holloway Road 85, Holloway Road 69, Holloway Road 463, Liverpool Road 72, Rhodes Street 1a, St. James' Road 106, St. James' Road 16, Westbourne Road 254, York Road Certified underground Bakehouses. 415, Caledonian Road 480, Caledonian Road 37, Charlesworth Street 5 Crossley Terrace 1, Frederick Street 70, George's Road 78, Goodinge Road 107, Roman Road 118, Roman Road 32, St. James' Road (Factory) 132, St. James' Road 376, York Road Bakehouses not in use. 25, Cornelia Street (aboveground) 46, Roman Road (underground) 16, Sheringham Road „ 25, Wellington Road (underground) 92, Wellington Road ,, 214, York Road „ Highbury District. Bakehouses aboveeround. 17, Annette Road (Factorv) 53, Boleyn Road 10, Blackstock Road 202, Blackstock Road 225, Blackstock Road 112a, Drayton Park (Factory) 3, Highbury Park 232, Holloway Road 370, Holloway Road (Factory) 132, Holloway Road 56, Hornsey Road 100, Hornsey Road 154, Hornsey Road 123, Newington Green Road 190, Seven Sisters Road 258, Seven Sisters Road 210, Seven Sisters Road 48, Seven Sisters Road 226, St. Paul's Road 206 19101) Certified underground Bakehouses. 52, Balls Pond Road 156, Blackstock Road 146, Blackstock Road 128, Blackstock Road 66, Blackstock Road 64, Drayton Park 98, Gillespie Road Hawthorne Street Salvation Army Bakery (Factory) 13, Highbury Place 132, Holloway Road 246, Hornsey Road 57, King Henry's Walk 1 Mildmay Park 42, Newington Green Road 77, Newington Green Road Bakehouses not in use. 98, Balls Pond Road (underground) 77, Boleyn Road „ 182, Drayton Park „ 25, Lowman Road (underground) 2, Queen's Square „ Barnsbury District. Bakehouses aboveground. 129, Barnsbury Road 32, Bingfield Street (Factory) 36, Caledonian Road 170, Caledonian Road 275, Caledonian Road 59, Caledonian Road 199, Caledonian Road 40, Cloudesley Road 213, Copenhagen Street 57, Copenhagen Street 185, Copenhagen Street 112, Copenhagen Street Certified underground Bakehouses. 21, Barnsbury Road 68, Barnsbury Road ioo, Bemerton Street 72, Bemerton Street 60, Bingfield Street 44, Bingfield Street 76, Caledonian Road 159, Caledonian Road 370, Caledonian Road 299, Caledonian Road 27, Dennis Street 26, Half Moon Crescent 179, Hemingford Road 44, Northdown Street 12, Randall's Road 1 and 3, Richmond Road 52,.Stanmore Street 6, Wharfdale Road 62, Winchester Street Bakehouses not in use. 62, Barnsbury Street (underground) 12, Bemerton Street (aboveground) 19, Brooksby Street „ 334, Caledonian Road (underground) ax, Caledonian Road „ 96, Caledonian Road ,, 205, Copenhagen Street „ 181, Copenhagen Street ,, 29, Hemingford Road (Underground) 269, Liverpool Road ,, 279, Liverpool Road „ 123, Offord Road „ 29, Offord Road „ 44, Outram Street (aboveground) 86, Thornhill Road (underground) 120, York Road „ 207 [1910 South-East District. Bakehouses aboveground. 76, Baxter Road 229, Balls Pond Road 5, Charlton Place (Factory) 52, City Garden Row 38, Coleman Street 40, Cross Street 8, Danbury Street 226, Essex Road 172, Essex Road 361, New North Road 313, New North Road 126, Packington Street 20, Popham Road 50, Popham Road 69, St. Peter Street 84, St. Peter Street 230, Upper Street 137, Upper Street Certified underground Bakehouses. 24, Alfred Street 50, Arlington Street 257, Balls Pond Road 14, Charlton Crescent 55, Clephane Road 1, Cross Street 57, Essex Road 68, Essex Road 102, Essex Road 114, Essex Road 350, Essex Road 398, Essex Road 6, High Street 126, Liverpool Road 262, Liverpool Road 192, New North Road 263, New North Road 121, Packington Street 33, Park Street 16, Rheidol Terrace 32, Shepperton Road 1, Shepperton Road Oxford House, Sherborne Street 51, Southgate Road 1, Theberton Street West 14, Upper Street 102, Upper Street Bakehouses net in use. 28, Baxter Road (underground) 29, Camden Street ,, 30, Canonbury Street ,, 24, Church Street ,, 289, City Road „ 202, Essex Road „ 322,Essex Road (aboveground) 67,Essex Road (underground) 44, High Street „ 38, High Street „ 2, High Street (underground) 9, Islington Green (aboveground) 298, New North Road „ 32, Parkfield Street (underground) 76, St. Paul's Street „ 3, St. Paul's Street „ 107, Upper Street (aboveground) 129, Upper Street „ 51, Windsor Street „ 208 1910] Outworkers' Premises.- There were 2,114 outworkers' premises on the register, containing 2,114 workrooms, as contrasted with 1,850 premises in the preceding year, and with 1,831 in 1908, and 1,989 in 1907. There has, therefore, been an increase of 264 in the number of outworkers when compared with those of 1909, and of 125 on the return of 1907. Particulars as to the outworkers' premises are fully set out in Table 3 (page 212) of the returns required by the Secretary of State. The inspection of outworkers' premises is of prime importance, but the investigations of one of the female inspectors (Mrs. Young) prove that the list of trades, scheduled by the Secretary of State, is not sufficiently full, for it does not include those outworkers who are engaged in trades that have a close connection with food or confectionary. Her recent discovery in Islington of persons engaged in preparing certain sweets for market is proof of the fact. Indeed, so important did it seem to the Public Health Committee and to the Medical Officer of Health, that the matter was at once reported to the Home Office and the Local Government Board, who are believed to be about taking action in the matter. Mrs. Young's remarks respecting cigarette making and certain branches of confectionary work, are as worthy of attention as they are of importance, and it is, therefore, to be hoped that these trades will be placed before long among the scheduled trades by the Secretary of State, for it is clear that if they are carried on under present conditions, the articles which the outworkers prepare may be a serious danger to the public health. Mrs. Young, soon after her discovery, took advantage of the Whitsuntide holidays to visit Belgium, where she learned from the Minister of the Interior that his Government had then a Bill before the House of Representatives, which would enable him to schedule the trades of which she speaks. It is, therefore, not too much to hope that our Government will follow suit. Restaurant kitchens and places where food is prepared.—The total number now on the register is 746 kitchens, with 1,030 rooms. During the year 8 workshops with 9 workrooms were closed, while 16 with 21 workrooms were added to the register. In the preceding year there were 738 such places, with 939 rooms. It would be difficult to say how necessary the inspection of these places is for the protection of the public, for cleanliness in the preparation of food is all 209 [1910 important. Mrs. Young shows in her report that out of 417 workplaces where food is prepared, 80, or 19.1 per cent., were found to be unsatisfactory. It is not pleasant reading to find that the kitchens of 12 out of 91 hotels and restaurants were unsatisfactory, that those of 24 out of 137 coffee and dining rooms were in a similar state, and that 6 out of 24 refreshment or tea rooms were in a similar state, and that 15 out of 49 fried fish shops had to be dealt with. A complete list of these places, giving the number which were satisfactory, and the reverse, are given in her report. The state of the utensils was also inquired into, and it was found that in 60 cases they were unsatisfactory. The provision made for the storage of food was also inspected, with the result that the Inspector reports that it was unsatisfactory in 68 instances. Other matters, too, received attention, which Mrs. Young duly sets out in her report, which altogether is one of very considerable interest and value, but only one will be referred to here, and that is the necessity that exists that all refuse from restaurant kitchens, and all places where food is prepared, should be removed not less than twice every week. The Medical Officer of Health, however, will go further and say that the refuse of all premises should be so removed. He has long since reported in this direction, but his recommendation was defeated on the ground that the cost would be doubled, although the amount of refuse to be removed would be the same. He has always believed that some serious error was made at that time in the calculation, for his experience of eleven years in a great northern county borough (Sunderland), where he was responsible for the removal of refuse, enabled him to arrive at a very different conclusion. Workshops notified to H.M. Inspector.- Under the provisions of section 133 of the Factory and Workshop Act, the Medical Officer of Health, as soon as he becomes aware that any woman, young child, or person is employed in a workshop, shall forthwith send notice to the Inspector of Factories. During the year 127 such instances were notified in accordance with this section. p 210 1910] Workshops notified to Home Office, 1910. Trade. Number of Workshops. Protected Persons Employed, Females. Male Young Persons. Total. Dress Making 28 67 — 67 Blouse Making 20 52 — 52 Laundry 10 32 — 32 Millinery 7 13 — 13 Mantle Making 6 24 — 24 Tailoring 6 15 — 15 Tie Making 6 22 — 22 Skirt Making 3 5 — 5 Underclothing Making 4 7 — 7 Fur Work 4 12 — 12 Hair Work 1 2 — 2 Artificial Flower Making 2 2 — 2 Photographic Work 3 3 — 3 Rag Sorting 2 14 — 14 Leather Work 1 13 — 13 Fruit Preserving 1 40 — 40 Fancy Shade Making 1 4 — 4 Opera Cloak Making 1 1 — 1 Glass Cutting 1 3 — 3 Costume Alterations 1 1 — 1 Collar and Cuff Making 1 1 — 1 Postcard Painting 2 3 — 3 Mattress Making 1 3 — 3 Children's Frock Making 1 1 — 1 Trunk Making 2 7 2 9 Cycle Repairing 1 — 1 1 Wheelwright 2 — 1 1 Engineering 2 2 1 3 Shoe Making 5 — 5 5 Scale Making 1 — 2 2 Stick Mounting 1 — — — Total 127 349 12 361 211 [1910 SECRETARY OF STATE'S RETURNS on the administration of the Factory and Workshop Act. 1901, in connection with FACTORIES, WORKSHOPS. WORKPLACES. AND HOMEWORK. 1.—INSPECTION OF FACTORIES. WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 429 40 Nil Workshops (Including Workshop Laundries) 1,870 198 •• Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 2,324 17 •• Miscellaneous Re-inspections 6,381 362 •• Total 11,004 617 Nil 2.—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 490 505 Nil Nil Want of ventilation 19 20 „ „ Overcrowding 26 24 „ „ Want of drainage of floors 113 116 „ „ Other nuisances 449 413 „ „ Sanitary Accommodation insufficient 31 26 „ „ unsuitable or defective 502 491 „ „ not separate for sexes 8 5 „ „ Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) .. .. „ „ Breach of Special sanitary requirements for bakehouses (ss. 97 to 100) .. .. „ „ Other offences (Excluding offences relating to outwork which are included in Part 3 of this report) .. .. „ „ Total 1,638 1,600 Nil Nil *Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. P 2 212 1910] 3.-HOME WORK. NATURE OF WORK* Outworkers' Lists, Section 107. Inspections of Outworkers' Premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises. (Secs. 109, 110). Lists received from Employers. Addresses of Outworkers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served under Public Health Act, 1891. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Received from other Councils. Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Lists,† Outworkers.† Lists. Outworkers. Contractors Workmen. Contractors Workmen. (1) (2) (3) (11 (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) Wearing Apparel— (1) making, &c. 328 334 2 988 53 .. 204 2,969 1,454 .. .. .. 615 44 50 .. 12 .. .. (2) cleaning and washing .. 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Artificial Flowers 14 .. 164 30 .. 110 150 24 .. .. .. 58 2 1 .. 4 .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sacks .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and Upholstery 6 .. 16 10 .. 2 2 .. .. .. .. 6 .. .. .. .. .. .. Fur pulling .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c. 2 .. 2 2 .. 14 6 .. .. .. .. 12 .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper Bags and Boxes 4 .. 46 38 .. 159 140 50 Nil Nil Nil 200 28 16 Nil 1 Nil Nil Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brush making 6 .. 26 14 .. 20 56 4 .. .. .. 40 2 3 .. .. .. .. Racquet and Tennis Balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Stuffed Toys 4 .. 12 .. .. .. 4 .. .. .. .. 6 .. .. .. .. .. .. File making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Electro Plate 2 .. 2 2 .. 7 6 .. .. .. .. 6 .. .. .. .. .. .. Cables and Chains 2 .. 6 1 .. 3 3 .. .. .. .. 3 .. .. .. .. .. .. Anchors and Grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart Gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, Latches and Keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 368 538 3,262 150 .. 519 3,336 1.532 .. .. .. 946 76§ 70§ .. 17 .. .. *When an occupier gives out work of more than one of the classes specified in column 1, ana subdivides his list in such a way as to show the number of workers in each class of work, the list is included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers are assigned in columns 3 and 4 (or 6 and 7) into their respective classes. †The figures given in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. §76 instances of unwholesome premises because of unsatisfactory domestic conditions; 70 instances of unwholesome premises because of statutory nuisances (Public Health Act, 1891.) 213 [1910 4— REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses may be enumerated here. Workshops where men are employed 530 Workshops where women are employed 785 Laundries 114 Bakehouses 253 Restaurant kitchens 746 Total Number of Workshops on Registers 2,428 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 127 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspector. 2 Other Nil. Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 98 Mr. WEST'S REPORT. Town Hall, Upper Street, Islington, N. 29th March, 1911. To the Medical Officer of Health. Sib, I have pleasure in herewith submitting to you my report for the year ending the 1st January, 1911. During such time I have made 4,270 visits to the various places of business (factories, workshops and workplaces) on the register. I have made 2,021 inspections 214 1910] and 2,249 re-inspections. The visits to the various trade premises were as follows:—214 factories, 936 workshops, 229 workplaces, 474 bakehouses, 168 outworkers' premises, and 2,249 miscellanous. Artificial florists 3 Marquetrie workers 3 Automatic machine maker 2 Marking-ink maker 1 Bakehouses 253 Mineral water sundries 1 Builders, etc. 9 Marble masons 3 Blacksmiths 7 Metal workers 2 Basket makers 1 Musical instrument maker 1 Blind makers 3 Motor works 11 Brush makers 6 Musical string makers 2 Bamboo cane workers 4 Mantle makers 5 Balloon maker 1 Naturalist 1 Billiard table maker 1 Optician 1 Brawn maker 1 Organ builder 1 Boot polish maker 2 Pianoforte makers 34 Brace maker 1 Provision dealers 1 Bust maker 1 Plaster clock makers 2 Confectioners 7 Plumbers 3 Cycle makers 11 Picture frame makers 11 Cabinet makers 31 Perambulator makers 2 Coppersmith 1 Photographers 5 Camera bellows maker 1 Picture post-card printer 1 Cardbox-box makers 6 Paper sorter 1 Cap makers 2 Pea packer 1 Claypipe makers 1 Rag sorters 8 Cork cutter 1 Rubber workers 4 Cattle food maker 1 Scale makers 3 Coopers 2 Shoemakers 135 Cloth shrinker 1 Sun dial maker 1 Corset maker 1 Sealing wax maker 1 Carpenters 5 Saddle-tree maker 1 Coach painters 4 Scientific instrument makers 6 Dairy-can maker 1 Stove makers 2 Dentist 1 Soap maker 1 Engineers 9 Stick mounter 3 Exhibition stall fitters 3 Scene painter 1 Embroider 1 Sign writers 4 Enamellers 2 Shop fitter 1 Farriers 26 Sealing wax maker 1 Furriers 45 Surgical appliance makers 3 Fancy brooch maker 1 Stationer 1 Feather dressers 3 Seat makers (Patent) 1 Fire escape maker 1 Trunk makers 9 Fish cleaner 1 Tailors 59 File cutter 1 Tarpaulin maker 1 Fish curers 2 Tinsmiths 3 French polisher 1 Ticket writers 6 Fancy goods makers 2 Tea sifters 2 215 [1910 Flour merchants 2 Toy makers 4 Gun makers 2 Undertakers 2 Glove maker 1 Umbrella maker 1 Gilder (card edge) 1 Umbrella and stick handle maker 1 Glass engravers 2 Upholsterers 9 Gas-mantle maker 1 Wire mattress maker 1 Glass worker 1 Wheelwrights 38 Harness makers 8 Wood choppers 6 Hat shape makers 3 Watch makers 8 Hair work 2 Wire workers 2 Incubators 1 Wood letter maker 1 Japanner 1 Wreath case maker 1 Leather goods 7 Wax figure maker 1 Ladder makers 2 Total 935 Limelight works 1 Lamp makers 3 Laundries 2 Sanitary Improvements.—During the year I have served 179 notices for the abatement of nuisances, 184 workshops have been cleansed and lime whited, 23 w.c.'s have been provided (14 for males and 9 for females) at various workshops, whilst 440 other improvements were carried out under my supervision. Also 48 workroom cards were distributed showing the cubic capacity and the. number of employees allowed in each workroom. There were in addition 40 water supplies provided. Bakehouses.—At the close of the year there were 253 bakehouses on the register. 1 have made 474 inspections of these premises in addition to a number of other visits. I have also reported through you to H.M. Inspector of Factories, as required by Section 27 of the Public Health Act, 1891, the addresses of 27 workshops where young persons under the age of 18 years were employed, and where the Abstract of the Factory Act was not affixed Register.—During the year, 80 workshops have been added to the Register, whilst 96 have been removed, so that at the close of the year there were 935 workshops containing 1,358 workrooms and 68 outworkers' premises on the Register. I am, Sir, Your obedient servant, GEORGE WEST, Sanitary Inspector of Workshops, etc. Mrs. YOUNG'S REPORT. Town Hall, Upper Street, N. 2nd February, 1911. To the Medical Officer of Health. Sir,— Herewith I have pleasure in submitting to you a report of the work done by me during the year ending December 31st, 1911. 216 1910] The total number of inspections and calls made were as follows:— Inspections of Hotel and other Kitchens where food is prepared 497 Outworkers' premises 946 Re-inspections and calls 2208 3,651 296 intimation notices were served to cover 637 sanitary defects; also 3 statutory and 42 intimation courtesy notices. 248 letters were sent to employers who failed to forward lists of their outworkers; and 229 workshop cards, specifying the cubic space of the workrooms, were delivered. Hotel and. other Kitchens.—At the beginning of the year there were 738 kitchens, with 1,018 workrooms registered. During the period under report 8 workshops with 9 workrooms have been closed, and 16 workshops with 21 workrooms added to the register. The numbers now registered therefore are 746 workshops with 1,030 workrooms. I he following is a brief summary of the general conditions (satisfactory or other wise) found on inspection:— Satisfactory. Unsatisfactory. Hotels and Restaurants 91 12 Coffee and Dining rooms 137 24 Refreshment and Tea rooms 24 6 Fried Fish shops 49 15 Ham and Beef and Tripe 40 6 Stewed eels : eel pies 6 1 Oyster bars 2 0 Provision shops, selling cooked meats 68 16 417 80 Condition of utensils and storage and improvements effected:— Unsatisfactory. Improved. Utensils 60 30 Storage 68 38 552 sanitary defects were found in the kitchens and 547 remedied under the Public Health and other Acts, as follows :— Found. Remedied. Want of cleanliness 238 238 „ ventilation 6 7 Overcrowding 1 1 Want of, or defective bins 70 69 Defective and wet floors 68 68 Other nuisances 111 113 Sanitary accommodation insufficient 1 0 unsuitable or defective 19 20 not separate for sexes 1 1 Offences under the London County Council General Powers Act 37 30 552 547 217 [1910 The following tables show the comparative general conditions relative to the basement, ground floor, and upper storey kitchens when inspected in the years 1907, 1908, 1909 1910:— 1907— Total. Satisfactory Unsatisfactory. Percentage Unsatisfactory. Basement 88 41 47 50 per cent Ground floor 431 288 143 30 „ Upper storey 74 63 11 15 „ 1908— Basement 134 80 54 40 „ Ground floor 438 339 99 23 „ Upper storey 79 73 6 7 „ 1909— Basement 109 69 40 37 „ Ground floor 355 300 55 16 „ Upper storey 66 65 1 2 „ 1910— Basement 84 55 29 34 „ Ground floor 342 281 61 17 „ Upper storey 68 65 3 4 „ The basement kitchens show very little improvement in the numbers registered as unsatisfactory, because, as I mentioned in my previous report, the structural conditions prevent proper light and ventilation. In regard to the possible alteration of these premises I have given some consideration to the other parts of the house when making an inspection ; and it appears that at least 40 per cent, of them could be altered without serious inconvenience or expense to the owners and occupiers. There are, in some instances, upper floors at present disused, or merely used for storage purposes, that might be converted into kitchens at a comparatively small cost. In others a yard, or garden at the rear offers ample accommodation for the erection of a lean-to kitchen, well lighted and ventilated. In the remaining 60 per cent, the facilities for alteration are not so good as in the previous examples, though in no case does it appear impossible. But the responsibility of carrying this improvement into effect on a time limit of, say, three years, should fall upon the owners, with the necessary proviso that for the future no premises would be let for the purposes of preparation or storage of food for sale that were not structurally in compliance with the regulations laid down. I would respectfully submit to you that this is not the drastic and unnecessary alteration that it would appear to persons who are unacquainted with the facts. In my previous reports I have drawn attention to the very unsatisfactory conditions of these places, and can only add that as regards light and ventilation the men and women in them work under conditions that would not be tolerated in a well-ordered stable. In reference to the percentage of ground floor and upper storey kitchens reported unsatisfactory, the inspections made during the year have been chiefly those places previously unfavourably reported on, in preference to those places known to be clean and satisfactory. If these had been included there would have been a marked increase in the satisfactory number of upper storey kitchens. 218 1910] An effort has been made to get the floors of frying rooms in fried fish shops, and also the floors in basement kitchens rendered impervious by paving with cement concrete. The need for this received vivid illustration. A fish frying room had a wooden floor that had become defective, and the owner consented to replace it with cement concrete. On removing the boards the soil beneath was found to be alive with vermin, such as beetles, cockroaches, worms, etc., and there were also several rat runs. It appears that wherever a wooden floor allows the percolation of fat, rats will travel for a considerable distance to get to it. The question of refuse disposal remains in a chaotic condition. From the large hotels and restaurants refuse is removed, free of extra charge when desired, though no one resides on the premises, and the refuse accumulated is undoubtedly caused by trading. Hut in the small coffee shops, where possibly no one is employed, and two families occupy the premises, there is only a weekly clearance. As far as I can ascertain, in these cases any extra removal is charged for, and the occupiers prefer to keep the bins crowded to their utmost capacity. The small shops are in the poorest parts of the Horough, and the refuse accumulated stews and steams in the sun and rain with the most objectionable results. Not the least of the nuisances arising from these receptacles is the number of flies that infest their neighbourhood. In all my previous reports I have tried to draw attention to this serious and dangerous nuisance, and pointed out the necessity of a regular bi-weekly clearance from all places where food is prepared. May I now respectfully submit to you, that if at present, this is not practicable, it would be of great benefit if only carried out during the summer months, say from May to October inclusive. Owing to the use of gas cookers there is little opportunity of burning vegetable garbage, which accumulates in increased quantities during that period. I am convinced that it would be of service in preventing disease, especially summer diarrhoea, among young children. No further washing accommodation has been provided for the workers; therefore this section of the London County Council General Powers Act, which has laid down the regulation "that due cleanliness shall be observed by all persons employed in such places," is practically inoperative, having failed to compel the employers to provide the necessary conveniences. Outworkers' Premises.—The total number of names and addresses received during the year is as follows:— From employers in Islington 2,562 From employers in other districts per the Medical Officer of Health 3,193 5,755 The number of outworkers residing in the Borough at the beginning of the year was 1,850. Since then 417 have removed, and 681 names been added to the register. The total number of resident outworkers is now therefore 2,114, an increase of 264 over the corresponding period for the previous year, and the highest number yet registered. There is a steady increase in the numbers notified year by year, but this may be due to the systematic registration of firms and persons employing. If, however, the increase is caused by augmented numbers of workers it is a fair indication of better conditions of trade : the rule being to supply the indoor staff with work in preference to the outdoor. 219 [1901 There are probably many hundreds of outworkers employed in other trades than those scheduled; such as book-folders, cigarette makers, certain branches of confectionery, and other processes in which the preparation of food stuffs is involved. As at present the employers are not compelled to notify them, it is impossible to ascertain to what extent these industries are carried on as domiciliary businesses. In a series of regulations now before the Belgian Senate it has been deemed necessary to include them. As an additional reason for this measure it is believed that in certain branches the labour is of so unskilled a nature (labelling, wrapping, etc.) that there is a tendency to keep children employed, not only before and after school hours, but during attendance times, where it is possible to evade the law. An instance of the value of this registration in the prevention of the spread of infectious disease was brought to your notice during the year. In November I reported to you a case in which some widows' caps were returned to the factory by the homeworker, immediately on the doctor's diagnosis of scarlet fever, and before disinfection could be carried out. Having been exposed to infection prompt measures were taken to trace them, as they had already been sent from one warehouse to another. The matter was duly reported to you, and they were ultimately found in the dispatch department of a City house. The Public Health Authority at the Guildhall were informed by telephone and the caps and other articles with which they had been in contact disinfected. A similar case occurred shortly afterwards when two dozen hat shapes were traced to the City, and there disinfected on the receipt of your letter. In both these instances the work was returned to the factory before the visit of the District Inspector re disinfection, etc. It is therefore probable that if the premises had not already been registered as domicliary workshops nothing further would have been heard of the work and the infected goods would have been sold to the public. Seventeen cases of infectious disease occurred on the homeworkers' premises during the year. Disinfection was duly carried out in each instance under the supervision of the district inspector. The number of persons engaged in the trades scheduled are shown below:— Making of wearing apparel 4,936 Artificial flower making 342 Furniture and upholstery 12 Paper bags and boxes 322 Brush making 89 Stuffed toys 10 Electro plate 14 Umbrellas 21 Chain making 9 5,755 The general conditions under which homework is carried on in Islington remain fairly satisfactory. Out of 946 inspections made only 76, or 8 per cent, of the places visited were reported unsatisfactory because of the unwholesome domostic conditions. Seventy statutory defects, consisting of dirty walls and ceilings, defective w.c. accommodation and want of sanitary refuse bins were found and have been remedied. 220 1910] In reference to the domestic conditions it is noteworthy that the poorest homes are seldom the least satisfactory from this standpoint. Genuine poverty is rarely associated with squalor. Unfortunately to the uninitiated dirt is taken as a symbol of want, and deserving and needy persons and families who resolutely maintain a tidy cleanliness are passed over for the lazy and thriftless, whose chief asset is their neglected home and miserable children. This also applies to the homeworkers' premises. In those registered as unsatisfactory the income is as high, or even higher, than that of the majority of the workers. It is sheer lazy thriftlessness that causes the conditions found in these cases; and that appears to be undermining the whole of the lower working class life; nor (judging from the reports of teachers and employers of youths and girls), is it likely to be remedied by our present system of elementary education. It affects the economic conditions of the labour market as well as the home. Employers agree that it is a rare thing to get a boy or girl to stay in any situation where there is hard work to be done, or sustained effort required. The old saw that there is "no royal road to learning" receives confirmation here, for the drudgery of school work being removed and everything made as pleasant as possible, the results are similarly evanescent, while the children leave school apparently thoroughly imbued with the idea that all hard work and anything that calls for endurance is to be as rigorously excluded from life, as it was from the school curriculum. The girls go from factory to factory, without any sense of responsibility and drift into marriage (or not) in the same careless way, reproducing in their children a generation a little more shiftless than themselves. It is a serious problem that should be faced, but is seldom recognised and named for what it is. For this reason it has been a pleasure to visit some of the older women, who, trained in the school of necessity, and with only their own efforts to assist them, have yet upheld a respectable independence. There are hundreds of single women; and widows who have honorably maintained their children, and who, though now advanced in years, continue to work and keep a tidy home, and whose chief source of happiness lies in their sturdy independence. One woman of 68 has worked for one firm 52 years and continues to work, at the same time looking after her mother, an old woman of 94. Another having worked for one firm for 50 years was pensioned by her friends, but she still does a little to help an invalid sister. These are not exceptional cases; except perhaps in the length of time lived : they are typical of the women workers of the past generation. One regrets that the struggle was rendered doubly hard by the underpaid conditions that prevailed; but the doubt remains as to whether the swing of the pendulum towards avoidance of the difficulties is not too far in the other direction, judging from the evidence already quoted as to the powers of industry and independence shown by the rising generation. I am, Sir, Your obedient servant, (Mrs.) A. CATHERINE YOUNG 221 [1910 Miss DAVIES' REPORT. Town Hall, Islington, Afrit 21st, 1911. To the Medical Officer of Health. Sir, I beg to submit to you a report of the work done by Miss Brown during January and February, and by myself from May 10th to the end of the year 1910. During the year the following inspections and visits have been made :— Inspections of Factories 195 Inspections of Workshops 934 Inspections of Workplaces 30 Miscellaneous re-inspections and calls 1,924 Total 3,083 Register of Factories—There were on the register at the end of the year 193 factories as contrasted with 185 at the end of the previous year. The following is a list of the Factories and Steam-Laundries on the register. Industry. Number. Industry. Number. Laundry 47 Collar and Cuff making 1 Printing 17 Corset making 1 Box making 12 Curtain making 1 Book binding 9 Dental requisites making 1 Confectionery making 7 Frame making 1 Costume making 7 Glass letter making 1 Chemists' sundries making .. 6 Leather work 1 Dyeing and cleaning 6 Lock and key making 1 Cigar and cigarette making 5 Marquetrie 1 Engineering 4 Mirror making 1 Meat preserving 4 Musical roll making 1 Blouse making 3 Outdoor games making 1 Aerated water making 2 Pattern card making 1 Bakery 2 Photographic mount making 1 Blind making 3 Piano string making 1 Brushmaking 2 Pill making 1 Cabinet making 2 Publishing 1 Fur sewing 2 Sack making 1 Mangling 2 Sauce making 1 Mattress Making 2 Skirt making 1 Millinery 2 Slate making 1 Outfitting 2 Surgical appliances making 1 Polish making 2 Surgical leather work 1 Shoe accessories making 2 Syphon making 1 Toy making 2 Table stationery making 1 Apron making 1 Toothbrush making 1 Arc lamp making 1 Vinegar making 1 Beer bottling 1 Washing-powder making 1 Boot upper making 1 White lead works 1 Bottle making 1 Wicker work 1 Brewery 1 Wood cutting 1 Button making 1 — Capsule making 1 Total 193 222 1910] The work of the Sanitary Inspector in regard to factories deals only with the sanitary accommodation. The conveniences must be sufficient for the numbers employed, separate for the sexes, kept in a cleanly condition, adequately ventilated, easily accessible and, if for females, provided with proper doors and fastenings. These requirements being defined by the Sanitary Accommodation Order, 1903. The number of conveniences was sufficient in all, except two, of the factories in the Borough, and in both of these cases the number of employees has been reduced so that the accommodation is now adequate. In one factory the approaches to the convenience for the men and the women were not separate, but this was promptly remedied when the attention of the occupier was drawn to the fact. The condition of the conveniences, as regards cleanliness, was not very satisfactory. In one factory the six w.c.'s for females were in a particularly disgusting condition, and a letter was sent to the owner in addition to the usual notice. The cleansing of the conveniences is carried out by either a person especially appointed to do this work or in turns by the younger employees. The former plan is usually associated with satisfactory conditions. Under proper supervision the second course is excellent and has a high educational value, as the girls are taught what constitutes cleanliness in these matters and how to effect and maintain it. Any factories which have been visited and which had not been previously inspected by His Majesty's Inspector of Factories were at once notified to the Home Office, and these are not included in the number of workshops so notified under Public Health (London) Act, 1891 (Sec. 27). As the Local Authority is held responsible for the inspection of the sanitary accommodation of factories, it would seem advisable that future legislation should provide for the notification of factories to the Local Authority in the same manner as the present law requires the notification of workshops. Register of Workshops.—At the end of the year 1910 there were 785 workshops and 114 laundries, comprising 1,448 workrooms, on the register. During the year 113 workshops and 9 laundries had been added, while 185 workshops and 23 laundries had been removed. The following is a list of the trades carried on in the various workshops:— Nature of business. Number of Workshops. Number of Workrooms Dressmaking 244 307 Laundries 114 287 Millinery 79 154 Fur sewing 58 74 Tie making 39 42 Mantle making 38 59 Tailoring 37 46 Blouse making 36 72 Underclothing making 19 24 Rag sorting 12 19 Artificial flower making 10 28 Children's frock making 10 11 Leather goods making 9 14 Box making 8 22 Embroidery 8 14 228 [1910 Nature of business. Number of Workshops. Number of Workrooms. Photographic work 8 16 Waistcoat making 7 8 Feather dressing 6 8 Trunk making 6 8 Corset making 5 8 Fancy goods making 5 7 Boot and shoe work 4 6 Dressing gown making 4 5 Hair work 4 9 Waterproof making 4 8 Cap making 3 7 Confectionery making 3 8 Costume alterations 3 3 Firewood cutting 3 3 Frilling making 3 5 Jet and sequin work 3 3 Shirt making 3 4 Umbrella making 3 3 Underskirt making 3 3 Wig making 3 3 Apron making 2 3 Artists' brush making 2 3 Baby linen making 2 3 Boot polish making 2 2 Braces making 2 5 Chemists' sundries manufacturing 2 7 Cushion making 2 2 Drug packing 2 2 Electrical engineering 2 2 Evening cloak making 2 3 Fancy shade making 2 2 Glass work 2 2 Hosiery 2 2 Ink making 2 3 Paper sorting 2 3 Postcard painting 2 2 Trousers' making 2 2 Upholstery 2 6 Back support making 1 1 Balloon making 1 1 Bath glove making 1 1 Bed couch making 1 1 Blind making 1 1 Bonnet shape making 1 1 Bottle washing 1 2 Buttonhole making 1 1 Camera bellows making 1 1 Candle shade making 1 1 Collar and cuff making 1 3 Cork cutting 1 2 224 1910] Nature of business. Number of Workshops. Number of Workrooms. Decorative glass work 1 1 Doll dressing 1 1 Dolls' hair curling 1 7 Dressmakers' stand making 1 1 Dyeing and cleaning 1 1 Fancy ornament making 1 1 Fruit preserving 1 1 Funeral furnishing 1 1 Fur muff making 1 2 Gelatining 1 1 Class etching 1 1 Glass painting 1 1 Gold beaters skin preparing 1 4 Hassock making 1 1 Hat-shape making 1 2 Japanning 1 1 Jewel case making 1 1 Kitchen jacket making 1 1 Lace work 1 1 Limelight making 1 I Making of syphon sundries 1 3 Metal sorting 1 1 Mineral waters making 1 1 Musical string making 1 2 Needlecase making 1 2 Pelisse making 1 1 Perambulator hood making 1 2 Piano key covers making 1 1 Pickling 1 1 Purse making 1 4 Pyjamas making 1 2 Scientific instrument making 1 1 Sausage skin making 1 2 Stall making 1 1 Stationery manufacturing 1 2 Surgical appliances making 1 4 Surgical furniture making 1 1 Surgical instrument making 1 1 Surplice making 1 2 Swansdown sewing 1 1 Theatrical costume making 1 1 Tent making 1 1 Ticket fastening 1 1 Toy making 1 2 Valentine making 1 3 Wax figure making 1 4 Wreath case making 1 2 Total 899 1,448 225 [1910 The general condition of the workshops in this Borough appears to be good. Satisfactory hygienic conditions in this branch of sanitary work must have an appreciable effect in raising the standard of public health when it is considered that in this Borough alone about 11,(XX) women are employed in registered factories and workshops. As the centre of women's labour becomes transferred more and more from the home to the workshop, so this work increases in importance. There are a considerable number of basement workrooms on the register, but the majority of these are well lighted and ventilated, although in a few cases the amount of light is not satisfactory. If similar legislation to that governing underground dwellings was enacted for underground workshops, many improvements in their condition could be carried out. Two underground workrooms were found extremely unsatisfactory, but in both cases the occupiers were persuaded to remove to rooms on a higher floor. The exodus of many businesses from the main thoroughfares to what were formerly the purely residential districts of the Borough, although probably somewhat detrimental to the value of property in those districts, has been of great benefit to the workers, as many of these houses contain large, lofty, well-lighted rooms, which make almost ideal workrooms with most pleasant outlooks on quiet streets or green gardens. The majority of the owners and occupiers of workshops appear to realise that a standard of good sanitary conditions is required by legislation and enforced by the public health authority and endeavour to comply, without compulsion, with the conditions which are certainly not extravagant in their demands. Many of the nuisances found are caused by the employees themselves. They are still extremely distrustful of an open window and are very careless and destructive in their use of sanitary fittings. There appears to be a considerable demand for capable women workers. The more intelligent girls are now entering offices, where the shorter hours are more attractive. These girls were of the type which rose to be forewomen and manageresses and their loss is felt in the dressmaking and millinery workrooms. It is hoped that this demand will lead to increased wages being paid to skilled employees in these and similar trades. The number of workshops has decreased during the year. The number of workshops closed is not much greater than in the previous year, but there has been a large decrease in new workshops. This was probably due in some degree to the severe depression suffered by many trades during the summer and autumn seasons following the death of the late King. Workplaces.—Thirty work-places were inspected during the year. These were all receiving offices for laundries. The number employed in each place is usually limited to one or two, although one receiving offices gives employment to eleven girls, and five rooms are in use for sorting and packing. Arrangements for sanitary accommodation have been made in connection with all these workplaces, but several of them were unprovided with any satisfactory means of heating. Letters were sent to two firms drawing their attention to these conditions. Cleanliness.—During the year 84 workshops were found to be in a dirty condition and 83 premises were cleansed, upon instruction, during that time. Many of the workrooms are lime-washed each year, and in some trades (e.g., laundry work), it is necessary, but the time elapsing between this cleansing in most workrooms is three years. In fact there is a popular fallacy current among employers that the law demands a triennial papering, painting or limewashing. No period is specified in legislation regarding workshops (other than bakehouses), but as three years usually meets the requirement, this fallacy may as well remain in circulation. R 226 1910] Overcrowding.—There is a marked increase in the number of workshops which were found overcrowded during the year, rising from 8 in 1909 to 24 in 1910. In each case the number in the room was one above that allowed under the Factory and Workshop Act. The additional person was usually the "city girl" who is only in the workroom for portions of the day; nevertheless the premises must be considered overcrowded under these circumstances, as while she is in the room she is a person requiring 250 cubic feet of space, otherwise her presence is detrimental to the well-being of the other workers. Ventilation.—Insufficient means of ventilation were found in 5 cases during the year and additional ventilation was provided for 8 premises. Comparatively few workrooms are fitted with mechanical ventilating appliances. In the small workrooms they are unnecessary as the natural means of ventilation {e.g., windows, chimneys) if properly used are sufficient, and are of greater educational value to the workers. If the employees become accustomed to open windows in their workrooms it is more probable that they will continue the custom in their homes. Sanitary Accommodation.—During the year 3 instances of insufficient accommodation, 95 of closets in a foul condition, 76 of unsuitable or defective closets, and 3 of closets not kept separate for the sexes were found. During that period one nuisance arising in premises from insufficient accommodation was remedied, 95 closets were cleansed, 71 were repaired and separate approaches to the conveniences used by the sexes were made in one case. Miscellaneous defects.—These cover a wide range of nuisances such as defective floors, walls and ceilings, dampness, low temperature, etc. During 1910 the number found amounted to 87, and 85 were remedied before the close ot the year. Any defective drainage, together with any nuisances which came under my notice more directly connected with the residential portions of the premises visited, were referred to the inspector of the districts in which the premises were situated. Workroom Cards.—During the year 298 cards have been distributed to the occupiers of workshops, specifying the number of cubic feet in each workroom and the number of persons allowed to occupy such room during ordinary working hours and during overtime. Notices.—Intimation notices have been served with respect to 68 premises, these consisting of 12 factories, 54 workshops and 2 workplaces. One statutory notice was served, but not enforced as the factory became empty and has not since been occupied. As may be seen from the figures with the majority of nuisances it is unnecessary to serve a notice, the defects being remedied upon verbal instruction. Workplaces notified to Home Office.—During the year 100 names and addresses, together with the number of protected persons employed, have been forwarded to the Home Office. These are workshops where no Abstract of the Factory and Workshop Act was affixed or which had not been visited by H.M. Inspector of Factories. It is quite a small minority of occupiers who notify the occupation of a workshop to the Home Office, so that there are probably still a considerable number of unregistered workshops in the Borough, as many trades are carried on in dwelling-houses with no exterior indications that they are business premises. If these occupiers also abstain from advertising for employees there is every prospect of the workrooms remaining undiscovered. It would seem advisable that 227 [1910 defaulters under the section of the Factory and Workshop Act requiring occupiers to give notice within one month after commencement of occupation of a workshop should be more frequently penalised than has hitherto been the case. I remain, sir, Your obedient servant, M. GWYNETH DAVIES, Sanitary Inspector of Workshops. INSPECTION OF HOUSES LET IN LODGINGS. The inspection of these houses is undertaken by Inspectors Ward and Hancock, who made 11,080 inspections, re-inspections and calls to them. The total number of houses on the lists which it is the duty of the inspectors to visit is 1,009, and as they inspected 1,579 houses, it follows that each house was inspected on the average 1.3 times, while the visits made to each house to see that work required to be done was carried out, averaged 9.4. Altogether 952 notices, of which 800 were intimations and 92 statutory notices, were served on the owners or occupiers, and reference to 3,332 nuisances found in 1,343 houses. Synopsis of Inspector's Work.—In abating the nuisances the work set forth below became necessary:— Drains reconstructed 6 „ repaired 14 „ traps supplied to 47 W.C.'s., extra provided 4 „ amended 45 „ water supply provided 290 Dustbins provided 95 „ repaired 6 Yards paved or re-paved 31 Water supply.—Cisterns (new) provided 1 „ Cisterns, repaired and cleansed 57 Water supply provided 46 Rooms cleansed and limewashed 1043 Walls and passages repaired, cleansed or limewashed 197 Floor space ventilated 7 Floors repaired 66 Overcrowding abated 85 Verminous rooms disinfected, &c. 8 Roofs repaired 138 Other improvements or nuisances abated 1146 228 1910] HOUSES LET IN LODGINGS. Table CXI. Summary of Sanitary Work carried out under Inspectors Ward and Hancock in Houses Let in Lodgings during the year 1910, Inspector Ward. Inspector Hancock Tota1. 1st Quarter 2nd Quarter. 3rd Quarter. 4th Quarter. Year. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Number of Houses inspected 118 150 104 114 486 259 286 284 264 1,093 1.579 Re-inspections, Calls made, etc. 884 963 852 1,088 3,787 1,452 1,427 1,315 1.520 5,714 9,501 Total inspections and calls 1,002 1,113 956 1,202 4,273 1,711 1,713 1,599 1,784 6.807 11,080 Notices Served. Intimation Personally 24 22 8 17 71 97 80 104 83 364 435 By Post 29 32 27 29 117 73 07 79 89 308 425 Statutory Personally .. .. .. 8 11 2 7 28 28 By Post .. 7 7 16 12 11 18 57 64 Improvements. Drains— Constructed .. .. .. .. .. .. .. .. .. .. .. Re-constructed 2 .. .. .. 2 .. 3 1 .. 4 6 Repaired .. 2 .. 1 3 3 4 3 1 11 14 Ventilated .. .. .. .. .. .. 1 .. .. 1 1 Gully and other Traps fixed .. .. .. 2 2 3 12 10 20 45 47 Urinals— Water supplied—cleansed .. .. .. .. .. .. .. .. .. .. .. Cesspools— Abolished .. .. .. .. .. .. .. .. .. .. .. Water Closets— W.C. erected with pan, trap and water supply 1 1 .. .. 3 .. .. 1 .. 1 4 Pan and trap only provided 7 6 2 6 21 1 3 2 7 13 34 Water supply provided 33 54 51 41 179 39 15 29 28 111 290 Ventilated .. .. .... .. .. .. .. .. .. .. .. Position altered 11 .. .. .. 11 .. .. .. .. .. 11 Dust Bins— Provided .. 8 7 6 21 20 10 15 29 74 95 Repaired .. .. .. 2 2 4 .. .. .. 4 6 Areas— Constructed .. .. .. .. .. .. .. .. .. .. .. Yards— Paved .. .. .. .. .. 1 .. .. .. 1 1 Re paved 3 3 3 8 17 2 1 2 8 13 30 Sinks— Provided .. .. 3 .. 3 .. .. 7 17 24 27 Domestic Water Supply— Cisterns provided .. .. .. .. .. 1 .. .. .. 1 1 Cisterns repaired and cleansed 10 10 10 .. 30 2 15 .. 10 27 57 Water supply provided to dwelling house 1 .. .. 1 2 2 .. .. .. 2 4 Water supply provided for tenement house .. 2 .. .. 2 7 10 6 17 40 42 Other Improvements— Rooms cleansed or limewashed 42 122 133 100 397 22 418 127 79 646 1,043 Walls and passages repaired, cleansed and whitewashed 27 50 12 13 102 .. 69 19 7 95 197 Floor space ventilated 1 .. 2 2 5 .. .. 1 1 2 7 Floors repaired 17 10 19 9 55 2 .. .. 9 11 66 Roofs repaired 19 19 31 12 81 10 7 12 28 57 138 Overcrowding abated 4 7 6 3 20 13 20 13 19 65 85 Illegal use of underground rooms for sleeping discontinued .. .. 2 .. 2 3 .. 1 4 8 10 Other Improvements or Nuisances abated 119 113 126 130 488 180 142 121 177 620 1 108 Rooms Disinfected .. .. .. 1 1 4 3 .. 7 8 Total Improvements 298 407 407 337 1,449 315 734 373 461 1,883 3,332 Total Premises Improved 153 179 133 161 626 170 230 133 184 717 1,343 229 [1910 DISTRICT INSPECTION. The work performed by the district inspectors represents as usual a very large number of inspections; indeed, the total inspections and visits to premises numbered 66,365, and related to 5,576 houses in which 17,105 sanitary improvements of one kind and another were effected. The premises visited included ice-cream shops, factories, dairies and milkshops, stables, yards, manure depots, vacant land, passages and courts, urinals attached to publichouses, and premises for which certificates under the Customs and Inland Revenue Acts were required, as well as those for which certificates as to the water supply were demanded. They also made 252 smoke observations; and in addition they inspected many thousands of shops, stalls, and markets on Saturday evenings for the detection of unsound food, which, however, are not set out separately in the returns. House to House Inspections.—934 houses were inspected as the result of house to house visitation. Much trouble has again been experienced in this class of work, especially where it happens that the houses are owned by the people living in them. They resent the interference of an inspector, no doubt owing to the expense he may be compelled to put them to in causing them to amend sanitary defects. There was an increase of 151 in the number of house to house visitations, although it is considerably below the number inspected in 1908. The fact is that owing to the large increase of the duties devolving on the inspectors, it is not possible for them to pay that attention to house to house inspection that is necessary. Synopsis of the Inspector's Work.-The following statement gives a brief synopsis of the district inspectors' work:— House to house inspections 934 Other inspections of dwelling houses 4,928 Re-inspections and calls made 54,467 Visits of inquiry re notifiable infectious diseases 1,525 „ school cases of „ 6,077 Butchers' shops, stalls, etc. (Saturday nights) 339 Ice cream shops and factories 136 Dairies and milkshops 2,113 Stables and yards 2,108 Manure depots 82 Certificates under the Customs and Inland Revenue Acts 71 Water certificates for newly erected houses or flats 41 Smoke observations 252 280 1910] Notices Served.—There were 2,517 intimation notices served by the inspectors with respect to nuisances, of which l,766 were delivered personally and 751 by post. In 387 instances it became necessary, as the intimations had not been attended to, to report the nuisances to the Public Health Committee, who ordered statutory notices to be served, of which 113 were delivered personally, and 274 by registered letter post. Nuisances Discovered.—The subjoined list of the principal nuisances discovered speaks for itself as to the character and utility of the work that has been carried out. It contrasts favourably with the record of previous years:— Houses. Dirty 794 Damp 202 Out of repair 359 Water Closets. Foul 415 Without water supply 150 With deficient water supply 209 Improperly constructed 359 Defective 321 Stopped 85 Improperly situated 24 Insufficient external ventilation 42 Insufficient in number 94 Soil Pipes. Defective 132 Unventiiated 99 Improperly ventilated 120 Yards. Improperly paved 617 Dirty 80 Undrained 21 Drains. Foul 25 Defective 748 Chocked or stopped 273 Unventilated 183 Overcrowding 97 Underground Rooms 83 Other Nuisances 4,981 Total Nuisances 10,513 231 [1910 NOTICES SERVED FOR THE ABATEMENT OF SMOKE NUISANCES DURING 1910. Black Smoke having been observed issuing from the chimneys of the undermentioned premises, notices were served on the owners of the business requiring its abatement. 82, York Road. Ink Factory, Gillespie Road. Mayfield Laundry, Gillespie Road. Smethurst's Laundry, 91a, Fonthill Road. 166-170, Holloway Road. Highbury Brewery, Holloway Road. 114, Duncombe Road. Lighting Station (G.N.R.), Drayton Road. Potted Meat Factory, Brewery Road. Hobbs Hart, Arlington Street. 132, Holloway Road. Green's Factory, Dagmar Terrace. Thorley's Factory, All Saints Street 16, Rheidol Terrace. SYNOPSIS OF THE DISTRICT INSPECTORS' SANITARY WORK FROM 1891 to 1910 (20 years). Houses inspected and visited 1,181,844 Drains Constructed - 20,694 „ Improved and repaired 17,288 „ Traps fixed 98,343 Water closets, pan, trap, etc., furnished 21,598 „ Pan and trap only, furnished 19,670 „ Water only, furnished 8,482 Soil pipe, defective, renewed or remedied 4,012 „ Insufficiently ventilated, fully ventilated 3,491 ,, Unventilated, ventilation supplied 5,897 Dust Bins, Provided 17,455 „ Repaired 3,942 Surface drainage, Constructed 11,930 „ Relaid 23,621 Water supply, new cisterns provided 4,319 ,, Cisterns repaired and cleansed 11,873 „ New supply 7,439 Houses generally Repaired 9,455 „ Cleansed 17,579 „ Ventilated 13,434 Other Improvements 137,231 Total Improvements 457,753 232 1910] Table CXII. Showing summary of Sanitary Work from Inspectors' reports for the Year 1910. DISTRICTS. Totals. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 House to House Inspections 125 13 100 46 18 58 114 73 74 93 149 40 9 22 934 Other premises inspected 360 403 201 328 219 404 321 310 491 330 432 511 203 415 4928 Re-inspections, Calls made, etc. 4012 4005 3536 3382 3868 3464 4521 4628 3597 3615 4495 3978 2313 5053 54467 Ice Cream Factories inspected 10 13 15 12 4 .. 6 10 10 20 21 10 .. 5 136 Dairies and Milkshops ,, 127 135 99 256 146 78 159 157 153 89 271 269 86 88 2113 Stables ,, 59 17 21 59 167 98 47 11 7 24 26 11 6 56 609 Yards ,, 44 109 327 56 117 176 123 38 91 196 51 90 30 51 1499 Manure Depots ,, 82 .. .. .. .. .. .. .. .. .. .. .. .. .. 82 Vacant land, Passages and Courts inspected 7 1 33 8 .. 3 33 6 1 24 28 15 20 4 183 Urinals attached to P.H.'s inspected 14 44 51 46 184 47 46 22 23 154 61 1 .. 18 711 Premises (re Certificate Customs and Inland Revenue Acts) inspected .. 20 13 .. 5 15 1 .. 12 .. .. .. .. 5 71 Premises (re Water Certificates) inspected .. .. 1 .. .. 18 .. 2 7 .. .. 6 .. 7 41 Smoke observations 10 31 5 27 7 2 14 .. 25 34 33 51 5 8 252 Shops, Stalls and Markets (Saturday evening) 26 25 21 19 25 26 27 26 26 24 34 23 13 24 339 Total Inspections and calls 4876 4816 4423 4239 4760 4389 5412 5283 4517 4603 5601 5005 2685 5756 66365 Notices Served. Intimation—Personally 282 36 86 147 64 15 197 178 151 30 242 76 38 224 1766 By Post 2 12 3 5 1 5 147 39 .. 1 12 267 84 173 751 Statutory—Personally 7 1 1 20 1 1 9 2 10 2 6 15 6 32 113 By Post 19 6 9 30 33 11 12 25 8 31 12 24 14 40 274 Improvements. Drains— Constructed l 1 1 4 3 4 3 .. 3 2 1 4 1 7 35 Re-constructed 56 47 42 41 40 26 76 64 25 52 11 39 43 44 606 Repaired 45 8 23 39 22 34 14 19 37 27 57 25 18 49 417 Ventilated 35 45 26 27 34 16 60 57 23 41 17 29 28 46 484 Gully and other traps fixed 302 263 144 182 196 105 450 292 148 234 52 184 153 314 3019 Urinals—Water supplied, cleansed 8 .. 5 6 .. 1 9 2 5 10 5 .. .. 4 55 Cesspools—Abolished .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Water Closets— W.C. erected with pan, trap and water supply 9 7 3 7 4 4 3 1 4 2 1 7 5 7 64 Pan and trap only provided 93 91 69 69 62 36 125 126 42 86 41 53 52 101 1046 Water supply provided 30 44 5 26 25 11 30 17 33 38 33 27 20 65 404 Ventilated 5 .. 2 3 1 3 3 4 .. 6 5 1 1 11 45 Position altered 1 .. 6 2 .. 2 .. .. 1 1 2 .. 1 1 17 Dust Bins—Provided 114 69 27 82 73 8 131 93 91 121 148 90 32 147 1226 Repaired 7 .. .. 1 3 4 1 1 1 2 7 1 .. 2 30 Areas— constructed .. .. .. .. 1 6 1 .. 1 1 1 .. .. 5 16 Yards—Paved 7 4 23 10 3 6 8 15 8 21 5 15 .. 21 146 Re paved 97 69 29 80 76 31 138 101 55 52 89 77 49 109 1052 Sinks—provided 40 22 1 16 12 6 17 21 42 34 24 46 25 54 360 Domestic Water Supply— Cisterns provided 7 .. 1 1 2 .. 3 .. 1 .. .. 1 .. 1 17 Cisterns repaired and cleansed 43 31 22 61 25 16 36 10 12 32 85 135 12i 55 478 Water Supply provided to dwelling house 26 23 6 18 4 3 5 36 12 30 17 22 10 15 227 Water supply provided for tenement house 88 15 1 19 17 6 21 2 35 50 44 41 15 63 417 Other Improvements— Rooms cleansed and limewashed 60 77 44 113 33 113 100 40 128 48 210 182 113 232 1493 Walls and passages repaired, cleansed and whitewashed 6 14 6 36 6 8 16 12 17 9 135 54 23 63 405 Floor space ventilated 2 4 8 25 .. 6 7 8 3 2 14 15 9 9 112 Floors repaired 15 13 21 32 13 26 33 12 15 9 46 35 25 43 338 Roofs-repaired 35 24 16 44 17 17 40 13 25 18 77 65 23 37 451 Overcrowding abated .. 1 .. 2 1 10 3 2 3 4 9 9 1 15 60 Illegal use of underground Rooms for sleeping discontinued .. .. .. .. .. .. .. .. .. .. 23 .. 1 5 29 Other Improvements, or Nuisances abated 180 140 60 177 91 142 155 68 178 180 220 217 107 370 2285 Rooms Disinfected 143 215 67 128 171 75 87 81 146 89 100 182 131 155 1770 Total Improvements 1455 1230 658 1251 935 725 1576 1097 1094 1201 1479 1456 898 2050 17105 Total Premises Improved. 510 392 234 429 316 206 443 299 436 415 629 479 271 517 5576 233 [1910 Table CXIII. Giving a Summary of the Nuisances discovered by the District Sanitary Inspectors during the Four Quarters and for the Year 1910, for the abatement of which notices were served. nuisances. quarters. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. 1. The house or part of the house in a dirty condition 157 230 199 208 794 2. ,, ,, in a damp condition .. 60 45 46 51 202 3. ,, in a dilapidated condition 59 94 90 116 359 4. The inlet of surface drain improperly trapped 32 43 22 17 114 5. The water-closet so foul as to be a nuisance 127 92 115 81 415 6. ,, ,, without a water supply 42 28 34 46 150 7. ,, ,, with a deficient supply of water 68 51 47 43 209 8. ,, ,, improperly, constructed so as to be a nuisance 114 103 83 59 359 9. „ ,, so defective as to be a nuisance 90 78 76 77 321 10. ,, ,, stopped 22 19 21 23 85 11. ,, „ placed in an improper position 4 5 7 8 24 12. Insufficient external ventilation to water-closets 17 8 8 9 42 13. Insufficient water-closet accommodation 15 26 27 26 94 14. The soil pipe defective 37 47 28 20 132 15. „ unventilated 33 31 15 20 99 16. ,, improperly ventilated 40 35 21 24 120 17. The yard in a condition injurious to health by reason of the want of proper paving 189 115 136 177 617 18. The yard dirty 22 20 13 25 80 19. ,, undrained 11 2 2 6 21 20. A gully trap improperly placed within the house 37 55 47 40 179 21. The waste pipe of sink directly connected with the drain 22 21 15 13 71 22. „ „ improperly trapped 8 7 5 3 23 23 „ „ untrapped 120 123 134 134 511 24. ,, of lavatory directly connected with the drain 3 4 1 4 12 25. ,, improperly trapped .. 1 1 1 3 26. „ „ untrapped 27 21 20 14 82 27. „ of bath directly connected with the drain 4 3 .. 3 10 28. „ „ improperly trapped .. .. 1 .. 1 29. „ „ untrapped 24 14 20 11 69 30. The water cistern so foul as to be a nuisance 78 112 88 89 367 31. „ „ being without a close fitting cover .. 90 107 100 87 384 32. „ „ being placed in an improper position 26 33 30 24 113 33. „ „ defective 9 8 11 3 31 234 1910] TABLE CXIII.—continued. NUISANCES. QUARTERS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. 34. An accumulation or deposit of refuse injurious to health, by reason of the want of a proper dustbin or ashpit 84 91 64 63 302 35. The dustbin or ashpit defective 193 262 220 265 940 36. „ placed in an improper position 5 1 .. 1 7 37. The drain foul 4 4 12 5 25 38. ,, defective 169 200 195 184 748 39 ,, choked or stopped 66 104 56 47 273 40. „ unventilated 36 65 47 35 183 41. The rain-water pipe in direct communication with the drain 54 67 40 32 193 42 ,, ,, in direct communication with the soil-pipe.. 4 3 1 4 12 43. „ „ defective 33 46 36 66 181 44. The water supply used for domestic purposes connected with the cistern which is used for flushing the W.C. 2 15 .. 1 18 45. The house without a proper water supply 107 137 122 116 482 46. The roof defective 77 71 74 103 325 47. The guttering defective 45 60 45 78 228 48. The area improperly paved 9 11 8 6 34 49. ,, dirty 1 4 .. 3 8 50. „ undrained .. .. 2 1 3 51. The paving of the washhouse defective 9 19 20 20 68 52. The back addition walls defective 9 17 5 2 33 53. The want of a proper manure receptacle 4 7 5 5 21 54. The bakehouse walls dirty .. .. .. .. .. 55. An animal kept in such a manner as to be a nuisance 14 6 22 12 54 56. The house or part of a house so overcrowded as to be injurious or dangerous to the health of the inmates 25 25 22 25 97 57. An underground room occupied as a dwelling contrary to the provisions of the Act 8 24 27 24 83 58. A tent, van, shed or similar structure used for human habitation which is in such a state as to be injurious or dangerous to the health of the inmates .. .. .. .. .. 59. The space below floor in the basement or ground floor being unventilated 5 2 5 6 18 60. The space below floor in the basement or ground floor being improperly or insufficiently ventilated 23 19 20 22 84 All Nuisances 2,573 2,841 2,511 2,588 10,513 235 [1910 Table CXIV. Giving a Summary of the Sanitary Work performed by the District Inspectors in 1910. Inspections. QUARTERS. The Year. First. Second. Third. Fourth. House to House Inspections 221 327 221 165 934 Number of Houses Inspected 1,133 1,156 1,309 1,330 4,928 Re-inspections, Calls made, &c. 12,979 13,683 12,321 15,484 54,467 Total Visits 14,333 15,166 13,851 16,979 60,329 Visits to Ice Cream Factories 6 99 29 2 136 Do. Dairies and Milkshops 502 510 545 556 2,113 Do. Stables and Yards 569 574 441 524 2,108 Do. Manure Depdts 22 23 17 20 82 Do. Vacant Land Passages and Courts 59 38 46 40 183 Do. Urinals attached to P.H.'s 203 172 172 164 711 Do. Under Customs and Inland Revenue Acts 20 9 36 6 71 Do. re Water Certificates 24 5 4 8 41 Do. Shops and Stalls on Satur day Nights 78 79 87 95 339 Smoke Observations 71 67 50 64 252 All Inspections, Visits, &c. 15,887 16,742 15,278 18,458 66,365 REMOVAL OF DUST. The applications for the removal of dust were the fewest hitherto recorded, being only 44, 5 of which were made in the first quarter, 19 in the second. 11 in the third, and 9 in the fourth. It is remarkable that the applications for its removal have fallen since 1891 from 10,138 to 69 in 1909, and, as just stated, to 44 last year. This is truly a marvellous decrease. The particulars for each year since 1891 are as follows:— Applications to Remove Dust. Applications to Remove Dust. 1891 10,138 1901 157 1892 9,964 1902 198 1893 4,986 1903 152 1894 4,506 1904 116 1895 4,596 1905 89 1896 4,245 1906 58 1897 312 1907 55 1898 303 1908 64 1899 262 1909 67 1900 234 1910 44 Dust Receptacles Provided.—During the year 1,226 dust receptacles were provided, while 30 were repaired 236 1910] Table CXV. Summary of Applications for the Removal of Dust during the Year 1910. Ward. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Number of Assessments Michaelmas. 1910. Number of Applications to every 100 Assessments. 1 – 2 4 – 6 4,911 0.122 2 1 2 1 2 6 4,736 0.127 3 2 2 – – 4 4,516 0.088 4 – 4 – – 4 5,486 0.073 5 – 2 2 – 4 5,728 0.070 6 – 3 1 4 8 4,120 0.194 7 – – 1 – 1 4,037 0.025 8 – – – 1 1 2,729 0.037 9 1 1 1 1 4 2,981 0.134 10 – 2 – 1 3 3,551 0.084 11 1 1 1 – 3 4,622 0.065 Totals 5 19 11 9 44 47,417 0.093 237 [1910 HOUSING, TOWN PLANNING, ETC., ACT, 1909. On the 3rd December, 1909, the very day on which the Act became law, the Council referred it to the Public Health Committee for consideration and report, and as a result the Medical Officer of Health presented a report to them, the main features of which are embodied in the observations which follow herewith:— Only that part of the Act which deals with the housing question is applicable to Islington, the clauses respecting town planning being administered by the London County Council. This Act adds one more to the already numerous Housing Acts, of which there are eight in operation in the United Kingdom, although four only refer to England and Wales; and it is to be regretted that, instead of consolidating as well as amending these Acts, it has contributed its quota to the confusion of persons unskilled in law. Indeed, an eminent lawyer has written of it that "the perusal of the first part of the new Act will disclose a bewildering maze of cross-references to the provisions of previous statutes.*" Such legislation is to be deplored, and, therefore, it is to be regretted that consolidation and amendment did not go hand in hand. It is almost impossible to report on this Act without reporting on the whole law with respect to housing as it now stands. To say that the new Act makes certain amendments in the old Acts affords no information to persons who do not know them. The fact is that the old Acts were such a failure that they were rarely enforced ; indeed, so rarely that since 1891 or 1892 no one connected with the public health administration of Islington has touched them, the one experience with respect to the Norfolk Square area having proved conclusively that they were both difficult and costly to administer. If there be any members of the Council to-day who were members of the Public Health Committee of that day (and the Medical Officer of Health can remember only one) they will long have forgotten all about the provisions of the Acts under which they worked, while of course every one else is in absolute ignorance of them, unless indeed, they, through interest in the subject, have made a special study of them. It may, therefore, be pointed out that the principal Act deals with unhealthy areas, and unhealthy dwellings. Also with working class lodging houses, with which this Council will have nothing to do. * Willis (W. A.). "Housing and Town Planning in Great Britain," London (Butterworth), 1910. 238 1910] With respect to unhealthy areas, it is the duty of a sanitary authority when an official representation is made to them, viz.: one by the Medical Officer of Health, that any houses, courts, alleys, etc., are unfit for human habitation, or that the narrowness, closeness, or bad arrangement, or the bad condition of streets of houses or groups of houses, or the want of light or ventilation, or proper conveniences, or any other sanitary defects, or one or more of such causes, are dangerous or injurious to the health of the inhabitants living in the buildings in the area or in neighbouring buildings, to pass a resolution to the effect that such area is an unhealthy one, and that an improvement scheme ought to be made in connection with it, and after passing this resolution they shall proceed to make a scheme for the improvement of the area. As a rule, every scheme affecting an area must provide for the accommodation in suitable dwellings of at least as many persons of the working classes as may be displaced, and such dwellings, unless there be special reason for contrary action, must be within the limits of the area or its vicinity. There are, however, two exceptions to this rule. In the first place, if the Local Government Board are satisfied that accommodation can be provided at some other place within the area or its vicinity, or that the necessary accommodation has been or is about to be provided either by the local authorities or other persons, the Board may authorise the scheme, and its requirements will be deemed to have been complied with. In the second place the local authority may apply for a dispensation, and the Local Government Board may dispense with the obligation to provide accommodation if the official that conducted the Local Inquiry, for a Local Inquiry must always be held before a scheme is sanctioned, reports that it is expedient to grant it. If the Local Authority fail to pass a resolution respecting a scheme after an official representation has been made, they must forthwith send a copy of the representation and their reasons for not acting upon it to the Local Government Board, who, if they are satisfied that a scheme ought to have been made, may order the Local Authority to make it, and to do all things necessary under the Housing Acts for carrying the scheme into execution. Part II. of the principal Act relates to unhealthy dwellings, and deals with the closing and demolition of unhealthy houses, and with the removal of buildings which though themselves are not unfit for habitation are an obstruction to the good sanitary conditions of neighbouring houses. 239 [1910 In the new Act the expression "dwelling house" now includes uninhabited as well as inhabited houses, and as formerly, any of the gardens, outhouses, appurtenances attached thereto, and includes the site of the dwelling house. Under this division of the Act it is the duty of the Medical Officer of Health to represent to the Local Authority any dwelling houses which appear to him to be in a state so injurious or dangerous to health as to be unfit for human habitation, and if within three months after receiving such representation no action is taken, the County Council may intervene. With respect to the power and duty of making closing orders, the Act provides that when a Local Authority receive a representation from the Medical Officer of Health or from any of their officials, or receive other information that any dwelling house is in such a state, dangerous, or injurious to health so as to be unfit for habitation, and it appears that such representation or information is accurate, they must make the order prohibiting the use of the dwelling house for human habitation until in their judgment it is rendered fit for the purpose. This is an entirely new and very far-reaching power. Formerly the authority could only proceed under the nuisance sections of the Public Health London Act, 1891, by proceedings in the Courts of Summary Jurisdiction for penalties and closing orders. Now these restrictions have been swept aside, and the Sanitary Authorities becomes de facto, instead of in name only, the authority on the sanitation of the houses in their district. When a closing order has been made by the Council, it becomes their duty to forward a copy of the Order to the County Council. After July 1st, 1910, a room habitually used as a sleeping place, the floor of which is more than three feet below the surface of the street adjoining or nearest to the room, is to be deemed a dwelling house so dangerous or injurious to health as to be unfit for human habitation under either of the following conditions:—(1) If it is not of an average height of 7 feet from floor to ceiling, or (2) if it does not comply with such regulations as the Local Authority may prescribe for securing the proper ventilation and lighting of such rooms and their protection against dampness, effluvia and exhalation. Such a room must be closed under a closing order, but such order is not to prevent the room being used for purposes other than a sleeping place. With respect to houses against which a closing order has remained operative for three months, the Local Authority are required to consider the question 240 1910] of the demolition of the dwelling house with a view to making a demolition order, but every owner of such dwelling house is entitled to be heard when the question is considered. The Authority must, however, order the demolition of the building if upon consideration they are of opinion that the dwelling house has not been rendered fit for human habitation, and that the necessary steps are not being taken with all due diligence to render it fit, or that the continuance of any such building is a nuisance, dangerous or injurious to the health of the public or of the inhabitants of the neighbouring dwelling houses. Notice of the demolition order must be served on the owners of the building in respect of which they are made, and they, if aggrieved by the order, may appeal to the Local Government Board. If the Local Authority makes default in carrying out this part of the Act, the County Council may intervene and exercise powers of closing a demolition. The above particulars, stated briefly, and of course very imperfectly, give the duties of the Couucil under the Housing of the Working Classes Acts as amended and increased by the Housing and Town Planning Act. Up to now, the action of the Sanitary Authority was impeded on every side, but such is the case no longer, for they have been given a very free hand, and no doubt they will be expected to avail themselves just as freely of the powers which have been delegated to them. Indeed, this must be taken for granted, as already a new department with special officials has been created at the Local Government Board with the object of seeing that the Act is enforced, but while the duties of the Sanitary Authorities have been increased, the liabilities of landlords and private owners have also been made more stringent, so that in future the implied condition as to the fitness of premises for habitation has been extended in London from rentals of £20 to rentals of £40, while the letting of properties shall imply a condition that their fitness for human habitation exists not only at the commencement of the tenancy, but that it shall be maintained during the term of the holding, and unlike previous Acts, the owner will not be allowed to contract himself out of his liability. Power is given to the Local Authority to interfere when a landlord does not comply with his implied undertaking to keep the premises in a proper state. These powers include (1) the making of a closing order, or (2) the service of a notice on the owner to execute such works as shall be specified in it as being necessary to make the house in all respects reasonably fit for human habitation, or (3) if at the expiration of the time specified in the notice nothing has been done, the Local Authority may do the work themselves. 241 [1910 Under the provisions of the new Act, the tenant will still have his remedy at common law or otherwise by action against his landlord for breaches of the implied conditions. For the purpose of viewing the state and condition of any house in respect of which the conditions of tenancy are implied, the landlord or his representative or the Local Authority through their appointed officials may at all reasonable times of the day, on giving 24 hours' notice in writing to the tenant or occupier, enter such houses, premises, or buildings. The Council at their meeting on the 18th February, passed the following resolutions:— (a) "That subject to the reservations contained in the Standing Orders of "the Council, it delegated to the Public Health Committee the powers and "duties imposed on them by the Housing Town Planning, etc., Act, 1909." (b) "That the officers of the Council upon whom would devolve the "duty of entering houses, premises and buildings for the purposes of the "Housing, Town Planning, etc., Act. 1909, be specially authorised in that "behalf, and that the Seal of the Council be affixed to such authorisation." On the 9th May it became the duty of the Medical Officer of Health to make a representation respecting an unoccupied house at the rear of 436, Liverpool Road. The report on the subject was as follows:— To the Chairman and Members of the Public Health Committee. Gentlemen, Representation under the Housing and Town Planning Act, 1909, respecting an unoccupied house at rear of No. 436, Liverpool Road. There is an unoccupied house at the bottom of the garden of 436, Liverpool Road, which is in a dilapidated state. The roof is broken and the floors and ceilings are broken and dilapidated, and the premises generally are unfit for human habitation, but may be rendered fit for occupation by the expenditure of a considerable sum of money. These premises are a nuisance and a danger to the health of the people living in houses in Holloway Road, on which they abut. In these circumstances it becomes my duty to make a representation to you under the Housing and Town Planning Act, section 17 (1) that this dwelling house at the rear of 436, Liverpool Road is in a state so dangerous or injurious to health as to be unfit for human habitation. s 242 1910] In sub-section 2 of the same section it becomes the duty of the Local Authority if it appears to them to be in such a state to make an order prohibiting the use of the dwelling house for human habitation until in the judgment of the Local Authority the dwelling house is rendered fit for that purpose. Under sub-section 3 it is provided that a closing order shall be forthwith served on every owner of the dwelling house in respect to which it is made, and any owner aggrieved by the order may appeal to the Local Government Board by giving notice of appeal to the Board within 14 days after notice is served upon him. I am, Your faithful servant, A. E. HARRIS, Medical Officer of Health. Town Hall, Islington, N. 9th May, 1910. The Public Health Committee subsequently submitted a report to the Council recommending that an Order under section 17 of the Housing and Town Planning Act, 1909, be made with respect to these premises, and that the Seal of the Council be affixed to such Order. This was accordingly done by the Council, who on June 3rd passed the necessary Order. The Medical Officer of Health also made representations with respect to dwelling houses numbered and known as 48, 50, 52 and 54 Queensland Road; 10, 12, 14 and 16, Henshall Street, and 27 and 29, Orchard Street, that they were in such a state as to be dangerous or injurious to health, and unfit for human habitation, and the Public Health Committee having recommended the Council that they be closed, they (the Council) after having heard the owners or other persons interested in the property, made the necessary Orders on the 21st October, 1910. STATE OF PAUPERISM IN THE BOROUGH. As a rule pauperism and ill-health go hand in hand, for wherever people are destitute and without food, there too, as a rule, much illness is to be found. It is satisfactory, however, to know that in Islington at all events, such has not been the case, for if the health of the borough had risen in the ratio in which the number of paupers increased, instead of being as good as it is, it would have been very indifferent. Still, it is not satisfactory to find that the average number of paupers relieved weekly has now reached the large figure of 10,773, as contrasted with an average 243 [1910 of 8,510 per week in the 11 years 1899-1909. The matter is one of very great importance,, not only from a ratepayers' point of view, but from that of public health. There can be no doubt that were there less pauperism, there would be improved health. It is difficult to understand why the number of paupers has increased from 6,854 per week in 1899 to 10,773 in 1910, an increase of 3,919 per week. It would be sad, indeed, to think that this increase reflected the state of business and work in the borough. Is it possible that there are other reasons than mere slackness of work which have their influence on the excessive pauperism which undoubtedly exists in Islington? It would be interesting to know how many of these people have lived in Islington for say five years, for then one might arrive at a conclusion as to whether the system of relief has attracted the poor of other places to the borough. The following statement shows the average number of people relieved in each week of the last 12 years 1899 6,854 Per week relieved. 1900 6,956 „ 1901 7,327 „ 1902 7,668 „ 1903 8,004 „ 1904 8,086 „ 1905 9,224 „ 1906 9,069 „ 1907 9,599 „ 1908 10,349 „ 1909 10,476 „ Average 8,510 „ 1910 10,773 „ Indoor Paupers. — The average number relieved each week was 5,017, or 153 in excess of the average which obtained in the preceding year, and as contrasted with a weekly average of 4,018 in the decennium 1900-1909. Outdoor Paupers — On an average 5,755 were relieved in each week, as compared with 5,612 in 1909, with 5,791 in 1908, and with a decennial weekly average of 4,658. Of these paupers, the average number of adults was 3,721, and of children under 16 years of age 2,035. Vagrants.—No vagrants were relieved, as the wards were closed in January, 1909. Children Boarded out.—On a weekly average, these numbered 106, as compared with 107 in the preceding year. They were also 17 less than the decennial weekly average of the years 1900-1909. S 2 244 1910] Table CXVI. Showing the State of Pauperism in the Borough during the years 1900-1909 and 1910. Years. Average number Relieved during each week. Death- rates. Indoor Paupers, Adults and Children. Outdoor Paupers. totals Outdoor. Totals. All paupers relieved, cols. 2 & 5. Vagrants Relieved. Children Boarded out. Adults. Children under 16. 1 2 3 4 5 6 7 8 9 1900 3,397 2,288 1,271 3,559 6,956 7 100 17.03 1901 3,522 2,444 1,361 3,805 7,327 12 130 15.98 1902 3,594 2,662 1,412 4,074 7,668 10 125 16.55 1903 3,879 2,739 1,386 4,125 8,004 17 127 14.52 1904 3,622 3,069 1,395 4,464 8,086 65 122 15.74 1905 4,295 3,302 1,627 4,929 9,224 58 126 14.93 1906 4,189 3,335 1,545 4,880 9,069 12 134 15.26 1907 4,261 3,556 1,782 5,338 9,599 75 135 15.38 1908 4,558 3,752 2,039 5,791 10,349 13 125 13.93 1909 4,864 3,649 1,963 5,612 10,476 Wards closed 107 14.96 Average 4,018 3,080 1,578 4,658 8,676 27 123 15.49 1910 5,017 3,721 2,035 5,755 10,773 No Wards 106 13.79 Table CXVII. Showing the State of Pauperism in the Borough during the year 1910 Quarters. 1 Average number Relieved during each week. Indoor Paupers, Adults and Children. 2 Outdoor Paupers. Totals. 5 Totals corresponding periods 1909 6 Vagrants Relieved. 7 Children Boarded out. 8 Death rates. Adults. 3 Children under 16. 4 1st Qr. 5,141 3,788 2,091 11,020 10,346 No Wards 101 15.12 2nd ,, 4,883 3,594 1,943 10,420 10,153 106 11.90 3rd „ 4,897 3,629 1,947 10,473 10,089 109 10.78 4th ,, 5,148 3,871 2,160 11,179 10,820 108 17.48 The Year 5,017 3,721 2,035 10,773 10,476 — 106 13.79 245 [1910 COMMON LODGING-HOUSES. These houses are controlled by the London County Council under by-laws which give that body powers of inspection both by day and night. They are licensed annually, and therefore their keepers or owners are more amenable to control, and obey the by-laws more carefully than do the owners of any other class of lodgings. They number 48 in Islington, of which 37 are licensed for men, 9 for women, and 2 for married couples. Table CXVIII. Showing the Addresses of the Common Lodging-Houses in the Borough. (Under the Control of the London County Council). Situation of Premises. Authorized No. of Lodgers Sex of Lodgers. M = Men. W = Women. MC = Married Couples. Name of Licensee. 36, Ball's Pond Road 28 M. Alfred Edward Hurworth 14, 16, Barnsbury Street 51 M. Ellen Maples. 18, 20 & 22, Barnsbury Street 91 M. „ 47a, Campbell Road 71 M. Wm. J no. Cragg. 35, Campbell Road 27 W. „ 37 & 39, Campbell Road 61 M. „ 10 & 12, Campbell Road 52 M Hugh Hersey. 180, Caledonian Road 51 M. Mrs. Finetta Jefcoate 55, Colebrooke Row 71 W. Dave Levy 13 & 14, Duncan Terrace 60 W. B. Jaffa. 155, Englefield Road 64 M. Wm. Jno. Cragg. 1 & 3, Eden Grove 107 M. Lewis Henry Levy. 87, Essex Road 52 M. Jas. Shuttleworth, Jun. 89, Essex Road 35 M. „ 8, Flower's Mews 72 M. Mrs. Finetta Jefcoate. 102, 104 & 106, George's Road 51 W. Robert Wm. Maples. 68, George's Road 38 W. Ellen Maples. 1, Gordon Place, Highgate Hill 5 M. George Willis. 2, Gordon Place 5 M. ,, 3, Gordon Place 5 M. „ 4, Gordon Place 10 M. „ 5, Gordon Place 10 M. „ 6, Gordon Place 9 M. „ 7, Gordon Place 9 M. „ 13, Gordon Place 9 M. „ 29, Halton Road, and la, Allen Street 59 M. Chas. Jas. Vincent Somerville. 29, Hornsey Road 88 M. Sidney Allen. 8a, Hornsey Street 48 M Colin F. Campbell. 10, Milton Place 22 M. Lewis Henry Levy 4 & 6, Queensland Road 34 M. Margaret Jones. 8 & 10, Queensland Road 18 M.C. „ 2.3 & 25, Queensland Road 28 W. „ 160 & 162, St. James' Road 67 M. Arthur Willie Horsley 235a, Upper Street 37 M. Hugh Hersey. 128, York Road 20 M. Hugh Hersey. 246 1910] ARTIZANS' AND OTHER DWELLINGS. There are now some 439 dwellings, containing 5,097 separate flats or tenements, in the borough, and they are occupied for the most part by the working classes. Some of the older buildings are not nearly so fully occupied as they used to be in former days, partly because some of them have shown distinct deterioration, while others have become more or less out of date in comparison with the more modern erections, which provide not only more light, but more household conveniences. In the Table which is appended herewith are given the names of some of the principal dwellings in the borough:— WARD. Name of Dwellings. Where situated. No. of Blocks. No. of separate Dwellings. Tufnell Wessex Buildings Wedmore Street 3 225 „ *Lincoln House Dartmouth Park Hill 1 6 „ *Suffolk House „ „ 1 6 „ *Durham House „ „ 1 3 „ *Carlisle House „ „ 1 6 „ *No 46 and 48, Dartmouth Park Hill „ „ 2 12 „ *Nos. 8, 9, 10, 11 and 12, Wyndham Mansions Wyndham Crescent 1 30 „ *Nos. 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 and 29, Cathcart Hill Junction Road 1 78 „ *Roydon Mansions „ 1 3 „ *Manor Mansions Holloway Road 2 10 „ *Hargrave Mansions Hargrave Road 10 60 „ *St. John's Park Mansions Pemberton Gardens 8 64 „ *Nos 18 and 21, Pemberton Gardens Holloway Road 2 5 „ *Fulford Mansions Fairmead Road 2 14 „ *10, St. John's Park Holloway Road 1 3 „ *47, Hargrave Park Junction Road 1 3 „ *Nos. 49 to 67, Hargrave Park „ „ 10 30 Upper Holloway *Albermarle Mansions Holloway Road 3 24 „ Whitehall Mansions Archway Road 1 30 „ Elthorne House Elthorne Road 1 6 „ *Elthorne Mansions „ „ 1 12 „ *Nos. 34, 36, 38, 40, and 42, Dresden Road Dresden Road 5 15 „ *Nos. 27, 29, and 31, Cheverton Road Cheverton Road 3 9 „ Nos. 221 to 259, Hornsey Road Hornsey Road 38 114 „ Nos. 269 to 283, Hornsey Road „ „ 8 16 „ *473, Hornsey Road „ „ 1 3 Tollington Nos. 83 and 85, Alsen Road „ „ 2 8 „ Turle Mansions Wray Crescent 1 11 „ *St. Mark's Mansions Tollington Park 4 16 „ *Tollington Park, Nos. 14, 16,20, 22,24, 26, 28 and 30 „ „ 8 16 „ *Albeit Mansions Crouch Hill 1 12 „ *Brambledown Mansions „ 1 12 „ *Hanley House Hanley Road 1 9 „ *Grenville Road, Nos. 28, 30, 32, 34, 36 and 38 Hornsey Road 6 12 Lower Holloway Queen's Arms Buildings North Road 1 63 „ City Arms Buildings North Road 1 63 * These flat tenements are occupied by the better middle-class people. 247 [1910 ARTISANS AND OTHER DWELLINGS—continued. WARD. Name of Dwellings Where situated. No. of Blocks. No. of separate Dwellings. Lower Holloway Camden Dwellings York Road 1 44 „ North London Cottages Market Road 1 8 „ *Crown Mansions Liverpool Road 2 24 „ Crown Mansions Paradise Passage, Liverpool Road 1 10 „ St. James's Mansions St. James's Road 1 6 „ Pleasant Buildings York Road 3 27 „ Edinburgh Place Brewery Road 2 45 „ Aberdeen Place Brewery Road 2 35 „ Anchor Dwellings „ 2 15 „ *Nos. 24, 34 & 33, Arundel Square Offord Road 3 12 „ * Loraine Mansions Widdenham Road 38 160 „ * Morgan Mansions Holloway Road 8 64 „ L.C.C. Dwellings Burns Caledonian Road 1 30 Scott 1 30 Wallace 1 70 Knox 1 66 Bruce 1 76 Highbury Lome Buildings Benwell Road 4 26 „ Holloway House Hornsey Road 1 6 „ Highbury House „ 1 6 „ Hatton House „ 1 6 „ Drayton House „ 1 6 „ Ingram House „ 1 6 „ 23, Hornsey Road „ 1 3 „ 25, Hornsey Road „ 1 3 „ 27, Hornsey Road „ 1 3 „ *York House Highbury Crescent 1 24 „ *Thane Mansions Thane Villas 1 10 „ * Walton House Thane Villas 1 10 „ * Wilmington House Highbury Crescent 1 8 „ *Nos. 1 and 2, Fieldway Houses Fieldway Crescent 2 16 „ *17, Highbury Crescent Highbury 1 8 „ *Nos. 1 to 16, Aberdeen Court Aberdeen Park 2 16 „ *Nos. 1 to 6 Durham House Fieldway Crescent 1 6 „ * 1 to 6 Westmoreland House „ „ 1 6 „ *Nos. 1 to 6 Highbury Gardens Highbury Crescent 1 6 „ *15, Highbury Crescent „ 1 4 „ *16, „ 1 4 „ *55, Highbury Park Highbury 1 10 „ *Nos. 1 to 3, Hamilton Road „ 1 3 „ 60, Holloway Road Holloway 1 3 „ *Newington Green Mansions Newington Green 1 43 „ * Manhattan Mansions Holloway Road 1 32 Thornhill Beaconsfield Buildings East Street 3 475 „ Clarence Terrace Rufford Street 1 53 „ Carlton House Stanmore Street 1 15 „ Pembroke House „ 1 15 Barnsbury Cloudesley Mansions Cloudesley Place 2 12 „ Stonefield Mansions Cloudesley Square 1 12 „ Oatlands House Upper Park Street 1 12 „ Ashley House „ 1 12 „ Halliford House „ 1 12 * These flat tenements are occupied by the better middle-class people. 248 1910] ARTISANS AND OTHER DWELLINGS—continued. WARD. Name of Dwellings. Where situated. No. of Blocks. No. of separate Dwellings. Barnsbury Thanet House Upper Park Street 1 15 „ Thornhill Houses Thornhill Road 5 84 „ Arvon House Offord Road 1 10 „ Buckland House „ 1 10 „ 33a & 33b, Thornhill Road Barnsbury 1 2 „ Colne House Offord Road 1 8 „ Bures House „ 1 8 „ 371, Liverpool Road Barnsbury 1 4 „ 1 and 2, Heathcote House Barnsbury Square 1 2 St. Mary's Albert Mansions Liverpool Road 1 8 „ Liverpool Buildings Liverpool Road 26 276 „ Essex House Essex Road 1 13 „ Anson House „ 1 8 „ Thatched House Buildings „ 1 8 „ Bampton House Pleasant Place 1 10 „ Catton House „ 1 10 „ Tiverton House „ 1 10 „ Dawlish House „ 1 10 „ Fowler House Halton Road 1 10 „ Arundel House „ 1 10 „ Brookfield House „ 1 4 „ Worcester House Astey's Row 1 10 „ Lincoln House Astey's Row 1 10 „ Carleton House Cross Street 1 6 „ Devonshire House „ 1 10 „ Dagmar House Dagmar Terrace 1 16 „ Tufnell House Pleasant Place 1 10 „ Nos. 9 to 23 (inclusive), Pleasant Place Essex Road 14 42 „ Nos. 1, 2, 3, 4, 5, Carleton Terrace Halton Road 5 15 „ No. 7, Astey's Row Essex Road 1 4 „ Nos. 1,2,3, Clarence Houses „ 1 4 „ York House „ 1 4 „ Canonbury Avenue Canonburv Road 17 148 „ Lewis' Trust Buildings Liverpool Road 6 323 Canonbury Ebenezer Buildings Rotherfield Street 5 36 „ *1 to 6, Wallace Gardens Wallace Road 3 6 „ *7 to 15 Wallace Gardens „ „ 5 9 „ * Canonbury Mansions Canonbury Place 1 5 St. Peter's Palmerst n Buildings City Garden Row 3 72 „ Torren's Buildings Torren's Street 6 83 „ Myddelton Buildings High Street 5 80 „ Albany Cottages Popham Street 1 98 „ Cornwall Cottages „ 1 94 „ Edinburgh Cottages „ 1 86 „ Queen's Cottages „ 1 86 „ Quinn Buildings „ 13 240 „ Peabody Buildings Greenman Street 10 294 „ Dibden Street Buildings Dibden Street 4 32 „ Pickering Street Buildings Pickering Street 11 83 „ Nos. 10a, 11a, 12a, 13a, Norfolk Street Essex Road 2 6 „ Nos. 16, to 30, Norfolk Street „ „ 15 30 „ Nos 141 to 147, Shepperton Road New North Road 4 12 439 5,097 * These flat tenements are occupied by the better middle-class people. PART V. FOOD. INSPECTION OF FOOD AND THE PLACES WHERE FOOD IS PREPARED. THE ADULTERATION OF FOOD AND THE ADMINISTRATION OF THE ADULTERATION ACTS. WATER SUPPLY. 250 1910] INSPECTION OF FOOD. By far the greater part of this work devolves on Inspector Wilkinson, the Inspector of Meat, who not only performs the special duty of examining the carcases and joints of animals intended for human consumption, but also inspects other foods such as fish, vegetables, etc., exposed for sale in the shops, on the stalls in the market streets, and by costers. He also inspects the slaughterhouses and cowhouses of the borough. Unsound Food. Altogether 4 tons 1 cwt. 1 qr. and 25 lbs. of unsound food was destroyed during the year, as compared with 2 tons 4 cwt. 3 qrs. 18 lbs. in 1909. Of the quantity destroyed 1 ton 18 cwt. 1 qr. and 14 lbs. was diseased or unsound meat, which had been removed chiefly from slaughterhouses. The principal fact to be noted about this large amount of unsound food is that the livers of 387 sheep were found to be infested with " fluke." This worm is usually found in the bile ducts of the liver of sheep and oxen and occasionally in the bile ducts of the horse, and gives rise in sheep to a disease known as "liver rot." It is also generally found to a much greater extent in animals fed on damp and swampy lands, except on salt marshes. It is more prevalent in wet seasons than in dry. Whalley, in his well-known book on meat inspection, says of it that it is absolutely of no consequence to man, seeing that if portions of a "fluke" infected liver were devoured by him, no parasitic infection could possibly occur. Indirectly the disease is of vast importance, not only on account of the great monetary loss which it annually entails on the nation, but also from the immense and incalculable diminution of our food supply which results from its ravages. Inspection of Shops, Street Markets, Stalls, &c —As usual these places were regularly inspected by the Food Inspector, and in addition on Saturday nights by half the district inspectors in rotation. 11,280 visits were made by Inspector Wilkinson in addition to the inspections made by the inspectors on Saturday evenings and Sunday mornings. Unsound Fish.—Altogether 1,195 lbs. weight of fish which had been bougnt at Billingsgate Market was surrendered by 14 purveyors, the majority of whom were costers. The fish had been bought at the market from sample, but on the "trunks" being opened, it was found that the food was unsaleable. It was, therefore, surrendered and afterwards taken either to the Council's destructor or to Ashburton Grove Refuse Shoot and destroyed. 251 [1910 A full list of the articles destroyed is set out ui Table "A" of Inspector Wilkinson's report. The following list shows the articles destroyed in each quarter of the year:— 1st Quarter. cwts. qrs. lbs. Diseased meat and organs from slaughterhouses 5 3 17 Unsound fish surrendered 3 0 6 Unsound vegetables, &c., surrendered 1 1 13 Unsound meat from shops 2 3 7 Total 13 0 15 2nd Quarter. cwts. qrs. lbs. Diseased meat and organs from slaughterhouses 3 3 0 Diseased meat and organs from shops 1 1 4 Unsound meat from shops, &c. – 1 11 Unsound fish from shops and stalls 2 0 13 Unsound fruits and vegetables from shops and stalls 2 1 17 Total 9 3 17 3rd Quarter. cwts. qrs. lbs. Diseased meat and organs from slaughterhouses 4 3 4 Diseased meat from other premises 2 3 15 Meat unsound by decomposition from shops – 2 24 Unsound fish from shops and stalls 4 0 8 Unsound pickles (surrendered) – – 17 Total 12 2 12 4th Quarter. tons. cwts. qrs. lbs. Diseased and unsound meat and organs from slaughterhouses 1 3 3 21 Diseased meat from shops – – 3 16 Unsound onions from shops - ; – 6 0 0 Unsound fish from shops – 1 1 20 Unsound turkeys 1 13 0 0 Unsound meat from shops, &c. – – 2 8 Total 2 5 3 9 Total for the Year 4 1 1 25 252 1910] Butchers' Open Window Stalls-— Inspector Wilkinson in his report very properly draws attention to the question as to whether the open shop fronts in the shops of butchers and provision dealers should not be prohibited, for it is quite true as he states that there is a large quantity of filth deposited on the food stuffs because of their non-protection from street dust. The matter becomes of great importance now that we know that such a disease as Tuberculosis may be, and indeed is, conveyed by such dust. Perhaps in the case of butchers it is not of so great importance as in that of fruiterers, for meat is, of course, cooked before it is eaten, and, therefore, the germs of the disease are most probably destroyed, but the reverse is the case with fruit and certain vegetables, which are generally eaten raw. Indeed, no person can pass a fruiterer's shop on a dry, hot, dusty summer's day without noticing the dull appearance of strawberries, gooseberries, and other fruits offered for sale. As such fruits are eaten without cooking, it is a matter of the greatest importance that they should be protected from contamination. The time has, therefore in the opinion of the Medical Officer of Health, arrived when all food stuffs, especially those which are eaten in their raw state, should cease to be sold in open-fronted shops. The Blowing of Lamb and Veal.—Inspector Wilkinson in his report alludes to the blowing of lamb and veal by butchers. It is a filthy and obnoxious practice, and has been alluded to by the Medical Officer of Health in some of his previous annual reports, notably in 1904 and 1905, and should not be tolerated by the public. If the blowing be done by a human being, then if there be anything the matter with him, the germs of the disease from which he may happen to be suffering may be carried into the very centre of the joints of meat. The man to whom the inspector alludes in his report had been in the employment of two butchers, and had had the duty cast on him of blowing the meat This man was suffering from tuberculosis of the lungs, from which he subsequently died. A state of affairs that permits this to occur is radically wrong, and should not be allowed to continue for a moment, and yet year after year passes by and the legislature takes no action. It is not only wrong for a human being to blow meat with his lungs, but it is also wrong to do so by mechanical means, because the operation, effected in the polluted air of the slaughterhouse, drives this air into the meat, and, therefore, renders it liable to very speedy decomposition. 258 [1910 It is also wrong to blow the meat with the ordinary air, for by bringing it into contact with the deep tissues of the joints, decomposition is most certainly hastened. This practice then is objectionable from every point of view, even from that of disguising the quality of the meat, an object which the butcher may have in view when he orders the meat to be blown. Several towns throughout the country have obtained legislation in this direction, and one of the enactments reads as follows:— "It shall not be lawful to blow or inflate the carcase or any part of the "carcase of any animal slaughtered within or brought into the district, and any "person offending against this enactment, or exposing or depositing for sale "within the district a carcase blown or inflated, or any part thereof, shall be "liable to a penalty not exceeding twenty shillings." Slaughterhouses.—There are now only 32 slaughterhouses, as contrasted with 34 in the preceding year, on the register. These places have decreased from 62 in 1892 to the above figure. Many of the slaughterhouses that have disappeared were obviously very unfitted for the purpose for which they were used. All of them, however, were not equally unsuitable, and therefore their licences were not objected to. Of late years, however, owing to the large increase in the consumption of chilled and frozen meat imported from the Argentine, New Zealand, Australia, and in lesser amounts from the United States, many butchers have ceased to deal in English meat as their staple, and have catered for their customers by selling the cheaper meat. The Medical Officer of Health, while regretting the decrease in the sale of English meat, feels no sorrow at the closure of these private slaughterhouses, for it is his opinion that all animals should be slaughtered under the most favourable conditions, which can only be attained to the fullest extent in well-managed public abattoirs. He does not mean by this that a very large proportion of the meat killed in the private slaughterhouses of the borough is not of first-class quality, for it is ; but it is obvious that in a borough or township it is impossible for one or even two meat inspectors to be present at the slaughtering of all the animals, and, therefore, the inspector has to trust to a large extent to the honour and honesty of the butchers for fair dealing. In Islington for a good many years it has been found that the butchers when they discover that an animal or the organs of an animal were diseased put them aside for examination by the inspector when he called. Rigid 254 1910] inspection for many years has taught them that honesty is the best policy, for although they might escape detection in one or two instances, yet in the end it was certain. From the return which is given below it will be seen that there were 37,958 animals slaughtered in the borough in 1910 as contrasted with 38,350 in the preceding year, or a decrease of 392, which was made up as follows: 72 oxen, 6 cows, 9 calves, 303 sheep, 2 goats. For some years past there has been a very large decrease in the number of cows killed in the borough: indeed last year there was not one; neither was there in 1908 or in 1906, while in 1907 only 4 were slaughtered. These particulars are shown in the following statement:— ls killed 1904. 1905. 1906. 1907. 1908. 1909. 1910. Oxen 2,360 2,195 2,172 2,146 1,941 1,763 1,691 Cows 4 17 – 4 – 6 – Calves 154 127 143 142 86 100 91 Sheep 32,973 30,686 30,668 24,380 28,476 36,479 36,176 Pigs 25 48 11 2 4 – – Goats – – – – – 2 – 35,516 33,073 32,994 26,674 30,507 38,350 37,958 255 [1910 LICENSED SLAUGHTER-HOUSES. Registered No. Name of Licensee Situation of Premises. Condition of Licence. 119 Gayes, W J. D. 4, Athelstane Mews 120 Chapman, Thos. 34, Balls Pond Road To kill small cattle only and not more than three beasts a week. 121 Clarke, Jno. 259, Balls Pond Road 122 Wood, Edward 53, Barnsbury Street To kill small cattle only and for purposes of own shop. 124 Hack, Thomas 40, Bingfield Street Small cattle only. 125 Guyer, Aubrey 18, Brecknock Road Small cattle only. 126 Webber, George 41, Caledonian Road 129 Luxton, John Carter's Yard, 170, Essex Rd. 130 Philip, Alfred (Between) 185-7, Church Road 132 Toop, William (Rear of) 1, Clayton Street . 134 Mobbs, Jas. Hy 219, Copenhagen Street Small cattle only. 135 Sparrey, Thomas 62, Essex Road Cattle admitted only between 11 p.m. and 7 a.m., and not more than five large animals to be killed per week. 136 Hammond, F. 6, George's Road 138 Chalk & Cox 32, High Street 139 Webber, Wm. 81, Highgate Hill 140 Stone, Sidney 234, Holloway Road 141 Wilde, Fredk. 498, Holloway Road 142 Watson, R. C. 576, Holloway Road 143 Tuck, Wallace 152, Hornsey Road 144 Worboys, Richd 410, Hornsey Road 145 Webber, Jno. 9, Junction Road, Upper Holloway 146 Buckingham, J. 393, Liverpool Road 147 Gregory, Arthur T. 81, Newington Green Road .. Small cattle only. 151 Newbury, Louisa 102, Roman Road 152 Eteen, R E. 49, St. Peter Street Small cattle only. 154 Stone, A. 194, Seven Sisters Road 155 Farmer, Chas. J 280, Seven Sisters Road 157 Fothergill, H. 79, Stroud Green Road Cattle received upon the premises only between 7 p.m. and 8 a.m., and killing limited to requirements of own shop. 158 Richardson, J. 149, Upper Street Small cattle only. 159 Luxton, John (E. side of) Wycombe Mews 160 Lidstone (Ltd ) 398, York Road 156 Taylor, A. 53, Southgate Road Small cattle only. Total 32 Slaughterhouses. 256 1910] Cowhouses.—The cowhouses now number only 5, as contrasted with 31 in 1892. Year by year they have grown fewer and fewer It is difficult to understand the reason. It is true that many of them were anything but satisfactory as places for the production of milk, but on the other hand it must be acknowledged that others were quite suitable, and, indeed, much better than those usually found on country farms. The Medical Officer of Health has stated before now that he would prefer a properly regulated London cowhouse to many that are associated with farms, because the former are far better inspected by the sanitary authorities and, therefore, better kept by their owners. They are more cleanly in every way; the only drawback is to the animals themselves, which, once they enter the cowshed, never leave it until they have run dry, when they are sold either for meat or to a farmer for breeding purposes. Although the five cowhouses are licensed to hold 125 cows, they, as a matter of fact, only contain 43. It is to be regretted that one of the best cowhouses in London that owned by Mr. George Arnold, 233, Seven Sisters Road, which is licensed to hold 64 animals, and which for several years was occupied to its fullest extent, does not contain a single animal. The proprietor still continues to purvey milk on a considerable scale, but prefers to purchase it from farmers. For years there has been great competition in the milk trade, and cutting prices have largely obtained, so that the London owners of cows have felt compelled, in order to meet the competition, to buy their milk from farmers or wholesale dealers, as they found it was cheaper to do so than to produce it in London. The following statement shows the number of cowhouses licensed in the borough in each year since 1892:— Years. Cowhouses. Years. Cowhouses. 1892 31 1902 13 1893 31 1903 13 1894 25 1904 10 1895 19 1905 9 1896 19 1906 9 1897 19 1907 7 1898 15 1908 7 1899 14 1909 7 I900 13 1910 5 1901 13 257 [1910 List of Licensed Cowhouses in the Borough of Islington. Registered No. Name of Licensee. Situation of Premises. No. of Cows licensed to hold. 109 Jones, Elizabeth .. 3, Frome Street 18 111 White, George 24, Hercules Place, Holloway 12 112 Wright, Henry 11, Matilda Street 15 114 Jones, Edward 88, Roman Road 16 115 Arnold, George 233, Seven Sisters Road 64 Total 5 Cowhouses. INSPECTOR WILKINSON'S REPORT. Public Health Department, Town Hall, Upper Street, N. 23rd March, 1911. To the Medical Officer of Health. Dear Sir, I have pleasure in submitting the following report on my duties in connection with the inspection of slaughterhouses, butchers' and other shops and premises where foodstuffs are sold, or deposited for sale, or are in course of preparation for sale; also the inspection of cowhouses and offensive trade establishments during the year 1910. Slaughterhouses.—The number of these on the register has been further reduced to 32, as compared with 34 at the end of the previous year, owing to the licence of one, situate at Hazelville Road, being surrendered by the occupier, and one, situate at 410, Essex Road, being refused a renewal at the annual licencing session of the London County Council on account of its not having been used for the purposes of a slaughterhouse for a period of nine months previously. The total number of visits paid to these during the year was 1,770. The byelaws as to cleansing and general conduct have been satisfactorily observed and no complaint has been received regarding them. I am of opinion, however, that further powers are necessary in some cases to ensure the cleanliness of slaughtermen's clothing and cloths used in washing and wiping of meat, as well as the regulation, or, better still, the prohibition, of the blowing of meat, which I have ofttimes previously mentioned. Whilst, in my opinion, blowing even by mechanical means is entirely unnecessary and only meant to deceive the eye, there can be no question that blowing by the aid of the human lungs is most repulsive, for even at the best if the T 258 1910] operator is in perfect health he can only impart into the tissues of the meat vitiated air, and as you will no doubt remember I have previously related my personal experience of a slaughterman in an advanced stage of consumption (who ultimately succumbed to the disease) being engaged where no special apparatus was provided for inflation. It is somewhat singular that in the County of London, where the blowing of meat obtains to a greater extent than has been my experience in other parts of the country, no powers exist for dealing with it, although some of the Urban Authorities immediately outside London possess them. Another matter requiring attention is that of the custom in some instances of emptying or puncturing the bowels of animals in the same room as that in which the carcases are hanging, whereas, in my opinion, the stomach and bowels should not be opened or wilfully punctured until removed from that room either into the open air or into some other room which does not ventilate into the slaughterhouse. To say that the carcase should be removed from the slaughterhouse after it is dressed to a suitable cooling room would be practically impossible in the average London slaughterhouse. Neither, in my opinion, is such a course necessary if the abdominal organs are removed therefrom before being opened or punctured, as this is the only source of obnoxious effluvium in the process of slaughter, and even this would not be noticeable at a very short distance if discharged in the open air, so that no nuisance would likely be experienced on adjoining property. The number of animals slaughtered during the year was as follows, viz:— Oxen Calves Sheep and Lambs Pigs Total 1691 91 36,176 Nil 37,958 That of the previous year being as under, viz:— Oxen Calves Sheep and Lambs Pigs Goats Total 1,769 100 36,479 Nil 2 38,350 It will thus be seen that 392 fewer animals were killed than in the previous year, but the average per slaughterhouse would be actually greater in the latter year. It is a pleasure to report that the quality of the animals generally has again been quite above the average of what is shewn in an ordinary fat stock market, or slaughtered in any municipal abattoir of which I have had experience. I have no fear of contradiction in saying that the average supply of meat from the Islington private slaughterhouses, not only during the past year, but extending over many years in succession, has not only been equal to, but decidedly better, than that of any public abattoir of which I have had knowledge. I do not wish to infer that a higher standard of inspection obtains here than in most municipal slaughterhouses, or that meat is passed in the latter that ought to be condemned, but the principal difference lies in the fact that a good percentage of the live stock throughout the country consists of animals (male and female) that have served their day in the propagation of their species, or for dairy purposes; as well as the thousands of animals that inherit a predisposition to tuberculosis and other diseases which are too often disseminated amongst them by their insanitary surroundings in rural districts, with the result that 259 [1910 they cease to thrive and as a consequence they are disposed ot for slaughter as second or third rate quality, the bulk of which probably find their way to private slaughterhouses, where no proper supervision is provided by the local authority. Particulars of carcases or parts thereof and internal organs surrendered on account of various diseases and affections will be found in Table " A " of this report, from which it will be seen that of 1,691 oxen 10 were more or less affected with tuberculosis, or about 0.6 per cent., but only in one instance was the disease of such a generalised character as to necessitate the destruction of the whole carcase. It may be noticed that in my return of the number of animals all bovines are classed together as oxen, whereas in the table mentioned 4 of the animals are classified as cows; these as well as a few others of the total were young cows which had evidently not been prolific milkers, and as a consequence had been fed up for the butcher, lactation having ceased and the mammary gland shrunk almost to the condition of a clean heifer, such are classed rather as heifers, or heifer-cows as they are sometimes described, as compared with ordinary dairy cows that are worn out with age and long service. An unusually large number of parasitic livers of sheep will be seen in the table named, together with the carcases of 4 sheep and parts of 6 others due to emaciation or other alteration, the primary cause of which was due to the parasitic affection. These were all young animals from the west country where in the autumn of the year under consideration thousands of sheep were disposed of at considerably less than their original cost as stores, without any return for the grazing, owing to the epidemic form of the disease. You will remember that you took special interest in the subject at the time and endeavoured to get at the root or cause by communicating with and submitting specimens to Sir John McFadgean, Professor of Veterinary Pathology, and S. Stockman, Esq., M.R.C.V.S., Chief Veterinary Officer of the Board of Agriculture. These parasitic diseases are not so serious from a public health standpoint as are some other diseases and affections, but from a commercial standpoint are a very serious loss to the farming and general community, in that so much waste is occasioned not only by the loss of the organ directly involved, but by an immense loss in condition of the animals affected, due to the obstruction of the natural function of those organs by the infesting parasites and the cirrhotic condition followiing such infestation. The animals above referred to, although being as previously stated young, were considerably wanting in nutritive quality, but as they were slaughtered for the wholesale market at Smithfield, the public of this Borough were not directly prejudiced thereby. Further particulars as to abnormal affections in other animals will be found in the table already referred to. T 2 1910] 260 TABLE A. No. of Cases Description of Animals Affected. Extent of Disease or Affection. Nature of Affection. How disposed of. 2 Cows Part of Forequarters and cer tain internal organs Tuberculosis (localised) Affected parts and organs destroyed 1 Ox Hindquarters, brisket and flank, with all internal organs do do. do. 1 Heifer Head, tongue, lungs and liver do. Destroyed 1 Cow Pharyngeal glands do. Head destroyed 1 Ox Lungs and mediastinal glands do. Organs destroyed 1 do. Liver, lungs, tripe, &c. do. do. do. 2 do. Head and tongue do. do. do. 1 Oxen Carcase and all organs Tuberculosis gener. alised Carcase and organs destroyed 1 Cow Thin flanks and certain internal organs Injury from external violence Affected parts and organs destroyed 1 do. Tripe and adjacent membranes do. Affected organs destroyed 2 Sheep Carcase and all organs Moribund Carcase and organs destroyed 4 do. do. do. Emaciation do. do. 6 do. Breasts and parts of abdominal Walls Contiguous to diseased organs Affected parts destroyed 1 do. Hindquarters and organs Braxy do. 1 do. do. Bruised Destroyed 60 Oxen Liver Parasitic (Dis. Hep.) do. 16 do. do Abscess do. 387 Sheep do Various parasitic diseases do. 5 do. Liver and lungs Various affections do. 6 do. Lungs do. do. 1 Ox Liver Hydatid disease do. 1 do. Lungs Melanosis do. 1 Sheep Heart Pericarditic do, 261 [1910 Shops, Stalls, Sfc., Inspection of.—This includes the inspection of all perishable foodstuffs exposed for sale, or deposited for that purpose, or for the preparation of sale, at shops, costers' stalls and barrows, sausage factories, etc. The approximate number of established traders is as follows, viz. :— Butchers', Provision Dealers, etc., shops 241, Fish shops 105, Fruit and Vegetable shops 215, and 8 premises where meat and other foods are made up or prepared for sale and having no retail business directly connected therewith (Sausage factories, etc.). There are also some half-dozen meat stalls, the same number of fish stalls and barrows, and approximately 30 fruit, etc., stalls and barrows, but the number of itinerant traders fluctuates considerably, according to different seasons of the year and other varying circumstantes. To these a total of 11,280 inspections have been recorded, independent to those of the District Inspectors on Saturday evenings and Sunday mornings, of which I have no proper record, made up as follows, viz. :— To Butcher and Provision Shops 5,458 visits To Sausage Factories, &c. 188 „ To Butcher and Provision Stalls 417 ,, To Fish Shops 1,382 „ To Fish Stalls 494 To Fruit and Vegetable Shops 2,244 ,, To Fruit and Vegetable Stalls 1,097 ,, Total 11.280 The conduct of these businesses generally has been very satisfactory, for although over 2 tons of unsound foods have been destroyed from these sources during the year, a perusal of Table " B " of this report will shew that the bulk of this was examined by request and that with one exception, where a few quarts of mussels were exposed for sale in an unsound condition, the whole of the foodstuffs recorded in that table were surrendered, and with that exception there was in no case sufficient grounds for seizure and further proceedings. A summons was taken out in the exception named, resulting in a fine of 40s. and 2s. costs. The method of constant supervision by frequent visits is, in my opinion, having the effect in preventing traders from running the risk incurred by exposing for sale foods of unsound or doubtful condition. The butchers' meat generally has been of a good nutritive quality, although you are already well aware that in a population of some 330,000 inhabitants there must be a very large number of families who cannot afford the best home-killed meat, but it is satisfactory to note that the amount of meat from old and poorly nourished animals has been comparatively very small, a good cheap substitute being found in chilled beef from the Argentina, which is now coming in regular consignments, and are, as a rule, of excellent nutritive quality, the breed and general condition of which are yearly improving. Mutton and lamb from New Zealand, Australia and the River Plate, of excellent quality, although of necessity in a frozen condition, is still a great boon to thousands who cannot afford to pay higher prices, and even many more favourably circumstanced prefer these on 1910] 262 the grounds that the margin of difference in the quality is not so marked as is that of the price. These foreign consignments are well inspected previous to exportation and also at ports of arrival and wholesale markets, so that the inspection in the retail shops is chiefly concerned in the detection of signs of decomposition, although outward appearances in this respect are often misleading, as chilled and frozen meats soon become discoloured on section and have a wet, sodden appearance, which in a dry atmosphere later becomes of a sullen dirty appearance, too often aggravated by the amount of dust and dirt that have been blown on to it from the dusty street, and this brings me to the question of whether open shop fronts in butcher and provision trades should not be abolished, for the amount of filth thus deposited on foodstuffs is to those who fully realise it simply appalling, and there is no doubt that a compulsorily closed window would be a great benefit not only to the public generally, but also to the trades concerned. The total amount of foodstuffs destroyed during the year was as follows, viz. :— Tons cwts. qrs. lbs. Unsound Food, as per Table A— 1 18 1 14 „ „ as per Table B— 2 3 0 11 Tons 4 1 1 25 The total amount for the previous year was as under, viz.:— Tons cwts. qrs. lbs From Slaughterhouses (Table A)— 1 1 0 10 From Shops, &c. (Table B)— 1 3 3 8 Tons 2 4 3 18 TABLE B. Number of cases. Description of Food. Nature of Unsoundness. Conditions under which found. How disposed of. Weight in lbs. Observations. 3 Pork Tuberculosis Examined by request Council's destructor 256 Portions of 3 pigs affected with localised tuberculosis, bought at Smithfield Market. Affected parts surrendered and Condemnation Notes given. 10 86 ox and heifer tongues Affection of mucous membrane do. do. do. do. 311 Blisters and peeling of membrane, and in some cases hcemorrhagic patches, conditions not well understood. Frozen tongues from United States surrendered, and Condemnation Notes given. Further reference in Report. 1 Oxen cheeks Decomposition do. do. do. do. 56 Surrendered, and Condemnation Note given (foreign cheeks frozen) 14 Quantities of fish do. do. do. Council's destructor or Ashburton Grove shoot 1,156 Fish bought at Billing»gate, unsatisfactory on being opened. Condemnation Notes given. 4 Oxen tripes do. do. do. Council's destructor 434 Country consignments unsatisfactory on arrival. Condemnation Notes given. 7 Fruit and vegetables do. do. do. do. do. 1,056 Found unsound on being opened. Condemnation Notes given. 268 [1910 TABLE B.—continued. Number of cases. Description of Food. Nature of Unsoundness. Conditions under which found. How disposed of. Weight in lbs. Observations. 1 Pears Decomposition Metropolitan Cattle Market Council's destructor 55 Tasmanian fruit, cases not opened and sorted prior to entering Market. Surrender of bad fruit accepted and dealer cautioned. 1 12 quarts of mussels do. Exposed for sale do. do. 21 Summons taken out, defendant fined 40s. and 2s. costs. 2 Tinned salmon Slightly blown In store stocks do. do. 18 Surrender accepted, and importer's representative consulted by M.O.H. 2 Turkeys Decomposition Examined by request do. do. 1,417 Delivered in an unsound condition, surrendered and Condemnation Note given. 1 Turkeys Slightly decomposed Metropolitan Cattle Market do. do. 39 Not decidedly unsound, although doubtful. Vendor agrees to surrender. 1 Leg of pork Alleged to have caused illness Brought to Town Hall do. do. 8 Complaint of illness not received until 4 days had elapsed. Pork submitted being in an undercooked condition. 1910] 264 265 [1910 Cowsheds.—Owing to disuse two further licences have been allowed to lapse, one being for premises situate at Northampton Street and the other at 108, Elmore Street. There are now only 5 licensed cowsheds within the Borough, and in one of their number (the largest and best equipped) no cows were kept during 10 months of the year. It would thus appear that cowkeeping in London will soon be a thing of the past, although the present largest cowkeeper in the Borough recently informed me that he would like to find suitable accommodation for 40 more cows. The existing premises have been satisfactorily conducted as a whole during the year, when a total of 64 visits were recorded. Offensive Trade Establishments.—Comprising 3 tripe dressers, 2 gutscrapers and 1 knacker's yard, have received a total of 96 visits, during which they have proved to be carried on in a fairly satisfactory manner, and although some complaints were lodged here regarding offensive smells in the neighbourhood of York Road and Pleasant Grove (four of the trades concerned being carried on in that locality) since you made a representation to the Borough Engineer on the subject, which resulted in improved street gullies, additional sewer ventilation and closed sewer manhole covers, I am pleased to say the complaints have entirely ceased. I am, Sir, Yours obediently, H. WILKINSON, Meat Inspector, etc. Milkshops and Dairies.—At the end of the year 565 milkshops were on the register, and to them 2,113 visits were paid by the district inspectors. The Chief Inspector, Mr. J. R. Leggatt, also visited them, while the Medical Officer of Health also inspected a considerable number. A serious question arose towards the end of the year as to whether power was given by section 5 of the London County Council (General Powers) Act, 1908, to Metropolitan Sanitary Authorities to remove from the register or to refuse to register premises for the sale of milk where the articles sold in the shops were likely to contaminate the milk. The matter was therefore carefully considered by the Medical Officer of Health, the Council's Solicitor and the Public Health Committee, with the result that it was found that no such powers were given, notwithstanding the fact that several successful prosecutions had been undertaken in other parts of London. There can be no doubt that the intention of the London County Council, when drawing the clause, was to give these powers to the Metropolitan Sanitary Authorities, but when it became necessary to study the section, in view of proceedings which the Medical Officer of Health had in view, it became apparent on close scrutiny that these were not conferred. The position will be best seen from the following report presented by the Medical .Officer of Health to the Public Health Committee:— 1910] 206 To the Chairman and Members of the Public Health Committee. Gentlemen, Registration of Milkshops. London County Council (General Powers) Act, 1908. You will recollect that a little time since I expressed the opinion that section 5 of this Act did not enable Sanitary Authorities to remove from the register or to refuse to register shops for the sale of milk because of the nature of the articles sold therein, and that the section only applied to the sanitary condition of the premises. In this connection you will also recollect that I informed you I had consulted Mr. Bramall. Since then we have had one or two conversations on the subject, and he has now written to me a letter containing his considered opinion on the question. It is as follows:— East India Chambers, 23, Leadenhall Street, E.C. 6th March, 1911. Dear Dr. Harris, Registration of Milkshops. London County Council (General Powers) Act, 1908. I am sorry that I did not realise that you wished me to write to you, after the very long conversation we had on this subject. The question I understand is this:—By Section 5 of the County Council (General Powers) Act, 1908, it is provided that notwithstanding anything contained in " The Dairies, Cowsheds and Milkshops Order of 1885 " any Sanitary Authority may remove from the register, or may refuse to enter upon such register, the name of any person carrying on, or proposing to carry on, the trade of a dairyman upon premises which are in the opinion of the Sanitary Authority for any reason unsuitable for the sale of milk. The question really turns upon the words " premises unsuitable for the sale of milk," and I understand it is this, whether the Sanitary Authority are only entided to consider the condition of the premises themselves, structurally or otherwise, or whether where the premises are otherwise suitable, they can be considered unsuitable by reason of the storage in the same premises of things likely to contaminate the milk. 267 [1910 I have considered the matter again fully, and I cannot see any reason to alter my views, which I have already expressed, that the Sanitary Authority can only look at the premises as such, and not consider anything that may happen to be stored on the premises. The natural meaning of the words " premises unsuitable " is that the actual building is in itself unsuitable, as for instance, that it is badly ventilated, has a w.c. opening out of it, is dirty, infested with vermin, or other similar causes, or even if the premises were adjoining some kind of factory from which noxious fumes would be likely to reach the milk, although this is doubtful. If the legislature had intended to say what you at first thought they had, namely to provide that if things unsuitable to be kept with milk were stored on the same premises, the registration might have been cancelled, it would have been perfectly easy to say so, and I think it is always a good rule of construction not to attempt to read into words a meaning which they do not naturally express, and which it would have been perfectly easy to express in apt words if that had been the intention. I am fortified in this opinion by the phraseology of Section 2 of the Public Health Act " Any premises in such a state as to be a nuisance or injurious or dangerous to health may be dealt with summarily." It has been held that this applies to premises which, but for their condition, would not be a nuisance, and not to premises which are a nuisance by reason of the purposes for which they are used, and also by the fact that the Order in Council provides (sec. 11) " It shall not be lawful for any dairyman or purveyor of milk to use a milkstore or milkshop as a sleeping apartment, or for any purpose incompatible with the proper preservation of the cleanliness of the milkstore or milkshop, and of the milk vessels and milk therein, or in any manner likely to cause contamination of the milk therein," and by the regulations of the London County Council, Section 30, every purveyor of milk shall not keep milk for sale in any place where it would be liable to become infected or contaminated by any offensive effluvia, or by any offensive or deleterious gases or substances. The matters, therefore, which you require to be prohibited seem to me to be dealt with by the Order in Council and by the regulations of the County Council. Yours faithfully, Arthur M. Bramall. A. E. Harris, Esq., Medical Officer of Health, Islington. 1910] 268 In the circumstances I do not see that we have any alternative but to register the persons applying to us for registration, and I can foresee great trouble in dealing with milkshops in the future. We are exactly now in the position we were in before the passing of this Act, and this is due entirely to the bad drafting of the clause, for undoubtedly the intention of the London County Council and of Parliament itself was to enable Sanitary Authorities to remove from the register, or refuse to register, places which owing to the nature of the articles sold therein rendered them unfit for the sale of milk. I am of opinion that the attention of the London County Council should be drawn to this subject, and that they should be requested to amend the law so as to give effect to their original intentions. Meanwhile I suppose the names of those persons who have applied for registration should be entered in our books. This is a very unfortunate occurrence, and one that should have been foreseen by the County Council. I am, Your faithful servant, A. E. Harris, Medical Officer of Health. Town Hall, Islington, 6th March, 1911. A copy of this report was sent to the London County Council, and it is, therefore, to be hoped that in the near future the power to refuse to register, or to remove from the register, places in which any articles are sold which are likely to contaminate milk will be conferred by new legislation. Bakehouses.—These have been dealt with in part 4 of the report in connection with the administration of the factory and workshops. Kitchens, Restaurants, and Eating Houses.—These also have been dealt with in part 4 of this report. Places where Ice Creams are made.--At the end of 1910 there were 235 of these premises on the register, as compared with 230 in 1909. Altogether 136 inspections were made, as contrasted with 167 in the preceding year. These visits resulted in the service of 15 notices. The condition of premises where ice-creams are manufactured is much superior to that which prevailed prior to the passing of the London County Council (General Powers) 269 [1910 Act, 1902. Something, however, yet remains to be done, viz.: the enactment of legislation to enable Sanitary Authorities to insist that suitable storage be provided for the articles of which these popular comestibles are composed. At present they are kept anywhere, and have sometimes been found in the bedrooms of the makers. Canned Salmon. —Towards the end of June a complaint having been made that a blown tin of salmon had been sold at one of the leading shops, the Food Inspector visited it, and very carefully examined all the tins, among which he found eight that were blown, which he accordingly seized and condemned. The Medical Officer of Health afterwards pierced some of them under water to discover if they contained air or gas, when he found that bubbles at once rose to the surface. On opening the tins, however, the salmon presented a very good appearance and showed no trace of decomposition by taste or smell. One of the proprietors of the firm, together with the English representative of the canners, who called on the Medical Officer of Health to discuss the matter, held that although the cans undoubtedly contained air, the fish was not bad, an opinion which was also held by the Medical Officer of Health. The facts were placed fully before the Public Health Committee, who were informed by him that hitherto where prosecutions had been taken the food in the cans had been more or less decomposed, and that therefore the preserved food products which they contained were unfit for human food; and that all that the most recent authorities would say about a blown tin was that it was a suspicious circumstance, and consequently it should not be sold. Also, that all canners recognised this fact, and were always willing to replace blown goods. The Medical Officer of Health was also of opinion that if legal proceedings were taken against the vendors they would fail. He had two of the suspected tins opened for the committee's examination, and they were satisfied that the salmon appeared quite sound. It may be stated that the canned salmon in question has the repute of being the best brand on the market. As a result of this seizure the English representatives of the canners cabled to Vancouver, giving instructions that the "pack" then about to be made, and which would be finished by the middle of August, should be put up in tins with a stronger bottom, as they believed that the make of the can had been the cause of the trouble. This bottom forms part and parcel of the can itself as the vessel is stamped out, and, therefore, no solder is used, which was the reason why stamping was resorted to. 1910) 270 The firm very freely gave the Medical Officer of Health full particulars as to the methods they adopt at their Vancouver cannery in preparing the salmon for sale, and as they are the most modern they are now given. They are as follows : — (1) The salmon are caught in nets, seins and traps and are brought to the canneries in boats or steamers. (2) They are raised from these vessels by elevators to the fish dock. (3) They are given a thorough external washing. (4) They are butchered and cleansed by machinery. (5) They are critically examined and passed into the brine tanks for a final cleansing. (6) They are passed into the dripping tank, where all the water is drained off from them. (7) The fish are conveyed by endless chain carriers to the cutting machines, where the salmon is divided into pieces the length of a can by rapidly revolving circular knives. (8) In the case of the flat and oval 1 lb. and ½ lb. cans, the salmon is packed by hand, as no practical machines for dealing with these cans can be devised, but over 80 per cent. of all salmon is packed by machinery in the tall cans, as a machine does not get tired and neglectful. These tall cans are fed with salmon from large hoppers, which are attached to the cutting machines. The salmon having been first cut into cylindrical pieces, the pressure of a piston presses it into the cans. (9) To each can is added, before being filled with fish, one-quarter of an ounce of table salt. (10) From the filling machines the cans are transferred to tables where they are thoroughly inspected, weighed, and any deficiency supplied. (11) Endless belts convey the cans to cleansing machines, where the exterior is subjected to a jet of hot air under high pressure and then polished with rapidly rotating wire brushes. 271 [l910 (12) The tops are placed on the cans and soldered, after which they pass over runways under numerous jets of cold water, which cools the solder. (13) The central vents of the tops, which are open until this stage of the process, are sealed. (14) The cans are placed in open steel trays, or coolers, as they are called, which are immersed in tanks of hot water; air bubbles, escaping, call attention to leaking tins, which are removed and passed on to the leak menders for immediate repair. The contents of a mended can are as good as any other. (15) The trays containing the cans are then placed one upon another on cars and run into a track into steel retorts, where the salmon is subjected to the first cooking. This requires about 50 minutes under steam pressure of 6 lbs., equal to a temperature of 220° Fahrenheit. (16) The cans are withdrawn and vented by piercing the tops with small brads to allow the hot air to escape. After this the second vent holes are soldered. (17) The cans are placed in another retort for the second cooking under steam pressure of 12 lbs., or at a temperature of 240° Fahrenheit. (18) After the second cooking the cans are cleansed by scouring them in a tank of strong lye and then washing in boiling water and lastly in cold water, after which they are allowed to stand for several weeks, during which time they are repeatedly tested and examined for defects. All such cans are removed. (19) Finally they are dipped into lacquer to prevent rust and are then cased. It will be noticed that the cans are pierced twice, and consequently such a fact in this method of canning is not the suspicious circumstance, which writers on tinned goods usually hold double piercing to be. Dirty Milk Vessels.—Special attention was paid to the state of the milk measures used by purveyors of milk, and it is satisfactory to find that they were generally in a cleanly state. The Chief Inspector has during the last two or three years made it a regular practice to point out to them the necessity of keeping their measures thoroughly clean. He used to find 1910] 272 in many cases, especially in tin measures, caseous matter deposited in the joints and in the interstices where the handles were strengthened with wire. Matters have now much improved There was, however, one case to which attention might be called. A milkman was discovered selling milk from a bottle-shaped milk can, the cover of which on examination was found to be coated with offensive caseous matter, which appeared to be of many days' growth, notwithstanding that the owner asserted that it was scalded daily. A sample of the deposit was shown to the Public Health Committee, who ordered a prosecution. The man was fined £2 2s. Ice Cream Shops.—These places were frequently inspected by the Inspectors during the course of sale of the ice creams, but nothing was seen that would cause them to take action. In one instance, however, a Police Constable, 379 N., while on duty on a Sunday morning in April, noticing that a boy, who had just bought an ice cream from a street vendor, spat it out, asked him what was the matter with it, and received the reply, " It is rotten, guv'nor." As a result the constable prevailed on the man to proceed with him to the Upper Street Police Station pending the arrival of a sanitary inspector, for whom he had sent. On the arrival of Sanitary Inspector Agar, he found two cylinders on the barrow, each of which was half full, one with ice cream, the other with water ice, and noticed that each smelled fusty and sour, while their taste was sour and unpleasant, and in his opinion unfit for human consumption. He, therefore, had the ices brought before a Justice and had them formally condemned. It turned out afterwards that the outfit had been borrowed for the day; that the ingredients were good, but that the maker knew nothing about the manufacture of the articles. He did not reside in Islington, nor was he registered for the sale of ice creams. He was prosecuted and bound over in the sum of £2 to come up for judgment, if called upon, within twelve months. THE ADULTERATION OF FOODS AND DRUGS. The administration of the Adulteration Acts has always been considered in Islington to be one of the most important duties devolving on the Public Health Department, and rightly so, for the purity of the food of human beings is all important both to the young and the old, as well as to the strong and the infirm. 273 [1910 The detection of fraudulent dealers, is, however, not always easy, for they are up to many tricks and artifices, and of late years have begun to look on all new customers with suspicion, dreading that they might be inspectors or inspectors agents. It has, therefore, become necessary, in order to circumvent such dealers, to resort to two devices, (a) to make the agent a customer for a time, and (b) to privately examine the goods that have been sold to him until they have commenced to palm off adulterated articles on him, when an official sample is purchased. Even then the result is not always although it is usually, successful, because it may happen that when the sample is purchased a new assistant or an assistant who did not recognise the agent as a customer may have served him, and, therefore, given him a pure article; or else for some unaccountable reason, perhaps a fit of spasmodic honesty, or a pricking of conscience, if such people possess one, the vendor sells a genuine article, although for some time previously he had been selling adulterated goods. Inspector Burrell has, however, been very successful in his operations, which is proved by the fact that he has succeeded in obtaining not less than 1 adulteration in every 10 samples officially purchased. This matter will be dealt with later on in the report. Samples analysed in 1910.—1,204 samples were submitted for analysis to the Public Analyst, who reported that 1 076 were genuine and 128, or 10 6 per cent., adulterated. This compares with an average of 11.4 per cent. in the nineteen years 1891-1909, and must be considered very satisfactory in view of the difficulties that have arisen in late years in the detection of dishonest tradesmen. These men, too, are not so numerous as formerly, for year by year it is found that their numbers are more circumscribed. Indeed, it may be said with respect to the dealers in dairy produce, milk, butter and its substitute, margarine, that adulteration, if not altogether confined to Welshmen, many of whom think that the English working man is fair game for them, is practised by few other people. Adulteration is very seldom discovered now in any business of any size. Indeed, it is practically confined to small shops in poor neighbour hoods. The inspector has sampled the shops in the main thoroughfares in vain, for adulterated goods are not to be found in them; unless, indeed, by chance the wholesale dealers or importers have fraudulently sold foodstuffs adulterated in some new manner to the retailers, who in such circumstances would be more sinned against than sinning. 1910] 274 Table CXIX. Showing the Number of Samples of Foods and Drugs Analysed, with the Result of the Analyses for the Year 1910 and for the preceding Nineteen Years. Years. No. of Samples Examined. Genuine. Adulterated. Per cent. Adulterated. 1891 368 345 23 6.2 1892 367 302 65 17.7 1893 378 327 51 13.5 1894 411 350 61 14.8 1895 825 697 128 15.5 1896 825 699 126 15.3 1897 863 765 98 11.3 1898 875 784 91 10.4 1899 899 820 79 8.8 1900 925 798 127 13.7 1901 942 800 142 15.1 1902 932 796 136 14.6 1903 1,016 898 118 11.6 1904 1,204 1,101 103 8.5 1905 1,200 1,101 99 8.2 1906 1,190 1,079 111 9.3 1907 1,213 1.131 82 6.7 1908 1,200 1,058 142 11.8 1909 1,201 1,060 141 11.7 Totals 16,834 14,911 1,923 11.4 1910 1,204 1,076 128 10. 6 The Public Analyst, in his several quarterly reports during the year, reported against the articles examined as follows: — Examined. Genuine. Adulterated. Per cent. 1st Quarter - 322 - 287 -35 10.9 2nd „ - - 300 - 268 -32 10.7 3rd ,, - - 294 - 259 -35 11.9 4th „ - - 288 - 262 - 26 9.0 The Year 1,204 1,076 128 10.6 275 [1910 Milk, Butter, and Oleaginous Foods. As many as 936 of these foods were submitted to the) Public Analyst, of which he returned 96, or 10.2 per cent., as adulterated or sold contrary to the provisions of the Adulteration Acts. Since 1905 the percentages of these foods discovered to be adulterated were follows:— 1905 7.2 per cent 1908 9.5 per cent. 1906 10.2 „ 1909 8.7,, 1907 6.5 ,, 1910 10.2 ,, Samples. Adulterated. Percentage Adulterated in 1910. Percentage Adulterated in 1909. Percentage Adulterated in 1908. Milk 620 58 9.3 6.8 8.6 Milk (Separated) 1 50.0 Butter 200 10 5 .0 12. 5 9.5 Margarine 40 28 70.0 30.0 35.7 Cheese 40 Lard 355.0 936 96 10.2 8.7 9.5 Milk.—620 samples were submitted to the Public Analyst, who reported against 58, or 9.3 per cent., as adulterated. This is the largest percentage of adulteration that has been obtained since 1906. It compares with 6.9 per cent. in 1909, with 8.6 per cent. in 1908, with 6.7 per cent. in 1907, and 11.8 per cent. in 1906. The following statement shows the number of samples examined by the Public Analyst in each quarter, together with the numbers returned as adulterated. Samples Examined. Adulterated. Per cent. Adulterated. 1st Quarter 166 10 6.0 2nd „ 150 19 12.7 3rd „ 150 19 12.7 4th „ 155 10 6.4 621 58 9.3 1910] 276 The record of the adulteration of milk in Islington since 1892 has been as follows:— MILK ADULTERATION. Samples Analysed. Genuine. Adulterated. Per cent. Adulterated 1892 171 139 32 18.7 1893 213 173 40 18.7 1894 206 169 37 I7.9 1895 413 343 70 16.9 1896 468 418 50 10.6 1897 513 464 49 9.5 1898 543 492 51 9.4 1899 532 477 55 10.3 1900 541 485 56 10.3 1901 632 556 76 12.0 I902 586 528 58 9.9 1903 508 458 50 9.8 I904 600 553 47 7.8 1905 594 549 45 7.6 1906 634 560 74 11.8 1907 597 557 40 6.7 1908 604 552 52 8.6 1909 605 563 42 6.9 Totals 8,960 8,036 924 10.3 1910 621 563 58 9.3 The detection and successful prosecution of fraudulent milk dealers is not always easy, but on the contrary is at times most difficult, and not always unattended with danger. The following particulars, already reported to the Public Health Committee, illustrate the matter. They are interesting and instructive as showing the audacity of some of those leather-lunged rascals who periodically crop up in populous places, and especially in London: — 277 [1910 About noon on Friday, October 7th, Inspector Burrell was in Rufford Street, when he saw two men with a milk barrow containing a swing churn as well as several hand cans and an eight-quart can, which was suspended from hooks on the shaft rail. His attention was drawn to them because the man, who appeared to be the owner of the barrow, continuously rattled the churn lid and should " Pure new milk." The inspector approached the barrow and asked for " a pennyworth of milk," at the same time handing a half-pint jug for it. He was served without remark from the eight-quart can, which at that time contained about seven quarts. The inspector handed the vendor a penny, and as he had been given short measure, he waited in order that the salesman might have an opportunity of returning the change before he declared who he was. No change being forthcoming however, he informed the seller that he was an Inspector under the Sale of Food and Drug Acts, and that he had purchased the milk for the purpose of having it analysed by the Public Analyst. The seller made no immediate remark, but after a few seconds followed Mr. Burrell to the footpath, where he was dividing the sample, and said, " Here ! you want some change; you have only got a farthingsworth," and thereupon offered him three farthings. Mr. Burrell informed the man that he had very distinctly asked him for a pennyworth of milk, and that he should decline to accept any change, as he had had every opportunity of giving it before he told him who he was. The seller and his assistant then took up a position one on either side of the inspector, both considerably impeding him in the operation of dividing the sample by their attempts to handle the bottles and force the change on him, and by their insulting behaviour. The vendor at this time said the milk was skim milk, and commenced to shout " Milk, penny a quart." The inspector showed the defendant the divided samples that he might have an opportunity of checking the numbers, but instead he jostled him and declined to check them. He, however, accepted the third part. On asking the defendant for his name and address, he replied " The same as on the barrow," and then repeatedly shouted " Pure new milk." 1910] 278 At this time Mr. Burrell drew the attention of one of the Council's dustmen, who happened to be in the neighbourhood, to the fact that the defendant was shouting " Pure new milk." The barrow handle was inscribed " John Morgan, 11, Bowles Road, Camberwell Road "; the churn was marked " C. & G. Prideau, Shillingstone Station a hand can on the side of the barrow was inscribed " The Berkshire Farmers' Direct Milk Supply. Pure Separated Milk." In answer to the inspector's questions the defendant said that the business was his, but later on stated that it belonged to his brother. He also stated that his name was John Morgan, but that the name on the barrow (John Morgan) was that of his brother; indeed, he made so many mis-statements that it was quite obvious he was doing his best to mislead Mr. Burrell. While the inspector was examining the eight-quart can above referred to, the vendor became violent and jostled him away from the barrow, and as it was impossible to proceed further by reason of his behaviour and the pressure of the crowd, which by that time numbered about 150, Mr. Burrell sent for a constable. Morgan and his assistant then moved rapidly away, but were finally overtaken by the inspector and P.C. 465 Y. in an adjacent street. Here Morgan repeated his tactics of giving untruthful answers to the questions put to him. He finally stated, however, that his name was Stephen Morgan and that he lived at No. 11, Bowles Road, Camberwell Road, but that the business belonged to his brother, Jack Morgan, of 75, Blackfriars Road. On Monday, 11th October, the Camberwell Public Health Department was communicated with, when it was ascertained that Stephen Morgan was not registered as a milk seller at 11, Bowles Road. Later in the day Mr. Burrell visited this address and was informed by a female who answered the door that there was nobody named Morgan residing on the premises, and that there was nobody engaged in the milk trade living there. The inspector, however, was assured by a lad who lived in the vicinity that a family had recently moved into No. 11 and that a man, who lived there, was in the habit of going about with a milk barrow. He then visited the premises at the rear of No. 11, Bowles Road, which are in the occupation of a van builder, where he found the following milk 279 [1910 utensils:—A churn marked " C. & G. Prideau, Shillingstone Station." A milk barrow in course of repair marked "The Gallow Park Dairy Co., No. 9;" a milk barrow and churn marked " The Express Dairy." There was also a card on the handle inscribed " W. Wood, Shardess Square, Old Kent Road." On prosecuting further inquiries in the vicinity of Morgan's alleged address, Mr. Burrell was informed by a milkman that Morgan was an assumed name, but that the man's real name was Welch. The inspector next visited 75, Blackfriars Road, which is a common lodging house, and was informed by the deputy manager that they had no lodger of the name of Morgan. On returning to the office, Mr. Burrell had the records examined and found the following entries against a man named Welch, whose description answered to that of Morgan:— Selling as milk (skim) adulterated with 11 per cent. of added water. May 6th, 1896. The defendant was fined £2 and 2s. costs. Using threatening language to inspector. Bound over in the sum of £5 to keep the peace for three months. Selling adulterated milk (56 per cent. of added water) at Albany Cottages, Essex Road, on April 23rd, 1902. Fined £10 and 12s. 6d. costs; in default of distress two months' imprisonment. The defendant absconded and a warrant was issued for his arrest. He was arrested more than two years later at Willowbrook Road, Peckham, on Thursday evening, October 20th, 1904, and as he did not pay the fine went to prison. Morgan is only an alias for Welch, and, indeed, it is a notable fact that when he was sampled in 1896 and 1902 he adopted exactly similar tactics of obstruction and of gathering a crowd. The Public Analyst certified his milk as adulterated with 17 per cent. of water, and as to 74 per cent. of its fat abstracted. A summons was duly served at his address, but in serving it the greatest difficulty was experienced by the Warrant Officer, who, accompanied by Inspector Burrell, went on two occasions in the early morning, between 4 and 5, to Camberwell. Persons in the house denied that either Morgan or Welch were living in it, and, indeed, it was only on the second day that an admission was obtained from a woman, who, it turns out, is Welch's daughter-in-law, that 1910] 280 he lived there. She would not have acknowledged the fact had not the Warrant Officer threatened her with punishment for shielding Welch. The case was heard at Clerkenwell, and the defendant, who admitted he was Welch, was fined £30 12s. 6d., or three months' imprisonment. He went to gaol. Sunday Milks.—During the year 160 samples of milk were purchased on Sundays, and of these 14, or 8.7 per cent., were reported by the Public Analyst as being adulterated. This compares with 8.8 per cent. in 1909, and 9.4 per cent. in 1908. The amount of adulteration is considerably lower than that of the milk sold on week-days, which is a noteworthy circumstance, as formerly the milks that were purveyed on Sundays invariably showed a higher percentage of adulteration. Week-day Milks.—336 samples were examined, of which 44, or 13.1 per cent, were adulterated. This percentage compared with 6.7 in 1909, with 10.2 in 1908, and 8.2 in 1907. Farmers' Milks. The samples of these milks were all taken at the railway stations as they arrived from the farms. Their analyses may, therefore, be taken as showing the state of milk which is delivered by farmers. Altogether 125 samples were obtained, and all were declared by the analyst to be genuine. They were, therefore, above the official standard. The average percentage of adulteration of these milks during the last thirteen years has been only 1.6, and it is a noteworthy fact that in 1898, 1900, 1904, 1907, and 1910 all the tested milks were above the official standard. There is no doubt that taken as a whole the English farmer is an honest man, and rarely adulterates his milk. It is not to be supposed from this remark that he is also a wise man, for undoubtedly he at times keeps cattle which supply poor milk and do not pay for their keep. As a rule he keeps no records of the amount and quality of the milk of each of his cows, and, therefore, animals are to be found in many herds whose milk neither comes up to the standard nor pays for the fodder which they consume. The results of the analyses during the year were as follows:— Obtained. No of Samples Analysed. Average Percentage of Fat. Average Percentage of Solids, not Fat. Average Percentage of Total Solids. On Sundays 160 3.55 8.57 12.12 On Week-days 336 3.44 8.50 11.94 At Railway Stations 125 3.74 8.70 12.44 Official Minimum Standard — 3.00 8.50 11.50 281 [1910 Quality of the Milk.—The results of the analyses of the milks purchased on Sundays, on week-days, and obtained in the course of transit at railway stations have always been kept separate, so that it is possible to ascertain the average quality of these several milks, which can then be compared with the official minimum standard. On Sundays.—This practice was as usual adopted last year, and from the reports of the Public Analyst it appears that the 160 samples obtained on Sundays show an average of 3.55 per cent. of fat, 8.57 per cent. of solids not fat, and 12.12 per cent. of total solids. In other words, these 160 milks, which also included 14 adulterated samples, showed a content of 24 per cent. more fat than the official minimum standard required. On week-days.—With respect to the milks taken on week-days, it was found that .the average analyses of the 336 samples showed 3.44 per cent. of fat, 8.50 per cent. of solids not fat, and 11.94 per cent, of total solids. It, therefore, comes to this, that although they included 44 adulterated milks they contained nearly 15 per cent. more fat than the official minimum standard required. Again, the 125 milks obtained at the railway stations on arrival from the farms contained an average of 3.74 per cent. of fat, 8.70 per cent. of solids not fat, and 12.44 per cent. of total solids ; in other words, the fat content was 24.6 per cent. above the official minimum standard. It was, therefore, possible for fraudulent dealers to reduce their milk by the addition of separated milk to the extent of 20 per cent. without fearing a prosecution, and that too although it could be proved without fear of contradiction in a Court of Justice that the milk had been adulterated. This may seem to the lay mind an extraordinary thing to say, but it is nevertheless a fact, which the following instance will illustrate: At the close of the year a prosecution was undertaken against a milk vendor in Islington, who on the service of the summons immediately pleaded a warranty. When the case came before the Court, the Council's solicitor produced the three persons at the farm through whose hands the milk had passed to show that it had not been adulterated by them, but that it had been forwarded just as it came from the cows. He also called two railway guards who had charge of the trains in which the milk was conveyed to London; and he also called the head porter at Finsbury Park Railway Station who had the supervision of the milk on its arrival at the Great Northern Railway Station. Every one of these witnesses swore that so far as they were concerned the milk was untouched, and that while in their charge it was impossible to tamper with it. At this stage the case was adjourned for 1910] 282 fourteen days, and in the interval the Inspector under the Adulteration Acts was sent down to the farm to obtain samples of the milk from the bulk which was about to be forwarded to London. He saw that milk delivered at the country station. On its arrival in London samples were obtained by another inspector from the churns, and finally after the milk had been taken away from the station to the vendor's premises, and while in course of delivery to his customers other samples were obtained by two inspectors. The results of the analyses of all these samples was that the fats, and solids not fat, contained in the samples obtained at the farm and those obtained in Finsbury Park Station were identical, while those obtained in the street in course of delivery to the vendor's customers showed an abstraction of 20.4 per cent. of fat. He had skilfully reduced the fat content to nearly the minimum standard. When the matter was carefully gone into by the Public Analyst he found that he was bound by the official minimum standard, and, therefore, could not give a certificate to enable a prosecution to proceed. It has been conceded by everyone who has a knowledge of the law that the position taken up by the Public Analyst was perfectly correct, and strange though it may appear, although it could be proved beyond the shadow of a doubt that this man adulterated the milk, no prosecution could follow. This was to be regretted, because the object of taking the samples was for the purpose of rebutting the evidence that it was perfectly well known he would give, having relied on a warranty, that he or his servants had not adulterated the milk; or in case such evidence would not be allowed, to issue a fresh summons against him. The result was that evidence as to the adulteration of a sample of milk obtained subsequent to the issue of a summons could not be produced against the defendant, nor could a prosecution be undertaken for adulterating the milks which had been reduced to the minimum official standard. Thus a milk vendor escaped punishment for his undoubted wrong-doing. Such a state of the law is most deplorable, and in the interests of all honest traders, and more especially in the greater interest of the public generally, an end should be speedily put to such a state of affairs. The subsequent Table gives the results of the examination of all the milk analysed in Islington, whether obtained on Sundays, week-days, or at the railway stations in course of delivery:— 283 [1910 Table CXX. Showing the analyses of 7,570 milks examined in Islington during the thirteen years 1898-1910, and distinguishing those purchased on Sundays, on Week days, and procured at the Railway Stations while in transit from the Farmer to the London Milk Purveyor. Years. Sunday Milks. Week-day Milks. Railway Milks (Farmers). No. of Samples. Per cent. of non-fatty solids. Per cent. of fat. No. of samples. Per cent. of non-fatty solids. Per cent. of fat. No. of samples. Per cent. of non-fatty solids. Per cent. of fat. 1898 193 8.50 3.50 230 8.56 3.69 120 8.84 4.04 1899 181 8 .49 3.50 231 8.53 3.58 120 8.82 4.23 1900 196 8.64 3.62 224 8.55 3.53 121 8.75 3.93 1901 196 8.56 3.64 295 8.60 3.49 141 8.77 3.69 1902 192 8.59 3.60 274 8.64 3.51 90 8.76 3.85 1903 167 8.42 3.86 218 8.47 3.74 120 8.66 3.90 1904 164 8.52 3.78 317 8.48 3.74 120 8.62 3.97 1905 161 8.55 3.68 323 8.51 3.72 112 8.66 3.87 1906 195 8.49 3.58 332 8.52 3.59 110 8.75 3.69 1907 150 8 .64 3.63 327 8.65 3.76 120 8.77 3.96 1908 160 8.58 3.69 324 8.58 3.52 120 8.73 3.88 1909 159 8.66 3.67 326 8.85 3.62 120 8.74 3.86 Total Twelve Years 2,114 8.55 3.65 3,421 8.58 3.62 1,414 8.74 3.91 1910 160 8. 57 3.55 336 8.50 3.44 125 8.76 3.74 From these analyses the following averages for the years 1898-1910 have been deduced:— Solids not fat. Fat Total solids. 2,274 Sunday Milks 8.55 3.64 12.19 3,757 Week-day Milks 8.57 3.62 12.19 1,539 Farmers' Milks 8.74 3.89 12.63 Total Milks 8.62 3.72 12.34 1910] 284 Table CXX1. Giving the particulars of the Milk taken during each quarter of 1910 on Sundays, on Week-days, and at the Railway Stations. 1910. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Quarters. Sundays. Week-days. Railway Stations. All Milks. Sundays. Week-days. Railway Stations. All Milks. Sundays. Week-days. Railway Stations. All Milks. Sundays. Week-days. Railway Stations. All Milks. 1st Quarter 40 95 31 166 37 88 31 156 3 7 •• 10 7.5 7.4 •• 6.0 2nd ,, 40 80 30 150 36 65 30 131 4 15 •• 19 10.0 18.7 •• 12.7 3rd „ 40 80 30 150 33 68 30 131 7 12 •• 19 17.5 15.0 •• 12.7 4th „ 40 81 34 155 40 71 34 145 •• 10 •• 10 •• 12.3 •• 6.4 The Year 160 336 125 621 146 292 125 563 14 44 •• 58 8.7 13.1 •• 93 Table CXXII. Showing the Samples of Milk Analysed, the number found adulterated, with the percentage of Samples adulterated for the past thirteen years. Year. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Sundays Week-days. Ry. Stations All Milks. Sundays. Week-days. Ry. Stations. All Milks. Sundays. Week-days. Ry. Stations. All Milks. Sundays. Week-days. Ry. Stations. All Milks. 1898 193 230 120 543 165 207 120 492 28 23 .. 51 15.0 10.0 .. 9.4 1899 181 231 120 532 154 204 119 477 27 27 1 55 14.9 11.2 0.8 10.3 1900 196 224 121 541 170 194 121 485 26 30 .. 56 13.3 13.4 .. 10.3 1901 196 295 141 632 172 247 137 556 24 48 4 76 12.3 16.3 2.8 12.0 1902 192 274 90 556 172 238 88 498 20 36 2 58 10.4 13.1 2.2 10.4 1903 167 218 120 505 147 190 118 455 20 28 2 50 11.9 12.8 1.7 9.9 1904 164 317 120 601 158 276 120 554 6 41 .. 47 3.6 12.9 .. 7.8 1905 161 323 112 596 151 294 106 551 10 29 6 45 6.2 9.0 5 3 7.5 1906 195 332 110 637 173 281 108 562 22 51 2 75 11.3 15.4 1.8 11.8 1907 150 327 120 597 137 300 120 557 13 27 .. 40 8.7 8.2 .. 6.7 1908 160 324 120 604 145 289 118 552 15 35 2 52 9.4 10.8 16 8.6 1909 159 326 120 605 145 304 114 563 14 22 6 42 8.8 6.7 50 6.9 1910 160 336 125 621 146 292 125 563 14 44 .. 58 8.7 13.1 •• 9.3 Totals 2,274 3,757 1,539 7,570 2,035 3,316 1,514 6,865 239 441 25 705 10.5 11 7 1.6 9.3 285 [1910 1910] 286 Butter and Margarine.—200 samples of butter were analysed by the Public Analyst, of which 10, or 5 per cent., were adulterated. This percentage compares with 12.5 in 1909, 9.5 in 1908, and 6.2 in 1907. There can be no doubt that owing to the vigorous manner in which fraudulent dealers in butter were followed up in 1909, there was less substitution of margarine for butter than usual. How long this improvement will continue it is hard to say, for there is a tendency on the part of certain vendors to resume the practice of substituting margarine for the article demanded. It is necessary when considering the adulteraton of butter also to take into consideration the breaches of the Margarine Act, and when this is done it will be found that last year out of 40 samples of margarine which were purchased, 28, or 70 per cent., were sold contrary to the Act. Now in every one of these instances it is more than probable that if butter had been asked tor, margarine would have been supplied ; and, indeed, this was proved in several of the cases by the informed sampling that had been made of the goods. As a rule, such substitutions are practised by very small traders in poor neighbourhoods, who frequently sell their goods in unstamped wrappers. This offence is a serious one in the eye of the law, for the penalty for the first offence may be £20; for the second offence £50, and for a third or any subsequent offence £100. This provision was passed in 1887 to protect the butter industries of the country, which suffered severely from the sale of what was then called "butterine" and now is known as "margarine." The fraud became so extensive that it was felt that very strong and drastic measures should be taken to put an end to it. From that day to this all honest traders have complied with the Act that was then passed, but it is regrettable to think that there are still a large number of persons who dishonestly sell margarine for butter, although it is not strange to find these are the same persons who, as a rule, do not sell margarine in stamped wrappers. It has already been pointed out that it is very difficult to punish persons who deal fraudulently in food stuffs, for although they are very dishonest, they are very careful to whom they sell, and in fact will not sell to any person until they know him as a customer, fearing lest he should be the Inspector's agent. These people, curiously enough, when asked for margarine are not quite so careful, and very frequently use unstamped wrappers. It has been said, and there is no doubt that there is a great deal of truth in the statement that they do so at times at the request of customers, because the Medical Officer of Health has been informed on what he considers reliable authority that there is a certain class of women, wives of working men, who ask to be supplied with the margarine in an unstamped wrapper, 287 [1910 with the object of deceiving their husbands, so that they may buy drink with the difference in the cost of the articles. It has also been said that young children when sent out for butter get margarine in an unstamped wrapper, and keep the difference in the price for themselves. This is hardly to be wondered at, for, in the words of the old adage "As the old cock crows, the young one learns." These facts, however, be they as they may, it is not strange to find that the offence is looked on by some magistrates as a serious one, although there is at least one magistrate who hears our cases who thinks differently, and who rarely inflicts a serious penalty, yet there are others who do not hesitate to inflict full penalties. There was one remarkable case heard during the year. The man was summoned for the tenth time since 1895. His first summons was for milk adulteration, when he was fined 12s. 6d.; the second was for adding 18 per cent. of water to milk in 1897, which, however, was withdrawn on production of a warranty. The third offence was the addition of 12 per cent. of added water to milk, when he was fined £2 and 12s. 6d. costs; the fourth was for selling margarine as butter, when he was fined £5 and 12s. 6d. costs; the fifth was for selling milk with 4 per cent. of added water, when he was cautioned; the sixth was for selling margarine as butter, when he was fined £14 and 14s. 6d. costs.; the seventh time was for selling milk with 5 per cent. of added water, when he was cautioned ; the eighth was on the 7th March, when he was cautioned for selling milk containing 5 per cent. of added water, the ninth was on the 7th September, when he was fined, for selling margarine as butter, £3 and 12s. 6d. costs, and on the tenth and last occasion he was ordered to pay 12s. 6d. costs for selling margarine in an unstamped wrapper. Now if ever there was a case in which a severe penalty should have been inflicted, it was this, and yet the man had only to pay the costs, 12s. 6d. Leniency in the circumstances related above was truly misplaced. There is another magistrate who sometimes hears Islington cases who apparently does not consider it an offence to sell margarine in unstamped wrappers, and has indeed nearly said as much on the Bench. Of course, if magistrates hold these views, the Margarine Act must speedily become a dead letter. It ought to be stated that the last proceedings against the man whose long record was given above were taken on information received by the Medical Officer of Health from the Board of Agriculture, who had been made acquainted with his fraudulent dealings by the Grocers' Association. Since then a further complaint was received from the same source and resulted in a prosecution, when the defendant was fined £5 and 12s. 6d. costs. 288 19101 During the year 20 of the chief grocers in Islington were informally sampled, and cut of this number it was found that only one sold margarine in an unstamped wrapper. The man was prosecuted for a similar offence last year. It will thus be seen that the practice of selling margarine in unstamped wrappers is practically confined to the lower class tradesman, or businesses for the most part confined to the lower class of the community. Forty samples of cheese were examined, all of which were reported as genuine. A letter from the Borough Council of Battersea, on which I was desired to comment, was considered by the Public Health Committee, to whom I submitted the folowing report:— To the Chairman and Members of the Public Health Committee. Gentlemen, Standards for Cheese, Etc. I am in entire agreement with the recommendations contained in the letter from the Borough Council of Battersea that the Local Government Board should fix a standard for cheese, which is not only one of the most ancient foods (for I believe it was known as long ago as the days of King David, and that the Greeks were acquainted with it long before the birth of Christ), but also one of the most nourishing and largely used. Its standardisation is all the more necessary because, as competition increases, the tendency is to put cheeses on the market with less fat, or in other words to make them from milk which has been largely deprived of its butter fat; so that ultimately we shall be told that such a cheese is genuine because it has been known and sold by the trade for years, and therefore a prosecution must fail. In the United States cheese is defined in Circular 19 of the Office of the Secretary of the United States Department of Agriculture as " the sound, solid, and ripened product made from milk or cheese by coagulating the casein thereof with rennet or lactic acid, with or without the addition of ripening ferments and seasoning, and contains, in the water free substance, not less than 50 per cent. of milk fat." 289 [1910 A similar definition would probably be suitable for English cheeses, but of course the Food Department of the Local Government Board would consider this point. But why stop short at defining cheese when every one of our foods requires a definition? What of cocoa? What of bread? What of jam? What of meat extracts? What of sausages? What of potted meats? What of condensed milk? What of alcoholic beverages? What of malt extract? I can tell the Committee that if there had been a definition of Irish whiskey and of Scotch whiskey there never would have been a whiskey prosecution, and a Royal Commission, which, whatever may be said of it was the means of eliciting a very strong opinion from the distinguished analysts who gave evidence of the great difficulty they were placed in through being compelled to form their own standard of purity for foods which they analysed so that the Royal Commissioners reported to the Government that "practically all the local officers who gave evidence laid stress on the anomalous position in which the authorities and their public analysts are placed in matters of this kind as a result of the conditions imposed upon them by the Sale of Foods and Drugs Acts." If we look at the state of the jam trade to-day we will find that a very considerable proportion of the jams contain large percentages of glucose, while I will venture to assert that nearly every man, woman and child in the country imagine they are made by boiling fruits with sugar. Similar sophistications are taking place with respect to other foods, so that one never knows now-a-days when a prosecution is undertaken what mine may be sprung. Indeed, it may be that the defendants may boldly put forward the plea that what has been done is "the custom of the trade," which in the eyes of lawyers covers a multitude of offences, although the public may all the time have imagined they are getting under a specific name the same article that they knew in their childhood, and which their parents and grand-parents before them had consumed. Other countries, and even our Colonies, have laid down, or are laying down, standards of purity, but this country of ours, which has grown supine in so many things, is doing practically nothing. John Bull requires wakening up. I am, Your obedient servant, A E. HARRIS, Medical Officer of Health. Town Hall, Islington, N., January 3rd, 1910. w 290 1910] Groceries.—148 samples of various articles contained under this heading were purchased and submitted to the Public Analyst, of which 24, or 16.2 per cent. as contrasted with 28.3 per cent. in 1909, were returned by him as adulterated. The falling off in the percentage is mainly due to the fact that coffees containing chicory are now nearly always sold with a declaration. Demerara Sugar.—7 samples of Demerara sugar were obtained for analysis, of which 3, or 43 per cent. were found to be other than Demerara sugar. The substitution of yellow crystals for this article is not nearly so common now as it was in former years. Still a certain class of grocers, who have their shops in mean streets, pursue the practice, although in some instances unknowingly, for it has been ascertained in one or two cases that they themselves had bought as Demerara sugar the article which they subsequently sold, and which proved to be yellow crystals. The high percentage of adulteration is entirely due to the fact that the Inspector informally sampled a number of shops before purchasing the article, and, therefore, it is higher than it would have been if all the samples that were purchased had been submitted to the Public Analyst. Golden Syrup.—14 samples were obtained, and of these 3, or 21.4 per cent. were adulterated, as compared with 14.3 in 1909. It is high time that a standard was made for golden syrup, for the addition of glucose to it goes on apace, while the actual substitution of coloured glucose is not unknown. The Medical Officer of Health submitted the following report to the Public Health Committee on the 9th May, in reference to a sample of golden syrup that had been reported against by the Public Analyst:— To the Chairman and Members of the Public Health Committee. Gentlemen, golden syrup. On March 31st last Inspector Burrell purchased some golden syrup at a shop in Liverpool Road. It was handed to him in a glass. The syrup was duly submitted to the Public Analyst, who certified that 58 per cent of the so-called golden syrup consisted of glucose made from starch, whereas golden syrup is made from sugar. In other words, nearly three-fifths of the substance was not what it professed to be. On the paper wrapper in which the article was wrapped appeared the words "Amber Syrup," and, therefore, in these circumstances a summons could 291 [1910 not be issued against the vendor. He was, however, warned that when golden syrup was again asked for, it must be supplied; and that as amber syrup contains a considerable proportion of starch glucose, it was a punishable offence to sell it as golden syrup. Comparatively recently a mixture of genuine golden syrup and commercial glucose has been placed on the market, but as a rule it was sold only by the smaller class of tradesmen. The sale of glucose under the name of golden syrup shows how necessary it is that standards should be fixed for foods, for here we have a well-known article of commerce being pushed on one side by an article that has no proper definition. It may be a good food, and nothing is said against it in this respect; but a syrup which is nearly all glucose can in no sense pretend to be golden syrup or a substitute therefor, for whereas golden syrup is the produce entirely of the sugar cane, the so-called amber syrup may be anything, and there is no reason whatever why it should not consist of any substance of a sweet character which is of a syrupy nature. If to-morrow a sample of so-called amber syrup were taken for analyses, the first question that would arise in the mind of the Analyst would be " What is Amber Syrup ? " and to it there could be no answer, for amber syrup may as in this instance, be an article containing 58 per cent, of glucose and 42 per cent. of golden syrup or one consisting altogether of glucose and colouring matter. Meanwhile the sale of this syrup may go on for years without the possibility of prosecution, although it might contain ever varying proportions of glucose, or indeed, it might consist entirely of glucose, or glucose mixed with any other syrupy substance. The sale of this amber syrup is a good example of how fraudulent goods are palmed off on the public. As a rule I think it may be taken that such syrup cannot be purchased from the larger grocers, and that its sale is confined to the smaller class of shopkeepers who cater for the poorer classes, to whom it is sold by the wholesale grocers at a price very little under that of golden syrup, but at the same time sufficient to tempt retail grocers particularly as it is certain to be represented as an article "as good or better " than the genuine golden syrup, if indeed it be not represented to be the genuine article itself. The people, however, reap no advantage, for the retail price is the same as golden syrup, and, therefore, the poor suffer through not receiving the proper article, for nobody would pretend that starch glucose is as wholesome a food, or possesses the same sweet qualities, as golden syrup. w 2 292 1910] During the last twelve months we discovered three instances in which this amber syrup was substituted for golden syrup, and in each instance the quantity of the glucose varied, the proportions being from 64 to 75 per cent. These samples were not sold as amber syrup, but as golden syrup, so that it was possible to prosecute the vendors, but in the case now before us no prosecution is possible because the paper wrapper was stamped with the words " Amber Syrup." I bring this matter before you as an example of how necessary it is that all our foods should be defined, as they are in many countries. Let me say that what is happening with respect to golden syrup is also taking place with respect to extract of malt, a medicine and food of very great use in disease, for it too is largely adulterated with glucose: but unfortunately, it is not possible by any chemical process at present known to differentiate between it and the malt extract. It is time that the Government of this country made standards for all our foods. I am, Your faithful servant, A. E. HARRIS, Medical Officer of Health. Town Hall, Islington, N., 9th May, 1910. Sauces.—Seven samples of sauce, of which 5, or 71.4 per cent., were reported as adulterated, were obtained. The cases are peculiar. A complaint was received by the Medical Officer of Health that certain sauces, manufactured in Islington, contained copper, and accordingly samples were obtained and submitted to the Public Analyst for analysis. In his report on them he stated that they were found to be contaminated with copper, and were in consequence reported as adulterated, but that the amount of the metal was less than the amount recommended in the minority reports of the Preservatives Commit tee as permissible addition. He then went on to say that "the copper in the case "of these sauces was an accidental contamination and not a wilful addition, as "it is in the case of sulphate of copper employed to give an unwholesome "looking green to tinned vegetables." As the Medical Officer of Health had never heard of copper being discovered in sauces, and as there was no reason for its addition, he came to the conclusion that its presence must have been the result of accidental contamination, and consequently, accompanied by Mr. Leggatt and Mr, Burrell, 293 [1910 he made an inspection of the premises, which resulted in the discovery of verdigris on a copper coil that was used for boiling the sauces in a large vat. This coil was clamped with wooden supports, but was clean, and he was assured that it was regularly scrubbed after use. He, however, had the wooden clamps, which held the copper coil together, unscrewed, with the result that on that part of the coil protected by the wood there was a considerable deposit of verdigris. He had no doubt that this was the cause of the contamination. The owner of the business, who gave him every facility to examine the works, issued immediate orders to have these wooden clamps so altered that they could be easily unfastened after each use, and the Medical Officer of Health has no doubt that in future there will be no contamination from copper. Pork Sausages.—Among the articles examined were seven samples of pork sausages, one of which was reported as containing an excessive amount of boracic acid. When the certificates were received from the Public Analyst the Medical Officer of Health presented the following report to the Public Health Committee:— To the Chairman and Members of the Public Health Committee. Gentlemen, Pork Sausages. Recently several samples of pork sausages were purchased for analysis, with the result that small quantities of preservatives were found in all. In one case when a vendor discovered that it was intended to analyse the sample, he said "There is no pork in it; you do not expect to get pork at 5d. per lb." Thus sausages sold as pork sausages according to him might contain meat other than pork. This sample, like the others, with one exception, was sent to the Public Analyst for analysis, and returned as genuine, the reason no doubt being that it is practically impossible to differentiate between the several classes of meat, particularly when chopped up so fine as it is in sausages, and cooked. In one case the Analyst has returned the sausages as containing 59.5 grains of boracic acid per pound. Now this amount is excessive and on looking through my notebook, I find a note to the effect that the manufacturers of sausages in the United Kingdom never use more than 35 grains 294 1910] per lb., or an equivalent of 0.5 per cent I also find that in 1907, Professor Klein, the well-known bacteriologist, reported to the Incorporated Society of the London Meat Trades, that in his opinion provided the conditions as to the locality, general cleanliness, character of the meats and the bread are satisfactory, 1½ ounces of boric preservative per 25 lbs., or 26 24 grains of preservative to the lb. of sausage material, should be the minimum quantity. I also find that in an important case heard at Burnley the same authority gave evidence, and stated that he found that 2G grains of boracic acid per lb. of sausage were necessary to keep a sausage for four days, and that a fresh sausage not containing a preservative would in hot weather start to decompose in 24 hours ; also that the presence of boric acid would prohibit a multiplication and growth of ptomaines if present in sufficient quantities. It has never been satisfactorily proved to my mind that boracic acid in itself has caused injury to health and, therefore, I have not as you are aware advised prosecutions because of its addition to food Nevertheless I am of opinion that when this chemical is added to foods, it should not exceed the amount required to keep that food in a good condition for three or four days; that is to say, sufficiently long to enable the vendor to keep a perishable article in good condition. These is, however, another side to the question, and it is that no vendor of food shall be allowed to dose persons with chemicals which might possibly affect them. It is one thing to add sufficient for temporary preservative purposes, and another to add them in unnecessary quantities. In any case there should be a declaration as to the use of a preservative and its quantity per lb. In this case there can be no question as to the effect of the excessive addition of boracic acid, and I think that in such cases the Courts would uphold a prosecution. In these circumstances I have to ask your instructions with respect to this sample. I am, Your faithful servant, A. E. HARRIS, Medical Officer of Health. Town Hall, Islington, N., 18th July, 1910. 295 [1910 The Public Health Committee decided not to prosecute, but to caution the offender, who had been an old and respected trader of the borough. It was stated that the large amount of boracic acid was due to the carelessness of his servant. The particulars as to the several samples of groceries analysed are as follows:— No. of Samples. No. Adulterated. Percentage Adulterated. Percentage Adulterated in 1909. Coffee 12 2 16.6 55.5 Cocoa 28 I 3.5 4.8 Demerara Sugar 7 3 43.0 94.7 Pepper (White) 14 — — — Mustard 14 — — — Golden Syrup 14 3 21'4 14.3 Honey 5 — — — Arrowroot 7 — — 28.6 Sauces 7 5 71.4 — Malt Vinegar 14 9 65.0 75.° Preserved French Beans — — — 50.0 Dripping 7 — — — Ground Ginger 3 — — 14.3 Cinnamon 7 — — — Condensed Milk 1 — — — Sausages 7 1 14.3 — Gooseberries 1 — — — 148 24 16.2 28.3 Alcoholic Drinks.—33 samples were examined by the Public Analyst of which 5, or 5.3 per cent. were adulterated:— No. of Samples. No. Adulterated. Percentage Adulterated. Whiskey (Scotch) 12 I 8.3 Whiskey (Irish) 12 — — Rum 12 3 25.0 Gin 12 — — Brandy 12 1 8.3 Total 60 5 8.3 296 1910] Drugs.— 60 drugs were examined, of which only 3, or 5 per cent. were found to be adulterated. The following is a return of the drugs examined:— No. of Samples. No. Adulterated. Percentage Adulterated. Oil of Eucalyptus 4 — — Comp. Liquorice Powder 3 — — Quinine Wine 3 — — Blaud's Pills 3 — — Liniment of Ammonia 3 I 33.3 Sweet Spirits of Nitre 3 — — Glycerine - 9 — — Prescriptions 5 — — Lime Water 8 I 12.5 Solution of Ammonium Acetate 3 I 33.3 Tinct. of Camphor Co. 3 — — Camphorated Oil 3 — — Ung. Hydrarg. Co. 5 — — Ung. Potass. Iodide 5 — — 6o 3 5.0 297 [1910 Table CXXIII. Showing the Samples of Foods and Drugs submitted to the Public Analyst during the year 1910. Description. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Genuine. Adulterated. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Milk 165 150 150 155 620 155 131 131 145 562 10 19 19 10 58 Milk (Separated) 1 .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. Butter 50 50 50 50 200 46 49 46 49 190 4 1 4 1 10 Cheese 10 10 10 10 40 10 10 10 10 40 Dripping 7 .. .. .. 7 7 .. .. .. 7 .. .. .. .. .. Lard 10 15 5 5 35 10 15 5 5 35 .. .. .. .. .. Coffee 7 .. 5 .. 12 5 .. 5 .. 10 2 .. .. .. 2 Cocoa 7 7 7 7 28 7 7 6 7 27 .. .. 1 .. 1 Golden Syrup 7 .. 7 .. 14 6 .. 5 .. 11 1 .. 2 .. 3 Honey .. 5 .. .. 5 .. 5 .. .. 5 .. .. .. .. .. White Pepper 7 .. 7 .. 14 7 .. 7 .. 14 .. .. .. .. .. Mustard .. 7 .. 7 14 .. 7 .. 7 14 .. .. .. .. .. Ground Ginger .. 3 .. .. 3 .. 3 .. .. 3 .. .. .. .. .. Sausages .. 7 .. .. 7 .. 6 .. .. 6 .. .. .. .. 1 † Gooseberries 1 .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. Demerara Sugar .. .. .. 7 7 .. .. .. 4 4 .. .. .. 3 3 Cinnamon .. .. 7 .. 7 .. .. 7 .. 7 .. .. .. .. .. Arrowroot .. .. 7 .. 7 .. .. 7 .. 7 .. .. .. .. .. Sauce .. .. .. 7 7 .. .. .. 2 2 .. .. .. 5 5 Condensed Milk 1 .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. Vinegar (Malt) 8 6 .. .. 14 1 4 .. .. 5 7 2 .. .. 9 *Irish Whiskey 3 3 3 3 12 3 3 3 3 12 .. .. .. .. .. *Scotch Whiskey 3 3 3 3 12 3 3 3 2 11 .. .. .. 1 1 *Rum 3 3 3 3 12 2 3 2 2 9 1 .. 1 1 3 *Gin 3 3 3 3 12 3 3 3 3 12 .. .. .. .. .. *Brandy 3 3 3 3 12 2 3 3 3 11 1 .. .. .. 1 Lime Water .. 3 5 8 2 5 7 .. 1 .. .. 1 Oil of Eucalyptus .. .. .. 4 4 .. .. .. 4 4 .. .. .. •• .. †Contained 0.012 per cent of Tin. *Examined for strength only. 29ft 1910] Table CXXIII.—continued. Description. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Genuine. Adulterated 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. Blaud's Pills •• 3 •• •• 3 •• 3 •• •• 3 •• •• •• •• •• Comp. Liquorice •• 3 •• •• 3 •• 3 •• •• 3 •• •• •• •• •• Quinine Wine 3 •• •• •• 3 3 •• •• •• 3 •• •• •• •• •• Liniment of Ammonia 3 •• •• •• 3 2 •• •• •• 2 1 •• •• •• 1 Sweet Spirits of Nitre 3 •• •• •• 3 3 •• •• •• 3 •• •• •• •• •• Sol. of Ammonium Acetate 3 •• •• •• 3 2 •• •• •• 2 1 •• •• •• 1 Tinct. Camph. Co. 3 •• •• •• 3 3 •• •• •• 3 •• •• •• •• •• Glycerine •• 3 •• 6 9 •• 3 •• 6 9 •• •• •• •• •• Camphorated Oil •• 3 •• •• 3 •• 3 •• •• 3 •• •• •• •• •• Prescriptions •• •• 5 •• 5 •• •• 5 •• 5 •• •• •• •• •• Ung. Hydrara Co. •• •• 5 •• 5 •• •• 5 •• 5 •• •• •• •• •• Ung. Pot. Iodide •• •• 5 •• 5 •• •• 5 •• 5 •• •• •• •• •• 311 290 285 278 1,164 283 266 258 257 1,064 28 24 27 21 100 MARGARINE ACT. Margarine 11 10 9 10 40 4 2 1 5 12 7 8 8 5 28 299 [1910 Abstracts from the Public Analyst's Returns, together with the proceedings taken during the Quarters of the Year 1910. ADULTERATED SAMPLES.—First Quarter, 1910. Sample Numbered Article submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and if so, the name of such Authority. Result of Analysis. Showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. Action taken, with result of prosecution. 500 T.L.B. Butter Inspector 100 per cent. of Margarine Fined £5 and 12/6 costs. 3 L.B. Margarine do. 100 per cent. of Margarine Same defendant as No. 500. Summons withdrawn at Magistrate's request. 504 T.L.B. Butter do. 100 per cent. of Margarine Fined £5 and 12/6 costs, or one month's imprisonment. 522 T.L.B. Milk* do. 4 percent, of fat abstracted Cautioned by letter. 567 T.L.B. Milk * do. 13 per cent. of added water Fined £2 and 12/6 costs. In default of distress 14 days' imprisonment. 579 T.L.B. Rum do. 37 0 degrees under proof Ordered to pay 12/6 costs. 610 T.L.B. Milk * do. 22 per cent. of added water. Sample coloured with Annatto Fined £5 and £2 2s. costs. (Four previous convictions.) 619 T.L.B. Liniment of Ammonia do. 30 per cent. of Total Oil deficient 16 7 per cent. of Arachis oil present 74 4 per cent. of Ammonia and 70.5 per cent. of water in excess Fined £2 and £1 13s. 6d. costs. 624 T.L.B. Brandy do. 264 degrees under proof Ordered to pay 12/6 costs. 632 T.L.B. Milk * do. 4 per cent. of added water Cautioned by letter. 642 T.L.B. Butter do. 95 per cent. of Margarine Fined £2 and 12/6 costs, or 14 days' imprisonment. 659 T.L.B. Milk* do. 12 per cen. of original fat abstracted Fined £2 and 12/6 costs, or 14 days' imprisonment. 666 T.L.B. Sol. Amm. Acetate do. 98 per cent. of Amm. Acetate deficient Fined £1 and 12/6 costs. 676 T.L.B. Malt Vinegar do. Vinegar other than Malt Ordered to pay 12/6 costs. 677 T.L.B. do. do. do. do. Fined £1 and 12/6 costs. 678 T.L.B. do. do. do. do. Ordered to pay 12/6 costs. 679 T L B. do. do. do. do. Fined 1/- and 12/6 costs. 300 1910] ADULTERATED SAMPLES.—First Quarter. 1910— (continued). Sample Numbered Article submitted for Analysis. State whether the sample was submitted to the Anilysis by an Officer acting under directions of a Local Authority, under Section 13 of Act, and if so, the name of such Authority. Result of Analysis. Showing whether the sample was Genuine or Adulterated, and, if adulterated, what were the nature and extent of the Adulteration. Action taken, with result of prosecution. 680 T L B Malt Vinegar Inspector .. Vinegar other than Malt Fined £1 and 12/6 costs. 681 T L.B ,, ,, ,, ,, ,, ,, Ordered to pay 12/6 costs. 682 T.L.B. ,, ,, ,, ,, ,, ,, Fined 10/-and 12/6 costs 686 T.L.B. Milk* ,, 7 per cent. of added water and 2 per cent. of original fat abstracted, 9 per cent. of original fat deficient Fined £1 and 12/6 costs 690 T.L.B. ,, * ,, 4 per cent. of original fat abstracted and 1 per cent. of added water No proceedings 693 T L B. ,, * ,, 5 per cent. of added water ,, ,, 723 T.L.B. Margarine ,, 100 per cent. of Margarine Fined £3/3 and 12/6 costs. 724 T.L.B. ,, ,, 100 ,, ,, Fined £3/3 and 12/6 costs. 734 T.L.B Butter ,, 95,, ,, Fined £3 and 12/6 costs. 739 T.L.B. Margarine ,, 100 ,, ,, Fined £1 and 12/6 costs. 740 T.L.B ,, ,, 100 ,, ,, Ordered to pay 12/6 costs 742 T L B. ,, ,, 100 ,, ,, Fined £1 and 12/6 costs. 753 T.L.B. Coffee ,, 69 per cent. of Chicory Ordered to pay 12/6 costs. 754 T.L.B ,,. . ,, 61 ,, ,, Fined £2 and 12/6 costs 763 T.L.B. Milk* ,, 4 per cent. of added water Cautioned by letter 766 T.L B ,, * ,, 4,, ,, ,, ,, 772 T L B. Margarine ,, 100 per cent. of Margarine Fined £2 and 12/6 costs. 781 T L.B. Golden Syrup ,, 58 per cent. of Starch Glucose: Cautioned by letter. Total number of samples analysed during the Quarter, 322. * Boric Acid and Formalin absent. 801 [1910 ADULTERATED SAMPLES.—Second Quarter, 1910. Sample Numbered Article submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and if so, the name of such Authority. Result of Analysis. Showing whether the sample was Genuine or Adulterated, and, if adulterated, what were the nature and extent of the Adulteration Action taken, with result of prosecution. 794 T.L.B. Milk * Inspector 5 per cent. of added water No proceedings. 805 T.L.B. do. * do. 10 ,, „ Fined £4 and 12/6 costs. 811 T.L.B. do. * do. 22 per cent. of original fat abstracted Dismissed on defence that the summons was served on the wrong 1 person—although in the name given 1 by vendor. 813 T.L.B. do. * do. 6 per cent. of added water Fined £1 and 12/6 costs. 833 T.L.B. do. * do. 10 „ ,, Dismissed (warranty). 834 T.L.B. do. * do. 3 per cent. added water and 1 per cent. of original fat abstracted No proceedings. 840 T.L.B. do. * do. 84 per cent. of original fat abstracted Fined £2 and 12/6 costs. 841 T.L.B. do. * do. 10 per cent. of added water Ordered to pay 12/6 costs. 844 T.L.B. do. * do. 8 ,, ,, Dismissed (warranty). 854 T.L.B. do. * do. 10 „ ,, Fined £2 and 12/6 costs. 856 T.L.B. do. * do. 10 ,, ,, Fined 10/- and 12/6 costs. 858 T.L.B. do. * do. 10 ,, ,, Fined 10/- and 12/6 costs. 865 T.L.B. do. * do. 7 ,, ,, Dismissed (warranty). 873 T.L.B. do. * do. 34 ,, ,, Ordered to pay 12/6 costs. 1910] 802 ADULTERATED SAMPLES (Second Quarter, 1910)—continued. Sample N umbered Article submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and if so, the name of such Authority. Result of Analysis. Showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. Action taken, with result of prosecution. 879 T.L.B. Margarine Inspector 100 per cent. Margarine Cautioned by letter. 880 T.L.B. do. do. 100 do. do. Fined 8/- and 12/6 costs. 889 T.L.B. Milk * do. 6 per cent of added water Fined £1 and 12/6 costs. 906 T.L.B. Margarine do. 100 per cent. Margarine Ordered to pay 12/6 costs. 907 T.L.B. do. do. 100 do. do. No proceedings; cautioned. 931 T.L.B. Milk * do. 10 per cent added water and 18 per cent of original fat abstracted Fined £3 and 12/6 costs. 991 T.L.B. do. * do. 30 per cent. original fat abstracted Summons not served. Defendant absconded. 993 T L B. Margarine do. 100 per cent. Margarine Ordered to pay 12/6 costs. 994 T.L.B. do. do. 100 do. do. do do. 995 T.L.B. do. do. 100 do. do. Summons not served. Defendant absconded. 996 T.L.B. do. do. 100 do. do. No proceedings ; cautioned by letter. 35 T.L.B. Milk * do. 4 per cent. added water No proceedings. 39 T.L.B. do. * do. 10 do. do. Fined £2 and 12/6 costs. 48 T.L.B. Butter do. 10 per cent. Margarine Fined £3 and 12/6 costs. 64 T.L.B. Liquor Calcis do. 18 6 per cent. of the Lime deficient Fined £2 and 12/6 costs. 68 T.L.B. Sausages do. 0 85 per cent. of Boric Acid No proceedings ; cautioned by letter. 82 T.L.B. Malt Vinegar do. Vinegar other than Malt do. do. do. 83 T.L.B. do. do. do. do. Fined £2 and £1 costs. * Boric Acid and Formalin absent. Total number of Samples analysed during the Quarter, 300. 808 [1910 ADULTERATED SAMPLES (Third Quarter, 1910). Sample Numbered. Article submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and if so, the name of such Authority. Result of Analysis. Shewing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. Action taken, with result of prosecution. 90 T L B. Milk † Inspector 4 per cent, of fat abstracted Cautioned by letter. 92 T.L B. ,, † ,, 5 per cent, of added water ,, ,, 93 T.L B. ,, † ,, 4 „ ,, ,, ,, 102 T.L.B. ,, † ,, 6 per cent. of fat abstracted Ordered to pay 12s. 6d. costs. 105 T LB. ,, † ,, 50 ,, ,, ,, ,, ,, 106 T.L.B. ,, † ,, 2 per cent, of added water, 15 per cent, of fat abstracted. Summons dismissed. Sample bottle broken prior to hearing summons. 109 T.L B Butter ,, 39 per cent. of Margarine Fined £3 and 12s. 6d. costs. 114 T.L.B. Milk † ,, 8 per cent. of added water Summons withdrawn. the defendant naving died since purchase of sample. 149 T L.B. ,, † ,, 15 per cent. of fat abstracted Fined one penny. 151 T.L.B. ,, † ,, 31 per cent. added water Fined 5s. and 12s. 6d. costs. 153 T L B. ,, † ,, 15 ,, ,, ,, £2 and 12s. 6d. costs. 168 T.L.B. Bhtter† ,, 50 per cent. of Margarine ,, £3 and 12s. 6d. costs. 177 T L.B ,, † ,, 90 ,, ,, ,, £1 and 12s. 6d. costs. 203 T.L.B. Milk † ,, 4 per cent. of added water Cautioned by letter. 204 T.L.B. ,, † ,, 4 per cent. of fat abstracted ,, ,, 205 T.L.B. ,, † ,, 4 per cent. of added water ,, ,, 215 T.L.B. Butte ,, 100 per cent. Margarine Fined £4 and 12s. 6d. costs 236 T.L.B. Rum ,, 26 degrees under proof Cautioned by letter. 1910] 804 ADULTERATED SAMPLES (Third Quarter, 1910)—continued. Sample numbered. Article submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and if so, the name of such Authority. Result of Analysis. Showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. Action taken, with result of prosecution 242 T.L.B. Milk † Inspector 22 per cent. of added water Fined £10 and 12s 6d. costs. 247 T.L.B. „ † ,, 5 ,, ,, Cautioned by letter. 249 T.L.B. „ † ,, 4 per cent. of fat abstracted 251 T.L.B. „ † ,, 18 „ ,, Summons dismissed. Warranty successfully pleaded. 258 T.L.B Margarine ,, 100 per cent. Margarine Fined £16 and £1 1s. costs (two offences). 260 T.B.L. Milk † ,, 9 per cent. of added water Fined £3 and 12s. 6d. costs. 265 T.B.L. Margarine ,, 100 per cent. of Margarine Summons withdrawn. 282 T.B'L. Cocoa ,, 45 per cent. of added sugar and 28 per cent. of added starch Cautioned by letter. 286 T.B.L. Margarine ,, 100 per cent. of Margarine Ordered to pay 12s. 6d. costs. 287 T.B.L. ,, ,, 100 „ ,, ,, ,, ,, 288 T.B.L. ,, ,, 100 ,, ,, ,, ,, ,, 305 T.B.L. ,, ,, 100 „ „ Fined £2 and 12s. 6d. costs, or 14 days 306 T.B.L. ,, ,, Margarine containing 40 per cent. of Butter fat ,, 2s. 6d. and 12s. 6d. costs, or 7 days 307 T.B.L. ,, ,, 100 per cent. of Margarine Ordered to pay 12s. 6d. costs. 370 T.B.L. Golden Syrup ,, 35 per cen. of Starch Glucose Withdrawn on payment of £1 Is. costs 373 T.B.L. ,, ,, 21 ,, ,, ,, ,, ,, 375 T.B.L. Milk † ,, 12 per cent. of added water Fined £1 5s., to include costs. † Boric Acid and Formalin absent. Total number of Samples analysed during the Quarter, 294. 805 [1910 ADULTERATED SAMPLES (Fourth Quarter. 1910). Sample Numbered. Article submitted for Analysis. State whether the sample was submitted to the Analyst by an Officer acting under direction of a Local Authority, under Section 13 of Act, and if so, the name of such Authority. Result of Analysis. Showing whether the sample was Genuine or Adulterated, and, if Adulterated, what were the nature and extent of the Adulteration. Action taken, with result of prosecution. 383 T.L.B. Milk ‡ Inspector 17 per cent of added water, and 74 „ original fat abstracted Fined £30 and 12/6 costs, or 3 months' imprisonment. 398 T.L.B, ,, ‡ ,, 5 per cent. of added water Cautioned by letter. 408 T L B. Butter ,, 90 per cent. of Margarine Summons not served, the defendant having absconded. 418 T.L.B. Margarine ,, 100 „ ,, Fined £1 and 12/6 costs. 433 T.L.B. ,, ,, 100 „ „ Cautioned by letter. 479 T.L.B. Scotch Whiskey ,, 32 7 degrees under proof Cautioned by letter. 487 T.L.B. Rum ,, 26.9 „ Ordered to pay 12/6 costs 510 T.L.B. Sauce ,, 0.0052 per cent. of copper Small percentage of copper did not warrant proceedings 512 T.L.B. Margarine ,, 100 per cent. of Margarine Fined £2 and 12/6 costs 515 T.L.B. Milk ‡ ,, 20 ,, of added water Fined £5 and 12/6 costs, or 1 month's imprisonment. 525 T.L.B. ,, ‡ ,, 88 ,, original fat abstracted Fined £3 and 12/6 costs. 583 T.L.B Sauce ,, 0 0011 „ Copper Small percentage of copper did not warrant proceedings. 584 T.L.B. ,, ,, 00021 „ „ Small percentage of copper did not warrant proceedings. 593 T.L.B. Demerara Sugar ,, Dyed Sugar other than Demerara Fined 10/- and 12/6 costs, or 3 days 594 T.L.B. ,, ,, White Granulated Sugar Cautioned by letter. 595 T.L.B. Milk ‡ ,, 5 per cent. of added water 19 ,, original fat abstracted Ordered to pay 12/6 costs. 612 T.L.B. ,, ‡ ,, 19 per cent. of added water Summons withdrawn. 613 T L B. ,, ‡ ,, 16,, ,, ,, ,, 616 T.L.B. ,, ‡ ,, 11 ,, ,, ,, ,, 617 T.L.B. ,, ‡ ,, 6 „,, ,, ,, 618 T.L.B. ,, ‡ ,, 6 ,, ,, ,, ,, 634 T L B. Margarine ,, 100 „ Margarine Cautioned by letier. 635 T.L.B. Sauce ,, Trace of Copper Small percentage of copper did not warrant proceedings. 636 T.L.B. ,, ,, 0.0017 per cent. of Copper Small percentage of copper did not warrant proceedings. 643 T.L.B. Margarine ,, 109 per cent. of Margarine Cautioned by letter. 647 T L.B. Demerara Sugar ,, Dyed sugar other than Demerara Summons withdrawn. ‡ Boric Acid and Formalin absent. Total Number of Samples analysed during the Quarter, 288. 306 1910] INFORMAL SAMPLING OF FOODS IN ISLINGTON FOR THE DETECTION OF ADULTERATION DURING 1910. The private sampling of foods is now a most important part of the work of your Inspector appointed under the Adulteration Acts, and, therefore, the Medical Officer of Health has thought it his duty to report on the result of his operations during the year, and to give you a synopsis of his work during the two preceding years. During 1910 the Inspector obtained and qualitatively examined 633 samples, of which 436 were genuine, while 81 had been sold either with a verbal declaration or with an imprint on the wrapper, and 73, or 11.5 per cent., were adulterated as compared with 18.7 per cent. in 1909, and 13.8 per cent. in 1908. Milk.— He examined 203 samples of milk, for the most part obtained from shops, because it is impossible when it is purchased from roundsmen to examine a privately purchased sample and also to obtain an official sample of the same milk during the same round. Of these 205 samples, he found that 15, or 7.3 per cent., were adulterated. These 15, however, do not include milks which had been adulterated to a less extent than 5 per cent. An examination of his returns for 1908 and 1909 shows that in 1908 there were 4 out of 130 samples adulterated, or 3.0 per cent.; and that in 1909 there were 12 out of 98, or 12.2 per cent., adulterated. Butter.— He examined 47 samples of butter, of which only 4 were adulterated, or 8.5 per cent. These figures are in strong contrast with those of the two preceding years, for in 1908 out of 155 samples he found that 24, or 15.5 per cent. ; and in 1909, out of 92 samples, that 19, or 20.7 per cent., were adulterated. There has, therefore, been a marked decrease in the adulteration of butter, which really means that less margarine has been sold for it than formerly. Margarine. — Your Inspector also turned his attention to the sale of margarine in unstamped wrappers, and discovered 36 samples out of 221 that were sold in contravention of the Margarine Act, so that 16.3 per cent. were so sold. Demerara Sugar.—This article was sampled in 36 instances, with the result that in 3 cases, or 8.3 per cent., it was found that dyed sugar had been 807 [1910 substituted. In 27 instances, or 75 per cent. of the purchases, a declaration was made that the article was a dyed or other sugar. Compared with the preceding years, these figures show a marked improvement, for in 1908 the percentage of sugars sold with a declaration was only 20.0, and in 1909, 52.3. as against 75.0 last year. Again in 1908 24.0 per cent. were adulterated, and in 1909 31.5 per cent., as against 8.3 per cent. last year. Such results as these prove conclusively that much good has been effected by the informal sampling performed by the Inspector. Coffee.—The Inspector continued to sample this article, with the result that out of 92 samples he could only find that 5, or 5.4 per cent., were adulterated. In 46 instances, or 50 per cent. of the sales, an oral or printed declaration (generally the latter) was made, while in 41 instances the article was pure coffee. How different these figures are to those that obtained in 1908, or even in 1909, for in the former year 19.4 per cent. were adulterated, and in 1909, 15.9 per cent. In two years, therefore, the percentage of adulteration has fallen from 19.4 to 5.4. Malt Vinegar.—During the year the Inspector made a new departure by turning his attention to this commodity, with the result that out of 32 purchases he found 10, or 31.2 per cent., spurious articles. Fourteen of the vinegars were found to be genuine, and 8 were sold with a declaration that they were not malt vinegars. These returns respecting informal sampling must be very gratifying to the Council, for in the case of each food it has resulted in a marked decrease in the percentage of adulteration on the previous returns, and shows what really good work has been accomplished by Inspector Burrell, to whom great credit is due for the painstaking manner in which he has devoted himself to his work, for which he has by patient study qualified himself. His operations have of course leaked out, for the certainty with which he came down on wrong-doers has become a matter of talk among a certain class of traders. It has been shown that of the 633 samples tested, 73 were adulterated. Now of these 73 samples, 50 duplicate samples were purchased and submitted to your Public Analyst, who reported against 43 for prosecution, which resulted in ,£78 11s. 6d. being awarded in fines and costs to the Council. Thus it is seen that 86 per cent. of the persons fraudulently selling adulterated articles were punished, not, however, always to the extent of their offences. The Inspector finds it more and more difficult to obtain adulterated samples, and, indeed, has found it necessary to make his agent a regular customer at the shop 1910] 308 where he suspected that adulterated articles were sold before he could obtain a sample that could be accepted as a true standard of the article. \\ hen at last he found that an adulterated article had been sold, he came on the scene officially to the consternation of the offender, who in one case said, "Whoever would have thought it—why, a little boy bought it! "In another case the delinquent exclaimed in an injured manner, "I made a friend of that woman too ! " Nevertheless, if fraud is to be detected, police methods, however distasteful, must be adopted. There is no other way when one is dealing with tradesmen who do not hesitate to sell adulterated goods, and whose offence is all the greater because they generally cater for the very poor, who need all the nourishment they can obtain from their food, for which they are always charged full price. These samplings have occupied much time and necessitated fully 2,000 visits to the shops of the borough. MILK. Year. No. of Samples. Adulterated. Percentage of eration. 1908 130 4 3.0 1909 98 12 12.2 1910 205 15 7.3 433 31 7.2 COFFEE. Year. No. of Samples. Genuine. Declared. Adulterated. Percentage Declared. Percentage of Adulteration. 1908 93 46 29 18 31.2 19.4 1909 107 52 38 17 35.5 15.9 1910 92 41 46 5 50.0 5.4 292 139 113 40 38.7 13.7 309 [1910 BUTTER. Year. Samples, Declared. Adulterated. Percentage of Adulteration. 1908 155 — 24 15.5 1909 92 4 19 20.7 1910 47 — 4 8.5 294 4 47 16.0 demerara sugar. Year. Samples. Declared. Adulterated. Percentage Declared. Percentage Adulterated 1908 25 5 6 20.0 24.0 1909 111 58 35 52.3 31.5 1910 36 27 3 75.0 8.3 172 90 44 52.3 25.6 margarine. Year. Samples. Declared. Adulterated. Percentage Declared. Percentage Adulterated. 1910 221 185 36 837 i6.3 malt vinegar. Year. Samples. Declared. Adulterated. Percentage Declared. Percentage Adulterated. 1910 32 8 10 25.0 31.2 310 1910] ALL SAMPLES. Year. No. of Samples. Declared. Adulterated. Percentage of Adulteration. 19 340 38 47 13.8 1909 471 96 88 18.7 1910 633 8l 73 11.5 1,444 215 208 14.4 Table CXXV. SUMMARY OF PROSECUTIONS.—During year 1910. Total Prosecutions. Successful. Dismissed. Withdrawn. Amount of Penalties Received. £. s. d. "Public Health (London) Act, 1891" 21 15 1 5‡ 26 15 0 "Sale of Food and Drugs Acts, 1875-99" 75 65 9* 1§ 177 11 7 "Margarine Act, 1887" 22 20 ... 2† 44 2 6 "Dairies, Cowsheds and Milkshops Order, 1885" 1 1 ... ... 2 2 0 "London County Council General Powers Acts" 5 4 1 ... 11 13 0 Total 124 105 11 8 262 4 1 ‡ Work carried out subsequent to issue of summonses. * In 5 instances warranties were successfully pleaded. The others were dismissed on technical points. § Defendant died before case came on for hearing. † One summons issued in incorrect name. 311 [1910 WATER SUPPLY. The following are the particulars as to the water supply of the district receiving water from the New River, as abstracted from the last return of the Metropolitan Water Board. They are a continuation of those which have been given for some years past:— 1908-9 1909-10 Houses Supplied 214,737 216,494 Houses on constant system 214,669 216,426 Houses not on constant system 08 68 Percentage of houses on constant system 99.9 99.9 Population supplied 1,405,126 1,41,215 Average daily supply (gallons) 43,333,418 43,434,947 Quantity of water supplied during the year (gals.) 15,816,697,652 15,853,755,570 Average daily supply per house (gals.) 202.58 201,31 ,, ,, ,, head (gals.) 30.84 30.69 Average number of persons supplied per house 6.57 6.56 Capacity of subsidence reservoirs 468,100,000 468,100,000 No. of days supply 10.80 10.78 APPENDIX. o VITAL AND SANITARY STATISTICS, 1910. together with the PRESCRIBED RETURNS OF THE LOCAL GOVERNMENT BOARD AND Abstracts for Previous Years. 1910] 314 Table A. Showing the Deaths from All Causes in Islington during the Year 1910. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. Western Borough. DISEASES. AGES. Under 5 Over 5 DISTRICTS. Males. Females. Totals 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H. B. S.E. Small Pox (a) Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (b) Unvaccimated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (c) No Dtatement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Measles 21 131 14 .. .. .. .. .. .. .. .. .. .. 152 14 10 11 24 36 16 43 26 78 88 166 Scarlet Fever .. 7 1 3 .. .. .. .. .. .. .. .. .. 7 4 1 2 .. 2 2 4 .. 7 4 11 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Epidemic Influenza 2 .. .. .. .. 2 2 3 5 5 5 8 4 2 34 4 6 5 3 9 4 5 20 16 36 8 Whooping Cough 64 67 3 .. .. .. .. .. .. .. .. .. .. 121 3 11 17 12 20 22 27 15 57 67 124 2 Diphtheria i 22 8 2 1 .. .. .. .. .. .. .. .. 23 11 2 8 2 2 3 10 7 14 20 34 1 Enteric Fever .. .. .. 1 i .. 2 8 1 2 1 1 .. .. 17 2 7 .. 2 1 3 2 9 8 17 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Diarrhoea, Dysentery 2b 2b .. .. .. .. 1 2 1 2 2 2 1 52 11 6 10 5 11 4 18 9 35 28 63 Epidemic Enteritis 7 5 .. .. .. .. .. .. 1 .. .. .. .. 12 1 1 .. 1 5 2 1 3 9 4 12 3 Other Allied Diseases 8 5 2 .. .. .. .. .. .. .. .. .. .. 13 2 1 2 2 3 2 2 3 10 5 15 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tetanus .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Syphilis 8 .. .. .. .. .. 1 .. 1 .. .. .. .. 8 2 3 .. .. .. 3 .. 4 6 4 10 4 Gonorrhoea .. .. .. 1 .. .. .. .. .. 1 3 .. .. .. 5 .. 1 .. .. 2 .. 2 5 .. 5 1 Phagedaena .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. 1 7 3 .. .. .. 1 .. .. 1. 4 .. .. .. .. 3 6 .. .. .. 2 1 4 2 2 7 9 3 Puerperal Fever .. .. .. .. .. 1 6 1 .. .. .. .. .. .. 8 1 1 1 .. 1 2 2 .. 8 8 1 Pyaemia .. 1 .. .. 1 .. .. 1 2 1 .. .. .. 1 5 .. .. 1 .. .. 1 4 4 2 6 2 Infective Endocarditis .. .. .. .. 3 .. .. .. .. .. 1 .. .. .. 4 1 1 .. .. 1 1 .. 2 2 4 8 Other Allied Diseases 5 .. 1 1 .. .. .. .. 2 1 2 3 .. 5 10 .. 4 2 1 2 1 5 9 6 15 Malarial Fever .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 .. 1 Rheumatic Fever .. .. 4 3 .. 1 2 1 .. .. .. .. .. .. 11 3 .. 1 .. 3 2 2 6 5 11 Rheumatism of Heart .. .. 2 2 .. .. .. .. .. .. .. .. .. .. 4 2 1 .. .. 1 .. .. 2 2 4 8 Tuberculosis of Brain 24 31 7 6 1 1 2 .. .. .. .. .. .. 55 17 6 7 4 16 .. 17 15 42 20 72 Tuberculosis of Larynx .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 2 .. .. .. 1 .. 1 .. 1 1 2 3 Phthisis 3 8 2 6 21 35 92 70 84 48 16 5 .. 11 379 37 52 29 45 67 60 100 234 156 380 2 Abdominal Tuberculosis 14 10 2 1 .. .. 3 1 3 1 1 .. .. 24 12 6 3 1 .. 8 8 1 23 13 36 2 General Tuberculosis 5 6 3 .. 2 .. 2 2 .. 2 1 .. .. 11 12 .. 2 3 2 5 5 6 11 12 23 3 Other forms Tuberculosis .. 3 .. 1 3 .. 2 2 1 .. 1 2 1 3 13 .. 1 2 3 5 2 3 12 4 16 Other Infective Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Actinomycosis .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. 1 .. .. .. 1 .. 1 Hydatid Disease .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases due to Altered Food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Acute Alcoholism .. .. .. .. .. .. 2 .. .. .. 1 .. .. .. 3 2 .. .. .. .. .. 1 1 2 3 1 Chronic Alcoholism .. .. .. .. .. .. 1 .. 5 1 1 .. .. .. 8 3 .. 1 .. .. .. 4 5 3 8 Chronic Industrial Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Osteo-arthritis .. .. 1 .. .. .. .. 2 2 1 5 4 .. .. 15 1 .. 4 2 5 3 .. 4 11 15 Gout .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 2 .. .. .. 1 1 .. .. 2 .. 2 9 Cancer .. 2 1 .. 3 2 6 40 72 100 85 47 3 2 359 38 46 29 46 76 58 68 158 203 361 2 Diabetes Mellitus .. .. .. 1 2 1 3 7 7 10 2 .. .. 34 5 4 3 2 8 5 7 20 14 34 Purpura Haemorrhagica .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anaemia .. .. .. .. 1 1 2 4 5 1 2 .. .. .. 16 2 .. 1 3 4 1 5 8 8 16 Lymphadenoma .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 2 .. .. .. .. .. .. 2 1 1 2 Premature Birth 121 1 .. .. .. .. .. .. .. .. .. .. .. 122 .. 7 14 11 17 18 28 27 69 53 122 Injury at Birth i .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 1 Debility at Birth 17 .. .. .. .. .. .. .. .. .. .. .. .. 17 .. 2 1 .. 3 5 4 2 7 10 17 Atelectasis 14 .. .. .. .. .. .. .. .. .. .. .. .. 14 .. 1 2 .. 2 1 7 1 8 6 14 Congenital Defects 32 1 .. .. .. .. .. .. .. .. .. .. .. 33 .. 2 2 1 4 4 12 8 13 20 33 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus .. 77 10 .. .. .. .. .. .. .. .. .. .. .. 87 .. 4 18 lb 11 5 14 19 57 30 87 In the 8 deaths under one year 5 were due to cerebro spinal fever ; of the 5 of one year an i under five 1 was due to varicella and 2 to cerebrospinal fever ; the 2 deaths of five years and under ten were due to cerebro-spinal fever. 315 [191 Deaths in Institutions within Borough. Table a.—Continued. DISEASES. AGES. Under 5. Over 5. DISTRICTS. Males. Females. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H. B. S.E. Dentition 3 4 .. .. .. .. .. .. .. .. .. .. .. 7 .. .. .. 1 .. 2 4 .. 4 3 1 Rickets .. 4 .. .. .. .. .. .. .. .. .. .. .. 4 .. .. 1 .. 1 1 1 .. 3 1 Old Age, Senile Decay .. .. .. .. .. .. .. .. .. 1 21 .. 59 .. 212 24 32 17 27 29 36 47 76 136 Convulsions 22 2 1 .. .. .. .. .. .. .. .. .. .. 24 1 3 2 2 7 4 5 2 17 8 Meningitis 14 4 3 1 1 1 1 3 2 .. .. .. .. 18 12 3 5 4 3 5 5 5 14 16 Encephalitis 1 .. .. .. l .. 1 .. .. 1 2 .. .. 1 5 .. .. .. 1 2 .. 3 2 4 1 Apoplexy .. .. .. .. .. .. .. 3 4 7 3 9 3 .. 29 1 1 1 2 8 5 11 14 l5 Softening of Brain .. .. .. .. .. .. .. .. 1 8 9 3 .. .. 21 2 3 2 2 3 6 3 7 14 Hemiplegia .. .. .. .. .. .. .. .. 2 8 12 7 3 .. 32 2 6 2 5 4 5 8 13 19 General Paralysis of the Insane .. .. .. .. .. .. 7 11 10 2 1 .. .. .. 31 1 9 3 4 7 1 6 28 3 Other forms of Insanity .. .. .. .. .. .. 1 7 2 9 5 2 .. .. 26 1 7 2 3 1 4 8 9 17 Chorea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebral Tumour .. .. 1 .. 1 .. 1 1 2 2 1 .. .. .. 9 1 1 .. 3 3 .. 1 5 4 Epilepsy .. .. 1 .. .. 1 1 3 1 1 4 1 .. 13 1 4 2 2 2 .. 2 6 7 Laryngismus Stridulus .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 .. Locomotor Ataxy .. .. .. .. .. .. .. 1 1 6 .. .. .. .. 8 .. 2 .. .. 2 2 2 8 .. Paraplegia .. 1 .. .. 2 .. 1 2 4 12 12 6 .. 1 39 3 5 2 1 9 5 l5 27 13 Other forms, Brain Diseases .. 2 1 1 .. I 2 .. 1 2 .. 1 .. 2 9 3 1 1 .. 1 2 3 4 7 Otitis 2 2 .. 1 1 .. .. .. .. .. .. .. .. 4 2 .. 2 .. 3 1 .. .. 3 3 Disease of Nose, Epistaxis .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 .. .. .. .. .. .. 1 Disease of Eye .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pericarditis .. 1 1 .. .. .. 1 .. .. .. .. .. .. 1 2 .. .. .. .. 1 1 1 1 2 Endocarditis .. .. .. .. .. .. 2 1 3 2 1 1 .. .. 10 1 5 1 .. 1 .. 2 5 5 Hypertrophy of Heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Angina Pectoris .. .. .. .. .. .. .. 1 2 1 2 1 .. .. 7 1 2 1 1 1 .. 1 4 3 Aneurism .. .. .. .. .. .. .. 2 5 2 3 1 .. .. 13 2 2 2 2 1 3 1 9 4 5 Senile Gangrene .. .. .. .. .. .. .. .. .. 1 5 7 1 .. 14 2 2 .. .. 4 4 2 6 8 16 Embolism, Thrombosis .. .. 1 .. 1 .. 1 2 2 5 19 4 .. .. 35 5 2 2 4 8 7 7 18 17 Phlebitis .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. 1 .. .. .. .. .. 1 Varicose Veins .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 155 Other Diseases, Heart and Vessels 8 1 5 8 8 5 26 42 79 128 143 85 24 9 553 61 73 19 67 120 79 13 60 302 1 Laryngitis .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 1 1 .. .. .. 1 .. .. 2 .. 1 Croup .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 .. Othei Diseases, Larynx and Trachea .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 1 1 .. 10 Acute Bronchitis 49 25 1 .. .. .. .. 3 9 12 19 16 2 74 62 9 11 l5 21 13 27 40 59 77 72 Chronic Bronchitis 1 .. 1 .. .. .. 1 3 23 45 85 69 26 1 253 30 24 15 23 36 54 72 118 136 8 Lobar Pneumonia 1 1 .. 1 1 .. 4 4 7 9 5 1 .. 2 32 3 2 4 5 5 3 12 21 15 29 Lobular Pneumonia 65 80 4 1 .. .. 1 5 6 8 5 9 4 145 43 26 16 15 33 34 31 33 88 100 34 Pneumonia 44 31 2 1 4 1 11 20 22 35 24 11 1 75 132 15 13 20 29 31 37 62 111 93 5 Emphysema, Asthma .. .. .. .. .. .. 1 4 1 6 6 3 .. 21 3 2 4 1 4 1 6 15 6 3 Pleurisy 1 .. 1 .. .. 1 2 3 3 3 3 .. 1 16 1 1 2 2 4 2 5 11 6 1 Other Diseases, Respiratory .. 1 .. .. .. .. 2 2 .. 1 3 .. .. 1 8 1 3 1 2 1 1 .. 6 3 Diseases of Mouth and Annexa .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 .. Diseases of Pharynx .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 Diseases of (Esophagus .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. 1 .. Ulcer of Stomach and Duodenum .. .. .. .. .. 2 5 11 6 4 3 2 .. .. 33 3 1 2 4 10 4 9 20 13 6 Other Diseases of Stomach 15 .. 1 .. .. .. 1 .. .. 4 2 4 .. l5 12 3 4 2 3 3 5 7 17 10 7 Enteritis 38 9 1 .. .. .. 1 .. .. 1 3 1 .. 47 7 3 5 2 11 8 11 14 31 23 Appendicitis .. 3 2 3 4 5 1 2 5 .. 2 .. .. 3 24 2 4 9 1 6 5 7 14 13 1 Obstruction of Intestine 4 .. .. 2 1 2 2 2 5 7 9 5 2 4 37 1 7 3 3 10 9 8 16 21 Other Diseases of Intestine 1 .. .. .. .. .. .. 1 1 1 1 2 .. 1 6 .. .. 2 2 .. 2 1 2 5 7 Cirrhosis of Liver .. .. .. .. .. .. .. 6 16 10 7 .. 1 .. 40 2 4 4 7 5 9 9 18 23 Other Diseases of Liver 3 .. .. .. .. .. 1 1 2 2 5 2 .. 3 13 .. 1 1 5 4 1 4 8 8 Peritonitis 1 1 2 2 2 .. 1 .. 2 5 .. .. .. 2 14 1 1 1 2 1 3 7 9 7 Other Diseases, Digestive System 6 .. .. .. .. .. .. .. .. 1 1 1 .. 6 3 2 1 .. .. 1 3 2 6 3 Diseases, Lymphatic System and Glands 2 .. .. .. .. 2 .. .. .. 2 3 .. .. 2 7 1 2 3 .. 2 .. 1 2 7 Acute Nephritis .. .. .. 2 .. .. 3 1 3 2 2 2 .. .. 15 2 2 .. 3 1 4 3 11 4 2 Bright's Disease .. .. 1 1 .. 3 6 12 23 30 31 12 2 .. 121 8 10 14 17 26 19 27 65 56 Calculus .. .. .. .. .. .. 1 .. .. 1 1 2 .. .. 5 .. 2 .. 1 .. .. 2 3 2 Diseases of Bladder and Prostate .. .. 1 .. .. .. .. 1 1 8 8 8 1 .. 28 1 4 6 2 5 4 6 26 2 Other Diseases, Urinary System .. .. .. .. .. 1 .. 3 .. 2 1 1 .. .. 8 2 1 .. 3 1 1 .. 2 6 1 Diseases of Testis and Penis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diseases of Ovaries .. .. .. .. 1 .. .. .. 1 1 1 .. .. .. 4 1 .. 1 .. .. 1 1 .. 4 Diseases of Uterus and dages .. .. .. .. .. .. .. 1 1 1 .. .. .. .. 3 .. 2 .. 1 .. .. .. .. 3 Diseases of Vagina and External Genitals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diseases of Breast 1 .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 .. .. .. .. 1 1 .. .. 2 Abortion, Miscarriage .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 2 .. .. .. .. .. 2 .. .. 2 Puerperal Mania .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Placenta Praevia, Flooding .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 816 1910] Table A.—Continued. ??? Borough. DISEASES. AGES. Under 5. Over 5. DISTRICTS. Males. Females. Totals. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. h. B. S.E. Puerperal Thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Other Diseases, Pregnancy and Childbirth 1 .. .. .. .. .. 2 2 1 .. .. .. .. 1 5 1 1 .. .. .. 1 3 1 5 6 Arthritis, Ostitis, Periostitis .. 1 .. .. 1 .. .. .. .. .. 1 .. .. 1 2 1 .. 1 .. 1 .. .. 2 1 3 Other Diseases, Osseous System .. .. 1 2 .. .. .. 1 .. 1 1 1 .. .. 7 .. .. 1 1 2 2 1 5 2 7 Ulcer, Bedsore .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 1 .. 1 1 Eczema .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pemphigus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases, Integumentary System .. .. .. 1 .. .. .. 1 .. 2 1 .. .. .. 5 1 2 1 .. 1 .. .. 1 4 5 Accidents and Negligence. In Mines and Quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ??? In Vehicular Traffic .. I 3 .. .. 2 2 4 2 3 4 2 .. 1 22 1 4 .. 9 2 3 4 19 4 23 On Railways .. .. .. .. .. .. .. 2 1 3 .. .. .. .. 6 1 .. .. 2 1 2 .. 6 .. 6 On Ships, Boats, etc. (not drowning) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. In Building Operations .. .. .. .. .. .. .. 3 3 1 .. .. .. .. 7 .. .. .. 1 1 2 3 7 .. 7 By Machinery .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 .. 1 By Weapons and Implements .. .. .. .. .. .. .. .. .. .. 1 .. .. • • 1 .. .. .. .. 1 .. .. .. 1 1 1 Burns and Scalds 4 6 .. .. .. .. .. .. .. 2 .. .. .. 10 2 1 .. 1 .. 4 .. 6 5 7 12 Poisons, Poisonous Vapours .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 2 .. .. .. .. .. 1 1 2 .. 2 Surgical Narcosis .. .. 1 .. .. 1 1 1 1 .. .. .. .. .. 5 .. 1 1 2 .. .. 1 3 2 5 Effects of Electric Shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Corrosions by Chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Drowning .. .. 2 .. .. .. .. .. 1 .. .. .. .. .. 3 .. .. .. .. 1 .. 2 2 1 3 Suflocation, Overlaid in Bed 26 .. .. .. .. .. .. .. .. .. .. .. .. 26 .. .. 1 2 3 1 9 10 14 12 26 Otherwise 4 1 .. .. .. .. .. 1 1 2 .. 1 • • 5 5 1 2 1 1 2 1 2 4 6 10 2 Falls not specified 2 2 .. 4 .. 1 1 1 5 5 6 5 4 4 32 5 1 6 5 5 5 9 16 20 36 Weather Agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Otherwise, not stated 3 1 1 .. .. .. .. .. .. 1 .. .. .. 4 2 1 .. 1 1 2 1 .. 4 2 6 Homicide 2 2 .. .. .. .. 1 .. .. .. 1 .. .. 4 2 1 1 .. .. 1 3 .. 3 3 6 Suicide. By Poison .. .. .. .. 1 1 5 4 6 5 1 .. .. .. 23 2 3 .. 5 2 4 7 15 8 23 By Asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Hanging and Strangulation .. .. .. .. .. .. 3 3 1 3 2 .. .. .. 12 2 .. .. 2 2 2 4 9 3 12 By Drowning .. .. .. .. .. .. .. 3 1 .. .. .. .. .. 4 .. 1 .. .. 1 2 .. 3 1 4 By Shooting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Cut or Stab .. .. .. .. .. .. 3 3 .. 1 .. .. .. .. 7 .. 1 1 .. 1 1 3 5 2 7 By Precipitation from Elevated Places .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. 2 1 .. .. .. 1 .. .. .. 2 2 By Crushing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By other and unspecified methods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ??? Execution .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 2 1 .. .. .. .. .. 1 2 .. 2 Sudden Death, cause not ascer- tained .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ill-defined and unspecified causes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Males 439 259 39 30 33 39 126 191 280 332 304 191 50 698 1615 204 291 186 323 345 429 535 .. .. 2313 Females 338 256 52 29 38 36 109 150 199 275 332 304 92 594 1616 220 244 206 276 414 373 477 .. .. 2210 8 TOTAL DEATHS 777 515 91 59 71 75 235 341 479 607 636 195 142 1292 3231 424 535 392 599 759 802 1012 2313 2210 4523 317 [1910 Table B. Showing the Deaths from All Causes registered during the Quarters of the Year 1910 at three periods of life. DISEASES. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total for Year Under 1 cno •"* | Over 5 Total. Under 1 UlQ ' Over 5 Total. Under 1 Over 5 Total. Uuder 1 Over 5 Total. Small Pox — {a) Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (b) Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (c) No Statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 .. .. 1 2 6 .. 8 2 17 2 21 16 108 12 136 166 Scarlet Fever .. 3 2 5 .. .. 1 1 .. 1 .. 1 .. 3 1 4 11 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 1 .. 20 21 .. .. 6 6 1 .. 1 2 .. .. 7 7 36 Whooping Cough 33 27 .. 60 23 15 2 40 5 8 .. 13 3 7 1 11 124 Diphtheria .. 7 2 9 .. 3 2 5 .. 4 3 7 i 8 4 13 34 Enteric Fever .. .. 2 2 .. .. 3 3 .. .. 5 5 .. .. 7 7 17 Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea, Dysentery 2 4 2 8 4 1 1 6 9 8 4 21 11 13 4 28 63 Epidemic Enteritis .. 1 .. 1 .. .. 1 1 4 3 .. 7 3 1 .. 4 13 Other Allied Diseases 1† 2* .. 3 3 2† 21 7 4† .. .. 4 .. l† .. 1 l5 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tetanus .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis 2 .. .. 2 3 .. 1 4 2 .. 1 3 1 .. .. 1 10 Gonorrhoea .. .. 2 2 .. .. 2 2 .. .. 1 1 .. .. .. .. 5 Phagedaena .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Erysipelas .. .. .. .. 3 .. 2 5 .. .. 1 1 .. .. 3 3 9 Puerperal Fever .. .. 3 3 .. .. 2 2 .. .. 1 1 .. .. 2 2 8 Pyaemia .. .. 1 1 .. 1 1 2 .. .. 2 .. .. 1 1 6 Infective Endocarditis .. .. 1 1 .. .. 1 1 .. .. 1 1 .. .. 1 1 4 Other Allied Diseases 1 .. .. 1 .. .. 3 3 2 .. 1 3 2 .. 6 8 15 Malarial Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 Rheumatic Fever .. .. 2 2 .. .. 5 5 .. .. .. .. .. .. 4 4 11 Rheumatism of Heart .. .. 2 2 .. .. 1 1 .. .. 1 1 .. .. .. .. 4 Tuberculosis of Brain 8 6 3 17 6 9 5 20 4 6 2 12 6 10 7 23 72 Tuberculosis of Larynx .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 1 2 Phthisis 1 1 96 98 2 2 102 106 .. 2 79 81 .. 3 102 105 390 Abdominal Tuberculosis 5 3 .. 8 3 2 3 8 2 2 3 7 4 3 6 13 36 General Tuberculosis .. 3 5 8 2 2 2 6 2 .. 2 4 1 1 3 5 23 Other Forms Tuberculosis .. .. 1 1 .. .. 5 5 .. .. 3 3 .. 3 4 7 16 Other Infective Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Actinomycosis .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 Hydatid Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases due to Altered Food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Alcoholism .. .. .. .. .. .. .. .. .. .. 3 3 .. .. .. .. 3 Chronic Alcoholism .. .. 2 2 .. .. 2 2 .. .. 2 2 .. .. 2 2 8 Chronic Industrial Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Osteo-arthritis .. .. 2 2 .. .. 6 6 .. .. 5 5 .. .. 2 2 15 Gout .. .. 2 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 Cancer .. .. 86 86 .. 1 87 88 .. .. 90 90 .. 1 96 97 361 Diabetes Mellitus .. .. 10 10 .. .. 10 10 .. .. 10 10 .. .. 4 4 34 Purpura Haemorrhagica .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 Haemophilia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anaemia .. .. 4 4 .. .. 4 4 .. .. 4 4 .. .. 4 4 16 Lymphadenoma .. .. 1 1 .. .. 1 1 .. .. .. .. .. .. .. .. 2 Premature Birth 31 .. .. 31 18 .. .. 18 32 .. .. 32 40 1 .. 41 122 Injury at Birth .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. 1 Debility at Birth 5 .. .. 5 2 .. .. 2 6 .. .. 6 4 .. .. 4 17 Atelectasis 5 .. .. 5 1 .. .. 1 4 .. .. 4 4 .. .. 4 14 Congenital Defects 9 .. .. 9 10 .. .. 10 4 1 .. 5 9 .. .. 9 33 Want of Breast Milk .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus 23 .. .. 23 11 3 .. 14 11 3 .. 14 32 4 .. 36 87 * 1 death between 1 and 5 years in the first Quarter was due to Varicella. + 1 death under 1 year in the first Quarter ; 1 between 1 and 5 ; and 2 over 5 years in the second Quarter ; 4 under 1 year in the third Quarter ; and 1 between 1 and 5 years in the fourth quarter; were due to Cerebro-Spinal Fever. 318 1910] Table B.—Continued. DISEASES. 1st Quarter, j 2nd Quarter. Total. 4rd Quarter. Total. 4th Quarter Total. Total for Year Under 1 1 to 5 Over 5 Total. Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Dentition 2 .... .. 2 .. 1 .. 1 .. 2 .. 2 1 1 .. 2 7 Rickets .. 1 .. 1 .. 2 .. 2 .. 1 .. 1 .. .. .. .. 4 Old Age, Senile Decay .. .. 67 67 .. .. 50 50 .. .. 24 24 .. .. 71 71 212 Convulsions 6 1 .. 7 8 .. 1 9 5 1 .. 6 3 .. .. 3 25 Meningitis 3 2 4 9 4 1 3 8 1 .. 4 5 6 1 1 8 30 Encephalitis .. .. .. .. .. .. 4 4 .. .. .. .. 1 .. 1 2 6 Apoplexy .. .. 9 9 .. .. 9 9 .. .. 2 2 .. .. 9 9 29 Softening of Brain .. .. 6 6 .. .. 4 4 .. .. 5 5 .. .. 6 6 21 Hemiplegia .. .. 10 10 .. .. 3 3 .. .. 7 7 .. .. 12 12 42 General Paralysis of Insane .. .. 10 10 .. .. 4 4 .. .. 11 11 .. .. 6 6 41 Other forms ot Insanity .. .. 10 10 .. .. 7 7 .. .. 6 6 .. .. 4 4 26 Chorea .. .. .. .. .. .. .. .. .. .. ...... .. .. .. .. .. .. Cerebral Tumour .. .. 1 1 .. .. 2 2 .. .. 4 4 .. .. 2 2 9 Epilepsy .. .. 2 2 .. .. 4 4 .. .. 5 5 .. .. 2 2 13 Laryngismus Stridulus .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. 1 Locomotor Ataxy .. .. 3 3 .. .. 1 1 .. .. 1 1 .. .. 3 3 8 Paraplegia .. .. 14 14 .. 1 3 4 .. .. 10 10 .. .. 12 12 40 Other forms, Brain Diseases .. 1 2 3 .. 1 3 4 .. .. .. .. .. .. 4 4 11 Otitis .. .. .. .. 2 .. .. 2 .. 2 2 4 .. .. .. .. 6 Disease of Nose, Epistaxis .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Disease of Eye .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pericarditis .. .. .. .. .. .. 1 1 .. .. .. .. .. 1 1 2 4 Endocarditis .. .. 6 6 .. .. 1 1 .. .. 2 2 .. .. 1 1 10 Hypertrophy of Heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Angina Pectoris .. .. I 1 .. .. 1 1 .. .. 3 3 .. .. 2 2 7 Aneurism .. .. 4 4 .. .. 3 3 .. .. 3 3 .. .. 3 3 13 Senile Gangrene .. .. 3 3 .. .. 3 3 .. .. 4 4 .. .. 4 4 14 Embolism, Thrombosis .. .. 10 10 .. .. 7 7 .. .. 8 8 .. .. 10 10 35 Phlebitis .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 Varicose Veins .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases, Henri and Vessels 3 .. 150 153 1 .. 114 115 2 .. 131 133 2 1 158 161 562 Laryngitis .. .. .. .. .. 1 1 2 .. .. ....... .. .. .. .. .. 2 Croup .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Other Diseases, L??? and Trachea .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 Acute Bronchitis 9 3 26 38 9 6 12 27 4 1 2 7 27 15 22 b4 136 Chronic Bronchitis .. .. 102 102 .. .. 47 47 .. .. 20 20 1 .. 84 85 254 Lobar Pneumonia 1 .. 8 9 .. 1 11 12 .. .. 6 6 .. .. 7 7 44 Lobular Pneumonia 21 25 13 59 13 9 7 29 7 8 4 19 24 38 19 81 l88 Pneumonia 20 3 35 58 3 9 33 45 5 6 21 42 16 13 43 72 207 Emphysema, Asthma .. .. 9 9 .. .. 1 1 .. .. .. .. .. .. 11 11 21 Pleurisy .. .. 5 5 .. .. 2 2 .. .. 3 3 1 .. 6 7 17 Other Diseases. Kespiratory System .. .. 1 1 .. .. 3 3 .. 1 4 5 .. .. .. .. 9 Diseases of Mouth and Annex a .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. 1 Diseases of Pharynx .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 Diseases of Œsophagus .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 Ulcer of Stomach and Duodenum .. 8 8 .. .. 9 9 .. .. 7 7 .. .. 9 9 33 Other Diseases of Stomach 4 .. 4 8 3 .. 2 5 3 .. 1 4 5 .. 5 10 27 Enteritis 3 1 2 6 11 .. 2 13 6 1 2 9 18 7 1 26 54 Appendicitis .. 1 10 11 .. 2 3 5 .. .. 6 6 .. .. 5 5 27 Obstruction of Intestine .. .. 8 8 1 .. 10 11 1 .. 9 10 2 .. 10 12 41 Other Diseases of Intestine 1 .. 3 4 .. .. 1 1 .. .. 1 1 .. .. 1 1 7 Cirrhosis of Liver .. .. 7 7 .. .. 7 7 .. .. 15 15 .. .. 11 11 40 Other Diseases of Liver 1 .. 3 4 1 .. 5 6 .. .. l 1 1 .. 4 5 16 Peritonitis .. .. 1 1 1 .. 5 6 .. 1 4 5 .. .. 4 4 16 Other Diseases, Digestive system .. .. .. .. .. .. 1 1 2 .. 2 4 4 .. .. 4 9 Diseases. Lymphatic System Glands 1 .. .. 1 .. .. 2 2 .. .. 2 2 1 •• 1 4 9 Acute Nephritis .. .. 2 2 .. .. 1 1 .. .. 7 / .. •• 5 S 15 Bright's Disease .. .. 39 39 .. .. 21 21 .. .. 33 33 .. .. 28 28 121 Calculus .. .. 1 1 .. .. 2 2 .. .. 2 2 .. .. .. .. 5 Diseases of Bladder and Prostate .. .. 9 9 .. .. 10 10 .. .. 4 4 .. .. 5 5 28 Other Diseases, Urinary System .. .. 4 4 .. .. 1 1 .. .. .. .. .. .. 3 3 8 Diseases of Testis and Pents .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diseases of Ovaries .. .. 2 2 .. .. i 1 .. .. 1 1 .. .. .. .. 4 Diseases of Uterus and Appendages .. .. 2 2 .. .. .. .. .. .. .. .. .. .. 1 1 3 Dis of Vagina and External Genitals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diseases of Breast .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 2 2 Abortion, Miscarriage .. .. 1 1 .. .. 1 1 .. .. .. .. .. .. .. .. 2 Puerperal Mania .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plaenta Prævia, Flooding .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Dis., Pregnancy and Childbirth. 1 .. 2 3 .. .. .. .. .. .. 2 2 .. •• 1 1 6 Arthritis, Ostitis. Periostitis .. .. 1 1 .. .. .. .. .. 1 .. 1 .. .. 1 1 3 Other Diseases. Osseous system .. .. 2 2 .. .. 1 1 .. .. .. .. .. .. 4 4 7 Ulcer, Be???sore .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 319 [1910 Table B.—Continued DISEASES 1st Quarter 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Total. Under 1 1 to 5 Over 5 Total. Under 1 1 to 5 Over 5 Total. Under 1 1 to 5 Over 5 Total. Under 1 1 to 5 Over 5 Eczema .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pemphigus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases, Integumentary System .. .. 1 1 .. .. .. .. .. .. 2 2 .. .. 2 2 5 Accidents and Negligence. In Mines and Quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. In Vehicular Traffic .. .. 4 4 .. .. 7 7 .. 1 7 8 .. .. 4 4 23 On Railways .. .. 3 3 .. .. .. .. .. .. 3 3 .. .. .. .. 6 On Ships, Boats, &c. (not drowning) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. In Building Operations .. .. 3 3 .. .. .. .. .. .. 3 3 .. .. 1 1 7 Bv Machinery .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 By Weapons and Implements .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 Burns and Scalds 1 3 1 5 .. .. .. .. 1 .. 1 2 2 3 .. 5 12 Poisons, Poisonous Vapours .. .. .. .. .. .. .. .. .. .. 2 2 .. .. .. .. 2 Surgical Narcosis .. .. 2 2 .. .. 1 1 .. .. 1 1 .. .. 1 1 5 Effects of Electric Shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Corrosions by Chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Drowning .. .. .. .. .. .. 2 2 .. .. 1 1 .. .. .. .. 3 Suffocation, Overlaid in Bed 12 .. .. 12 4 .. .. 4 5 .. .. 5 5 .. .. 5 26 ,, Otherwise .. .. .. .. 3 .. 1 4 .. .. 1 1 1 1 3 5 10 Falls not specified 1 1 11 13 .. .. 7 7 .. .. 8 8 1 1 6 8 36 Weather Agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Otherwise, not stated 1 .. .. 1 .. 1 1 2 2 .. 1 3 .. .. .. .. 6 Homicide .. .. .. .. 1 2 .. 3 .. .. 1 1 1 .. 1 2 6 Suicide. By Poison .. .. 8 8 .. .. 7 7 .. .. 2 2 .. .. 6 6 23 By Asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Hanging and Strangulation .. .. 2 2 .. .. 3 3 .. .. 5 5 .. .. 2 2 12 By Drowning .. .. 1 1 .. .. 1 1 .. .. 1 1 .. .. 1 1 4 By Shooting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Cut or Stab .. .. 5 5 .. .. .. .. .. .. 2 2 .. .. .. .. 7 By Precipitation from Elevated Places .. .. .. .. .. .. 1 1 .. .. 1 1 .. .. .. .. 2 By Crushing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By other and unspecified methods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Execution .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 2 2 Sudden Death, cause not ascertained .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ill-defined and unspecified causes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Males 124 49 451 624 76 45 368 489 89 43 354 486 150 122 442 714 2313 Females 95 50 4£8 613 83 40 362 485 49 39 308 396 111 127 4/8 716 2210 TOTAL DEATHS 219 99 919 1237 159 85 730 974 138 82 662 882 261 249 920 1430 4523 820 [1910 Table C. Showing the Population, Inhabited Houses, Marriages, Births and Deaths for the year 1910, and 10 years preceding. gross numbers. Year. Estimated Population. * No. of Inhabited Houses. Marriages. Registered Births. Number of Deaths. Deaths of Residents in Public Institutions. Total all ages. Under one year. Under five 1 2 3 4 5 6 7 8 9 1910 327985 39,949 2,870 8,201 4 523 777 1,292 1,801 1900 335,892 42,959 2,968 9,254 5,721 1,344 1,956 1,542 1901 335,325 38,645 2,994 9,264 5,361 1,290 1,928 1,533 1902 334,035 39,766 3,108 9,214 5,635 1,219 1,906 1,646 1903 333,273 39,902 3,053 8,983 4,839 1,136 1,674 1,539 1904 332,512 39,920 2,948 8,890 5,236 1,140 1,743 1,576 1905 331,753 39,910 2,984 8,756 4,935 1,074 1,639 1,581 1906 330,996 39,884 2,964 8,659 5,050 1,083 1,672 1,603 1907 330,241 39,900 2,962 8,531 5,079 996 i.54i 1,738 1908 329,487 39,926 2,781 8,665 4,679 894 1,320 1,699 1909 328,735 39,982 2,769 8,198 4,918 841 1,401 1,788 Average of 10 years. 332,225 40,079 2,953 8,841 5.147 1 ,102 1,678 1,624 • These populations have been estimated on the basis of Censuses 1901 and ign, as published by the Registrar-General, 25th May, 1911. 321 [1910 Table D. Showing the Annual Birth and Death-rates, Death-rates of Children and Deaths in Public Institutions per 1,000 Total Deaths for the year 1910 and 10 years preceding. Year. Birth-rates per 1,000 of the population. ♦Deathrates per 1,000 of the population. Corrected Death-rates per 1,000 of the population. Deaths of Children under 1 year per 1,000 of Registered Births. Deaths of Children under 1 year per 1,000 of Total Deaths Deaths of Children under 5 years per 1,000 of Total Deaths. Deaths of Residents in Public Institutions per 1,000 of Total Deaths. 1 2 3 4 5 6 7 8 1910 25.01 13.79 14.33 95 170 286 398 1900 27.5 17.0 18.2 145 235 342 269 1901 27.7 16.0 16.6 139 241 360 286 1902 27.1 16.5 17.1 132 216 338 292 1903 26.9 14.5 15.1 126 235 346 318 1904 26.7 15.7 16.3 128 218 333 301 1905 26.4 14.9 15.5 123 217 331 319 1906 26.2 15.2 15.8 125 214 331 317 1907 25.8 15.4 16.0 117 196 303 342 1908 25.8 13.9 14.4 103 191 282 363 1909 24.9 14.9 15.5 103 171 285 363 Average of 10 years. 266 15.5 16.1 124 213 325 317 • The rates for 1901 and 1911 have been calculated on the basis of Censuses of 1901 and 1911 as published by the Registrar-General, 25th May, 1911. The Death Rates in column 4 are corrected for sex and age distribution for the purpose of contrasting them on an equal basis with those of EngUnd. 822 1910] Table E. Showing the Births, Deaths, Infantile Mortality, the Deaths front the Principal Epidemic Diseases, and from Influenza Cancer, Phthisis, and Puerperal Fever occurring in the Year 1910. and during the Ten Years preceding. Year. Births. Birth-rates. Deaths. Death-rates. Deaths of Infants under 1 year of age. Deaths under 1 year to 1,000 Births. Deaths from the Principal Epidemic Diseases. Total Epidemic Death-rates. Influenza. Cancer. Phthisis Puerperal Fever Totals. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Simple and undefined Fevers. Diarrhœal Diseases. Deaths. Death-rates. Deaths. Death-rates. Deaths. Death-rates. Deaths. Deaths per 1,000 births. 1900 9,254 27.5 5,721 17.0 1,344 145 660 1 159 24 106 142 .. 46 2 180 1.96 149 0.44 303 0.90 602 179 6 0.65 1901 9,264 27.7 5,361 16.0 1,290 139 628 8 151 30 134 85 .. 47 1 172 1.87 46 0.14 289 0.86 545 163 15 1.62 1902 9,214 27.1 5,635 16.5 1,219 132 608 53 114 40 104 152 .. 45 1 99 1.79 83 0.24 326 0.96 515 1.51 12 1.30 1903 8,983 26.9 4,839 14.5 1,136 126 471 .. 120 24 43 152 .. 22 1 109 1.41 40 0.12 350 1.05 492 1.48 9 1.00 1904 8,890 26.7 5,236 15.7 1,140 128 606 1 181 35 28 83 .. 18 .. 260 1.82 48 0.14 323 0.97 533 1.60 14 1.57 1905 8,756 26.4 4,955 14.9 1,074 123 529 1 123 37 34 111 .. 17 .. 206 1.59 54 0.16 328 0.99 438 1.32 6 0.68 1906 8,659 26.2 5,050 15.2 1,083 125 562 .. 187 37 32 74 .. 19 .. 213 1.70 67 0.20 363 1.10 411 1.24 11 1.27 1907 8,531 25.8 5,079 15.4 996 117 432 .. 130 24 42 120 .. 13 .. 103 1.31 75 0.23 348 1.05 436 1.32 8 0.94 1908 8,665 25.8 4,679 13.9 894 103 358 .. 78 30 60 55 .. 18 .. 117 1.07 81 0.24 367 1.09 432 1.29 4 0.46 1909 8,198 24.9 4,918 14.9 841 103 418 .. 197 25 31 86 .. 12 .. 67 1.27 70 0.21 353 1.07 424 1.29 7 0.85 Corrected average. 8,729 26.61 5,082 15.49 1,088 125 520 6 142 30 60 105 .. 26 .. 151 1.59 70 0.21 331 1.01 477 1.45 9 1.03 1910 8,201 25.01 4,523 13.79 777 95 428 .. 166 11 34 124 .. 17 .. 76 1.30 36 0.11 361 1.10 390 1.19 8 0.97 Departure from Average. 528 1.60 559 1.7O 311 30 -92 -6 + 24 -19 — 26 + 19 .. -9 .. -75 — 0.29 -34 — 0.10 + 30 + 0.09 -87 — 0.26 — 1 — 0.06 Note.—All the rates in this table between the years 1901-1910 have been calculated on the basis of Censuses igoi and 1911. 323 [1910 TABLE F. Showing the Births and Birth Rates of Islington from 1841 to 1910. Years. Births Birth Rates. Years. Births Birth Rales Years. Births Birth Rates. Years. Births Birth Rates. 1841 1446 25.58 1861 5530 35.31 1881 9894 34.87 1901 9264 27.67 1842* 1508 25.28 1862 5619 34.76 1882 9991 34.79 1902* 9214 27.06 1843 1627 25.86 1863 6094 36.51 1883 9940 34.19 1903 8983 26.95 1844 1804 27.18 1864 6349 36.84 1884* 9872 33.54 1904 8890 26.73 1845 1838 26.20 1865 6743 37.90 1885 9667 32.45 1905 8756 26.39 1846 2152 29.13 1866* 6983 38.02 1886 9849 32.66 1906 8659 26.16 1847 2318 29.75 1867 7391 38.97 1887 9740 31.92 1907 8531 25.83 1848* 2529 30.76 1868 7608 38.86 1888 9609 31.10 1908* 8665 25.80 1849 2613 30.13 1869 7529 37.24 1889 9628 30.79 1909 8198 24.93 1850 3015 32.96 1870 7674 36.77 1890* 9230 29.16 1910 8201 25.01 1841-50 20850 28.65 1861-70 67520 37.20 1881-90 97420 32.49 | 1901-10 87361 26.36 1851 3033 31.46 1871 7671 35.73 1891 9797 30.61 1852 3462 34.19 1872* 8048 36.36 1892 9743 30.12 1853 3701 34.81 1873 8398 36.89 1893 9749 29.81 1854* 3964 35.50 1874 8697 37.16 1894 9678 29.28 1855 4148 35.37 1875 9068 37.67 1895 10183 30.48 1856 4306 34.97 1876 9225 37.26 1896* 9921 29.38 1857 4512 34.89 1877 9380 36.85 1897 9842 29.19 1858 4560 33.57 1878* 9498 36.28 1898 9453 28.07 1859 5011 35.13 1879 9714 36.08 1899 9658 28.71 1860* 5218 34.84 1880 9928 35.86 1900 9254 27.55 1851-60 41915 34.54 187180 89627 36.60 1891-190 97278 29.31 f The biith-rales for 1901-10 hare been calculated on the basis of the Censuses of 1901 and 1911, as published by the Registrar-General, May 25th, 1911. • These years contained 53 weeks. 824 1910] Table G. Showing the Illegitimate Births in Islington from 1841 to 1910. Years. Births. Years. Births. Years. Births. Years. Births. Years. Births. Years. Births Years. Births 1841 * 1851 100 1861 184 1871 280 1881 380 1891 265 1901 228 1842 33 1852 100 1862 207 1872 346 1882 353 1892 298 1902 248 1843 * 1853 95 1863 224 1873 335 1883 370 1893 267 1903 242 1844 * 1854 125 1864 248 1874 344 1884 341 1894 290 1904 273 1845 43 1855 126 1865 291 1875 363 1885 327 1895 286 1905 227 1846 53 1856 149 1866 272 1876 361 1886 331 1896 242 1906 244 1847 64 1857 151 1867 306 1877 337 1887 350 1897 269 1907 230 1848 85 1858 140 1868 317 1878 303 1888 345 1898 262 1908 231 1849 74 1859 174 1869 284 1879 401 1889 350 1899 279 1909 250 1850 97 1860 175 1870 318 1880 359 1890 328 1900 261 1910 240 7 yrs. 449 1851 to 1860 1335 1861 to 1870 2051 1871 to 1880 3429 1881 to 1890 3475 1891 to 1900 2719 1901 to 1910 2413 * The births in these years could not be ascertained. 325 [1910 TABLE H. Showing the Deaths and Death Rates of Islington from 1841 to 1910. † Years. Deaths. Death Kates. Years. Deaths. Death Rates. Years. Deaths Death Rates. Years. Deaths. Death Rates. 1841 1013 17.91 1861 3123 19.94 1881 5617 19.79 1901 5361 16.01 1842* 1101 18.46 1862 3496 21.62 1882 5643 19.65 1902* 5635 16.55 1843 1115 17.72 1863 4340 26.00 1883 5561 19.12 1903 4839 14.52 1844 1294 19.49 1864 4594 26.65 1884* 5515 18.74 1904 5236 15.74 1845 1258 17.96 1865 4617 25.94 1885 5740 19.27 1905 4955 14.93 1846 1383 18.72 1866* 5154 28.06 1886 5434 18.02 1906 5050 15.25 1847 1624 20.83 1867 4509 24.55 1887 5699 18.67 1907 5079 15.37 1848* 1745 21.22 1868 4886 24.95 1888 5197 16.82 1908* 4679 13.93 1849 1891 21.80 1869 4937 24.42 1889 5035 16.10 1909 4918 14.96 1850 1609 17.58 1870 5078 24.33 1890* 6152 19.43 1910 4523 13.79 1841-50 14033 19.28 1861-70 14734 24.64 1881-90 55593 18.55 1901-10 50275 5.17 1851 2082 21.59 1871 5048 23.44 1891 6326 19.77 1852 2086 20.60 1872* 4196 18.95 1892 6075 18.78 1853 2395 22.52 1873 4156 18.25 1893 6391 19.55 1854* 2800 25.07 1874 4816 20.57 1894 5263 15.92 1855 2680 22.85 1875 4833 20.07 1895 5760 17.24 1856 2677 21.74 1876 4969 20.07 1896* 5884 17.42 1857 2586 20.00 1877 5111 20.07 1897 5395 16.00 1858 2777 20.44 1878* 5376 20.53 1898 5705 16.94 1859 2898 20.32 1879 5456 20.27 1899 6293 18.71 I860* 3028 21.21 1880 5716 20.65 1900 5721 17.03 1851-60 26009 21.43 1871-80 19677 20.28 1891-1900 58813 17.72 f The death rates for 1901-10 have been calculated on the basis of the Censuses of 1901 and 1911, as published by the Registrar-General, May 25th, 1911. • These years contain 53 weeks. 32.6 1910] TABLE I. Infantile Mortality Returns, extracted from the Annual Reports of the Registrar-General, 1841-55, and from the Annual Reports of the Medical Officer of Health of Islington, 1856-1910. Years Deaths under 1 year old. Deaths per 1,ooo Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. 1841 190 131 1861 748 135 1881 1,400 140 1901 1,290 139 1842* 224 149 1862 725 130 1882 1,403 140 1902* 1,219 132 1843 - - 1863 906 147 1883 1,312 133 1903 1,136 126 1844 - - 1864 969 153 1884* 1,506 150 1904 1,140 128 1845 267 164 1865 1,088 161 1885 1,387 144 1905 1,074 123 1846 330 153 1866* 1,170 169 1886 1,510 154 1906 1,083 125 1847 348 150 1867 1,119 152 1887 1,549 159 1907 996 117 1848* 386 152 1868 1,266 164 1888 1,262 132 1908* 894 103 1849 441 168 1869 1,234 165 1889 1,242 130 1909 841 103 1850 360 119 187O 1,135 149 1890* 1,484 158 1910 777 95 1841-50 (8 years) 2,546 146 1861-7O 10,360 153 1881-90 14,055 144 1901-10 10,450 120 1851 457 151 1871 1,179 154 1891 1,481 152 1852 457 132 1872* 1,200 150 1892 1,417 145 1853 571 154 1873 1,172 138 1893 1,595 164 1854* 604 152 1874 1,278 147 1894 1,229 127 1855 605 146 1875 1,306 145 1895 1,416 139 1856 612 142 1876 1,397 152 1896* 1,490 150 1857 642 140 1877 1,302 140 1897 1,338 136 1858 648 142 1878* 1,453 154 1898 1,504 159 1859 665 133 1879 1,340 135 1899 1,548 160 186O* 747 144 1880 1,517 154 1900 1,344 145 1851-6O 6,008 143 1871-80 13,144 147 1891-00 14,362 148 * These years contained 53 weeks. 827 [1910 Table J. Showing the Cases of Infectious Diseases in Islington in Quinquennial Periods, 1891—1910. Year. Smallpox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total Notifications. Attack rates per 1,000 Population. 1891 1 728 7.56 189 2 343 33 6 1 .. 2059 6.43 1892 42 1709 738 219 .. 553 52 6 .. 3 3318 10.26 1893 118 2880 885 251 1 672 58 7 .. 1 4853 14.84 1894 90 1493 867 245 1 395 23 7 .. .. 3121 9.44 1895 25 1692 582 184 5 320 22 9 .. .. 2839 8.50 1891-5 276 8502 3828 1088 9 2280 167 35 1 4 16,190 9.90 1896 50 2031 1091 229 .. 385 30 6 2 .. 3824 11.32 1897 3 1577 729 256 .. 312 27 1 .. 1 2906 8.62 1898 .. 1336 544 237 2 279 19 1 .. .. 2418 7.18 1899 3 1494 705 353 .. 350 33 2 .. 3 2943 8.75 1900 2 1074 633 259 1 285 16 6 .. .. 2276 6.78 1896-00 58 7512 3702 1334 3 1611 125 16 2 4 14,367 8.53 1901 50 1286 911 281 2 285 34 3 .. .. 2852 8.52 1902 276 1372 878 257 .. 357 19 5 .. .. 3164 9.47 1903 9 865 455 130 .. 227 19 2 .. .. 1707 5.12 1904 17 1146 347 126 1 280 24 .. .. .. 1941 5.84 1905 3 1198 351 100 .. 252 24 .. .. .. 1928 5.81 1901-05 355 5867 2942 894 3 1401 120 10 .. .. 11,592 6.96 1906 1 1386 439 149 1 274 24 1 .. .. 2275 6.87 1907 .. 1216 481 92 .. 252 21 1 .. .. 2063 6.25 1908 .. 1409 530 97 .. 235 17 1 .. .. 2289 6.95 1909 3 1285 430 QS 1 221 14 .. .. .. 2049 6.23 1910 1 730 471 89 1 212 20 1 .. .. 1525 4.65 1906-10 5 6026 2351 522 3 1194 96 4 .. .. 10201 6.19 Note.—All rates in this table between the years 1901-10 have been recalculated on basis of Censuses of 1901 and 1911. 328 1910] Table K. Showing the Cases of Small Pox that occurred in the several Wards from 1891 to 1910. Year. Tufnell. *Upper Holloway. Tollington. Lower Holloway. Highbury. † Mildmay. Thornhill. Barnsoury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. .. • • 1 .. .. .. .. .. .. .. 1 1892 .. 12 .. 12 .. 7 .. .. 9 1 1 42 1893 .. 41 .. 28 6 3 14 6 6 5 9 118 1894 17 8 2 5 2 3 10 .. 15 2 26 90 1895 1 6 3 1 1 1 2 4 1 .. 5 25 1896 8 3 25 1 6 5 1 1 .. .. .. 50 1897 1 1 .. .. .. .. .. .. .. 1 .. 3 1898 .. .. .. .. .. .. .. .. .. .. .. .. 1899 .. .. 2 •• •• .. .. .. .. .. 1 3 1900 .. .. .. 1 .. 1 .. .. .. .. .. 2 1901 3 .. .. 11 4 1 13 6 4 4 4 50 1902 9 34 28 32 17 13 25 33 7 16 62 276 1903 3 1 .. 2 .. .. .. .. .. 1 2 9 1904 .. .. .. 1 .. .. 12 .. 2 2 .. 17 1905 .. .. .. .. .. .. 2 .. .. .. 1 3 1906 .. .. .. .. .. 1 .. .. .. .. .. 1 1907 .. .. .. .. .. .. .. .. .. .. .. .. 908 .. .. .. .. .. .. .. .. .. .. .. .. 1909 .. .. 3 .. .. .. .. .. .. .. 3 1910 .. .. 1 .. .. .. .. .. .. .. .. 1 * The figures for 1891-2-3 are inclusive of Tufnell and Tollington Wards, t The figures for 1891-2 are inclusive of Highbury Table L. Showing the Cases of Scarlet Fever that occurred in the several Wards from 1891 to 1910. Year. Tufnell. *Upper Holloway. Tollington. Lower Holloway. Highbury. † Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St.Peter's. Totals. 1891 .. 229 .. 108 .. 99 55 59 27 46 105 728 1892 .. 435 .. 225 .. 313 148 100 94 194 200 1709 1893 .. 790 .. 368 .. 633 355 209 136 201 187 2880 1894 176 235 114 196 152 67 165 116 91 90 91 1493 1895 142 166 220 214 168 117 182 89 108 112 174 1692 1896 181 244 191 169 230 127 150 149 104 191 295 2031 1897 144 153 193 187 137 126 155 91 76 113 202 1577 1898 159 151 152 182 151 102 114 38 58 107 122 1336 1899 100 172 183 178 176 118 117 102 79 98 171 1494 1900 78 85 102 138 152 90 85 66 51 107 120 1074 1901 97 109 129 172 178 83 137 86 61 93 141 1286 1902 140 147 160 187 121 88 187 67 45 94 136 1372 1903 76 78 113 129 130 70 88 42 28 36 75 865 1904 72 76 222 135 127 65 147 84 45 103 70 1146 1905 100 142 112 130 114 42 96 71 97 119 175 1198 1906 139 135 67 204 133 68 121 70 97 155 197 1386 1907 120 78 91 164 125 112 110 92 49 105 170 1216 1908 158 162 167 204 119 79 135 94 78 88 125 1409 1909 155 149 126 206 149 94 81 110 51 84 80 1285 1910 83 121 76 91 53 49 72 45 32 45 63 730 * The figures for 1891-2-3 are inclusive of Tufnell and Tollington Wards, f The figures for 1891-2-3 are inclusive of Highbury. 829 [1910 Table M. Showing the Cases of Diphtheria that occurred in the several Wards from 1891 to 1910. Year. Tufnell. Upper Hollo way. Tollington Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. 305 .. 43 .. 112 37 44 44 54 73 712 1892 .. 299 .. 43 .. 95 49 43 54 37 75 695 1893 .. 283 .. 57 .. 140 94 46 55 62 117 855 1894 86 91 177 131 93 40 81 37 45 25 97 843 1895 64 77 50 67 80 21 46 28 21 34 76 564 1896 129 177 84 89 87 46 200 95 29 49 82 IO67 1897 71 77 118 66 43 60 81 43 30 52 59 700 1898 44 52 50 36 41 64 54 30 26 92 42 531 1899 148 99 88 56 62 28 28 29 39 52 59 688 1900 61 64 46 62 49 74 47 43 55 38 85 624 1901 83 69 61 104 87 55 96 67 61 60 159 902 1902 128 100 62 165 106 38 73 31 29 55 84 871 1903 43 45 47 120 37 17 34 17 21 36 35 452 1904 28 37 45 37 26 28 49 30 13 25 29 347 1905 38 41 40 23 45 42 34 18 10 38 22 351 1906 25 56 49 60 50 22 47 28 27 35 38 437 1907 35 65 41 55 39 30 64 30 39 35 47 480 1908 45 76 52 79 45 26 49 24 19 60 47 522 1909 52 63 28 49 34 24 46 34 18 27 50 425 1910 48 92 62 31 18 22 87 20 22 21 40 463 Table N. Showing the Cases of Membranous Croup that occurred in the several Wards from 1891 to 1910. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill, Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. 20 .. 2 .. 5 3 1 1 2 10 44 1892 .. 10 .. 3 .. 10 3 1 2 8 6 43 1893 .. 10 .. 5 .. 3 3 3 1 .. 5 30 1894 2 2 .. 5 .. 2 6 1 .. 5 1 24 1895 1 3 .. 3 3 1 1 .. 1 1 4 18 1896 3 3 .. 4 4 1 3 1 1 1 3 24 1897 2 4 2 5 .. .. 1 .. 3 3 3 29 1898 2 4 .. .. 1 .. 4 .. 1 .. .. 13 1899 2 1 1 2 1 1 3 2 1 .. 3 17 1900 2 .. .. 1 .. .. 1 2 .. 1 1 9 1901 1 .. 1 1 .. 2 .. 2 .. 1 .. 9 1902 .. 1 .. 1 1 .. .. 1 .. .. .. 7 1903 .. .. .. 1 .. .. 1 .. .. .. 1 3 1904 .. .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. 1 .. .. .. .. 1 .. .. .. .. 2 1907 .. .. .. .. .. .. .. .. 1 .. .. 1 1908 .. 2 .. 3 1 .. 1 .. .. .. 1 8 1909 1 2 1 .. .. .. .. 1 .. .. .. 5 1910 1 2 1 1 •• 1 2 .. .. .. .. 8 380 19101 Table 0. Showing the Cases of Typhoid Fever that occurred in the several Wards from 1891 to 1910. Year. Tufneli. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's Canonbury. St. Peter's. Totals. 1891 .. 61 .. 25 .. 33 31 15 8 5 11 189 1892 .. 78 .. 19 .. 49 25 16 7 12 13 219 1893 .. 88 .. 19 .. 56 17 17 9 24 21 251 1894 24 23 18 32 25 23 19 21 9 21 30 245 1895 21 16 12 25 26 22 10 9 9 14 20 184 1896 17 22 19 35 30 15 40 10 9 12 20 229 1897 25 25 43 34 25 27 20 18 10 11 18 256 1898 22 34 24 30 26 21 18 16 10 15 21 237 1899 39 40 94 24 49 17 31 17 15 16 11 353 1900 14 37 42 25 23 27 34 15 9 13 20 259 1901 33 42 19 39 22 28 15 14 14 27 29 281 1902 29 22 18 32 23 12 37 25 11 20 28 257 1903 9 13 14 11 13 13 21 7 4 13 12 130 1904 13 10 10 16 6 20 23 3 2 8 15 126 1905 3 12 9 13 9 14 7 10 4 5 14 100 1906 7 22 27 18 16 2 14 16 2 2 23 149 1907 9 10 10 10 15 6 11 2 6 6 7 92 1908 2 10 3 31 9 2 10 6 8 11 5 97 1909 4 13 2 14 10 7 16 7 6 14 2 95 1910 7 13 5 13 4 5 13 13 4 8 4 89 Table P. Showing Cases of Typhus Fever that occurred in the several Wards from 1891 to 1910. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. .. .. .. .. .. .. 1 .. .. 1 2 1892 .. .. .. .. .. .. .. .. .. .. .. .. 1893 .. 1 .. .. .. .. .. .. .. .. .. 1 1894 .. .. 1 .. .. .. .. .. .. .. 1 1895 3 .. .. .. .. .. .. 2 .. .. .. 5 1896 .. .. .. .. .. .. .. .. .. .. .. .. 1897 .. .. .. .. .. .. .. .. .. .. .. .. 1898 .. .. 1 .. .. .. .. .. .. 1 .. 2 1899 .. .. .. .. •• .. •• .. .. .. .. .. 1900 .. .. .. .. 1 .. .. .. .. .. .. 1 i901 .. .. .. .. .. .. 1 1 .. .. .. .. 1902 .. .. .. .. .. .. .. .. .. .. .. .. 1903 .. .. .. .. .. .. .. .. .. .. .. .. 1904 1 .. .. .. .. .. .. .. .. .. .. 1 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. .. .. .. .. .. .. .. .. .. .. 1 1907 .. .. .. .. .. .. .. .. .. .. .. .. 1908 .. .. .. .. .. .. .. .. .. .. .. .. 1909 .. .. .. .. .. .. .. .. 1 .. .. 1 1910 .. .. .. .. .. .. .. 1 .. .. •• 1 831 [1910 Table Q. Showing the Cases of Erysipelas that occurred in the several Wards from 1891 to 1910. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. 139 .. 23 .. 42 30 28 13 23 45 343 1892 .. 194 .. 46 .. 80 35 39 44 39 73 550 1893 .. 244 .. 70 .. 75 63 51 49 41 79 672 1894 34 85 23 59 29 19 43 19 20 26 38 395 1895 29 62 23 38 36 24 26 21 16 12 33 320 1896 54 65 20 51 35 30 22 29 18 22 39 385 1897 24 66 21 38 25 26 19 15 16 19 43 312 1898 23 60 20 31 22 16 !5 17 13 22 40 279 1899 15 70 36 47 25 12 39 23 22 19 42 350 1900 31 45 25 30 24 13 29 16 15 20 37 285 1901 24 52 30 16 18 14 37 10 15 25 44 285 1902 33 47 34 41 30 18 33 19 13 51 38 357 1903 23 28 22 25 16 10 25 10 12 31 25 227 1904 36 19 30 29 23 19 30 15 16 38 25 280 1905 26 18 22 36 25 16 29 17 19 16 28 252 1906 20 26 14 27 28 23 41 26 13 16 40 274 1907 26 20 21 35 17 18 33 22 13 18 29 252 1908 24 22 25 28 18 18 26 23 13 14 24 235 1909 23 22 23 26 22 19 17 18 14 14 23 221 1910 19 17 24 33 19 5 22 16 22 21 14 212 Table R. Showing the Cases of Puerperal Fever that occurred in the several Wards from 1891 to 1910. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. S Peter's. Totals. 1891 .. 10 .. 9 .. 7 2 1 1 .. 3 33 1892 .. 28 .. 5 .. 7 5 2 2 .. 2 51 1893 3 5 4 7 5 3 3 3 2 .. 3 38 1894 1 3 6 4 3 2 2 1 1 .. .. 23 1895 1 2 1 2 6 2 3 1 1 3 .. 22 1896 3 2 3 5 2 1 5 2 1 3 3 30 1897 5 6 2 4 3 1 4 .. 1 1 .. 27 1898 .. .. 2 2 .. 2 3 2 1 4 3 19 1899 1 7 4 9 1 1 4 3 .. 1 2 33 1900 4 2 1 3 3 .. .. 2 .. 1 .. 16 1901 2 3 4 5 5 2 3 4 .. 3 3 34 1902 2 1 2 1 4 .. 5 .. .. 3 1 19 1903 3 4 1 4 4 I .. 1 .. .. 1 19 1904 5 4 3 .. 2 1 5 1 1 1 1 24 1905 1 1 3 9 2 1 3 .. .. 2 .. 24 1906 2 1 3 4 3 1 5 2 1 1 1 24 1907 3 5 5 .. 2 1 1 2 1 1 21 1908 2 .. 1 5 2 1 1 2 1 .. .. 17 1909 2 .. 3 2 2 I 1 .. 1 1 1 14 1910 2 4 1 3 2 1 3 1 1 1 1 20 332 1910] Table S. Showing the Cases of Continued Fever that occurred in the several Wards from 1891 to 1910. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. 1 .. 2 .. .. 3 .. .. .. .. 6 1892 .. 2 .. .. .. 3 .. .. .. 1 .. 6 1893 1 .. .. .. 1 .. 1 .. 1 1 2 7 1894 .. .. 2 1 3 .. .. .. .. 1 .. 7 1895 .. 4 1 .. 1 3 .. .. .. .. .. 9 1896 1 2 .. .. .. 1 1 1 .. .. .. 6 1897 .. .. .. .. .. .. .. .. .. .. 1 1 1898 .. .. .. .. .. .. .. .. .. 1 .. 1 1899 .. .. .. .. .. .. 1 .. .. .. 1 2 1900 .. .. .. 3 . . 2 .. .. .. 1 .. 6 1901 .. .. .. 1 .. .. 1 .. .. .. 1 3 1902 .. .. .. .. .. .. 5 .. .. .. .. 5 1903 1 .. .. .. .. .. .. .. .. 1 .. 2 1904 .. .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. .. .. .. .. .. 1 .. .. .. .. 1 1907 .. .. .. .. .. 1 .. .. .. .. .. 1 1908 .. 1 .. .. .. .. .. .. .. .. .. 1 1909 .. .. .. .. .. .. .. .. .. .. .. .. 1910 .. .. 1 .. .. .. .. .. .. .. .. 1 Table T. Showing the Cases of Relapsing Fever that occurred in the several Wards from 1891 to 1910. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. 1 .. .. .. .. .. .. .. .. .. 1 1892 .. .. .. .. .. .. .. .. .. .. .. .. 1893 .. .. .. .. .. .. .. .. .. .. .. .. 1894 .. .. .. .. .. .. .. .. .. .. .. .. 1895 .. .. .. .. .. .. .. .. .. .. .. .. 1896 .. .. .. 1 .. .. .. .. 1 .. .. 2 1897 .. .. .. .. .. .. .. .. .. .. .. .. 1898 .. .. .. .. .. .. .. .. .. .. .. .. 1899 .. .. .. .. .. .. .. .. .. .. .. .. 1900 .. .. .. .. .. .. .. .. .. .. .. .. 1901 .. .. .. .. .. .. .. .. .. .. .. .. 1902 .. .. .. .. .. .. .. .. .. .. .. .. 1903 .. .. .. .. .. .. .. .. .. .. .. .. 1904 .. .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. .. .. .. .. .. .. .. .. .. .. .. 1907 .. .. .. .. .. .. .. .. .. .. .. .. 1908 .. .. .. .. .. .. .. .. .. .. .. .. 1909 .. .. .. .. .. .. .. .. .. .. .. .. 1910 .. .. .. .. .. .. .. .. .. .. .. .. 388 [1910 Table U. Showing the Cases of Cholera that occurred in the several Wards from 1891 to 1910. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. .. .. .. .. .. .. .. .. .. .. .. 1892 .. .. .. .. .. .. .. .. .. .. *3 3 1893 .. .. .. .. .. .. 1 .. .. .. .. 1 1894 .. .. .. .. .. .. .. .. .. .. .. .. 1895 .. .. .. .. .. .. .. .. .. .. .. .. 1896 .. .. .. .. .. .. .. .. .. .. .. .. 1897 .. .. .. .. .. .. 1 .. .. .. .. 1 1898 .. .. .. .. .. .. .. .. .. .. .. .. 1899 .. 2 1 .. .. .. .. .. .. .. .. 3 1900 .. .. .. .. .. .. .. .. .. .. .. .. 1901 .. .. .. .. .. .. .. .. .. .. .. .. 1902 .. .. .. .. .. .. .. .. .. .. .. .. 1903 .. .. .. .. .. .. .. .. .. .. .. .. 1904 .. .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. .. .. .. .. .. .. .. .. .. .. .. 1907 .. .. .. .. .. .. .. .. .. .. .. .. 1908 .. .. .. .. .. .. .. .. .. .. .. .. 1909 .. .. .. .. .. .. .. .. .. .. .. .. 1910 .. .. .. .. .. .. •• .. .. .. .. .. •Asiatic Cholera. 334 1910] TABLE V. Showing some of the Work of the Public Health Department. Years. Number of cases of Notifiable Infectious Diseases, inclusive of Phthisis. Number of cases of Non-notifiable Diseases notified by the Public Elementary Schools. Number of Infectious Diseases notified to School Teachers. Number of acknowledgments of Infectious Diseases to Medical Men, &c. Number of Letters received. Number of Letters written. Number of letters sent to County Council Schools after disinfection of Pupils homes. Number of Visits made by Sanitary Inspectors to houses. Number of Visits made to Workshops and Factories. Visits made _ by Food Inspector. Number of Houses wherein Nuisances were abated. Number of Houses wherein Drainage Work has been carried out. Number of Disinfections. Number of Intimation Notices served. Number of Statutory Notices served. 1891 2059 .. .. 2059 .. 1330 .. 45059 17 .. 3382 177 1487 .. .. 1892 3478 .. .. 3478 .. 1617 .. 58786 57 .. 5001 293 2624 • • .. 1893 5187 .. .. 5187 2140 2050 .. 51861 34 .. .. 888 4197 .. .. 1894 3338 .. .. 3338 7444 2931 .. 75969 124 .. .. 1129 3202 .. .. 1895 3086 .. .. 3086 8409 3756 151 72382 40 .. 6309 1672 3039 6412 .. 1896 4149 .. .. 4149 8218 4600 147 67801 5996 .. 7077 1690 4540 6231 232 1897 3133 .. .. 3133 9062 4722 324 69098 6761 .. 6674 1728 3859 4862 573 1898 2571 .. .. 2571 8344 4039 978 70540 6882 .. 6011 1683 3391 5586 608 1899 3164 829 .. 3164 7160 3562 1650 64551 7233 4501 5505 1341 4051 5878 471 1900 2442 3066 .. 2442 6084 3311 1517 60936 7411 6086 5673 1095 3515 4544 316 1901 3054 3395 .. 3054 6486 3718 1690 58407 7371 - * 4461 843 3304 4432 328 1902 3447 2307 .. 3447 6872 5247 2092 63701 8060 4000 5827 1426 4464 3955 275 1903 2215 2298 .. 2215 6131 4409 1255 72140 7846 4889 6756 1711 2157 4363 372 1904 2068 2425 .. 2068 5738 3565 1319 68182 7463 4690 5411 1201 2587 5153 451 1905 2189 3397 .. 2189 5829 3518 1497 76418 7914 4955 7061 1132 2945 5464 630 1906 2550 4135 .. 2550 5911 3438 1774 83168 6980 6968 6004 1043 3220 5157 669 1907 2335 5829 .. 2335 6131 3358 1648 81628 10727 9938 6038 1259 3162 5847 518 1908 2483 4359 1943 2483 6318 4469 1914 8637I 11565 13148 6332 1346 3351 5624 789 1909 3228 4605 1924 3228 5880 4197 1852 76416 11476 11093 7276 990 3281 5757 709 1910 2860 6077 1249 2860 6433 4229 1208 77445 11004 11280 6919 1078 2870 5304 716 ' Meat Inspector left Borough service for an appointment under City Corporation, and the appointment was vacant some time. 885 [1910 BATHS AND WASHHOUSES. Table showing the Number of Persons using the Swimming Baths, Private Baths, and the Washhouses during 1910. Swimming Baths. Bathers. Caledonian Road. Hornsey Road. Essex Road. Total. Public. 1st class Males 10,571 37,498 15,435 63,504 Females 1,206 13,816 1,990 I7,OI2 '2nd class Males 19,114 23,877 18,629 61,620 Females 2,651 6,529 3,955 13,135 Schools. 1st class Boys ... 6,146 153 6,299 Girls ... 3,791 ... 3,791 2nd class Boys 40,664 44,027 52,568 137,259 Girls 24,022 26,962 22,637 73,621 Totals 98,228 162,646 115,367 376,241 Private (Slipper Baths.) 1st class Males 15,467 30,830 18,512 64,809 Females 1,164 4,601 2,245 8,010 2nd class Males 49,598 47,939 55,087 152,624 Females 15,966 22,025 24,307 62,298 Total 82,195 105,395 100,151 287,741 Washhouses. Washers 32,780 27,910 43,992 104,682 Total Persons using the Establishments. Total admissions at each establishment in 1910 213,203 295,951 259,510 768,664 386 1910] LOCAL GOVERNMENT BOARD RETURN.—TABLE I. Metropolitan Borough of Islington. VITAL STATISTICS OF WHOLE DISTRICT DURING 1910 AND PREVIOUS YEARS. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of NonResidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District Under 1 Year of Age. At all Ages. Number. Rate.* Number. Rate per 1,000 Births registered. Number. Death Rate.* Number. Death Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1900 335,892 9,254 27.5 1,344 145 5,767 17.2 1,542 599 553 5,721 17.0 1901 335,325 9,264 27.7 1,290 139 5,222 15.6 1,394 491 630 5,361 16.0 1902 334,035 9,214 27.0 1,219 132 5,530 16.5 1,541 632 737 5,635 16.5 1903 333.273 8,983 26.9 1,136 126 4,772 14.3 1,472 560 627 4,839 14 .5 1904 332,512 8,890 26.7 1,177 132 5,241 15.8 1,619 632 627 5,236 15.7 1905 331,753 8,756 26.4 1,032 118 4,902 14.8 1,528 566 619 4,955 14.9 1906 330,996 8,659 26.1 1,045 120 5,000 15.1 1,589 634 684 5,050 15.2 1907 330,241 8,531 25.8 943 110 4,987 15.1 1,675 593 685 5,079 15.4 1908 329,487 8,665 25.8 827 95 4,530 13.7 1,566 568 717 4,679 13.9 1909 328,735 8,198 24.9 805 98 4,782 14.5 1,673 634 770 4,918 14.9 Averages for yrs. 19001909. 332,172 8,841 26.6 1,082 122 5,073 15.3 1,560 591 665 5,147 15.5 1910 327.985 8,201 25.0 718 87 4,376 13.3 1,674 563 710 4,523 13.8 * Rates in Columns 4, 8 and 13 calculated per 1,000 of estimated population on the basis of Censuses 1901-1911. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths included in column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term " Residents" is meant persons who have been taken out ot the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institutions" taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. Area of District in acres (exclusive of area covered by water) 3.085 Total population at all ages, 327,423 Number of inhabited houses, 39,949! Average number of persons per house, 8 2 At Census of 1911 t Estimated from Rate Books. LOCAL GOVERNMENT BOARD RETURN—Table II. Metropolitan Borough of Islington. VITAL STATISTICS OF SEPARATE LOCALITIES IN 1910 AND PREVIOUS YEARS. Names of Localities Upper Holloway. Lower Holloway. Highbury. Barnsbury South-East. Year. * Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. •Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered Deaths at all Ages Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a b. c. d. a. b. c. d. a. b. c. d. 1900 99,071 2,699 1,635 375 41,618 1,170 738 181 62,092 1,551 932 186 55.445 1,782 1,004 265 77,666 2,052 1,412 337 1901 100,099 2,707 1,454 318 41,433 1,179 688 193 59,540 1,463 898 202 54,457 1,788 1,033 253 79,796 2,127 1,288 324 Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South-East. 1902 32,189 743 491 93 34,376 1,131 605 117 33,506 849 527 122 41,163 1,122 714 175 63,569 1,488 945 169 54,292 1,757 1040 266 74,940 2,122 1,313 277 1903 32,343 740 440 83 34,693 1,108 535 138 33,173 850 437 105 40,956 1,126 618 159 63,387 1,460 796 178 54,145 1,648 859 210 74,576 2,051 1,114 263 1904 32,497 799 571 113 35,010 1,066 523 98 32,840 815 475 104 40,749 1,114 693 180 63,206 1,423 775 140 53,998 1,672 963 237 74,212 2,ooi 1,236 268 1905 32,651 758 483 96 35,326 1,667 550 108 32,508 809 428 95 40,542 1,118 644 169 63,025 1,303 837 153 53,851 1,706 897 212 73,850 1,995 1,116 241 1906 32,804 746 432 91 35,641 1,061 542 111 32,177 747 425 95 40,336 1,118 721 173 62,844 1,348 779 128 53,705 1,679 967 232 73,489 1,960 1,184 253 1907 32,957 745 482 95 35,955 1,023 559 90 31,847 755 480 100 40,131 1,094 644 162 62,664 1,278 816 137 53,559 1,709 949 211 73,128 1,927 1,149 201 1908 33,110 816 425 66 36,269 1,027 485 76 31,517 728 396 85 39,926 1,067 571 134 62,484 1,416 816 143 53,413 1,625 885 193 72,768 1,986 1,101 197 1909 33,262 759 440 81 36,582 993 558 77 31,188 705 430 68 39,721 1,084 617 110 62,305 1,301 793 121 53,268 1,493 872 166 72,409 1,863 1,208 218 Averages 1 1902-9 32,727 763 470 90 35,481 1059 545 102 32,345 782 450 97 40,441 1,105 653 158 62,935 1,377 820 146 53,779 i,661 934 216 73,671 1,988 1,177 240 1910 33.414 741 424 58 36,894 985 535 87 30,860 724 392 64 39,517 1,050 599 114 62,126 1,271 759 105 53,123 1,545 802 1 71 72,051 1,885 1,012 178 Notes.—(a) The separate localities adopted for this Table are registration sub-districts. (ib) Deaths of residents occurring in public institutions beyond the district are included in sub-columns c of this Table, and those of non-residents registered in public institutions in the district excluded. (c) Deaths of residents occurring in public institutions whether within or without the district are allotted to the respective localities, accoiding to the addresses of the deceased. (rf) Care is taken that the gross totals of the several columns in this Table respectively equal the corresponding totals for the whole districts in Tables I. and IV. : thus, the totals ot subcolumns a, b. and c agree with the figures for the year in the columns 2, 3, and 12 respectively of Table I : the gross total of the sub columns c agree with the total of column 2 in Table IV , and the gross total of sub-columns d with the total of column 3 in Table IV. * Estimated populations, 1902-9, are based upon figures of Censuses 1901 and 1911. 337 1910 LOCAL GOVERNMENT BOARD RETURN.—TABLE III. Cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year 1910. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Tufnell. Upper l.olloway Tollington. Lower Holloway Highbury. Barnsbury. South-East Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South-East. Total cases removed to Hospital. Small-pox 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 471 10 189 219 27 26 .. 49 94 63 32 48 109 76 46 89 58 27 42 110 66 438 Erysipelas 212 6 5 18 20 144 19 19 17 24 33 25 38 56 2 5 4 7 3 10 10 41 Scarlet Fever 730 2 211 434 45 38 83 121 76 91 114 117 128 76 118 72 86 102 112 124 690 Typhus Fever 1 .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 Enteric Fever 89 .. 5 15 25 42 2 7 13 5 13 9 26 16 5 9 3 12 5 20 11 65 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 Puerperal Fever 20 .. .. .. 7 13 2 4 1 3 3 4 3 1 3 1 1 1 2 1 10 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1525 18 410 686 126 264 21 160 249 171 172 199 295 279 130 224 140 133 153 255 212 1,247 888 1910] LOCAL GOVERNMENT BOARD RETURN.—TABLE IV Metropolitan Borough of Islington. CAUSES OF, AND AGES AT DEATH DURING YEAR, 1910. Causes of Death. Deaths of Residents at subjoined Ages, whether occurring in or beyond the District. Deaths of Residents (at all Ages) belonging to Localities whether occurring in or beyond the District. Total Deaths in Public Institutions in the District, whether Residents or Non-residents. All ages. Under 1 yr 1 and under 6. 5 and under 15. 15 and under 26. 26 and under 66. 65 and upwards Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South-East Islington. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 166 21 131 14 .. .. .. 10 11 24 .. 16 43 26 51 Scarlet Fever 11 .. 7 4 .. .. .. 1 2 2 2 4 .. 3 Whooping Cough 124 64 57 3 .. .. .. 11 17 12 20 22 27 15 24 Diphtheria and Mem branous Croup 34 1 22 10 1 .. .. 2 8 2 2 3 10 7 4 Croup 1 .. .. .. 1 .. .. .. .. .. .. .. 1 .. 1 Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 17 .. .. 1 1 13 2 2 7 .. 2 1 3 2 1 Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 36 2 .. .. 2 15 17 4 6 5 3 9 4 5 6 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 76 33 31 .. .. 7 5 7 10 6 l6 6 19 12 34 Enteritis 54 38 9 1 .. 2 4 3 5 2 11 8 11 14 13 Gastritis 27 15 .. 1 .. 5 6 3 4 2 3 3 5 7 10 Puerperal Fever 8 .. .. .. 1 7 .. 1 1 1 .. 1 2 2 5 Erysipelas 9 3 .. .. 1 5 .. .. .. .. 2 1 4 2 11 Phthisis (Pulmonary Tuberculosis) 390 3 8 8 56 294 21 37 52 29 45 67 60 100 225 Other Tuberculous Diseases 149 43 50 20 7 23 6 12 13 10 22 25 33 34 33 Cancer, Malignant Disease 361 .. 2 1 5 218 135 38 46 29 46 76 58 68 156 Bronchitis 390 50 25 2 .. 96 217 39 35 30 44 49 81 112 145 Pneumonia 429 110 112 9 6 132 60 44 31 39 67 70 71 107 94 Pleurisy 17 1 .. 1 1 11 3 1 1 2 2 4 2 5 5 Other Diseases of Respiratory Organs 33 .. 2 .. .. 18 13 5 5 5 3 6 2 7 13 Alcoholism Cirrhosis of Liver) 51 .. .. .. .. 41 10 7 4 5 7 5 9 14 4 Venereal Diseases 15 8 .. 1 .. 3 3 3 1 .. .. 5 .. 6 11 Premature Birth 122 121 1 .. .. .. .. 7 14 11 17 18 28 27 .. Diseases and Accidents of Parturition 17 2 .. .. 1 12 2 2 3 1 1 1 5 4 6 Heart Diseases 645 8 2 15 14 308 298 72 86 56 74 136 94 127 246 Accidents 138 39 11 11 5 48 24 11 9 12 24 20 24 38 33 Suicides 48 .. .. 2 43 3 5 5 1 7 7 9 14 4 Homicides 6 2 2 .. .. 1 1 1 1 .. .. 1 3 .. 1 Executions 2 .. .. .. .. 2 .. 1 .. .. .. .. .. 1 3 All other causes 1147 213 43 48 42 358 443 95 158 108 143 197 190 256 158 All causes 4523 777 515 150 I46 1662 1273 424 535 392 599 759 802 1012 1300 889 [1911 LOCAL GOVERNMENT BOARD RETURN.—Table V. Metropolitan Borough of Islington. INFANTILE MORTALITY DURING THE YEAR 1910. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1.2 Weeks. 2 3 Weeks. 3-4 Weeks. Total Deaths under One Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5 6 Months. 6 7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. All Causes Certified 163 45 41 29 278 69 62 42 6l 41 31 30 45 38 43 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Common Infectious Diseases. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. 2 2 6 6 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Whooping Cough .. .. .. .. .. 5 6 3 4 5 10 .. 6 6 12 Diarrhœal Diseases. Diarrhœa, all forms .. 1 1 1 3 1 .. 3 4 3 1 6 3 4 2 Enteritis, Muco-enteritis, Gastroenteritis .. .. 1 .. 1 4 7 2 9 2 .. .. 4 3 4 Gastritis, Gastro-intestinal Catarrh .. .. 2 1 3 3 4 2 1 .. 1 1 .. .. .. Wasting Diseases Premature Birth 81 15 5 8 109 7 2 1 .. 1 .. .. .. .. 1 Congenital Defects 27 6 4 1 38 1 1 .. 2 2 .. 1 .. 1 .. Injury at Birth 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. Want of Breast-milk, Starvation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus 21 7 9 3 42 9 11 7 9 5 2 2 2 1 2 Tuberculous Diseases. Tuberculous Meningitis 1 .. 2 .. 3 2 4 .. 2 1 1 1 2 .. 3 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. 1 1 .. 5 2 2 1 2 .. 1 .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. 1 1 1 .. 2 1 1 1 Other causes. Erysipelas .. .. .. .. .. .. 1 .. 1 .. 1 .. .. .. Syphilis .. .. 2 2 4 2 .. 1 .. .. .. .. .. 1 .. Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) 2 1 .. .. 3 2 .. .. 1 1 1 .. 3 1 .. Convulsions 5 6 2 2 15 2 2 .. 1 .. 1 .. .. 1 .. Bronchitis 1 4 5 3 13 9 3 3 2 5 i 2 5 4 1 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 2 2 4 2 10 12 8 7 10 13 7 8 11 5 8 Suffocation, overlying 5 .. .. 2 7 4 6 2 6 .. 1 .. .. .. .. Other Causes 15 3 4 3 25 6 2 5 6 1 2 5 5 4 2 Totals 163 45 41 29 278 69 62 42 61 41 31 30 45 38 43 Births in the year legitimate 7,961 illegitimate 240 Deaths in the year of legitimate infants 740 illegitimate infants 37 Populatioi Estimated to midd 327.985- Deaths from all Causes at all Ages 4.523 340 1910] LONDON COUNTY COUNCIL RETURN. Borough of Islington. PROCEEDINGS DURING 1910. PREMISES. Number of Places— On Register at end of 1909. Added in 1910. Removed in 1910. On Register at end of 1910. Number of inspections, 1910. Number of Notices. 1910. Number of Prosecutions 1910. Milk premises 587 46 68 565 2113 299 1 Cowsheds 7 ... 2 5 64 ... Nil Slaughter-houses 34 ... 2 32 1770 ... ,, Other offensive trade premises 7 ... 1 6 96 ... ,, Ice cream premises 230 25 20 235 136 15 ,, Registered houses let in lodgings + + • • • ... ... ... 11080 (a)* 138 (b)f 814 (a)* Nil (b) † 1 * (a) For overcrowding. † (4) For other conditions. † No Register now kept unaer new By-Laws. Total number of intimation notices served for all purposes 5443 Overcrowding, 1910. Number of dwelling rooms overcrowded 198 Number remedied 198 Number of prosecutions I Underground rooms— Illegal occupation dealt with during year 39 Number of rooms closed 39 Number of prosecutions 1 Insanitary houses— Number closed under the Public Health (London) Act, 1891 Nil Number closed under the Housing of the Working Classes Acts — Number of premises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 188 341 [1910 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 14 Revenue Acts— Number of houses for which applications were received during year 452 Number of tenements comprised therein 581 Number of tenements for which certificates were (a) granted 371 (b) refused 147 (c) deferred nil Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. (6) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health (d) As to paving of yards, etc., of dwelling houses- (e) In connection with the removal of offensive matter, etc.— (f) As to cesspools and privies, removal and disposal of refuse, etc. (g) For securing the cleanliness of tanks, cisterns, etc. (h) With respect to water closets, earth closets, etc. (i) With respect to sufficiency of water supply to water closets (j) With respect to drainage, etc. (Metropolis Management Act, section 202) 3 (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 2 Number of prosecutions under L.C.C. General Powers Act, 1907— (I) With respect to Water Supply to Tenement Houses 2 Mortuaries— Total number of bodies removed 609 Total number of infectious bodies removed 2 The Metropolitan Borough of Islington. REPORT on The Free Distribution of Antitoxin Serum for the Treatment of Diphtheria Among the Poorer Inhabitants of the Borough. BY ALFRED EDWIN HARRIS, Medical Officer of Health. (Printed by Order of the Public Health Committee, December 19th, 1910.) LONDON: Vail 8Co., Printers to the Council, 170, Farringdon Road, E.C. The Antitoxin Treatment of Diphtheria. To the Chairman and Members of the Public Health Committee. Gentlemen, Herewith I forward you a copy of the Local Government Board's Diphtheria Antitoxin (London) Order dated August 15th, 1910, in which the Board sanction the provision of a temporary supply of antitoxin for the poorer inhabitants of a metropolitan borough. In the Board's letter covering the Order it is pointed out that the free provision of diphtheria antitoxin which is authorised by the Order must not be regarded as a substitute for removal to hospital of a patient suffering from diphtheria, unless means are available for his efficient isolation at home, but rather that the antitoxin treatment should be applied at the very earliest moment after the disease had been recognised or suspected, so that its severity might be decreased, and its fatality prevented. The supply of antitoxin by a local authority for the treatment ot diphtheria was, so far as I know, first suggested by myself; and, indeed, some twelve years ago, the question was considered by the Public Health Committee of that time, and a report as to the efficacy of the serum was presented to them by me. As that report deals with the success of such treatment so far as then known, it is now given so that a comparison may be made between it and that which has obtained in later years, which will be discussed further on. That report which I made to the Public Health Committee is dated December 19th, 1898, so that exactly to the very day you are considering a similar question to that considered by your predecessors twelve years later. It is as follows.— "The antitoxin treatment of diphtheria has now been generally acknowledged throughout the civilized world, and especially throughout Europe, to have been a most complete success. "This treatment was first undertaken in the year 1891, but it was not until three years later (1894) that a serum sufficiently strong was obtained to produce marked results. "Since 1894 antitoxin has been tried with the most unmistakable and happy results in the diphtheria wards of the continental hospitals; and since 1895 in those of the Metropolitan Asylums Board, in which it has also been successful. 3 "A few figures to prove these statements will be of interest. "Professor Welch shows in a Paper published in the ' Transactions of American Physicians ' that he collected 82 hospital reports dealing with a total of 7,000 cases treated with antitoxin, among whom the average fatality was only 17'3 per cent., and that in 45 of these reports the previous or simultaneous fatality had averaged 42T per cent. "In Berlin, Baginsky reported 525 cases of diphtheria in children treated in the Kaiser and Kaiserin Friedrich's Hospital for Children between March 15th, 1894, and March 15th, 1895, with a fatality of only 15.0 per cent. Right in the middle of this period (August and September) the supply of antitoxin failed, and at once the mortality rose higher than it had been before the new treatment was introduced, namely, to 48.4 per cent. "A similar depletion of the stocks in hospitals situated so widely apart as Prague, Vienna and Trieste caused similar involuntary experiments, with the result that the fatality, which had fallen during the periods of antitoxin treatment to 12.7, 22.0 and 18.7 per cent. respectively, rose again during the interval in which no antitoxin could be procured to 53.0, 65.6 and 50.0 per cent. "In the Charite Hospital for Children in Berlin, previous to the serum treatment being introduced in 1894, the fatality among the little patients had been 53.6 per cent., but from that date to the end of 1897 it was only 15.9, which is equal to a saving of an additional 377 in every 1,000 patients treated. "In all the Berlin Hospitals from 1886 to 1893 (inclusive) 14,522 persons were treated for diphtheria, of whom 5,408 died, or 37.3 per cent. From the latter date, when the antitoxin treatment began, to the end of 1897 there were 10,026 patients under treatment, of whom 1,823 died, or 18.2 per cent. Consequently there was a saving of 191 additional lives in every 1,000 treated. "In the Metropolitan Asylums Board's hospitals during the three years 1892-3-4 the fatality averaged 25.6 per cent., while in the succeeding three years it was only 16.7 per cent., or a saving of 89 lives in every 1,000 treated. "The following are the figures as given in 'The Lancet' of the 10th instant * by Dr. E. W. Goodall:— 1892 24.8 per cent. 1893 27.1 „ 1894 25.0 „ 1895 18.3 „ 1896 17.7 „ 1897 14.9 „ *Dec. 10th, 1898. 4 "Let me illustrate what this means by an example. In the three years 1892-3-4 I find that there were 8,523 persons admitted into the Board's hospitals, among whom the mortality averaged 25.6 per cent., so that there were 2,181 deaths. "If the antitoxin treatment had been used at this period it is fair to assume that the fatality (16.7) which obtained in the years 1895-7 would also have obtained then, and consequently the number of deaths, instead of being 2,181, would have been only 1,423. Thus there would have been a saving of 758 persons from death. "These are strong arguments in favour of the antitoxin treatment in hospitals. "The saving of life would, moreover, have been still greater if only all the cases were treated by antitoxin at the earliest possible moment of the attack. This has been clearly proved by the statistics of all hospitals, home and foreign alike. "Hence the anxiety of the Metropolitan Asylums Board, that, where delay arises in the admission of the cases to their hospitals, practitioners should be in a position to obtain a supply of antitoxin, and therefore the Board is prepared to supply it. "A word as to the cases treated at home. These have invariably shown a lesser fatality than those which are treated in hospital, firstly because they are, as a rule, of a milder type—only the graver cases going to hospital—and secondly because they include cases of mistaken diagnosis. "Now the home fatality in London in three years (1892-3-4) was 215, 23.7 and 24.5, or an average of 23.2 per cent., whereas in the next three, or antitoxin, years (1895-6-7) it was 23.3, 2T3 and 201, or an average of 21.6 per cent. In other words, whereas 232 out of every 1,000 cases died in the former period, 216 died in the latter, indicating a saving of only 16 lives. The fact is that the treatment is not generally available for the home patients, and is not pursued. The cause of this is that the general practitioner is not placed in a similarly fortunate position to the hospital physician, who has the remedy always at hand. "I have, therefore, been approached on this matter by Dr. J. G. Glover, one of the elected representatives of the Medical Profession on the Medical Council of the United Kingdom, who has suggested that the Vestry, as the Public Health Authority, might keep a stock of serum at my office. Also that it should be on sale to any member of the medical profession who required it for the treatment of Islington patients. He attributes a great deal of the home mortality which takes place in London and the country to the difficulty of obtaining supplies of antitoxin. 5 "It is fortunately a remedy that is not required every day by practitioners, and unfortunately one that does not ' keep well.'* Consequently, if stored by them and not used quickly, it would deteriorate and might fail in its effect at the critical moment—to the sacrifice of a life. "I am entirely in sympathy with Dr. Glover's suggestion, because practitioners find it difficult to get the serum at a moment's notice without sending far afield, and at a time, too, when moments are precious. "It is an entirely new departure which I advocate, but one which I trust will be practised shortly by every public health authority in the country, whose duties and responsibilities do not begin and end with that which is written in Acts of Parliament." The above report, it will be seen, deals only with the treatment of Diphtheria with antitoxin when such treatment was in its infancy. Since then twelve years have passed, and it has now reached its maturity. Nevertheless, in those days I had full confidence in its efficacy, and did not hesitate to advise that a supply of the serum should be available in times of emergency for the medical profession. Now that the curative powers of antitoxin have been thoroughly tested, it will be well to consider what it has effected since 1897; and happily very full figures are available, thanks chiefly to the Metropolitan Asylums Board and to some other institutions which have kept records of their work. In 1897 the mortality in the Hospitals of the Metropolitan Asylums Board fell from the average of 30.4 per cent. which obtained in the four years 1890-93 to 24'3 per cent. In 1898 it was 17.5 per cent.; in 1899, 15.4; in 1900, 12.9; in 1901, 12.6; in 1902, 10.2; in 1904, 10.9; in 1905, 9.0; in 1906, 10 4; in 1907, 10 4; in 1908, 10.9, and in 1909, 9.7 per cent. Thus we see that there has been practically a steady fall in each year. The figures in the later years indicate that the mortality has now reached a fairly uniform percentage. Let us see what this means. Vide Chart B. In 1908, 5,247 cases of Diphtheria were treated with antitoxin in the Metropolitan Asylums Board's Hospitals, and of these 507 died. Now if this serum had not been used, it is fair to infer that the fatality would have been the same as in the pre-antitoxin years, namely, 30.4 per cent., so that it may safely be inferred that instead of 507 deaths, the actual number which occurred, there would have been 1,595 deaths; consequently the saving of 1,090 lives may fairly be ascribed to the administration of the serum. When we examine the records of the severest cases of Diphtheria, that is to say those in which it became necessary to resort to tracheotomy so as to give the patients even a remote chance of living, we find the figures equally convincing, for we discover that the fatality has been reduced from an average of * Antitoxin serum is now made which is guaranteed to keep for two years. 6 66.2 per cent. in the four years 1890-93 to 30.7 per cent. in 1909, from which we may inter that if no antitoxin had been administered, the deaths in 1909, instead of being 110, the actual number, would have been 248. We may take it, therefore, that there has been a saving of 138 lives. Vide Chart C. Last year (1909) Professor Kroenlein, Professor of Surgery at the University of Zurich, requested his senior Surgeon, Dr. Ph. Schoenhozer, to examine the records and report on the cases of Diphtheria treated at his clinique during a period of twenty-eight years. As in 14 of these years the old methods had been practised and in 14 the modern antitoxin treatment, a comparison of therapeutic results is possible. In the pre-antitoxin period (1881-1894) it was found that out of 1,336 patients, 534, or 40 per cent., succumbed to the disease, whereas in the antitoxin period, out of 1,986 patients registered from 1884 to 1906, only 266, or 13.4 per cent. died. Of the tracheotomy cases 66 per cent. died in the pre-antitoxin period, and only 14 per cent. died under the antitoxin regime.* Doctors Mackay and O'Brien have reported that in 1908, at the Fairheld Infectious Diseases Hospital, Melbourne,† to which they were attached, the.e were only 23 deaths among 404 patients treated with anti-toxin, or a fatality of 5'7 per cent.; or excluding patients dying within 24 hours of admission, only 16 deaths, or a fatality of 4 per cent. They also state that at the Coast Hospital, Sydney, in 1907, there were only 23 deaths among 350 cases, or a fatality of 6.6 per cent.; and that in Perth Public Hospital in the same year there were only 18 deaths among 249 cases, or a fatality of 7.6 per cent. These figures are very forcibly supported by the results obtained in the Metropolitan Asylums Board Hospitals. It would be interesting, if the figures were available, but they are not, to analyse the results of the antitoxin treatment of Islington patients. Fortunately, however, the number of notifications and deaths are, and they are set out in Appendix A. The figures show that in the three pre-antitoxin years, 1891-93, there were 2,379 separate cases notified, of which 548, or 23.0 died, whereas in the succeeding seven years (1894-1900) there were 5,151 cases, of which 1,077 died or 20.9 per cent. During this period the fatality ranged from 25T per cent. to 16.7 per cent., and it is a noticeable fact that in each successive year the percentage of deaths decreased. In the following nine "years 1901-1909, when antitoxin treatment was much more fully adopted, there were 4,822 cases and 508 deaths, or 10'5 per cent.; while the fatality ranged from 14.7 per cent. in 1901 to 7.2 per cent in 1909. When all the figures I have quoted are taken collectively, it cannot be doubted that a very strong case is made out for the antitoxin treatment. There is another factor in the antitoxin treatment which is of the very greatest importance, namely, that the earlier the treatment is adopted the more certain is the cure of the patient. * Lancet, May 15th, 1909. † lntercolonial Medical Journal of Australasia, February 20th, 1909. 7 Here again the figures published by the Metropolitan Asylums Board and those obtained from other sources singularly agree. I give the figures for 1908. Out of 202 cases treated on the 1st day there were 6 deaths (3.0%) „ 1076 „ 2nd „ 70 (6.5%) „ 1182 „ 3rd „ 125 (10.6%) „ 822 „ 4th „ 106 (12.9%) „ 1249 „ 5th and upwards 185 (14.8%) The experience of Drs. Mackay and O'Brien at the fairfield Infectious Diseases Hospital, Melbourne, is much the same, for they found that in those cases receiving antitoxin in the first 24 hours the fatality was nil, in those receiving it on the second day it was 4 2 per cent., and in those receiving it on the fourth day 16.7 per cent.* It was no doubt because of these and similar results in other places that the Local Government Board issued their Order, so that the poor as well as the wealthy might receive the antitoxin treatment at the very earliest moment, for early treatment means, almost to a certainty, life, whereas delay means considerable danger, if not death. The great lesson these figures teach is that the treatment should be commenced the moment Diphtheria is suspected, and even before the diagnosis is positive, and certainly before the result of a bacteriological examination has been obtained. Since the above portion of this report was written, I have seen in the last issued number of "The Lancet"†, a brief account of what is being done in Chicago, which accentuates what I have said. The Health Department of that great city have just issued an appeal to its inhabitants to assist in the prevention of Diphtheria, in which they claim that during the last 14 years in which antitoxin has been supplied, the death-rate from it has only amounted to 36 per 100,000 of the population, whereas before its introduction it was 136. Nevertheless, they are not satisfied with the result, for they maintain that there should be practically no deaths from this disease, as antitoxin, if given in proper doses and at the proper time, will cure Diphtheria, while if given in immunising doses it would prevent its development if taken in time by those exposed to infection. In order that the remedy may be readily obtainable, they have opened no less than 28 free antitoxin stations in various parts of the city so that it may be close at hand and gratuitous to everybody ; consequently they say that if lives are lost, it is simply because the persons concerned do not avail themselves of these advantages. The Health Department of Chicago further state that according to the experience acquired during the last 14 years, recovery is certain if antitoxin *The Intercolonial Medical Journal of Australasia, February 20th, 1909 †December 17th, 1910. 8 is given the first day the disease is manifest, and that if the treatment be delayed until the second day, the patients in nearly all cases will be saved, while even on the third day most children will recover, but that if not given before the fourth day there will be many deaths. After the fourth day antitoxin does little or no good. They also assert that when antitoxin is given the first day, 2,000 units generally suffice for a dose ; that on the third day 5,000 units are required and that on and after the fourth day 10,000 units are rarely of any service. A further fact has also come to my knowledge. It appears that in April of the present year, the Health Authorities of Newcastle-on-Tyne, on the advice of their Medical Officer of Health, Dr. H. E. Armstrong, resolved on public grounds to supply antitoxin free of charge to all the medical practitioners in their city, in order to avoid the least possible delay in its administration to suspected cases of Diphtheria. This arrangement was to last for six months. On the completion of that period, Dr. Armstrong reported that the experiment had proved highly satisfactory; that the medical men had taken very full advantage of the offer, and that almost all cases, except those which had been removed to hospital before the private practitioner could re-visit, were inoculated with the serum before removal. The method of distribution was as follows:—Each general practitioner on request receives two or three phials, according to his requirements, and immediately on his sending an inoculated case to hospital, or on his request, a further supply is forwarded. The Medical Officer of Health communicated personally with those practitioners who at first neglected to apply for the antitoxin, all of whom at once acted on his suggestions. Although the period under report is too short to allow any definite conclusions to be arrived at, nevertheless, the mortality among the hospital cases was 1.2 per cent. lower than during the preceding 12 months, and the proportion of cases requiring tracheotomy was less than half that of the preceding year. As regards cost, two-thirds of the persons inoculated were sent to hospital, so saving expenditure of antitoxin there, while of the remaining third a considerable proportion were not patients, but receiver1 the remedy as a preventative. The scheme appears to have succeeeded so well in promoting an early and general use of antitoxin in Newcastle that the Sanitary Committee have now decided that the free use of the serum to all the medical practitioners is to be continued in that city. This statement, which appeared in one of the health Journals,* has been confirmed by a letter to myself from Dr. Armstrong. Here, then, are examples which the British people might well follow, because without doubt the result must be that Diphtheria will be practically expunged as a fatal disease from our registers. * The " Medical Officer," Nov. 17, 1910. 9 In all these circumstances I have no hesitation in recommending that a supply of antitoxin be kept at the Town Hall, where it could be obtained during the day, and that another supply should be kept at the Great Northern Hospital where Mr. Glenton-Kerr, the Secretary, assures me they will be pleased to store it, if supplied to them, for the use of medical men requiring it during the night, and for that matter during the day, for it would save the practitioners in the north of the borough the long journey to the Town Hall. If you entertain these proposals, as I am certain you will, a circular letter will be sent, together with a copy of this report, to each of the medical men practising in Islington, so that they may fully understand the reasons which have induced you to keep the supply, the cost of which will be probably about £30 per annum. The results must be beneficial, and I anticipate that in the course of time the fatality from this dreadful disease, which is now fairly stationary at 10 per cent., will be reduced to at least 5 per cent., if not less, if the remedy be (???) used, an achievement which would redound still further to the credit of the modern scientific method of the treatment of the disease. I am, Your faithful servant, Medical Officer of Health. Town Hall. Islington, N. 19th December, 1910. 10 APPENDIX "A." Fatality from Diphtheria in Islington, 1891-1909. Year. Cases. Deaths. Fatality. 1891 756 178 23.5 Pre-Antitoxin Period. 1892 738 170 23.0 23.0 per cent. 1893 865 200 22.6 1894 867 218 25.1 Antitoxin Periods. 1895 582 144 24.7 1896 1091 257 23.5 1897 729 131 18.0 20.9 per cent. 1898 544 93 17.1 1899 705 128 18.2 1900 633 106 16.7 1901 911 134 14.7 1902 878 104 11.8 1903 455 43 9.4 1904 347 28 8.1 1905 351 34 9.7 10.5 per cent. 1900 439 32 7.3 1907 481 42 8.7 1908 530 60 11.3 1909 430 31 7.2 CHARTS showing the mortality rates amongst Diphtheria patients at the Metropolitan Asylums Board's Hospitals, before and after the introduction of the Antitoxin treatment of Diphtheria.