(ISL 59 1911, FIFTY-SIXTH 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 Koad, E C, 1912, MEMBERS OF THE PUBLIC HEALTH COMMITTEE, (November, 1910, to November, 1911,) Mayor, Alderman GEORGE SAMUEL ELLIOTT, J,P, A Idermen, CHARLES CROLE-REES WM, EDWIN MANCHESTER ROBERT STEPHENS CUFFLIN Councillors, Ward, Ward, 1, ROBERT JAMES GANN 6, WM, MASON BRADBEAR 1, REUBEN LOOMES 7, ALEXANDER C, COLEMAN 2, HAROLD E, BUTCHER 7, HENRY MILLS, J,P 2, ROBERT WM, HILL 9, WM, THORESBY COOKSEY, J,I 3, WILLIAM J SMITH 9, WM, JOHN MERRINGTON 4, FRANK HALLAM 10, FRANCIS BANNING 5, THOS, LUKE HARWOOD 11, WALTER E, MAKKHAM Chairman Councillor THOMAS LUKE HARWOOD Vice-Chairman Councillor WM, J, SMITH OFFICERS OF THE public health Department Medical Ojficer of Health, ALFRED EDWIN HARRIS, L,R,C,S,, L,R,C,P,Edin, Public Analyst, FRANK LITHERLAND TEED, D,Sc,, F,I,C,, F,C,S, Solicitor, ARrHUR MELLOR BRAMALL, Superintendent of Public Health Department 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, ANNIE CATHERINE YOUNG, Cert, Sanit, Insp, Ex, Bd, MARIAN GWYNETH PARKER DAVIE3, 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 BURRELL, Cert, Sanit, Inst, Inspectors of Nuisances and Sanitary Inspectors, District 1 WILLIAM COOK, Cert, Sanit, Inst „ 2 HARRY JAMES BICKNEI,L, Cert, Sanit, Inst, „ 3 ALLEN BAGSHAW, Cert, Sanit, Inst, „ 4 GEORGE JAMES BRIDEL, Cert, Sanit, Insp, Ex, Bd „ 6 WILLIAM HOLSGROVE FLOOD, Cert, Sanit, Inst, „ 6 CHARLES EDWIN HORSMAN, Cert, Sanit, Inst, „ 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 CHARLES EDWARD LEWIS CANHAM, Cert, Sanit, Insp, Ex, Bd, „ 13 THOMAS WALLACE AGAR, Cert, Sanit, Inst, „ 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 Third Clerk GEORGE JAMES ELDRIDGE, Fourth Clerk EDWARD ALBERT ABBOTT, Fifth Clerk WALTER JOSEPH WOLFE, Sixth Clerk WILLIAM GEORGE BUNCH, Seventh Clerk ARTHUR ROBERT WITTRICIC, Junior Clerk CLEMENT MARSTONE WHEBLE Messenger, ALBERT EDWARD BOUKER, IV, INDEX, Page Adulteration of Food 309 Ages at Death 45 Alcoholism 128 Analyst's quarterly reports 321-327 Annual Birth and Death rates, and Death-rates of Children 341 Appendicitis 103 Area of Borough 19 Artizans' and other Dwellings 284 Bacteriological Diagnoses 20 Bakehouses 241-246 Baths and Washhouses 355 Births 27 „ in Decennial periods from 1841 343 „ notification of 31 Butcher's Shops and Shops where food is sold 297 Butchers' open window stalls 297 Butter and Margarine 317 Cancer 107,114 Chicken Pox 192 Common Lodging Houses 283 Constitutional Diseases 106, 124 Continued Fever 91, 158 Cow Houses 301 Deaths 37 ,, from Classified Causes 55 ,, at different age periods 39 45, 48, 52 in the Quarters 47 ,, „ Sub-Districts 46 „ „ Wards 49 „ „ Encircling Boroughs 96, 97 „ from Epidemic Diseases 72-98 Deaths registered from all causes during the Year 334 Deaths registered from all causes in each Quarter 337 Deaths in Decennial periods from 1841 345 Deaths in Public Institutions 130 Death-rates of Populous Towns 57 Density nl Population 20 Diabetes Mellitus 122 Diarrhoea 91 Diphtheria 87 ,, Notification of 149 ,, Fatality from 148 Diphtheria and Croup 151 Disinfectants distributed and used 233 Disinfecting Station 232 Disinfection Work 230 District Inspection 268 Dust, removal of 279 Enteric Fever 90 ,, Notification of 153 „ Fatality from 153 Epidemic Diseases 72-98 ,, Cerebro-Spinal Meningitis 182 Erysipelas 104 ,, Notification 155 ,, Fatality from 155 V, Pag* Factories and Workshops 238 Facts about Tuberculosis 179 Fatality from Infectious Diseases 142, 199 Food, Adulteration of 309 Informal sampling of 328 Food Inspection 294 Health Visitors 32, 116 Hospital Isolation of Infectious Diseases 198-200 Houses Let in Lodgings 26-5 House to House Inspections 269 Housing, Town Planning, &c,, Act, 1909 287 Ice Creams 308 Illegitimate Births 30, 344 ,, ,, in Decennial periods from 1841 344 Infantile Mortality 58-72 „ in Decennial periods from 1841 346 Infectious Diseases on Business Premises 201 Infectious Diseases in Streets 207 „ „ in Schools 189 „ „ (Non-notifiable) in Schools 192, 197 Infectious Sickness in the several Wards from 1891 348, 353 „ „ in Quinquennial periods from 1891 347 Informal Sampling of Foods 328 Influenza 99 Inspection of Food 294 „ Kitchens of Restaurants 247, 258 „ Slaughter Houses and Cow Houses 298-307 ,, Houses let in Lodgings 265 Inquests 138 Isolation of Infectious Diseases 198 Local Government Board Returns 356-360 London County Council Return of Sanitary Work 361-362 Margarine Act 317 Marriages 24 Measles 81 „ Notification of 192-194 Meat Inspection 294 Midwives attending Disinfecting Station 234 Milkshops, Registered 307 Milk, Quality of 312 Milkshops and Dairies 307 Mortality in Sub-Registration Districts 46 Mortuary and Coroner's Court 138 Notification of Infectious Diseases 140, 159, 160 M „ „ „ in Registration Sub-Districts 140,161,162 „ „ „ „ in the Sanitary Inspectors' Districts 165 „ „ „ ,, in the Wards 141, 163, 164 „ ,, „ n during the several Months 166 „ „ » ii in the Encircling Boroughs 167, 168 „ „ „ ,i in Metropolitan Boroughs 169, 170 „ „ Phthisis 174 ,, ,, Births Act 31 Non-notifiable Infectious Diseases in Schools 192, 197 Occupation of persons attacked with Infectious Disease 201 Offensive Trades 307 Ophthalmia Neonatorum 132 Other Notifiable Diseases 171 vi, Page Outworkers' Premises 246, 254 Pauperism 281 Persons to an Acre 20 Phthisis 119 „ Notification of 174 „ Sanatoria Accommodation 360 „ Voluntary Notification of 181 Places where Food is prepared 247 Pneumonia 125 Population—Estimated in 1911 3 ,, at Censuses 1901 and 1911 13,17 „ in Sub-Districts 18-20 „ and Density of Wards 21 Population, Inhabited Houses, Marriages, Births, and Deaths 340 Prosecutions, Summary of 331 Puerperal Septic Diseases 104 Puerperal Fever 105 „ „ Notification of 157 „ „ Fatality from 157 Polio-myelitis and Polio-encephalitis 188 Pulmonary Tuberculosis 119 Registered Lodging Houses 265 Regulations, Tuberculosis 174 Respiratory Diseases 124 Restaurant Kitchens 247, 258 Samples analysed in 1911 319 Sanitary Inspectors' Work 268 Scarlet Fever 85 „ Notification ot 145 „ Fatality from 147 Seasonal Mortality 47 Septic Diseases 103 Shelter House 234 Slaughter Houses 298 Small Pox 81 „ Notification of 144 Smoke Nuisances 272 Street Markets 295 Streets where Infectious Diseases occurred 207-219 Summary of Sanitary Work in fourteen Districts 275 Summary of Applications for Removal of Dust 279 Trades carried on in Houses where Infectious Diseases have occurred 205 Tubercular Diseases 115-122 Tuberculosis, Final Report of Royal Commission 117 „ Pulmonary, Notification of 174 Typhus Fever 91, 155 Unsound Food 294 Unsound Fish 295 Vaccination 221-229 Venereal Diseases 129 Verminous Persons 234 Water Certificates 271 Water Supply 332 ,, to Tenement Houses 275 Whooping Cough 88, 192 Workshops and Factories, Inspection of 238 Work of Public Health Department, Summary of 354 REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1911, To the Worshipful the Mayor, Aldermen and Councillors of the Borough of Islington, Mr, Mayor, Madam and Gentlemen, It affords me great pleasure, in submitting my Report on the Health and Sanitary condition of your Borough during 1911, to state that, judged by its mortality and sickness, it was in a very satisfactory state, It is true that the death-rate of 14 9 per 1,000 was not the lowest on record, but it was nevertheless, with three exceptions, the lowest in a hundred years, It must also be considered very good because, owing to the changes that have occurred in the age and sex distribution of the population during the last 20 years, as shown by the Census Returns, the death-rate has been adversely affected to the extent of 10 per 1,000 of the population per annum, which is equal to 327 deaths, I regret that Islington is still without Health Visitors to undertake the duties devolving on the Council under the Notification of Births Act, and the several Tuberculosis Orders, I trust, however, that the time may not be far distant when the addition of such useful adjuncts to the public health administration of your Borough may find favour in your sight, and add still further to its efficiency, I take this opportunity of thanking the members of the Public Health Committee, and particularly Councillor Harwood, their Chairman, for their invariable courtesy to myself, and for the kindly consideration they have at all viii, times given to my reports and advice, I cannot, however, avoid a feeling of regret that in a comparatively short time this Committee will be dissolved, and that a new one will take its place just at a time when its members had commenced to understand, and fully appreciate, the high importance of public health work, which is often of a most intricate, detailed, and very delicate character, This is one of the penalties of triennial elections, I would also thank my colleagues in the Public Health Department, especially Mr, J, R, Leggatt, the Chief Sanitary Inspector and Superintendent, and Mr, Geo, H, King, the Chief Clerk, for the manner in which each has discharged the duties devolving on him, which at times were of a burdensome character, To Mr, William Millar of the Town Clerk's Department, but who acts as clerk to the Public Health Committee, I am also much indebted for valuable assistance, I am, Your faithful Servant, Medical Officer of Health, 2C)th June, 1912, ix, SUMMARY of Vital Statistics, 1911, Population (Enumeiated at Census) 327,403 persons „ (Estimated at middle of year) 1911 327,247 persons Estimated decrease on population, 1910 738 persons Mean Population, ten years (1901-1910) 331,434 persons Area 3,092 acres Density 106 persons per acre Marriages 2,843 Persons married 5,686 Persons married rate 1737 per 1,000 inhabitants Births Males 4,050 Females 3,923 Persons 7,973* Birth rate 24,36 per 1,000 inhabitants* Deaths from All Causes Males 2,479) Females 2,387 Persons 4,866 Death rateH'87 per 1,000 inhabitants Deaths from Principal Epidemic Diseases Males 328 Females 275 603 Persons Death rate 1,84 per 1,000 inhabitants Infantile Deaths under 1 year Males 566 Females 467 Total 1,033 Infantile mortality rate 129 per 1,000 births Excess of Births over Deaths 3,163 * In addition to these births the Registrar-General has transferred 140 from districts outside the borough, but born of Islington parents, whose places of residence cannot be located, The actual number of births is, therefore, 8,113, and the birth-rate 24 79 per 1,000 inhabitants, t Including 56 " Transferable Deaths " from places outside the Borough, PART I, THE POPULATIONS, AREAS AND DENSITIES OF THE SUB-REGISTRATION DISTRICTS, THE WARDS AND THE BOROUGH, B ERRATA, Page 7 Line 23—For "population" read "populations," Pagb 15 Last Par,, Line 1—For "effected" read "affected," Page 100 Par, 3, Line 1—For " is set out" read "as set out," Page 116 Line 14—After the words "presented" read "to the Public Health Committee," Page 175 Line 9, Par, 2—After the word "percentage " read "of the notifications," Page 179 Line 7—For " 500,000" read "50,000," Page 223 Line 5, Par, 5 —For " to such births " read " of such births," Page 235 Line 1 of Table—For "seamen" read "seaman," Page 259 Last Par,, Line 3—For " number of Laundries " should read "44," Page 268 Last Par,, Lines 4, 5, 6, 7—Where the word " to" occurs read "of," Page 273 Line 6—Delete " great," Page 282 Line 3—Read for " year," " years," 3 [1011 RE PORT of the Medical Officer of Health FOR THE YEAR 1911, POPULATIONS, SUB DISTRICTS, AREAS AND DENSITIES, Population,—The number of the population was ascertained by a National Census made on the night of April 2nd, 1911, It was the twelfth decennial enumeration of the English people, As regards Islington, it showed that for the first time there was no increase in the number of its inhabitants, that in fact there was a decrease, True, the decrease was small; but, however small, it is none the less unsatisfactory, For a long while it was suspected, because the number of unoccupied houses in the borough had increased; and, indeed, a street which was for long years Islington's glory and its most busy thoroughfare, both during the day and night, had latterly exhibited a beggarly array of closed shops, That they will not long remain so is certain, for there are not wanting signs that they will by-and-by be reoccupied, although possibly not by businesses of the same high-class as formerly, but probably by those which will meet the wants of the different class of people who are now occupying houses in Highbury, Canonbury, and Barnsbury, which aforetime were owned or rented by " can iage people " and similarly wealthy folks and good middle-class persons, The census returns showed that the number of people living in the borough was 327,403, as compared with 334,991 in 1901, There was, therefore, a decrease in the population, and for the fiist time, to the extent of 7,588 persons, or 2-26 per cent,, as compared with the number ascertained at the preceding census, B 2 1911] 4 Let us compare these figures with those of the preceding census returns, which have been set out in the following Table:— Table I, Showing the Population of Islington at the several Censuses since 1801, together with the Actual and Percentage Increase at each succeeding decennial period, Years of Census, Enumerated Population, Increase of Population, Percentage Increase, 1801 10,212 — — 1811 i5,o65 4,853 39,7 l82I 22,417 7,352 40,5 1831 37,316 14,899 66,4 1841 55,776 18,460 49,4 1851 95,329 39,553 70,7 l86l 155,341 60,122 63,1 1871 213,749 58,408 37,1 l88l 282,865 69,116 32,3 1891 319,155 36,290 12,8 1901 334,991 15,836 4',9 1911 327,403 7,588 (decrease) 2,2 (decrease) Here we have in epitome the history of Islington, its rise, but, let us hope, not its fall, Of course it was impossible that its population could go on for ever increasing at the ratio of 70-7 per cent, as it did in the decade 1841-51, because in a comparatively few years it would have been full to overflowing, and, indeed, the area of the parish was not sufficiently ample on which to build the houses necessary to contain the people in such large numbers, 5 [1911 Nevertheless at the next decennial census (18(il) it is found that the population had increased by 63,1 per cent,; in actual numbers by 60,122 peisons ; while at the census of 1871, although the percentage increase had fallen to 371, yet the actual increase was not much lower than in 1861, 58,408, as against 60,122, In 1881 the percentage increase once more showed a decrease for it was only 32,3, while the actual increase was 69,116 persons, as compared with the figures in the previous paragraph, Since 1881, however, the increases, actual and percentage, have steadil} declined, so that in 1891 they were 36,290, and 12-8 per cent, respectively; in 1901 15,836, or 4,9 per cent,; and now in 1911 there is at last a decrease of 7,588 persons, equal to 2,2 per cent,, as compared with the 1901 census, Why has this decrease occurred? It is not easy to give a definite answer to this question, but probably the following causes have had some effect:— 1, For a very long period, at least two hundred and fifty years, Islington had been the home of many city men, They found it of easy access from the city in those early days; a short distance to walk, drive, or ride, It was attractive because of its wide fields, its green pastures, its wooded country, its pleasant walks, its general country life, its sheep and its cattle, its buxom milk maids, and its general air of rusticity, It was, above all, healthy and salubrious, It, therefore, gradually became the great suburb of the City of London, many of whose merchants quitted their city residences for more commodious and better equipped houses in rural Islington, It would be both interesting and instructive to follow the growth of the borough step by step: to record the names of the historical, literary, and other well-known people who resorted thither at one time or another either for health sake or for a country home, but this is hardly the time or the occasion to do so, Still the fact that they did live here shows that from an early period Islington was looked upon as a pleasant place to retire to every evening, after a day of anxiety in the city, Stow in his Survey of London, speaks of it as " a country town hard by, which in the former age was esteemed so pleasantly seated, that in 1581 Queen Elizabeth (in one of the twelve days that she resided in the Tower) on an evening rode that way to take the air," Thus early its healthy and pleasant position was well recognised, so that it is no wonder to find that it became a health resort; and that many persons, of " quality " and otherwise, resorted to it for their health sake, just as to-day people go to the 1911] 6 coast for a similar reason, Indeed, this was so well known, that an old author writes of it that its " bracing air is often had resource to by persons in the decline of life," Nelson, too, in his History, Topography and Antiquities of Islington prints on the title page a verse of a poem by Wm, Fox, jun,, of which the concluding six lines are as follows:— And Iseldon, as ancient records tell, In distant time as now, had much to boast Of other praise, in Nature's bounty rich, For thither, then, from London's hectic town Her famed chalybeates oft allur'd the sick; Her fresh lactarian draughts the babe sustain'd, The same Fox also wrote:— There Addison from public haunts withdrew To polish, to correct, to charm mankind, Close on these skirts our Milton passed his days Of waning life—forsaken, blind and poor; Thither the melancholy Collins fled The wand'rings of a 'wildered mind to soothe, The number of inhabitants of the parish in 1801 was 10,212, 4,189 males and 6,023 females, of whom 115 were stated to be employed in agriculture ; 892 chiefly in trade, manufactures, or handicraft; and 9,205 not included in either of these classes, The number of inhabited houses was 1,6(55, occupied by 2,228 families, and 80 uninhabited, making a total of 1,745, Nelson also writes, when discussing these returns, made under the " Population Act," with regard to some of the above particulars, that " the statement is without doubt erroneous, The excess in the number of families in proportion to the houses inhabited, may, however, be accounted for, by many having apartments here, especially during the summer months," Its fame as a place of pleasure was celebrated in prose and verse, as well as on the stage, and mention of it is to be found in Ben Jonson's plays, in The Spectator, in Goldsmith's Essays, Defoe's History of the Plague, and other works, The " village " in the early days was practically confined to the neighbourhood of Islington Green, whence as the population increased, it extended along 7 [1911 the Lower Street (now Essex Road) and Upper Street, There were also " hamlets " at Lower Holloway and Upper Holloway, In those days (1735) there were only fields between Canonbury Tower and what is now the Upper Street, and through them a footpath led from midway down Cross Street to Canonbury House, Then Islington began to broaden, and houses quickly began to raise their heads between the Lower Road (now Essex Road) and Upper Street and to the north of that street, Thence extension was made into Highbury, and Highbury Place and Highbury Terrace appear, So far as house building operations are concerned, what happened during one hundred years may be gathered from the following figures:— Years, Houses, Years, Houses, 1708 325 1793 1200 1754 937 1801 1745 1788 1060 1811 2656 Thus in a little over one hundred years the number of houses in the parish increased six-fold, In 1811 the 2,656 houses in Is'ington covered only a small poition of the parish, which was three miles two furlongs in length, from northwest to south-east; two miles one furlong in breadth trom east to west; and ten miles in circumference, It contained an area of 3,032 acres three roods, of which in 1805-6 (according to the terrier and survey then taken by order of the vestry) about 2,700 were meadow and pasture, and the remainder housesi, yards, gardens, and wastes, The population in those early days (1708-1788) are not obtainable, but if 5,5 persons * are allowed as the average for each house, it would probably have been as follows:— Years, Population, Years, Population, 1708 1787 1793 6600 1754 5153 1800 10212 1788 5830 1811 15065 After 1811 the population grew with great rapidity as already shown, so that to-day there are none left of those 2,700 acres, which were meadow and pasture land in 1805, to be built upon, Stone, bricks, and mortar have replaced those pleasant fields, and instead of the cattle that grazed on them, and the frequent pleasure seekers, swarming thither from the city, who roved over them, to spend a few happy hours in the fields, or to partake of the " milk and new * This was the number in 1793, 1911] 8 cheese " for which Islington was famed, there now dwell a third of a million of people, Then gradually the residents began to feel themselves hemmed in as the rural aspect of the place vanished, and therefore, they began to desire more room for themselves and for their children, At first the movement outwards was slow, then it increased more quickly, until at last it became considerable, and the parish, Highbury in particular, suffered, Lately, however, there has undoubtedly been an opposite tendency, so that it is hoped that the tide has now definitely turned, 2, In their greed to build as much as they could on a given piece of land, builders, who were for the most part of the speculative class, erected houses with basements, which in the older buildings were almost, if not entiiely, below the level of the street, These answered very well so long as there was no servant difficulty, but as it increased so did basements become unpopular ; particularly as the mistresses then found it necessary to be more and more in their kitchens, The servants, themselves, too, objected to them, and many flatly refused to take situations in houses with them, The result of this agitation was to increase the demand for non-basement houses, which could not be fully met in Islington, nor for the matter of that in many of the metropolitan boroughs, People, therefore, went farther afield, for the most part outside of the County of London, where non-basement houses were built, But now they find out not only that they are almost as crowded in some of these districts as they were in Islington, and that the real country seems as far away from them as ever, but also that their servants long for the amusements of London which they can obtain so cheaply and so abundantly there, People with limited means, too, discover after a while that although rates and rents may be less, yet living is dearer ; and that frequent visits to town by wives and children for clothing and the like, together with the cost of season tickets for the male members of a family, more than counterbalance other gains ; and that after all the pleasures of the garden in summer, a fortnight to a month of which is lost during the annual holidays, do not compensate for the long, and ofttimes dreary evenings of the winter, These are all telling in favour of the reaction which has set in, and which is certain to become stronger as time passes, In the newer districts very attractive houses have been largely built in the Queen Anne style, but without the Queen Anne solidity, They have nice artistic exteriors, but the rooms are sometimes dark, the French windows 9 [1911 are not suitable for this country, and, owing to their door-like method of opening, do not afford efficient ventilation to the rooms, 1 heir panes of glass, divided by many bars admit the minimum of light, while they require the maximum of labour to clean; and the fanlights, many of which do not open, are for the most part glazed with coloured glass, so that near the ceilings efficient ventilation and light are not afforded where they are most requisite, Builders will find out by and by that people will discover, as already many have, that large windows with sliding sashes, are the only efficient means for providing those two great necessities of life, good light and ventilation, without draughts, to keep the air of the house sweet and pure; and that the sliding sashes also afford far better means for regulating the supply of air than is furnished by the windows of these picturesque houses which are better adapted for warm climates, where the people live with open windows nearly all the year round, In England, however, except in some very sheltered spots, they are not suitable, Light and ventilation are the two great requirements of men, women and children, if they are to enjoy healthy lives; and it is just in the supply of these two requisites such houses are most deficient, High gabled roofs, and artistic dormers and French windows, and walls covered with beautiful creepers, cannot compensate for these necessities, These views are not those of the writer alone: they are held by many people who have studied the question, Indeed, only recently a well-known surveyor expressed himself in much stronger terms than have gained expression in the above paragraphs, If to these drawbacks of living out of London are added the incessant railway travelling to and from home, day by day, all the year round, it is clear that the fagged business man cannot obtain that quiet and rest from his labours which he requires to enable him to perform his daily task with all that vigour and thoroughness which his business demands, London as a whole is healthy—even marvellously healthy—for such a great community, Indeed, it contains many special spots which are as salubrious as need be desired; and even Islington, once the pleasure garden and the resort for health of the citizens of London, as we have seen, still includes districts which are as healthy as many of the much advertised health resorts either by the sea or in the country, Its undulating and gradually rising contour, with its gently sloped dales, now imperceptible because they have long since been 19111j 10 covered with houses, have afforded easy drainage, and hence a dry soil, so that now as formerly Islington is a healthy place in which to have one's being, We have now seen what Islington was when it was a village, and how it has grown from such a small beginning to be an immense town—with 327,403 inhabitants, Let us examine the census returns more closely, Sex Distribution and Ages of the Population at Census—The returns give 155,901 males and 171,502 females, making a total of 327,403 persons, as compared with 159,290 males, 175,701 females, and 334,991 persons at the census of 1901, The proportion of males to females is as 100 to 110, which was also the proportion in 1901, A return, which the Registrar General has kindly placed at the disposal of the Public Health Department, shows that the ages of the population, males and females, were as follows:— 11 [1911 Table II, Showing the Number ami Sex of the Population at Thirty-two Age Periods at the Census 1911, Ages, Persons, Males, Females, All Ages, 327,403 155,901 171,502 Under 1 year 7,232 3,664 3,568 i 6,555 3,329 3,226 2 6,820 3,454 3,366 3 6,679 3,337 3,342 4 6,425 3,234 3,191 Under 5 years 33,711 17,018 16,693 5 30,340 15,184 15,156 10 16,963 8,487 8,476 !3 5,651 2,837 2,814 14 5,419 2,732 2,687 15 5,730 2,863 2,867 16 5,608 2,748 2,860 17 5,600 2,696 2,904 18 5,697 2,702 2,995 19 5,669 2,713 2,956 20 5,831 2,731 3,100 21 24,728 11,553 13,175 25 30,610 14,402 16,208 30 27,380 13,069 14,31 35 24,i75 11,461 12,714 40 20,988 9,896 11,092 45 18,239 8,566 9,673 50 15,090 7,047 8,043 55 12,227 5,621 6,606 60 10,010 4,543 5,476 65 7,734 3,409 4,325 70 5,171 2,014 3,157 75 2,777 961 1,816 80 1,301 428 873 85 455 129 326 90 113 25 88 95 15 6 9 100 and upwards 1 1 —- Not stated 170 59 111 1911] 12 These figures have been condensed in the following Table, so that an exact comparison may be made with preceding census returns:— Table III, Showing the Numbers, Ages and Sex of the Population at Nine Age Periods at the Census, 1911. Age periods, Males, Females, Totals, 0— 5 17,018 16,693 33,711 5—15 29,240 29,133 58,373 15—25 28,020 30,885 58,905 25—35 27,485 30,547 58,032 35—45 21,374 23,833 45,207 45—55 15,627 17,744 33,371 55—65 10,164 12,073 22,237 65—75 5423 7,482 12,905 75 & Upwards 1,550 3,112 4,662 All Ages 155,901 171,502 327,403 In order to ascertain the ages of both sexes at which the decrease of the population has occurred, the following Table has been framed:— 18 [1911 Males, Females, Persons, Ace Period, 1901, 1311, Increase or Decrease, 1901, 1911, Increase or Decrease, 1901, 1911, Increase or Decrease, 0— 5 18,223 17,018 -1215 17,779 16,69,) -1086 36,012 33,711 -2301 5—15 30,893 29,240 -1653 30,986 29,133 -1853 61,879 58,373 -3506 15—25 31,443 28,020 -3423 35,228 30,885 -4343 66,671 58,905 -7766 25—35 28,813 27,485 -1328 32,201 30,547 -1654 61,014 58,032 -2982 35—45 20,752 21,374 + 622 22,880 23,833 + 953 43,632 45,207 + 1575 45—55 14,513 15,627 + 1114 16,634 17,744 + 1110 31,147 33,371 + 2224 55—65 9,117 10,164 + 1047 11,094 12,073 + 979 20,211 22,237 +2026 65—75 4,122 5,423 + 1301 6,149 7,482 + 1333 10,271 12,905 +2634 75 & Up, 1,404 1,550 + 146 2,750 3,112 + 362 4,154 4,662 + 508 Totals, 159,290 155,901 -3389 175,701 171,502 -4199 334,991 327,403 -7588 The contents of this Table are worthy of close study, for they show us at what ages the population of the borough increased or decreased during the decennial period 1901-1910, To many persons the figures will no doubt come as a revelation, because they naturally thought, as there was a decrease in the number of inhabitants, that there would also be a decrease at each period of life, Now, nothing of the kind has occurred, for as the Table demonstrates, there was a decrease at all age periods up to thirty-five years of age, and that the decrease was common as well to males as females, Thus it is found that the total decrease from 0-35 years of age was 16,555, of which 7,619 occurred among males, and 8,936 among females, On the other hand the figures show that there was an increase in the number of persons who were over thirty-five, and that such increase occurred at each age-period, and for each sex, Thus the total increase was 8,967, of which 4,230 were credited to males and 4,737 to females, 1911] 14 These changes have been going on slowly, but very surely, for the past twenty or thirty years. They are not the fruition of to-day or yesterday, but of many years. This is very apparent in the figures which are given in Table V., which reduces the number ascertained at the last four censuses to a common basis:— Table V. Showing the Number of People living at Nine Groups of Ages in every Thousand of the Population in 1881, 1891, 1901, and 1911. Census Years. age periods of life. 0-5 —15 —25 —35 —45 — 55 —65 —75 75 and upwards. 1881 133 20G 193 172 122 80 52 27 10 1891 118 206 200 172 124 87 54 28 11 1901 108 185 199 182 130 93 60 31 12 1911 103 178 180 177 138 102 68 40 14 Here we see that among the children under five years of age there has been the very considerable decrease between 1881 and 1911 of 30 in every thousand of the population, and that that decrease has been steadily maintained at each census. Again, in the age period 10-15, the Table shows that since 1881 there has been a fall of 28 in every thousand of the population, and that the decrease has been continuous since 1891. Again, in the age period 15-25, there has been a decrease of 18 persons in every thousand of the population as compared with 1881, although the proportion was fairly stationary in 1891 and 1901. At the age period 25-35 there has been a fall of the proportion in every thousand of the population living at this age from 172 to 177, although the proportion in 1901 unaccountably rose to 182. Now comes a change, for after thirty-five years of age had passed the proportion of people living at each period of life shows a steady increase since 1881 15 1911 Thus at the age period 35-45 it rose from 122 in 1881 to 124 in 1891, thence to 130 in 1901, and finally to 138 in 1911. There is a similar tale to be told with respect to the period of life between 45 and 55, for here the proportions since 1881 have been respectively 80, 87, 93 and 102 in each thousand of the population. Again, the proportions show a steady increase between 55-05, for they rose from 52 persons in each thousand of the population in 1881 to 08 in 1911, the intervening proportions being 54 in 1891 and 60 in 1901. Between 05 and 75 years of age also the proportions increased from 27 in 1881 to 28 in 1891, to 31 in 1901, and to 40 in 1911. And lastly, the number of people in every thousand of the population increased from 10 in 1881 to 14 in 1911, being 11 in 1891 and 12 in 1901. If the age proportions be cast into two groups, under 35 years of age, and over 35 years of age the following results are obtained:— Age Periods. 1881. 1891. 1901. 1911. 0.35 709 696 674 638 35 and upwards 291 304 326 362 All ages 1,000 1,000 1,000 1,000 These figures show a progressive decrease in the younger life of the population, and a similar increase in the older. They indicate that the proportion of young lives has fallen ten per cent., while that of the older lives has increased twenty-four per cent. This change, unfortunately, has detrimentally effected the death-rate of the borough to the extent of 10 per thousand in the annual death-rate, as compared with 1891, and as ascertained by a careful calculation. This fact must, therefore, be recollected when making comparisons between the death-rate of the present and past years. For another reason also this is a really serious and regrettable feature of the returns, because the younger a population is 1911] 16 (within limits) the more full of energy and vitality it is. A young population like a young man is full of aspirations and "go"; whereas an old population, like an old man, is usually languid and indifferent. It takes no interest in affairs, and can only be induced with difficulty, often under pressure, to come forward to vote, even when matters of moment are to be determined by the results of an election. In this connection one cannot help wondering if this is the explanation of the apathy of the voters at the last municipal election here, when only 51.7 per cent. of the electors cast their votes. The young are ever seeking change, eager to advance, and to demand their "rights." This accounts for many labour strikes, and the recent miners' strike was no exception; for every one, who has had a close and intimate knowledge of them, is well aware that the matured man with a family and the old man are slow to enter on them, and when begun are anxious to terminate them. The young are ever urging on the old. It is the way of the world. It is the young nations who are the go-ahead nations. We see it is so with Germany, with the United States, with Canada, and with other British Dominions beyond the Seas. So it was in ancient times with Greece and with Rome; and in later days with Spain. No doubt it ever will be so. This is, however, a digression, although an interesting one. The figures have also a bearing on the migration of the population towards the outward suburbs, for they incontestably prove that it is the young men, with their wives and children, who go farther afield to live; while the older men and women are content to remain in Islington, where they were probably brought up, within easy reach of their businesses. It is only what one might reasonably expect. The old are always more satisfied with their surroundings than the young, who are ever anxious for something new. Nor is this feeling confined to the male sex, for it is common to both sexes. And so we find that it is the young who emigrate, who people the new lands that have been opened up, and who have borne the British flag to the ends of the earth. The movement outwards from Islington is only in microcosm what has happened throughout the Kingdom, in England, Scotland, and Ireland, especially in the last-named country, whose decrease in population has been almost solely caused by the emigration of its young men and women. Let us now examine the census returns to discover in what districts the reduction of the population has occurred: 17 [1911 Table VI. Showing the Population of the Several Wards at the Censuses oj 1901 and 1911. Wards. Years. Increase. Decrease. 1901. 1911. Tufnell 31,995 33,526 1.531 — Upper Holloway 33.978 37,"6 3.138 — Tollington 33.922 30,609 — 3,313 Lower Holloway 41,424 39,352 — 2,072 Highbury 34.758 33,805 — 953 Mildmay 24,766 23,923 — 843 Thornhill 33.280 31,522 — 1,758 Barnsbury 21,198 21,499 301 — St. Mary 17.236 16,908 — 328 Canonbury 29,860 28,921 — 939 St. Peter 32.574 30,222 — 2,352 334,991 327,403 4,970 12,558 4.970 Total Decrease 7.588 From this return we learn that a decrease in the population has occurred, with three exceptions, in every ward; and it is, moreover, a notable fact that in the exceptional cases the increases have taken place in the more northern, or in the more recently built districts of the borough on its northern slopes. In other words, Tufnell and Upper Holloway Wards have benefited by the movement to the suburbs. The increase in Barnsbury is to be accounted for by the building of large blocks of good class artizan dwellings by the London County Council some eight years ago, and by the Lewis Trustees two or three years ago, which were at once occupied to their fullest capacity, and which neutralized any 1911] 18 decrease of population that might have been caused by the less crowded state of the many houses let out in lodgings or occupied by more than one family in the ward. Although only a year has elapsed since the census was taken, there can be no question as to the re-occupation of many of the houses, which were then unoccupied. As for example in Tollington, where there has been a decided decrease in the number of unlet residences. To a notable but much less extent houses unoccupied twelve months in Lower Holloway, are now occupied by tenants,, while in Highbury many houses that were empty are now let as boarding houses. Table VII. Showing the Populations and the Separate Occupations or Families of the several Registration Sub-Districts at the Census, 1901 and 1911. Registration Districts. Populations. Families or Separate Occupiers. 1901. 1911. Increase or Decrease. 1901 1911 Increase or Decrease. Tufnell 31,995 33,526 + 1,531 7,306 8,190 + 884 Upper Holloway 33.978 37,116 + 3,138 7,487 8,309 + 822 Tollington 33,922 30,609 - 3,313 7,564 7,249 - 315 Lower Holloway 4M24 39,352 — 2,072 9,243 9,068 - 175 Highbury* 63,797 61,992* - 1,805 14,901 15,229* + 328 Barnsbury 54,478 53,021 - 1,457 13,781 I3,3H - 467 South-East Islington* 75,397 71,787* -3,610 18,847 18,599* — 248 The Borough 334,991 327,403 - 7,588 79,129 79,902 + 773 * The corrected figures for Census 1911 are not yet published for these districts. This is an interesting Table, for it brings into prominence a most remarkable and interesting feature of the census; that although the population had decreased by 7,588 persons in the ten years 1901-10, yet the number of families or separate occupiers had increased by 773. These increases are, however, confined to three of the sub-registration districts: Tufnell, Upper Holloway, and Highbury. It is not difficult to supply a reason for the increases 19 {1911 in the two former districts, because each returned an increased population: in Tufnell of 1,531 persons, and in Upper Holloway of 3,138. In Highbury, however, the case is different, for here there was a decrease of 1,805 persons in the population. One is not surprised, therefore, to learn that in Tufnell there was an increase of 884 families or separate occupiers, and in Upper Holloway of 822; but to find that there was in Highbury an increase of 328 families or separate occupiers is remarkable; and can only indicate that many of the large houses have been turned into flats or boarding houses. Indeed, this is the explanation. 1 his practice, too, is likely to extend; and as it extends it will bring more business to that part of the borough, and in all probability reinstate the fallen fortunes of Upper Street, which depends so much on the prosperity of this sub-district. Area.— Islington contains 3,092 acres, of which 292 are parks, open spaces, water, railways, or maikets, so that only 2,800 acres are available for houses and roads and streets. Water, such as the Regent's Canal, and the New River, takes up 17.2 acres, railways 196.9 acres, markets 14.9 acres, and parks and open spaces 62.8 acres, so that altogether 291.8 acres are unavailable for housing the people. This is not a great area, although distributed as it is over the borough it affords very satisfactory lungs for it. Table VIII. shows how this space is distributed:— Table VIII. Sub-Districts. Gross Area (Acres) Water. Railways. Markets. Parks and Open Spaces. Total Unavailable Space. Net Area 1 2 3 4 5 6 7 8 Tufnell 411 7.4 20.8 ... 6.2 34'4 376.6 Upper Holloway 299 ... 7.3 ... ... 7.3 291.7 Tollington 315 ... 21.9 ... ... 21.9 293.1 Lower Holloway 413 ... 33.0 14.9 11.0 58.9 354.1 Highbury 799 ... 76.1 ... 32.4 108.5 690.5 Barnsbury 3io 5*1 22*0 ... 4.7 31.8 278.2 South-East Islington ... 545 47 15-8 ... 8.5 29.0 516.0 The Borough 3.092 17.2 196.9 14.9 62.8 291.8 2,800.2 C 2 1911] 20 Density of Population.—The number of people living on each acre of the borough is 106, which is a greater number than is to be found in most municipal boroughs in London or in the country. Indeed, in the latter there is none with such a congested population, while in London there are only 7, The density of population in the sub-registration districts ranges from 82 persons per acre in Tufnell, to 171 in Barnsbury; while in the wards the congestion was as low as 82 in Tufnell (which ward is also a sub-registration district) and as high as 195 in St. Peter's. Table IX. Showing the Areas, Densities, and Estimated Populations of the Sub-registration Districts at the middle of the year 1911. Sub-Districts. Area in Acres Acres to a person. Persons to an Acre. Estimated Population Mid-year 1911. Tufnell 411 0.0122 82 33,566 Upper Holloway 299 0.0080 124 37,205 Tollington 315 0.0103 97 30,533 Lower Holloway 413 0.0I05 95 39,313 Highbury 799 0.0I29 77 61,947 Barnsbury 310 0.0058 171 52,985 South-East Islington 545 0.0076 131 71,698 The Borough 3.092 0.0094 106 327,247 21 [1911 Table X. Showing the Areas, Densities and Estimated Populations of the Wards at the middle of the year 1911. WARDS. Area in Acres. Persons to an Acre, or Density of Population. Estimated Population Mid-year, 1911. No. 1—Tufnell 411 82 33,566 2—Upper Holloway 299 124 37.205 3—Tollington 315 97 30,533 4—I ower Holloway 413 95 39,313 5—Highbury 417 81 33,781 6—Mildmay 339 70 23,902 7—Thornhill 172 183 31,479 8—Barnsbury 137 157 21,506 9—St. Mary's 148 114 16,900 10—Canonbury 286 101 28,898 11—St. Peter's 155 195 30,164 The Borough 3.092 106 327.247 1911] 22 Table XI. Showing the Estimated Number of Persons living in Islington at the middle of 1911, at Nine Age Periods, and distinguishing Males and Females. Ages. Males. Females. Persons. 0—5 17,008 16,686 33,694 5—15 29,229 29,121 58,350 15—25 28,010 30,865 58,875 25—35 27.475 30,530 58,005 35—45 21,363 23.823 45,186 45—55 15,6^1 17.731 33.352 55—65 10,158 12,064 22,222 65—75 5.418 7.485 12,903 75 and upwards 1.548 3.112 4,660 All ages 155.830 171.417 327,247 Table XII. Showing the number of Persons in the several Places mentioned living at Nine Groups of Ages in every thousand of their populations, according to the Census 1911. districts. -5 —15 —25 —35 -48 -55 -65 -75 75 and Upwards. England and Wales Not y et published. Urban Districts Rural ,, London Islington 103 178 180 177 138 102 68 40 14 PART II. MARRIAGES, BIRTHS AND DEATHS. 1911] 24 MARRIAGES. There were 5,686 persons married or 2,843 marriages, in 1911, and the marriage rate, that is to say the number of persons married per 1,000 of the population was 17.37. Compared with the preceding year these figures show a decrease of 54 in the number of persons married, or of 27 marriages, and of 0.l3 per 1,000 in the rate. These are decreases of a negligible character. Any person, who studies the marriage records of Islington, cannot fail to notice that the mean marriage rate has been maintained at a fairly uniform level during the last seventy-two years. Indeed, in only two decades was it below 170 per 1,000 of the population; namely in 1841-50, when it averaged 16-81 per 1,000, and in 1881-90, when it was 15.55. During the decade 1901-10 it was 17.76, ranging from 16.84 in 1909 to 18.32 in 1903. The number of marriages in a community is usually considered a gauge of its prosperity ; and if the theory be correct then, despite all the pessimistic talk of some local people, Islington cannot be in the very parlous state that they would have us think. During the last seven years there has been an almost continuous outcry as to the decline of the borough, and yet in only two of these years, namely in 1908 and 1909, did the marriage rate fall below 17.0 per 1,000 of the population, and in these it was 16.88 and 16.84 respectively; these decreases are insignificant. The calamity which overtook Upper Street led doubtless to the exaggerated inference that the borough was in a bad way, as if there was only one great business thoroughfare in the borough. These marriage statistics prove, however, that the patient was not so ill, if he were ill at all, as the many doctors, who described and prescribed for his disease, alleged. Perhaps the patient will recover (indeed, he has recovered), now that the quinquennia] valuation is over; although for the matter of that, his pulse, which in this case is the marriage rate, was very good at the height of his illness, which is to say at the time in which the valuation was made, being just about the average of the preceding ten years. The figures relating to marriage are not to be lightly tossed on one side as of no significance. On the contrary there are none which so accurately indicate the state of trade, the poverty and the prosperity of the people, as they do; and, therefore, when they are high there can be little doubt that the community is prosperous. Men who are out of work, who are on short time, who are obliged to contribute their scanty wages to the up-keep of their father's home so as to keep a shelter over the heads of their parents and of their sisters and brothers cannot afford to get married. Nor do they, for they do not require 25 [1911 a political economist to teach them the simple fact that it costs more to house, clothe, and feed two human beings than one. Therefore, men do not marry at such times, but postpone the rite until trade is good and prosperity has come again. Such a time has come to Islington, for the marriage rate, els stated, is practically at the level of the preceding ten years. It is quite true that in the early part of the year the marriage rate was very low, being only 9.63 per 1,000 of the population in the first quarter. This rate was all the more extraordinary, because in the fourth quarter 1910, it was 19 24, and in the third quarter of the same year 21.80. It is, therefore, difficult to account for so sudden and large a decrease; although, as a rule, the number of marriages in the first quarter is below the average for the other quarters of the year. It is a curious fact that the marriage rate for the first and second quarters of 1911 taken together was almost the same as the similar rate in 1910, viz. : 14.71 per 1,000 of the population in 1910, and 14 01 in 1911. Table XIII. Showing the number of Persons Married and the Marriage Rates in the Borough in 1911. No. persons married. Persons married per 1,000 inhabitants. 1st quarter 788 9.63 2nd „ 1,512 18.48 3rd „ 1,784 21.80 4th „ 1,602 19.58 The year 5,686 17.37 The record of marriages in Islington since 1841, given in decades as abstracted and collected from the Registrar-General's annual reports is as follows:— 1911] 26 Table XIV. Showing the Marriages and Marriage Rates in Seven Decennial Periods, 1841-1910, and in 1911. 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 17.84 1871-80 20,889 17.06 1881-90 23,322 15.55 1891-1900 28,947 17.44 190I-10 29.433 17.76 1911 2,843 17.37 27 [1911 Table XV. Showing the Marriages and the Marriage Rates in the Borough during 1911 and in the preceding ten years. Years. No. persons married. Persons married per 1000 inhabitants. 1901 5.988 17.88 1902 6,2l6 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 1910 5,740 17.50 Average of 10 years 5,887 1776 1911 5,686 17.37 Decrease on mean 201 0.39 BIRTHS. There were 8,113 births credited to the borough during the year, of which 7,729 occurred in the borough, 244 in the Lying-in Hospital, Finsbury, and 140 19111 28 in other places, the information about which was forwarded to the Medical Officer of Health by the Registrar-General. By the Islington Registrar's returns 7,729 „ Finsbury Registrar 244 7,973 Transferred from other places by Registrar-General 140 8,113 The inclusion of infants, born outside the borough, in the returns is a new and a very proper departure, and was introduced by the Registrar-General to enable the local authority to reach the mothers, when they returned to their homes with their newly-born children, and to instruct them as to their care and feeding. Such information will be much appreciated where the Sanitary Authorities fulfil their obligations towards these babes. In Islington the information is of course of far less value than in other places, for the Council provide no health visitors. The birth-rate, which these 8,113 births represent, was 24.79 per 1,000 of the estimated population of the borough. Notwithstanding the inclusion of the infants born outside the borough, the birth-rate was the lowest hitherto recorded, while the actual number of births has not been so low since 1872, when 8,048 were registered, although meanwhile the population has grown from 221,345 to 327,247 persons, or an increase of 105,902. When we compare the past birth-rates with the present, and note that in the decade 1841-50 the rate averaged 28.65 per 1,000 of the population, the significance of the decrease may not be very apparent, but when we translate birth-rates into births, and say that a rate of 28.65 in 1911 means that 9,375 children would have been born, if this had been the birth-rate, instead of 8,113 or 1,262 less, it becomes very apparent. In the same way the birth-rates in the several decades would represent a very much greater number of births than were actually registered. If the birth-rate had been the same as in 1851-60 the births in 1911 would have numbered 11,303 ,, „ ,, 1861.70 „ „ „ 12,172 „ „ „ 1871.80 „ „ „ 11,978 „ „ „ 1881.90 „ ,, „ 10,632 ,, „ „ 1891.00 „ „ ,, 9,592 „ ,, ,, 1901.10 „ ,, ,, 8,626 29 [1911 These figures show that for some reason or other the population was not as fertile in 1911 as it was on the annual average in 1861-70 by the large number of 4,059 births; as in 1871-80 by 3,865 births; as in 1881-90 by 2 519 births; as in 1891-00 by 1,479 births; and as in 1901-10 by 513. Population taken in the gross is not, however, an altogether correct way to calculate birth-rates for the purpose of comparison, for not only may there be a great difference in age distribution, even in the same community from decade to decade, but also in its sex distribution. There can be hardly any doubt that the more correct way would be to calculate the birth-rate on the number of women in the community living at the child-bearing period of life, which is to say from 15 to 45 years of age. If this be done with respect to Islington for the three censal years 1891, 1901 and 1911, the following figures are obtained:— Years. Women aged 15—45 Births. Births per 1,000 Women. 15—45 Births per 1,000 of Population. 1891 84,148 9.797 116.4 30.61 1901 90,309 9,264 102.5 27.67 1911 72,124 8,048 111.5 24.79 From the above figures these facts are to be learned, that whereas the birth-rate calculated in the usual way on the gross population, males and females, children and adults, fell 19 0 per cent. between 1891 and 1911, when calculated on the number of women living in the borough at the child-bearing age it fell only 41 per cent., which means that if the birth-rate per 1,000 women at the child-bearing age had been the same as in 1891, there would have been 8,397 births instead of 8,048, the actual number registered, a difference of 349 ; and these 8,397 births would have equalled a birth-rate, calculated on the gross population, of 25.65 per 1,000, or a decrease in the birth-rate of 21.47 per cent. These facts then incontestably prove that the birth-rate calculated on the only proper basis, has fallen only 4.1 per cent. in twenty years, and has actually increased by 8.7 per cent. since 1901, or if allowance be made for the number of increased notifications due to the inclusion of certain births outside the borough by 4.4 per cent. Apparently then, so far as Islington is concerned, 1911] 30 very little fault can be found with the birth-rate since 1801, for as of old the Israelites could not make bricks without straw, so in these modern, and in so many aspects wonderful, days, children cannot be begotten without mothers; for it must not be forgotten that the number of women living at the child-bearing age has fallen from 84,148 in 1891 to 72 124 in 1911, which is a decrease of 12,024, or 14.3 per cent. The lesson to be derived from the facts just stated, is that it is a fallacy to calculate birth-rates on the gross population of the community, instead of on the number of women who, living at the child-bearing ages, are alone capablc of producing children. Nor must it be forgotten when considering the statistics relating to births that women are not now married so early in life as formerly, and that marriages before twenty-one are not nearly so numerous as they were twenty years ago; therefore, the fall in the birth-rate is undoubtedly partly due to the more limited time in which married women can bear their offspring. How much these later marriages of women have effected the birth-rate it is impossible to state with accuracy, for the particulars as to the age of persons marrying are no longer tabulated in the reports of the Registrar-General, which is to be regretted. The Medical Officer of Health in his annual report for 1904 discussed this question at length, when the conclusions he arrived at differed from those to which he has now given expression. The data were then altogether different, and, therefore, the inferences to be deduced from them were also different. A reference to that report might be made by members of the Council who are interested in this question, and in the general decline of the national birth-rate, which is of such great importance to the nation. Sex.—Of the 8,113 infants born 4,050 were males and 3,923 females, while the sex of 140 was not reported by the Registrar-General. Illegitimate Births.—There were 248 illegitimate births registered, or 8 more than in the preceding year, and 7 more than the average of the ten preceding years. They represented 3 06 per cent. of the total births. Notwithstanding that there was a slightly increased number of these births in 1911, it is nevertheless a fact that there has been a decrease in such births since the decennial period 1881-90, although in proportion to the registered births they have slightly increased. 31 [1911 Periods. Illegitimate Births. Total Registered Births. Illegitimate Births per 100 Registered Births. 1881-1890 3,475 97,420 3.57 1891-1900 2,719 97,278 2.79 1901-1910 2,413 87,301 2.76 1911 248 8,113 3.06 Table G in the appendix gives a return for each year since 1841 of the illegitimate births registered in Islington which have been carefully abstracted by the Medical Officer of Health from the annual reports of the RegistrarGeneral. The Notification of Births.—There were 7,232 notifications received during the year under the Notification of Births Act, 1907, which requires that all births shall be notified to the Medical Officer of Health within thirty-six hours of their occurrence. The notifications represented 891 per cent of the entire number of registered births. These figures contrast with the three preceding years as follows:— Births. Notifications. Deficiency. Per cent. notified. 1908 3,907 3,211 756 80.9 (From July 16th) 1909 8,198 6,983 1 215 85.2 1910 8,201 7,407 794 90.3 1911 8,113 7,232 881 89.1 The above returns indicate that there was a slight decrease in the percentage of births notified compared with the preceding year, although it was a distinct improvement on that of the years 1908 and 1909. An analysis of the returns shows that of the 7,232 notifications: 1,048 were notified by medical practitioners. 3,412 „ „ midwives. 2,772 „ ,, parents and other persons. Dnring the year 741 births were not notified under the Act, but their occurrence was afterwards ascertained from the District Registrars' returns. Enquiries elicited the fact that in 559 cases the mother was attended by a doctor, in 38 of which the father was not at home within six hours of the birth; in 49 cases by a midwife, in 3 of which the father was not 1911] 32 at home within six hours; and in 18 cases by other persons. In 115 cases no information could be obtained for the reasons stated below Information refused. Wrong address. (No such house, former address given and present one not traceable). Many futile calls made nobody at home. House empty. Child's death before registration. The fact that in 559 instances medical men did not comply with the act is regrettable, and would be still more so if the Council employed health visitors, as they ought to have done long since. It is presumed, however, that in those instances where doctors continued in attendance after the birth they gave their patients suitable instructions for the rearing of their infants. The notifications in preceding years by doctors, midwives and parents, etc., are shown in the following statement:— By Medical Practitioners. By Midwives. By Parents and other Persons. Total Notifications. 1908 483 974 1,754 3,211 (From July 16th) 1909 988 2,312 3,683 6,983 1910 1,011 3,271 3,125 7,407 1911 1,048 3,412 2,772 7,232 Educational Measures.—As soon as the birth of each child is ascertained, whether through the Notification Act or from the District Registrars' returns, literature of an educational character is at once forwarded to the mother by post. It is printed in booklet form, and contains instructions and hints on nearly every matter which it is necessary for a mother to know so that her child may be brought up in a healthy manner. There is no doubt that these leaflets have been appreciated by the more educated mothers, but unfortunately this has not been the case with the illiterates, who rarely read them, although there are no mothers who require instruction more than they. These people can only be reached by health visitors, who by their tact and training soon prevail on the majority of them to take a real interest in their babes, so that many afterwards turn out most excellent mothers. This is the universal experience of Medical Officers of Health. In Islington, of course, such mothers cannot be reached, because the necessary machinery is not provided. 83 [1911 TABLE XVI. Showing the number of Births registered in the Sub-Registration Districts, 1902-1911. Sub-District. 1902 1903 1904 1905 1906 1907 1908 1909 1910 I9II Tufnell 745 740 799 758 746 745 816 759 741 763 Upper Holloway 1,131 1,108 1,066 1,067 1,061 1,023 1,027 993 985 945 Tollington 849 850 815 809 747 755 728 705 724 739 Lower Holloway 1,122 1,126 1,114 1,118 1,118 1,094 1,067 1,084 1,050 986 Highbury 1,488 1,460 1.423 1.303 1,348 1,278 1,416 1,301 1,271 1,349 Barnsbury 1,757 1,648 1,672 1,706 1,679 1,709 1,625 1,493 1,545 1,498 Islington South-East 2,122 2,051 2.001 1,995 1,960 1,927 1,986 1,863 1,885 1,793 Borough 9,214 8,983 8,890 8,756 8,659 8,531 8,665 8,198 8,201 7,973* * In addition to these 7,973 births the Registrar-General transferred 140 whose mothers' place of residence cannot be located. The total births are therefore 8,113. 1911] 34 Table XVII. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1911, and in the four quarters of the year and of the County of London and the Great Towns during the same peried; also in the year 1910; together with the mean Borough Birth-rates for the years 1901-1910. Quarter. Males. Females. Total. Birth Rates. Islington, 1911. Islington 1901-10 London, 1911 77 Great Towns, 1911 1st 1,087 1,022 2,109 25.78 27.31 25.9 26.4 2nd 982 988 1,970 24.08 26.44 25.2 26.1 3rd 1,031 958 1,989 24.31 25.91 24.9 25.5 4th 950 955 1,905 23.28 25.77 24.0 24.4 The Year 1911 4,050 3,923 7,973 24.36 26.35 25.0 25.6 1910 4,196 4,005 8,201 25.01 2436 23.6 26.3 Increase or decrease -146 -82 -228 -0.65 -1.99 + 1.4 +0.7 35 [1911 D 2 Table XVIII. Showing the Births Males and Females in each quarter and for the year, 1911, and in the several Sub-registration Districts. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South-East Islington. The Borough Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. J Females. Total. 1st Qr. 116 93 209 138 126 264 100 87 187 129 140 269 165 153 318 204 204 408 235 219 454 1,087 1,022 2,109 2nd „ 102 95 197 104 109 213 84 110 194 112 115 227 146 157 303 197 192 389 237 210 447 982 988 1,970 3rd „ 106 92 198 135 105 240 93 92 185 128 122 250 153 159 312 190 153 343 226 235 461 1,031 958 1,989 4th „ 77 82 159 113 115 228 95 78 173 115 125 240 152 164 316 183 175 358 215 216 431 950 955 1,905 Year 401 362 763 490 455 945 372 367 739 484 502 986 616 633 1,249 774 724 1,498 913 880 1,793 4,050 3 923 7,973* * Vide note to Table XVI. 1911] 36 Table XIX. Showing the Birth-rates for each quarter and for the year 1911, of the several Sub-registration Districts and of the Borough. Sub-Districts 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Tufnell 24.91 23.47 23.60 18.95 22.73 Upper Holloway 28.38 22.90 25.80 23.95 25.40 Tollington 24.50 25.41 24.24 22.66 24.20 Lower Holloway... 27.37 23.09 25.43 24.42 25.08 Highbury 20-53 19-56 20.14 20.40 20.l6 Barnsbury 30-80 29*37 25.89 27.02 28.27 Islington, S. East 25*33 24'93 25.71 24.04 25.00 The Borough 25.78 24.08 24.31 23.28 24.36 Table XX. Showing the Population, Births, and Birth-rates in Seven Decennial Periods, 1841 to 1910, and in 1911. 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 1911. 1 2 3 4 5 1841-50 72.767 20,850 28.65 9,375 1851-60 121,353 41,915 34.54 11,303 1861-70 181,529 67,520 37.20 12,172 1871-80 244,884 89,627 36.60 11,978 1881-90 299,857 97,420 32.49 10,632 1891-1900 331,868 97,278 29.31 9,592 1901-10 331,434 87.361 26.36 8-626 1911 327,247 8,113 24.79 8,113 37 [1911 DEATHS. The year 1911 must undoubtedly be considered a healthy year, so far as Islington is concerned, for in seventy years the annual mortality in proportion to the population, which is to say the death-rate, has been as low on only three previous occasions: a fact which may be learned from Table H in the Appendix. The deaths numbered 4,810*, or 287 more than in the preceding year; they were on the other hand 227 below the average of 5,027 which obtained during the decade 1901-10. The mortality returns have varied very little during the last ten years, while during the last four the death-rate has been 13.93 per 1,000 of the population (1908), 14.96 (1909), 13.79 (1910), and 14.70 (1911). The mortality at the present time compares more favourably with the past records than is at first apparent, for the recent census (1911) has disclosed the fact that the age distribution of the population has changed in a manner unfavourable to a low death-rate; that is to say there is now a larger proportion of old people in the borough than formerly, and, therefore, a lesser proportion of young people. This alteration in the age incidence has been going on Steadily since 1881, and its extent has been dwelt on in a preceding part of this report (pp. 10-16). How it has effected the death-rate remains to be told. The change during the last twenty years will now be discussed; but first it is necessary to show what the age incidence of the population would have been in 1911, if it had continued the same as it was in 1891. In order to do this the subsequent tabular statement has been prepared. It shows, for nine age periods, and for males and females, the number of people who would have been living in Islington at each of these groups of ages, if there had been no alteration in the proportion of persons living at each of them. *There were also 56 "Transferable Deaths," that is deaths of persons who having a fixed or usual residence in the borough, died in a district other than that in which they resided; and these were transmitted by the Registrar General sometime after the close of each quarter. These deaths however, have not been added to the total deaths registered by 'he local Registrars, but are duly accounted for in the Local Government Board return, Table I. in the Appendix of this report. 1911] 38 Table XXI. Showing what the Population of Islington at Nine Age Periods would have been in 1911 if the Sex and Age Distribution had been the same as in 1891. Age Petieds. Males. Females Population oi 1911 if based on age distribution of 1891. Population at middle of 1911 Difference. Population of 1911 if based on age distribution of 1891. Population at middle of 1911. Difference. 1 2 5 4 5 6 7 0—5 18,653 17,008 -1,645 19,962 16,686 -3.276 5—15 33,380 29,229 -4,151 34,035 29,121 -4,914 15—25 30,437 28,010 -2,427 35,015 30,865 -4,150 25—35 26,834 27,475 + 641 29,450 30,530 + 1,080 35—45 19,306 21,363 + 2,057 21,270 23,823 + 2,553 45—55 13,090 15,621 + 2,531 15,380 17,731 + 2,351 55—65 7,527 10,158 + 2,631 10,145 12,064 + 1,919 65—75 3,600 5,418 + 1,818 5,563 7,485 + 1,922 75 and upwards 1,309 1,548 + 239 2,291 3.112 + 821 All ages 154,136 155,830 + 1,694 173,111 171,417 | -1,694 This Table may be read as follows:—If the proportion of male persons living at the age period 0.5 in 1911 had been the same as in 1891, the number of males living at this age period in 1911 would have been 18,653 instead of 17,008, the actual number, or 1,045 fewer males; and similarly if the proportion of female persons living at the age period 0.5 in 1911 had been the same as in 1891 the number of females living at this age period would have been 19,962, instead of 16,686 the actual number, or 3,270 fewer females. It is not a little remarkable to notice that the decrease in the proportion of the population has occurred at all age periods under 25 years, and that the increase in it at all age periods over that age. Let us now see how this age re-distribution has affected the mortality. This can be ascertained by applying the death-rates at each age period in 1911 given in Table XXIII. to the population given in columns 2 and 5 of Table XXI., and thereby obtaining the number of deaths that these death-rates represent. 39 [1911 Thus, for instance, in the Table last mentioned, the population at the age period 0 5 in column 2 is given as 18,553, and if this number be multiplied by 48.50, the death-rate among males at this period of life, and then divided by 1,000, the number of deaths, which in this case is 905, is ascertained: 1,000 : 48.50 :: 18,653 : 905 Table XXII. Showing the Deaths of males, females and persons in 1911 at Nine Age Periods and the number that would have occurred in that year if the age incidence had remained the same as in 1891. Males. Females. Persons. Age Periods. Deaths based on the age distribution of 1891. Actual Deaths. Difference. Deaths based on the age distribution of 1891 Actual Deaths. Difference. Deaths based on the age distribution of 1891. Actual Deaths. Difference. 1 2 3 4 5 6 7 8 9 10 0-5 905 825 -80 817 683 -134 1,722 1,508 -214 5-15 96 84 -12 74 63 -a 170 147 -23 15-25 84 77 -7 95 84 -11 179 161 -18 25-35 117 120 + 3 108 112 +4 225 232 + 7 35-45 192 212 + 20 151 169 + 18 343 381 + 38 45-55 221 264 + 43 193 222 + 29 414 486 + 72 55-65 239 322 +83 226 269 + 43 465 591 + 126 65-75 210 316 + 106 265 357 + 92 475 673 + 198 75 and upwards. 194 229 + 35 296 402 + 106 490 631 + 141 All ages 2,258 2.449 + 191 2,225 2,361 + 136 4,483 4,810 + 327 This Table shows that the aggregate number of deaths based on the 1891 age distribution would have been 4,483 (2,258 males and 2,225 females), as against 4,810 (2,449 males and 2,361 females), the actual number that occurred in 1911, so that it is apparent that the changes in the distribution of the ages and sex of the population have resulted in 327 deaths more than would have occurred if the age and sex incidence had remained stationary; and that they have detrimentally affected the death-rate of 1911 to the extent of 1-0 per 40 1911] 1,000 of the present population. The change in the age and six distribution was, therefore, detrimental to the health of the community. Let us now enquire as to what would have occurred supposing the deathrate at the several age periods had remained unchanged. Fortunately for Islington the detrimental effect on the death-rate was counterbalanced by a very considerable improvement in the death-rate from all causes and at all periods of life. Indeed, if this had not been the case the death-rate last year would have been 20.0 instead of 14.7 per 1,000 of the population. In order to show how this fact has been arrived at the two subsequent Tables have been prepared. In the first of these Tables are given the death-rates per 1,000 of the population living at each of the nine age periods in three different years, viz., in 1893, 1901 and 1911. It is not possible to give the rates for 1891, the census year, because the figures were not taken out by the predecessor of the Medical Officer of Health, but they are available for 1893, which, being very near the census year, may be taken as fairly correct for that year. Table XXIII. Showing the Death-rates at Nine Age Periods in 1893, 1901 and 1911. Age Periods. 1893. 1901. 1911 0—5 64.48 53.48 44.75 5—15 4.45 2.84 252 15—25 3.77 3.15 2.73 25-35 7.26 5.16 4.00 35—45 13.19 10.16 8.43 45—55 20.55 16.38 14.57 55—65 33. 61 31.18 26.60 65—75 72.24 57.59 52.16 75 & upwards 152.33 133.23 135.42 These death-rates show that there has been a general improvement in the mortality at each age period since 1893, and also since 1901, with the single exception of the age period above 75, at which time of lite the rate has risen from 133.23 per 1,000 in 1901 to 135.42 in 1911. 41 [1911 Now if the death-rates had remained the same in 1911 as in 1893, or as in 1901, the deaths as shown in the following Table would have occurred:— Table XXIV. Showing the Deaths that would have occurred in 1911 if the Death-rates which obtained in 1893 and 1901 had obtained in 1911. Ages. Deaths on the basis of the death-rates for 1893. Deaths on the basis of the death-rates for 1901. The actual deaths in 1911. Saving of lives between 1893 and 1911. Saving of lives between 1901 and 1911. 0—5 2.172 1,802 1,508 -664 -294 5—15 260 166 147 -113 -19 15—25 222 185 161 -61 -24 25—35 421 299 232 -189 -67 35—45 596 459 381 -215 -76 45—55 685 546 486 -199 -60 55—65 747 693 591 -156 -102 65—75 932 743 673 -259 -70 75 & upwards 710 621 631 -79 + 10 Totals 6,745 5,514 4810 -1,935 -704 This table shows us that, despite the adverse change in the age distribution, the diminution in the mortality at the several age perieas of life has resulted in a saving of 1,935 lives, of which 820, or 42.4 percent., were at the wage-earning period of life, that is, between 15 and 65, in 1911, as compared with the mortality of 1893, and with 704, of which 331, or 47'0 per cent., were at the wage earning period of life, as compared with 1901. The fact that there has been a steady fall in the mortality at each period of life, not only since 1893, but since 1901, if the slight increase of 10 among very old people in 1901 be excepted, is strong testimony to the healthy conditions of life which have obtained in Islington during the last twenty years. It represents the triumph of modern sanitation in the first place, and of education in the second, in a community which is closely crowded together, which lives largely in tenement houses or houses let in lodgings, and in which the lower classes, artizans and labourers, axe largely represented. When one compares such a healthy state of affairs as prevails in Islington with the mortality in other 42 1911] places of the same size, although with less density of population, and which are, unlike it, coterminous with rural areas, such a record as that described is wonderful. And let it be added that what has happened in Islington is happening in other metropolitan boroughs, for happily for Londoners, this borough does not hold a monopoly of the good results that accrue from the vigilant, but just, application of the laws relating to public health to insanitary conditions, and as a consequence the great metropolitan city—called in legal document a county —stands to-day unrivalled among the great capital cities of the world for its health. We hear a great deal from time to time of what the County Council has done for the health of London. Of course it, not forgetting its predecessor the Metropolitan Board of Works, has done a great deal, and no one but a fool can fail to recognise the fact. It has provided parks, it has given us a magnificent main drainage system, and it has induced Parliament to pass some useful sanitary legislation ; all of which could only be effected by a central body acting for the congeries of local bodies, known as Metropolitan Borough Councils, which, as separate entities, could not so easily provide these things. But nearly all the work of a sanitary character, which comes within the purview of provincial borough councils, has been done by the local sanitary authorities of London, to whom the chief praise is due for the present magnificent state of health of the metropolis. The County Council has, however, invariably encouraged the sanitary authorities to do their duty, and in one or two cases has even spurred them on to a fuller sense of their obligations to the community, and in other ways also has effected useful work ; but, nevertheless, the great fact remains that the magnificent health which London now enjoys is due mainly to the efforts of the late Vestries, who, between 1891, when the Public Health (London) Act was passed—for there was a great awakening of the public conscience at this period—and 1900, when the Metropolitan Borough Councils came into being, laid the foundations of the hard-working public health departments, as we know them to-day, of which the metropolitan boroughs are so justly proud, and which they generally maintain at a high level of excellence. When discussing this subject there is a temptation to print m parallel columns the Public Health Acts administered by the Metropolitan Borough Councils and those administered by the County Council. To do so would be to expose the fallacy that the London County Council is a great sanitary authority, for in the one case the Acts are many, in the other few. Unfortunately when the healthy condition of London is 48 [1911 discussed, not only in the County Council, in Parliament, but in the Press, the credit for it is invariably given to the great central body, while the borough councils, to whom is due nearly all of it, are either forgotten or ignored, although it was the local ratepayers who provided the funds, and their councils who directed the expenditure which has made the combined boroughs, called London, so healthy. They have long deserved far more applause and praise at the hands of the public than they have received for the enormous amount of really good work that they have done, and merit increased moral support and encouragement to enable them faithfully and fully to discharge the very weighty duties which, during recent years, have devolved upon them. They have been, however, unfairly handicapped, because they are the authorities who raise the moneys, which not only the London County Council, but also the Metropolitan Asylums Board, the Boards of Guardians, and the Metropolitan Police spend; and, consequently, when owing to the increasing demands of these bodies — and they are made by precepts—the rates go up, the blame, as a rule, falls, not upon the offenders, but upon the borough councils, who, themselves, in all probability, have curtailed their own expenditure so that the rates may be kept down to the lowest possible point. Consequently the work of the borough councils suffers, and, therefore, from this point of view it is to be regretted that they make and collect the rates, and that they are not able to present precepts on a central authority for the sums necessary to enable them to comply fully with the obligations which the legislation of recent years has imposed on them, and particularly on their public health departments. Perhaps if this were done the provisions of the Factory Acts, the Housing and Town Planning Act, the obligations of the Notification of Births Act, and of the Tuberculosis Orders could be carried out in their entirety, with results that would make London even a healthier place than it is at present, good though its state of health undoubtedly is. Islington has shown what a borough council can do to improve its health conditions, for it happens that here the County Council has done nothing during its existence, beyond building two blocks of artizans' dwellings, to improve the sanitary conditions under which the people live. It is not represented that Islington has done all that it ought to have done, especially in respect to some recent legislation, but it is contended that it has done all, or nearly all, that it could afford to do, and that what it has done, as a rule, it has done well. That this statement cannot be denied is proved by the figures given in Table XXIV., that the deaths which would have been (3,745 in 1911, if the conditions that obtained in 1893 had continued, were in fact only 4,810, or a decrease of 28.7 per cent. This is a truth of which the Borough Council and 44 1911] its officials and the people of Islington may well be proud; and which ought to encourage them to continue the good work of the past, and to make still greater efforts in the future, even if a greater expenditure should have to be incurred, in teaching the people how to be healthy, and in still further improving the conditions amidst which they live. This will prove to be true economy, for there can be no doubt that the amount of money, spent in saving lives by improving sanitary conditions, never even approximates the money value of the lives that have been saved, or the cost of those things which the loss of these lives represents, e.g., of funerals, sickness, medicines, loss of wages, and pauperism. A human life has been valued at £400, and on that basis the result of the sanitary work of Islington since 1893, as shown by the death returns of 1911, was the saving of 1,935 lives, which last year alone represented a money value of £794,000; or even taking the value of a life at only half the amount stated, it would still represent the enormous sum of £397,000 saved to the community in one year. Judge then what enormous sums of money must have been saved by good sanitary administration during a number of years. It runs into millions. And who reaped the benefits? The ratepayers. Becaust the sums of money that would have been lost through the evils attendant on sickness and death, would otherwise have been spent on food, clothing, housing, amusement, and all the other necessaries and luxuries of life. It is therefore, to the interest of the ratepayers to spend their money with no niggardly hand, but without lavishness, in improving the health of the people; more especially as they themselves are likely to benefit physically and financially in the results that accrue; and for aught any one of them knows, may result in warding off death or illness from himself, and in the prolongation of his life. If only a Medical Officer of Health could say to an individual member of his council or to an individual citizen of his town: "You, or your wife, or your child will die if your council do not spend money in rigidly enforcing certain sanitary laws; but if it is spent, they will live " ; or patting a person on the back say to him : " My advice to the sanitary authority has saved your life " ; would there not be an immediate and an enormous stimulus given to sanitary work, in its broadest aspects ? And yet we know that the active administration of the sanitary laws do save lives; and, therefore, no one can positively say to-day, that his life has not been saved owing to our improved sanitary conditions, although he still grumbles at the cost. The pity of it is that his indebtedness to the Medical Officer of Health cannot be brought home to him in the same way as the indebtedness of a patient to his physician or surgeon, who has saved his life; for then the work of Medical Officers of Health, by whose offorts and by the advice given to sanitary 45 [1911 authorities, so many thousands of lives are annually saved, would be more fully recognised, not only by the people, but by the State; and their efforts would not be so frequently thwarted, nor would they be looked on, as is too frequently the case, by a certain class of small-minded people, sometimes interested, as faddists. Nevertheless, their labour, not only in this country, but in other civilized communities, especially in the United States, is receiving much more recognition; and their advice is not so lightly put on one side, as formerly, for the people, especially the democracy, have slowly, but very surely, learned by experience that the Medical Officer of Health and his staff of sanitary inspectors are their best friends. And so it should be among all classes; for you cannot have ill-health among the less-favoured members of the community, without its reflex action being felt by those in more favoured circumstances. The present writer well recollects how, many years ago, he vainly appealed, when Medical Officer of Health to a great county borough, to his council to rid itself of a great nuisance, without avail, and how in one of the last reports he presented to that body he told them that they were acting like the ostriches in the desert, who, covering their heads in the sand, thought they were safe, because they could not see their danger; but that, nevertheless, some day their town would be afflicted with an epidemic of typhoid fever, from which, up to that time, it had been happily and miraculously free. And he proved to be no false prophet; for the day did come, not long after he had left the borough, when many people, some of them most worthy citizens, were carried off by that fever. Of course, then that council came to recognise the danger,, and the nuisance is becoming a thing of the past; and there are no doubt many who regret that attention had not been given to the warnings of their Medical Officer of Health. Ages at Death.—If Table XXIX. be consulted it will be found that at each period of life up to and including the age period 55-65, there was a decrease in the number of deaths as compared with the mean of the similar periods of life during the preceding ten years. Thus among infants (0-1) there were 1,033 registered as compared with a mean of 1,045. The deaths were, however, 256 more than were registered in 1910 ; and, indeed, they exceeded the numbers registered in 1907, 1908 and 1909, in which years they were respectively 996, 894 and 841. The increase last year over the four years mentioned was mainly due to the prolonged and hot summer which we enjoyed. Among children from 1-5, however, the return of 475 deaths was 91 below the mean of the ten years 1901-10; and it was also the lowest recorded, with one exception, in any of these years. In the age period 5-15 there were 147 deaths registered, which were only better on four occasions in twenty years, namely: in 1903, 46 1911] 1905, 1906 and 1909. The age period from 15-25 was responsible for only 161 deaths, or 20 below the average of the preceding ten years and it was only as good on two previous occasions in twenty years. Again, at the age period 25-35 there were only 232 deaths registered, or 59 below the return of the years 1901-10, and the return was smaller than any recorded during the twenty years 1891-1910. The return for the age period 35-45 was very good also, as it was 25 below the average of the preceding ten years, and was better on only three occasions in twenty years. Between 45-55 there was also a comparatively small mortality, for the returns only recorded 486 deaths, or 27 below the average of the preceding ten years, and it has only been so low on three occasions in twenty years. Among persons aged from 55-65 there were 591 deaths, or 18 below the average of the ten years 1901-10, which, with two exceptions, was the lowest return in twenty years. Hence onward at each period of life there was an increased mortality, for the 673 registered deaths between the ages of 65-75 were 24 above the average of the ten years 1901-10 ; while those of persons between 75-85, 482 in number, were 8 in excess of the average ; and those of persons 85 and upwards 149 in number, were 11 above it. This increase in the number of persons dying at the later periods of life, which was commented on in the Medical Officer of Health's report for 1909, is without doubt due to the larger number of old persons now living in the Borough, owing to the change in the age incidence of the population discussed in an earlier part of this report. Mortality in the Sub - Districts.—The number of deaths in the seven sub-districts varied from 399 in Tufnell, to 1,136 in Islington South East; while the death-rates ranged from 11.89 per 1,000 in Tufnell, to 17 0 in Barnsbury. Tufnell Sub-District.—There were 399 deaths registered, which is the smallest number known since the district was formed. It is 25 less than in the preceding year, and 66 less than the average of the past nine years. The death-rate (11'89) is also the lowest since the formation of the sub-district, as well as the lowest for any of the sub-districts during the year. Upper Holloway,—599 deaths, equal to a death-rate of 16.1 per 1,000 of the population, were registered. This mortality is the highest recorded since 1902, when 605 occurred, and was partly due to an increase in the deaths under a year old. 47 [1911 Tollington.—Here the deaths numbered 403, which is 11 in excess of those registered in 1910, but 40 below the average since 1902. They were equal to an annual death-rate of 13.20 per 1,000 of the population of the district. Lower Holloway.—In this district the deaths were 023 in number, which is 24 above the number registered in the preceding year, although 24 below the average of the preceding nine years. The death-rate was 15.84 per 1,000 Highbury.—The death returns were particularly satisfactory, as the deaths, 749 in number, were not only 64 below the average of the nine years 1902-1910, but also below the lowest return in those years. The death-rate was 12.09 per 1,000 of the population. Barnsbury.—The mortality in this district was below the average of the preceding nine years, the number of deaths registered having been 901, as compared with 919 in the years 1902-10. It is, nevertheless, 101 above the return for the preceding year, which was a remarkably healthy one. The infantile mortality was alone responsible for 72 of this increase. The death-rate was 17'0 per 1,000. Islington South-East.—The returns gave 1,136 deaths, equal to a death-rate of 15-84 per 1,000 of its population, as compared with 1,159 deaths in the preceding nine years. SEASONAL MORTALITY. First Quarter.—The deaths numbered 1,392, or 123 less than the corrected average (1,515) of the ten years (1901-1910), and were equal to an annual death-rate of 15.66 per 1.000, as compared with a mean decennial rate for this quarter of the year of 17.05 per 1,000. The mortality, in proportion to population, was very low, when comparison is made with the death-rates of the corresponding quarters of the years 1886-1910. The highest mortality occurred in the last week of February, and the lowest in the second week of March, at which periods the death-rates were respectively 17.89 and 13.64 per 1,000 annually. Second Quarter—The deaths entered in the returns numbered 1,053, or 80 less than the corrected average (1,133) of the ten years (1901-1910). They were equivalent to the low annual death-rate of 12.87 per 1,000, as compared with a mean decennial rate for this quarter of the year of 13.85 per 1,000. The highest mortality occurred in the third week of April, and the lowest in the third week of May, at which periods the death-rates were respectively 17.53 and 8.92 per 1,000 annually. 48 1911] Third Quarter.—There were 1,22.4 deaths registered, or 174 less than the corrected average (1,050) of the ten years (1901-1910). They represented an annual death-rate of 14.96 per 1,000, as compared with a mean decennial rate for this quarter of the year of 12.83 per 1,000. The mortality, in proportion to population, was higher than has been experienced in the borough in the third quarters of the past six years, yet it compares favourably with the death-rates of the preceding years 188G-1904. The highest mortality occurred in the second week of September, and the lowest in the third week of July, at which periods the death-rates were respectively 1912 and 9 40 per 1,000 annually. Fourth Quarter.—1,141 were recorded, or 191 less than the corrected average (1,332) of the ten years (1901-1910). They were equal to the low annual death-rate of 13.94 per 1,000, as compared with a mean decennial rate for this quarter of the year of 16.28 per 1,000. The highest mortality occurred in the third week of December, and the lowest in the second week of November, at which periods the death-rates were respectively 16.6 and 10.68 per 1,000 annually. The death-rate is the lowest on record for any corresponding period. Table XXV. Showing the Estimated Poplations, together with the Deaths and Deathrates from All Causes, at Nine Age-periods of life among Males, Females, and Persons. Males. Females. Persons. Ages. Population. Deaths. Death Rates. Population. Deaths. DeathRates. Population. Deaths, DeathRates. 0—5 17,008 825 48.50 16.686 683 40.93 33,694 1,508 44.75 5—15 29,229 84 2.87 29,121 63 2.16 58,350 147 2.52 15—25 28,010 77 2.75 30,865 84 2.72 58,875 161 2.73 25—35 27,475 120 4.37 30,530 112 3.66 58,005 232 4.00 35—45 21,363 212 9.92 23,823 169 7.09 45,186 381 8.43 45—55 15,621 264 16.90 17,731 222 12.52 33,352 486 14.57 55—65 10,158 322 31.70 12,064 269 22.30 22,222 591 26.60 65—75 5,418 316 58.32 7,485 357 47 70 12,903 673 52.16 75 and upwards 1,548 229 147.94 3,112 402 129 20 4,660 631 135.42 All ages 155,830 2,449 15 72 171,417 2,361 13-77 327,247 4,810 14.70 †The deaths of 640 persons who had come from other districts of London for treatment in the Public Institutions, etc., of Islington are excluded from these returns, while the deaths of 807 residents who had died in Institutions, &c., outside the district are included. 49 [1911 Table XXVI. Showing the Deaths and Death Rates from All Causes in the Wards during the Four Quarters or 1911. Wards. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Year. Deaths Deathrates. Deaths. Deathrates. Deaths. Death- rates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 108 12.8 7 92 i0*g6 97 11.56 102 12.15 399 11.89 Upper Holloway 175 18.81 133 I4'29 138 14.83 153 16.45 599 16.10 Tollington 103 13.49 106 13-88 103 13.49 91 11.92 403 13.20 Lower Holloway 186 18.92 120 12*20 186 18.92 131 13.33 623 15.84 Highbury 112 13.26 83 9*83 118 13.98 94 11.13 407 12.05 Mildmay 76 12.72 66 11*04 66 11.04 80 13.38 288 12.05 Thornhill 146 18.55 117 14*86 158 20.07 136 17.28 557 17.70 Barnsbury 105 19.53 84 1562 77 14.32 78 14.51 344 15.99 St. Mary's 79 18.70 62 14*67 54 12.78 69 16.33 264 15.62 Canonbury 138 19.10 89 12*32 95 13.15 93 12.87 415 14.36 St. Peter's 164 21.75 101 I3-39 132 17.50 114 15.11 511 16.94 The Borough 1,392 17.01 1,053 12,87 1,224 !4.96 1,14! 13.94 4,810 14.70 N.B. The heavy figures show the healthiest Ward in the several periods to which they refer. E TABLE XXVII. ing the Deaths and Death Rates together with the mean Mortality of the Sub-Districts for the Seven Years, 1904-10 and during the Year, 191 DEATHS. DEATH-RATES. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Average 1904-10. 1911 1904. 1905. 1906. 1907. 1908. 1909. 1910. Average 1904-10. 1911 rfnell 571 483 432 482 425 440 424 465 399 17.57 14.79 13.17 14.62 12.59 13.23 12.69 14.11 11.8 pper Holloway 523 550 542 559 485 558 535 536 599 14.94 15.57 I5.20 15.54 13.12 15.25 14.50 14.91 16.1 bllington 475 428 425 480 396 430 392 432 403 14.46 13.16 I3.2I 15.07 12.32 13.79 12.70 13.56 13.2 ower Holloway 693 644 721 644 571 617 599 641 623 17.00 15.88 17.87 16.04 14.03 15.53 1516 15.97 15.8 ighbury 775 837 779 816 816 793 759 796 749 12.26 13.28 12.39 13.02 12.8l 12.73 12.21 12.70 12.0 arnsbury 963 897 967 949 885 872 802 905 901 17.83 16.65 18.00 17.72 16.25 16.37 15.09 16.89 17.0 lington, S. East 1,236 I,Il6 1,184 1,149 1,101 1,208 1,012 1,144 1,136 16-65 15.11 16.11 15.71 14.84 16.68 14.04 !5.64 15.8 he Borough 5.236 4.955 5,050 5,079 4,679 4,918 4.523 4,919 4,810 15.74 14.93 15.25 15.37 13.93 14-96 13.79 14.90 14.7 51 [1911 Table XXVIII. Showing the Deaths and Death-Rates of Islington in 1911, and in the four quarters of the year, and of the County of London and the Great Towns during the same period, the mean Borough Death-Rates for the years 1901-10, and the deaths and death-rates in the year 1910. Quarter. Males Females. Total. Death Rates. 77 Great Towns, 1911. Islington, 1911. Islington, 1901-10. London, 1911. First 705 687 1,392 17.01 17.70 17.1 16.8 Second 548 505 1,053 12.87 13.85 13.2 13.8 Third 668 556 1,224 14.96 12.83 15.5 16.6 Fourth 528 613 1,141 13.4 16.28 14.3 14.7 The Year 1911 2 449 2,361 4 810 14.70 15.16 15.0 15.5 1910 2,313 2,210 4,523 13.79 14.70 13.4 14.2 Increase + 136 + 151 + 287 + 0.91 -0.46 + 1.6 + 1.3 52 1911] Table XXIX. Showing the Ages at Death during the Years 1901—1910 and in 1911. Years. AGES. 0—1 1—5 All under 5 yrs. 5—15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85 upwards All above 5 yrs. Totals. 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 39o 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 1,320 161 170 257 408 471 597 637 510 148 3,359 4.679 1909 841 560 1,401 140 144 271 415 539 600 692 544 172 3,517 4,918 1910 777 515 1,292 150 146 235 341 479 607 636 495 142 3,231 4,523 Mean. 1,045 566 1,611 155 181 291 406 5i3 609 649 474 138 3,416 5,027 1911 1,033 475 1,508 147 161 232 381 486 591 673 482 149 3,302 4,810 Increase or Decrease -12 -91 -103 -8 -20 -59 -25 -27 -18 +24 + 8 + 11 -114 -217 53 [1911 Table XXX. Showing the Deaths and Death-rates from All Causes in the Four Quarters and in the Sub-districts, together with the Death-rates of the Borough during the same periods. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South-east 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 108 12.87 175 18.81 103 13.49 186 18.92 208 13.43 251 18.95 361 2014 1,392 17.01 Second Quarter 92 10.96 133 14.29 106 13.88 120 12.20 163 10.52 201 15.17 238 13.27 1,053 12.87 Third Quarter 97 11.56 138 14.83 103 13.49 186 18.92 192 12.39 235 17.74 273 15.23 1,224 14.96 Fourth Quarter 102 12.15 153 16.45 91 11.92 131 13.33 186 12.01 214 16.15 264 14.72 1,141 13.94 The Year 399 11.89 599 16.10 403 13.20 623 15.84 749 12.09 901 17.00 1,136 15.84 4,810 14.70 N.b.—The heavy figures show which was the healthiest sub-district in the quarters to which they refer. 54 1911] Table XXXI. Showing the Deaths and Death-Rates from All Causes for each Quarter since 1888. (The Lowest Death Rate in each quarter is printed in heavy type.) Years. QUARTERS. First. Second. Third. Fourth. Year. Deaths Death Rates. Deaths Death Rates. Deaths Death Rates. Deaths Death Rates. Deaths Death Kates. 1888 1,629 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 1,282 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 1,421 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 15.98 1902 1,796 21.50 1,220 14.60 1,149 13.76 1,470 16.34 5,635 16.55 1903 1,383 16.59 1,226 14.71 1,031 12.37 1,199 14.39 4,839 14.52 1904 1,436 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 15.26 1907 1,640 19.86 1,224 14.82 939 11.37 1,276 15.45 5,079 15.38 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 1910 1,237 15.08 974 11.88 882 10.75 1 430 17.44 4,523 13.79 Corrected Mean 23 years 1,594 19.49 1,232 15.07 1,189 14.53 1,407 17.19 5,422 16.57 1911 1,392 17.01 1,053 12.87 1,224 14.96 1,141 13.94 4,810 14.70 Increase or Decrease -202 -2-48 -179 -2.20 + 35 + 0.43 -266 -3.25 -612 -1.87 55 [1911 Table XXXII. Showing the Deaths and Death-rates from eleven Classified Diseases in the Sub-Districts and in the Borough. Classified Diseases. Tufnell Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. South-East Islington. The Borough. Deaths. Death Rates. Death Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Death. Death Rates. Deaths. Death Rates. Miasmatic 21 0.62 44 1.18 25 0.82 37 094 43 0.69 68 1.28 90 1.25 328 1.00 Diarrhœal 22 0.65 30 0.80 31 1.01 53 1.35 38 0.61 87 1.64 63 0.88 324 0.99 Constitutional 92 2.74 117 3.14 88 2.88 130 3.31 162 2.61 142 2.68 212 2.96 943 2.88 Developmental 42 1.25 50 1.34 30 0.98 52 1.32 60 0.97 100 1.89 93 1.30 427 1.30 Nervous 24 0.71 55 1.48 25 0.82 26 0.66 37 0.59 49 0.92 59 0.82 275 0.84 Circulation 56 1.67 98 2.63 44 1.44 80 2.03 114 1.84 94 1.77 147 2.05 633 1.93 Respiration 59 1.76 83 2.23 74 2.42 99 2.52 132 2.13 182 3.43 226 3.15 855 2.61 Digestive Organs 29 0.86 48 1.29 32 1.05 50 1.27 51 0.82 55 1.04 72 1.00 337 1.03 Urinary System 19 0.56 24 0.64 12 0.39 25 0.63 39 0.63 38 0.72 60 0.83 217 0.66 Violence 13 0.39 17 0.46 22 0.72 23 0.58 29 0.47 46 0.87 53 0.74 203 0.62 Ill-defined 8 0.24 16 0.43 10 0.32 25 0.63 20 0.32 21 0.39 22 0.30 122 0.37 The heavy figures denote that these death-rates were the highest experienced in the several districts during the year from the diseases mentioned. 56 1911] Table XXXIII. Showing the Deaths (arranged in Classes) from All Causes, in the Four Quarters. Classified Causes of Death. Quarters. Year. 1st. 2nd. 3rd. 4th. I. Specific or Febrile Causes 190 100 331 97 718 1. Miasmatic Diseases 157 82 45 44 328 2. Diarrhoeal ,, 10 10 274 30 324 3. Malarial ,, .. .. .. .. .. 4. Zoogenous „ .. 1 .. .. 1 5. Venereal ,, 3 3 4 3 13 6. Septic ,, 20 4 8 20 52 II. Parasitic Diseases .. 1 .. 1 2 III. Dietic 4 1 11 2 18 IV. Constitutional Diseases 256 239 228 220 943 V. Developmental 103 101 101 122 427 VI. Local 753 529 470 625 2,377 1. Diseases of Nervous System 84 63 62 66 275 2. ,, Organs of Special Sense 4 2 3 5 14 3. ,, Circulatory System 194 138 131 170 633 4. ,, Respiratory „ 334 197 87 237 855 5. ,, Digestive ,, 66 75 118 78 337 6. ,, Lymphatic „ 4 1 .. 5 10 7. ,, Urinary „ 60 44 62 51 217 8. ,, Reproductive „ 1 4 3 4 12 9. ,, Bones and Joints 4 5 2 8 19 10. „ Integumentary System 2 .. 2 1 5 VII. Violence 49 50 53 51 203 1. Accident or Negligence 38 40 38 44 160 2. Homicide 1 .. 2 1 4 3. Suicide 10 10 13 6 39 4. Execution .. .. .. VIII. Ill-defined Causes 37 32 30 23 122 All Causes 1,392 1,053 1,224 1,141 4,810 Note—The heavy figures denote that the diseases to which they are applied were most fatal in the Quarter to which they refer. 57 [1911 Table XXXIV. 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 1911. England and Wales 15 9 133 15 5 13 6 14 C 77 Great Towns 16 R 13 8 16-6 14 7 155 136 Smaller Towns 15 4 12 4 15 0 12-6 13 8 England and Wales less the 213 Towns 15 4 13 1 14 5 12 7 13 9 County of London 17 1 13 2 15 5 14 3 15 0 Bristol 17 0 14 6 15 1 13 6 15 J Birmingham 17 8 15-3 18 2 15 8 16-8 Liverpool 20 0 18 3 22 6 18 9 •200 Manchester 16 9 15 9 188 16-4 170 Leeds 17 3 14 1 181 15 9 16-4 Sheffield 21 3 135 15 4 14-2 16 1 The Encircling Boroughs 18.0 13.2 16.2 14.8 15.4 St. Pancras 18.7 13.4 15.0 14.8 15.5 Stoke Newington 16.0 11.7 11.4 12.9 13.0 Hackney 15.9 13.3 13.8 14.3 14.3 Hornsey 10.1 9.1 9.3 9.3 9.5 Finsbury 23.3 16.1 20.4 19.0 19.8 Shoreditch 23.7 17.3 21.3 17.9 20.1 Islington 17.01 1287 14.96 13.94 14.70 58 [1911 INFANTILE MORTALITY. 1,033 deaths were registered among the 8,113 births which were entered in the returns, so that the death-rate among infants was equal to 127 per 1,000 of the births, which is the highest rate known since 1904, when it was 128. It also compares with 136, the average rate for the preceding twenty-five years, which is a decrease of only 3.4 per cent. It contrasts also with an average death-rate of 143 which obtained in the seventy years 1841-1910, on which it shows a decrease of only 11.2 per cent. These reductions are not much to be proud of considering that the general death-rate last year was just 10 5 per cent. below the mean rate for the twenty-five years, and 25.0 per cent below that for seventy years, during all of which, with slight variations, the death-rate from all causes was steadily improving, while the infantile mortality rate remained practically stationary. Death-rates from Infant deaths per all causes. 1,000 Births. 1841-1850 19.28 146 1851-1860 21.43 143 1861-1870 24.64 153 1871-1880 20.28 147 1881-1890 18.55 144 1891-1900 17.72 148 1901-1910 15.17 120 Mean death-rate 19.58 143 1911 14.86 129 These figures bear out the statement given above. When we come to examine the returns for last year in the several parts of the borough, some of them will be found to be very bad, and suggestive of the inquiry as to why the proportion of deaths to births should be excessive in some districts as compared with others. These are the records for the several sub-registration districts:— 59 |1911 Deaths per 1,000 Births Deaths. 1911. 1910. Tufnell 65 85 78 Upper Holloway 109 115 88 Tollington 97 131 88 Lower Holloway 160 162 108 Highbury 130 104 82 Barnsbury 243 162 111 South-East Islington 229 128 94 The Borough 1,033 129 95 Here we see that whereas the mortality was only 85 per 1,000 births in Tufnell, it was as high as 162 in both Lower Holloway and Barnsbury. Why was there this great difference? The answer can be expressed in a few words; lack of education, and want of knowledge as to how to rear the infants. These are the poorer districts, where we find mothers, who although they love their children just as dearly as the rich, for "Lawdy! all the best mothers don't live up the West," yet rear them injudicially; and in their anxiety to do full justice to their offspring, feed them on many things which are absolutely injurious, wanting that advice and guidance which their more fortunate sisters elsewhere receive from their physicians, their trained nurses, and their experienced mothers. Their breast milk is as good, if not better than that of many more wealthy mothers; and even among the very poor, according to a report recently issued by the Medical Officer of Health of Birmingham, where many samples of milk were obtained from 18 nursing mothers in a poor-class district, there was nothing to show that the milk of the robust woman was better than that of the weakly woman, ana that the age of the mother or the number of the children she had had made apparently no appreciable difference in the composition of the milk. The solids, not fat, in the specimens examined were very constant, averaging 8 4 per cent., while the variations in amount was from 7.7 per cent. to 9.3 per cent. Altogether 130 samples of the milk of these eighteen women were examined. All of them were taken from women who were more or less in a poverty-stricken condition, but who were receiving one substantial meal during five days a week; and it was found that the percentage of fat on these days increased in nearly all cases, and diminished when the meals were discontinued. 60 1911] It is the knowledge of such facts as these that makes Medical Officers of Health anxious to give advice to women as to how they should feed themselves, and to bring the poorest women into touch with those charitable organisations which are ready to assist them in procuring suitable nourishment, so that they may give abundant and good breast milk to their infants. This is one direction in which an effort should be made to prevent the waste of infant life which is continuously going on—a waste, unfortunately, which too many persons deliberately ignore. So patent is this fact that Mr. William Schooling, so well known as an Actuary, and who is a great authority on life insurance, in an article published in the Daily Telegraph on April 27th of this year, felt constrained to write:— "We are appalled by the sinking of the Titanic,, or by a volcanic eruption "that devastates a neighbourhood and destroys many lives, but we lack the imagination to see that consumption and infantile mortality are causing "annually a far greater loss of life than many Titanic disasters in quick "succession. We are rightly insisting upon the adoption of all possible "measures for preventing the repetition of any such loss of life as followed "from the sinking of the Titanic. We, for the most part, do not stir a little "finger for the adoption of preventive measures, which are known to be "practicable, for the diminution of disease and the prevention of premature "death. "I am not in the least urging that sympathy with the sufferers from the "Titanic disaster is anything but good, and a fine tribute to the character of "the nation. But it may be urged that there are invisible forces at work, "submerged icebergs in the social sea, causing an appalling moitality, and a "shudder-causing amount of suffering among the community which can be and "should be prevented. There is talk that the absence of field glasses may have "prevented the sighting of the iceberg which sent the Titanic to the bottom. "Is it not the case that people as a whole are declining to use the mental "glasses which are available, and which would show them how to avoid »/ " they would the causes of disease that are doing such damage to the life " of the nation?" These facts, so tersely put, have for many years been incessantly placed by the Medical Officer of Health before his Council and his Public Health Committee, but hitherto without success in obtaining the machinery to enable him to deal with this great loss of life among our infants, as well as the prevention of the irreparable damage to so many of those who survive. 61 [1911 In 1907 he presented a detailed report on the Prevention of Infantile Mortality (a subject about which he first wrote more than thirty years ago, as well as on many occasions since), and to that report he would direct the attention of the Council. The facts contained in it remain uncontroverted because they are incontrovertible. Several of them have been quoted again and again by persons who are considering this great question,, and they have been referred to in the report of the Royal Commission on the Poor Laws. The document, however, remains a dead letter on the book-shelf in Islington, which some day, when the writer may have gone hence, may be adduced as a proof of the want of the due appreciation by the Council of that day of what was passing around them, and of their declining to use the mental glasses to which Mr. Schooling alludes. Let us look for a moment at some of the chief causes of this mortality among infants:— Measles destroys on an average 32 per annum, in 1911 28 Diphtheria „ 52 „ „ 31 Diarrhœal diseases „ 126 „ „ 227 Premature birth „ 167 „ „ 149 Atrophy and Marasmus „ 180 „ ,, 115 Tuberculous diseases „ 66 „ „ 40 Bronchitis „ 91 „ „ 51 Pneumonia ,, 111 „ „ 100 Convulsions „ 42 „ „ 117 Suffocation „ 64 „ „ 92 All these deaths are more or less preventable, even those due to premature birth. And yet when this subject was discussed some years ago, much laughter was created by a Councillor who commented on the inclusion by the Medical Officer of Health of the deaths due to this cause—and, indeed, it was described as nonsense. But what is the fact? There is hardly a death from any cause so assuredly preventable, because frequently it only requires that the mother should be reached while in a pregnant state, particularly if she has been prematurely confined on a previous occasion, and advised as to what she should do, so as to bring her offspring into the world, fully developed, strong, and healthy. And the chief advice is to refrain from work, and to rest, or to cure some abnormal habit of body. Many infants would be saved if the mothers were reached in time; and it is for this, among other reasons, that institutions have been established where expectant mothers are afforded an opportunity of consulting proper advisers as to what they should do so as to bear healthy progeny. We have no such institution in Islington. Would that we had ! 1911] 62 With respect to the deaths from the diarrhœal diseases, the inquiries made by the staff of the Public Health Department show that many of them were undoubtedly due to improper feeding, for it has been found that in five years only 39 deaths out of 363 due to diarrhoea, occurred among infants who were fed on the breast alone. Thus there were only 10.7 per cent. who were fed on the breast alone, and 89.3 per cent. otherwise. The facts are all set out in Tables XXXVII. and XXX VI11. Can any sentient person deny that much can be done to prevent all the improper feeding that these Tables represent? And recollect they only refer to a portion, although the greater portion, of the infants destroyed by one class of disease, and that therefore they do not show how many have been slain, or how many have been maimed for life by other diseases due to improper feeding. They must, however, set us thinking, and make us ask ourselves—What must we do to save these children from disease and death? The answer has been given in the reports of the Medical Officer of Health. It is to be found constantly in the press of this country, for happily able men, who guide that great institution, have grasped the situation, although perhaps as yet not quite fully, and have from time to time opened their columns to most valuable contributions on the subject. These journals can do a great deal to encourage timid communities in doing their full duty, not in a half-and-half manner, by adopting half and-half measures, but to its fullest extent. Long years ago the Carthagenians sacrificed their children to a mythical deity, Saturn, and those of them who had no children bought those of the poor at a price for the purpose, and slew them, amidst the blowing of flutes and hautboys and the beating of drums and timbrels that their cries might not be heard. Are not we in these countries and in these modern days also annually sacrificing thousands of our children on the altar of ignorance by failing to dispel it and to replace it with knowledge? Surely we are! If the premises be correct that want of knowledge is the cause of so many deaths—and who can deny it? for to do so would mean a charge of deliberate murder against those mothers who improperly feed their children—then there can be no denial of the obligation that rests on sanitary authorities to spread the necessary knowledge far and wide, so that an end may be put forever to the annual holocaust which disgraces modern civilisation. During the last few years two National Conferences have been held on infantile mortality in London, and before long it is probable that International Conferences will be held on the same subject. Truly it is time that the nations professing the Christian religion, to whose Divine Founder little children were very dear, took up the subject! For, indeed, they have closed their eyes and ears far too long to the woes of the infants in their 63 [1911 midst; and have, therefore, failed to do their duty towards their progeny, whose premature deaths, apart from those caused by the ill-feeding already mentioned, are due in such innumerable instances to entirely preventable causes. Last year the Local Government Board drew special attention to the excessive mortality among children in the summer months in a circular addressed to the Sanitary Authorities of England and Wales, suggesting " the lines along which it was most important that action shou'd be taken, but they do not wish it to be understood that this advice covers the entire ground, or that it does not need to be supplemented by action directed towards the special needs of individual districts." And what is the advice they tender at the very outset? It is as follows :—Firstly, it is important that exact advice should be given as to the feeding and management of children, and more generallv as to preventing the exposure of their food to contamination from decomposing organic matter. The distribution of clearly worded leaflets is useful in this connection. But even more important are personal visits and the offer of practical advice to the MOTHERS OF BABIES BORN WITHIN THE LAST TWELVE MONTHS, and simple instructions are most likely to be followed if given during a period of special danger." In that circular the Board write that they "would be glad if the Medical Officer of Health, in his annual Report dealing with the current year (1911), will set out the course of action adopted in the district to prevent diarrhoea and child mortality generally in the special circumstances of the present year." What is to be his reply? Why, what can it be but that his Council have ignored the advice, which he has again and again tendered to them, to appoint Health Visitors to pay those " personal visits " and offer that " practical advice " which the Board deem of the first importance. • Several leaflets have, however, been issued of an instructive and educational character, which have been much more appreciated by educated women, even in good positions in life, than by the very poor, whose want of learning does not enable them to understand instructions, simple though they are, without personal explanation. The following are the titles of the leaflets:— 1911] 64 " Hints on the care and feeding of infants for the guidance of mothers." " Directions for the prevention of diarrhœa." " Hints about Babies." " Why infants should be fed at their Mothers' Breasts." " Directions respecting Ophthalmia Neonatorum, otherwise Purulent Disease of the Eyes of New Born Children" " The House Fly: sometimes called the Typhoid Fly. A Menace to Life." Copies of each of these are sent to the mother of every infant on the day on which the information of its birth is received by the Medical Officer of Health. There is no doubt that these leaflets have done good among certain classes, who are able to appreciate them, but, unfortunately, where most required, that is among the very poor, they are least appreciated. It is these people whom it is so necessary to reach with those personal visits which the Local Government Board so strongly recommend, and which are now made by the Health Visitors of every Sanitary Authority of importance in the Kingdom. TABLE XXXV. Showing the Deaths among Infants per 1,000 Births during the year 1911 and also the mortality rates for the years 1902-10. Sub-Districts. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Mean 1902 10. 1911. Increase or decrease on mean. Tufnell 123 112 141 12 7 122 127 81 107 78 113 85 -28 Upper Holloway 103 125 92 101 105 88 74 77 88 95 115 +20 Tollington 144 124 128 117 127 132 117 96 88 119 131 + 14 Lower Holloway 156 141 161 151 155 148 125 101 108 138 162 +24 Highbury 114 122 98 117 95 107 101 93 82 92 104 +12 Barnsbury 151 127 142 124 138 123 119 111 111 127 162 +35 South East Islington 130 128 134 121 129 104 99 117 94 117 128 + 11 The Borough 132 126 128 123 125 117 103 103 95 117 129 +12 65 [1911 TABLE XXXVI. Showing the Mortality per 1,000 Births among Infants under one year of age in the three years 1901-03; in the ten years 1901-10; and in 1911 from certain specified causes. Causes of Death Mean rate of 3 years 1901-2-3 per 1,000 Births. 1911. Mean rate 10 years 1901-10 per 1,000 Births. Premature Birth and Congenital Defects 24.25 23.08 23.81 Bronchitis and Pneumonia 25.07 18.14 21.98 Atrophy and Marasmus 20.54 16.18 17.30 Diarrhœal Diseases (all forms) 19.01 37.63 19.46 Convulsions 6.66 2.13 4.12 Whooping Cough 6.44 3.89 5.38 Measles 3.27 3.51 3.55 Phthisis 1.85 0.50 1.03 Other forms of Tuberculosis 5.68 5.27 5.26 Diphtheria 0.43 0.25 0.34 Total of above 113.80 111.38 102.23 All other causes 18.91 18.19 17.40 Total 132.71 129.57 119.63 66 1911] TABLE XXXVII. Particulars of Investigations into the Deaths of Infants from Diarrhœa during the five years 1907-11. Ages of Infants in three monthly periods. Total under twelve months. Total for 5 years. 0—3. 3—6. 6—9. 9—12. 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907-11 Food of Infants. Breast milk only 3 3 .. 1 6 1 2 1 2 2 .. .. .. 3 4 1 1 1 1 7 5 6 2 7 19 39 Cows' milk only 4 9 3 1 11 6 14 5 3 20 7 11 6 3 18 6 .. 1 2 11 23 34 15 9 60 141 Condensed milk only .. 2 1 .. 8 2 1 4 .. 18 1 3 2 .. 9 1 .. 2 2 5 4 6 9 2 40 61 Artificial foods only .. .. 1 .. .. .. .. .. .. 3 .. 3 .. .. 5 3 .. .. .. 5 3 3 1 • • 13 20 Ereast & cows' milk. I 3 .. .. 3 2 1 .. 3 5 .. 2 1 .. 1 2 .. .. 1 5 5 6 1 4 14 30 ,, condensed milk .. 1 .. .. 4 .. .. .. .. 4 .. .. .. .. 4 .. .. 1 .. .. .. .. 1 • • 4 16 ,, artificial foods .. .. .. .. .. .. 1 .. 1 6 .. 1 1 .. 2 .. .. 1 .. 6 .. 2 2 1 14 19 Mixed foods .. .. .. .. .. 1 1 .. .. .. .. .. 1 .. 8 .. 3 .. .. 2 1 4 1 .. 10 16 Not stated .. .. .. .. .. .. .. .. .. 6 .. 1 1 1 4 .. .. .. 1 4 .. 1 1 2 17 21 8 18 5 2 35 12 20 10 9 64 8 21 12 7 55 13 4 6 7 47 41 63 33 25 201 363 State of Mother's Health. Good health 3 16 4 1 24 7 11 5 7 34 8 13 9 5 34 10 3 5 4 35 28 43 23 17 127 238 Moderate 3 1 1 .. 3 2 4 1 1 9 .. 4 2 1 10 .. 1 .. 1 6 5 10 4 3 28 50 Bad 2 1 .. 1 5 3 5 4 1 14 .. 3 .. 1 5 3 .. 1 1 3 8 9 5 4 27 53 Not stated .. .. .. .. 3 .. .. .. .. 7 .. 1 1 .. 6 .. .. .. 1 3 .. 1 1 1 19 22 8 18 5 2 35 12 20 10 9 64 8 21 12 7 55 13 4 6 7 47 41 63 33 25 201 363 Mother's State as to Occupation. No occupation 6 15 4 .. 27 6 16 7 . . 43 7 15 6 1 36 5 .. 5 .. 34 24 46 22 1 140 233 Occupied at work 2 3 1 .. 5 6 4 3 8 15 1 5 5 5 15 7 4 1 6 10 16 16 10 19 45 106 Unknown .. .. .. 2 3 .. .. .. 1 6 .. 1 1 1 4 1 .. .. 1 3 1 1 1 5 16 24 8 18 5 2 35 12 20 10 9 64 8 21 12 7 55 13 4 6 7 47 41 63 33 25 201 363 Method of Feeding. Breast 3 3 .. 1 6 1 2 1 2 2 .. .. .. 3 4 1 1 1 1 7 5 6 2 7 19 39 Bottle with tube 2 7 2 .. 2 5 9 5 3 4 3 13 7 2 5 8 .. 4 3 6 18 29 18 8 17 90 Bottle (boat shape) without tube 2 7 2 1 22 6 8 4 4 49 5 6 3 1 37 3 .. 1 2 25 16 21 10 8 133 188 Spoon 1 1 1 .. 2 .. .. .. .. 3 .. 1 .. .. 2 1 2 .. .. 1 2 4 1 .. 8 15 Otherwise .. .. .. .. .. 1 .. .. .. .. .. 1 .. 2 .. 1 .. .. 2 .. 2 1 .. 4 7 Not stated .. .. .. .. 3 .. .. .. .. 6 .. 1 1 1 5 .. .. .. 1 6 .. 1 1 2 20 24 8 18 5 2 35 12 20 10 9 64 8 21 12 7 55 13 4 6 7 47 41 63 33 25 201 363 67 [1911 Table XXXVII.—continued. Ages of Infants in three monthly periods. Total under twelve months. Total for 5 years. 0—3. 3—6. 6—9. 9—12. 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 1908 1909 1910 1911 1907 11 Method used to cleanse Feeding Apparatus. Scalding water 2 2 .. .. 6 6 3 3 2 15 1 5 3 .. 9 5 .. 1 1 5 14 10 7 3 35 69 Hot 1 4 .. .. 1 .. 1 3 .. 2 1 3 1 1 2 .. .. 1 .. 1 2 8 5 1 6 22 Hot water and soda.. 1 3 2 .. 12 2 9 2 2 21 3 6 2 2 20 .. .. 2 1 15 6 18 8 5 68 105 Cold water .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 .. .. 1 2 Brush and hot water .. 3 2 1 4 3 4 1 2 14 3 4 4 .. 8 6 .. 1 3 9 12 11 8 6 35 72 Otherwise 1 .. 1 .. .. .. 1 .. .. 1 .. .. 1 .. 2 1 .. .. .. .. 2 1 2 .. 3 8 Not stated (including 39 at breast) 3 6 .. 1 12 1 2 1 3 11 .. 2 1 4 13 1 4 1 2 17 5 14 3 10 53 85 8 18 5 2 35 12 20 10 9 64 8 21 12 7 55 13 4 6 7 47 41 63 33 25 201 363 No. of Rooms occupied by Family. 1 room .. 3 .. .. 6 .. 5 1 3 18 .. 2 4 .. 3 .. 1 2 1 7 .. 11 7 4 34 56 2 rooms .. 6 2 1 16 .. 8 6 2 16 .. 8 5 2 22 .. 1 2 2 19 .. 93 15 7 73 118 3 ,, .. 7 2 .. 8 .. 3 1 3 8 .. 5 2 5 16 .. .. 2 9 12 .. 15 7 10 39 71 4 ,, .. .. .. 1 6 .. .. .. .. 10 .. 2 .. .. 4 .. 1 .. 1 5 .. 3 .. 2 25 30 5 ,, or more .. 2 1 .. 1 .. 1 2 1 6 .. 1 .. .. 5 .. .. .. .. 4 3 1 12 20 Not stated .. .. .. .. .. 3 .. .. .. 2 .. .. 1 .. .. .. .. 3 .. 6 .. .. 4 10 Unknown .. .. .. .. 3 .. .. .. .. 6 .. 1 1 .. 4 .. .. .. 1 1 .. 1 1 1 14 17 .. 18 5 2 35 .. 20 10 9 64 .. 21 12 7 55 .. 4 6 7 47 63 33 25 201 322 State of Rooms as to Cleanliness. Clean 8 13 5 2 28 12 15 8 7 52 8 16 6 5 44 12 2 3 6 36 40 46 22 20 160 288 Dirty .. 4 .. .. 1 .. 3 1 1 4 .. 3 3 .. 3 .. .. 2 .. 5 1 12 6 1 13 33 Unwholesome .. .. .. .. 2 .. 1 .. 1 2 .. .. .. 1 2 .. .. 1 .. 3 .. 1 1 2 9 13 Not stated .. 1 .. .. 1 .. 1 1 .. .. .. 1 2 1 2 .. .. .. .. 2 .. 3 3 1 5 12 Unknown .. .. .. .. 3 .. .. .. .. 6 .. 1 1 .. 4 .. .. .. 1 1 .. 1 1 1 14 17 Prevalence of F'lies. 8 18 5 2 35 12 20 10 9 64 8 21 12 7 55 13 4 6 7 47 41 63 33 25 201 363 Numerous .. 2 .. .. 14 .. 3 4 2 30 .. 5 1 .. 30 .. .. 1 .. 25 .. 10 6 3 99 118 Moderate .. .. .. .. 3 .. .. 1 .. 1 .. 4 1 .. 3 .. .. .. 1 2 .. 4 2 1 12 19 Few .. 2 3 1 12 .. 6 3 2 17 .. 3 5 2 11 .. .. 2 2 15 .. 11 13 7 55 86 (None noted .. 14 2 1 6 .. 11 2 5 13 .. 9 5 4 11 ... 4 3 4 5 .. 38 12 14 35 99 .. 18 5 2 35 .. 20 10 9 64 .. 21 12 7 55 .. 4 6 7 47 .. 63 33 25 201 322 68 1911] XXXVIII. Summary of Investigations into the Deaths of Infants from Diarrhoea during the five years 1907-11. Ages of Infants in three monthly periods. Total under twelve months. 0—3. 3—6. 6—9. 9-12. Food of Infants. Breast milk only 13 8 7 11 39 Cows' milk only 28 48 45 20 141 Condensed milk only 11 25 15 10 61 Artificial foods only 1 3 8 8 20 Breast and cows' milk 7 11 4 8 3 condensed milk 5 4 4 3 16 ,, artificial foods 8 4 7 19 Mixed foods 2 9 5 16 Not stated 3 6 7 5 21 68 115 103 77 363 State of Mother's Health. Good health 48 64 69 57 238 Moderate 8 17 17 8 50 Bad 9 27 9 8 53 Not stated 3 7 8 4 22 68 115 103 77 363 Mother's state as to occupation. No occupation 52 72 65 44 233 Occupied at work 11 36 31 28 106 Unknown 5 7 7 5 24 68 115 103 77 363 Method of Feeding. Breast 13 8 7 11 39 Bottle with tube 13 26 30 21 90 Bottle (boat shape) without tube 34 71 52 31 188 Spoon 5 3 3 4 15 Otherwise .. 1 3 3 7 Not stated 3 6 8 7 24 68 115 103 77 363 Method used to cleanse Feeding Apparatus. Scalding water 10 29 18 12 69 Hot 6 6 8 2 22 Hot water and soda 18 36 33 18 105 Cold water .. .. 2 .. 2 Brush and hot water 10 24 19 19 72 Otherwise 2 2 3 1 8 Not stated (including 39 at breast) 22 68 18 20 25 85 115 103 77 363 No. of Rooms Occupied by the Family. 1 rooms 9 27 9 11 56 2 rooms 25 32 37 24 118 3 ,, 12 15 28 16 71 4 ,, 7 10 6 7 30 5 ,, or more 4 10 6 .. 20 Not stated .. 3 3 4 10 Unknown 3 6 6 2 17 60 103 95 64 322 State of Rooms as to Cleanliness. Clean 56 94 79 59 288 Dirty 5 9 9 10 33 Unwholesome 2 4 3 4 13 Not stated 2 2 6 2 12 Unknown 3 6 6 2 17 68 115 103 77 363 Prevalence of Flies. . Numerous 16 39 37 26 118 Moderate 3 5 8 3 Few 18 28 21 19 86 None noted 23 31 29 16 99 60 103 95 64 322 5 TABLE XXXIX. 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 1905-1911. Ages at Death. Deaths. Deaths per 1,000 Births 1905. 1906. 1907. 1908. 1909. 1910. 1911. Total 7years 1905. 1906. 1907. 1908. | 1909. 1910. 1911. Total 7 years. Under 1 week 185 182 187 186 156 163 170 1,229 21.13 21.01 21.91 21.46 19.02 19.87 21.32 20.84 1—2 weeks 61 42 58 52 52 45 52 362 6.96 4.85 6.80 6.00 6.34 5.49 6.52 6.14 2—3 „ 54 49 51 33 26 41 34 288 6.17 5.66 5.98 3.81 3.17 5.00 4.26 4.88 3—4 36 35 34 39 35 29 37 245 4.11 4.04 3.98 4.50 4. 27 3. 54 4.64 4.15 Total under a month 336 308 330 310 269 278 293 2,124 38.37 35.56 38.67 35.77 32. 80 33. 90 36.74 3601 1—3 months 215 228 189 180 147 131 205 1,295 24.55 26.32 22.14 20.78 17.92 15.97 25.71 21.95 Total under 3 months 551 536 519 490 416 409 498 3,419 62.92 61.88 60.81 56.55 50.72 49.87 62.45 57.96 3-6 months 196 230 169 151 148 144 200 1,238 22.38 26.56 19.81 17.43 18.05 17.56 25.08 21.00 6—9 months 164 162 167 126 144 106 170 1,039 18.73 18.71 19.57 14.54 17.57 12.92 21.32 17.61 9—12 months 163 155 141 127 133 118 165 1,002 18.61 17.90 16.52 14.76 16.22 14.38 20.70 17.00 Total under 1 year 1,074 1,083 996 894 841 777 1,033 6.698 122.64 125.05 116.71 103.28 102.56 94..73 129.55 113.57 i9il] 70 Table XL. 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 1,387 143 1886 370 144 268 111 577 237 302 126 1,517 154 1887 288 117 323 132 580 239 366 153 1,557 160 1888 326 132 270 115 359 152 316 132 1,271 132 1889 421 164 162 94 376 164 302 130 1,261 131 1890 356 144 326 142 422 177 384 170 1,488 161 1886-90 1,761 141 1,349 113 2,314 195 1,670 142 7,094 147 1891 338 129 349 144 397 165 397 169 1,481 151 1892 425 171 295 122 384 164 313 136 1,417 145 1893 403 161 393 156 508 212 391 166 1,595 164 1894 313 125 267 113 363 154 286 123 1,229 127 1895 353 134 315 128 427 172 321 138 1,416 139 1891-95 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 319 145 221 102 166 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 1911 242 115 191 99 407 204 193 101 1,033 127 Note: The lowest infantile mortality rates in the periods of the year to which they refer are printed in heavy type. 1 ABLE ALL Showing the Chief Causes of Infantile Mortality in the fourteen years, 1897-1910 and in 1911. Cause of Death. Years. Mean 14 years. 1911 Differ ence. 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 i. Common Infectious Diseases. Small-pox 1 .. .. .. 1 4 .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 +1 Measles 12 65 27 42 37 24 29 51 27 36 27 24 31 21 32 28 - 4 Scarlet Fever 1 2 .. 2 2 1 1 1 .. 1 .. 3 1 .. 1 .. - 1 Diphtheria (including Membranous Croup 6 6 3 5 7 1 4 2 2 3 1 4 1 1 3 2 - 1 ii. Diarrhœal Diseases. Whooping Cough 58 67 66 68 38 76 63 30 51 30 53 29 36 61 52 31 - 21 Diarrhœa, all forms 138 220 208 148 143 72 83 200 149 171 73 80 46 33 126 227 + 101 |Enteritis, Muco-enteritis, Gastro-enteritis 65 105 159 67 70 43 46 20 53 92 49 52 26 38 63 73 + 10 Gastritis, Gastrointestinal Catarrh 8 9 13 21 21 23 22 18 15 14 9 7 23 15 16 9 - 7 iii. Wasting Diseases. Premature Birth 174 191 187 176 169 194 174 178 163 144 164 167 136 121 167 149 - 18 Congenital Defects 39 30 21 36 48 33 47 43 48 59 47 51 52 46 43 35 - 8 Injury at Birth .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 4 + 4 Want of Breast-milk, Starvation 3 2 2 1 5 2 7 6 4 5 8 4 4 .. 4 14 + 10 Atrophy, Debility, Marasmus 256 244 285 221 188 192 183 177 138 134 137 138 133 94 180 115 - 65 iv. Tuberculous Diseases, Tuberculous Meningitis 23 29 80 25 24 20 20 10 19 20 17 13 18 24 23 19 - 4 Tuberculous Peritonitis Tabes Mesenterica 55 48 30 25 26 25 20 20 24 17 17 14 20 14 25 11 - 14 Other Tuberculous Diseases 20 20 27 28 19 23 30 16 12 12 23 13 8 8 18 16 - 2 v. Other Causes. Erysipelas 2 .. 6 3 2 3 4 3 1 3 3 4 4 3 3 .. - 3 Syphilis 17 12 7 17 10 11 10 11 13 9 5 13 10 8 11 4 - 7 Rickets 6 4 8 2 5 3 1 4 3 5 .. 2 1 .. 3 6 + 3 Meningitis (not Tuberculous) 27 25 16 19 23 16 18 10 19 18 10 13 11 14 17 10 - 7 Convulsions 60 46 62 57 68 69 47 47 38 24 16 15 14 22 42 17 - 25 ( Bronchitis 129 129 124 119 104 116 90 78 77 82 83 39 55 50 91 51 - 40 Laryngitis 4 5 2 4 5 2 4 1 3 .. 1 .. 1 .. 2 1 - 1 Pneumonia 86 87 112' 118 123 134 109 101 107 103 153 106 106 110 111 100 - 11 Suffocation, overlying 39 48 45 43 39 46 15 25 14 22 23 23 27 26 31 20 - 11 Other Causes 109 110 108 97 113 86 108 88 94 79 77 80 77 64 92 90 - 2 1,338 1,504 1,548 1,344 1,290 1,219 1,136 1,140 1,074 1,083 996 894 841 777 1156 1,033 - 123 1911] 72 In England and Wales, in the seventy-seven great towns, in the seven greatest towns, and in the boroughs surrounding Islington, the infantile mortality was as follows :— England and Wales 130 per 1,000 births Rural Districts 118 ,, 77 Great Towns 140,, 136 Smaller Towns 133 ,, London 128 ,, Birmingham 164 ,, Liverpool 154 ,, Manchester 154 ,, Leeds 158 ,, Bristol 141 ,, Sheffield 140 „ The Encircling Boroughs. Hornsey 80 ,, Stoke Newington 107 ,, Hackney 115 ,, Shoreditch 177 ,, Finsbury 128 ,, St. Pancras 122 ,, The Encircling Boroughs 127 ,, Islington 129 ,, MORTALITY FROM THE PRINCIPAL EPIDEMIC DISEASES. Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Fevers (that is to say, Typhus, Enteric and Continued) and Diarrhceal Diseases. There were 603 deaths registered from these diseases, which is the largest number known since 1904. In the preceding year they numbered 428, while in 1909 they were 418, and in 1908, 358. It is, therefore, apparent that the increase when compared with the immediately preceding years was excessive. It was, however, 97 below the corrected average number of deaths registered in the 26 years 1885-1910. The return, notwithstanding, cannot be considered satisfactory in view of the low mortality that has been experienced since 1904. The principal cause of the increased returns for the last few years has undoubtedly been due to the very excessive number of deaths from diarrhoea, which numbered 324, as compared with an average of 181 in the preceding 26 years. But reference will be made to these later on. Death-rate. —The 603 deaths were equal to a death-rate of 1.84 per 1,000 persons living in the borough, as compared with 1.30 in 1910; 1.27 in 1909 ; 1.09 in 1908 ; and as contrasted with a mean rate of 2.14 in the 26 years 1885-1910. Since 1899, with slight variations, there has been a tendency on the part of these diseases to decrease; thus in 1899 the death-rate was 2.32 per 1,000 inhabitants, which by 1908 had fallen to 109. In 1909 it was 1.27, and in 1910 1.30. A return of the deaths from the several diseases since 1885 is given in Table XLII. 78 [1911 Table XLII. Showing the Deaths from the principal Epidemic Diseases for the Twenty-six years 1885-1910 and in 1911, 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. Diarrhoeal 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 1178 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 1 283 933 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 24 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 1911 — 124 20 53 70 — 12 — 324 603 1.84 †From this date Membranous Croup was included. 1911] 74 Table XLII1. Showing the Corrected Mean Number of Deaths from the Principal Epidemic Diseases 1885-1910 and in 1911. Diseases. Corrected Average Number of Deaths 1885-1910. 1911. Decrease. Small pox 8 . . - 8 Measles 176 124 - 52 Scarlet Fever 43 20 - 23 Diphtheria 102 53 - 49 Whooping Cough 152 70 - 82 Typhus Fever .. . .. Enteric Fever 37 12 - 25 Continued & Ill-defined Fevers 1 .. - 1 Diarrhoea 181 324 + 143 The above Diseases 700 603 - 97 The following statement shows the position occupied by Islington with respect to the Epidemic Diseases in the country and in the neighbouring metropolitan boroughs. Epidemic death-rates per 1,000 inhabitants. England and Wales 1.88 77 Great Towns 2.29 136 Smaller Towns 1.98 Rural Districts 1.40 The Encircling Boroughs 2.20 The Encircling Boroughs. St. Pancras 1.92 Stoke Newington 1.60 Hackney 1.97 Hornsey 0.90 Finsbury 3.14 Shoreditch 3.17 County of London 2.19 Islington 1.84 75 [1911 Epidemic death-rates per 1,000 inhabitants. Epidemic death-rates per 1,000 inhabitants. West Ham 3.08 Salford 2.48 Bristol 2.01 Bradford 1.40 Birmingham 2.74 Leeds 2.27 Nottingham 2.36 Sheffield 3.27 Liverpool 3.06 Hull 3.04 Manchester 2.44 Islington 1.84 The number of deaths in, and the epidemic death-rate of, each subregistration district were as follows :— Deaths. Epidemic Death-rates. Tufnell 37 1.10 Upper Holloway 68 1.82 Tollington 56 1.83 Lower Holloway 84 2.14 Highbury 69 1.11 Barnsbury 148 2.79 Islington, South-East 141 1.96 603 1.84 1911] 76 Table XLIV. Deaths from each of the principal Epidemic Diseases during the year 1911, 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 ... 6 2 2 4 ... 1 22 37 Upper Holloway ... 18 3 7 10 ... ... 30 68 Tollington ... 8 2 8 6 ... 1 31 56 Lower Holloway ... 17 1 6 6 ... 1 53 84 Highbury ... 15 ... 6 8 ... 2 38 69 Barnsbury ... 27 7 10 13 ... 4 87 148 S. East Islington ... 33 5 14 23 ... 3 63 141 The Borough ... 124 20 53 70 ... 12 324 603 Preceding year, 1910 ... 166 11 34 124 ... 17 76 428 77 [1911 Table XLV. Death-Rates from each of the principal Epidemic Diseases during the year 1911, 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 ... 0.18 0.06 0.06 0.12 ... 0.03 0.65 1.10 Upper Holloway ... 0.48 0.08 0.19 0.27 ... ... 0.80 1.82 Tollington ... 0.26 0.06 0.26 0.20 ... 0.03 1.02 1.83 Lower Holloway ... 0.43 0.03 0.15 0.15 ... 0.03 1.35 2.14 Highbury ... 0.24 ... 1.10 0.I3 ... 0.03 0.61 1.11 Barnsbury ... 0.51 0.13 0.19 0.25 ... 0.07 1.54 2.79 S. East Islington ... 0.46 0.07 0.19 0.32 ... 0.04 0.88 1.96 The Borough ... 0.38 0.06 0.16 0.21 ... 0.04 0.99 1.84 Preceding year, 1910. ... 0.51 0.03 0.10 0.38 ... 0.05 0.23 1.30 78 1911 Table XLVI. Showing the Deaths and Death-rates from the Principal Epidemic Diseases in the Wards during the Four Quarters of 1911. WARDS First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths Deathrates. Deaths Deathrates. Tufnell 6 0.72 7 0.83 18 2.14 6 0.71 37 1.10 Upper Holloway 21 2.26 10 1.07 23 2-47 14 1.50 68 1.82 Tollington 11 1.44 6 0.78 33 4.32 6 0.78 56 1.83 Lower Holloway 16 1.62 9 0.91 52 5.29 7 0.71 84 2.14 Highbury 8 0.95 2 0.24 30 3.55 3 0.35 43 1.27 Mildmay 6 1.00 8 1.34 9 1.51 — — 23 0.96 Thornhill 19 2.41 8 1.01 63 8.00 9 1.14 99 3.14 Barnsbury 17 3.16 10 1.86 17 3.16 5 0.93 49 2.28 St. Mary's 6 1.42 7 1.66 17 4.02 5 1.18 35 2.07 Canonbury 7 0.97 3 0.41 14 1.94 1 0.14 25 0.86 St. Peter's 26 3.45 11 1.46 39 5.17 8 1.06 84 2.79 Totals 143 1.75 81 0.99 315 3.85 64 0.78 603 1.84 73 [1911 Table XLVII. Showing the Deaths from each of the Principal Epidemic Diseases in the several Wards during the Year 1911. wards. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Continued and III defined fever. Diarrhoea. Total Epidemic Deaths. Tufnell ... 6 2 2 4 ... 1 ... 22 37 Upper Holloway ... 18 3 7 10 ... ... ... 30 68 Tollington ... 8 2 8 6 ... 1 ... 31 56 Lower Holloway ... 17 1 6 6 ... 1 ... 53 84 Highbury ... 5 ... 4 3 ... 1 ... 30 43 Mildmay ... 8 ... 2 5 ... 1 ... 7 23 Thornhill ... 12 5 7 5 ... 2 ... 68 99 Barnsbury ... 15 2 3 8 ... 2 ... 19 49 St. Mary's ... 8 1 5 5 ... 2 ... 14 35 Canonbury ... 9 1 3 1 ... ... ... 11 25 St. Peter's ... 18 3 6 17 ... 1 ... 39 84 The Borough ... 124 20 53 70 ... 12 ... 324 603 1911] 80 Table XLVIII. Showing the Death-rates of the Wards from each of the Principal Epidemic Diseases during the Year 1911. WARDS. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Continued and Ill-defined Fever. Diarrhoea. Death-rate from Epidemic Diseases. Tufnell ... 0.18 0.06 0.06 0.12 ... 0.03 ... 0.65 1.10 Upper Holloway ... 0.48 0.08 0.19 0.27 ... ... ... 0.80 1.82 Tollington ... 0.26 0.06 0.26 0.20 ... 0.03 ... 1.02 1.83 Lower Holloway ... 0.43 0.03 0.15 0.15 ... 0.03 ... 1.35 2.14 Highbury ... 0.15 ... 0.12 0.08 ... 0.03 ... 0.89 1.27 Mildmay ... 0.34 ... 0.08 0.21 ... 0.04 ... 0.29 0.96 Thornhill ... 0.38 0.16 0.22 1.16 ... 0.06 ... 2. 16 3.14 Barnsbury ... 0.70 0.09 0.14 0.37 ... 0.09 ... 0.88 2.27 St. Mary's ... 0.47 0.06 0.29 0.29 ... 0.12 ... 0.83 2.07 Canonbury ... 0.31 0.03 0.10 0.03 ... ... ... 0.38 0.86 St. Peter's ... 0.60 0.10 0.20 0.56 ... 0.03 ... 1.29 2.78 Total ... 0.38 0.06 0.16 0.21 ... 0.04 ... 0.99 1.84 81 [1911 SMALL POX. There was no death from small pox registered during the year. MEASLES. This disease,, which was more or less prevalent in 1909 and 1910, still remained a source of anxiety, for no less than 124 deaths were registered from it, as contrasted with 166 in 1910, and 197 in 1909, and 78 in 1908. The return is, however, 52 below the corrected average of 126 in the preceding 26 years. Measles is usually very fatal to child life, and last year out of 124 deaths 122 were under five years of age. The deaths were mainly confined to the first and second quarters of the year, and were in fact a continuation of the epidemic which prevailed during the two preceding years. This is well seen in Table LIII., which gives the deaths from measles during each week in 1911 ; and shows that 83 deaths occurred in the first quarter, 33 in the second, and only 5 and 3 in the third and fourth quarters respectively. Thus towards the end of the year the disease was practically non-existent. Its heaviest incidence fell on Barnsbury, where 15 deaths were registered, producing a death-rate of 0-70 per 1,000 of the population, following which came St Peter's with 18 deaths, and a death-rate of 0'60; Upper Holloway with 18 deaths, and a death-rate of 0-48; and Lower Holloway with 17 deaths, and a death-rate of 0-43. In the other wards the incidence was not nearly so heavy. Owing to the prevalence of the disease among scholars, class rooms were closed and disinfected in several of the schools, a list of which is to be found in that part of the report dealing with disinfection. In addition to this procedure 980 scholars were excluded from the various schools on the appearance of the disease in them. These exclusions included 812 infants, 48 boys, 106 girls, as well as 14 children from mixed classrooms. Full particulars are given in that part of the report which deals with disease among children attending the public elementary schools. g 1911] 82 Table XLIX. 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 3 3 •• •• 6 Upper Holloway 14 2 •• 2 18 Tollington 7 1 •• •• 8 Lower Holloway 12 3 1 1 17 Highbury 10 5 •• •• 15 Barnsbury 19 7 1 •• 27 Islington, South East 18 12 3 •• 33 The Borough 83 33 5 3 124 Table L. Showing the Death-rates from Measles of the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 0.36 0.36 .. .. 0.18 Upper Holloway 1.50 0.21 •• 0.21 0.48 Tollington 0.92 0.13 •• •• 0.26 Lower Holloway 1.22 0.31 0.10 0.10 0.43 Highbury 0.65 0.32 • • .. 0.24 Barnsbury 1.43 0.53 0.07 .. 0.51 Islington, South East 1.00 0.67 0.17 •• 0.46 The Borough 1.01 0.40 0.06 0.04 0.38 83 [1911 Table LI. Showing the Death-Rates of the Encircling Boroughs from Measles tn the Four Quarters of 1911. Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. St. Pancras 1.58 0.37 0.02 0.02 0.50 Stoke Newington 1.34 0.63 0.16 0.08 0.55 Hackney 1.54 1.00 0.05 .. 0.66 Hornsey 0.42 0.52 .. .. 0.24 Finsbury 2.87 0.64 0.09 .. 0.90 Shoreditch 3.27 0.79 0.47 0.07 1.15 The above Districts 1.82 0.69 0.10 0.02 0.66 Islington 1.01 0.40 0.06 0.04 0.38 Table LII. Showing the Secondary Causes of the Deaths from Measles. Secondary Diseases. Quarters. The Year 1911. 1 2 3 4 Males. Females. Totals. Pneumonia 58 25 3 1 50 37 87 Bronchitis 10 2 .. 1 7 6 13 Convulsions 1 .. 2 .. 1 2 3 Diarrhoea 2 .. .. .. .. 2 2 Meningitis 2 .. .. 1 2 1 3 Whooping Cough 3 1 .. •• 2 2 4 Enteritis 1 1 .. 1 1 2 Laryngitis 1 1 .. .. 2 •• 2 Nephritis 1 .. .. •• 1 •• 1 Marasmus .. 2 .. .. 1 1 2 Stomatitis 2 •• .. •• 1 1 2 Total Secondary Diseases 81 32 5 3 68 53 121 Deaths where no secondary disease was entered 2 1 •• •• .. 3 3 Total Deaths 83 33 5 3 68 56 124 G 2 1911] 84 Table LIII. Showing the Deaths from Measles during each Week of 1911. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Week. Deaths. Week. Deaths. Week. Deaths. Week. Deaths. 1 8 14 12 27 1 40 ... 2 11 15 3 28 2 41 1 3 10 16 2 29 ... 42 ... 4 5 17 5 30 1 43 ... 5 8 18 4 31 1 44 ... 6 6 19 2 32 ... 45 ... 7 5 20 1 33 ... 46 1 8 5 21 ... 34 ... 47 ... 9 6 22 1 35 ... 48 ... 10 3 23 ... 36 ... 49 ... 11 5 24 1 37 ... 50 ... 12 5 25 2 38 ... 51 ... 13 6 26 ... 39 ... 52 1 13 weeks 83 13 weeks 33 13 weeks 5 13 weeks 3 85 [1911 Table LIV. Showing the deaths from Measles in the Quarters, 1901-10 and 1911 Years. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. 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 93 75 11 8 187 1907 4 56 44 26 130 1908 19 12 7 40 78 1909 89 94 10 4 197 1910 1 8 21 136 166 Corrected average number of deaths 34 44 22 42 142 1911. 83 33 5 3 124 Increase or Decrease + 49 -11 -17 -39 -18 SCARLET FEVER. Twenty deaths were caused by this disease, or 9 more than in 1910, and 5 less than in 1909. The number is also 23 below the corrected average for the preceding 26 years. The disease of late years has shown a decided tendency to decrease; and, indeed, since 1897, when 61 deaths were reported, they have only once reached 40, and were as low as 11 in 1910. It is difficult to explain the cause of this large decrease, although undoubtedly the disease is of a much milder type than formerly, which is probably its chief cause. 1911] 86 Particulars with respect to the incidence of the disease in the subregistration districts are to be found in the two Tables which follow:— Table LV. 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 .. 2 Upper Holloway 1 1 1 .. 3 Tollington .. .. 1 1 2 Lower Holloway .. .. 1 .. 1 Highbury .. .. .. .. .. Barnsbury 1 1 2 3 7 Islington, South East 1 1 2 1 5 The Borough 4 3 8 5 20 LVI, Showing the Death-rates from Scarlet Fever of the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell 0.12 .. 0.12 .. 0. 06 Upper Holloway 0.11 0.11 0.11 .. 0.08 Tollington .. •• 0.13 0.13 0.06 Lower Holloway .. •• 0.10 .. 0.03 Highbury .. •• •• .. .. Barnsbury 0.08 0.07 0.15 0.23 0.13 Islington, South East 0.06 0.06 0.11 0.06 0.07 The Borough 0.05 0.04 0.10 0.06 0.06 87 1911 Diphtheria was responsible for 53 deaths, which is a decrease of 49 on the average, 102, that obtained in the twenty-six years 1885 and 1910. The mortality was, however, 19 in excess of that of 1910, and 22 of that of 1909. In 1901 as many as 134 deaths were caused by it, and in 1902, 104. Since then, however, the decrease in the mortality has been very marked, as may be seen in the following statement:— 1901 134 1902 104 1903 43 1904 28 1905 34 1906 32 1907 42 1908 60 1909 31 1910 34 1911 53 Such a decrease as these figures denote is highly satisfactory; and indeed, when one compares the mortality with such figures as 200 in 1893, and 218 in 1894, 257 in 1896, that satisfaction must be greatly enhanced. Despite what may be said by certain cranks opposed to anti-toxin treatment, they are clear proof of the efficacy of this drug, even if every allowance be made (or the milder type of the disease, which prevails. This is shown by the fact that whereas the cases decreased from 855 in 1893 to 593 in 1911, or 30-7 per cent., the deaths fell from 200 to 53, or 73.5. The effect of the anti-toxin treatment was fully dealt with in a special report, presented to the Council in 1910. It is therefore unnecessary to further argue the matter now. Table LVII. 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 .. 1 1 5 7 Tollington 2 •• 3 3 8 Lower Holloway 1 1 2 2 6 Highbury 1 2 1 2 6 Barnsbury 5 2 2 1 10 Islington, South East 2 1 4 7 14 The Borough 11 8 13 21 53 88 1911 Table LVIII. Showing the Death-rates from Diphtheria of the Sub-Districts for each Quarter, Sub-Districts. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Whole Year. Tufnell .. 0 12 .. 0.12 0.06 Upper Holloway .. 0.11 0.11 0.54 0.19 Tollington 0.26 .. 0.39 0.39 0.26 Lower Holloway 0.10 0.10 0.20 0.20 0.15 Highbury 0.06 0.13 0.06 0.13 0.10 Barnsbury 0.38 0.15 0.15 0.08 0.19 Islington, South East 0.11 0.06 0.22 0.39 0.19 The Borough 0.13 0.10 0.16 0.26 0.16 WHOOPING COUGH. Only on one occasion during the last 26 years have there been so few deaths from this disease as those registered in 1911, when 70 were recorded. The exception was in 1908, when there were 55. The return is 82 below the average which obtained from 1885-1910, and is in marked contrast to the returns during the years 1885-1891, in each of which, with one exception, the deaths numbered more than 200. The diminution in the number of deaths was shown last year by dividing the 26 years, 1886 to 1910, into quinquennial periods, thus:— 1886-1890 195 per annum. 1891-1895 173 ,, 1896-1900 166 ,, 1901-1905 117 ,, 1906-1910 92 ,, It is difficult to assign any reason for this great decrease unless it be that parents are now aware that whooping cough is a preventable disease. If this be the explanation, the result is really marvellous, for it means a decrease of 51.8 per cent. 89 1911 Table Lix. 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. Tufnell 1 2 1 .. 4 Upper Holloway 5 4 .. 1 10 Tollington 1 5 .. .. 6 Lower Holloway 2 2 2 .. 6 Highbury 1 4 3 .. 8 Barnsbury 8 3 2 .. 13 Islington, South East 14 6 3 .. 23 The Borough 32 26 11 1 70 Table LX. Showing the Death-rates from Whooping Cough of the Sub-Districts for each Quarter. Sub-districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. ' Whole Year. Tufnell 0.12 0.24 0.12 .. 0.12 Upper Holloway 0.54 0.43 .. 0.11 0.27 Tollington 0.13 0.65 .. .. 0.20 Lower Holloway 0.20 0.20 0.20 .. 0.15 Highbury 0.06 0.26 0.19 .. 0.18 Barnsbury 0.60 0.23 0.15 .. 0.25 Islington, South East 0.78 0.33 0.17 .. 0.32 The Borough 0.39 0.32 0.13 0.01 0.21 90 1911 ENTERIC FEVER. Thirteen deaths from Enteric or Typhoid Fever were entered, as contrasted with a corrected average of 37 in the twenty-six years 1885-1910, which is a very considerable and most gratifying decrease. The deaths are 5 below those registered in 1910, but are the same in number as those known in 1909. Since 1902 the deaths have fallen steadily, although for that matter there has been a general decrease since 1885, which is well seen in the following statement, which shows the deaths arranged in quinquennial periods since that year:— 1886-1890 264 1891-1895 187 1896-1900 219 1901-1905 149 1906-1910 79 Such results are entirely satisfactory, especially as they are accompanied by a very large decrease in the notification of individual cases, and are strong evidence of the improvement in the sanitary condition of Islington. Table LXI. 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 Upper Holloway .. .. .. .. .. Tollington 1 .. .. .. 1 Lower Holloway .. 1 .. .. 1 Highbury .. .. 2 .. 2 Barnsbury 1 .. 2 1 4 Islington, South East 1 .. .. 2 3 The Borough 3 1 4 4 12 91 1911 Table LXII. Showing the Death-rates from Enteric Fever of the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter 3rd Quarter 4th Quarter Whole Year. Tufnell .. .. .. 0.12 0.03 Upper Holloway .. .. .. .. .. Tollington 0.13 .. .. .. 0.03 Lower Holloway .. 0.10 .. .. 0.03 Highbury .. .. 0.13 .. 0.03 Barnsbury 0.08 .. 0.15 0.08 0.07 Islington, South-East 0.06 .. .. 0.11 0.04 The Borough 0.04 0.01 0.05 0.05 0.04 TYPHUS FEVER. No death was recorded. CONTINUED AND ILL DEFINED FEVERS. Nil return. DIARRHCEAL DISEASES. These include Diarrhoea, Dysentery, Choleraic Diarrhoea, Zymotic Enteritis, Epidemic Enteritis, Infective Enteritis, Enteric Catarrh, Gastro-intestinal Catarrh, and Gastro-enteric Catarrh. Diarrhoea, and Gastritis with Enteritis have, however, been classified separately, and during 1911 caused 324 deaths, as contrasted with 76 in the preceding years, and with an average of 181 in the twenty-six years 1885-1910. There was thus the large increase of 143 deaths on the average of these years. Such a large mortality is to be deplored, especially as there was an increase of 46 in the deaths from enteritis and gastritis. 92 1911 The diarrhœal diseases as a whole caused 461 deaths, which are equal to a death-rate of 1.41 per 1,000: the 324 deaths from diarrhoea alone being equal to a rate of 0.99 per 1,000, as compared with one of 0.23 in the preceding year. The third quarter of the year was responsible for the chief mortality, for in it 342 deaths from these diseases, together with enteritis, were registered ; in other words, 74.2 per cent. of the total deaths from these two diseases occurred in this quarter. In the first quarter there were only 31, or 6.7 per cent; in the second quarter 32, or 6.9 per cent., and in the fourth 56, or 12.2 per cent. These figures tell us plainly that the hot and dry summer experienced last year had a very aggravating effect on the mortality returns. This is well seen in the chart facing page 47, which shows the weekly mortality of the borough during 1911, and in the twenty-six preceding years. There it may be seen that although the death-rate had been considerably below the average of the 26 years in nearly every week, yet from the first week of August until the first week in September, it was persistently above it. Such a rise in the mortality was almost entirely due to the diaxrhoeal diseases and to a few other ailments which are affected by heat. It is to be noticed also that 309 out of 461 deaths, or 67 per cent., occurred under the age of 1 year, while 74 were between the ages of 1 and 5 years, and 78 above 5. It is thus clearly apparent that the chief mortality was among children under 1 year of age, and as has been mentioned when dealing with infantile mortality, these deaths are for the most part preventable, for there is no reason why so many children, as shown in the Tables dealing with the method of feeding infants, were fed on such a variety of fermentable foods instead of on the breasts of their mothers. Table LXVI. gives the deaths, the temperature of the air, the temperature of the earth, and the rainfall for each week of the third quarter, where it will be seen that as the temperature both of the air and the earth rose, so also did the deaths from the diarrhoeal diseases, and when they began to fall so also did the mortality from them. 93 1911 Table LXIII. 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 1 1 16 4 22 Upper Holloway 1 2 21 6 30 Tollington .. .. 29 2 31 Lower Holloway 1 2 46 4 53 Highbury 3 .. 34 1 38 Barnsbury 2 5 71 9 87 Islington, South East 2 .. 57 4 63 The Borough 10 10 274 30 324 Table LXIV. Showing the Death-rates from Diarrhœa in the Sub-Districts for each Quarter. Sub-Districts. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. Whole Year Tufnell 0.12 0.12 1.91 0.48 0.65 Upper Holloway 0.11 0.21 2.26 0.64 0.80 Tollington .. .. 3.80 0.26 1.02 Lower Holloway 0.10 0.20 4.68 0.41 1.35 Highbury 0.19 .. 2.19 0.06 0.61 Barnsbury 0.15 0.38 5.36 0.68 1.64 Islington, South East 0.11 .. 3.18 0.22 0.88 The Borough 0.12 0.12 3.35 0.36 0.99 94 1911] Table LXV Showing the Deaths from Diarrhœal Diseases together with those classed under Enteritis and its sub-headings, arranged in quarterly periods, and at three groups of ages. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. The Year. Ages. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Diarrhœa. Enteritis, etc. Totals. Under i year 4 11 15 7 11 18 201 46 247 15 14 29 227 82 309 1 to 5 years ... 2 2 4 1 3 4 47 10 57 5 4 9 55 19 74 Over 5 years 4 8 12 2 8 10 26 12 38 10 8 18 42 36 78 Totals 10 21 31 10 22 32 274 68 342 30 26 56 324 137 461 Note.—In this Table the deaths under Enteritis include only those which are not epidemic or zymotic. 95 1911 TABLE LXVI. Showing the Diarrhœal Deaths including those from Epidemic Enteritis in the Third Quarter, 1911. 1911. Deaths. Meteorology. Temperture of the air. 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 temperature of 65 years Temperature of the earth 3 feet below surface. Rainfall in inches. No. of days on which rain fell. July 8th .. .. .. .. .. .. 1 1 65.6 + 3.5 59.80 0.00 1 ,, 15 th 1 .. .. .. .. .. .. 1 65.2 + 2.3 62.16 0.00 .. ,, 22nd .. .. .. 1 .. 1 1 3 69.5 + 6.2 63.31 0.00 .. ,, 29th .. .. .. .. .. 2 .. 2 71.0 + 8.4 65.17 0.26 5 1 .. .. 1 .. 3 2 7 67.8 +5.1 62.61 0.26 6 August 5th 1 2 .. .. 2 3 2 10 68.0 + 5.9 66.11 0.06 1 ,, 12th 2 4 3 8 6 9 7 39 72.5 + 10.1 66.43 0.00 ,, 19 th 2 3 4 8 9 7 10 43 69.4 + 7.2 67.06 0.58 1 „ 26 th 4 6 4 6 5 11 11 47 63.9 + 2.9 66.39 0.29 3 9 15 11 22 22 30 30 1 139 68.4 + 6.5 66.50 0.93 5 Sept. 2nd 2 1 6 6 6 5 6 32 65.3 +5.2 65.36 0.41 2 ,, 9th 2 1 5 6 1 8 9 32 66.9 + 7.7 64.63 0.01 2 ,, 16th 1 3 2 4 1 6 8 25 60.3 +2.4 64.19 0.41 2 ,, 23rd 1 1 1 4 3 17 .. 27 54.3 -1.9 61.74 0.48 4 „ 30th .. .. 4 3 1 2 2 12 55.0 0.0 59.94 0.44 4 6 6 18 23 12 38 25 128 60.3 + 2.7 63.17 1.75 14 3rd Quarter 16 21 29 46 34 71 57 274 65.5 + 4.8 64.09 2.94 25 96 1911J Table LXVII. Showing the Deaths occurring in Islington and in the several Encircling Boroughs from All Causes, from the principal Epidemic Diseases, and from Phthisis in the year 1911. THE ENCIRCLING BOROUGHS. Estimated Populations, 1911. 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 Diarrhœa. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 St. Pancras 218,031 3,371 420 ... 108 12 37 55 ... 7 ... 201 342 624 122 Stoke Newington 50,669 658 81 ... 28 3 3 18 ... 1 ... 28 64 107 107 Hackney 222,674 3,185 440 ... 148 11 20 58 ... 8 ... 195 311 621 115 Hornsey 84,916 805 77 ... 20 1 5 14 ... 1 ... 36 42 116 80 Finsbury 87,639 1,725 276 ... 79 6 17 24 ... 8 ... 142 163 418 128 Shoreditch 111,284 2,226 413 ... 128 6 24 32 ... 1 ... 222 204 601 177 The above Borough: 775,213 11,970 1,707 ... 511 39 106 201 ... 26 ... 824 1,126 2,487 127 Islington 327,247 4,810 603 ... 124 20 53 70 ... 12 ... 324 379 1,033 129 97 H [1911 LXVIII. 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 1911. THE ENCIRCLING BOROUGHS. Estimated Populations, 1911. 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 Diarrhœa. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 St. Pancras 218,031 15.5 1.92 ... 0.50 0.05 0.17 0.25 ... 0.03 ... 0.92 1.57 122 Stoke Newington 50,669 13.0 1.60 ... 0.55 0.06 0.06 0.36 ... 0.02 ... 0.55 1.26 107 Hackney 222,674 14.3 1.97 ... 0.66 0.05 0.09 0.26 ... 0.03 ... 0.88 1.40 115 Hornsey 84,916 9.5 0.90 ... 0.24 0.01 0.06 0.16 ... 0.01 ... 0.42 0.49 80 Finsbury 87,539 19.7 3.14 ... 0.90 0.07 0.19 0.27 ... 0.09 ... 1.62 1.86 128 Shoreditch 111,284 20.0 3.71 ... 1.15 0.05 0.22 0.29 ... 0.01 . 1.99 1.83 177 The above Boroughs 775,213 15.4 2.20 ... 0.66 0.05 0.14 0.26 ... 0.03 ... 1.06 1.45 127 Islington 327,247 14.7 1.84 ... 0.38 0.06 0.16 0.21 ... 0.04 ... 0.99 1.16 129 98 1911 Table LXIX. 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. Co 1s. All Causes. Principal Epidemic Diseases (Cols. 3-9). Enteric Fever. Small-Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis (under 2 years). Deaths under 1 Year to 1,000 Births. 1. 2. 3. 4. 5. 6 7. 8. 9. 10. England and Wales 14.6 1.88 0.07 0.00 0.36 0.05 0.21 0.13 1.06 130 77 Great Towns 15.5 2.29 0.06 0.00 0.47 0.06 0.24 0.15 1.31 140 136 Smaller Towns 13.8 1.98 0.07 0.00 0.41 0.06 0.18 0.12 1.14 133 England and Wales less the 213 Towns 13.9 1.40 0.07 0.00 0.22 0.04 0.19 0.11 0.77 118 London 15.0 2.19 0.03 0.00 0.57 0.04 0.23 0.14 1.18 128 Bristol 15.1 2.01 0.04 .. 0.46 0.04 0.40 0.11 0.96 141 Birmingham 16.8 2.74 0.06 0.00 0.57 0.12 0.19 0.12 1.68 164 Liverpool 20.0 3.06 0.04 .. 0.42 0.17 0.31 0.17 1.95 154 Manchester 17.0 2.44 0.07 .. 0.47 0.06 0.20 0.12 1.52 154 Leeds 16. 4 2.27 0.05 .. 0.18 0.10 0.33 0.34 1.27 158 Sheffield 16.1 3.27 0.07 .. 1.74 0.06 0.14 0.09 1.17 140 St. Pancras 15.5 1.92 0.03 .. 0.50 0.05 0.25 0.17 0.92 122 Stoke Newington 13.0 1.60 0.02 .. 0.55 0.06 0.36 0.06 0.55 107 Hackney 14.3 1.97 0.03 .. 0.66 0.05 0.26 0.09 0.88 115 Hornsey 9.5 0.90 0.01 .. 0.24 0.01 0.16 0.06 0.42 80 Finsbury 19.7 3.14 0.09 .. 0.90 0.07 0.27 0.19 1.62 128 Shoreditch 20.0 3.71 0.01 .. 1.15 0.05 0.29 0.22 1.99 177 Encircling Boroughs 15.4 2.20 0.03 .. 0.66 0.05 0.26 0.14 1.06 127 Islington 14.7 1.96 0.04 .. 0.38 0.06 0.21 0.16 1.11 129 99 1911 INFLUENZA. There were 37 deaths registered from influenza, or 35 fewer than the average which obtained during the twelve preceding years. The deaths were also only one more than those which occurred in 1910. The disease, as we have known it recently, would not be of much consequence, were it not that it is the cause of many other ailments, which so frequently prove fatal. Thus during last year in 14 instances the determining causes of death were pneumonia, in 11 heart failure, in 5 bronchitis, and in 2 meningitis. Indeed, meningitis is among the less common lesions which are sometimes proved to be influenzal; and, therefore, when under treatment it might be well for physicians to examine the cerebro-spinal fluid for the bacillus influenza so as to establish the diagnosis. A recent writer in the Journal of Clinical Research, says:—" That in some fatal cases the inflammation has not been confined to the meninges, but has affected the brain substance as well, leading to acute exudation of lymph and small round cells into the peri-vascular and peri-cellular lymphatic spaces. If these changes occur in the brain it is more than probable that they may also take place in the spinal cord. Not a few of the subjective sensory changes, pain, and feelings of weakness that accompany influenza and persist after the fever has gone may be due to them." I here is no doubt that very often influenza is diagnosed when it is nonexistent, and that it is unfairly credited with illness which is not due to its specific bacillus. It is well known that in influenza there is a well marked derangement of the digestive system, which at times is so great that the patients have no appetite and feel an aclual disgust at even the idea of food, while they also suffer from constipation, flatulence, and vomiting. These feelings are doubtless due to the action of the bacillus, which Breccia only last year showed by experiment had a marked inhibitory influence on the pepsin of man and other animals. The disease is very little fatal in young life, but from 35 years of age onwards it demands a fairly heavy toll, as may be seen in the following tabular statement:— H 2 100 1911 Average 1898- Departure from Ages. i 1898. 1899. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1910. 1911 average 0-5 8 6 3 4 4 3 4 4 4 5 3 1 2 4 3 - 1 5-10 2 2 3 1 — 1 — 1 1 1 — 1 — 1 — — 1 10-15 — — — — — 1 — — 15-25 4 4 9 — 3 2 3 — 4 3 5 2 2 3 1 — 2 25-35 4 12 7 2 7 3 2 3 5 10 3 4 2 5 4 — 1 35-45 5 17 16 5 13 5 7 5 4 19 8 8 3 9 2 - 7 45-55 9 15 18 5 14 9 7 7 10 5 14 10 5 10 6 - 4 55-65 15 28 28 12 6 8 6 9 13 6 16 9 5 11 3 - 8 65-75 11 24 36 12 17 6 11 12 16 12 14 20 5 15 10 - 5 75-85 6 14 25 5 15 3 7 12 8 12 14 11 8 11 7 - 4 85 and up wards - 1 4 4 — 4 — 1 1 2 1 4 4 4 3 1 - 2 — — — — — — — — — — — — — — — — 65 126 149 46 83 40 48 54 67 75 81 70 36 72 37 - 35 — — — — — — — — — — — — — — — Its fatality is greater in the cold than in the warm months, so that whereas, as a subsequent Table shows, there were only 4 deaths on the average during the ten years 1901-10 in the third quarters of the year, there were respectively 29, 13 and 13 in the first, second and fourth quarters. The disease, which was almost entirely unknown in this country for very many years, has, however, never been absent since the epidemic of 1890-1-2-3. Its record in the borough, going back to 1856, is set out in quinquennial periods, is well seen in the following statement:— Quinquennia. Deaths. Average number of Deaths per annum. 1856-60 18 3.6 1861-65 12 2.4 1866-70 10 2.0 1871-75 2 0.4 1876-80 2 0.4 1881-85 2 0.4 1886-90 40 8.0 1891-95 818 163.6 1896-00 420 84.0 1901-05 271 54.2 1905-10 329 65.8 101 1911 It is very apparent from these figures that the borough has not as yet returned to its normal state with respect to this ailment, which not only directly, but also indirectly, carries off so many persons—how many it would be difficult to state. Indeed, in 1899 it was shown in these reports that in the fourth quarter alone of that year there was an excess of 248 deaths from diseases of the nervous, respiratory, and circulatory systems, as compared with the average number registered in the corresponding quarters of the preceding five years. Let us hope that its present undoubted tendency to decrease may be the forerunner of its entire extinction. Table LXX. Showing the Deaths from Influenza in the Quarters of the Year 1911, together with the corrected averages of the corresponding periods 1901-1910. Years. Quarters. Totals. First. Second. Third. Fourth. 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 1910 21 6 2 7 3 Corrected Averages 29 13 4 13 59 1911 18 9 1 9 37 Increase or Decrease -11 -4 -3 -4 -22 102 1911] Table LXXI Showing the Secondary Causes of Death from Influenza in the Four Quarters of the Year 1911. 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. 4 th. 1st. 2nd. 3rd. 4th 1st 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd 4th 1st. 2nd. 3rd. 4th Pneumonia .. 1 .. .. 1 1 .. .. .. .. .. .. 1 .. .. .. 2 .. 1 .. .. .. .. .. 5 .. .. 2 14 Bronchitis 1 .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. 5 Heart Disease, etc. 1 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. 3 1 1 .. .. .. 1 .. .. 11 Septicaemia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 All Secondary Causes 2 2 .. 1 1 1 .. 2 .. .. .. .. 1 1 .. .. 4 1 1 4 2 2 .. .. 6 1 .. 2 34 No Secondary Causes .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 3 Totals 2 2 .. 1 2 2 .. 2 .. .. .. .. 1 1 .. .. 5 1 1 4 2 2 .. .. 6 1 .. 2 37 103 1911 APPENDICITIS. The deaths due to appendicitis maintain their average record, 24 having been registered as contrasted with an average of a similar number during the last 9 years. The subjoined tabular statement has been prepared to show the ages at which people died from it. Ages. 1902. 1903. 1904. 1905. 1906 1907. 1908. 1909. 1910. Average 1902-10 1911. 0-5 — 1 — 1 — 1 2 2 3 1 — 5-10 2 4 2 4 3 — 7 7 2 3 3 10-15 7 3 5 1 2 7 1 2 3 3 2 15-20 1 4 3 6 3 3 3 3 4 3 4 20-25 1 7 2 3 1 2 3 1 5 3 2 25-35 3 5 8 3 2 2 2 1 1 3 4 35-45 2 3 2 4 5 — 4 4 2 3 3 45-55 3 2 1 4 1 1 2 1 5 2 — 55-65 — 1 3 2 2 3 1 2 — 2 3 65-75 1 2 1 1 1 — — 2 2 1 1 75-85 — — — — — — — — — — 2 85 and upwards — — — — — — — — — — — 20 32 27 29 20 19 25 25 27 24 24 12.5 per cent. of the deaths during 1911 occurred at the age period 5-10 8.3 „ „ „ 10-15 16.7 „ „ „ 15-20 8.3 „ „ „ 20-25 16.7 „ „ 25-35 12.5„ „ 35-45 „ „ „ 45- 55 12.5 „ „ „ 55-65 4.2 ,, „ „ 65-75 8.3 „ „ „ 75-85 100 „ „ „ All ages SEPTIC DISEASES. These include Erysipelas, Pyaemia, Septicaemia and so-called Puerperal Fever, and as a group caused 52 deaths as contrasted with 43 in 1910, and 40 in 1909. 104 1911 Erysipelas.—Twelve deaths were attributed to it, of which 8 occurred in public institutions. Further particulars respecting it are seen in the two subjoined tabular statements, the first of which gives the number of deaths in each year from 1897 to 1911; while the second shows the deaths in the sub districts during 1911:— 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 1910 9 Average 13 1911 12 Table LXXII. Deaths from Erysipelas in the Sub-Districts during the Year 1911. Deaths. Death Rates. Tufnell 2 0.06 per 1,000 inhabitants. Upper Holloway 1 0.03 ,, ,, Tollington 1 0.03 ,, ,, Lower Holloway 1 0.02 ,, ., Highbury 2 0.03 ,, ,, Barnsbury 4 0.07 ,, ,, Islington, South-East 1 0.01 ,, ,, The Borough 12 0.03 ,, ,, Puerperal Septic Diseases.—These include Puerperal Pyaemia, Septicaemia, Sapraemia, Septic Intoxication, and Puerperal Fever (so-called), which is frequently used as a generic name for the others. Collectively they caused 7 deaths, or 2 under average of the preceding ten years; and they were in the proportion of 0.87 to every thousand births. 105 1911 They are more important from their fatality than from their number, for during last year while there were only 14 cases known there were 7 deaths. Consequently 50 per cent, of the patients died. Such a fatality can only be adequately described by one word—horrible. It is well, therefore, to keep ever before us a statement of its behaviour in the borough. Deaths Years, Deaths. per 1.000 births. 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 1910 8 0.97 Corrected average 9 1.04 1911 7 0.87 Table LXXIII. Showing the Deaths from Puerperal Fever in the Sub Districts for each Quarter and the Year 1911. Sub-Districts. 1st Quarter. 2nd Quarter 3rd Quarter 4th Quarter. Whole Year. Tufnell .. .. .. 1 1 Upper Holloway .. .. .. .. .. Tolling ton .. .. .. .. .. Lower Holloway .. .. .. 3 3 Highbury 1 .. .. .. 1 Barnsbury 1 .. .. .. 1 Islington, South East .. 1 .. .. 1 The Borough 2 1 .. 4 7 106 1911 TABLE LXXIV. Showing the Deaths from Puerperal Fever /ier 1,000 Births in the Sub Districts for each Quarter and the Year 1911. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. .. .. 6.29 1.31 Upper Holloway .. .. .. .. .. Tollington .. .. .. .. .. Lower Holloway .. .. .. 12.50 3.04 Highbury 3.14 .. .. .. 0.80 Barnsbury 2.45 .. .. .. 0.66 Islington, South East .. 2.24 .. .. 0.56 The Borough 0.95 0.51 .. 2.10 0.87 CONSTITUTIONAL DISEASES. These diseases form a group which are only second in importance to those known as the epidemic diseases. They include Cancel, Rheumatic Fever, Rheumatism, Rickets, Diabetes, Gout, Anaemia, Gangrene Purpura, and Tuberculosis, whether of the lungs or any other part of the body. In 1911 they caused 943 deaths, as compared with 1,039 in the preceding year, and they were equal to a death-rate of 2.88 per 1,000 of the population. During the twenty years, 1891-1910, they have caused 21,538 deaths, or an average of 1,077 per annum, which are equal to an annual death-rate of 3.25 per 1,000 of the population during this period. They therefore represent more than a fifth of the entire mortality of the borough. The deaths and death-rates from these diseases are well worth studying year by year, and for the first time they are now given:— 107 1911 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 Deaths 1,064 1,037 1,093 997 1,114 1,122 1,084 1,067 1,115 1,119 Death-rates 3.32 3.21 3.I8 3.02 3.33 3.26 3.21 3.17 3.32 3.33 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 Average 1911 Deaths. 1,080 1,101 1,070 1,116 1,007 1.042 1,041 1,048 1,032 989 1,077 943 Death-rates. 3.22 3.23 3.21 3.36 3.03 3.15 3.15 3.12 3.14 3.01 3.25 2.88 The figures show that there has been a slight decrease in the total number of deaths from this group of diseases. It was chiefly due to the lesser number of deaths registered from tuberculous diseases, (vide Table LXXX.) cancer or malignant DISEASE. Cancer or malignant disease caused 329 deaths, of which 143 were those of males and 186 of females; and they were in the proportion of 1.0 to every thousand of the population, which is practically the death-rate which has obtained during the last five years. It is a melancholy fact that this disease shows no signs of decreasing; indeed, on the contrary it has increased, as the following figures demonstrate:— Year. 1891 1892 1893 1894 1895 1891-95 Males. 74 70 82 78 96 400 Females. 144 149 156 161 170 780 Persons. 218 219 238 239 266 1180 Deaih-rate. 0.68 0.68 0.73 0.72 0.79 0.72 108 1911 Year. 1896 1897 1898 1899 1900 1896-00 1901 1902 1903 1904 1905 1901-05 1906 1907 1908 1909 1910 1906-10 1911 Males 104 112 106 104 115 541 103 133 155 147 138 676 154 177 157 146 158 792 143 Females. 187 192 177 166 188 910 186 193 195 176 190 940 209 171 210 207 203 1000 186 Persons. 291 304 283 270 303 1451 289 326 350 323 328 1616 363 348 367 353 361 1792 329 Death rate. 0.85 0.90 0.84 0.80 0.90 0.86 0.86 0.95 1.05 0.97 0.99 0.96 1.10 1.05 1.09 1.07 1.10 1.08 1.00 These returns indicate that cancer has been on the increase in Islington, and that whereas the death-rate from it was only 0.72 per 1,000 of the population in the five years 1891-5, it was 108 in the five years 1906-10, which is to say it has increased fifty per cent. It is alleged that this increase is more apparent than real; that in fact the more numerous deaths ascribed to it are due to the better diagnosis by medical men, of which more later on. The actual number of deaths from males in the same periods increased from 400 to 792, or 98 per cent., and among females from 780 to 1,000, or 26 per cent. The increased mortality among males was common to England and Wales, in which the general rule since 1890 has been that the mortality has been greater among males than females, although prior to that date the reverse obtained. Much of the increase in the deaths from cancer has been alleged to be due to the better recognition of the disease as stated on p. 110 by Dr. Bashford, 109 [1911 but if the matter be considered dispassionately it must be admitted that nothing has occurred during recent years to assist the medical profession in their diagnosis. Therefore, the cause must be sought in some other direction. What that is, it is impossible to say. In Islington, if we compare the deaths that occurred at the several age periods of life, we will find that while there was a decrease of 2 in the number of deaths at all ages up to and including forty-four, there was on the other hand an increase of 39 at the ages above that time of life. The largest number of deaths attributed to any special organ was 37 referred to cancer of the stomach, of which 19 were of males and 18 of females, so that there was an almost equal division of the mortality. On the other hand, whereas 12 males died from cancer of the tongue, no female died; and again while 21 males succumbed to cancer of the sesophagus, only 1 female did. But on the other hand out of 30 deaths from disease of the liver only 11 were those of males, as against 19 females. Again among women there were 32 deaths from cancer of the breast, 42 from cancer of the uterus, 6 from cancer of the ovaries. The disease, arranged as to the groups of organs attacked, was fatal as follows:— Males. Females. Total. Nervous system — 2 2 Heart 1 7 8 Respiratory system 8 4 12 Digestive system 111 77 188 Lymphatic system 1 — 1 Urinary system 12 2 14 Generative system 1 85 86 Locomotory system 3 4 7 Bones and Joints 2 2 4 Unspecified 4 3 7 143 186 329 This synopsis brings out this fact very clearly that were it not for the deaths from cancer of the female organs of generation, the deaths among males would have exceeded those among women, the respective numbers then being 143 and 101. It is a noticeable fact that 85 per cent, of the mortality among women occurred after the child-bearing age had been safely passed. 110 1911 Little more has been added to our knowledge of the disease during the last few years, but it is proved beyond doubt that heredity is a predisposing cause, and that chronic irritation of a particular organ may lead to cancer. In this connection, Dr. E. F. Bashford, the general superintendent and director of the Cancer Research Fund writes in his report for 1910-11, as follows:— " For the first time it is fully demonstrated that it is wrong to make " statements of a disquieting nature about the increase of cancer in general. " In conjunction with other investigations means are afforded of determining " for parts of the body where the disease appears to be increasing, whether the " increase is real or only apparent, and of ascertaining the causal factors " peculiar to such parts. While it is evident that several of the differences " brought out by the figures can be explained by more accurate diagnosis, and " by transference of the seat of the disease from the secondary to the primary " situations—e.g., by the relation revealed between cancer of the liver and gall" bladder and the alimentary tract, this may not account fully for other features. " In particular, the increase recorded for the mamma in women, and the tongue " in men requires fui ther study and elucidation. Secondly, the analysis shows " that the incidence is very unequally distributed among the several situations, " and, indeed, that the whole curve of incidence may be different for different " organs. A progressive increase up to the highest age-periods is characteristic " of the face, lip, mouth, bladder, urethra and breast only. The other organs " show a distinct diminution in the highest age periods, but it is not yet " possible to determine whether this curve indicates a liability rising to a " maximum followed by a diminution, or is merely the result of deaths being " still ascribed to other causes in the case of cancer of internal organs in aged " people. The study of the occurrence of cancer in mankind, and in domesticated " animals in widely separated parts of the globe has shown that the practice of " peculiar customs now (involving the subjection of particular parts of the body " to chronic irritation), provokes the disease in situations and organs from which " it is absent when these customs do not obtain. It is reasonable to suppose " that the frequency of cancer would be diminished if such practices as the use " of the kangri in Kashmir, the chewing of Betel-nut, and the eating of very hot "rice in China, were discontinued. " As to the influence of heredity, the breeding experiments which have " been in progress for many years, have been alluded to in several earlier " reports. They have now yielded upwards of 2,000 mice of known ancestry " and age. Five hundred and sixty-two females were available for a study of " the influence of heredity on the development of cancer of the mamma, when 111 1911 " an analysis was made on October 24th, 1910. The date shows that heredity " plays a part in the development of cancer of the breast in mice. At all age " periods the disease is more frequent when the mother or either grandmother, " or all three, had died from cancer of this organ. Without wishing to " minimise unduly the important influence which heredity is thus demonstrated " to have, it is necessary to warn against needless alarm, or the awakening of " pessimistic anticipation of the outlook on future efforts to cope with cancer. " While it is at present impossible to explain how the liability is transmitted, it " can be averred with certainty that it does not consist in the inheiitance ot a " soil more suitable to the growth of cancer in general. It is not inheritance " of a general constitutional predisposition suitable for growth, as is shown by " the fact that implantation of cancer is not more successful in mice of a " cancerous stock than in others. It can only be inferred, with some probability, " that it is a local or ciicumscribed tissue predisposition, in virtue of which the " mammary tissue is prone to pass from mere proliferative action into continuous " or cancerous proliferation. Further, heredity predisposition is only one of " the factors in play, for it has been found that chronic inflammatory changes " are remarkably frequent in the mammae of female mice of the laboratory. " Other factors still unrecognised may exist." Ages at Death.—The ages at death, which are fully set out in the tabulated statement given below, which shows that up to thirty-five years of age the number of deaths from cancer are insignificant, but that above that period of life they are very serious, because on the average of the ten years 1901-10, it is found that only 16 deaths occurred in the younger period of life, as contrasted with 325 in older; or translated into percentages only 4-7 per cent, of the deaths occurred among persons under 35, as against 95*3 per cent, among those over that age. Average. Ages. 1901. 1902. 1903. 1904, 1905. 1906 1907. 1908 1909. 1910. 1901-1910. 1911. 0-5 — 3 4 1 2 1 1 1 — 2 1 1 5-15 1 3 3 2 1 3 3 2 3 1 2 3 15-25 2 5 7 5 3 3 3 8 3 5 4 4 25-35 8 8 5 10 11 7 6 6 10 6 9 5 35-45 33 29 43 43 22 35 39 41 27 40 35 32 45-55 63 75 75 61 74 90 64 63 79 72 71 67 55-65 76 103 95 84 95 110 95 112 96 100 97 92 65-75 75 7° 83 9° 92 74 102 93 94 85 86 87 75-85 27 27 34 22 25 38 27 39 34 47 32 31 85& up wards 4 3 1 5 3 2 8 2 7 3 4 7 289 326 350 323 328 363 348 367 353 361 341 329 112 1911 Table LXXV. Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the Year 1911. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury Islington, South-East. The Borough. 1st 10 11 6 11 15 5 18 76 2nd 7 8 7 9 17 11 23 82 3rd 13 15 7 15 19 10 11 90 4th 8 12 7 10 14 7 23 81 The Year 38 46 27 45 65 33 75 329 Table LXXVI. Deaths and Death-rates from Cancer or Malignant Disease at seven age periods. Ages. Males. Females. Persons. Deaths. Deaths per 10,000 living at the age. Deaths Deaths per 10,000 living at the age. Deaths. Deaths per 10,000 living at the age. 0-25 3 0.40 5 0.65 8 0.53 25-35 2 0.73 3 0.98 5 0.86 35-15 11 5.15 21 8.81 32 7.08 45-55 24 15.36 43 24.25 67 20.09 55-65 46 45.28 46 38.13 92 41.41 65-75 47 86.75 40 53.41 87 67.42 75 & upwards 10 64.60 28 89.98 38 81.55 All Ages 143 9.17 186 10.85 329 10.00 113 1911 Table LXXVII. Mortality from Cancer or Malignant Disease during the Year 1911. ORGANS AFFECTED. Sex. Age at Death. Males. Females. Totals. 0—5 —15 —25 —35 —45 —65 —65 —75 —75 upwards. Diseases of Nervous System Brain M .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. 1 .. .. .. .. 1 Spinal Cord M .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. 1 .. .. .. .. 1 Diseases of Heart, etc Endocarditis M. .. .. .. .. 1 .. .. .. .. 1 .. 8 F .. .. 2 1 2 1 1 .. .. .. 7 Respiratory System— Larynx M .. .. .. .. .. 1 1 1 I 4 .. 4 F. .. .. .. .. .. .. .. .. .. .. .. Lung M. .. .. .. .. 1 1 .. .. .. 2.. 6 F. .. .. .. .. 1 1 .. 1 1 .. 4 Throat M .. .. .. .. .. 1 .. 1 .. 2 .. 2 F. .. .. .. .. .. .. .. .. .. .. .. Digestive System— Rectum M. .. .. .. 1 .. 2 4 4 3 14 .. 25 F. .. .. .. 1 .. 3 3 1 3 .. 11 Pylorus M. .. .. .. .. .. 1 2 1 .. 4 .. 6 F. .. .. .. .. .. .. 1 1 .. .. 2 Liver M .. .. .. .. .. 4 2 4 .. 11 .. 30 F. .. .. .. .. .. 3 5 6 .. .. 19 Ventriculi M. .. .. .. .. .. .. .. 1 .. 1 .. 2 F. .. .. .. .. .. 1 .. .. .. .. 1 œsophagus M. .. .. .. .. .. 3 11 6 .. 21 .. 22 F. .. .. .. .. .. .. l .. .. .. 1 Stomach M. .. .. .. .. 4 4 8 3 .. 19 .. 37 F. .. .. .. .. .. 4 5 6 3 .. 18 Peritoneum M. .. .. .. .. .. .. .. .. .. .. .. 2 F. .. .. .. .. 1 .. .. .. 1 .. 2 Gall Bladder M .. .. .. .. .. .. .. 1 .. 1 .. 3 F. .. .. .. .. .. .. 1 1 .. .. 2 Abdomen M. .. .. .. .. .. .. .. .. .. .. .. 3 F. .. .. .. .. 2 .. .. .. 1 .. 3 Colon M. .. .. .. .. .. 1 1 4 .. 6 .. 13 F. .. .. .. .. 1 2 l 3 .. .. 7 Jaw M .. .. .. .. 1 1 l 1 .. 5 .. 7 F. .. .. .. .. .. .. l .. .. .. 2 Intestines (parts not specified) M. .. .. .. .. .. 2 4 2 .. 8 .. 15 F. .. .. .. .. .. 1 2 2 .. .. 7 Omentum M. .. .. .. .. .. .. .. 1 .. 1 1 F. .. .. .. .. .. .. .. .. .. .. .. Tongue M. .. .. .. .. 1 1 3 4 3 12 .. 12 F. .. .. .. .. .. .. .. .. .. .. .. Cæcum M. .. .. .. .. .. .. 2 .. .. 2 .. 3 F. .. .. .. .. .. .. .. 1 .. .. 1 Anus M. .. .. .. .. .. .. .. l .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Mesentery M. .. .. .. .. .. .. .. .. .. .. .. 1 F .. .. .. .. .. .. .. .. 1 .. 1 I 114 1911] Table LXXVII.—continued. ORGANS AFFECTED. Sex. Age at Death. Males. Females. Totals. —5 —15 -25 -35 -45 -55 —65 —75 —75 upwards. Digestive System—continued. M. .. .. .. .. .. .. 2 .. .. 2 .. 2 Pharynx F. .. .. .. .. .. .. .. .. .. .. .. M. .. .. .. .. .. .. .. 1 .. 1 .. 1 Lips F. .. .. .. .. .. .. .. .. .. .. .. M. .. .. .. .. .. .. 1 1 .. 2 .. 2 Tonsils F. .. .. .. .. .. .. .. .. .. .. .. Lymphatic System— Cervical Gland M. .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Urinary System— .. Kidney 5 F. .. .. .. .. 1 .. .. .. .. .. 1 M. .. .. .. .. 1 .. .. 1 .. 2 .. 3 Bladder F. .. .. .. .. .. 1 .. .. .. .. 1 M. 1 5 6 6 Prostate F. .. .. .. .. .. .. .. .. .. .. .. Generative System- Breast F. .. .. .. .. 6 6 9 9 2 .. 32 32 U terus F. .. .. .. 1 6 14 11 5 5 .. 42 42 Ovary F .. .. .. .. 1 1 4 .. .. .. 6 6 F .. .. .. .. .. 2 1 .. 1 .. 4 4 Vagina F. .. .. .. .. .. .. .. .. 1 .. 1 1 Testis M. .. .. .. .. .. 1 .. .. .. 1 .. 1 Organs of Locomotion— M. .. .. .. .. .. .. .. 1 1 2 .. 5 Neck F. .. .. 1 .. .. .. .. 1 1 3 M. .. .. .. .. .. .. .. .. .. .. .. 1 Axilla F. .. .. .. .. .. .. .. .. 1 1 M. .. .. .. .. .. .. .. .. .. .. .. 1 Leg F. .. .. .. .. .. .. .. .. .. .. Bones and Joints— M. .. 1 .. .. .. .. .. .. .. 1 .. 2 Femur F. .. .. .. .. .. .. .. 1 .. .. 1 M. .. .. .. .. .. .. .. .. .. .. .. 1 Tibia F. .. .. 1 .. .. .. .. .. .. .. l M. .. 1 .. .. .. .. .. .. .. 1 .. 1 Parietal Bone F. .. .. .. .. .. .. .. .. .. .. .. Unspecified M. 1 .. .. .. .. .. 1 1 1 4 .. 1 F. .. .. .. .. .. 1 .. 2 .. .. 3 Total Males and Females for Year M 1 2 .. 2 11 24 46 47 10 143 .. .. F. .. 1 4 3 21 43 46 40 28 .. 186 .. Total Deaths 1 3 4 5 32 67 92 87 38 113 186 329 115 1911 TUBERCULOSIS. Pulmonary Phthisis, Tabes Mesenterica, Tuberculous Meningitis, Tuberculosis of the Larynx, General Tuberculosis and other forms of Tuberculosis, such as Lupus, Tuberculous Caries, and Pott's Disease. These diseases are all included under the general term—tuberculosis; and together they contributed 512 deaths to the general mortality of the year. They were equal to a death-rate of 1.56 per 1,000 of the population. These figures show a decrease, when compared with the average of the preceding ten years, of 104 deaths, and of 0.29 per 1,000 in the death-rate. They are, therefore, so far satisfactory. The deaths and death-rates from the combined tuberculous diseases aie set out in the following statement:— Deaths. Death-rates. Deaths. Death-rates. 1901 677 2.01 1907 608 1.84 1902 672 2.01 1908 604 1.83 1903 632 1.90 1909 582 1.77 1904 682 2.05 1910 539 1.64 1905 580 1.75 1906 578 1.74 Average 616 1.85 1911 512 1.56 Decrease 104 - 0-29 The general tendency of these figures is to decrease; for in only two years have the deaths exceeded those of the year immediately preceding them. The decreased mortality was common to males and females, for the deaths of the former numbered 294, as compared with a decennial average of 357, a decrease of 63, and of the latter 218 as against an average of 259, a decrease of 41. It may be said that these decreases are small. This is true; but then it must be recollected that they are due almost solely to the general improvement which has taken place in the conditions amidst which the people live, and not to any direct attack on the special causes which so much contribute to the spread of the tubercle bacilli. Thus little or nothing has been done to prevent the sale of tuberculous milk, to disinfect rooms occupied, or recently vacated, by tuberculous persons, to prevent promiscuous spitting, to bring light and clean air into the homes of the attacked, to teach them how they may best avoid i 2 116 1911 being a danger to other persons, and to make people generally understand that tuberculous diseases are eminently preventable. But the public are thoroughly awakening to the fact, and are now insisting that their sanitary authorities must move in these matters; that they must in fact adopt all modern methods for the prevention and cure of the disease, whether they be dispensaries, sanatoria, health-visitors, or the distribution of literature of an educational character. Many enlightened corporations, county councils and district councils are doing all these things now, and laggard authorities, however unwillingly, as in the case of the notification of infectious disease, must in due course follow the lead that has been so well set them. The causes and prevention of tuberculosis have been reported on from time to time, and at length, by the Medical Officer of Health, so that his Council is fully cognizant of his views on the subject; and, indeed, in the beginning of the current year he presented a series of lengthy reports, five in number, which, practically, dealt with every aspect of the subject. It is hoped that they will bear good fruit. If, however, this should not be the result, and he does not for a moment imagine that this will be the case, then he will still feel that at least he has done his duty towards the people of Islington, whose adviser he is on all matters appertaining to the prevention of illness among them. How important these diseases are in relation to the general health of the community may be realized from the following facts, as regards Islington. Tuberculosis causes 5.1 per cent. of all deaths under one year. „ 13.5 „ „ between 1 and 5 years. „ 18.5 „ „ „ 5 „ 15 „ „ 37.5 „ „ „ 15 „ 25 „ „ 39.5 „ „ „ 25 „ 35 „ „ 27.8 ,, ,, „ 35 „ 45 ,, „ 18.1 ,, ,, ,, 45 „ 55 „ „ 7.6 „ „ „ 55 „ 65 „ „ 2.7 „ „ „ 65 „ 75 „ „ 0.7 „ „ „ 75 and upwards. These figures require little or no comment, they speak for themselves, while as regards certain periods of life they are staggering. It may, however, be well to emphasize the fact that between the ages of 15 and 25 they represent more than one-third of all the deaths occurring at that age ; that between 25 117 1911 and 35 years of age they represent two-fifths, which is to say that out of every five people who die two die from tuberculosis; and that between 35 and 45 years of age they represent more than one-third. And as the greater number of these deaths occur among the poorer and, therefore, the worst fed, worst clothed and housed inhabitants, the ravages of tuberculosis among them is heart-rending. The disease is almost a class disease. In discussing this question we should never lose sight of these great facts, for if we do we will fail to realize how urgent is the prevention of tuberculosis. But if we do realize them then we must be of opinion that the requisite machinery cannot be provided too quickly to put an end to the suffering and the poverty entailed on a section of our fellow citizens. Before proceeding to analyse the returns for the separate diseases it may be well here to refer to the Final Report of the Royal Commission on Tuberculosis which has now become a great historical document that will be and, indeed, already has been, productive of much good. The Royal Commission, it will be recollected, was formed immediately after Koch's astonishing pronouncement that bovine tuberculosis could not be conveyed to man, hence if this were true it matters little whether or not tuberculous meat or milk were consumed by him. In England and, indeed, in Europe and the United States, his opinion was met with an almost unanimous incredulity ; and at once the German Government, the United States Government, and the English Government instituted committees or commissions to enquire into its accuracy. The German and United States finished their work long since, but the English Commissioners, who inquired most fully and thoroughly into the subject, only presented their final report last year. The interim reports had, however, indicated plainly what their findings would be. The questions put to the Commissioners were three in number. 1. Whether the disease in man and animals is one and the same. 2. Whether animals and man can be reciprocally infected with it. 3. Under what conditions, if at all. the transmission of the disease from animals to man takes place; and what are the circumstances favourable or unfavourable, to such transmission. Their replies, summarised, were as follows:— 1. The human and bovine type of tubercle bacilli must be considered distinct, and the disease which they cause is not identical, that is to say not one and the same. 1911 118 2. Mammals and man can be reciprocally infected with tuberculosis. 3. The transmission of tuberculosis from animals to man must be mainly dependent on the susceptibility of any given animal to this disease and on the opportunities afforded such animal for transferring the acquired and developed infection in the human subject; and that animals, domestic and otherwise, which have been found capable of suffering from severe generalized tuberculosis of the human type are comparatively few; and, further, that none of these active multipliers of tuberculosis are common food animals. Thus the bovine animal is not an active multiplier of the human tubercle bacillus, nor has the cow herself, however, she may excrete bovine bacilli in her milk, been convicted of eliminating human tubercle bacilli in this way. It cannot, however, be affirmed that man is wholly free from risk of being infected through animal food with human tuberculosis. Also with regard to the transmission of bovine bacilli to man, that only rarely has a pulmonary lesion in adult man yielded the bovine bacillus, but that their experience of abdominal tuberculosis has been very different, and that, of young children dying from primary abdominal tuberculosis, the fatal lesions could in nearly one-half of the cases be referred to the bovine bacillus and to that type alone. In children, too, and often in adolescents, suffering from cervical gland tuberculosis, a large proportion of the cases examined by them could be referred to the bovine tuberculosis ; and that there can be no doubt that a considerable proportion of the tuberculosis affecting children, especially that affecting the abdominal organs and the cervical glands, is of bovine origin. Also that primary abdominal tuberculosis as well as tuberculosis of the cervical glands is commonly due to infection of the tuberculous infective material. Consequently the evidence goes to demonstrate that a considerable amount of the tuberculosis of childhood is to be ascribed to infection from bacilli of the bovine type transmitted to children in meals consisting largely of the milk of the cow. Now that the British, the German and the United States Commissions have reported on these grave matters in similar strain, is it too much to hope that the. sale of tuberculous milk and tuberculous meat, the former especially, shall be prevented, and that tuberculous animals shall be eliminated from the herds of these islands ? It is now time to examine the returns as to the separate diseases, which are classed as tuberculous. 119 [1911 Pulmonary Phthisis.—This disease, which is popularly known as "consumption," was responsible for the deaths of 379 persons, of whom 223 were males and 156 females. The deaths among males were 50 below the average of the preceding ten years, and those among females were 33 below it, while the total deaths were 83 below the average of 462, which obtained during the years 1901-10. The death-rate from phthisis was equal to l.16 per 1,000 of the population, or 0.23 below the decennial rate. The death-rate among males was con. siderably more than among females, the relative figures being 1.43 per 1,000 males, and 0.91 per 1,000 females. Each death-rate was, however, below the mean decennial rate, that for males showing a decrease of 0.24 per 1,000, and that for females 0.13. It is extremely satisfactory to note that the death-rate from pulmonary phthisis was the lowest hitherto recorded in Islington. Years. Pulmonary Phthisis. Proportion of Deaths from Phthisis per 100 Deaths from All Causes. Death rates from All Cause. per 1,000 inhabitants. Deaths Death rales per 1,000 inhabitants. 1891 544 1.70 8.6o 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 .02 10.16 15.9 1902 515 1.51 9.14 16.5 1903 492 1.48 10.16 14.5 1904 533 1.6o 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 14.9 1910 390 1.19 8.62 13.8 Corrected average 498 1.52 9.25 16.4 1911 379 1.16 7.88 14.7 The following return shows the deaths at each age period:— Age periods. Deaths Age periods. Deaths. 0-5 II 55-65 44 5-15 9 65-75 17 15-25 44 75-85 1 25-35 74 Total 370 35-45 108 45-55 71 120 1911 The deaths from phthisis represented 74 per cent. of the entire number of deaths from the tuberculous diseases, which is slightly above the proportion for England and Wales in 1909. Table LXXVIII. Showing the Deaths from Phthisis in the Sub Districts during the Four Quarters of the Year 1911. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury Barnsbury. South-East. Borough 1st 14 8 5 16 23 16 27 109 2nd 9 7 13 14 13 20 22 98 3rd 3 10 10 13 11 14 18 79 4th 8 12 10 11 13 21 18 93 The Year 34 37 38 54 60 71 85 379 Tabes Mesenterica.—Thirty-three deaths were attributed to this disease which principally affects child life, and they represent a death-rate of 0.10 per 1,000 of the population. Of the deaths 17 were those of males and 16 of females; while 19 were under five years of age, and 14 over that time of life. This disease, generally called abdominal tuberculosis, is the one which the Royal Commissioners say is commonly due to infection of the bovine tuberculous material transmitted in meals consisting largely of the milk of the cow. Tubercular Meningitis. —This disease of the meninges of the brain caused 50 deaths, 27 of males and '23 of females, which were equal to a deathrate of 0.15 per 1,000 of the population. The deaths among children, of whom 42 were under five years old, caused a death-rate of T25 of those living at that period of life. Tuberculosis of the Larynx.—There were ten deaths from it, which were equally divided among males and females. These deaths represented a death-rate of 0.03 per 1,000 inhabitants. General Tuberculosis.—Twenty-five deaths were attributed to it, 13 of males and 12 of females, and the death -rate was 0.07 per 1,000 of the population. As many as 10 of the deceased were under one year of age, 6 between 1 and 5, and only 9 at all other ages. Other forms of Tuberculosis.—Altogether there were only 15 deaths, 9 males and 6 females. With the exception of 3, all were over five years old. The death-rate was 0.05 per 1,000 inhabitants. 121 [1911 Table LXXIX. Showing the Deaths from the Tuberculous Diseases during 1911. 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 4 7 368 223 156 34 37 38 54 60 71 85 379 0.33 0.15 1.16 Tabes Mesenterica ii 8 14 17 16 3 1 5 6 8 5 5 33 0.56 09.0 0.10 Tubercular Meningitis 19 23 8 27 23 3 10 3 6 4 10 14 50 1.25 0.10 0.15 Tuberculosis of the Larynx — — 10 5 5 — 3 1 1 2 3 — 10 — 0"02 0-03 General Tuberculosis io 6 9 13 12 2 3 3 2 2 3 10 25 0.47 0.05 0.07 Other Forms of Tuberculosis 2 1 12 9 6 — 4 1 1 2 2 5 15 0.09 0.07 0.05 All Tubercular Diseases 46 45 421 294 218 42 58 51 70 78 94 119 512 2.70 0.48 1.56 122 1911 Table LXXX. Mortality from Tuberculosis of the Lung (including Phthisis) and, other Forms of Tuberculosis. Years. Number of Deaths. Death Kates. Tuberculosis of the Lung (inc'uding Phthisis). Other forms of Tuberculosis. Tuberculosis of the Lung (including Phthisis). Other forms of Tuberculosis. Males (all ages). Females (all ages). Persons (all ages). Males (all ages). Females (all ages). Persons (all ages). Children (under 5). Males (all ages). Females (all ages). Persons (all ages). Males (all ages). Females (all ages). Persons (all ages). Children (under 5). 1901 325 220 545 82 50 132 99 2.04 1.25 1.62 0.51 0.28 0.39 2.74 1902 308 207 515 84 73 157 120 1.92 1.17 1.54 0.52 0.41 0.47 3.31 1903 291 201 492 80 60 140 103 1.80 1.13 1.48 0.49 0.34 0.42 2.82 1904 315 218 533 83 66 149 104 1.94 1.22 1.60 0.51 0.37 0.45 2.84 1905 243 195 438 74 68 142 107 1.49 1.08 1.32 0.45 0.38 0.43 2.90 1906 252 159 411 88 79 167 112 1.54 0.88 1.24 0.54 0.44 0.50 3.02 1907 260 176 436 83 89 172 110 1.58 0.97 1.32 0.45 0.49 0.52 2.95 1908 218 184 432 96 76 172 109 1.53 0.99 1.31 0.59 0.41 0.52 2.85 1909 255 169 424 80 78 158 116 1.53 0.92 1.29 0.48 0.42 0.48 3.07 1910 234 156 390 89 60 149 93 1.39 0.84 119 0.53 0.32 0.45 2.45 Average 273 189 462 84 70 154 107 1.67 1.04 1.39 0.51 0.38 0.46 2.89 1911 223 156 379 71 62 133 80 1.43 0.91 116 0.45 0.36 0.40 2.37 Decrease on Average 50 33 83 13 8 21 27 0.24 0.13 0.23 0.06 0.02 0.06 0.52 DIABETES MELLITUS. During the year 27 deaths were registered from diabetes, which is 5 less than in 1910, and 7 less than in 1909. They are also 2 below the average of the preceding ten years. Seventeen deaths occurred among persons above fifty-five years of age. Indeed, the records of the ten years demonstrate that over sixty-five per cent. of the mortality occurs at this period of life, which is only slightly above the proportion in 1911. It is a disease in which grape sugar is persistently excreted in the urine. It is more frequent among males than females, although singularly enough during the last ten years the annual average number of deaths among males and females in Islington has been almost equal, viz.: 15 males and 14 females; and last year the numbers were 13 males and 14 females. Its causes are various. Thus there may be a 123 1911 family history, brothers and sisters sometimes suffer from it; sometimes an uncle or aunt; but rarely the father or mother. Injuries may set up temporary sugar in the urine, which is sometimes followed by permanent disease. Fright, passion, mental disturbances, anxiety and worry, figure as factors. It is also sometimes associated with gout, obesity, and alcoholism ; also influenza, pneumonia, bronchitis, pleurisy, acute febrile affections, exposure to inclement weather conditions; and occasionally it follows upon pregnancy. The disease sometimes is followed by defective vision, chiefly soft cataract. Severe forms of diabetes always terminate fatally and in from three to five years, although occasionally in less time. In mild cases life may be much prolonged ; indeed, ten to twenty years are not unusual and even much longer. In these cases if the patient is careful in his diet, which should be most restricted and most carefully selected, the symptoms may disappear, but they are certain to return if he resumes his ordinary diet. Table LXXXI. Showing the Deaths from Diabetes Mellitus at ten age periods during the years 1901-1910, and in 1911. Ages at Death. Years. Mean 10 years. 1911 1901 1902 1903 1904 1905 190<; 1907 1908 1909 1910 0- 5 — — — — — — — — — — — — 5-15 — 1 1 — — — 1 — — 1 — — 15-25 2 — 1 3 1 1 1 — 4 3 I 1 25-35 3 2 2 2 3 3 I I 2 1 2 1 35-45 1 7 2 3 2 3 I 2 1 3 2 3 45-55 5 4 2 5 4 3 2 4 10 7 5 4 55-65 10 9 8 11 6 7 7 7 8 7 8 9 65-75 8 2 7 9 11 14 5 5 5 10 8 8 75-85 3 3 3 1 1 1 2 1 3 2 2 1 85 upwards 1 — — 1 — — 1 1 3 — 1 — All Ages 33 28 26 35 28 32 21 21 36 34 29 27 Males 20 12 11 19 15 13 11 10 22 20 15 13 Females 13 16 15 16 13 19 10 11 14 14 14 14 124 1911 TABLE LXXXII. Showing the Deaths from the several Constitutional Diseases during the Years 1901-1910, also the Corrected Mean Number of Deaths for these Years, together with the Deaths in 1911. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Corrected Means 19011910. 1911. Increase or Decrease Rheumatic Fever 9 17 16 13 18 15 11 9 10 15 13 9 - 4 Rheumatism 12 15 21 21 11 19 13 14 28 15 17 17 — Gout 7 11 6 11 7 6 13 7 4 2 7 9 - 2 Rickets 19 17 9 11 11 11 5 5 3 4 9 10 + 1 Cancer 289 326 350 323 328 363 348 367 353 361 337 329 - 8 Tabes Mesenterica 38 43 40 40 39 35 26 45 41 36 37 33 - 4 Tubercular Meningitis 80 77 71 74 63 80 74 63 72 72 72 50 -22 Phthisis 545 515 492 533 438 411 436 432 424 390 456 379 -77 Other Tubercular and Scrofulous Diseases 14 37 29 35 40 52 72 64 45 41 42 50 + 8 Purpura 2 2 1 1 2 1 3 3 .. 1 2 2 — Anæmia. Chlorosis, Leucocythæmia 9 7 8 14 15 16 15 14 13 16 13 22 + 9 Diabetes 33 28 26 35 28 32 21 21 36 34 29 27 - 2 Other Diseases 5 2 1 5 7 1 4 4 3 2 3 10 + 7 Totals 1,062 1,097 1,070 1,116 1,007 1,042 1,041 1.048 1,032 989 1,037 943 -94 DISEASES OF THE RESPIRATORY ORGANS. These diseases include Bronchitis, Pneumonia, Pleurisy and Asthma, and taken together caused 855 deaths, of 17.8 per cent. of the total deaths registered in 1911. They were equal to a death-rate of 2.61 per 1,000 of the population. During the ten years 1901-10 they were credited with 10,038 deaths out of 50,275 registered in Islington, or 19.9 per cent. Thus nearly one in every five persons dies from them. Of late years there has been a decrease in their number. Indeed, as shown in the report for 1910 they have fallen from 0,268 in the quinquennium 1891-95 to 4,934 in that of 1900-10, which is a decrease of 21.3 per cent. 125 1911 Acute Bronchitis.—157 deaths were ascribed to acute bronchitis, of which 58 we;e those of males and 99 were of females. The return is 21 above that of 1910. No less than 51 out of these 157 deaths occurred among children in their very first year of life, and 18 between 1 and 5 years. Altogether 69 of these children had not reached the end of then fifth year. Nine deaths occurred in the public institutions of the borough. Chronic Bronchitis. —247 deaths from this disease were registered, as compared with 254 in the preceding year. 116 were males and 131 females. In contrast with the ages at death from acute bronchitis, it is noticeable that only one occurred among children under ten years old, while 18 were among pei sons aged from 45 to 55; 43 among persons 55-65; 82 among persons 65-75, and 71 among old people between 75 and 85, while as many as 18 occurred among old people who had passed their 85th year. 66 deaths, or over 26 per cent, of the entire number, occurred in public institutions, chiefly in the Workhouse Infirmaries. Pneumonia.—To this disease were ascribed 395 deaths, as contrasted with 429 in the preceding year, of which number 215 were males and 180 females. There weie also 100 deaths among infants under one year old, and 96 among young children between 1 and 5 years of age, 5 among children between 5 and 10. 69 deaths, as compared with 71 in the preceding year, occurred in public institutions, generally the Workhouse Infirmaries. This disease is commonly known as "Inflammation of the lungs," but it has been rightly called "pneumonic fever." It has been known from the earliest years of medical history, and, indeed, Hippocrates, the "Father of Medicine," gives an account of it, while others of the medical fathers, such as Celsus and Galen, speak of it. It is, moreover, an infectious disease, which fact makes it of interest from a public health point of view. This characteristic was recognised so long ago as 1497, when Pavonasola, writing of it in his book "Practica," alluded to it as contagious. A century later (1592) Dunns noted this character; while 21 years later still Ravico at Venice writes of a malignant epidemic. In the eighteenth century, according to Thirsch, malignant epidemics of the disease prevailed in Spain, England, Denmark, and North America, while it has also been recorded by other writers 126 1911 that many epidemics occurred in France and Switzerland in the same century, and a notable one at Plymouth in 1745-46. In the nineteenth century there were epidemics in North America during the years 1812-25. In France (1814) there was an epidemic among the conscripts, and at Christiana on December 18th, 1866 an epidemic broke out in the Akerhaus Prison, which lasted until May, 1867. It was attributed to overcrowding. To the same cause Dr. Bryson attributed an epidemic which broke out in the Mediterranean fleet in 1860. In 18G9 in the town of Eidsvold in Norway, there was an outbreak in a row of cottages near some glass works, when the town was otherwise free from disease. In the spring of 1874 an epidemic occurred at East Sheen, Mortlake, and the disease received the name of "Sewer-gas pneumonia," because the infection was attributed to the sewer air emitted from a ventilator to the main sewer. During the same year an epidemic occurred in Dublin, which was attributed to a similar cause. In the same and following year an epidemic which was noted by Dr. Wynter Blyth swept over the south-western counties of England. In 1888 there was a serious outbreak in Middlesborough, which was investigated by the late Dr. Ballard, the first Medical Officer of Health of Islington, but at that time on the Medical Staff of the Local Government Board. This outbreak lasted 24 weeks, during which there were about 1,000 cases and 369 deaths, or a moitality of 36-9 per cent. In April and May, 1890, the disease appeared in epidemic form at Scotter, Lincolnshire, and no less than 22 deaths occurred among 32 known cases, so that the mortality was 69 per cent. This outbreak was conjointly attributed to sewer-air emanations and to simple contagion. In the year 1893 there was an epidemic at Yeadon, Yorkshire, in which 35 cases were known, of whom 15, or 37 per cent. died. 1 here have also been other, indeed, numerous, epidemics, which most people consider results from undue exposure to weather or similar causes. Some time ago (1898) Dr. H. Mackenzie showed that it affects tome 220,830 persons annually in England, of whom 31,950, or 14.5 per cent., die. 127 1911 Keeping the above facts before us, we must recognise Pneumonia to be a specific febrile disease, in every respect analogous to Small Pox, Diphtheria, Enteric Fever, and other infectious diseases. It is caused by a microbe, in which the lungs, although not invariably, are the circumscribed battle ground in which the Diplococcus pneumoniae and the Bacillus pneumoniae play a part, although not an exclusive one, for it has been shown by Fliigge that the micro-organism peculiar to erysipelas, to influenza, to tuberculosis, and to enteric fever, may all give rise to pneumonic fever. It is usually most prevalent in the spring, more especially the late spring, and reaches its lowest prevalency in the summer, rising gradually to the winter The origin of the malady, according to Hirsch, is dependent on sudden changes of temperature and considerable fluctuations in the proportion of moisture in the air, proper to winter and spring. The same authority holds that any exceptionally large number of cases of "inflammation of the lungs" at the other seasons, especially in summer, has coincided with the prevalence of similar meteorological conditions phenomenally at that season. The period of incubation of the disease, viz., the time that lapses between the moment at which the individual is infected and its manifestation on him, is very short, usually from a few hours to a few days. The disease is year by year coming more and more under the purview of Public Health Authorities, although hitherto no definite steps have been taken with respect to it in this country. In some cities of the United States, notably in Chicago, it has been scheduled among the diseases to be notified, so that instructions respecting preventive measures may be givep to those in attendance on the patient, and to enable the authorities to disinfect the premises. Probably later on something will be done in England, where, however, up to the present, there has been no movement in the direction of notification or otherwise. The matter is not yet ripe—but there can be no doubt that pneumonic fever will one day be recognised as a disease to be dealt with by Public Health Authorities for the protection of the public. At all events, since 1890, a special weekly record of the deaths from the disease has been kept, which has been charted for this report, and w hich the Medical Officer of Health has not the least doubt will become valuable some day. 128 1911 Pleurisy.—This disease caused 27 deaths, of which nine were of persons under five years old. Five deaths were registered in the public institutions. Asthma and Emphysema. —8 deaths were known, all of which occurred among adults who had passed their 45th year. Other Diseases of the Respiratory System. — To these were credited 22 deaths, as compared with 13 in 1910. Deaths among Infants.—As it is interesting to note the deaths among infants, they are given. Acute Bronchitis. Pneumonia. Total. 1st quarter 22 38 60 2nd „ 8 26 34 3rd „ 5 11 16 4th „ 16 25 41 5i 1OO 151 ALCOHOLISM. Among all the mortality returns included in these annual reports there are none which so conclusively indicate a change in the habits of the people as those embraced under this heading, for they clearly indicate that the drink habit is gradually, but, nevertheless, very surely, disappearing from the borough, and, therefore, that the people living here, as in many other places, are becoming more sober. During the ten yean, 1901-10 there have died on the average 29 persons per annum. Last year there were only 4 deaths. The decrease began in 1902, and has continued since, although not always quite uniformly, for in 1907 the figure rose to 28 from 16 in 1906. Nevertheless, the diminution is remarkable. Thus in the five years 1901-5 there were 138 deaths registered, while in the next five years they had decreased to 84. If we divide the ten years into pairs, it is found that in the years 1901-2 there were 65 deaths, in 1903-4 48, in 1905-6 41, in 1907-8 45, in 1909-10 29. It is curious to note that there was an increase in 1907-8, which was, however, fully made up for by the decrease in 1909-10. The drop to 4 deaths in 1911 emphasised the change to which the other figures pointed. The number of deaths of males and females was alike, 2. 129 1911 The number of deaths during each year since 1901 is as follows:— Acute. Chronic. Total. Males. es. 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 1911 — 4 4 2 2 232 104 128 VENEREAL DISEASES. These diseases, which averaged, in the ten years 1901-10, 19 deaths per annum, in 1911 had fallen to 13. Of these 6 were of infants under one year of age, and 7 were of adults. There were no deaths among children between 1 and 5 years old. The satisfactory feature of the return is the decrease in the deaths of infants, which during ten years have averaged 10 per annum ; and this satisfaction is increased if the return for the preceding ten years, given below, be split into two quinquennial periods, because it shows that in the first five years there were 56 infantile deaths, and in the second 45, a decrease of 11. Also that among children, 1 to 5 years of age, the numbers fell from 4 to 2. The figures regarding adults were not so satisfactory, for they were identical—35. Under 1 year. 1—5 years. Adults. Total. 1901 10 1 6 17 1902 11 — 10 21 I903 10 1 8 19 1904 12 2 6 20 1905 13 — 5 18 1906 9 1 6 16 1907 5 — 11 16 1908 13 1 6 20 1909 10 — 5 15 1910 8 — 7 15 1901-10 101 6 70 177 1911 6 — 7 13 K 130 1911 DEATHS IN PUBLIC INSTITUTIONS. Within the Borough.—1,804 persons died in the Public Institutions located in Islington, of whom 1,181 belonged to this borough, the remaining 623 having come here for treatment or relief. Among the latter were 431 persons who died in the Holborn Infirmary, and 97 in the Great Northern Central Hospital, 14 in the Islington Infirmary, 7 in the London Fever Hospital, 13 in St. Pelagia's Creche, and 10 in the Memorial Cottage Hospital. Of the 1,181 deaths of inhabitants, 817 occurred in the Islington Infirmary, 208 in the Islington Workhouses and Schools, and 113 in the Great Northern Central Hospital. The proportion which the 1,181 deaths bore to the borough mortality was 24'3 per cent. Without the Borough.—760 deaths of persons belonging to Islington were registered as occurring in Public Institutions in districts of London outside the Borough. They included, among others, 64 in the North-Eastern Fever Hospital, 60 in the Children's Hospital, Great Ormond Street, 97 in St. Bartholomew's Hospital, 37 in the Colney Hatch Asylum, 51 in the Royal Free Hospital, 45 in the University College Hospital, and 29 in Claybury Asylum. These 760 deaths represented 15.6 per cent. of all the deaths registered in the year. Within and without the Borough.—The deaths of Islingtonians in Public Institutions numbered 1,941, and were equal to 39.9 per cent. of the total deaths registered during the year. Fatal accidents or sudden deaths outside the Borough — Forty-seven inhabitants died from accidental deaths, or suddenly, in places outside Islington. 131 1911 Table LXXXIII. Showing the Deaths of Inhabitants in Local Institutions and in Institutions outside the Borough, also to the Deaths of Non Inhabitants in Local Institutions during the ten years 1901-1910 and in 1911. Years, Total Deaths in Local Institutions cols. 3 and 4). Inhabitants ot 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 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 1,574 955 619 717 106 648 1,603 31.5 1907 1,675 1,082 593 760 130 656 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 1910 1,683 1,120 563 839 97 681 1,801 39.8 Average 1,571 990 581 706 120 661 1.651 32.8 1911 1,804 1,181 623 817 113 760 1,941 40.3 132 1911 Table LXXXIV. 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 1911. public institution. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. Total Inhabitants. NonInhabitants. Islington Infirmary 54 114 8l 115 96 156 201 817 14 Islington Workhouses 24 30 14 34 20 40 4b 208 6 Workhouse Schools — — — — — — — — — Gt. Northern Hospital 21 27 26 11 19 7 2 113 97 Holborn Infirmary — — — — — 3 2 5 43i Aged Pilgrims' Asylum — 1 1 — 1 — — 3 3 St. Pelagia's Creche — — — — — — — — 13 Aged Blind Home — — — — — — — — 10 Medical and Surgical Home — — — — — — — — — Children's Nursing Home — — — — — — — — — St. |ohn's Nursing Institute — — — — — — — — Kingsdown Orphanage — — — — — — — — Shoreditch Infirmary — — — — — — — — 3 Whittington College — — — — — — — Tufnell Park Nursing Institution — — — — — — — — — St. Andrew's Nursing Home — — — — — — — — — Alexandra Nursing Home, Turle Road — — I 1 — — 1 3 — Highbury Nursing Home — — — — — — — — 3 Nature Cure Home, Hornsey Lane — — — — — — — — 1 H.M. Prison, Holloway 4 — — — — — — 4 3 H.M. Prison, Pentonville — — — 3 — — — 3 5 Drovers' Almshouses — — — 2 — — — 2 — London Fever Hospital — — — — — — 2 2 7 Memorial Cottage Hospital — — — — 7 2 7 16 10 Invalid Home, Aubert Park — — — — 1 — — 1 6 Invalid Home, Highbury Terrace — — — — — — — — 2 Bookbinders' Asylum — — — — — 1 — 1 1 Metropolitan Benefit Societies' Asylum — — — — 1 — — 1 5 Bricklayers' and Tilers' Almshouses — — — — — — — — 1 Dyers' Almshouses — — — — 1 — — 1 2 Pennefather Memorial Home — — — — — — — — — Cloth workers' Almshouses — — — — — — 1 1 — Totals 103 172 123 166 146 209 262 1,181 623 There were also 17 deaths at places not mentioned in this list. 133 [1911 Table LXXXV. 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 1911. Sub-Registration Districts. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males, j Females. Total. Males. Females. Total. Tufnell 6 7 13 10 1 11 10 5 15 12 8 20 38 21 59 Upper Holloway 14 15 29 21 10 31 14 7 21 10 20 30 59 52 111 Tollington 7 4 11 11 5 16 3 6 9 2 7 9 23 22 45 Lower Holloway 14 11 25 14 2 16 15 8 23 7 10 17 50 31 81 Highbury 16 13 29 10 12 22 18 8 26 12 16 28 56 49 105 Barnsbury 23 22 45 21 26 47 30 19 49 18 15 33 92 82 174 South-East Islington 40 34 74 17 19 36 40 23 68 23 31 54 120 112 232 Borough 120 106 226 104 75 179 130 81 211 84 107 191 438 369 807 134 1911] Table LXXXVI. Showing the Deaths of Inhabitants in Public and Charitable Institutions situated without the Borough, during the Year 1911. Institutions. 1st Quarter. 2nd Quarter. 3rd Quartcr 4th Quarter. Year. Middlesex Hospital 9 5 4 5 23 Friedenheim (Home of Peace), N.W. 1 6 5 2 14 North Western Fever Hospital 7 5 1 2 15 University College Hospital 8 14 12 11 45 Eastern Fever Hospital 13 .. 2 1 16 Children's Hospital, Gt.Ormond Street 18 12 22 8 60 Banstead Asylum 4 1 1 2 8 Manor Asylum (Epsom) .. .. .. 2 2 Darenth Asylum .. .. 1 1 2 Hanwell Asylum 6 .. 1 5 12 New Hospital for Women (Euston Road) .. 2 1 1 4 Metropolitan Hospital 9 5 8 4 26 German Hospital 3 3 1 4 11 St. Bartholomew's Hospital 28 19 31 19 97 Royal Chest Hospital 7 2 2 3 14 1 2 1 2 6 Guy's Hospital 1 2 .. 1 4 Colney Hatch Asylum 12 8 10 7 37 North Eastern Fever Hospital 9 18 18 19 64 Leavesden Asylum 5 2 1 3 11 St. Thomas's Hospital .. .. .. 1 1 Cane Hill Asylum 1 2 1 2 6 Royal Free Hospital 13 7 15 16 51 London Temperance Hospital 3 4 3 3 13 Cancer Hospital (Chelsea) .. 1 2 3 London County Asylum (Dartford) 4 1 1 1 7 London Hospital — 3 5 3 1 12 St. Anne's House, Stoke Newington 2 .. .. 1 3 Mildmay Hospital 1 1 .. .. 2 Homoeopathic Hospital, Gt. Ormond Street 2 .. 2 2 6 Claybury Asylum 11 7 2 9 29 St. George's Hospital 1 1 1 3 Hackney Infirmary .. .. .. 1 1 St. Pancras Infirmary .. .. 1 2 3 St. Pancras Workhouse .. .. .. 1 1 City of London Lying-in Hospital 2 .. 1 1 4 Marylebone Infirmary 2 .. l 2 5 Westminster Hospital .. .. 2 .. 2 St. Mary's Hospital 1 .. .. .. 1 Tooting Bee Asylum 2 3 4 1 10 Charing Cross Hospital 2 2 3 .. 7 National Hospital, Queen's Square, W,C .. .. 2 .. 2 St. Luke's House, Pembridge Square, S.W, 2 .. 4 .. 6 Holborn Workhouse, Hoxton 3 1 1 2 7 Caterham Asylum 1 2 1 2 6 Hostel of God (Clapham) .. 1 .. .. 1 Shoreditch Infirmary .. .. .. 3 3 Horton Asylum 2 3 .. 1 6 Heart Hospital, Soho Square .. 1 .. .. 1 St. Peter's Hospital .. .. 2 1 3 Long Grove Asylum 1 4 .. .. 5 Belmont Workhouse 1 1 .. .. 2 Grove Hall Asylum .. .. 1 .. 1 Royal Hospital for Incurables .. .. 2 1 3 1 .. .. • • 1 135 1911 Table LXXXVI.—continued. Institutions- 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Seaman's Hospital, Greenwich 1 .. .. .. 1 Park Hospital 1 .. 4 .. 5 Hampstead Workhouse .. 1 .. .. 1 Holborn Workhouse, Mitcham .. 1 .. .. 1 St, Anne's Home, Streatham Hill .. 1 .. .. 1 East London Hospital .. 1 1 1 3 Queen's Hospital, Bethnal Green 4 1 1 3 9 Lock Hospital .. .. 1 .. 1 Royal Hospital, Waterloo Road .. .. 1 .. 1 Mount Vernon Hospital 1 .. .. .. 1 Home Hospital, 16, Fitzroy Square 1 .. 1 .. 2 Hampstead General Hospital 1 .. .. .. 1 West London Hospital .. .. .. .. 1 City of London Asylum, Stone 1 .. .. .. 2 Bethlem House .. .. .. .. 1 South Eastern Fever Hospital .. .. l .. 1 Samaritan'Free Hospital .. 1 .. .. 1 Royal London Ophthalmic Hospital .. I .. .. 1 Home of Good Shepherd, Shoreditch 1 .. .. .. 1 Italian Hospital .. I .. .. 2 Brompton Hospital .. .. .. .. 1 North-West London Hospital .. 1 .. .. 1 Children's Infirmary, Carshalton 2 .. .. .. 2 Bethnal Green Infirmary Sick Asylum, Cleveland Street .. 1 l 1 1 1 3 North London Nursing Institution, Stoke Newington .. .. 2 2 4 Southwark Infirmary .. .. 1 .. 1 The Babies' Home, Brunswick Place, Shoreditch .. l 1 .. 2 City of London Workhouse, Hackney .. l .. .. 1 Queen Charlotte Hospital .. .. .. 1 1 Camberwell House Asylum 2 .. .. 1 3 Central London Throat and Ear Hospital .. 1 2 .. 3 Queen Mary's Hospital, Carshalton .. l 1 .. 2 Alexandra Hospital, Queen's Square .. l .. .. 1 Brook Hotpital .. 1 .. 1 Northumberland House, Green Lanes .. .. I .. 1 Quinton Polyclinic, Poland Street. W. .. .. 1 .. 1 Infants'Hospital, Westminster .. .. 1 I St' Barnabas Home, Clerkenwell .. .. .. 1 1 H.M. Prison, Brixtion, S.W. .. .. .. 1 1 St. Peter's Home .. .. .. .. 1 1 St. Giles' Infirmary .. .. .. 1 1 Sick Asylum, Hendon .. .. .. 1 1 Accidental and other Deaths:— 218 167 198 177 760 In Brownswood Park, Green Lanes 1 .. .. .. 1 In Penton Place 1 .. .. .. ] 1 .. .. .. 1 In City Road, near Chest Hospital 1 .. .. .. 1 In Regent's Canal, near DeBeauvoir Crescent, Hackne 1 .. .. 1 In River Thames off Tunnel Pisr, Wapping 1 .. .. 1 In Crown Place, North St. Pancras 1 .. .. 1 At National Sporting Club, Covent Garden 1 .. .. 1 At Police Station, Leman Street, E 1 .. .. 1 At Police Station, Shepherdess Walk 1 .. .. 1 1 .. .. 1 1911] 136 Table LXXXVI.—continued. Institutions. 1st Quarter. 2nd Quarler. 3rd Quarter. 4tb Quarter. Year. At "Ravenswood," Highgate Road .. 1 .. .. 1 At 21, Stamford Hill .. 1 .. .. 1 On doorstep of 67, White Lion Street .. 1 .. .. 1 In River Thames, off Battersea Park .. 1 .. .. 1 At the Hotel Metropole, S.W. .. 1 .. .. 1 In River Thames off Hay's Wharf .. 1 .. .. 1 At North London Police Court .. 1 .. .. 1 At 57, King Henry Road, Hampstead .. 1 .. .. 1 At 46, Newgate Street, E.C. .. 1 .. .. 1 In Waiting Room, Euston Station, L. & N.W.R. .. .. 1 .. 1 In New North Road (Shoreditch) .. .. 1 .. 1 In Gray's Inn Road .. .. 1 .. 1 In Dalston Lane, Hackney .. .. 1 .. 1 On Permanent Way, Holborn Station, G.N.P. & B.R .. .. 1 .. 1 In Hyde Road, Hoxton .. .. 1 .. 1 At No 2 Pond, Hampstead Heath .. .. 1 .. 1 At 218, Adelaide Road, Hampstead .. .. 1 .. 1 At Olive House, Perry Hill, Lower Sydenham .. .. 1 .. 1 In Hoist at Farringdon Street Goods Station, G N.R. .. .. 1 .. 1 In backyard at 20, North Villas, Camden Square .. .. 1 .. 1 At 88, Chancery Lane, E C. .. .. 1 1 2 At 375, Oxford Street, W. .. .. 1 .. 1 At 131, High Street, Clapham .. .. .. l 1 At Hornsey Wood Tavern .. .. .. l 1 In Engine House, Scenic Railway, Coronation Exhibition .. .. .. l 1 At 7, The Terrace, St. Pancras .. .. .. l 1 In Grays Inn Road, near Frederick Street, St. Pancras .. .. .. l 1 At 146, Fellows Road, Hampstead .. .. .. l At corner of Commercial Street, E. .. .. .. l 1 In Kingsland Road, near Stamford Road .. .. .. l 1 At 14, Beaumont Street, St. Marylebone .. .. .. l 1 At 112, Grosvenor Road, W. .. .. .. l 1 On London Fields, Hackney .. .. .. l 1 At 188, Brixton Hill, S.W. .. .. .. l 1 In Regent's Canal near Chalk Farm Road Bridge .. .. .. l 1 Total Deaths 226 179 211 191 807 137 [1911 Table LXXXVII. 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 1911. 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 237 184 196 200 817 3 3 4 4 14 240 187 200 204 831 Islington Workhouses and Schools 70 43 49 46 208 1 1 4 .. 6 71 44 53 46 214 Great Northern Central Hospital 20 27 35 31 113 30 26 20 21 97 50 53 55 52 210 Holborn Infirmary 1 1 1 2 5 125 99 93 114 431 126 100 94 116 436 St. John's Nursing Institute .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tufnell Park Nursing Institute .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. London Fever Hospital 1 .. .. 1 .. 3 .. .. 2 7 4 2 3 9 Aged Pilgrims' Asylum 1 .. .. 1 3 2 1 .. .. 3 3 1 1 1 6 St. Pelagia's Creche. .. .. .. .. .. 3 4 3 3 13 3 4 3 3 13 Memorial Cottage Hospital 2 5 2 7 16 2 4 1 3 10 4 9 3 10 26 Alexandra Nursing Home,Turle Road 2 1 .. .. 3 .. .. .. .. .. 2 1 .. .. 3 Aged Blind Home .. .. .. .. .. 1 2 3 4 10 1 2 3 4 10 Medical and Surgical Home .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Invalid Home, Aubert Park .. .. .. 1 1 1 1 1 3 6 1 1 4 4 7 H.M. Prison, Holloway 1 1 .. 2 4 .. 2 .. 1 3 l 3 .. 3 7 H.M. Prison, Pentonville .. 1 .. .. .. 3 .. .. .. 3 5 l 2 2 3 8 Children's Nursing Home . . .. .. .. . . .. .. .. .. .. .. .. .. .. .. Kingsdown Orphanage .. .. .. .. . . .. .. .. .. .. .. .. . . .. . . Whittington College . . .. .. .. .. .. .. .. .. .. .. .. .. .. . . Metropltn. Benefit Societies' Asylum . . .. .. .. 1 l .. .. .. 5 1 2 2 1 6 Shoreditch Workhouse .. .. .. .. . . 3 .. .. .. 3 3 .. .. .. 3 Drovers' Almshouses .. .. .. .. 2 .. .. .. . . . . .. .. 2 .. 2 Bookbinders'Asylum .. .. .. .. 1 1 .. .. . . 1 1 .. 1 .. 2 Invalid Home, Highbury Terrace .. .. .. .. .. 1 .. .. 1 2 l .. .. l 2 Dyers' Almshouses 1 .. .. .. 1 .. .. .. . . 2 2 1 .. .. 3 Highbury Nursing Home .. .. .. .. .. .. 1 .. 2 3 .. 1 .. 2 3 Bricklayers' and Tilers' Almshouses .. .. .. .. .. .. .. .. 1 1 .. .. .. 1 1 Cloth workers' Almshouses 1 .. .. .. 1 .. .. .. .. .. 1 .. .. .. 1 St. Andrew's Nursing Home .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nursing Home, Hornsey Lane .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nature Cure Home ,, • • •• .. .. • • .. .. 1 1 .. .. 1 • • 1 Totals 338 262 289 292 1181 178 151 132 162 623 516 413 421 454 1804 138 1911] INQUESTS AND MORTUARY. During the year 646 bodies were received into the Mortuary, as compared with an average of 645 in the preceding 10 years. The daily average number of bodies so received was 1.7, as compared with 1.8 in 1910. In 425 cases inquests were held, as contrasted with an average of 419 in the years 1901-1910. Bodies received into Mortuary. Inquests. 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 1910 609 385 Average 645 419 1911 646 425 The following table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1910 and 1911. 1910. No. of bodies received. Daily Average. No. of Inquests held. 1911. No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 159 1.7 117 1st Quarter 171 1.9 126 2nd ,, 142 1.6 81 2nd ,, 144 1.6 97 3rd „ 126 1.4 84 3rd „ 177 2.0 95 4th 182 2 0 103 4th „ 154 1.7 107 Total for Year 609 1.7 385 Total for Year 646 1.8 425 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. 1911] 140 THE NOTIFICATION OF INFECTIOUS DISEASES. Small Pox, Diphtheria, Membranous Croup, Enteric or Typhoid Fever, Typhus Fever, Erysipelas, Continued Fever, Relapsing Fever, and Cholera. The returns showed that 1,759 cases of the above diseases were notified during 1911, as compared with 1,525 in the preceding year, and with an annual average of 2,617 in the preceding twenty years. Only on two previous occasions have there been so few cases notified in the borough, namely, in 1910, when, as already stated, they numbered 1,525, and in 1903, when they were 1,707. The cases were in the proportion of 5.37 to every 1,000 of the population, as contrasted with 7.89 in the years 1891-1910. The record for the year was, therefore, good. The full returns for preceding 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 1902 3,164 9.29 1892 3,318 10.26 1903 1,707 5.12 1893 4,853 14.84 1904 1941 5.84 1894 3.121 9.44 1905 1,928 5.8I 1895 2,839 8.50 1906 2.275 6.87 1896 3,824 11.32 1907 2,063 6.25 1897 2,906 8.62 1908 2,289 6.82 1898 2,418 7.18 1909 2,049 6.23 1899 2,943 8.75 1910 1,525 4.65 1900 2,276 6.78 1901 2,852 8.52 1891-1910 52,350 7.89 1911 1,759 5.37 The Sub-Registration Districts.—The attack-rate, by which is meant the number of cases per 1,000 inhabitants, varied considerably in the several sub-districts, ranging from 6.98 in Barnsbury to 3.26 in Highbury, which is a difference of more than fifty per cent. in favour of the latter place, and which is to be accounted for by the two facts (a) that Highbury is much less crowded, containing only 77 persons to the acre, while Barnsbury contains 171; and (b) that the people in Highbury are of a higher social status. 141 [1911 The cases and attack-rates for each sub-district are given in the following statement:— Cases. Attack-rates. Tufnell 155 4.62 Upper Holloway 211 5.67 Tollington 205 6.71 Lower Holloway 204 5.19 Highbury 202 3.26 Barnsbury 370 6.98 Islington South East 412 5.75 Total 1,759 5.37 Wards.—The cases referred to the several wards were as follows:— Cases. Attack-Rates. Tufnell 155 4.62 per 1,000 inhabitants. Upper Holloway - 211 5.67 Tollington - 205 6.71 Lower Holloway - 204 5. 19 Highbury - 95 2.81 Mildmay 91 3.81 Thornhill - 241 7.66 Barnsbury - 129 6.oo St. Mary 126 7 .46 Canonbury - 141 4.88 St. Peter 161 5. 34 Total 1,759 5.37 Highbury ward exhibited an even lower attack-rate than Highbury subdistrict, and again affords proof, if proof were wanting, that social position, which invariably implies good surroundings, free circulation of air, good living, and also education, is almost the certain guarantee of freedom from those illnesses, sometimes called filth diseases, with which this section of the report deals. Seasonal Attacks.—The attacks of the infectious diseases usually increase as the year advances, although there is sometimes a slight decrease in the second quarter, as was the case in 1911. 1911] 142 First Quarter.—There were 336 cases notified, and these equalled an annual attack-rate of 4.11 per 1,000 of the population. They were 156 below the decennial average for this quarter. Second Quarter.—The number of cases reported was 313, or 156 less than the decennial average. They represented an annual attack-rate of 3.82 per 1,000 inhabitants. Third Quarter.—458 cases were notified, or 120 less than the average of the corresponding quarters of the ten years 1901-10. They equalled an annual attack-rate of 5.60 per 1,000 of the population. Fourth Quarter.—As many as 652 cases were recorde I, representing an annual attack-rate of 7.97 per 1,000 inhabitants. They were, however, only 10 above the annual average of the fourth quarter of the preceding ten years. High though the rate was, it was lower than the aggregate rate of the Encircling Boroughs, and only slightly above the attack-rate of the County of London. The following statement gives the particulars for each quarter:— Quarters. Cases. Attack-rates. Decennial average. Increase or decrease. First 336 4.11 492 -156 Second 313 3.82 462 -149 Third 458 5.60 578 -120 Fourth 652 7.97 642 + 10 FATALITY FROM THE INFECTIOUS DISEASES. By the term fatality is meant the percentage proportion of the deaths to the attacks. Thus, if there were 100 attacks and 5 deaths, the fatality would be 5.0 The fatality, which was 5.9 per 100 cases, was again low, being 2.7 below the average of the twenty years 1891-1910. It was, however, 0.7 above that of the preceding year. It is a singular fact that as the cases of illnesses have decreased so nearly always has the fatality, although not always to the same extent. This may be seen on the chart on the opposite page. It is not easy to understand the reason why the disease is not so virulent when the cases are few, but that it is generally the case is apparent on studying the curves. Showing the number of oases of the Notifiable INFECTIOUS DISEASES and the Fatality from them since 1891 148 [1911 Years. Cases Deaths. Fatality. 1891 2,059 258 I2.5 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 1911 1,759 104 5.9 Total 54,109 4,261 7.9 If this table is split up into two periods of ten years, results are obtained which show that the improved fatality has been considerable in the ten years 1901-10. Years. Cases. Deaths. Fatality. 1891—1900 - 3,055 - 292 9.5 1901—1910 - 2,179 - 136 6.2 Difference ~ 876 - 156 3.3 1911] 144 Indeed, not only is the improvement apparent in the annual fatality, but it is equally so when the periods are examined quarter by quarter. Decennial Periods. Attacks. Deaths. Fatality. First Quarter 1891-00 591 65 11.0 1901-10 476 37 7.8 Decrease 115 28 3.2 Second Quarter 1891-00 624 61 9.8 1901-10 468 28 5.9 Decrease 156 33 4.9 Third Quarter 1891-00 853 75 8.8 1901-10 585 31 5.3 Decrease 268 44 3.5 Fourth Quarter 1891-00 987 91 9.2 1901-10 650 40 6.1 Decrease 337 51 3.1 These figures are extremely satisfactory, for they show that the decrease in the fatality has not been confined to any particular season of the year, but has been common to each alike. We will see when we come to examine each of the notifiable infectious diseases separately, to what extent the reduction has occurred in them. Hospital Isolation.—Of the 1,759 cases of the diseases notified under the provisions of the Public Health (London) Act, 1891, 1,416 were isolated or treated in hospitals. These represent 80.5 per cent, of the cases, which is only 1.1 per cent. below that of the preceding year. SMALL POX. No case of the disease was notified, although 63 were known in London, distributed in ten of its boroughs. Of these cases 39 occurred in Stepney and 11 in Poplar. In England and Wales 265 cases were notified, representing a rate of 0.01 per 1,000 of their population, as compared with a rate of 0.01 in London. Fatality.—The fatality from Small Pox in Islington during twenty years has not decreased; on the contrary it has risen from 3.0 in the decennimum 1891-00 to 16.6 per cent. in 1901-10. Showing the cases of SCARLET FEVER notified in each week in 1911, and the averages for the corresponding week in the ten years 1901-1910 145 [1911 SCARLET FEVER. There were 804 cases notified, which is an increase of 74 on the return for 1910, but 370 below the corrected average of the ten years 1901-10, and as many as 797 below that of the ten years 1891-00. There has been of late years a decrease in the cases of Scarlet Fever in Islington, although not as great as could be desired, for while during the ten years 1891-00 16,014 cases were notified, and only 11,893 cases reported in the ten years 1901-11, yet in the first five years of the latter decennium, 5,867 cases occurred as against 6,026 in its second five years—an increase of 159 cases. Although this is not a very large number, one would prefer that it had been a decrease. It is satisfactory to note that during the last two years, 1910-11, the cases were fewer than in any previous year since this disease became compulsorily notifiable. The 804 cases represented an attack-rate of 2.46 per 1,000 of the population, as compared with one of 2.90 in England and Wales, 2.84 in England, 3.66 in Wales, 2.32 in the County of London, and 2.26 in the six encircling boroughs. A study of the Chart on the opposite page shows that, in only three weeks during the year did the number of cases exceed the average of the preceding ten years. These exceptions occurred in the last three weeks of the year. At all other times the weekly curve kept welf below the decennial mean. The following Table is interesting, as showing the house distribution of Scarlet Fever. It was first given last year:— Number of cases of Scarl't Fever 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. 7 cases in one house. 8 cases in one house. No. of houses infected in 1911. No. of houses infected. (1910 499 65 12 5 3 — — — 584 ] 1911 546 80 19 3 1 — — 1 650 No. of cases occurring in Public Institutions. Cases. Public Institutions Infected Islington Infirmary 5 London Fever Hospital 2 H.M. Prison, Holloway 2 Kingsdown Orphanage 7 16 1911] 146 If the figures in this Table (excluding the Public Institutions) be translated into percentages, the contrast with the preceding year will be best seen, for it shows the percentages of the houses responsible for 1, 2, 3, or more cases in the two years. 1910. 1911. Houses in which 1 case occurred 85.45 84.02 2 cases 11.13 12.30 3 2.05 2.92 4 0.86 0.46 5 0.51 0.15 6 7 8 0.15 100.00 100.00 Here we find no very great difference between the two years. There was, however, a slight decrease in 1911 in the percentage of houses in which single attacks occurred, while there was an increase in the proportion of houses in which there were 2 cases. It is not easy to prevent the occurrence of secondary cases, because frequently the infection has already been conveyed to another child or to other children before the parents have recognised the serious nature of the disease; and also because it is not always possible to prevent patients, on their return home from the hospitals, bringing the infection with them; although it should he distinctly understood that every possible care is taken to prevent such an occurrence. It will be noticed in the Table that 8 cases came from one house. Table LXXXVIII. 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 8 16 16 20 60 Upper Holloway 19 12 12 26 69 Tollington 8 17 17 27 69 Lower Holloway 13 16 50 34 113 Highbury 17 14 16 46 93 Barnsbury 27 44 74 56 201 Islington, South East 33 25 50 91 199 The Borough 125 144 235 300 804 147 [1911 Table LXXXIX. 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 0 95 1.9L 1.91 2. 38 1.79 Upper Holloway 2.04 1.29 1 29 2.80 1. 86 Tollington 1. 05 2.23 2.23 3 .54 2. 26 Lower Holloway 1 .32 1. 63 5 .09 3 .46 2.87 Highbury 1. 10 0. 91 1.03 2.97 1.50 2 .04 3. 32 5.58 4. 23 3.79 Islington, South East 1.84 1.40 279 5 .08 2.78 The Borough 1. 53 1 76 2. 87 3 67 2.46 Table XC. Showing the Fatality from Scarlet Fever. (Deaths to 100 cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarte . 3rd Quarter. 4th Quarter. Whole Year Tufnell 12 .5 6.3 . . 3.3 Upper Holloway 5 .3 8.3 8.3 .. 4.3 Tollington •• .. 5. 9 3. 7 2. 9 Lower Holloway .. • • 2.0 .. 0.9 Highbury .. • • .. .. .. Barnsbury 3. 7 2.3 2.7 5.4 3. 5 Islington, South East 3.0 4.0 4. 0 1.1 25 The Borough 3.2 2. 1 3.4 1.7 2. 5 Hospital Isolation.—As many as 7GG out of the 804 known cases, or 95.3 per cent., were removed to hospital for treatment and isolation. This is a slight increase on the proportion removed in 1910, when it was 94.5 per L 2 1911] 148 cent. These are very remarkable figures, for they very plainly indicate the desire of the parents to utilise the hospitals, and to get good and cheap treatment for their children. All except 110 cases were taken to the Metropolitan Asylums Board's Hospitals. Fatality.—As only 20 out of the 804 cases died, the fatality was 2.5 per cent., which is only 0.3 below the mean of the eighteen years 1893-1910. It was, however, above that of the preceding four years. It is low enough, however, to show that the risk of death from ajn attack of scarlet fever is now very small. DIPHTHERIA. To this disease, which includes Membranous Croup, were credited 593 cases, or 71 in excess of the average of the preceding ten years; and they represented an attack-rate of 1.81 per 1,000 of the population as contrasted with a rate of 1.60 in the ten years 1901-10. The rate in England and Wales was 1 .32 per 1,000; in London 1.64; and in the country boroughs of England 1.47. In the boroughs which encircle Islington, which are of most interest to its inhabitants, the cases and attack-rates were:— Cases. Attack-rates. St. Pancras 422 1.94 Stoke Newington 80 1.56 Hackney 316 1.42 Hornsey 134 1.58 Finsbury 179 2.03 Shoreditch 175 1.57 The Encircling Boroughs 1306 1.68 Islington 593 1 .81 During the greater pait of the year the notified cases in each week were, as a rule, below the averages of the corresponding weeks of the preceding ten years. At the beginning of September, however, they began to increase rapidly, so that in its fourth week the curve, as shown in the Chart, reached its highest point, being as many as 10 above the decennial average for that week. Thence to the end of the year it was, with two exceptions, considerably above the curve of the decennial period. No particular reason can be given for the increase, unless, indeed, the unusually dry and warm autumn caused it. Showing the cases of DIPHTHERIA notified in each week in 1911, and the averages for the corresponding week in the ten years 1901-1910. 149 [1911 Altogether 493 houses, apait from public institutions, were invaded, and the cases were distributed as follows:— 1 case in each of 431 houses. 2 cases „ „ 45 „ 3 ,, „14 ,, And in the public institutions there were: 2 in Cornwallis Workhouse. 7 in Islington Infirmary. 5 in Kingsdown Orphanage. 1 in London Fever Hospital. Hospital Isolation.—526 of the 593 notified cases, or 88.7 per cent., were isolated in hospitals, of which 418 were taken to those of the Metropolitan Asylums Boaro. This is a decrease of 4.3 per cent, on the return of the preceding year. Fatality.—The 53 deaths represented a fatality of 8.9 per cent, or 1.7 above the percentage which obtained in 1909 and 1910. It is, however, 1.3 below the rate of 10.2 which was recorded in the ten years 1901-10, and 12.6 below the rate of 216 recorded in the ten years 1891-1900. The great decrease in the fatality is due mainly to the anti-toxin treatment. Table XCI. 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 15 7 13 20 55 Upper Holloway 16 15 24 44 99 Tollington 15 11 26 43 95 Lower Holloway 16 18 10 13 57 Highbury 13 16 16 23 68 Barnsbury 42 17 27 17 103 Islington, South East 27 19 29 41 116 The Borough 144 103 145 201 593 •(Inclusive of Membranous Croup.) 1911] 150 Table XCII. 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 79 0 .83 1 .55 2. 88 1.64 Upper Holloway 1 .72 1.61 2.58 4 .73 2 .66 Tollington 1 .97 1.44 3. 41 5.63 3 .11 Lower Holloway 1.63 1. 83 1 .02 1 .32 1. 45 Highbury 0 .84 1 .03 1 .03 1.49 1.10 Barnsbury 3.18 1 .28 2. 04 1 .28 1 .95 Islington, South East 1 .51 1 .06 1. 62 2 .29 1.62 The Borough 1 76 1. 26 1 77 2 .46 1. 81 Table XCIII. 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 14. 3 5 .0 3 .6 Upper Holloway 6. 6 4. 2 11. 4 7.1 Tollington 13. 3 .. 11. 5 7.0 8.4 Lower Holloway 6 .2 5 .5 20 .0 15. 4 10. 5 Highbury 7. 7 12. 5 6.2 8. 7 8.8 Barnsbury 12. 2 11. 8 7.4 5. 9 1.0 Islington, South East 7.4 5. 3 13. 8 17. 1 12. 1 The Borough 76 78 8.9 10. 4 8. 9 151 [1911 Table XCIV. Showing the Cases and Deaths from Diphtheria and Membranous Croup, together with the Fatality and the Departure from the Mean Fatality during the ten years 1901-1910 and 1911. 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. 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 4.2 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 1910 463 8 471 34 - 34 7. 2 - 4.1 1901-10 5,250 43 5,293 520 22 542 10.2 - 1911 590 3 593 53 - 53 8. 9 - 1.3 * The last column shows the departure from the average fatality of the ten years preceding the year indicated. Table XCV. Showing the Cases, Deaths and Fatality from Diphtheria at Home ami in Hospitals. Quarter. Cases Nursed at Home. Cases Nursed at Hospitals. Cases 1 Deaths. 2 Percentage Fatality. 3 Cases. 4 Deaths. 5 Percentage Fatality. 6 ISt 16 1 6.2 128 1O 7.8 2nd 13 2 15.4 90 6 6.6 3rd 16 2 12.5 129 11 8.5 4th 22 3 13.6 179 18 10.0 Year 67 8 12.0 526 45 8.55 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. 152 1911] Table XCVI. Showing the Fatality from Diphtheria˚ at each year of life up to 15 years of age, and at each decennial period after that age. Ages. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. The Year. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. Cases. Deaths. Deaths to 100 Cases. 0— 1 1 1 100 ... ... ... 1 ... ... 4 1 25 6 2 33 1— 2 7 1 14 3 2 66 5 2 40 15 2 13 30 7 23 2— 3 10 2 20 10 1 10 7 ... ... 12 4 33 39 7 18 3— 4 21 1 5 11 3 27 14 2 14 17 2 12 63 8 13 4— 5 18 1 6 12 ... ... 18 ... ... 21 2 9 69 3 4 5—6 20 1 5 12 1 8 20 3 15 33 7 21 85 12 14 6— 7 14 ... ... 11 1 9 15 1 7 20 2 10 60 4 7 7—8 12 2 17 9 ... ... 11 1 9 15 ... ... 47 3 6 8— 9 6 ... ... 9 ... ... 7 1 14 9 ... ... 31 1 3 9—10 4 1 25 4 ... ... 7 ... ... 8 ... ... 23 1 4 10—11 5 ... ... 1 ... ... 8 1 13 12 ... ... 26 1 4 11—12 1 ... ... 1 ... ... 7 1 14 6 ... ... 15 1 7 12—13 4 ... ... 2 .... ... 1 ... ... 3 ... ... 10 ... ... 13—14 1 ... ... 4 ... ... 2 ... ... 7 ... ... 14 ... ... 14—15 2 ... ... 1 ... ... 1 ... ... 2 ... ... 6 ... ... 15—25 12 ... ... 9 ... ... 11 ... ... 10 ... ... 42 ... ... 25—35 5 1 20 3 ... ... 7 ... ... 5 ... ... 20 1 5 35—45 ... ... ... 1 ... ... 3 1 33 2 1 50 6 2 33 45—55 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 55—65 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 65 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 144 11 8 103 8 8 145 13 9 201 21 10 593 53 9 * Inclusive of Membranous Croup. Showing the cases of ENTERIC FEVER notified in each week in 1911, and the averages for the corresponding weeks in the ten years 1901-1910. 153 [1911 ENTERIC FEVER. There were 73 cases of Enteric Fever notified, of which 18 occurred in the first quarter, 7 in the second, 24 in the third, and a like number in the fourth. These cases were 67 below the corrected average of the preceding ten years. The return is also the best within that period, as may be seen in Table CV1., which gives the cases of the several notifiable infectious diseases from 1901 to 1910. The lowest record in the ten years 1891-1900, was 184 cases, and the highest 359, while the corrected average of the ten years was 239. Now we find that the average has dropped to 140. This is a matter for congratulation, especially as in the same periods the average number of deaths fell from 41 to 22. The 73 cases represent an attack-rate of 0.22 per 1,000 of the population. This rate compares very favourably with that of England and Wales, in which it was 0-30 per 1.000. Wales, in which it was 0-30 per 1,000. In London it was also low, being 0.23 per 1,000, while in the Encircling Boroughs the cases and rates were as follows:— Cases. Deaths. St. Pancras 70 0.32 Stoke Newington 6 0.12 Hackney 51 0.22 Hornsey 7 0.08 Finsbury 80 0.91 Shoreditch 22 0.20 Encircling Boroughs 236 0.30 Islington 73 0.22 The weekly incidence of the disease in 1911, together with the weekly averages of the ten years preceding, is seen in the accompanying chart. Hospital Isolation.— 56 of the 73 cases, or 76.7 per cent., were removed to hospital for treatment, as against 17, or 23.3 per cent, who were treated at home. Fatality.—As there were 12 deaths, the proportion of deaths to cases was 17.2 per cent., which is 0.9 per cent, lower than in the preceding year. It is thus seen that the disease still retains its fatal character, and, therefore, everything of a preventive nature that can be adopted should be practised. It is not, however, always easy to trace the origin of the disease, which at times is exceedingly obscure; indeed, again and again inquiries have utterly failed to discover it. There are many channels of infection, by which the germ of the disease can be conveyed; and some of them are our foodstuffs, which, 1911] 154 unfortunately, are not always free from suspicion. Thus the disease has been traced by various investigators to water, milk, oysters, mussels, cockles, winkles and other shell-fish; also to fried fish, water cress, and even celery, not to mention many other articles. Flies are now known to be the agents which contaminate many articles of food in common use. Table xcvii. 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. Year. Tufnell 2 1 2 2 7 Upper Holloway 3 .. 3 2 8 Tollington 1 2 1 3 7 Lower Holloway •• 1 2 •• 3 Highbury 3 1 6 4 14 Barnsbury 5 1 4 5 15 Islington, South East 4 1 6 8 19 The Borough 18 7 24 24 73 Table XCVIII. 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 0.24 0.12 0.24 0.24 0.21 Upper Holloway 0.32 .. 0.32 0.21 0.21 Tollington 0.13 0.26 0.13 0.39 0.23 Lower Holloway • • 0.10 0.20 .. 0.08 Highbury 0.19 0.06 0.39 0.26 0.23 Barnsbury 0.37 0.08 0.30 0.38 0.28 Islington, South East 0.22 0.06 0.33 0.45 0.26 The Borough 0.22 0.08 0.29 0.29 0.22 Showing the cases of ERYSIPELAS notified in each week in 1911, and the averages for the corresponding week in the ten years 1901-1910. 155 [1911 Table XCIX. Showing the Fatality from Enteric Fever. (Deaths to 100 cases of Sickness). Sub-Districts 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter Whole Year Tufnell .. .. .. 50.0 14.3 Upper Holloway .. .. •• .. Tollington 100.0 .. •• .. 14.3 Lower Holloway .. 100.0 •• 33.3 Highbury .. .. 33.3 • • 14.3 Barnsbury 20.0 .. 50.0 20.0 26.7 Islington, South East 25.0 .. .. 25.0 16.1 The Borough 16.7 14.3 16.7 16.7 16.4 TYPHUS FEVER. No case was known, and only six cases occurred during the preceding ten years, several of which were of a doubtful character. The disease, so far as Islington is concerned, may be looked on as extinct or as a negligible quantity. ERYSIPELAS. 275 cases were notified, as compared with 212 in the preceding year, and with a corrected average of 256 in the preceding ten years. The cases are therefore, 19 above the decennial average. The attack-rate was equal to 0.84 per 1,000, and was above the rate of 0.69 which obtained in England and Wales; but was considerably below the rate of 1.07 for the County of London. In the County Boroughs of England it was 0.81, and in the boroughs which encircle Islington 1.33. Hospital Isolation.—This is a disease in which comparatively few cases are removed to hospital; indeed, only those which are most severe and require most careful treatment are taken there. Thus we find that out of the 275 cases, only 62, or 22.6 per cent., were treated in hospital, as contrasted with 213, or 77.4 per cent, who remained at home. Fatality.—12 deaths occurred among the cases, representing a fatality rate of 4.3 per cent. With the exception of Scarlet Fever this was the lowest rate recorded among the diseases notifiable under the Public Health (London) Act, 1891. 1911] 156 Table C. 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 7 4 5 15 31 Upper Holloway 9 6 4 15 34 Tollington 5 7 6 15 33 Lower Holloway 6 7 2 12 27 Highbury 2 5 5 14 26 Barnsbury 5 8 12 23 48 Islington, South East 13 18 19 26 76 The Borough 47 55 53 120 275 Table CI. 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 0.83 0.48 0.59 1.79 0.92 Upper Holloway 0.97 0.65 0.43 1.61 0.91 Tollington 0.65 0.92 0.78 1.97 1.08 Lower Holloway 0.61 0.71 0.20 1.22 0.69 Highbury 0.13 0.32 0.32 0.90 0.42 Barnsbury 0.37 0.60 0.91 1.74 0.91 Islington, South East 0.73 1.00 1.06 1.45 1.06 The Borough 0.58 0.67 0.65 1.47 0.84 157 [1911 Table CII. Showing the Fatality from Erysipelas. (Deaths to ioo cases of Sickness). Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year. Tufnell .. .. .. 13.3 6.4 Upper Holloway .. .. .. 6.6 2.9 Tollington .. .. .. 6.6 3.0 Lower Holloway 10.7 .. .. .. 3.7 Highbury .. .. • • 14.3 7.7 Barnsbury .. 12.5 16.7 4.3 8.3 Islington, South East .. .. 5.3 .. 1.3 The Borough 2.1 1.8 5.3 5.8 4.4 PUERPERAL FEVER. Fourteen cases of this most fatal of diseases to women were notified during the year, as contrasted with 20 in 1910, and 14 in 1909. They were also 8 below the corrected average of the preceding ten years. The disease in the ten years 1891-1900 averaged 29 cases per annum, and in the succeeding decennium 22. The attacks were in the proportion of 1.76 to every 1,000 registered births, as compared with 2.55 in the preceding ten years. Hospital Isolation.— 6 cases were attended in hospital, while 8, or 57.2 per cent., remained at home. Fatality.—It is very regrettable to find that exactly one half of the patients died, so that the fatality late was 500 per cent. No words can express the fatal nature of this disease better than the recital of this bald fact. Table CIII. 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 .. 1 Tollington 1 .. .. •• 1 Lower Holloway .. 2 .. 2 4 Highbury 1 • • .. • • 1 Barnsbury .. 1 .. 2 3 Islington, South East .. 1 .. 1 2 The Borough 2 4 1 7 14 1911] 158 Table CIV. 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 .. .. .. 9.57 2.62 Upper Holloway .. .. 4.17 .. 1.06 Tollington 5.35 .. .. 1.35 Lower Holloway .. 8.81 .. 8.33 4.06 Highbury 3.14 .. .. .. 0.80 Barnsbury . .. 2.57 .. 5.58 2.00 Islington, South East .. 2.24 •• 2.32 1.11 The Borough 0.95 2.03 50.3 3.67 1.76 Table CV. Showing the Fatality from Puerperal Fever. Deaths to Ioo cases of Sickness. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Whole Year Tufnell • • .. .. 50.0 50.0 Upper Holloway .. • • .. * * .. Tollington .. .. .. .. .. Lower Holloway • • • • .. 100.0 75.0 Highbury 100.0 .. .. .. 100.0 Barnsbury .. 100.0 .. .. 33.3 Islington, South East • • 100.0 •• •• 50.0 The Borough 100.0 25.0 .. 57.1 50.0 CONTINUED FEVER. No case was notified, as against an average of I in the preceding ten years. 159 [1911 Table CVl. Showing the number of Cases of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1901-10 and in 1911. diseases. years. Corrected average number of cases. — Increase or Decrease. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1901-1910. 1911. Small Pox 50 276 9 17 3+ 1 ... ... 3 1 35 ... —35 Scarlet Fever 1286 372 865 1146 1198 1386 1216 14O9 1285 730 1174 804 —370 Diphtheria 902 871 452 347 351 437 480 552 425 463 518 590 +72 Membranous Croup 9 7 3 ... ... 2 1 8 5 8 4 3 —1 Enteric Fever 281 257 130 126 100 149 92 97 95 89 140 73 —67 Typhus Fever 2 ... ... 1 ... 1 ... ... 1 1 1 ... —1 Eiysipelas 285 357 227 280 252 274 252 235 221 212 256 275 + 19 Puerperal Fever 34 19 19 24 24 24 21 17 H 20 22 14 —8 Continued Fever 3 5 2 ... ... 1 1 1 ... 1 1 ... — 1 Relapsing Fever ... ... ... ... ... ... ... .. ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... .. ... ... ... ... Totals 2852 3164 1707 1941 1928 2275 2063 2289 2049 1525 2151 1759 —392 I Case returned after a few days not Small Pox. 1911] 160 Table CVII. Showing the Attack-Rates of the several Notifiable Infectious Diseases during the Ten Years 1901-10 and in 1911. diseases. years. Mean Attack Rates. Attack Rate. Increase or Decrease 1901. 1902. 1903 1904. 1905 1906. 1907. 1908. 1909. 1910. 1901-1910. 1911. Small Pox 0.15 0.81 0.03 0.05 0.01 0.00 ... ... 0.01 0.00 0.11 ... —0.11 Scarlet Fever 3.84 4.03 2.60 3.45 3.6l 4.1 8 3.68 4.20 3.91 2.22 3.59 2.46 —1.13 Diphtheria 2.69 2.56 1.36 1.04 1.06 1.32 1.45 1.64 1.29 1.41 1.58 1.80 + 0.22 Membranous Croup.. 0.03 0.02 0.00 ... ... 0.00 0.00 0.02 0.01 0.03 0.00 0.01 ... Enteric Fever 0.84 0.75 0.39 0.38 0.30 0.45 0.28 0.29 0.29 0.27 0.43 0.22 —0.21 Typhus Fever 0.00 ... ... 0.00 ... 0.00 ... ... 0.00 0.00 0.00 ... o-oo Erysipelas 0.85 1.05 o.68 0.84 0.76 0.83 0.76 0.70 0.67 0.84 0.78 0.84 +0.06 Puerperal Fever 3.67 2.06 2.11 2.70 2.74 2.79 2.46 1.96 1.71 2.44 2.55 1.76 —0.79 Continued Fever 0.01 0.01 0.00 ... ... 0.00 0.00 0.00 ... 0.00 0.00 ... 0.00 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 8.52 9.29 5.12 5.84 5.81 6.25 6.25 6.82 6.23 4.65 6.57 5.37 —1.20 * These figures are calculated as per 1,000 Registered Births. 161 [1911 TABLE CVIII. Showing the number of Cases of Infectious Diseases notified in the Sub-Registration Districts during 1911. 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 ... 60 54 1 7 ... 31 2 ... ... ... 155 4.62 Upper Holloway ... 69 99 ... 8 ... 34 1 ... ... ... 211 5.67 Tollington ... 69 95 ... 7 ... 33 1 ... ... ... 205 6 .71 Lower Holloway ... 113 56 1 3 ... 27 4 ... ... ... 204 5.1I9 Highbury ... 93 68 ... 14 ... 26 1 ... ... ... 202 3.26 Barnsbury ... 201 102 1 15 ... 48 3 ... ... ... 370 6.98 Islington South East ... 199 116 ... 19 ... 76 2 ... ... ... 412 575 The Borough ... 804 590 3 73 ... 275 14 ... ... ... 1759 5'37 (All Duplicates have been deducted). M 1911] 162 TABLE CIX. Showing the Attack-rates of Infectious Diseases notified in the Sub-Registration Districts during 1911. Sub-Registration Districts. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal* Fever. Continued Fever. Relapsing Fever. Cholera. Attack-Rate per 1,000 of the Population. Tufnell ... 1.79 1.61 0.03 0.21 ... 0.92 2.62 ... ... ... 4.62 Upper Holloway ... 1.86 2.66 ... 0.21 ... 0.92 1.06 ... ... ... 5.67 Tollington ... 2.26 3.11 ... 0.23 ... 1.08 1.35 ... ... ... 6.71 Lower Holloway ... 2.87 1.43 0.02 0.08 ... 0.69 4.06 ... ... ... 5.19 Highbury ... 1.50 1.10 ... 0.23 ... 0.42 0.80 ... ... ... 3.26 Barnsbury ... 3.79 1.93 0.02 0.28 ... 0.91 2.00 ... ... ... 6.98 Islington, South East ... 2.78 1.62 ... 0.26 ... 1.06 1.11 ... ... ... 5.75 The Borough ... 2.46 1.80 0.01 0.22 ... 0.84 1.76 ... ... ... 5.37 * Per 1,000 Registered Births. 163 [1911 TABLE CX. Showing the number of Cases of Infectious Disease notified in the Wards during the year 1911. (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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Tufnell ... 60 54 1 7 ... 31 2 ... ... ... 155 4.62 Upper Holloway ... 69 99 ... 8 ... 34 1 ... ... ... 211 5.67 Tollington ... 69 95 ... 7 ... 33 1 ... ... ... 205 6.71 Lower Holloway ... 113 56 1 3 ... 27 4 ... ... ... 204 5.19 Highbury ... 40 41 ... 4 ... 9 1 ... ... ... 95 2.81 Mildmay ... 47 22 ... 9 ... 13 ... ... ... ... 91 3.81 Thornhill ... 138 67 1 6 ... 26 3 ... ... ... 241 7.66 Barnsbury ... 63 35 ... 9 ... 22 ... ... ... ... 129 6.00 St. Mary's ... 61 40 ... 7 ... 18 ... ... ... ... 120 7 46 Canonbury ... 79 27 ... 5 ... 28 2 ... ... ... 141 4-88 St. Peter's ... 65 54 ... 8 ... 34 ... ... ... ... 161 5.34 Totals ... 804 590 3 73 ... 275 14 ... ... ... 1759 5.37 1909 3 1285 425 5 95 1 221 14 ... ... ... 2049 5.83 1910 1 730 463 8 89 1 212 20 1 ... ... 1525 4.65 M 2 164 1911] Table CXI. Showing the Attack-Rates of the Notifiable Infectious Diseases notified in the Wards during the Year 1911. WARDS. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever.* Continued Fever. Relapsing Fever. Cholera. Total AttackRates. Tufnell ... 1.79 1.6l 0.03 0.21 ... 0.92 0.06 ... ... ... 4.62 Upper Holloway ... 1.86 2.66 ... 0.2I ... 0.91 0.03 ... ... ... 5.67 Tollington ... 2.26 3.11 ... 0.23 ... 1.08 0.03 ... ... ... 6.71 Lower Holloway ... 2.87 1.43 0.02 0.08 ... 0.69 0.10 ... ... ... 5.19 Highbury ... 1.18 1.21 ... O.l 2 ... 0.27 0.03 ... ... ... 2.81 Mildmay ... 1.97 0.92 ... 0.38 ... 0.54 ... ... ... ... 3.81 Thornhill ... 4.38 2.13 0.03 0.19 ... 0.83 0.10 ... ... ... 7.66 Barnsbury ... 2.93 1.63 ... 0.42 ... 1.02 ... ... ... ... 6.00 St. Mary's ... 3.61 2.37 ... 0.41 ... 1.07 ... ... ... 7. 46 Canonbury ... 2.73 0.93 ... 0.17 ... 0 .97 0.07 ... ... ... 4.88 St. Peter's ... 2.16 1.79 ... 0.26 ... 1.13 ... ... ... ... 5.34 Totals ... 2.46 1.80 0.01 0.22 ••• 0.84 0.04 ... ... ... 5.37 * Per 1,000 population. 165 1911 Table CXII. Showing the Number oj Cases of Infectious Diseases which were investigated by the District Sanitary Inspectors during the Year 1911. Sanitary Inspectors. Number of the Sanitary District. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. R lapsing Fever. Cerebro Spinal Fever. Total.[ Mr. Cook 1 ... 49 40 1 3 ... 30 2 ... ... ... 125 ,, Bicknell 2 ... 69 99 ... 8 ... 34 1 ... ... ... 211 „ Bagshaw 3 ... 41 48 ... 4 ... II ... ... ... ... 104 „ Bridel 4 ... 40 61 ... 5 ... 27 2 ... ... ... 135 „ Flood 5 ... 44 34 1 6 ... 9 1 ... ... ... 95 „ Horsman 6 ... 75 36 ... 1 ... 13 1 ... ... ... 126 „ Fortune 7 ... 22 23 ... 3 ... 1 ... ... ... 49 ,, Metcalf 8 ... 39 15 ... 8 ... 10 ... ... ... ... 73 „ Irving 9 ... 77 47 ... 3 ... 24 2 ... ... ... 153 „ Watson 1O ... 62 17 ... 3 ... 22 2 ... ... ... 106 „ Jeffery 11 ... 51 49 ... 4 ... 26 • •• ... ... ... 130 ,, Canham 12 ... 113 48 ... 5 ... 21 2 ... ... ... 189 ,, Agar 13 ... 51 34 ... 9 ... 23 ... ... ... ... 117 ,, Callow 14 ... 71 39 ... 11 ... 25 ... ... ... ... 146 Totals ... 804 590 3 73 ... 275 14 ... ... ... 1,759 1911 168 Table CXIII. Showing the Cases of Infectious Disease which were notified in the several Months during the Year 1911. 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 ... 40 66 ... 6 ... 17 1 ... ... ... 130 February ... 46 33 1 7 ... 9 ... ... ... ... 96 March ... 39 44 ... 5 ... 21 1 ... ... ... no April ... 22 31 1 3 ... 18 3 ... ... ... 78 May ... 46 34 ... ... 17 1 ... ... ... 98 June ... 76 37 ... 4 ... 20 ... ... ... ... 137 July ... 63 29 ... 3 ... 19 ... ... ... ... 114 August ... 61 36 ... 5 ... 10 ... ... ... ... 112 September ... 111 79 1 16 ... 24 1 ... ... ... 232 October ... 105 71 ... 11 ... 37 4 ... ... ... 228 November ... 90 65 ... 8 ... 45 1 ... ... ... 209 December ... 105 65 ... 5 ... 38 2 ... ... ... 215 Total ... 804 590 3 73 ... 275 14 ... ... ... i,759 167 1911 Table CXIV. Showing the Cases of Infectious Disease notified during the Year 1911 in Islington and in the Encircling Boroughs. The Encircling Boroughs. Estimated Populations, 1911. 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 218,031 • • • 443 422 69 ... 199 17 ... ... ... 1,150 Stoke Newington 50,669 ... 99 79 6 ... 42 — ... ... ... 226 Hackney 222,674 3 613 316 48 ... 364 16 ... ... ... 1,360 Hornsey 84,916 1 179 134 7 ... 40 2 ... ... ... 363 Finsbury 87,639 ... 179 178 80 ... 223 4 ... ... ... 664 Shoreditch 111,284 3 240 175 22 ... 160 5 ... ... ... 605 The Encircling Boroughs 775,213 7 1,753 1,304 232 ... 1,028 44 ... ... ... 4,368 Islington 327,247 ... 804 593 73 ... 275 14 ... ... ... 1,759 1911] 1 fi8 Table CXV. Showing the Attack-Rates per 1,000 inhabitants of the Infectious Diseases notified during the Year 1911 in Islington and in the Encircling Boroughs. The Encircling Boroughs. Estimated Populations, 1911. Small Pox. Scarlet Fever or Scarlatina. Diphtheria (including Membranous) Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever.* Continued Fever. Relapsing Fever Cholera. Total Attack-Rates 1 2 3 4 5 6 7 8 9 10 11 12 13 St. Pancras 218,031 ... 2.03 1.94 0.32 ... 0.91 0.08 ... ... ... 5.28 Stoke Newington 50,669 ... 1.95 1.56 0.12 ... 0.83 ... ... ... ... 4.46 Hackney 222,674 0.01 2.75 1.42 0.22 ... 1.63 0.07 ... ... ... 6.11 Hornsey 84,916 0.01 2.11 1.58 0.08 ... 0.47 0.02 ... ... ... 4.27 Finsbury 87.639 ... 2.04 2.03 0.91 ... 2.55 0.05 ... ... ... 7.58 Shoreditch 111,284 0.03 2.l6 1.57 0.20 ... 1.44 0.04 ... ... ... 5.44 The Encircling) Borough 775,213 0.01 2.26 1.68 0.30 ... 1.33 0.06 ... ... ... 5.64 Islington 327,247 ... 2.46 1.81 0.22 ... 0.84 0.04 ... ... ... 5.37 Increase or Decrease ... 0.01 0.20 + 0.13 —0.08 ... -0.49 — 0.02 ... ... ... — 0.27 * Per 1,000 of the population. 169 [1911 Table CXVI. Showing the Cases of Infectious Disease notified in the several Metropolitan Cities and Boroughs during the year 1911. Cities and Boroughs. Estimated population in the middle of 1911. Notified Cases ok Infectious Disease. Small Pox Scarlet Fever. Diphtheria. * Typhus Fever Enteric Fever. Other continued Fevers. Puerperal Fever. Erysipelas. Cerebro-spinal meningitis. Other Notifiable Iniectious Diseases. Total. london 4,522,628 63 10,488 7,388 1 1,025 23 303 4,847 101 69 24,308 West Districts. Paddington 142,541 .. 227 169 .. 37 1 7 117 2 1 561 Kensington 172,296 .. 232 219 .. 23 .. 7 125 1 1 608 Hammersmith 131,837 .. 239 196 1 27 1 3 100 1 1 569 Fulham 153,726 .. 382 313 .. 38 3 23 118 3 1 881 Chelsea 66,218 .. 143 83 .. 7 .. 0 52 .. 1 291 City of Westminster 159,709 1 253 145 • • 30 1 6 82 3 1 522 North Districts. St. Martlebone 117,844 .. 329 135 .. 18 .. 4 109 2 1 598 Hampstead 85,599 .. 129 151 .. 14 .. 6 50 .. 5 355 St. Pancras 218,031 .. 443 422 .. 69 .. 17 199 7 2 1,159 Islington 327,234 .. 804 593 .. 73 1 14 275 13 1 1 ,773 Stoke Newington.. 50,669 .. 99 79 .. 6 .. 42 .. .. 226 Hackney 222,674 3 613 316 .. 48 .. i6 364 7 4 1,371 Central Districts. Holborn 49,084 .. 120 85 .. 11 .. •2 37 .. .. 255 Finsbury 87,639 .. 179 178 .. 80 .. 4 223 2 .. 666 City of London 19,475 .. 23 23 .. 8 .. 1 14 .. .. 69 East Districts. .. Shoreditch 111,284 3 240 175 .. 22 .. 5 160 4 3 612 Bethnal Green 128,247 3 243 201 .. 31 1 14 249 6 1 748 Stepney 279,560 39 467 517 .. 80 .. 30 488 7 5 1,633 Poplar 162,290 11 376 284 .. 63 3 11 205 6 5 964 South Districts. .. Southwark 191,595 .. 480 293 .. 45 2 14 316 5 3 1,158 Bermondsey 125,840 .. 302 254 .. 26 .. 13 152 2 3 752 Lambeth 298,032 764 405 .. 61 .. 21 246 9 9 1,515 Battersea . 167,765 .. 354 223 .. 32 .. 9 162 11 4 795 Wandsworth 313,389 .. 866 513 .. 58 5 24 204 5 5 1,680 Camberwell 261,407 1 634 352 .. 33 2 10 254 2 5 1,293 Deptford 109,475 1 375 165 .. 13 4 2 180 • • 1 741 Greenwich 95,982 .. 307 318 .. 10 .. 9 133 1 .. 778 cm q Lewisham 161,677 .. 349 343 .. 36 .. 11 105 1 3 o4o Woolwich 121,509 .. 514 237 .. 18 .. 15 81 1 3 869 Port of London .. 1 2 1 .. 8 .. 6 .. .. 18 * Including Membranous Croup 1911] 170 Table CXVII. Showing the Attack-Rates of the Infectious Diseases notified in the several Metropolitan Cities and Boroughs during the year 1911. Cities and Boroughs. Small Pox. Scarlet Fever. Diphtheria. * Typhus Fever. Enteric Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cerebro-Spinal Meningitis. Other Notifiable Infectious Diseases Attack-Rates per 1,000. County of London 0 01 2.32 1.64 .. 0.23 .. 0.07 1.07 0.02 0.01 540 West Districts. .. Paddington .. 1.59 1.19 .. 0.26 0.01 0.05 0.82 0.01 0.01 3.94 Kensington .. 1.35 1.27 .. 0.13 .. 0.04 0.72 0.01 0.01 3.53 Hammersmith .. 1.96 1.61 0.01 0.22 0.01 0.02 0.82 0.01 0.01 4.67 Fulham .. 2.48 2.03 .. 0.25 0.02 0.15 0.77 0.02 0.01 5.73 Chelsea .. 2.16 1.25 .. 0.11 .. 0.08 0.78 .. 0.01 4.39 City of Westminster 0.01 1.58 0.91 .. 0.19 0.01 0.04 0.51 0.02 0.01 3.27 North Districts. St. Marylebone .. 2.79 1.15 .. 0.15 .. 0.03 0.92 0.02 0.01 5.07 Hampstead .. 1.51 1.76 .. 0.16 .. 0.07 0.58 .. 0.06 4.15 St. Pancras .. 2.03 1.94 .. 0.32 .. 0.08 0.91 .. .. 5.28 Islington .. 2.46 1.81 .. 0.22 .. 0.04 0.84 .. .. 5.37 Stoke Newington .. 1.95 1.56 .. 0.12 .. .. 0.83 .. .. 4.46 Hackney 0.01 2.75 1.42 .. 0.22 .. 0.07 1.63 .. •• 6.11 Central Districts. Holborn .. 2.45 1.73 .. 0.22 .. 0.04 0.75 .. .. 5.19 Finsbury .. 2.04 2.03 .. 0.91 .. 0.05 2.55 .. .. 7.58 City of London •• 1.18 1.18 .. 0.41 .. 0.05 0.72 .. .. 3.54 East Districts. Shoreditch 0.03 2.16 1.57 .. 0.20 .. 0.04 1.44 .. .. 5.44 Bethnal Green 0.02 1.90 1.57 .. 0.24 0.01 0.11 1.93 0.05 0.01 5.84 Stepney 0.14 1.67 1.85 .. 0.28 .. 0.11 1.75 0.02 0.02 5.84 Poplar 0.07 2.32 1.75 .. 0.39 0.02 0.07 1.26 0.04 0.03 5.94 South Districts. Southwark .. 2.51 1.53 .. 0.23 0.01 0.07 1-65 0.03 0.02 6.05 Bermondsey .. 2.40 2.02 .. 0.21 .. 0.10 1 21 0.02 0.02 5.98 Lambeth .. 2.56 1.36 .. 0.21 .. 0.07 0 82 0.03 0.03 5.08 Battersea .. 2.11 1.33 .. 0.19 .. 0-05 0 97 0.06 0.02 4.73 Wandsworth .. 2.76 1.64 .. 0.18 0.02 0.07 0 65 0.02 0.02 5.36 Camberwell 0.00 2.43 1.35 .. 0.13 0.01 0.04 097 0.01 0.02 4.95 Deptford 0.01 3.43 1.51 .. 0.12 0.04 0.01 1 64 .. 0.01 6.77 Greenwich .. 3.20 3..31 .. 0.10 .. 0.10 1 39 0.01 .. 8.11 Lewisham .. 2.16 2 .12 .. 0.22 .. 0.07 0 65 0.01 0.02 5.25 Woolwich 1 .. 4.24 1.95 .. 0.15 .. 0.12 0 67 0.01 0.02 7.16 * Including Membranous Croup. 171 [1911 OTHER NOTIFIABLE DISEASES. Under this heading are included (a) Pulmonary Tuberculosis, (b) Plague, (c) Cholera, (d) Acute Poliomyelitis, (e) Cerebro-Spinal Fever, (f) Ophthalmia Neonatorum. Before proceeding to discuss such cases of these diseases as occurred in Islington, it might be well to place before the Council a short review of the history of the notification of the infectious diseases. This has been briefly and clearly done in a letter addressed to the President of the Local Government Board by the Medical Officer to that Board, and printed in the "Statistics of the incidence of notifiable infectious diseases in each sanitary district in England and Wales in the year 1911." "Soon after the establishment of registration of deaths in the year 1837, it became evident that, although the information thus furnished gave valuable indications as to the directions in which sanitary amelioration was particularly required, it did not completely meet the needs of the case. Mortality statistics necessarily ignore everything that precedes the close of life, and, owing to the varying fatility of the disease, sickness is not always in the same ratio as mortality. An epidemic may have secured a strong foothold before a fatal case occurs; and from an economic standpoint it is necessary to ascertain the amount and duration of sickness as well as the mortality in a community; just as during warfare, in estimating the fighting force of an army, a list of those disabled by disease or wounds is needed as well as a list of the killed. "Many attempts have been made by private persons and voluntary societies to secure the registration of various forms of sickness. Among the names specially to be held in honour in connection with projects for the registration of both non-infectious and infectious diseases are those of W. H. Rumsey, B. W. Richardson, and A. Ransome. The returns organised in the year 1857, by the Metropolitan Association of Health Officers, may be specially mentioned, as they secured the co-operation of a Government Department. This Association collected returns as to sickness of all kinds attended at the public expense, in hospitals and dispensaries, and by Poor Law Medical Officers, which had been voluntarily and gratuitously contributed by medical officers in charge of the above classes of patients; and for nearly two years the General Board of Health, whose duties were shortly taken over by the Privy Council, printed and distributed, in the form of weekly and quarterly returns, the contributed statistics as to sickness and as to meteorological conditions. 1911] 172 "The British Medical Association between 1865 and 1874, made repeated efforts to secure more complete registration of disease, and in 1869 a deputation from the Association on the subject was sympathetically received by Mr. Goschen, the then President of the Poor Law Board. "Under the Board's General Order of the 12th February, 1879, it was the incumbent on district and workhouse medical officers appointed since 28th February, 1879, to furnish the Medical Officer of Health with returns of pauper sickness and deaths, as well as to notify to him the outbreak of any dangerous infectious disease. Either because the information obtained was not sufficiently accurate for statistical purposes, or for some other reason, this information has not been utilised by the Medical Officers of Health to the extent which was desirable. "Although the attempts to establish a national system of registration of disease appear to have gradually ceased, the leaven of the protracted agitation in favour of it was at work. In particular, as the appointment of Medical Officers of Health became more general, these officers represented with increasing force the public danger implied in the absence of information as to the occurrence of infectious diseases as soon as they were recognised. Gradually the idea of compulsory notification of infectious maladies, as the most urgent branch of a national system of registration of disease, became realised in a characteristically British fashion. Local experiment preceded general action. Huddersfield in 1876 and Bolton in 1877, by local Acts secured the compulsory notification of the chief infectious diseases within their areas of administration. Other towns followed their example. In 1889 the Infectious Disease (Notification) Act was passed. This Act provided for the notification, in districts where it was adopted, of a specified list of infectious diseases, and gave power to sanitary authorities to add to the list of notifiable diseases with the consent of the Board. In a few years it was adopted in the majority of the sanitary districts of England and Wales. In 1899 an amending Act rendered notification of the scheduled infectious diseases compulsory in all districts. "Plague was made compulsorily notifiable throughout England and Wales on 19th September, 1900, by Order of the Board. "Cases of pulmonary tuberculosis occurring in patients under the medical care of Poor Law Medical Officers became compulsorily notifiable under the Public Health (Tuberculosis) Regulations, 1908, from the 1st January, 1909. 173 [1911 "Under the Public Health (Tuberculosis in Hospitals) Regulations, 1911, cases of pulmonary tuberculosis occurring in the practice of hospitals, including dispensaries and similar institutions wholly or partially supported, otherwise than by the contributions of the patients, or from rates and taxes, became similarly notifiable from the 1st May, 1911 ; and from the 1st January, 1912, under the Public Health (Tuberculosis) Regulations, 1911, all cases of pulmonary tuberculosis under medical care became compulsorily notifiable, except in a few instances set out in the Order. "Of the local value of the notifications of infectious diseases thus received no doubt can be entertained. These notifications have forced on sanitary authorities the knowledge of the presence of these diseases in their midst, and the reiteration of the lesson thus imparted has led to investigation of sources of disease, and to the adoption, to a greater extent than would otherwise have been likely, of measures for preventing the spread of infection. Under active local administration, particularly, each notified case has become the starting-point for the discovery of cases previously overlooked. "The possession by each Medical Officer of Health of information as to the number of cases of the different infectious diseases in his own district does not exhaust the utility of notification. The interchange of prompt and trustworthy information as to similar cases in neighbouring districts, in the rest of the country, and even in other countries, evidently would enable the Medical Officer of Health to forecast the possibilities of introduction of a given disease and to be on the alert on the first suspicion of its presence. The realisation of these possibilities led Dr. Tatham, then Medical Officer of Health of Salford, to arrange in 1888 with the Medical Officers of Health of 32 other towns to exchange weekly lists of notifications, these being tabulated and confidentially circulated. In 1889 the Local Government Board undertook this tabulation and distribution of weekly returns to the towns which co-operated in the scheme, and has continued this task. From 1892 onwards the Board have published in their Annual Report statistics of the number of cases of and deaths from the compulsorily notifiable diseases occurring in districts which numbered 117 in 1892, and had increased to 252 in 1910. From 1901 onwards the RegistrarGeneral of Births and Deaths has published statistics of notifiable diseases supplied by the Board, and in the case of the County of London by its Medical Officers of Health. These statistics, which at first related to 100 towns, are now published in the form of quarterly and annual returns of infectious diseases in 213 towns." 174 1911] Here, then, we see the usefulness of those "notifications which have forced on sanitary authorities the knowledge of the presence of these diseases in their midst, and the reiteration of the lesson thus imparted has led to investigation of sources of disease, and to the adoption, to a greater extent than would otherwise have been likely, of measures for preventing the spread of infection. Under active local administration, particularly, each notified case has become the starting-point for the discovery of cases previously overlooked." It is because the notification of the more common fevers showed that diseases could be prevented by eradicating the causes, or by the adoption of precautions, that medical men, and enlightened persons among laymen, advocated the notification of those other infectious diseases which have been enumerated at the head of this section of this report. That these notifications will do much good, nay, are doing so, is certain, particularly in the case of pulmonary tuberculosis; although it is quite possible that the public may not as yet fully appreciate it. But by and by when dispensaries, sanatoria, and other suitable treatment are more available for our poorer citizens, they, as well as those in better circumstances, will acknqwledge the benefit that notification has conferred. PULMONARY TUBERCULOSIS. In the quotation from the official report it will be noticed that pulmonary tuberculosis was notifiable in 1911 under two orders of the Local Government Board, viz:—(a) The Public Health Tuberculosis Regulations, 1908, and (b) The Public Health (Tuberculosis in Hospitals) Regulations, 1911. It is necessary to deal with each Order separately. Notifications under the Public Health (Tuberculosis) Regulations, 1908.—Under these regulations 1,341 notifications were received, as compared with 1,277 in 1910, and with 1,582 in 1909, so that there was an increase of 64 on the return of 1910, and a decrease of 241 on that of 1909. The 1,341 notifications, however, related to only 735 persons, of whom only 484 were Islingtonians; while those of 1910 related to only 696 persons, of whom 478 were Islingtonians, and those of 1909 related to 808 persons, of whom 574 were Islingtonians. Notifications. Persons. Islingtonians. 1909 1,582 808 574 1910 1,277 696 478 1911 1,341 735 484 175 [1911 There is considerable difficulty in dealing with these notifications owing to the number of certificates received from various officials in dealing with the same individuals, as well as to the wanderings of the individuals themselves, and their "in and out" vagaries, in the workhouses and workhouse infirmaries. The notifications are sent to the Medical Officer of Health on four different forms, A, B, C and D, of which the following is a summary:— Notifications received. Form A. Medical Officers of Poor Law Institutions 496 Form B. Medical Officers of Poor Law Districts 250 Form C. Superintending Officers of Public Institutions 593 Form D. Relieving Officers of Poor Law Districts 2 Total Notifications 1,341 Of the total number of notifications received (1,341) during the year under the Regulations, 460, or 34.3 per cent., related to the transfer of patients from one institution to another. Thus from Holborn Workhouse, Shepherdess Walk, which is without this borough, 318 cases were transferred to Holborn Infirmary within this borough; 123 cases were transferred from the Islington Workhouse to the Islington Infirmary, both within this borough; and 19 cases were transferred from the Cornwallis Road Workhouse to the Islington Infirmary, both within this borough. From this resume it is apparent that a large percentage was of little or no utility from a public health point of view, which is the identical commentary that the Medical Officer of Health made with respect to the returns of 1910. In the following statement the officials from whom the certificates were received last year, are shown:— Islington Infirmary Medical Officers 276 „ Workhouse „ „ 161 „ District „ „ 256 „ Relieving Officers 2 Holborn Infirmary Medical Officers 1 „ Workhouse „ „ 28 Superintending Officers of Institutions within the Borough 256 „ „ „ without „ 336 Other sources 25 1,341 176 1911] It is regrettable that only two certificates were received from relieving officers, for undoubtedly such notifications would enable the Public Health Department to disinfect the rooms vacated by these phthisical persons at once, and before re-occupation by other persons. It would, also, enable a more correct record of their whereabouts to be obtained; for unfortunately, it not inf: equently happens that a patient is completely lost sight of for a time, until at length he reappears in another part of the borough, having in the meantime been on an itinerary, which is not always confined to Islington. In the following Table is shown how certificates are duplicated and reduplicated owing to the migrations of these poor law cases. It gives the particulars for three years. Years. Number of Certificates received respecting individual pitients. 28 20 17 15 14 12 11 10 9 8 7 6 5 4 3 2 1 1909 .. .. 1 1 .. 1 1 2 2 2 6 7 20 45 72 202 489 1910 .. 1 .. .. 1 .. 1 .. 2 2 3 10 16 27 65 166 402 1911 1 .. 1 .. .. .. .. 1 .. 2 3 4 13 33 77 189 419 This Table may be read in this way: in 1909 1 patient was notified 17 times; 1 patient was notified 15 times; 1 was notified 12 times; 1, 11 times; 2, 10 times; 6, 7 times; 202, twice; 489, once. Last year it will be noticed that an individual was notified 28 times. If this were his complete record perhaps it would not excite great wonder, but when it is recollected that he is the same man of whose wanderings the Medical Officer of Health gave a full account in the Annual Report for 1910, in which year he was notified 20 times, he becomes of special interest; indeed, up to the date on which these lines were written, he has been notified 59 times. He is followed very closely by another man, who was notified 12 times in 1909, 14 in 1910, and 17 in 1911, and at the time of writing he has been notified 47 times. These men are continually in and out of the local poor law institutions, of which they seem to make considerable use. Public Health (Tuberculosis in Hospitals) Regulations, 1911. —On May 1st, 1911, the notification of pulmonary tuberculosis among hospital patients became compulsory on Medical Officers of hospitals and dispensaries. Under this set of regulations 586 notifications relating to 500 persons were 177 [1911 received. They have come from many institutions situated in and out of London; indeed, from some which are as far away as the Isle of Wight and Bournemouth. In addition to these, 42 notifications were received relating to patients belonging to other districts, which were forwarded as required by the regulations, to the Medical Officers of Health of the districts in which their homes were situate. Article 7 of these regulations provides that nothing in them shall have effect so as to apply or authorise or require a Medical Officer of Health, or a Council, or any other person in authority either directly or indirectly to put in force with respect to any patient in respect of whom a notification has been transmitted to a Medical Officer of Health any enactment which renders the patient or the person in charge of him or any other persons liable to a penalty, or subjects the patient to any restriction, prohibition, or disability affecting himself or his employment, occupation or means of livelihood on the ground of his suffering from pulmonary tuberculosis. Sub-section 2 of this article permits a Council:— 1. To take the necessary measures to secure the disinfection of infected articles, and the cleansing or disinfection of premises which have been used by the patient. 2. To take the necessary measures for the safe disposal or destruction of the infectious discharges of the patient. 3. To supply all such reasonable assistance, facilities and articles as will tend to diminish the risk of infection arising from the conditions affecting the use or occupation of any room, when used or occupied by the patient as a sleeping apartment. 4. To furnish for the use of the patient, on loan, or otherwise, any appliance, apparatus, or utensil which may be of assistance in preventing the spread of infection, and 5. To appoint such officers to do such acts and make such arrangements as may be requisite for giving advice and for carrying out the provisions of these regulations, and of the Public Health (Tuberculosis) Regulations, 1908. From this resume we see that these regulations give practically unlimited power and authority to sanitary authorities to do everything that may be required to prevent this disease. They have, therefore, power to appoint nurses; to provide shelters; to open dispensaries; to provide sputum cups; to print, N 178 1911] publish, and distribute literature such as placards, handbills, leaflets, suitable summaries of information and instructions respecting the disease, and the precautions to be taken against its spread. The Council, therefore, possess powers full, ample and complete with which to deal with the disease ? Why were they given? to be used or not to be used? To be treated as of no consequence in dealing with the disease, and, therefore, to be lightly brushed aside, or to be considered of great value? The Medical Officer of Health does not for a moment doubt that each Councillor's reason will suggest the right answer; and, indeed, he firmly believes that all are of opinion that these orders are the testament of the Government in the campaign against tuberculosis ; and that the authorities who do not use them will justly deserve to have their powers taken from them and passed on to hands who will be pleased to enforce them, so that the lives of many men, women and children may not be jeopardised, and that protection from the disease may be afforded to many thousands more. The Medical Officer of Health knows that hitherto there has been reluctance to spend money in this direction, but the Council should recollect, and the words are those of the greatest of Greeks (one of whose plays was recently performed in London) written over two thousand years ago:— Though a man be wise, It is no shame for him to live and learn, And not to stretch a course too far. Much has happened in the course of a few years ; therefore those arguments on which the conclusions were based do not avail to-day. Thus we see that the issue of these regulations is one more step in the prevention of tuberculosis. Indeed, at the present moment owing to the compulsory notification of the disease by private medical practitioners all the machinery necessary to enable the Council to become acquainted with the disease has been provided by the Government. There is only wanting, to complete the whole, means of instructing, treating, and isolating such cases according to their requirements. The latter will soon be provided under the National Insurance Act of 1910, so that there is every prospect that before long Anti-tuberculous Dispensaries and Sanatoria will be available for these patients. That the prevention of the disease is one of national importance, and also that in Islington it is not of less local importance, may be gathered from the facts which are briefly set out below. One has but to read them to understand that tuberculosis is, indeed, a disease which demands all our efforts, advisory, physical and monetary, to prevent, for it is indeed a blot on the fair 179 [1911 fame of our country that such an enormous loss of life should be allowed to occur annually without most strenuous efforts being made to prevent it. FACTS ABOUT TUBERCULOSIS. (1) In England and Wales in 1909, 10.5 per cent of the total mortality of the country was due to Tuberculous Diseases. (2) In England and Wales more than 500,000 persons died from Tuberculous Diseases in the year 1909. (3) In Islington during the ten years 1901-10, out of 50,275 persons who died from all causes, 6,154, of 12.2 per cent., died from Tuberculous Diseases. (4) In Islington (1901-10) every twelfth death was caused by Pulmonary Tuberculosis (Consumption). (5) In Islington (1901-10), out of 6,154 persons who died from Tuberculous Diseases, 4,351, or 70.7 per cent., were at the wage-earning period of life. (6) In Islington (1901-10), nearly every third death at the wage-earning period of life was caused by Tuberculous Diseases. (7) In Islington (1901-10), more than every fourth death at the wage-earning period of life was caused by Pulmonary Phthisis (Consumption). (8) In Islington (1901-10), two out of every five deaths between 25 and 35 years of age were caused by Tuberculosis. (9) In Islington (1901-10), out of the 6,154 deaths from Tuberculous Diseases, 4,658, or 75.7 per cent., were due to Pulmonary Phthisis. (10) In Islington (1901-10), out of the 4,658 persons who died from Pulmonary Phthisis, 3,686, or 711 per cent., were at the wage-earning period of life. (11) In Islington (1901-10), out of the 726 deaths from tuberculosis Meningitis, 563, or 77.5 per cent., occurred among children under 5 years of age. (12) In Islington (1901-10), out of 383 deaths from Abdominal Tuberculosis (Tabes Mesenterica) 315, or 87 4 per cent., occurred among children under 5 years of age. (13) In Islington out of the 615 persons who die annually from all Tuberculous Diseases, 144, or 23.4 per cent., die in Public Institutions, mainly the Workhouse Infirmary. N 2 180 1911] (14) In Islington the Poor Law Administration cost in 1910-11, exclusive of Notification Fees, £203,810. (15) In Islington the amount paid in Fees for Hospital accommodation for the prevention of Infectious Diseases averages £40,000 per annum, equal to 515d. in the £ rateable value. (16) The cost of pauperism due to Tuberculous Diseases is estimated at one-seventh the total. On this basis, therefore, the cost in Islington last year would be £29,115, equal to about 3.8d. in the £ rateable value. (17) The estimated value of an adult human life is £300 to £400. (18) In Friendly Societies, consumptive patients who die cost three times more than the patients who die from all causes, namely: £21 as against £7. (19) In New York the estimated loss in money through deaths from Consumption has been reckoned at £4,600,000 per annum. (20) In London on the same basis it would be £3,000,000 per annum. Table CXVIII. Showing the Deaths from All Causes and from All Forms of Tuberculosis during the ten years 1901-1910. Age at Death. Total. Under 1 year 1 5 15 25 35 45 55 65 75 85 and over. All Causes 10,450 5,606 1,548 1,812 2,912 4,062 5,130 6,095 6,488 6,736 1.376 50,275 Phthisis (including tuberculosis of Larynx.) 89 143 113 614 1,100 1,081 891 436 161 30 .. 4,658 Abdominal Tuberculosis 197 118 20 10 12 10 9 5 2 .. .. 383 Tubercular Meningitis 185 378 111 26 13 6 5 2 .. .. .. 726 General Tuber culosis 57 100 26 14 14 16 9 9 3 2 .. 256 Other Forms ol Tuberculosis 9 22 17 15 11 18 13 12 11 2 1 131 All Forms of Tuberculosis 537 767 287 679 1,150 1,131 927 461 177 34 1 6,154 181 [1911 Voluntary Notification ot Phthisis.—Only 55 cases were notified voluntarily by members of the medical profession, of which 33 occurred in their private practice as medical practitioners, and 22 in connection with their official positions in public institutions, such as the City Road Chest Hospital and the Brompton Hospital. Two of the Relieving Officers also notified cases of the disease, which, however, came within the Poor Law regulations. The following are the particulars of the cases notified during the year:— Y ears. 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 5° 109 1909 32 28 4 64 1910 23 34 1 58 1911 33 22 2 57 Seven years 253 191 230 674 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 risen from 283 houses and 380 rooms in 1905 to 426 houses and 579 rooms in 1911. The method of disinfection adopted is that of spraying formaldehyde sohuion 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:— Houses. Rooms. 1st quarter - - - 112 150 2nd „ - - - 102 131 3rd »> - - - 91 135 4th - - - 121 163 Total 426 579 182 1911] The figures for the year contrast with those of the preceding six years, as follows:— Houses. Rooms. 1905 283 380 1906 25s 369 1907 296 411 1908 281 361 1909 514 672 1910 481 645 EPIDEMIC CEREBRO-SPINAL MENINGITIS. This severe disease, which became compulsorily notifiable in London at the beginning of the second quarter of 1907, was notified in 13 instances, which brings the total of the known cases up to 56 during the last five years. The gravity of the disease may be judged from the fact that out of these 56 cases, 30 deaths occurred, which are equal to a percentage of 53.6. 1907. 1908. 1909. 1910. 1911. Total Cases. Total Deaths 1907-11. 1st quarter — 2 2 3 4 II 7 2nd „ 3 2 3 7 4 19 6 3rd „ 5 — 2 1 3 11 7 4th „ 3 3 3 4 2 15 10 11 7 10 15 13 56 30 OPHTHALMIA NEONATORUM. (Purulent Disease of the Eyes of newly-born Children). This disease became notifiable from the 13th March, l9ll, from which time to the end of the year 39 cases were notified, 3 in the first quarter of the year, 18 in the second, 9 in the third, and also 9 in the fourth. As soon as the disease is notified, a call is made at the house to inquire if the mother would be willing for a nurse to call from the North London Nursing Association to attend the patient: for that institution has most kindly agreed to send a member of their nursing staff to such cases. If they had not given this assistance one cannot think what we should have done in Islington. 183 [1911 It is unfortunate that in such a disease as this the visiting work cannot be done, as it ought to be, by the Council's own health visitors, instead of by the nurses of an outside institution, on whom, of course, there is no obligation to do anything. The notification of this disease was recommended to the Public Health Committee by the Medical Officer of Health so far back as June 20th, 1910, when they ordered the report then presented to them to be forwarded to the London County Council, together with a recommendation that the disease should be made compulsorily notifiable. The nature of this disease and the serious injury that it causes to the eyes of new-born children may be gathered from the facts which it was the duly of the Medical Officer of Health to lay before the Council. Ophthalmia Neonatorum is the most serious, nay, terrible, disease to which the newly-born child is subject, and is one of the most common causes of blindness in children. It is also one which may easily be prevented, if due and proper precautions are taken at birth, during which time the disease is contracted from the mother by the penetration of certain discharges (some of which may be, but not necessarily, of a venereal character) into the conjunctival tissues. Sometimes the infection is derived from the mother after birth; in other cases, if the child is in an institution, from another infective case. It is, however, the cases contracted from the mother during or after birth with which we have to deal. During the last six years, Dr. N. Bishop Harman has had the oversight of the schools for the blind and partially blind, and during that time he has examined over 400 children, noting the condition of their eyes, the degree of blindness, and determining the cause of it, with the result that he ascertained that 36.36 per cent, of the cases were due to Ophthalmia Neonatorum, 26.3 to congenital defects, and 17.6 to inherited defects, while 20.8 per cent, were due to 9 other causes. Thus it is seen that Ophthalmia Neonatorum easily heads the list. Great, however, as the percentage is, it is in reality greater than stated, for many of the other causes by careful treatment and operation are removed or so ameliorated as to escape from actual blindness, if, indeed, they do not obtain fair sight. Thus, if all these cases be eliminated, it is found in later years that the percentage of blindness from Ophthalmia Neonatorum exceeds 40 per cent. 184 1911] The London figures are supported by those of Germany, Austria, Denmark, and Holland, which Rhein-Hardt debited with 40 per cent.; with those of Paris, to which Claisse debited 46 per cent., to those of Breslau, to which an Investigator gave 34 per cent., and to Berlin, to which Katz attributed 41 as blind from this cause. Dr. Harmer made very close inquiries in one London district, half the population of which live in tenements and half in houses rented from £30 to £40 per annum. There are, however, only a few at the latter rental. He visited the local practitioners and obtained from them particulars of some 15,000 live births, and discovered that among these infants the incidence of the disease averaged 0.87, and the incidence of injury from the disease 0 047 per cent. Roughly, therefore, it may be said that of every 100 children born alive, one contracts the disease, and of every 2,000 born, one is blinded or partly blinded by its effects. He afterwards examined the returns of the examination of the vision of children attending the elementary schools in London, and he found that one child in about 4,000 showed the effects of the disease. He points out, however, that in comparing the results of these two inquiries, no allowance was made for the death of affected infants. The English Census returns for 1901 show that 1 person in every 7,000 was blind from childhood. If the conditions found in the London schools were applied to the whole population it would mean that in 1901 there were living 1,000 to 2,000 persons who were blind from purulent ophthalmia contracted at birth, and where blindness might have been prevented. Dr. Harman in his valuable contribution to the literature on this subject asks three questions:— (1.) What is the cause, or the most frequent cause, of the condition known as Ophthalmia Neonatorum? (2.) Is the disease a danger to the members of the community other than the infants affected? (3.) What class of the population are most affected by the disease ? And he answered these as follows:— (1.) A careful examination of a large number of cases of purulent discharge in the new-born has shown that 80 per cent, are due to inoculation of the eyes at or about the time of birth with gonorrhœal virus; and 185 [1911 that these are the cases that are dangerous to sight, for they produce the severest and most destructive form of inflammation, and consequently endanger the integrity of the cornea. The remaining 20 per cent, are of milder order, and are due to inoculation with the bacilli from other discharges. 02) The second question he answers affirmatively in this manner by citing an incident as evidence:—One day, at Moorfields Hospital, he saw a mother and three girls, aged 10, 8, and 4 years, and an infant 4 weeks. The baby had developed Ophthalmia Neonatorum on the fourth day of life ; a week later the youngesi girl contracted the disease; a few days later the second girl caught it, and subsequently the oldest girl, and 2t the time they were seen the four children had the disease, and the mother showed the initial symptoms of an attack. Further, it was found that each of the children suffered from a gonorrhœal vulvitis. Such an example demonstrates the great possibilities of the spread of the disease more forcibly than words. (3) His reply to the third question is answered by his experience at the Belgrave Hospital, for a long while situated in Pimlico, and tended a small but very poor district. Here 34.4 per cent, of the infants under 12 months old were suffering from the ophthalmia of the newly born. When, however, the hospital was moved to Kensington, he found the patients more numerous and better kept, and that only 6.2 of the infants were the subject of the disease. It is evident from these figures that poverty and neglect tend to increase the liability to the disease. Prevention of the Disease.—So long ago as 1807 Gibson, of Manchester, laid d ,wn three rules for the prevention of the disease which have never been bettered. As, however, they are primarily of a medical character, it is not necessary to repeat them here, more especially as certain medical measures recommended by a Special Committee of the British Medical Association who were appointed to consider what action was necessary for the prevention of the disease, will be given presently. This Committee made recommendations of two characters—first, as to the administrative and educational kind, and, secondly, as to medical measures. With respect to the first class, they placed notification in the forefront, which is also very strongly recommended by Dr. Harman in his very able contribution on the subject. With respect to 186 1911] notification, they say that it is advisable to urge upon the Local Government Board that the notification of Ophthalmia Neonatorum should be made compulsory, and that it shall be the duty of the Local Sanitary Authority upon receipt of notification to inquire as to the facilities for treatment, and if this be deficient, to arrange for the efficient treatment of the disease, but that its treatment should not involve separation of mother from child if this can be avoided. They also recommended that bacteriological examination of certain maternity discharges and discharges from the eyes of the infants should be undertaken free of charge by the Local Sanitary Authority when such a request is made by a medical practitioner; and further, as an educational measure, that notices relating the dangers of Ophthalmia Neonatorum should be issued by the Local Sanitary Authority, and that they should also be exhibited in post offices and other public places; further, that such notices should be periodically distributed by the Local Supervising Authority, which in London is the London County Council, to every midwife whose name appears on the Roll of Midwives for the particular area concerned. It was also a recommendation that the presence of purulent vaginal discharges should be included by the Rules of the Midwives' Board among the conditions for which medical help should be summoned, and, finally, they recommended that among the members of the medical staff of every maternity hospital there should be included an ophthalmic surgeon. With respect to the medical measures, they recommended that in every case in which a medical practitioner is not in attendance, the midwife or nurse should adopt the following routine procedure. (1) Directly the head is born and before the eyes are open, the lids of the surrounding skin should be wiped clean on each side with separate pieces of sterilized wool. (*2) That nothing should be dropped into the baby's eyes. (3) That the face and body should not be washed in the same water, but that fresh water should be taken with each. With respect to the mother, they recommended that when there is purulent vaginal discharge, whether in pregnancy or labour, medical help should be obtained and that in such cases if a doctor is not already present when the child is born, he should be sent for immediately in order that any necessary application to the child's eyes may be made, and that if there is any inflammation of the eyes, however slight, such as redness, swelling, or discharge, the midwife or nurse must explain that the case is one in which the attendance of a registered medical practitioner is required, and medical help must be obtained in accordance with the Rules of the Central Midwives Board. 187 [1911 The Committee made some further suggestions to medical practitioners in view of the conflicting opinions regarding the precautions that should be observed by them for the prevention of the disease, which, shortly, are as follows:— (a) In presumably non-infected confinements. A policy of non-interference with respect to the mother, but with respect to the child, the practitioner should make it his business to see that as soon as possible after the head is born, and as soon as the eyes are open, the eyelids are cleansed with sterilized wool and that separate water is used to wash the baby's head and body. Where, however, the confinements are of mothers where infection is known or expected to exist, they should take steps to examine bacteriologically any morbid discharges from the mothers' genito-urinary passages and that appropriate treatment should be adopted. With respect to the child in such a case, the baby's eyelids should be carefully wiped free from secretion and a single drop of 1 per cent, solution of Silver Nitrate should be placed in each eye. It might be stated that at the International Conference on the Blind held in Manchester in 1908, the Committee appointed by the Conference to consider the subject recommended that this disease should be added to the list of diseases compulsorily notifiable under the Notification Act 1899, and also in their opinion more definite teaching should be given to midwives of the seriousness of the disease in children, and they suggested that the Central Midwives Board should issue more stringent instructions on the danger of " whites" in lying-in women. The Order, adding the disease to the list of those which are already compulsorily notifiable, casts the duty of notification alike on the Head of the family, and upon every medical practitioner in attendance as soon as he becomes aware of its nature; but no obligation is imposed upon midwives, who it is estimated attend about a half of the confinements of the country. It will thus be seen that the consensus of opinion of every person or body, whether in England or on the continent, who has studied this question is in favour of prompt measures being taken with this disease as soon as it is recognised, and that these measures should consist of notification of the disease, action by the Sanitary Authority, and treatment by properly qualified persons. 188 1911] The Medical Officer of Health entirely concurs with these proposals, and he is firmly convinced that the time has arrived when something more than is now accomplished should be done to prevent the large amount of blindness that occurs among newly-born infants, and he recommends— (1) That midwives should receive special instructions as to the cause of this disease and how to recognise it in its early stages; and (2) That they should have power to call in medical advice to assist them in the treatment of the disease. NOTIFICATION OF POLIOENCEPHALITIS AND POLIOMYELITIS. Under section 56 of the Public Health (London) Act, 1891, the London County Council is empowered to make an Order rendering it compulsory to make notifiable an infectious disease not included in the above Act against which it is desirable in the interests of the public health to take precautions. This Order is practically an extension of that relating to Cerebro-Spinal Meningitis, as these are allied diseases, and are prubably caused by the same bacillus. Since 1905, when an epidemic occurred in Sweden, it has been known in Southern Europe and the United Slates of America, where it has appeared with considerable intensity in different States since 1907. It usually suddenly attacks persons in apparently good health, who, at first, may experience a sharp rise of temperature, although some cases may run their course without fever. According to Dr. H. A. Macewen, the range of temperature varies from 99 to 102.2 degrees F., although in the New York epidemic in 1907 it was somewhat higher, ranging from 101 degrees to 104 F. The fever seldom lasts longer than from two to seven days, but the fever in itself is no criterion as to the severity of the attack. There is usually great prostration, muscular weakness and weariness, while in" a large proportion of the cases there is headache. There may also be gastro-intestinal disturbances, and one observer (Krause) found digestive disturbances present at the onset in 90 per cent, of the cases in an epidemic which occurred in Germany. Nervous symptoms and severe drowsiness is of frequent occurrence, while irritability and restlessness are common; meningeal symptoms are of frequent occurrence, and pain, stiffness and rigidity of the neck are met with, while in severe cases the 189 [1911 head may be drawn back, owing to the retraction of the posterior muscles of the neck. A very full account of this disease has been recently published by the Local Government Board in their new series of Reports on Public Health and Medical Subjects, No. 61. During the year 1 case of the disease was notified. INFECTIOUS DISEASES IN PUBLIC ELEMENTARY SCHOOLS. 710 cases of infectious disease notifiable under the provisions of the Public Health (London) Act 1891 were reported during the year, or 206 less than the average which obtained during the preceding ten years (see Table CXX.). Scarlet Fever was accountable for 424 cases which, although 212 less than the average of the ten years 1901-1910 was an increase on that of the preceding year, when 369 scholars were attacked. Diphtheria.—With respect to it 272 scholars were affected as compared with a decennial average of 234, and with 197 in the preceding year. There was thus a decrease of 38 cases on the mean of the ten years. Enteric Fever was responsible for 14 cases, or 18 less than the average of the decennial period, although five more than were known in 1910. Of other diseases no case was known, as compared with 13 in the ten years 1901-1910. It may be stated that the 710 cases among scholars formed 40.4 per cent, of all the cases of the these diseases notified in the borough during the year. This is a decrease of 1.6 per cent, on the percentage which obtained during 1901-1910. 190 1911] Table CXIX. Showing the Scholars attached 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. 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 1910 .. 369 197 13 .. 579 38.0 Ten years' Average 1 636 234 32 13 916 42.0 1911 .. 424 272 14 .. 710 40.4 Increase or Decrease on Average -1 -212 +38 -18 -13 -206 -1.6 191 [1911 Table CXX. Showing the cases of Notifiable Infectious Diseases occurring in Public Elementary Schools during the Year 1911. 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. All Saints', Muriel Street .. 2 2 .. .. 4 .. 5 9 .. .. 14 Ambler Road .. 2 .. .. .. 2 .. 4 .. .. .. 4 Barnsbury Park .. 6 4 1 .. 11 .. 15 15 2 .. 32 Blackstock Road .. 2 5 .. .. 7 .. 11 24 4 .. 39 Blundell Street .. 2 1 .. .. A .. 9 7 1 .. 17 "Brecknock," York Road .. 6 1 .. .. 7 .. 33 32 .. .. 65 Buckingham Street .. 22 8 .. .. 30 .. 69 28 .. .. 97 Burghley Road .. 9 6 .. .. 15 .. 11 12 2 .. 25 Caledonian Road .. 4 3 .. .. 7 .. 36 19 .. .. 55 Canonbury Road.. .. 15 19 .. .. 34 .. 31 32 1 .. 64 Catholic School, Eden Grove .. 4 .. 1 .. 5 .. 16 17 3 .. 35 Chapel of Ease .. 4 4 .. .. 8 .. 13 14 .. .. 27 Cottenham Road. .. 9 14 .. .. 23 .. 30 130 4 .. 164 Drayton Park .. 1 11 .. .. 12 .. 3 16 .. .. 19 Duncombe Road .. 11 31 .. .. 42 .. 28 295 5 .. 328 Ecclesbourne Road .. 16 3 .. .. 19 .. 47 8 .. .. 55 "Forster," Hornsey Road .. 4 3 1 .. 8 .. 21 14 .. .. 35 Gifford Street .. 5 4 2 .. 11 .. 17 32 14 .. 63 Gillespie Road .. 2 2 .. .. 4 .. 19 6 .. .. 25 Grafton Road .. 5 4 .. .. 9 .. 9 21 1 .. 31 Hanover Street .. 7 2 .. .. 9 .. 9 1 .. .. 10 Hargrave Park .. 5 6 .. .. 11 .. 156 17 .. .. 173 Holy Trinity .. 1 2 .. .. 3 .. 4 6 1 .. 11 Hungerford Road .. 21 14 .. .. 35 .. 46 36 .. .. 82 Montem Street .. 23 15 1 .. 39 .. 37 51 3 .. 91 Newington Green .. 12 2 .. .. 14 .. 29 5 .. .. 34 Pakeman Street .. 3 4 .. .. 7 .. 18 14 .. .. 32 Poole's Park (Lennox Road) .. 4 13 .. .. 17 .. 22 48 1 .. 71 Popham Road .. 2 6 1 .. 9 .. 10 16 4 .. 30 Queen's Head Street .. 18 13 l .. 32 .. 48 37 8 .. 93 Richard Street .. 16 6 .. .. 22 .. 54 20 .. .. 74 Risinghill Street .. 2 .. .. .. 2 .. 17 10 .. .. 27 Rotherfield Street .. 4 4 .. .. 8 .. 28 15 .. .. 43 St. Bartholomew's .. .. .. .. .. .. .. .. .. .. .. .. St. Clement's. Cumberland Street .. 1 1 .. .. 2 .. 3 7 .. .. 10 St. James', George's Road .. 2 2 .. .. 4 .. 8 9 .. .. 17 St. John's, Conewood Street .. 3 .. .. .. 3 .. 2 1 2 .. 5 St. John's, Duncan Terrace .. 3 2 2 .. 7 .. 13 4 8 .. 25 St. John's, Holloway Road .. 4 1 .. .. 5 .. 24 13 .. .. 37 St. Joseph's, Highgate .. 1 2 .. .. 3 .. 4 12 .. .. 16 St. Jude's, Mildmay Park .. 5 2 .. .. 7 .. 17 1 .. .. 18 St. Mark's, Mitford Road .. 4 2 .. .. 6 .. 10 19 .. .. •29 St. Matthew's, City Road .. 1 .. .. .. 1 .. 7 .. .. .. 7 St. Matthias (Hackney) .. .. .. .. .. .. .. .. 2 .. .. •2 St. Mary's, Cross Street .. 11 2 .. .. 13 .. 25 13 5 .. 43 St. Paul's, Dorset Street .. 6 2 .. .. 8 .. 14 7 .. .. 21 St. Philip's .. .. .. .. .. .. .. .. .. .. .. St. Thomas, Everilda Street .. 4 5 .. .. 9 .. 7 9 .. .. 16 Shelburne Road .. 4 2 .. .. 6 .. 8 8 2 .. 18 Shepperton Road .. 1 .. .. .. 1 .. 8 5 .. .. 13 Station Road .. 4 3 1 .. 8 .. 18 14 2 .. 34 Thornhill Road .. 13 5 l .. 19 .. 61 23 4 .. 88 Tottenham Road .. 4 2 1 .. 7 .. 10 9 1 .. 20 Upper Hornsey Road .. 9 8 .. .. 17 .. 27 32 2 .. 61 Vittoria Place .. 14 .. .. .. 14 .. 55 20 5 .. 80 Westbourne Road .. 25 5 .. .. 30 .. 120 9 .. .. 129 White Lion Street .. 1 .. .. .. 1 .. 6 .. .. .. 6 Whittington, Highgate Hill .. 5 1 l .. 7 .. 12 10 .. .. 22 Winchester Street .. 24 3 .. .. 27 .. 59 11 2 .. 75 Yerbury Road .. 6 5 .. .. 11 .. 36 40 2 .. 78 York Road .. 20 5 .. .. 25 .. 64 10 .. .. 74 Total .. 424 272 14 .. 710 .. 1522 1'298 89 .. 2909 192 1911] NON-NOTIFIABLE DISEASES AMONG CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS. There were 4,876 cases of Measles, Chicken Pox, Whooping Cough, and other diseases of an infectious character, although not notifiable under the Public Health (London) Act, reported to the Public Health Department by the teachers of the several public elementary schools. This is a considerable decrease on the return for 1910, when 6,077 cases were notified. On the other hand, it is an increase of 994 on the average of the ten years 1901-1910. These are large figures, but it is to be noted that they are not diseases which materially interfere with school life, because they are mainly confined to little children in attendance at the infant classes, to which they are sent more to be out of the way of their mothers than for any education they may receive. The Medical Officer of Health has always felt, in dealing with these cases, th;it it was little or no injury to the children or the schools to exclude these scholars or to close their class rooms when the state of infection required it. Measles.—During 1910 there had been a serious outbreak of Measles among the younger scholars, when 2,194 cases were notified, and it is satisfactory to find that in 1911 the number had fallen to 1698. This figure is, however, 163 above the average of the cases that have been notified since 1901. It must be recollected that in the early years of the decennium as much care was not taken by the teachers to notify the disease as during the last three or four years. Chicken Pox.—Here again there has been a considerable decrease on the return of 1910, as only 585 cases were notified, as contrasted with 985 in that year. Whooping Cough.—The cases fell from 892 in 1910 to 533 last year. 193 [1911 Year. Measles. Chicken Pox. Whooping Cough. Other Diseases. Totals. 1901 2,772 247 l6l 215 3,395 1902 1,214 482 326 295 2,317 1903 1,049 206 277 766 2,298 1904 355 182 1,293 595 2,425 1905 999 637 732 1,011 3,379 1906 1,935 425 300 1,475 4,135 1907 2,065 981 831 1,952 5,829 1908 1,095 624 385 2,255 4,359 1909 1,667 491 708 1,739 4,605 1910 2,194 985 892 2,006 6,077 Totals 10 years 15,345 5,260 5,905 12,309 38,819 Average 1,535 526 590 1,231 3,882 1911 1,698 585 533 2,060 4,876 Increase or Decrease on Average +163 + 59 -57 + 829 +994 O 194 1911] Statement showing number of Children excluded from various Schools on account of Measles in their Homes. Note.—I. = Infant,' Department; B. = Boys'; J.B. = Junior Boys'; G. = Girls'; J. G. = Junior Girls: Mxd. = Mixed; J.M. = Junior Mixed: S.M. = Senior Mixed. Name of School. Dept. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total in Dept. Total for School. Ambler Road I. 29 ... ... ... 29 30 B. ... 1 ... ... 1 All Saints I. 5 ... ... ... 5 5 Angler's Gdns , Pophara Road I. 6 12 3 ... 21 23 B. ... 2 ... ... 2 Barnsbury Park I. 5 ... 1 ... 6 10 Mxd. 1 ... ... 2 3 G. ... ... ... 1 l Blackstock Road I. 14 4 ... ... 18 24 G. 1 5 ... ... 6 Blundell Street I. 20 8 4 ... 32 33 G. 1 ... ... ... 1 Buckingham Street I. 2 5 ... ... 7 14 G. 3 4 ... ... 7 Burghley Road I. 22 2 ... ... 24 30 B. 2 ... ... ... 2 G. 1 1 ... 2 4 Caledonian Road I. 14 2 ... ... 16 17 G. ... ... ... 1 1 Canonbury Road I. 25 5 ... ... 30 30 Cloudesley Street I. ... 1 ... ... 1 3 B. 2 ... ... ... 2 Cottenham Road I. 31 4 2 7 44 44 Drayton Park I. 2 ... ... ... 2 2 Duncombe Road I. 24 34 4 23 85 116 J. B. 7 2 ... ... 9 S.M. 4 1 ... ... 5 J. G. 2 12 2 ... 16 G 1 ... ... ... 1 Ecclesbourne Road I. 25 3 ... ... 28 36 B. 2 1 ... 1 4 G. 2 1 1 ... 4 Eden Grove G. 5 ... ... ... 5 5 Forster I. 18 ... 2 ... 20 21 G. 1 ... ... ... 1 Gifford Street I. 13 5 2 ... 20 27 G. 6 1 ... ... 7 195 [1911 Name of School. Dept. 1st Qr. 2nd Qr. 3rd Qr 4th Qr. Total in Dept. Total for School. Gillespie Road I. 15 5 1 ... 21 25 G. 4 ... ... ... 4 Grafton Road I. 3 6 ... 4 13 15 G. 1 1 ... ... 2 Hanover Street I. 10 3 3 ... 16 21 B. 1 ... ... ... 1 G. 2 1 ... 1 4 Hargrave Park I. 22 ... ... ... 22 34 G 2 ... ... ... 2 B. 8 2 ... ... 10 Hungerford Road I. 7 2 ... ... 9 14 B. 1 ... ... 1 2 G. 2 1 ... ... 3 Montem Street I. 19 8 3 ... 30 32 G. 1 1 ... ... 2 Newington Green I. ... 2 ... ... 2 3 G ... 1 ... ... 1 Pakeman Street I. 25 2 1 ... 28 32 B. 4 ... ... ... 4 Poole's Park I. 5 1 ... ... 6 17 B. 4 ... ... ... 4 G. 5 2 ... ... 7 Queen's Head Street I. 3 1 ... ... 4 10 G. ... 3 ... ... 3 J. M. 2 ... 1 ... 3 Richard Street I. 16 12 ... ... 28 29 G. ... 1 ... ... 1 Rotherfield Street I 39 5 5 ... 49 49 St James' I. 6 ... ... ... 6 6 St. John's. Pembercon Road I. 4 ... ... ... 4 4 „ Conewood Street I. 6 ... ... ... 6 0 St. Joseph's I. ... 2 ... ... 2 2 St. Jude's I. 5 ... ... ... 5 7 B. 2 ... ... ... 2 St. Mark's I. 4 ... ... ... 4 4 St. Mary's, Fowler Road I. ... 1 ... ... 1 1 St. Matthew's I. 10 ... ... ... 10 11 G. ... ... 1 ... 1 O 2 196 1911] Name of School. Dept. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total in Dept. Total for School. St. Paul's I. 7 ... ... ... 7 10 G. 1 ... ... ... 1 B. 2 ... ... ... 2 Shelburne Road Mxd 2 ... ... ... 2 2 Shepperton Road I. 2 1 2 ... 5 5 St. Thomas' I. 2 2 ... ... 4 5 G. 1 ... ... ... l Station Road I. 8 ... ... ... 8 14 G. 3 1 ... ... 4 B. 1 ... 1 ... 2 Thornhill Road B. ... 1 ... ... 1 3 G. ... 2 ... ... 2 Tottenham Road I. 19 ... ... ... 19 20 J. M. 1 ... ... ... 1 Upper Hornsey Road I. 29 3 3 4 39 52 G. 8 3 ... 2 13 Vittoria Place I. 22 6 ... ... 28 28 Westbourne Road I. 10 1 ... 1 12 12 Whittington I. 5 3 ... 1 9 9 Yerbury Road I. 10 10 ... ... 20 20 York Road I. 4 3 ... ... 7 8 G. 1 ... ... ... 1 672 215 42 51 980 980 SUMMARY. Department 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. Infants 572 164 36 40 812 Boys 36 9 1 2 48 Girls 54 41 4 7 106 Mixed 10 1 1 2 14 672 215 42 51 980 197 [1911 Table CXXI. Showing the Infectious Diseases notified during the year 1911 by the Teachers of Public Elementary Schools under the provisions of the London County Council Schools Code. School. Measles. Chicken Pox. Whooping Cough. Other Diseases. Totals. All Saints' 2 5 10 15 32 Ambler Road 55 2 13 21 91 Barnsbury Park 7 25 35 27 94 Blackstock Road 39 1 .. 21 61 Blundell Street 22 32 14 81 149 Brecknock, York Road 3 1 .. 7 11 Buckingham Street 1 13 4 54 72 Burghley Road 96 24 13 46 179 Caledonian Road 16 11 4 19 50 Canonbury Road 78 5 12 109 204 Catholic School, Eden Grove .. 5 2 7 14 Chapel of Ease .. 5 7 78 90 Cottenham Road 72 3 10 29 114 Drayton Park 14 22 13 18 67 Duncombe Road 208 19 44 132 403 Ecclesbourne Road 90 15 8 43 156 Forster, Hornsey Road 13 11 3 66 93 Gifford Street 26 42 33 136 237 Gillespie Road 65 4 19 88 Grafton Road 47 .. 3 19 69 Hanover Street 33 40 9 46 128 Hargrave Park 31 25 5 44 105 Holy Trinity 7 1 8 15 31 Hungerford Road 20 5 3 30 58 Montem Street 112 74 11 92 289 Newington Green 16 1 2 12 31 Pakeman Street 24 10 4 14 52 Poole's Park 6 8 28 60 102 Popham Road 18 5 29 49 101 Queen's Head Street 20 6 4 43 73 Richard Street 38 43 3 101 185 Risinghill Street .. .. .. .. .. Rotherfield Street 30 9 14 39 92 St. Bartholomew's .. .. .. .. .. St. Clement's .. 7 .. 11 18 St. James' 16 4 .. 41 61 St. John's, Conewood Street 12 .. .. 10 22 St John's, Duncan Terrace 2 .. .. 10 12 St. John's, Holloway Road 31 2 3 7 43 St. Joseph's 3 7 .. .. 10 St. Jude's.. 20 .. 9 5 34 St. Mark's 4 3 19 7 33 St. Matthew's, City Road 18 3 2 1 24 St. Matthias (Hackney) .. .. .. .. .. St. Mary's 7 .. 4 39 50 St. Paul's, Dorset Street 27 1 .. 11 39 St. Philip's .. .. .. .. .. St. Thomas' 13 l 2 22 38 Shelburne Road 64 5 23 24 116 Shepperton Road 3 3 9 60 75 Station Road 50 4 23 34 111 Thornhill Road 14 2 1 18 35 Tottenham Road 23 6 6 14 49 Upper Hornsey Road 71 19 14 45 149 Vittoria Place 47 4 10 64 125 Westbourne Road 9 9 21 53 92 White Lion Street .. .. .. .. .. Whittington 32 4 8 11 55 Winchester Street 1 .. .. 3 4 Yerbury Road 21 17 1 33 72 York Road 1 12 30 45 88 Total 1,698 585 533 2,060 4,876 198 1911] ISOLATION OF INFECTIOUS DISEASES. As many as 1,416 cases out of the 1,759 that were notified under the Public Health (London) Act, 1891 were isolated in Hospital, representing 80.5 per cent. of all the notified cases. 1896 48.4 per cent. 1904 75.5 Per cent. 1897 55.7 1905 76.1 „ 1898 58.4 1906 77.1 „ 1899 64.6 „ I9°7 80.0 „ 1900 68.2 „ 1908 80.4 „ 1901 69.6 „ 1909 83.2 „ 1902 71.9 „ 1910 81.6 „ 1903 72.6 „ 1911 80.5 „ The Metopolitan Asylums Board, as usual, isolated the largest number of these cases, and out of 1,416 persons removed from their homes, 1,300 were taken to their hospitals. Scarlet Fever.—766 cases out of 804, or 95.3 per cent., were isolated and treated in hospitals, and of these, 656, or 85.6 per cent., were removed to one or other of the hospitals of the Metropolitan Asylums Board. Diphtheria.—526 cases, or 887 per cent, of the 593 cases notified, were isolated in hospital, and of these, 418 were treated in the Metropolitan Asylums Board's Hospitals. Only 67, or 11.3 per cent., remained at home. Enteric Fever.—Of the 73 cases that were notified, 56, or 767 per cent., were removed to hospital, while 17, or 23.3 per cent., remained at home. Erysipelas.—275 cases were known, of which 62, or 22'6 per cent., were treated in hospitals. Nearly all these occurred in the institutions in which they were treated. Puerperal Fever.—6 cases out of 14 that occurred, or 42.8 per cent were treated in hospital, while 8 were treated at home. Table CXXII. 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 1911. 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 .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 766 38 804 95.3 4.7 19 1 20 2.5 2.6 2.5 Diphtheria 526 67 593 88.7 11.8 45 8 53 8.5 11.9 8.9 Enteric (Typhoid Fever) 56 17 73 76.7 23.3 11 1 12 19.6 5.9 17.2 Typhus Fever.. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 62 213 275 22.6 77.4 8 4 12 12.9 1.9 4.3 Puerperal Fever 6 8 14 42.8 57.2 4 3 7 66.6 37.5 50.0 Continued Fever •• •• •• .. .. .. .. .. .. .. •• Relapsing Fever •• .. •• .. .. .. .. .. .. .. •• Cholera •• •• •• .. •• •• .. .. .. .. .. Total.. 1,416 343 1.759 80.5 19.5 87 17 104 6.1 4.9 5.9 200 1911] Table CXXIII. Showing the Cases of Infectious Disease removed to the Metropolitan Asylums Board's Hospitals for treatment and isolation during 1911. Metropolitan Asylums Board's Hospitals. Small Pox. Scarlet Fever. Diphtheria. Enteiic Fever. Typhus Fever. Other Diseases. Total Admissions. Total Deaths. Eastern • • 2 19 • • • • 56 77 15 North Eastern • • 646 375 11 • • 291 1,323 64 Northwestern • • 7 21 10 • • 119 157 13 Western • • .. .. • • • • 5 5 • • South Western • • • • .. • • • • 1 1 • • The Grove • • 1 .. .. • • 5 6 • • Brook Hospital • • .. • • • • 1 1 • • South Eastern • • • • 3 1 • • 7 11 1 Convalescent Hospital • • • • • • • • • • • • • • Small Pox • • • • • • • • • • • • .. •• Totals • • 656 418 22 • • 485 1.581 93 * Including 281 cases of Measles and Whooping Cough. 201 [1911 OCCUPATIONS OF PERSONS ATTACKED WITH INFECTIOUS DISEASES. The Tables attached to this part of the report are always worthy of study, for they show the occupations of the patients who were suffering from the several infectious diseases specified in them. Thus, with respect to Scarlet Fever, it was found that 2 bookfolders, 7 clerks, 2 coachbuilders, 3 cashicrs, 5 drapers' assistants, 2 cloak room attendants, 4 dressmakers, 2 rurses, 2 bakers, and 3 servants were attacked with the disease, in addition to whom there was a baker, a carpenter, an errand boy, a hawker, and a messenger. This shows the many channels through which Scarlet Fever may be conveyed, for it is quite possible that any one of these persons, while in an infectious state, might convey its germs to the goods which they were handling. From this it will be seen how important a matter it is that early notification should be given of these infectious diseases, so as to prevent the persons suffering from them carrying on their work, and also to afford an opportunity to the Sanitary Authority to get the articles they have made disinfected before they are sold. Of course it unfortunately happens frequently that a doctor does not see the patients at the earliest possible moment, and, therefore, they sometimes continue at their work at a time when they should be isolated. From Table CXXVI, which shows the trades and businesses carried on in houses where infectious diseases have occurred, it will be seen how easily many of the goods manufactured or sold by these tradespeople can be infected by the disease which has occurred in the premises. It has consequently always been the endeavour of the Public Health Department to visit these business places at the earliest possible moment, so that the business may be stopped if necessary, the premises disinfected, and, where required, the goods also. 202 1911] Table CXXV. Showing the Occupations of Patients suffering from the several notifiable Infectious Diseases during the year 1911. Occupations. Small Pox. Scarlet Fever. Diphtheria. Memb Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Cerebro-spinal Fever. Total. Athletic Sports Outfitter ... ... 1 ... ... ... ... ... ... ... 1 Actress ... ... ... ... 1 ... ... ... ... ... 1 Bricklayer ... ... ... ... 1 ... ... ... ... ... 3 Barmaid ... ... ... ... 1 ... ... ... ... ... 1 Blouse Maker ... 1 ... ... ... ... ... ... ... ... 1 Brush Maker ... 1 ... ... ... ... ... ... ... ... 1 Butcher ... ... 1 ... ... ... ... ... ... ... 1 Box Maker ... 1 ... ... ... ... ... ... ... ... 2 Bookfolder ... 2 ... ... ... ... ... ... ... ... 4 Bedtick Sewing ... 1 ... ... ... ... ... ... ... ... 1 Baker ... 1 ... ... ... ... ... ... ... ... 3 Bagmaker ... ... 1 ... ... ... ... ... ... ... 1 Bookbinder ... ... ... ... ... ... ... ... ... ... 2 Bottlewasher ... ... 1 ... ... ... ... ... ... ... 2 Bookkeeper ... ... 1 ... 1 ... ... ... ... ... 2 Clerk ... 7 5 ... 4 ... ... ... ... ... 21 Carpenter ... 1 ... ... ... ... ... ... ... ... 1 Charwoman ... 1 1 ... ... ... ... ... ... ... 7 Coachbuilder ... 2 1 ... ... ... ... ... ... ... 3 Cloakroom Attendant ... 1 ... ... ... ... ... ... ... ... 1 Cashier ... 3 ... ... ... ... ... ... ... ... 3 Carpet Sewing ... 1 ... ... ... ... ... ... ... ... 1 Curate ... ... 1 ... ... ... ... ... ... ... 1 Carriage Cleaner ... ... 1 ... ... ... ... ... ... ... 1 Cricket Ball Maker ... ... ... ... 1 ... ... ... ... ... 1 Ceilarman ... ... ... ... ... ... ... ... ... ... 1 Card Cutter ... ... ... ... ... ... ... ... ... ... i Coachman ... ... ... ... ... ... ... ... ... ... 3 Coal Porter ... ... ... ... ... ... ... ... ... ... i Cook ... ... ... ... 1 ... 3 ... ... ... 4 Carman ... ... 1 ... 2 ... 5 ... ... ... 8 Commercial Traveller ... ... ... ... 2 ... ... ... ... ... 2 Cab Driver ... ... ... ... ... ... 1 ... ... ... 1 Coachman ... ... ... ... ... ... 3 ... ... ... 3 Chemist ... ... ... ... ... ... 1 ... ... ... 1 Coffee Stall Keeper ... ... ... ... ... ... ... ... ... ... 1 Drapers' Assistant ... ... ... ... ... ... ... ... ... ... 5 Drayman ... ... 1 ... ... ... ... ... ... ... 1 Draughtsman ... ... ... ... 1 ... ... ... ... ... 1 Dressmaker ... ... 3 ... 1 ... 2 ... ... ... 10 Doorkeeper ... ... ... ... ... ... 1 ... ... ... 1 203 [1911 Table CXXV.—continued. Occupations. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Cerebro-spinal Fever. Total. Decorator ... ... ... ... ... ... 1 ... ... ... 1 Druggist ... ... ... ... ... ... 1 ... ... ... 1 Errand Boy ... 1 1 ... ... ... 1 ... ... ... 3 Engineer's Labourer ... ... 1 ... ... ... ... ... ... ... 1 Electrician ... ... 2 ... 1 ... ... ... ... ... 3 Engineer ... ... 1 ... 1 ... ... ... ... ... 2 Electro Plater ... ... ... ... 1 ... ... ... ... ... 1 Embroiderer ... ... ... ... ... ... 1 ... ... ... 1 Factory Hand ... ... 3 ... ... ... ... ... ... ... 3 Furniture Hand ... ... ... ... 1 ... ... ... ... ... 1 Fish Salesman ... ... ... ... 1 ... 1 ... ... ... 2 Fancy Leather Work ... ... ... ... ... ... 1 ... ... ... 1 Greengrocer ... ... 1 ... 1 ... ... ... ... ... 2 Goods Inspector ... ... ... ... ... ... 1 ... ... ... 1 Hawker ... 1 ... ... ... ... ... ... ... ... 1 Housewife ... 2 1 ... ... ... 19 ... ... ... 22 Housemaid ... ... ... ... 1 ... 1 ... ... ... 2 Housekeeper ... ... ... ... 1 ... ... ... ... ... 1 Hairdresser ... ... ... ... ... ... 1 ... ... ... 1 Jam Maker ... ... 1 ... ... ... ... ... ... ... 1 Jeweller ... ... ... ... 1 ... ... ... ... ... 1 Labourer ... ... 2 ... 5 ... ... ... ... ... 11 Leather Work ... ... 1 ... ... ... ... ... ... ... 1 Laundry Hand ... ... 1 ... ... ... ... ... ... ... 5 Messenger ... 1 ... ... ... ... ... ... ... ... 1 Machinist ... 3 ... ... ... ... 1 ... ... ... 4 Motor Fitter ... 1 ... ... ... ... ... ... ... ... 1 Manager ... 1 ... ... ... ... ... ... ... ... 1 Milk Carrier ... ... 1 ... ... ... ... ... ... ... 1 Mangling ... ... ... ... ... ... ... ... ... ... 1 Mechanic ... ... ... ... ... ... ... ... ... ... 1 Nurse ... 2 1 ... ... ... ... ... ... ... 7 Nursemaid ... ... 3 ... ... ... 1 ... ... ... 4 Night Watchman ... ... ... ... ... ... 1 ... ... ... 1 Overseer ... ... ... ... ... ... 1 ... ... ... 1 Packer ... 2 ... ... ... ... 1 ... ... ... 3 Printer ... 1 ... ... ... ... 1 ... ... ... 2 Photographic Assistant ... 1 ... ... ... ... ... ... ... ... 1 Porter ... 1 ... ... ... ... ... ... ... ... 4 Pastrycook ... ... 1 ... ... ... ... ... ... ... 1 Perfumer ... ... 1 ... ... ... ... ... ... 1 Plasterer ... ... ... ... 1 ... ... ... ... ... 1 Portmanteau Maker ... ... ... ... 1 ... ... ... ... ... 1 Police Ccnstable ... ... ... ... 1 ... ... ... ... ... 1 Painter ... ... ... ... ... ... 5 ... ... ... 5 Pianoforte Maker ... ... ... ... ... ... 1 ... ... ... 1 204 1911 ] Table CXXV.—continued. Occupations. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Cerebro-spinal Fever. Total. Provision Dealer ... ... ... ... ... ... 1 ... ... ... 1 Plumber ... ... ... ... ... ... 2 ... ... ... 2 Pattern Card Maker ... ... ... ... ... ... 1 ... ... ... 1 Police Inspector ... ... ... ... ... ... 1 ... ... ... 1 Reporter ... ... ... ... 1 ... ... ... ... ... 1 Railwayman ... ... ... ... ... ... 1 ... ... ... 1 Scholar ... 476 3OO 1 15 ... l6 ... ... ... 808 Sign Writer ... 1 ... ... ... ... ... ... ... ... 1 Servant ... 4 2 ... 2 ... ... ... ... ... 8 Schoolmaster ... ... ... ... ... ... ... ... ... ... 1 Stick Mounter ... 1 ... ... ... ... ... ... ... ... 1 Smith ... 1 ... ... ... ... ... ... ... ... 1 Silk Lampshade Maker ... 1 ... ... ... ... ... ... ... ... 1 Shop Assistant ... ... 2 ... 1 ... 2 ... ... ... 5 Scullerymaid ... ... 1 ... ... ... ... ... ... ... 1 Sorter (G.P.O.) ... ... 1 ... ... ... 1 ... ... ... 2 Storekeeper ... ... ... ... ... ... 1 ... ... ... 1 Steward ... ... ... ... ... ... 1 ... ... ... 1 Saleswoman ... ... ... ... ... ... 1 ... ... ... 1 Tailoress ... 1 1 ... ... ... ... ... ... ... 2 Teacher ... 1 2 ... ... ... 1 ... ... ... 4 Typist ... 1 ... ... ... ... 1 ... ... ... 2 Telephone Operator ... ... 1 ... ... ... ... ... ... ... 1 Tailor ... ... 1 ... ... ... ... ... ... ... 1 Time Keeper ... ... ... ... ... ... 1 ... ... ... 1 Van Guard ... ... 1 ... 4 ... ... ... ... ... 5 Varnisher ... ... ... ... ... ... 1 ... ... ... 1 Wardrobe Dealer ... 1 ... ... ... ... 1 ... ... ... 2 Warehouseman ... 1 ... ... ... ... ... ... ... ... 1 Wood Carver ... ... 1 ... ... ... ... ... ... ... 1 Wood Marker ... ... ... ... 1 ... ... ... ... ... 1 Water Cress Seller ... ... ... ... 1 ... ... ... ... ... 1 Waitress ... ... ... ... ... ... 1 ... ... ... 1 Watchmaker ... ... ... ... ... ... 1 ... ... ... 1 Woodchopper ... ... ... ... ... 1 ... ... ... 1 Total ... 539 354 1 60 ... 134 ... ... ... 1088 205 [1911 Table CXXVI. List of Trades and Businesses curried on in Houses wherein Infectious Diseases have occurred during 1911. TRADES AND BUSINESSES. Small Pox. Scarlet Fever of Scarlatina. Diphtheria. Memb. Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Accountants ... 1 ... ... ... ... ... ... i Artificial Flowers ... ... 1 ... ... ... ... ... ... 1 Apron Making ... ... 1 ... ... ... ... ... ... 1 Assembly Rooms ... ... ... ... 1 ... ... ... ... 1 Asylum ... ... ... ... ... ... 1 ... ... 1 Builders ... 5 ... ... ... ... 1 ... ... 6 Bootmaking ... 5 ... ... ... ... 1 ... ... 14 Butchers ... 2 1 ... ... ... 2 ... ... 5 Brushmaking ... 1 ... ... ... ... ... ... ... 1 Brass Finishing ... ... ... ... ... ... 1 ... ... 2 Boarding House ... 1 ... ... 1 ... 1 ... ... 4 Bird Shop ... ... 1 ... ... ... ... ... ... 1 Baby Linen ... ... 1 ... ... ... ... ... ... 1 Bank ... ... 1 ... ... ... ... ... ... 1 Bakers ... ... ... ... ... ... 2 ... ... 2 Box Making ... ... ... ... ... ... 1 ... ... 1 Book Folding ... ... ... ... ... ... 1 ... ... 1 Cycle Shop ... 1 ... ... ... ... ... ... ... 1 Coffee Shop ... ... ... ... ... ... ... ... ... 2 Coal Merchants ... 1 ... ... ... ... ... ... ... 1 Coffin Frilling ... 1 ... ... ... ... ... ... ... 1 Confectionery ... ... ... ... ... ... ... ... ... 10 Cats' Meat Dealer ... 1 1 ... 1 ... ... ... ... 3 Chimney Cleaners ... 1 ... ... ... ... ... ... ... 1 Cabinet Making ... ... ... ... ... ... ... ... ... 2 Chemists ... 1 ... ... ... ... 1 ... ... 2 Coach Building ... ... 1 ... ... ... ... ... ... 1 Card Painting ... ... ... ... ... ... ... ... ... 1 Drapers ... ... 2 ... ... ... 1 ... ... 7 Dentist ... 1 1 ... ... ... ... ... ... 2 Dressmaking ... ... 1 ... ... ... ... ... ... 7 Dairy ... ... 1 ... ... ... ... ... ... 1 Engineering ... 1 1 ... ... ... ... ... ... 2 Fried Fish Shop ... 2 ... ... ... ... ... ... ... 4 Feather Curling ... 2 ... ... ... ... ... ... ... 2 Fire Station ... 2 ... ... ... ... ... ... ... 2 Furniture Dealers ... 2 1 ... 1 ... ... ... ... 4 Furriers ... 1 1 ... ... ... 2 ... ... 4 Fruiterers ... 1 ... ... ... ... ... ... ... 1 French Polishing ... ... 1 ... ... ... ... ... ... 1 Florists ... ... 1 ... ... ... ... ... ... 1 Fish Shop ... ... ... ... ... ... 1 ... ... 1 Grocers ... 1 1 ... 1 ... ... ... ... 3 General Shop ... 5 2 ... 1 ... 2 ... ... 10 Greengrocers ... 2 7 ... 1 ... ... ... ... 10 206 1911] Table CXXVI.—continued. TRADES AND BUSINESSES. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Memb. Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Glassblowing ... 1 ... ... ... ... ... ... ... 1 Hospital ... 1 ... ... ... ... ... ... ... 1 Hosiery ... 1 1 ... ... ... ... ... ... 2 Hairdressing ... 4 2 ... ... ... 4 ... ... 10 House Agents ... ... 1 ... ... ... ... ... ... 2 Jewel Case Making ... 1 ... ... ... ... ... ... ... 1 Knitting ... 1 ... ... ... ... ... ... ... 1 Laundry ... 1 2 ... ... ... ... ... ... 3 Licensed Premises ... 3 3 ... ... ... 3 ... ... 11 Ladies' Underwear ... ... ... ... ... ... ... ... ... 1 Mission Room ... 1 ... ... ... ... ... ... ... 1 Mantle Making ... 3 ... ... ... ... 1 ... ... 7 Milk Shop ... 3 ... ... ... ... 1 ... ... 4 Machinists ... ... ... ... ... ... ... ... ... 1 Miller ... ... 1 ... ... ... ... ... ... 1 Newsagents ... 2 ... ... ... ... ... ... ... 6 Nurses' Home ... ... ... ... ... ... ... ... ... 3 Orphanage ... 1 1 ... ... ... ... ... ... 2 Pork Butchers ... 1 ... ... ... ... ... ... ... 1 Paper Bag Making ... 1 ... ... ... ... ... ... ... 1 Printing ... 2 1 ... ... ... ... ... ... 3 Provision Dealers ... 1 1 ... ... ... ... ... ... 2 Photographers ... 1 ... ... ... ... 1 ... ... 2 Pawnbrokers ... ... 1 ... ... ... ... ... ... 1 Restaurant ... 3 ... ... ... ... ... ... ... 3 Rag Shop ... 2 1 ... ... ... 1 ... ... 4 Shirt Makers ... 1 1 ... ... ... ... ... ... 2 School Caretaker ... 1 ... ... ... ... ... ... ... 1 Scale Makers ... ... 1 ... ... ... ... ... ... 1 Tie Making ... 3 1 ... ... ... 1 ... ... 5 Tailoring ... 6 1 ... ... ... 1 ... ... 9 Thermometer Makers ... ... 1 ... ... ... ... ... ... 1 Tobacconists ... ... ... ... ... ... 1 ... ... 1 Vest Makers ... ... ... ... ... ... 1 ... ... 1 Washing ... 2 2 ... ... ... ... ... ... 4 Wardrobe Dealers ... 3 ... ... ... ... 1 ... ... 4 Watchmaking ... ... 1 ... ... ... ... ... ... 1 Wood Turning ... ... ... ... 1 ... ... ... ... 1 Totals ... 113 75 ... 15 ... 34 ... ... 237 207 1911 Table CXXVII. Showing the Streets in which the several cases of Infectious Disease occurred, during 1911. 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. Erysipelas. Puerperal Fever. I Cerebro-spinal Fever. Ophthalmia Neonatorum. Totals.[//###] All Saints Street ... 11 32 ... ... 11 ... ... ... 54 Alsen Road ... 21 11 ... 11 11 ... ... ... 54 Albion Street ... 22 11 ... ... ... ... ... ... 33 Arlington Street ... 43 22 ... ... 11 ... ... ... 76 Arthur Road ... 2 2 ... ... ... ... ... ... 11 33 Ann Street ... 11 33 ... ... ... ... ... ... 43 Alfred Street ... ... 11 ... ... ... ... ... ... 11 Avenell Road ... 11 ... ... ... ... ... ... ... 11 Almington Street ... 11 21 ... ... 22 ... ... ... 54 Albert Street ... 44 55 ... ... ... ... ... ... 97 Albion Grove ... ... 11 ... ... ... ... ... ... i1 Arcliwav Road ... 22 11 ... ... ... ... ... ... 38 Andover Grove ... ... ... ... ... 11 ... ... ... 11 Aberdeen Road ... 11 11 ... ... ... ... ... ... 22 Almorah Road ... 11 ... ... ... ... ... ... 11 22 Albany Cottages, Popham Street ... i1 34 ... ... 11 ... ... ... 55 Ambler Road ... 11 ... ... 11 ... ... ... ... 11 Aubert Park ... 11 ... ... ... ... ... ... 11 22 Arundel Place, Barnsbury ... 11 ... ... ... ... ... ... ... 11 Anson Road ... 11 ... ... ... ... ... ... ... 11 Athelstane Road ... 11 ... ... ... ... ... ... ... 11 Arundel Grove ... 11 11 ... ... ... ... ... ... 22 Ashburton Grove ... 22 11 ... 11 11 ... ... ... 53 Andover Road ... 11 11 ... ... ... ... ... ... 22 Alexander Road ... 11 21 ... ... 11 ... ... ... 42 Astey's Row ... 11 ... ... ... ... ... ... ... 11 Alma Grove ... ... 11 ... ... ... ... ... ... 11 Ashley Road ... ... 11 ... ... ... ... ... ... 11 Aslibrook Road ... 31 32 ... ... ... ... ... ... 63 Alma Road ... ... 11 ... ... ... ... ... ... 11 Allen Street ... ... 11 ... ... ... ... ... ... 11 Archibald Road ... ... 31 ... ... ... ... ... ... 31 Andover Gardens ... ... 11 ... ... ... ... ... ... 11 Annette Road ... 11 ... ... ... ... ... ... ... 11 Alwyne Place ... ... ... ... ... 11 ... ... ... 11 Blenheim Road ... 11 11 ... ... 11 ... ... ... 38 Bryett Road ... ... 11 ... ... 11 ... ... ... 22 208 1911] Table CXXVII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-spinal Fever. Ophthalmia Neonatorum. Totals. Bride Street ... ... 11 ... ... ... ... ... ... 11 Bedford Terrace ... 11 32 ... ... ... ... ... ... 43 Beversbrook Road ... ... 11 ... ... ... ... ... ... 11 Blackstock Road ... ... 11 ... 11 ... ... ... ... 22 Bemerton Street 11 43 33 ... 11 ... ... ... 11 107 Bingfield Street ... 2 ... ... 11 ... ... ... ... 33 Belitha Villas ... 22 ... ... ... ... ... ... ... 22 Barnsbury Road ... 77 11 ... ... 2 2 ... ... ... 1010 Brooksby Street ... ... 22 ... ... 11 ... ... ... 33 Balls Pond Road ... 43 11 ... ... 11 ... ... ... 65 Baiiord Street ... ... ... ... ... ... ... ... 11 11 Bracey Street ... 32 11 ... ... ... ... ... ... 43 Barnsbnry Grove ... ... 11 ... ... ... 11 ... ... 22 Barnsbury Square ... ... ... ... ... 11 ... ... ... 11 Baxter Road ... 63 11 ... ... ... ... ... ... 73 Bickerton Road ... ... 11 ... ... ... ... ... ... 11 Barnsbury Street ... 11 11 ... 11 ... ... ... ... 32 Birnam Road ... 11 54 ... ... ... ... ... ... 64 Blundell Street ... ... ... ... ... ... ... ... 11 11 Boxworth Grove ... 11 11 ... ... ... ... ... ... 22 Brecknock Road ... 22 ... ... ... 11 ... 11 ... 66 Britannia Row ... 11 11 ... ... 11 ... ... ... 33 Barbara Street ... 22 21 ... ... 11 ... ... ... 54 Ben well Road ... ... ... ... ... 11 ... ... ... 11 Beaconsfield Buildings ... 66 66 ... ... 11 ... ... ... 1311 Bryan Street ... 22 ... ... ... ... ... ... ... 22 Bismarck Road ... 11 ... ... 11 ... ... ... ... 22 Burns Buildings ... 11 ... ... ... 11 ... ... ... 22 Brookside Road ... ... ... ... ... ... ... ... ... 21 Baxter Grove ... 11 ... ... ... ... ... ... ... 11 Bank Chambers, Highbury ... ... 11 ... ... ... ... ... ... 11 Barnsbury Park ... ... 11 ... ... ... ... ... ... 11 Boleyn Road ... 22 11 ... ... 11 ... ... ... 44 Bath Place ... 31 11 ... ... ... ... ... ... 42 Brand Street ... ... 11 ... ... ... ... ... ... 11 Bryan Place ... 11 ... ... ... ... ... ... ... 11 Balmoral Grove ... ... 11 ... ... ... ... ... ... 11 Balfour Road ... ... 11 11 ... 11 ... ... ... 33 Brunswick Road ... ... 11 ... ... ... ... ... ... 11 Beaumont Road ... ... ... ... 11 ... ... ... ... 11 Bookbinders' Asylum, Balls Pond Road ... ... ... ... ... 11 ... ... ... 11 Beresford Road ... 11 ... ... ... ... ... ... ... 11 Church Road ... 11 ... ... ... 21 ... ... ... 33 209 [1911 Table CXXVII.—continued. NAME OF STREKT. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. .Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-spinal Fever. Ophthalmia Neonltorum. Totals. Cromwell Road ... 11 11 ... i1 ... ... ... 33 Corbyn Street ... 74 58 ... 11 11 ... ... ... 149 Carlsbad Street ... 53 42 ... ... 11 ... ... ... 95 College Street ... 11 22 ... ... ... ... ... ... 33 Cloudesley Road ... 22 33 ... ... ... ... ... ... 55 Charlesworth Street ... ... ... ... 11 ... ... ... 11 Copenhagen Street ... 1411 87 ... ... 22 ... ... ... 2418 Cardale Street ... ... 21 ... ... ... ... ... ... 21 Cottenliara Road ... 119 118 ... ... 55 ... ... ... 2720 Cheverton Road ... 11 11 ... ... 11 ... ... ... 33 Compton Road ... 32 11 ... ... 22 ... ... ... 65 Cornwallis Road ... ... 11 ... ... 11 ... ... ... 22 Corinth Road ... 43 11 ... ... ... ... ... ... 58 Caledonian Road ... 1712 99 ... ... 44 ... ... ... 3125 Campbell Road ... 11 22 ... ... 43 ... ... ... 76 Calabria Road ... 22 ... ... 11 ... ... ... ... 33 Charlotte Street ... 22 ... ... ... ... ... ... ... 22 Canonbuiy Avenue ... 22 22 ... ... 11 ... ... ... ... 55 Charlotte Terrace ... ... 11 ... ... 11 ... ... ... 22 Cloudesley Place ... 21 11 ... ... ... ... ... ... 32 Cumberland Street ... ... ... ... ... 22 ... ... ... 22 Calverley Grove ... 11 11 ... ... 11 ... ... ... 33 Cornwall Cottages, Popliam Street ... 11 ... ... ... ... ... ... ... 11 Camden Road ... 11 ... ... 11 ... ... ... ... 22 Canonbury Lane ... ... 11 ... ... ... ... ... ... 11 Chalfont Road ... 32 ... ... ... ... ... ... ... 32 Celia Road ... ... ... ... ... 11 ... ... ... 11 Cloudesley Square ... ... 11 ... 11 ... ... ... ... 22 Carville Street ... 22 11 ... ... ... ... ... ... 33 Clarence Terrace ... ... 11 ... ... ... ... ... ... 11 Cray ford Road ... ... 22 ... 11 11 ... ... ... 33 Church Lane ... 52 ... ... ... ... ... ... ... 62 Cleveland Road ... 32 ... ... ... ... ... ... ... 32 Crossley Street ... 54 11 ... ... ... 11 ... ... 76 Collier Street ... 11 ... ... ... ... ... ... ... 11 Church Street ... 11 ... ... ... ... ... ... ... 11 Cruden Street ... 22 ... ... ... ... ... ... ... 22 Caledonia Street ... 11 i1 ... ... ... ... ... ... 22 Camden Street ... ... ... ... ... ... ... ... ... 11 Coombe Street ... 11 ... ... ... ... ... ... ... 11 Compton Street ... ... 11 ... ... ... ... ... ... 11 Canonbury Road ... 22 22 ... ... ... ... ... ... 44 Coleman Street ... ... 32 ... ... 11 ... 11 ... 58 P 210 1911] Table CXXVII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-spinal Fever. Ophthalmia Neon-itorum. Totals. Clayton Street .... 22 .... .... .... 22 .... .... .... 44 Camden Dwellings, York Road .... 11 .... .... .... i1 .... .... .... 22 Corporation Street .... 64 .... .... .... .... .... .... .... 64 Charteris Road .... 11 i1 .... .... 11 .... .... .... 33 City Arms Buildings, North Road .... 11 .... .... .... .... .... .... .... 11 Carlton House, Stanmore Street .... .... i1 .... .... .... .... .... .... 11 Colebrooke Row .... 32 .... .... 11 .... .... .... .... 43 Clifton Terrace .... .... 73 .... .... 32 .... .... .... 104 Cross Street .... 22 .... .... .... .... .... .... .... 22 Cardigan Street .... 11 ... .... .... l1 .... .... .... 21 Canning Road .... .... .... .... .... i1 .... .... .... l1 Cloudesley Mansions, Cloudesley Street .... 11 .... .... .... .... .... .... .... l1 Crouch Hill .... ... 4 .... .... .... .... .... .... 42 Corinne Road .... .... 11 .... .... .... .... .... .... l1 Cardozo Road .... .... .... 11 .... .... .... .... .... l1 Canonbury Grove .... 21 .... .... 11 .... .... .... .... 32 City Road .... .... .... .... .... .... .... .... 11 l1 Crane Grove .... .... 11 .... .... .... .... .... .... l1 Canonbury Street .... .... 21 .... .... .... .... .... .... 21 Crescent Place .... 42 ... .... 11 .... .... .... .... 53 Camden Passage .... .... .... .... .... .... .... 11 .... l1 Courtney Road .... .... 11 .... .... .... .... .... .... 21 Conewood Street .... 11 .... .... .... .... .... .... .... l1 Chalfont Road .... 11 .... .... .... .... .... .... .... l1 Cornwall Cottages, Eden Grove .... 11 ... .... .... .... .... .... .... l1 Carmarthen Street .... 11 .... .... .... .... .... .... .... l1 Charlton Place .... .... 11 .... .... .... .... .... .... l1 Charles Street, St. James Koad .... .... .... .... .... .... .... .... 11 l1 Carlton Terrace .... .... 11 .... .... .... .... .... .... l1 Cathcart Hill .... 11 .... .... .... .... .... .... .... l1 Crescent Avenue .... 11 .... .... .... .... .... .... .... l1 Canon Street .... .... 11 .... .... .... .... .... .... l1 Citizen Road .... .... 11 .... .... .... .... .... .... l1 Duncan Terrace .... .... .... .... .... 11 .... .... .... l1 Durham Road .... 11 43 .... 21 22 .... .... .... 97 Dame Street .... 32 11 .... .... .... .... .... .... 4s Delhi Street .... 22 11 .... .... .... .... .... .... 33 Denmark Street .... .... 11 .... .... I1 .... .... .... 22 Duncombe Road .... 11 ii8 .... .... .... .... .... .... 128 Devonshire Street .... 22 11 .... 11 I1 .... .... .... 55 Denmark Road .... .... 11 .... .... .... .... .... .... 11 211 [1911 Table CXXVII.—continued. name OF STREET. Small Fox. Scarlet Fever. Diphtheria. Memb. Croup. Knteric Fever. Erysipelas. Puerperal Fever. Cerebro-spinal Fever. Ophthalmia Neomtorum. Totals. Dorinda Street . . . . . . 11 . . . . . . . . . . . . . . . . . . 11 Downham Road . . . 44 . . . . . . . . . . . . . . . . . . . . . 44 Denmark Grove . . . . . . . . . . . . . . . 11 . . . . . . . . . 11 Docwra's Buildings, King Henry's Walk . . . . . . . . . . . . . . . 11 . . . . . . . . . 11 Dennis Street . . . 55 . . . . . . 11 . . . . . . . . . . . . 66 Despard Road . . . 11 . . . . . . . . . . . . . . . . . . . . . 11 Dalmeny Road . . . . . . . . . . . . . . . . . . . . . . . . 11 11 Devonshire Road . . . 22 32 . . . . . . . . . . . . . . . . . . 54 Dillon Place, Hornsey Road . . . 11 . . . . . . . . . . . . . . . . . . 11 Dibden Street . . . . . . . . . 11 . . . . . . . . . . . . 11 Dagmar House, Dagmar Terrace . . . 11 . . . . . . . . . . . . . . . . . . . . . 11 Dean Street . . . . . . 11 . . . . . . . . . . . . . . . . . . 11 Drayton Park . . . . . . 11 . . . . . . . . . . . . . . . . . . 11 Danbury Street . . . . . . 11 . . . . . . . . . . . . . . . . . . 11 Essex Road . . . 55 11 . . . 11 33 . . . . . . . . . 1010 Evershot Road . . . 22 33 . . . . . . . . . . . . . . . . . . 55 Edward Square . . . 22 . . . . . . . . . 11 . . . . . . . . . 33 Eden Grove . . . 11 11 . . . . . . 21 . . . 11 . . . 54 Edwards Cottages, Canonbury Road . . . 42 11 . . . . . . . . . . . . . . . . . . 53 Elmore Street . . . 97 11 . . . . . . 44 . . . . . . . . . 1412 Edinburgh Cottages, Popham Street . . . 11 11 . . . . . . . . . . . . . . . . . . 22 Elton Street . . . . . . 11 . . . . . . 11 . . . . . . . . . 22 Ellington Street . . . 44 . . . . . . . . . 22 . . . . . . . . . 77 Elthorne Road . . . 22 127 . . . . . . 11 . . . . . . . . . 159 Ellenborough Road . . . 22 11 . . . . . . . . . . . . . . . . . . 33 Ecclesbourne Road . . . ... 22 . . . . . . . . . . . . . . . . . . 22 Elfort Road . . . 11 11 . . . . . . . . . . . . . . . . . . 22 Everilda Street . . . . . . 22 . . . . . . . . . . . . . . . . . . 22 Elliott's Gardens, Essex Road . . . . . . . . . . . . 11 . . . . . . . . . . . . 11 Enkel Street . . . . . . 11 . . . . . . . . . . . . . . . . . . 11 Eddington Street . . . . . . ... . . . . . . . . . . . . . . . 11 11 Freeling Street . . . 22 22 . . . 11 22 . . . . . . . . . 77 Francis Terrace, Junction Road . . . 11 . . . . . . . . . 11 . . . . . . . . . 22 Fairbridge Road . . . 44 107 . . . . . . . . . . . . . . . l1 I I7 Font-kill Road . . . 41 54 . . . . . . 22 . . . . . . 22 I311 Fairmead Road . . . . . . . . . . . . . . . 11 . . . . . . . . . 11 Fife Terrace . . . 11 . . . . . . . . . 11 . . . . . . . . . 22 Freegrove Road . . . 22 . . . . . . . . . . . . . . . . . . . . . 22 Frederick Street . . . . . . . . . . . . . . . 11 . . . . . . 11 22 Frome Street . . . 32 . . . . . . . . . . . . . . . . . . . . . 32 K 2 212 1911] Table CXXVII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Oiphtheria. Memb. Croup. | Enteric Fever. Erysipelas. Puerperal Fever. Cer^ro-Spina Fever. Ophthiilmia Neon torum Totals. Fortnam Road ... ... 11 ... ... ... ... ... ... 11 Fowler Boad ... ... ... ... ... 11 ... ... ... 11 Fullbrook Boad ... ... 11 ... ... ... ... ... ... 11 Frieuds Cottages, Canonbury Boad ... ... 11 ... ... ... ... ... ... 11 Fulford Mansions, Fairmcad Boad ... ... ... ... ... ... 11 ... ... 11 Foxliam Road ... ... ... ... ... 11 ... ... ... 11 Florence Street ... 11 ... ... ... ... ... ... ... ,1 Fieldway Cresceut ... ... 11 ... ... ... ... ... ... ii Gifford Street ... 11 11 ... 11 ... 11 ... ... 4* Grove Road ... 32 22 ... ... ... ... ... ... 54 Giesbacli Boad ... 11 ... ... ... ... ... ... 11 22 Grovedale Boad ... 33 43 ... ... ... ... ... ... r George's Boad ... 54 22 ... ... 31 ... ... ... to' Gloucester Boad ... 21 11 ... ... ... ... ... ... 32 Gibson Square ... ... ... ... ... 11 ... ... ... i1 Gerrard Strest ... 22 ... ... 11 ... ... ... ... 38 Goodinge Road ... 43 73 ... ... 22 ... ... ... I38 Grantbridge Street ... 22 ... ... ... 22 ... ... ... 44 Gladsmuir Road ... ... 11 ... ... ... ... ... ... i1 Gresley Road ... ... 11 ... ... ... ... ... ... ji Green Lanes ... 11 ... ... ... ... ... ... ... i1 Gordon Street ... ... 21 ... ... 11 ... ... ... 32 Girdlestone Boad ... 11 ... ... ... ... ... ... ... i1 Grafton Boad ... ... ... ... ... ... ... ... 11 i1 Gatcombe Boad ... 11 ... ... ... ... ... ... ... i1 Grosvenor Road ... 11 33 ... ... 22 ... ... ... 66 Grace Street ... 21 ... ... ... ... ... ... ... 21 Gladstone Street ... 31 ... ... ... ... ... ... ... 31 Grove Street ... ... ... ... ... 11 ... ... ... i1 Gainford Street ... 22 ... ... ... ... ... ... ... 22 Gordon Place ... ... ... ... ... 11 ... ... ... I1 Graham Street ... 22 ... ... ... ... ... ... ... 2s Grosvenor Street ... ... ... ... ... 21 ... ... ... 21 Great Northern Hospital, Holloway Road ... 22 ... ... ... 11 ... ... ... I1 Harvist Road ... ... ... ... ... ... 11 ... ... I1 Hampden Road ... 22 53 ... ... 22 ... 11 ... 108 Holloway Road ... 96 33 ... ... 33 22 ... ... 1713 Halton Road ... i1 53 ... ... ... ... ... ... 64 Highbury New Park ... ... 11 ... 11 ... ... ... ... 22 Hazellville Road ... ... 33 ... ... ... ... ... ... 33 Hydes Place ... 11 11 ... ... ... ... ... ... 21 213 [1911 Table CXXVII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthialmia Neon torum. Totals. Huddleston Road ... 76 11 ... ... 11 ... ... ... 98 High Street ... 21 ... ... ... ... ... ... ... 21 Hornsey Street ... 21 11 ... ... ... ... ... ... 32 Hornsey Rise ... ... 42 ... ... ... ... ... ... 42 Hanley Road ... 33 44 ... ... 21 22 ... ... 119 Hemingford Road ... 43 44 ... 11 22 ... ... 11 1211 Highbury Park ... ... ... ... 22 ... ... ... ... 22 Hartham Road ... 11 ... ... ... ... ... ... ... 11 Highbury Quadrant ... 22 ... ... ... ... ... 11 ... 38 Hungerford Road ... ... 33 ... ... ... ... ... ... 33 Hornsey Road ... 88 128 ... 22 44 ... ... 11 2722 H.M. Prison, Holloway ... 2 ... ... ... 2 ... ... ... 4 Hawthorn Street ... ... 11 ... ... ... ... ... ... 11 Hargrave Park ... 54 ... ... ... ... ... ... ... 54 Hollingworth Street ... 22 ... ... ... 11 ... ... ... 33 Hale Street ... ... 21 ... ... ... ... ... ... 21 Havelock Street ... 22 ... ... ... ... ... ... ... 22 Huntingdon Street ... 22 11 ... ... ... ... ... ... 33 Hurlock Street ... 32 ... ... ... ... ... ... ... 32 Hamilton Road ... 11 ... ... ... ... ... ... ... 11 Highbury Hill ... 22 11 ... ... ... ... ... ... 38 Hayman Street ... ... ... ... ... 11 ... ... ... 11 Hatchard Road ... 33 11 ... ... ... ... ... ... 44 Hatley Road ... 21 11 ... ... ... ... ... ... 32 Hope Street ... 11 ... ... ... ... ... ... ... 11 Half Moon Crescent ... 11 ... ... ... ... ... ... ... 11 Hanover Street ... 2l ... ... ... 11 ... ... ... 32 Hornsey Lane ... ... 41 ... 11 ... ... ... ... 52 Halse Street ... 64 ... ... ... ... ... ... ... 64 Hope Street ... ... 11 ... ... ... ... ... ... 11 Horsell Road ... ... 11 ... ... ... ... ... ... 11 Hargrave Mansions, Hargrave Park ... 11 ... ... ... ... ... ... ... 11 Hilldrop Crescent ... 11 ... ... ... ... ... ... ... 11 Hornsey Rise Gardens ... 11 ... ... ... ... ... ... ... 11 Harberton Road ... ... 11 ... ... ... ... ... ... 11 Hilldrop Road ... ... ... ... ... 11 ... ... ... 11 Isledon Road ... 11 21 ... ... 11 ... ... ... 43 Islington Infirmary ... 5 7 ... 1 10 ... ... ... 23 Islington Workhouse, St. John's Road ... ... ... ... 1 9 ... ... ... 101 Islington Workhouse, Cornwallis Road ... ... 2 ... ... 1 ... ... ... 31 Islington Green ... 42 ... ... ... ... ... ... ... 42 214 1911] Table CXXVII.—continued. name of street. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neon -torum. Totals. Junction Road ... 22 11 ... ... ... ... ... ... 33 James Street ... ... ... ... ... 11 ... ... ... 11 King Henry's Walk ... 21 22 ... ... 11 ... ... ... 54 Kingsdown Road ... 22 11 ... 11 11 ... ... ... 55 Kingsbury Road ... 31 11 ... 11 ... ... ... ... 53 King Edward Street ... 11 ... ... ... 11 ... ... ... 22 King Edward's Buildings, Brewery Road ... 11 ... ... ... ... ... ... ... 11 River Road ... ... ... ... ... 11 ... ... ... 11 King Henry Street ... ... 11 ... ... ... ... ... ... 11 Liverpool Road ... 11 64 ... ... 22 ... j l i1 2116 Liverpool Buildings ... ... 11 ... 22 11 ... ... 11 55 Lyon Street ... ... 11 ... ... 11 ... ... ... 22 Langdon Road ... ... ... ... ... 11 ... ... ... 11 London Street ... 44 33 11 ... 11 ... ... ... 99 Lofting Road ... ... ... ... 51 ... ... ... ... 51 Lysander Grove ... 11 ... ... ... ... ... ... ... 11 Landseer Road ... 21 11 ... ... 22 ... ... ... 54 Lucerne Road ... ... 11 ... ... ... ... ... ... 11 Liberia Road ... 11 ... ... ... ... ... ... ... 11 London Fever Hospital ... 2 i ... ... ... ... ... ... 31 Little Cross Street ... 11 22 ... ... ... ... ... ... 32 Linton Street ... ... 22 ... ... ... ... ... ... 22 Loraine Road ... 11 21 ... ... ... ... ... ... 32 Luard Street ... 64 ... ... ... 11 ... ... ... 75 Loraine Mansions, Holloway Road ... ... 11 ... ... ... ... ... ... 11 Lincoln House, Astey's Row ... 11 ... ... ... ... ... ... ... 11 Lady Margaret Road ... ... 22 ... ... ... ... ... ... 22 Lonsdale Square ... 21 ... ... ... 11 ... ... ... 32 Lesly Street ... 11 ... ... ... ... ... ... ... 11 Lambton Road ... ... 22 ... ... 11 ... ... ... 38 Lennox Road ... ... 22 ... ... ... ... ... ... 22 Leigh Road ... 11 ... ... ... ... ... ... ... 11 Leconfield Road ... 21 ... ... ... ... ... ... ... 21 Lambert Street ... ... ... ... ... 11 ... ... ... 11 Marlborough Road ... 87 33 ... ... 22 ... ... ... 1311 Mitford Road ... 32 22 ... ... ... ... ... 11 65 Mildmay Grove ... 11 ... ... ... ... ... ... ... 11 Mildmay Road ... 11 11 ... 11 ... ... ... ... 38 Moray Road ... 33 44 ... ... 11 ... ... ... 87 Marquess Grove ... 11 ... ... ... ... ... ... ... 11 Matilda Street ... 42 ... ... ... ... ... ... ... 42 Marquess Road ... 21 ... ... ... ... ... ... ... 21 215 [1911 Table CXXVII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Totals. Magdala Road ... 11 ... ... ... 11 ... ... ... 22 Malvern Terrace ... 21 ... ... ... ... ... ... ... 21 Mayton Street ... ... ... ... ... 11 ... ... ... 11 Milner Square ... 11 11 ... ... ... ... ... ... 22 Mount View Road ... ... ... ... ... 11 ... ... ... 11 Mayville Street ... 42 ... ... ... ... ... ... ... 42 Myddleton Buildings, High Street ... ... ... ... ... 11 ... ... ... 11 Muriel Street ... 22 ... ... ... 11 ... ... 11 44 Mercers Road ... ... ... ... 11 ... ... ... ... 11 Milton Place ... 11 ... ... ... 11 ... ... ... 22 Mildmay Park ... 11 ... ... 22 11 ... ... ... 44 Marcellus Road ... 11 11 ... ... ... ... ... ... 22 Morton Road ... ... ... ... ... 11 ... ... ... 11 Melgund Road ... ... 11 ... ... ... ... ... ... 11 Montem Street ... 32 11 ... ... ... ... ... ... 42 Mentone Road ... 21 ... ... ... ... ... ... 2l Mulkern Road ... 11 11 ... ... ... ... ... ... 22 Miranda Road ... 11 ... ... ... ... ... ... ... 11 Milner Street ... ... ... ... ... 11 ... ... ... 11 Middlesex Street ... ... 11 ... ... ... ... ... ... 11 Marriott Road ... 11 ... ... ... ... ... ... ... 11 Newington Green Road ... 44 11 ... ... 11 ... ... ... 65 North Road ... 6a 22 ... ... ... ... ... ... 95 New North Road ... 33 22 ... ... 11 ... ... 11 76 Noel Street ... 11 11 ... ... 11 ... ... ... 32 Nicholay Road ... ... 64 ... ... ... ... ... ... 64 North Avenue ... ... 11 ... ... ... ... ... ... 11 Northdown Street ... 43 11 ... ... 38 ... ... ... 87 North Cottages, Canonbury Road ... 11 ... ... ... ... ... ... ... 11 Norfolk Road ... 42 22 ... ... 11 ... ... ... 74 Nailour Street ... 22 11 ... ... ... ... ... ... 33 Nelson Place ... 22 ... ... ... ... ... ... ... 22 Newington Green ... 11 ... ... 11 ... ... ... ... 22 Northampton Street ... 11 ... ... ... ... ... ... ... 11 Nelson Square ... ... ... ... 44 ... ... ... ... 44 Northampton Grove ... ... ... ... ... 11 ... ... ... 11 Newhall Street ... ... ... ... ... 11 ... ... ... 11 Norfolk Street ... ... 21 ... ... 11 ... ... ... 32 Offord Road ... 44 33 ... ... 11 ... ... ... 88 Oxford Road ... 42 ... ... ... 11 ... ... ... 53 Orpingley Road ... 32 2a ... ... 11 ... ... ... 65 Outram Street ... 85 22 ... ... 11 ... ... ... 118 216 [1911 Table CXXVII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spina Fevter. Ophthalmia Neonatorum. Totals. Orchard Street ... 22 22 ... 11 ... ... ... ... 55 Onnond Road ... ... 11 ... ... ... ... ... ... 11 Oakley ltoad ... ... 11 ... 11 ... ... ... ... 22 Ockenden Road ... 21 ... ... ... 11 ... ... ... 32 Pembroke (Street ... 55 87 ... ... 22 11 ... 11 1714 Peabody Buildings ... 11 44 ... ... 11 ... ... ... 66 Pemberton Gardens ... 42 62 ... ... ... ... ... ... 108 Palmerston Road ... 22 22 ... ... 33 11 ... ... 87 Popbam Street ... ... 31 ... ... ... ... ... ... 31 Prospero Road ... ... 11 ... ... ... ... ... ... 11 Payne Street ... 54 ... ... 11 11 ... ... ... 76 Parkhurst Road ... 22 11 ... 11 ... ... ... ... 43 Parolles Road ... 22 ... ... ... ... ... ... ... 22 Pickering Street ... 11 22 ... ... 33 ... ... ... 66 Poynings Road ... ... 21 ... ... 11 ... ... ... 32 Packington Street ... 32 11 ... ... 11 ... ... ... 54 Prebend Street ... 32 53 ... ... ... ... 11 ... 95 Palmerston Buildings, City Road ... 32 ... ... ... 11 ... ... ... 54 Pleasant Place, Essex Road ... 32 11 ... ... 11 ... ... ... 54 Popbam Road ... 21 ... ... ... 21 ... ... ... 42 Poole's Park ... 11 11 ... ... 11 ... ... ... 35 Pakeman Street ... ... ... ... ... 11 ... ... ... 11 Paddington Street ... ... 21 ... ... ... ... ... ... 21 Providence Place ... 11 ... ... ... ... ... ... ... 11 Parkfield Street ... ... 11 ... ... 11 ... ... ... 22 Petberton Road ... 21 ... ... ... 11 ... ... ... 32 Pyrland Road ... 22 ... ... ... ... ... ... ... 22 Pulteney Street ... 11 ... ... ... 11 ... ... ... 22 Poets Road ... 11 ... ... ... ... ... ... ... 11 Pemberton Terrace ... 11 ... ... ... 11 ... ... ... 22 Price's Yard, Bingfield Street ... 11 ... ... ... ... ... ... ... 11 Queen's Arms Buildings, Cattle Market ... ... ... 11 ... ... ... ... ... 11 Queen Margaret's Grove ... 33 ... ... ... ... ... ... ... 33 Quinn Buildings, Popbam Street ... 22 11 ... ... 11 ... ... ... 44 Queensland Road ... 22 11 ... ... ... ... ... ... 33 Queensbury Street ... 11 11 ... ... ... ... ... ... 22 Queen's Cottages, Popliam Street ... ... ... ... ... 11 ... ... ... 11 Queen's Head Street ... 33 11 ... ... ... ... ... ... 44 Rhodes Street ... 11 22 ... ... ... ... ... ... 33 Rydon Street ... ... 22 ... ... ... ... ... 11 33 217 [1911 Table CXXVII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Piphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spina Fever. Ophthalima Neontorum. Totals. Richmond Road ... 22 11 ... ... 11 ... 11 ... 55 Roman Road ... 66 11 ... ... ... ... ... ... 77 Rothery Street ... ... ... ... 11 ... ... ... ... 11 Rock Street ... 11 21 ... ... ... ... ... ... 31 Ringcroft Street ... ... 11 ... ... ... 11 ... ... 22 Rlieidol Terrace ... ... ... ... ... 11 ... ... 11 22 Russell Road ... ... 11 11 ... ... ... ... ... ... 22 Roden Street ... ... 22 11 ... ... 11 ... ... ... 22 Rotherfield Street ... 43 ... ... ... ... 22 ... ... 65 Randalls Road ... 11 ... ... ... ... ... ... 11 Regina Road ... ... 32 ... ... ... 11 ... ... ... 43 River Street ... ... 11 ... ... ... ... ... ... ... 11 Riversdale Road ... 11 11 ... ... ... ... ... ... 22 Railway Street ... 11 ... ... ... ... ... ... ... 11 Rupert Road ... ... 54 33 ... ... 11 ... ... ... 98 Ronald's Road ... ... 33 ... ... ... ... ... ... 33 Remington Street ... ... ... ... ... 11 ... ... ... 11 Richmond Crescent ... ... ... 11 ... ... 11 ... ... ... 22 Raleigh Street... ... ... ... ... ... 11 ... ... ... 11 Salvage Corps, Upper Street ... 21 ... ... ... ... ... ... ... 21 St. Mary's Road ... 22 21 ... ... ... ... ... ... 43 Spencer Street ... 11 22 ... ... ... ... ... ... 33 St. Peter Street ... ... 11 ... ... 11 ... ... ... 22 Stavordale Road ... 22 ... ... ... ... ... ... ... 22 St. Jude Street ... 11 11 ... ... ... ... ... ... 22 St. Thomas' Road ... 22 11 ... ... ... ... ... ... 38 St. John's Road ... 11 22 ... ... 11 ... ... ... 44 Sudeley Street ... 11 ... ... ... 11 ... ... ... 22 Southgate Road ... 11 11 ... ... 22 ... ... ... 44 Sussex Road ... 22 11 ... ... 11 ... ... ... 44 Shepperton Road ... 22 ... ... ... 33 ... ... ... 55 Scholefield Road ... 11 ... ... 11 11 ... ... ... 33 St. Paul Street ... ... ... ... ... ... ... 11 ... 11 Studd Street ... ... ... ... ... 11 ... ... ... 11 Sherbourne Street ... 11 11 ... ... 11 ... ... 11 43 Stonefield Street ... 32 42 ... ... 11 ... ... 11 94 St. James Road ... 54 11 ... ... ... ... ... ... 64 Sheringham Road ... 22 ... ... ... ... ... ... ... 22 Station Road, Highbury ... ... ... ... ... ... ... ... 11 11 St. James Street ... 22 ... ... ... ... ... ... ... 22 Story Street ... 11 ... ... ... ... ... ... ... 11 Sam Lewis's Trust Buildings, Liverpool Road ... 44 33 ... ... 11 ... ... 11 96 Stanley Road ... ... 11 ... ... ... 11 ... ... ... 22 Sotheby Road ... — ... ... 21 ... ... ... ... ... ... ... 21 218 1911] Table CXXVII.—continued. NAME OF STREET. Small Pox. Scar'et Fever. Diphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spina Fever. Ophthalmia Neontitorum. Totals. Sutterton Street ... 11 11 ... ... ... ... ... ... 22 Stroud Green Road ... 11 ... ... 11 ... ... ... ... 22 Seven Sisters' Road ... 11 ... ... ... 11 ... ... ... 22 Sebbon Street ... ... 22 ... ... ... ... ... ... 22 St. Paul's Road ... 11 22 ... 11 ... ... ... ... 41 Sparsholt Road ... 11 11 ... ... ... ... ... ... 22 South Street ... ... ... ... 11 ... ... ... ... 11 St. John's Park ... 11 ... ... ... ... ... ... ... 11 Stradbroke Road ... ... ... ... ... 11 ... ... ... 11 St. Paul's Place ... 11 ... ... ... 11 ... ... ... 22 Sun Row ... ... ... ... ... 11 ... ... ... 11 Stanmore Street ... 11 11 ... ... 11 ... ... ... 33 St. George's Avenue ... 11 11 ... 11 ... ... ... ... 33 Sheen Grove ... 21 22 ... ... 11 ... ... ... 53 St. Clement's Street ... 11 ... ... ... 21 ... ... 11 43 St. John's Villas ... ... ... ... 11 ... ... ... ... 11 St. Alban's Place ... 31 ... ... ... ... ... ... ... 31 Stapleton Parade ... 11 ... ... ... ... ... ... ... 11 Shaftesbury Road ... ... l1 ... ... ... ... ... ... 11 Sunnyside Road ... ... 21 ... ... ... ... ... ... 21 Stock Orchard Crescent ... 11 11 ... ... ... ... ... ... 21 Southampton Street ... 11 ... ... ... ... ... ... ... 11 Tborpedale Road ... 54 44 ... ... 22 ... ... ... 1110 Tiber Street ... ... 11 ... ... ... ... ... ... 11 Torrens Buildings, City Road ... 32 ... ... 11 ... ... ... ... 43 Tufnell Park Road ... 11 11 ... ... ... ... ... ... 22 Thornhill Square ... 11 ... ... ... ... ... ... ... 11 Twyford Street ... 33 ... ... ... ... ... ... ... 33 Trinity Street ... 22 11 ... ... ... ... ... ... 33 Tenby Place ... 22 ... ... ... ... ... ... ... 22 Tollington Road ... ... 22 ... ... ... ... ... ... 33 Tremlett Grove ... 11 ... ... ... ... ... ... ... 11 Theberton Street ... 11 ... ... ... ... ... ... ... 11 Tollington Park ... 11 ... ... ... ... ... ... ... 11 Tavistock Terrace ... ... 11 ... ... ... ... ... ... 11 Thornhill Bridge Place ... 73 ... ... ... ... ... ... ... 73 Thornhill Road ... 11 ... ... ... 11 ... ... ... 22 Tibberton Square ... ... 11 ... ... ... ... ... ... 11 Tytherton Road ... 11 ... ... ... ... ... ... ... 11 Tabley Road ... 21 ... ... ... ... ... ... ... 21 Upper Street ... 42 63 ... • • • 65 ... ... ... 1610 Union Square ... 22 • • • ... ... ... ... ... ... 22 Upper Park Street ... 11 11 ... ... ... ... ... 11 33 Vittoria Street ... 11 11 ... ... ... ... ... ... 33 Vorley Road ... 32 21 11 ... ... ... ... ... 64 219 [1911 Table CXXVII.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spina Fever. Ophthalmia Neonatorum Totals. Victoria Road ... 33 22 ... ... ... ... ... ... 55 Victor Road ... 11 32 ... ... 11 ... ... ... 54 Victoria Place ... ... 11 ... ... ... ... ... ... 11 Warrender Road ... 22 11 ... ... ... ... ... ... 33 Wellington Road ... 53 53 ... ... 11 ... ... ... 117 Woodville Grove ... 22 21 ... ... ... ... ... ... 43 Whitehall Park ... 11 ... ... ... ... ... ... ... 11 Witherington Road ... ... 33 ... ... ... ... ... ... 31 Wall Street ... 11 ... ... ... ... ... ... ... 11 William Street, Wynford Road ... ... 11 ... ... ... ... ... ... 11 Wynford Road ... 11 ... ... ... ... ... 1l ... 22 Wedrnore Gardens ... ... 11 ... ... ... ... ... ... 11 Windsor Street ... 11 22 ... ... 11 ... ... ... 43 Williamson Street ... ... 11 ... 11 ... ... ... ... 22 Wray Crescent ... 21 22 ... 11 ... ... ... ... 54 Wyndham Crescent ... 11 ... ... ... ... ... ... ... 11 Westbourne Road ... 55 11 ... ... ... ... ... 11 77 West View, Higligate Hill ... ... 21 ... ... ... ... ... ... 21 Winchester Street ... 11 ... ... ... ... ... ... ... 11 Wharfdale Road ... 32 ... ... ... ... ... ... ... 32 Warner Street ... 112 11 ... ... 11 ... ... ... 133 Windermere Road ... ... 11 ... ... ... ... ... ... 11 Whitehall Mansions, Archway Road ... ... ... ... ... ... 11 ... ... 11 Witley Road ... ... 11 ... ... ... ... ... ... 11 Wedmore Street ... ... ... ... ... 11 ... ... ... 11 William Street, St. Peter's Street ... ... ... ... 11 ... ... ... ... 11 Whistler Street ... 22 33 ... ... ... ... ... ... 56 Wolsey Road ... 22 ... ... ... ... ... ... ... 2l Wells Terrace, Fonthill Road ... ... 11 ... ... ... ... ... ... 11 Woodville Road ... ... ... ... ... ... ... ... 11 11 Waterloo Terrace ... 22 ... ... ... ... ... ... ... 22 Widdenham Road ... 22 ... ... ... ... ... ... ... 22 Windsor Road ... ... 11 ... 11 ... ... ... ... 22 Wyatt Road ... 11 ... ... ... ... ... ... ... 11 Wessex Buildings, Wedmore Street ... 11 ... ... ... ... ... ... ... 11 York Road ... 32 53 ... ... 22 ... ... ... 107 Yerbury Road ... 11 ... ... 11 11 ... ... ... 33 Zoffany Street ... 11 ... ... ... ... ... ... ... 11 220 1911] BACTERIOLOGICAL EXAMINATIONS. During the year 788 specimens were examined for the medical profession practising in Islington (to enable them to diagnose with certainty suspicious cases of Diphtheria, Enteric Fever, and Phthisis) as compared with 682 in the preceding year, and 577 in 1905. A full statement for each year since 1898 is given in Table CXXVIII. Diphtheria.—484 specimens were examined, as contrasted with 401 in 1910 and 300 in 1909. This is the largest number hitherto forwarded for examination. In 157 instances the Lister Institute returned certificates showing positive results, and in 327 giving negative results. Enteric Fever.—Specimens of blood were examined in 52 instances, of which number 19 gave positive results, and 33 negative. Phthisis.—The sputum of 252 patients was examined, and the reports showed that 66 persons were suffering from the disease, and that 186 were not. All these examinations were made by the staff of the Lister Institute, who during the last thirteen and a half years have examined 5,721 specimens for the Borough Council, namely:—2,692 Diphtheria, 948 Enteric Fever, and 2,081 Phthisis, and enabling the medical profession of Islington to diagnose diseases definitely in 2,045 instances, or in 35.7 per cent. of the doubtful cases which they had under treatment. The following Tables give the results of the examinations that have been made during the last 13½ years. Diseases. Total Examinations. Positive Results. Negative Results. Percentage of Positive Results. Diphtheria 2,692 931 1,761 34.6 Enteric Fever 948 420 528 44.3 Phthisis 2,081 694 1,387 33.3 Total 5,721 2,045 3,676 35.7 221 [1911 Table CXXVIII. Showing the result of the Bacteriological Examinations made for the Diagnosis of Diphtheria, Enteric Fever and Phthisis, 1898-1911. Periods. Diphtheria. Enteric Fryer. Phthisis. Totals. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Positive 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 1911 157 327 484 19 33 52 66 186 252 788 Totals (for 13½ years) 931 1761 2692 420 528 948 694 1387 2081 5721 VACCINATION—OR THE STATE OF PREPAREDNESS TO MEET SMALL POX. The above heading clearly indicates the relationship, in the opinion of all persons who are able to express an independent judgment on the subject after studying the facts and figures, which subsists between vaccination and Small Pox; and it is, therefore, with much regret that the Medical Officer of Health has to draw attention to the steady decrease in the percentage of primary vaccinations. Eight years ago these vaccinations represented 82.3 per cent. of the births, less the infants who had died unvaccinated. In 1910, however, they had fallen to 66.7 per cent. Such a result is due to the ease with which exemption certificates can be obtained. 222 1911] Years. Vaccinations per 100 births, less infants who died unvaccinated. Years Vaccinations per 100 births, less infants who died unvaccinated. 1880 89.8 1896 73.9 1881 90.8 1897 73.3 1882 91.1 1898 64.9 1883 90.4 1899 66.4 1884 90.5 1900 67.9 1885 90.6 1901 75.8 1886 90.8 1902 80.0 1887 90.4 1903 8l.2 1888 88.4 1904 82.3 1889 89.0 1905 80.5 1890 89.3 1906 79.9 1891 87.4 1907 76.9 1892 85.5 1908 72.4 1893 85.0 1909 70.7 1894 84.0 1910 66.7 1895 70.9 The figures in this table afford a strong proof of the decrease of vaccination in Islington, for which some day it is more than possible that unvaccinated persons will have to pay, either with their lives or their disfigurement. In the present day too much dependence is placed on sanitation, the Medical Officer of Health and the notification of the disease. But, unfortunately, it may be unrecognised, if in a mild form, by the Practitioner, who seldom sees cases of Small Pox, and then persons may become infected who have been in contact with the patient, and who may afterwards carry it to their homes, to infect others, until presently it appears in widely different places, so that it becomes almost impossible to control it. On two or three occasions there have been outbreaks in Islington, which might have been most serious if it were not for the most energetic measures taken by the Medical Officer of Health, who all the time felt that the risks run by the public could never have occurred if vaccination and re-vaccination had been practised by the persons who had been attacked. To-day, practically, no one need be attacked with Small Pox, if he so desire, for he can at any time protect himself. Unfortunately it happens that when there is no Small Pox about, people become careless about vaccination; but when the dread disease appears then people rush to protect themselves and their children, although not always soon enough. In 1910, the last year for which the returns have been completed, it appears that out of 7,989 births 548 died before vaccination, so that only 7,441 228 [1911 were liable to the operation, of whom 4,961, or 66'7 per cent., were duly vaccinated. Insusceptibility.—21 infants were insusceptible, that is to say, they " did not take." Died Unvaccinated.—As already stated, 548 infants died before they were vaccinated, as compared with 507 in 1909 and 588 in 1908. Certificates of Exemption.—These numbered 1,080, which is by far the greatest number hitherto recorded. Let us examine the returns for the last few years. 1897 14 1904 89 1898 103 1905 110 1899 101 1906 123 1900 127 1907 259 1901 106 1908 588 1902 73 1909 824 1903 103 1910 1,080 The number of persons who obtained certificates for exemption in the several sub-registration districts varied considerably, as may be seen in the following statement, which gives the number of births less the infants who died unvaccinated, the number of exemption certificates which were granted, and the percentage number to such births. Sub-Districts. Births. Exemption Certificates. Percentage of Certificates to Births, Tufnell 692 117 16.9 Upper Holloway 905 112 12.4 Tollington 677 107 15.8 Highbury 1,187 236 19.9 Lower Holloway 960 105 10.9 Barnsbury 1,363 143 10.5 Islington South-East 1,657 260 15.7 Total 6,909 1080 15.6 This is an interesting table, although one which it is difficult to explain, because the reason 'is not very apparent why 19*9 per cent, of the infants should remain unvaccinated in Highbury, and only 10'9 per cent, in Lower Holloway and 10*5 per cent, in Barnsbury. The Medical Officer of Health 224 1911] would have expected absolutely different results, judging by the character of the populations. It affords food for thought. The people are not so much to blame as the persons in high places who made it possible for them to evade the vaccination of their children. Some day this country will pay dearly for legislation which permits the wholesale issue of these certificates. It is not necessary to be a prophet, or yet the son of a prophet, to foretell what will happen when the next epidemic of Small Pox visits us. The public have forgotten Lord Herschell's great report on the subject, that is to say, the Report of the Royal Commission on Vaccination, of which he was chairman. In a speech made at a meeting held in London on March 31, 1897, to promote a memorial to Jenner, he said respecting it: "A vast amount of material was considered by the Royal Commission, and it fell to my lot to have to digest that material and analyse it, and submit a report to my colleagues. I laid down in the first instance the tests that seemed most fitting to enable an answer to be furnished to the question, 'Is vaccination, or is it not, a preventive of the disease of Small Pox and a cause of the modification where it occurs?' I applied those tests, I can honestly say, entirely ignorant of the conclusions to which they would lead. " I was myself surprised at the force of the evidence which was afforded in favour of vaccination. The report which I prepared was submitted to the criticism of my colleagues. Amongst them were some by no means favourable to vaccination, to put the matter not too strongly, and we availed ourselves of the benefit of all their criticism. Wherever they pointed out that undue weight had been given to this fact, that this or that consideration had not been sufficiently weighed, we made modifications to meet those criticisms. I will call attention to a few facts which were arrived at in the way I have described, after making allowance for everything that could even plausibly be urged. In this country vaccination was for the first time made compulsory in 1853. The compulsory law was far from effective, and it was modified subsequently in 1867, and again in 1871." The Effects of Compulsory Vaccination. "I am going to invite your attention to the figures with reference to the effects of the introduction of compulsory vaccination into this country. It is undoubtedly recognised now that the protection of vaccination is not permanent. It operates most effectually during the earlier jears rather than the latter after the operation has been performed, and it is probably during the first nine or ten years after vaccination that its operation is most efficient. 225 [1911 Bearing that in mind, let me invite your attention to this, that in the years 1848 to 1854—that is, before the introduction of compulsory vaccination—the deaths of children under five years of age irom Small Pox* were 1,514 to every million persons living, and that from 1885 to 1894 they were 50 to every million persons living. Now take the other end of the scale—45 years and upwards. Of course, those of that age would be no more affected by compulsory vaccination between 1885 and 1894—the law having been passed in 1853—than children would be in the year prior to its introduction. In that class the deaths only fell from 24 per million to 19. Then we had careful investigation made into epidemics in five different towns." Small Pox in Vaccinated and Unvaccinated Towns. "A very exhaustive investigation had been previously made into the disease in Sheffield, and our investigations were carried out with the advantage gained by a study of the methods employed in the previous one. These investigations were conducted by medical men selected by the Commission, and with the full approval of those members of the Commission who were not friendly to vaccination. Of course, if vaccination be specially a protection under ten years of age, you would expect to find its inflnence apparent when you are dealing with towns where vaccination prevails largely as compared with towns where it was neglected. We have the figures for six towns. In Sheffield and Warrington the proportion of deaths from Small Pox of persons between one and ten years of age to those of all ages was about a quarter. In Leicester and Gloucester the proportion of those dying from the epidemic at those ages to the total deaths was between 60 and 70 per cent. In London the proportion was about 35 per cent., and in Dewsbury about 50 per cent., or one half. That was a striking fact, and when you examine the vaccination statistics of those towns you find that Warrington and Sheffield were, on the whole, well vaccinated, that their condition as to vaccination was practically the same, and that the proportion of deaths under ten years of age to the total deaths was practically the same—namely, about 25 per cent. At Gloucester and Leicester, where vaccination had been greatly neglected, and where again the unvaccinated condition was approximately the same, the proportion of those dying under ten to the total deaths was approximately the same—between 60 and 70 per cent. Then, coming to London, which was nearer in its proportion to Warrington and Sheffield, we find vaccination a good deal neglected, and there the percentage was 35 per cent. ; and in Dewsbury. where it was considerably more neglected, the proportion under * The deaths for the years 1848-54 include also deaths registered as Chicken-pox. q 226 1911] ten was one half. Surely that of itself is an extremely significant circumstance, even if it stood alone, pointing in the direction of the effectiveness of vaccination in preventing death from the disease." Modification of Small-Pox by Vaccination. "Then inquiries were made into the numbers of vaccinated and unvaccinated persons who took the disease, to see how far it modified the disease and rendered it less dangerous. What was the result? In those six towns, taken together, amongst unvaccinated persons the deaths were 35 per cent.; in the class of vaccinated persons the fatality was 5 per cent. only. That is taking the vaccinated of all the towns and comparing them with the unvaccinated class. But, if vaccination be most effective nearer to the time of the operation, the contrast should be still more striking in those under 10 years of age. Take then, the children from one to 10 in all those towns put together, and we have the following results: Vaccinated 570 attacks, lti deaths, or 2'8 per cent.; unvaccinated—1,235 attacks, 375 deaths, or 303 per cent.; and that is putting the doubtful cases with the vaccinated. If you eliminated the doubtful cases occuring in children, in London alone, you would reduce the 2"8 to 1"8 per cent. What of the type of the disease ? The severe type of the disease leaves behind it consequences which a man may have bitterly to regret during the whole of his life. We find in those very same classes, divided on the hypothesis of those who deny the efficacy of vaccination, according to mere chance, that of those in the vaccinated class about 82 per cent, take the disease mildly, and 17 per cent, severely; while in the unvaccinated class it is precisely the reverse, and the severe cases are 82 per cent, and the mild cases 17 per cent. We tried to ascertain the relative conditions of the fatality of the disease according as there was evidence of more or less efficient vaccination. There again we found that the more efficient the vaccination the less the fatality, and the less severe the type of disease; the less the evidence of efficient vaccination, the greater the fatality and the more severe the type of the disease. Is it not difficult for any human reason to get over a collection of facts such as those, and all th* more when we find this is not only the result ascertained by combining the cases in all those different towns, but that the same phenomenon is observed if you deal with the case of each town separately, and if you deal with the separate districts of a town ? Such facts as these should be pointedly called to public attention. Yet they are only a small part of the case. It would be impossible to resist the case in favour of the efficacy of vaccination if there were no other facts, but I could mention many other facts drawn not only from our own country but other countries also." 227 [1911 How is it possible for anyone, educated or uneducated, to pass over the judgment of this great lawyer, a Lord Chancellor, who was accustomed to examine and digest evidence, in favour of vaccination ? And yet little men step in, and arrogate to themselves a superior knowledge, and practically say that it is all nonsense. Some of us, however, who know the power of smallpox, and who have seen it doing its deadly work, can fully appreciate Lord Herschell's judgment, and we sincerely regret that the law has been modified to please men who for the most part have never seen the disease at its worst, or even at its best, and who unreasonably desire theentire repeal of the vaccination laws. It is to be hoped that it may be long before this country learns the truth about vaccination in the hard school of adversity due to an epidemic, for which it is now daily storing up the fuel for a great conflagration. Table CXXIX. Showing the State of Vaccination in Islington, 1880-1911, also in London and in England and Wales, 1880-1909. 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 ii 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 9,360 22 819 155 644 8.0 6.6 4.5 1883 9,950 8,192 25 890 194 644 8.4 6.5 4.9 1884 9,892 8,121 47 924 191 601 8.0 6.8 5.3 1885 9,683 7,874 41 991 157 617 8.0 7.0 5.5 1886 9,844 7,944 39 1,091 148 622 7.8 7.8 6.1 1887 9,732 7,769 44 1,133 171 615 8.1 9.0 6.7 1888 9,620 7.522 39 1,112 219 728 9.8 10.3 8.2 1889 9,638 7.5H1 22 1,120 198 717 9.5 11.6 9.6 1890 9,239 7,250 19 1,117 122 731 9.2 13.9 10. 9 1891 9,823 7,584 33 1,145 131 930 10.8 16.4 12.9 1892 9,626 7,221 28 1,182 127 1,048 12.2 18.4 14.3 1893 9,757 7,851 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 : q,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 20.4 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 30.7 32.3 1910 7,989 4,961 21 548 1,080 29 1,350 30.8 Not available. Not able. . 1911 6 m'ths) 3,956 2,265 25 294 578 41 753 34.7 * 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. Q 2 228 1911] Table CXXX. Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the year 1910. REGISTRATION sub-districts. Number of Births registered in 1910. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of Statutory Declarations of Conscientious Objection. Died Unvaccinated. Postponement by Medical Certificate. Removed to other Districts. Removed to places Unknown. Number of Children remaining Unvaccinated. or not accounted for in Report Book Total Number of Certificates of Primary Vaccination at All Ages received during year 1911. 1 2 3 4 5 6 7 8 9 10 11 Tufnell 735 436 3 ... 117 43 3 29 88 16 2,460 Upper Holloway 968 670 4 ... 112 63 ... 25 74 20 Tollington 713 461 4 ... 107 36 3 11 64 27 Highbury 1,249 763 6 ... 236 62 2 27 117 36 Lower Holloway 1,030 657 1 ... 105 70 7 6 118 66 2,727 Barnsbury 1,489 941 1 ... 143 126 4 13 230 31 Islington, South East 1,805 1,033 2 ... 260 148 10 8 273 71 The Borough 7,989 4,961 21 ... 1,080 548 29 119 964 267 5,187 229 [1911 Table CXXXI. Return furnished by the Vaccination Officers respecting the Vaccination of Children in the Sub-Registration Districts during the period, January to June, 1911. REGISTRATION SUB-DISTRICT. Number of Births registered from 1st January to 30th June. 1911. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Number of Statutory Declarations of Conscientious Objection. Died Unvaccinated. Postponement by Medical Certificate. Removed to other districts. Removed to places unknown. Number of children remaining unvaccinated or not accounted for in Report Book. 1 j\umber of Statutory Declarations of Conscientious Objections received during the year 1911 1 2 3 4 5 6 7 8 9 in 11 Tufnell 404 235 2 ... 69 25 9 19 31 14 637 Upper Holloway 466 312 2 ... 53 38 4 11 25 21 Tollington 372 219 ... ... 57 26 2 6 34 28 Highbury 607 350 5 ... 121 40 4 9 50 28 Lower Holloway 480 264 7 ... 49 36 7 5 56 56 636 Barnsbury 778 449 1 ... 91 63 9 5 84 76 Islington, South East 849 436 8 ... 138 66 6 6 124 65 The Borough 3,956 2,265 25 ... 578 294 41 61 404 288 1,273 230 1911] DISINFECTION. This important work continues to increase, both by reason of the increas in the number of diseases now notified as well as through the increase in th number of verminous rooms bedding, etc., which have to be dealt with. Disinfection of Rooms.—2295 rooms were disinfected as contrastei with 1777 in 1910. For this purpose formaldehyde, either in its vaporou form or in solution, is generally employed, although it is sometimes augmente< by sulphur dioxide, when it is necessary to reach vermin. The Cleansing and Stripping of Rooms.—As many as 1,222 rooms, as contrasted with 1,093 in 1910, were cleaned, sprayed or stripped. 1910. 1911. 1st Quarter 232 351 2nd ,, 284 214 3rd,, 224 269 4th,, 353 388 Disinfection of Schools and Institutions.—Class-rooms in 18 of the public elementary schools were disinfected as shown in the list given below; while wards were disinfected in the St. John's Road Workhouse and the Islington Infirmary. The following statement shows the Class-rooms, etc., disinfected:— 1st Quarter. St. Jude's Schools (Measles). Hanover Street L.C.C. Schools (Measles). Convent Schools, Eden Grove (Measles). Home and Colonial Schools, Highbury (Measles). Guardians Schools (Measles and Chicken Pox). Gillespie Road L.C.C. Schools (Chicken Pox). Shelburne Road L.C.C. Schools (Chicken Pox) Thornhill Road L.C.C. Schools (Diphtheria & Measles). Station Road L.C.C. Schools (Measles). Richard Street L.C.C. Schools (Measles). 2nd Quarter. St. John's Schools (Scarlet Fever) Receiving Home, Hornsey Rise (Measles). 3rd Quarter. Canonbury Road L.C.C. Schools (Diphtheria). 231 [1911 4th Quarter. Duncombe Road L.C.C. Schools (Diphtheria) Canonbury Road L.C.C. Schools (Scarlet Fever and Diphtheria). Queen's Head Street L.C.C. Schools (Scarlet Fever). Grafton Road L.C.C. Schools (Measles) Thornhill Road L.C.C. Schools (Scabies). The following places were also disinfected:— St. John's Road Workhouse (Chicken Pox and Whooping Cough). Islington Infirmary (Diphtheria). Table CXXXII. Showing the Disinfection oj Rooms by Formaldehyde Gas after Infectious Disease, in the Sanitary Inspectors' Districts, during the year 1911. Sanitary Inspectors' Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total 1911. 1910 1st Q'rter 33 62 31 49 33 28 29 20 57 19 35 58 38 56 548 321 2nd do. 37 49 19 48 23 48 15 20 48 21 49 65 19 32 493 373 3rd do. 21 47 28 49 38 50 22 43 58 32 42 66 27 41 564 409 4th do. 42 94 49 61 30 59 24 34 27 44 51 70 45 60 690 674 Year 133 252 127 207 124 185 90 117 190 116 177 259 129 189 2295 1777 Table CXXXIII. Showing the Cleansing, Spraying or Stripping of Rooms after Infectious Disease, in the Sanitary Inspectors' Districts, during the veur 1911. Sanitary Inspectors Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total 1911. 1910 1st Q'rter 15 34 46 34 29 19 26 21 8 12 18 22 45 22 351 232 2nd do. 12 12 31 18 11 5 11 21 11 11 21 15 22 13 214 284 3rd do. 29 57 17 18 12 12 28 5 12 21 20 3 23 12 269 224 4th do. 21 62 38 25 34 20 6 17 10 25 23 14 56 37 388 353 Year 77 165 132 95 96 56 61 64 41 69 82 54 146 84 1222 1093 282 1911] Disinfecting Station. — The amount of work done at the Disinfecting Station was the heaviest on record, for no less than 88,999 large articles were disinfected, as compared with 83,786 in 1910, (38,8t'0 in 1969, 62,455 in 1908, and 30,083 in 1907. The large increase in recent years is due to the fact that during the last four, a firm who export second-hand garments or conJemned military uniforms, mostly the latter, have had their goods disinfected by the Council, on payment for the work, to entitle them to a certificate, required by foreign or Dominion Governments, that they have been disinfected. The actual number of garments or other articles, bedding, etc., removed from the homes of residents, disinfected after exposure to infectious disease or contamination by vermin was 37,600 as compared with '27,168 in 1910, 37,273 in 1909, and 36,106 in 1908. TABLE CXXXIV. Summary of the chief articles of Clothing, Bedding, &c., disinfected during the year 1911, and also in the preceding year 1910. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1911 1910. Beds 549 492 530 736 2,307 1,933 Blankets 1,026 1,012 1,126 1,539 4,703 3,961 Bolsters 507 532 586 700 2,325 1,807 Carpets 99 125 139 113 476 334 Chair Bed Cushions 241 158 187 305 891 276 Mattresses 429 422 550 663 2,064 1,910 Palliasses 194 291 243 253 981 583 Pillows 1,146 1,086 1,383 1,692 5,307 4,335 Quilts 487 504 552 735 2,278 1,999 Sheets 983 942 1,043 1,346 4,314 2,802 Other Articles 2,510 2,653 2,582 4,209 11,954 7,228 Totals 8,171 8,217 8,921 12,291 37,600 27,168 The ensuing statement shows the nature of the articles disinfected for the clothing contractors. 238 [1911 1st Quarter. 2nd Quarter. 3rd Quarter 4 th Quarter. Year. Soldiers' Tunics 1,601 2,001 1, 87 11,00 5,789 ,, Overcoats 5,755 7,455 5.506 5,355 24,071 „ Jackets 3,259 3,295 3,978 1,911 12,443 Troupers 835 1,070 776 2,419 5,100 Vests 340 1,120 300 636 2,396 Other Articles 114 9,35 158 393 1,600 11,904 15,876 11,805 11,814 51,399 The following is a record of the work performed by the Steam Disinfectors during the past seventeen 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 ,, 1911 88,999 ,, Total for seventeen years 650,109 Disinfectants distributed and used.—The following statement gives the quantity of disinfectants distributed by the Sanitary Authority, or used in disinfecting and cleansing rooms :— How disposed of. Carbolic Powder. Disinfecting Fluid. Formaldehyde. Powder. Solution. Tons. cwts Gallons. cwt. qr lb. Gallons. To Householders 3 8 700 — _ Disinfection of Premises. — — 1 1 7 24 Cost = £60 14s. 9d. 234 1911] SHELTER HOUSE. During the year the Shelter House was not used by persons in whose homes an infectious disease had occurred. Disinfection of their rooms is now so speedily accomplished that they prefer to make some shift at home rather than undergo the inconvenience of even a short stay in it. Certain verminous persons, denizens of lodging-houses and others, 23 in number, were, however, given baths there. Midwives.—Seven midwives used the 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. 1911 25th Jan. 47, Campbell Road 1 Verminous. 6th Feb. Lodging House, Hornsey Road 1 Do. 23rd „ 87 & 89, Essex Road 1 Do. 2nd March do. do. Do. 14th ,, 47, Campbell Road 1 Do. 28th „ 66, Elthorne Road 1 Do. 18th April 29, Halton Road 1 Do. 24th „ 87, Essex Road 1 Do. 9th June No Home 1 Do. 3rd July 87, Essex Road 1 Do. 12th „ Lodging House, Campbell Road 1 Do. 14th Aug. 62, Barnsbury Street 1 Do 18th Sept. 47, Campbell Road 1 Do. 28th „ 10, do. do. 1 Do. 3rd Oct. 41, St, John's Villas 1 Do. 25th „ Lodging House, Eden Grove 1 Do. 31st „ 8a, Hornsey Street 1 Do. 7th Nov. 6, Gordon Place - 1 Do. 14th „ Church Army, Hornsey Road Do. 20th „ 8a, Hornsey Street 1 Do. 30 th „ 18, Caledonia Street 1 Do. 1st Dec. 41, St. John's Villas 1 Do. 285 [1911 Persons using Shelter House pending the disinfection of their homes. Date of Admittance. Address. Number in Family. Cause. 1911 7th March Seamen, H.M.S. Albion 1 Measles (contact with case). 16th Sept. 13, Harvist Mews 1 Eczema. Midwives attending Shelter House for the purpose of disinfection after attendance on cases of Puerperal Fever. Date of Attendance. Name. Address. 1911 2nd March Mrs. H. 21, Palmerston Road. 4th April Mrs. J. 77, Pembroke Street. 4th „ Nurse B. 77, Do. do. 2nd May Mrs. M. 392, Essex Road. 20th Oct. Nurse S. 417, Holloway Road. 23rd „ Mrs. L. 7, Crossley Terrace. 12th Dec. Nurse R. 158, Junction Road. PART IV. SANITATION. ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1991 INSPECTION OF WORKSHOPS, WORKPLACES, LAUNDRIES AND BAKEHOUSES. HOUSES LET IN LODGINGS. DISTRICT INSPECTIONS. STATE OF PAUPERISM. COMMON LODGING HOUSES. DUST REMOVAL. 238 1911] FACTORY AND WORKSHOP ADMINISTRATION. The Medical Officer of Health, in compliance with the Factory and Workshops Act, reports annually as to the manner in which the Act is administered in the district over which he has charge. All local authorities are compelled to keep registers of workshops, and to transmit copies of the annual reports of their Medical Officer of Health on the subject to the Secretary of State; in addition to which, in London, copies must be forwarded to the Local Government Board and the London County Council. The work under the Factory and Workshop Act, 1901, is constantly increasing, so that whereas at one time it was thought that two inspectors, a male and female, would be sufficient to execute it, it is now found that three barely suffice. Inspectors.—Three inspectors, one male and two females, are engaged in carrying out the work entailed on the Council under the Act. The male inspector inspects all factories and workshops where men are employed, and one female inspector visits factories and workshops, including laundries, where women are employed, while the other female inspector inspects the homes of homeworkers, the kitchens of restaurants and other places where food is prepared. Inspections and Visits.—The number of inspections and visits paid was 9,892, as compared with 11,004 in the preceding year, and 11,476 in 1909. The particulars of these inspections are as follows:—Factories (including factory laundries), 460; workshops (including workshop laundries), 1,772; workplaces other than outworkers' premises, 242; bakehouses, 208; kitchens of restaurants, 388; outworkers' premises, 1,633; miscellaneous re-inspections and calls, 5,189 ; total, 9,892. Notices served.—Arising out of these inspections, 469 intimation notices and 13 statutory notices were served for various purposes. These notices related to 1,403 defects, of which 1,374 had been remedied at the close of the year. In addition, 75 notices were served with respect to outworkers' rooms which were found in an unwholesome state. Registers.—4,938 workshops are at present on the registers. This number includes 532 workshops where men are employed, 812 workplaces where 233 flf) 11 women are employed, 106 laundries, 249 bakehouses, 746 kitchens of restaurants and eating houses, or of places where food is prepared, and 2,493 outworkers' premises. The following tabular statement gives the figures for the year as well as for 1910. Workshops and Workplaces. 1910. 1911. 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 530 769 41 39 532 748 Workshops where Women are employed 785 1,448 133 106 812 1,483 Laundries 114 2 10 106 Bakehouses 253 263 — 4 249 259 Restaurant Kitchens 746 1,030 10 9 746 1,031 Outworkers' Premises 2,114 2,114 826 417 2,493 2,493 Total 4,542 5,624 1,012 615 4,938 6,014 Sanitation.—1,403 sanitary defects were discovered, of which 465 related to want of cleanliness, 21 to want of ventilation, 18 to overcrowding, 50 to insufficient, or want of, drainage to the floors, and 345 to other nuisances. In 54 instances dustbins were wanting or defective, in 9 the w.c. accommodation was insufficient, in 247 it was foul, in 190 it was unsuitable or defective, and in 4 the sexes had not been provided with separate accommodation. Of these sanitary defects, 1,374 had been remedied at the close of the year. In addition to these, nuisances were found in 111 instances in the homes of outworkers, from which 47 cases of infectious diseases were reported. As showing the volume of work that has been done in factories, workshops, and workplaces since 1896, it may be said that 16,963 more or less serious nuisances, in addition to very many of minor importance, have been discovered and remedied. Their nature is set out in the following table, which has now been published tor a number of years. 240 19111 1896 1897 1898 1899 1900 1911 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Total Overcrowding 26 12 15 14 22 14 4 13 4 13 30 9 8 9 24 14 231 Ventilation 14 13 2 5 4 3 5 8 11 4 8 31 12 29 20 23 192 Dirty Premises 311 195 109 99 217 218 231 423 630 412 448 970 719 425 505 449 6,361 Drains 554 458 375 313 216 177 90 50 19 15 4 19 261 61 * * 2,612 W.C.'s 420 325 341 355 411 375 154 161 165 151 190 620 573 677 522 471 5,911 Water supplies 79 41 35 20 19 13 83 54 18 38 17 23 45 40 46 53 624 Surface drains 79 109 87 51 78 81 2 53 40 34 39 45 72 99 116 47 1,032 * Now included in District Inspector's summary. Cleanliness. — 465 premises were found in an uncleanly state, and 441) were remedied. The numbers for the six preceding years have been 505, 425, 719,970, 448 and 412. Effluvium Nuisances.—None were found. Ventilation.—Insufficient ventilation was discovered in 21 instances,and 23, which include some remaining over from 1910, were remedied before the close of the year. Overcrowding.—18 instances of overcrowding came under the observation of the Inspectors, and 14 of these had been abated before the year terminated. In the preceding years the numbers were 13 in 1905, 30 in 1906,9 in 1907, 8 in 1908, 9 in 1909, and 24 in 1910. Overcrowding in the workshops in Islington is not unduly prevalent. Want of Drainage of Floors.—In 50 instances the floors of workshops, chiefly laundries, were found to be insufficiently drained, and consequently a notice was served in each instance, and 47 have already been complied with. Sanitary Accommodation.—Special attention was given to the provision of this class of accommodation in workplaces, particularly to that provided for the sexes, and resulted in separate accommodation being required in 4 instances, in 2 of which it had been provided before the close of the year. 241 [1911 Nine nuisances due to insufficient accommodation were found, 8 of which were abated. 263 foul w.c. pans were cleansed, and 198 that were unsuitable or defective were remedied. Miss Davies draws particular attention to the condition of the sanitary conveniences, which she found on the whole to be unsatisfactory, although there are many exceptions, and says that it is amazing to find great difference in cleanliness in different sets of conveniences in the same building, which she accounts for by the fact that a different woman is employed to look after each set, and that although the women have the same time and materials, yet in one case they will be spotless and in another extremely foul. It is unsatisfactory to find that the majority of the nuisances were due more to the fault of the employed than the employer. She attributes this very rightly to the defective home training on the part of the former, many of whom appear absolutely indifferent to dirt. This part of her report is anything but pleasant reading. Bakehouses.—There were 249 bakehouses on the register at the end of the year, including 54 which were not in use, and of these Inspector West made 208 inspections, in addition to numerous re-inspections. The Chief Inspector (Mr. J. R. Leggatt) also made a careful inspection of them and reported as follows :— Town Hall, Upper Street, Islington, N., 8th May, igii. To the Medical Officer of Health. Dear Sir,— I beg to report that I have completed my annual inspection of the bakehouses above and below ground in the Borough which number 198, and that I found them, with a few exceptions, in a satisfactory condition. This is all the more gratifying, as Mr. West, Workshops Inspector, whose duty it is to systematically inspect the bakehouses, has unfortunately been absent from the office owing to a long and painful illness. Although fewer inspections have been made in consequence, the occupiers, mindful of their responsibilities and the requirements of the Council, have kept their bakehouses in a very fair state. The drying of clothes in the bakehouse continues, but not to the same extent as in previous years. I found that changes had occurred in the occupancy which perhaps account for some of the cases which came under my notice, r 1911] 242 Then again the inlet ventilators which are so necessary in an underground bakehouse, I found in many instances to be closed, probably on account of the atmospheric conditions which prevailed during the period of my inspection. I mention these matters each year, but of course in the absence of compulsory powers we must trust to the good sense of the people to discontinue the practice. I have, however, drawn attention by letter to these and other requirements such as cleansing, repairs, &c., and they have been remedied. The supervision of the necessary work has been carried out by the District Inspectors, in addition to their ordinary duties. I remain, Yours faithfully, JAMES R. LEGGATT, Superintendent and Chief Sanitary Inspector. LIST OF BAKEHOUSES. Upper Holloway District. Bakehouses above ground. 104, Andover Road 88, Andover Road 19, Archway Road 16, Brecknock Road 62, Cottenham Road 29, Cottenham Road 49, Campbell Road 130, Devonshire Road 67, Durham Road 103, Elthorne Road (Factory) 57, Elthorne Road 75, Elthorne Road 166, Fairbridge Road 103, Fairbridge Road 81, Fonthill Road 114, Fonthill Road 90, Grove Road 60, Grove 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 127, Marlborough Road 110, Marlborough Road 47, Palmerston Road 163, Seven Sisters Road 131, Stroud Green Road 51, Stroud Green Road 144, Tollington Park 5, Tollington Park (Factory) 243 [1911 Certified underground Bakehouses. 54, Archway Road 84, Ashbrook Road 33, Bedford Terrace 26, Blenheim Road 10, Campdale Road 3, Cardwell 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 32, Milton Grove 31, Salisbury Road 1, Stapleton Hall Road 212, Tufnell Park Road Bakehouses not in use. 5, Andover Road (underground) 44, Cheverton Road (aboveground) 23, Girdlestone Road (underground) 102, Highgate Hill (aboveground) 25, Lennox Road „ 599, Holloway Road (underground) 57, Marlborough Road ,, 33, Milton Grove ,, 53, Poole's Park (aboveground) 84, Yerbury Road (underground) Lower Holloway District. Bakehouses aboveground. V.V. Bakery, Brewery Road (Factory) Kemp's Bakery, Brewery Road (Factory) 421a, Caledonian Road 25, Cornelia Street 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. 46 Roman Road (underground) 25, Wellington Road „ 92, Wellington Road (underground) R 2 1911] 244 Highbury District. Bakehouses aboveground. 17, Annette Road (Factory) 53, Boleyn Road 10, 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 1000, Hornsey Road 154, Hornsey Road 123, Newington Green Road 190, Seven Sisters Road 258, Seven Sisters Road 48, Seven Sisters Road 226, St. Paul's Road 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) 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) 202, Blackstock Road (aboveground) 77, Boleyn Road (underground) 182, Drayton Park ,, 13, Highbury Place (underground) 25, Lowman Road ,, 2, Queen's Square ,, 210, Seven Sisters Road (aboveground) Barnsbury District. Bakehouses aboveground. 129, Barnsbury Road 12, Bemerton Street 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 245 [1911 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) 19, Brooksby Street (aboveground) 334, Caledonian Road (underground) 21, Caledonian Road ,, 96, Caledonian Road ,, 205, Copenhagen Street „ 181, Copenhagen Street ,, 29, Hemingford Road ,, 269, Liverpool Road (underground) 279, Liverpool Road ,, 123, Offord Road „ 29, Offord Road „ 44, Outram Street (aboveground) 86, Thornhill Road (underground) 120, York Road „ South-East District. Bakehouses aboveeround. 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 I37. Upper Street 51, Windsor Street 246 1911] 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 126, Liverpool Road 262, Liverpool Road 192, New North Road 263, New North Road I2i, 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 not 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 (underground) 6, High Street „ 2, High Street ,, 9, Islington Green (aboveground) 32, Parkfield Street (underground) 76, St. Paul's Street ,, 3, St. Paul's Street ,, 107, Upper Street (aboveground) 129, Upper Street „ Outworkers' Premises.—There were 2,493 outworkers' premises on the register. This is an increase of 379 on the return of the previous year. On the lists received from the employers in Islington there were 2,796 entries, in addition to which 2,932 were received from other Councils both within and without London. From the lists provided by local employers, 1,219 were forwarded to other Borough Councils. The Inspector of these places draws particular attention to some evils which she encountered during her inspections. In the first place, there was the case of the insanitary conditions under which caramels were wrapped, to the danger of the public health, and she points out very properly that there 247 [1911 was, unfortunately, no legal necessity for the employer to give information respecting these outworkers. Her investigations have resulted, as the Council is aware, in the issue by the Secretary of State of an Order which will in future compel the manufacturers of confectionery to keep lists of their outworkers, and to notify their addresses to the sanitary authority. There is another matter to which she also draws attention, viz., the fact that there is no compulsion on the manufacturers of cigars and cigarettes, bookfolders and bookbinders to notify outworkers engaged in these trades. This is much to be regretted, for in the event of an infectious disease occurring in the premises where they work these trades might easily disseminate its infection. Her remarks respecting the outworker suffering from tuberculosis are of a painful description, and it is not too much to say that there must be something seriously wrong when such a state of affairs can exist to-day. Altogether her report is a very instructive one, and should receive careful attention by everyone interested in public health work. Restaurants and kitchens where food is prepared. —There are on the register the addresses of 74(3 restaurant kitchens and places where food is prepared, containing 1,031 rooms, to which 412 visits were paid, as compared with 745, containing 1,029 in the preceding year. It was impossible for Mrs. Young to visit the whole of them, but those which more particularly required inspection were inspected. In many of these she found as usual a great difference in their sanitary state, according as they were situate in the basement, on the ground floor, or on the upper storey. Thus, of those in the basements, 25 per cent, were unsatisfactory; on the ground floors, 15 per cent.; while, on the upper storeys there were only 4 per cent. Workshops notified to H.M. Inspector.—Under the provisions of Section 133 of the Factory and Workshop Act, it is required that the Medical Officer of Health, when he becomes aware that any woman, young child, or person is employed in a workshop, shall forthwith send notice to H.M. Inspector of Factories. 168 workshops were reported during the year in accordance with this section. 248 1911] Workshops notified to Home Office, 1911. Trade. Number of Workshops. Protected Persons Employed, Females. Male Young Persons. Total. Dress Making 45 169 .. 169 Blouse Making 21 112 .. 112 Tailoring 10 17 1 18 Furrier 7 10 .. 10 Laundry 6 32 .. 32 Millinery 6 15 .. 15 Children's Dress Making 5 20 .. 20 Mantle Making 5 10 .. 10 Piano Making 4 .. 5 5 Tie Making 4 9 .. 9 Embroidery 3 6 .. 6 Packing 3 10 .. 10 Shoe Making 3 .. 4 4 Upholstery 3 1 2 3 Artificial Flower Making 2 3 1 4 Belt Making 2 2 .. 2 Children's Stay Making 2 4 .. 4 Dressmakers' Stands making 2 7 1 8 Pork Butchers 2 .. 3 3 Trouser Making 2 7 .. 7 Underclothing Making 2 4 .. 4 Apron Making 1 1 .. 1 Boot Upper Making 1 1 .. 1 Brush Making 1 .. 1 1 Cabinet Making 1 3 3 Carpet Planning 1 6 .. 6 Confectionery 1 22 .. 22 Cycle Repairing 1 .. 1 1 Dough Weighing 1 5 .. 5 Fancy Leather Goods Making 1 7 .. 7 Framing 1 .. 1 1 French Polishing 1 1 .. 1 Fusee Chain Making 1 .. .. .. Gilding 1 .. 1 1 Glass Blowing 1 .. 2 2 Gold Paint Making 1 .. 1 1 Hassock Making 1 2 .. 2 Imitation Fur making 1 7 .. 7 Jewel Case Making 1 1 2 3 Paper Bag Making 1 2 .. 2 Perambulator Making 1 2 .. 2 Pelisse Making 1 2 .. 2 Perfume Making 1 2 .. 2 Pipe Making 1 .. 1 1 Sack Mending 1 2 .. 2 Ticket Writing 1 1 .. 1 Umbrella Making 1 1 .. 1 Underskirt Making 1 1 .. 1 Waterproof Making 1 48 10 58 Wood Chopping 1 1 .. 1 Total 168 553 40 593 249 [1911 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 In pectors of Nuisances Premises. Number of Inspections. Written Notices Prosecutions (1) (2) (3) (4) Factories (Including Factory Laundries) 460 31 Nil Workshops (Including Workshop Laundries) 1,772 172 „ Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 838 230 „ Miscellaneous Re-inspections 5,189 .. „ Total 8,259 433 Nil 2 -DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 465 449 Nil Nil Want of ventilation 21 23 „ „ Overcrowding 18 14 1 „ Want of drainage of floors 50 47 Nil „ Other nuisances 399 370 2 „ Sanitary Accommodation insufficient 9 8 Nil „ unsuitable or defective 437 461 „ „ not separate for sexes 4 2 „ Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101 Nil Nil „ ,, 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 1,403 1,374 3 Nil * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 250 1911] 3. HOME WORK. NATURE OF WORK * Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises. (Secs. 109. 110). Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served under Public Health (London) Act. Prosecutions Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists.† Outworkers.† Lists. Outworkers Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel- (1) making, &c. 220 302 4,782 119 4 180 280 .. .. 36 47 .. 41 .. .. (2) cleaning and washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Household linen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Curtains and furniture hangings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery 4 .. 44 2 .. 3 2 .. .. .. .. .. 1 .. .. Electro-plate 2 .. 6 .. .. 1 .. .. .. .. .. .. .. .. .. File making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur pulling .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cables and chains .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c. 2 .. 2 1 .. 1 2 .. .. .. .. .. .. .. .. Artificial Flowers 18 .. 146 9 .. 16 20 .. .. 4 10 .. .. .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sacks .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Racquet and Tennis Balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper Bags and Boxes 12 164 5 .. 15 12 .. .... 20 15 .. 3 .. .. Brush making 2 .. 50 1 .. 4 .. .. .. 4 3 .. .. .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Stuffed toys .. .. 6 1 .. .. .. .. .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 260 302 5,202 138 4 220 316 Nil Nil 64 § 75§ Nil 47 Nil Nil * When an occupier gives out work of more than one of the classes specified in column 1, and, 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. 46 Boxmakers: 60 Artificial Florists ; and 20 Brushmakers are included in lists of Wearing Apparel Makers. † The figures required 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. § 64 instances of unwholesome premises because of unsatisfactory domestic conditions; 75 instances of unwholesome premises because of statutory misances ("Public Health (London) Act, 1891"). 251 [1911 4 — REGISTERED WORKSHOPS Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses may be enumerated here. Workshops where men are employed 532 Workshops where women are employed 812 Laundries 106 Bakehouses 249 Restaurant kitchens 746 Total Number of Workshops on Registers 2,445 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 168 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 19 Reports (of action taken) sent to H.M. Inspector. 15 Other Nil. Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 94 Mr. WEST'S REPORT. Town Hall, Upper Street, Islington, N. 1th March, 1912. To the Medical Officer of Health. Sir, I have pleasure in submitting my report for the year ending 30th December, 1911. During which time I have, with the assistance of Inspector Bridel, made 2,491 visits to the various places of business (factories, workshops and workplaces) on the register, 1,336 252 1911] inspections and 1,155 re-inspections. The visits to the various trade premises were as follows:—198 factories, 700 workshops, 135 workplaces, 208 bakehouses, 95 outworkers' premises, and 1,155 miscellaneous. Artificial florists 4 Automatic machine makers 3 Builders, etc. 9 Blacksmiths 7 Basket maker 1 Blind makers 3 Brush makers 7 Bamboo cane workers 4 Balloon maker 1 Billiard table maker 1 Boot polish makers 2 Brace maker 1 Bakers 249 Bust makers 3 Bedding maker 1 Confectioners 6 Cycle makers 13 Cabinet makers 30 Coppersmith 1 Camera bellows maker 1 Cap makers 2 Cardbox-box makers 6 Claypipe maker 1 Cork cutter 1 Cattle food maker 1 Coopers 2 Cloth shrinker 1 Corset maker 1 Carpenters 3 Coach painters 4 Carpet maker 1 Dairy-can maker 1 Dentist 1 Engineers 8 Exhibition stall fitters 3 Embroidery maker 1 Enamellers 2 Farriers 26 Furriers 49 Fancy brooch maker 1 Feather dressers 3 Fire escape maker 1 File cutter 1 Fish cleaner 1 Fish curers 2 French polisher 1 Fancy goods makers 2 Flour packer 1 Gun makers 2 Glove maker 1 Gilder (card edge) 1 Gas-mantle maker 1 Glass engravers 2 Glass worker 1 Harness makers 6 Hat shape makers 3 Hairworkers 2 Instrument maker (Brass) 1 Incubator maker 1 Ironplate worker 1 Japanner 1 Jewel Case makers 2 Leather goods making 5 Ladder makers, &c. 2 Limelight maker 1 Lamp makers 3 Laundries 2 Marquetaire work 3 Marking-ink maker 1 Mineral water sundries 1 Marble masons 3 Metal workers 3 Motor works 7 Musical string makers 2 Mica goods maker 1 Mantle makers 5 Naturalist 1 Optician 1 Organ builders 2 Pianoforte makers 39 Provision dealer 1 Plaster block makers 2 Plumbers 4 Picture frame makers 13 Perambulator makers 3 Photographic enlargers 5 Paper sorting 1 Pea packer l Rag sorters 6 Rubber merchants 4 253 [1911 Scale makers 3 Shoemakers 132 Stove makers 2 Scientific instrument makers 6 Stick mounters 3 Scene painter 1 Sealing wax maker 1 Sign writers 4 Soap maker 1 Saddle-tree maker 1 Surgical appliance makers 3 Stationer 1 Seat market 1 Sack repairer 1 Trunk makers 9 Tailors 60 Tarpaulin maker 1 Tinsmiths 3 Ticket writers 5 Tea sifters 2 Toy makers 4 Undertakers 2 Umbrella maker 1 Umbrella and stick maker 1 Upholsterers 10 Wheelwrights 36 Wood choppers 8 Watch and clock makers 12 Wire workers 2 Wood letter maker 1 Wreath case maker 1 Wax figure maker 1 Wire mattress maker 1 Whalebone hair cutter 1 Total 942 Sanitary Improvements.— During the year 132 notices have been served for the abatement of nuisances, 148 workshops have been cleansed and lime-whited, 6 w.c's. have been provided (4 for males and 2 for females) at various workshops, whilst 329 other improvements were carried out under our supervision. Also 30 workroom cards were distributed showing the cubic capacity and the number of employées allowed in each workroom. There were in addition 40 water supplies provided. Three drains which were found to be in a foul and defective condition were transferred to the district Inspector. Bakehouses.— During the year 208 inspections have been made to bakehouses besides a number of other calls to same. I regret to state that owing to my serious illness I was unable to record a larger number of visits to them, but hope in my next report to give a better account. At the end of the year there were 101 bakehouses in use above ground, 94 below ground and 54 not in use, making a total of 249. There has been reported through you to H.M. Inspector of Factories, as required by the Public Health Act, 1891, the addresses of 30 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 60 workshops have been added to the Register, whilst 53 have been removed, so that at the present time there are 942 workshops containing 1,331 workrooms and 71 outworkers' premises now on the register. I am, Sir, Your obedient servant, GEORGE WEST, Sanitary Inspector of Workshops, etc. 1911] 254 Mrs. YOUNG'S REPORT. Town Hall, Upper Street, N. 27th February, 1912 To the Medical Officer of Health. Sir, The following is a report of the work done by me during the year ending 30th December, 1911 :— Inspections made.— Hotel and Restaurant Kitchens 412 Outworkers' premises 1538 Domestic workshops 72 Re-inspections and calls 1529 3,551 Notices served. Intimation 246 „ courtesy 25 Statutory 8 = 279 Nuisances found and remedied under the Public Health Acts :— Found. Remedied. Want of cleanliness 216 19 ,, ventilation 4 Want of, or defective bins 36 47 Defective floors or yard paving 40 38 Other nuisances 137 114 Sanitary accommodation insufficient 1 0 unsuitable or defective 20 21 not separate for sexes 1 1 Unsatisfactory storage conditions 68 24 Dirty utensils 24 14 547 484 Registers.— Hotel and Restaurant Kitchens.— Workshops. Workrooms Total number at the beginning of the year 745 1029 „ „ added during the year 10 13 ,, „ closed „ ,, 9 11 Present Totals 746 1,031 Outworkers resident in the Borough.— Total number at the beginning of the year 2114 ,, ,, added during the year 826 ,, ,, removals ,, ,, 447 Now registered 2,493 255 [1911 Outworkers :— Notifications received from employers in the Borough of Islington 2,796 From employers in other districts per the Medical Officer of Health 2,932 Total number notified 5,728 Insanitary premises :— Notices served for statutory defects 75 Unsatisfactory domestic conditions 64 139 Infectious diseases :— Notifications where work is done 47 Disinfection of workrooms and work 47 Letters, etc., sent : To employers failing to supply lists . . 316 Notification of outworkers to other districts ... 1219 1,535 Workshop cards :— Distributed (stating cubic capacity, etc) ... 167 Numbers of persons engaged in trades scheduled :— Making of wearing apparel 5,269 Artificial flower making 162 Furniture and upholstery 47 Paper bags and boxes 179 Brush making 54 Stuffed toys 6 Electro plate 7 Umbrellas 3 Chain making 2 5,729 The following table shows the increase in the numbers of homeworkers registered as occupying one, two, or three room tenements for living and working since 1907:— 1907 1910 One room 242 443 Two rooms 312 677 Three 316 328 During the first quarter of the year an anonymous complaint as to the insanitary conditions under which caramels were being wrapped in certain parts of the Borough was forwarded to the Public Health Department. Confectionery making, with its allied branches, was not on the list of trades scheduled by the Home Office authorities, and any employers of outdoor labour therefore were exempt from the necessity of giving information as to the persons employed, or the conditions under which the work might be done outside their own premises. 256 1911] Acting on your instructions I investigated the complaints made and reported to you in detail; after which you caused the Government Departments concerned and various Public Health authorities to be informed of the nature and urgency of the matter. My report summarized the conditions found as constituting a danger to the health of the community and likely to seriously affect the economic status of the trade, owing to the low wages paid for the work. A question asked in the House of Commons in reference to this report was answered by the Secretary of State in such a manner as to discredit the correctness of certain technicalities, while fully admitting the accuracy of the main issues involved. Upon this the trades concerned protested against the action of the Islington Public Health Committee in giving publicity to the affair. Acting on your further instructions I verified the statements made in the original report and was able to submit to you evidence which conclusively proved its accuracy both technically and generally. My second report embodying this evidence was duly forwarded to the State Departments and the Home Office. Perhaps the best justification of the action taken lies in the issue of an Order by H.M. Secretary of State, which has added the making of confectionery with all its branches to the trades scheduled for notification. It is difficult to understand why all employers of outworkers are not compelled to notify their employees. As an instance, the trades of cigar and cigarette making, of book folding and binding are still exempt, though it is known that they are carried on as domiciliary occupations. In the event of infectious disease occurring on the premises both these trades would prove fruitful sources of dissemination. The experience of the past year proves that where work is done the ordinary notification is futile for public protection. Fear of loss of employment prompts a denial, and it is only the foreknowledge given by the outworkers' register that compels admission of the truth The following cases illustrate the facts. Six dozen ties were returned to the factory without disinfection from a house where a case of scarlet fever had occurred; and the Inspector was told that there was no work on the premises." In another house there were fifteen dozen ties, in another two infants' cots, in another six mantles, with others for which lack of space forbids detail. In all of them the presence of work was distinctly negatived on the District Inspector's enquiries. Fortunately the register of outworkers enabled me in every case to trace the goods and have them disinfected. Hut in trades such as those mentioned, which are not scheduled, what protection is there for the public health under similar circumstances? In conjunction with this question is the importance of the regulation which compels the notification of consumption. The following instance is an illustration of the need for making this notification more than a mere statistical record :— A homeworker (boxmaker), suffering from tuberculosis of the lungs, was discharged from the Infirmary as being sufficiently recovered to partly resume ???er work. She occupied a second floor back room, about twelve feet by nine, with her daughter, a girl of fourteen; they had one small bed, in which they both slept. The poor woman's weakness only permitted her to work half the day, and the Guardians made her a small allowance to pay the rent. There is therefore every probability of the girl contracting her mother's disease, for she lives and sleeps in the closest possible proximity to her, nor is anything done to save her. 257 [1911 But there is also a far-reaching evil to be dreaded by the public, who, under the system of poor relief, help to support the patient and enable her to keep at work, receiving from her, in return (though innocently enough as far as she is concerned), goods which have remained in this infected atmosphere not only during the day, but generally for one or two nights; goods which she handles when in the weakness of fever her hands are moist with deadly perspiration, and over which when she coughs the infinitesimally minute germs are freely scattered. In another report which I am submitting to you I have endeavoured to show how such painful instances may be helped, and the public health protected. Under the system and organisation of Anti-Tuberculosis Dispensaries, both in this country and abroad, the patient would have been provided with the means of isolation at night. She would have been taught how to care for herself and at the same time safeguard her child. Her room would have been regularly disinfected and proper appliances for the prevention of infection been supplied to her. Nor would she have been permitted to continue an occupation as homeworker, where there was a probability of the goods made under such conditions being afterwards sold to the public. But to relieve any want arising from this cessation of employment, nourishment and help would have been given and rendered fully effective by the personal supervision of the doctor and trained "nurses attached to the Dispensary, in their periodic visits to the house, which commends itself as being a better thing than giving a sum of money every week and (as happened in this case), helping to spread far and effectually a disease of which the notification was primarily intended as the precursor of prevention. The general conditions found in the homeworkers' premises visited, apart from the special considerations which I have mentioned, were fairly satisfactory. Of 1,538 inspections made, only 64 homes were registered as having " unsatisfactory domestic conditions." I most earnestly wish that I could report on equally satisfactory conditions as to the rates of wages paid, but it is a regrettable fact that these are extremely unsatisfactory; nor does the Trade Boards Act of 1909 appear to have made any appreciable difference, as far as the Outworkers residing in this Borough are concerned. As they are employed by various firms in the City, West-end, and local districts, their pay must be a fair sample of the prevailing rate, as far as the Metropolis is concerned. Elaborately trimmed blouses,, 1s. 6d. per doz.; camisoles, more than half composed of fine insertion and lace trimming, Is. 6d. per doz.; heavy cloth mantles, full length, With smart finish, including buttons and button holes, 7d. each; bathing costumes, with braided jackets and knickers, l¼d. each, and so on, in a painful repetition for which this report does not contain space; nor should I have quoted these, but that they are a tangible, though slight, indication of an evil that is apparently going on unchecked. It appears possible that the Act might have proved speedier in its remedial measures if the existing machinery of inspection had been utilised, at least partly, towards enforcing its provisions. All employers are compelled (under the Factory and Workshops Act, 1901, sec. 107) to send to the Medical Officer of Health for every district the names and addresses of their outdoor employees twice every year. As this is the only authority to whom the lists are forwarded it is obvious that the mass of information is in their hands Outworkers are already visited by Inspectors (male and female) under the various Councils, and the information as to wages, etc., could have been quickly and easily obtained and forwarded to the proper authorities. S 258 19111 The visits of inspection are made periodically, and fluctuations in trade and pay would thus become systematically registered. A considerable saving in public time and money might have been effected, and (this last by no means the least of the benefits gained) the workpeople saved from the exasperation of overlapping officialdom. Hotel and Restaurant Kitchens.— Owing to the increase of work attached to the Outworkers' Department it has been impossible for me to make as many visits as in previous years to places where food is prepared. The conditions found in the kitchens visited are summarised in the first page of this report and are practically identical with those of the preceding year. As 1 have before stated, the majority of those registered as " unsatisfactory " are basement kitchens, and structurally unsuitable for the preparation of food. It is, therefore, useless to expect a marked diminution in their numbers until the owners are compelled to build kitchens (or adapt existing premises for this purpose) on or above the ground level. The following tables show the comparative general conditions relative to the basement, ground floor, and upper storey kitchens, when inspected in the years 1907 and 1911 :— 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 „ 1911— Basement 80 60 20 25 „ Ground floor 272 230 42 15 „ Upper storey 60 58 2 4 „ The particulars for the intervening years were given in my report for 1910 (vide p. 217 of the Medical Officer of Health's report for that year). The chief cause of nuisance is the accumulation of garbage and refuse which is still, as a rule, only removed once weekly. In every previous report I have tried to draw attention to its seriousness, and each year's work serves to convince me that the danger from these receptacles is a far greater one than most people know, or imagine. The matter reached a climax, in one instance, when in October, 1909, Messrs. ]. Lyons & Co., Ltd., were summoned by the Council for such an accumulation, and I will close this report by respectfully reminding you of a recommendation, made by the Public Health Committee, which came before the Council at their meeting on the 11th December following, and also of a resolution passed by the Council at the same meeting. The Committee's recommendation was as follows :— "We have carefully considered the matter in all its bearings, and whilst we realise that the cost of more frequent removals from restaurants and other establishments of what must now be regarded as house refuse may be considerable, we have, with deference to the solicitor's opinion and with some reluctance, come to the conclusion that neither the Public Health (London) Act, 1891, nor the London County Council bye-law justifies the Council in refusing to remove house refuse, free of charge, as often as it is necessary to prevent It becoming a nuisance." 259 [1911 The Council's resolution, as recorded in the minutes, reads:— "As regards Messrs. Lyons' restaurants and premises similar in character, arrangements be made for the removal of house refuse as frequently as is deemed necessary to prevent nuisances arising from its non-removal." I am, Sir, Your obedient Servant, CATHERINE YOUNG, Sanitary Inspector of Workshops. Miss DAVIES' REPORT. Town Hall, Islington, April 3rd. 1912. To the Medical Officer of Health. Sir, I beg to submit to you the following report of my work during the year 1911. The following inspections and visits have been made during that period :— Inspections of Factories 238 Inspections of Workshops 1,072 Inspections of Workplaces 35 Miscellaneous re-inspections and visits 2,505 Total 3,850 Factories.— There were on the register at the end of the year 191 factories, 17 having been added during that period and 19 removed. The following is a list of the Factories (including Steam-laundries) on the register Industry. Number. Industry. Number Laundry Collar and Cuff making 1 Printing 16 Corset making 1 Book binding 10 Cotton works 1 Box making 10 Food preparing 1 Confectionery 8 French polishing 1 Cigar and cigarette making 6 Juvenile outfitting 1 Blouse making 5 Lock and safe making 1 Dyeing and cleaning 4 Mirror making 1 Engineering 4 Music roll making 1 Glass work 4 Outdoor games requisites making 1 Mantle making 4 Pattern card making 1 Brush making 3 Perambulator hood making 1 Chemists' sundries making 3 Photo-mounts making 1 Electric lamp making 3 Photographic apparatus making 1 Meat preserving 3 Piano works 1 Apron making 2 Piano string making 1 Bottling 2 Pickle making 1 Dressmaking 2 Picture frame making 1 Furniture polish making 2 Pill making 1 S 2 260 1911] Industry. Number. Industry. Number. Furrier 2 Sack making 1 Leather goods making 2 Sauce making 1 Mangling 2 Skirt making 1 Manufacturing stationers 2 Slate works 1 Mattress making 2 Stay-band making 1 Millinery 2 Syphon making 1 Mineral waters manufacturing 2 Surgical appliances making 1 Seed packing 2 Table stationery making 1 Toy making 2 Underclothing making 1 Blind making 1 Vinegar making 1 Boot polish making 1 Washing-powder making 1 Button making 1 White lead works 1 Cabinet making 1 Wicker work 1 Cake and Biscuit making 1 — Capsule making 1 Total 191 Although there has been a reduction of two in the number of factories on the register, the number of women employed in the new factories is about 150 in excess of the number which were employed in those factories which have been closed or removed. Several large premises which had been empty for a considerable period were opened as factories during the year. The cleanliness of the conveniences remains, on the whole, unsatisfactory, although there are a number of exceptions. It is amazing to find the great differences in cleanliness which sometimes occur in different sets of conveniences in the same building. This is due to the fact that a different woman is employed for each set, and although the women have the same time and materials, yet in one place the pans and traps will be spotless and in another extremely foul. So much depends on the standard of cleanliness of the workers employed. The majority of the nuisances found are to a considerable extent the fault of the employees and not the employers. Owing to defective home training many of the women appear absolutely indifferent to dirt. Two instances of this came under my notice lately. In one place I found the pan of the only convenience completely blocked and in a disgusting condition. On questioning the women I ascertained that this nuisance had been in existence for five days and yet not one of them had taken any steps to have it abated. In another place I found a small yard strewn with tea leaves and fragments of food, although a dust bin stood within six feet of the door of the mess-room. Insufficient accommodation was found in four factories, but these defects were remedied or were being remedied before the close of the year. In one factory separate approaches to the conveniences were required and the necessary alterations were made. I find that in some factories, although there is a sufficient number of w.c's. provided, that is on the basis of one w.c. for every 25 females employed, yet in actual practice the law is broken. Thus in one factory employing 40 women, 2 w.c's. were provided, but 35 women were using one accommodation and only five the other. However, when the matter was pointed out to the manager the necessary re-adjustment was made. All new premises provide most adequate lavatory and w.c. accommodation, and not merely the minimum of the latter demanded by law, which indicates increasing care for the well-being of the employees. Other indications of this care are not lacking; several factories added new or improved mess-rooms, some exceedingly well equipped with gas-ovens 261 ri9ii and pretty crockery; soup clubs, overalls for the employees, a piano and a roof garden were some of the innovations observed. During the year three factories which had not been visited by H.M. Inspector were notified to the Home Office. Register of Workshops.—At the end of the year 1911 there were on the register 812 workshops and 106 laundries, comprising 1,483 workrooms. During the year 133 workshops and 2 laundries were added, while 106 workshops and 10 laundries were 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 236 325 Laundries 106 262 Millinery 74 131 Fur sewing 65 88 Mantle making 40 61 Tailoring 40 51 Blouse making 38 77 Tie making 30 32 Underclothing making 17 21 Children's frock making 15 21 Rag sorting 11 14 Artificial flower making 10 25 Embroidery 10 18 Leather goods making 8 13 Box making 7 22 Fancy goods making 7 8 Skirt making 7 10 Corset making 6 9 Feather dressing 6 8 Photographic work 6 16 Trunk making 6 12 Trousers making 5 6 Boot and shoe work 4 6 Confectionery 4 9 Packing 4 7 Skirt making 4 5 Umbrella making 4 4 Wig making 4 6 Artists' brush making 3 4 Boot polish making 3 4 Cambric bow making 3 3 Dressing gown making 3 4 Dressmakers' stands making 3 4 Firewood cutting 3 3 Jewell case making 3 4 Postcard painting 3 3 Upholstery 3 8 202 1911] Nature of business. Number of Workshops. Number of Workrooms. Waistcoat making 3 4 Waterproof making 3 5 Apron making 2 2 Baby linen making 2 2 Braces making 2 3 Costume altering 2 2 Drug packing 2 2 Fancy glass work 2 2 French polishing 2 2 Frilling making 2 4 Hair work 2 2 Ink making 2 3 Jet and sequin work 2 3 Knitting 2 2 Muff and necklet making 2 3 Opera cloak making 2 2 Paper sorting 2 3 Sack mending 2 3 Tea-gown making 2 5 Underskirt making 2 2 Back support making 1 1 Balloon making 1 2 Bath glove making 1 1 Blind making 1 I Bonnet shape making 1 1 Bottle washing 1 2 Buttonhole making 1 1 Camera bellows making 1 1 Candle shade making 1 1 Cap making 1 1 Carpet planning 1 1 Chemists' sundries making 1 5 Collar and cuff making 1 1 Cork cutting 1 2 Decorative glass work 1 1 Doll dressing 1 1 Dolls' hair curling 1 7 Dough weighing 1 1 Dyeing and cleaning 1 1 Exhibition stall fitting 1 1 Fancy glass working 1 1 Fancy neckwear making 1 1 Fancy shade making 1 1 Fruit preserving 1 1 Funeral furnishing 1 1 Fusee chain making 1 1 Gelatining 1 2 Glass etching 1 1 263 [1911 Nature of business. Number of Workshops. Number of Workrooms Glass work 1 1 Cold beaters skin preparing 1 4 Hassock making 1 1 Hat-shape making 1 2 cap and apron making 1 1 Housemaids' dresses making 1 3 Japanning 1 1 Kitchen jacket making 1 1 Lace curtain making 1 1 Lace work 1 1 Leather cushion making 1 1 Limelight making 1 1 Mineral water sundries making 1 2 Motor cap making 1 2 Mourning flowers making 1 5 Music string preparing 1 2 Needlecase making 1 2 Needlework 1 1 Ornament making 1 1 Paper bag making 1 1 Pelisse making 1 1 Perambulator hood making 1 3 Perfumery 1 1 Piano key covers making 1 1 Pickling 1 1 Picture frame making 1 1 Pinafore making 1 1 Purse making 4 Pyjama making 1 1 Sausage skin preparing 2 Scientific instrument making 1 1 Sequin ornament making 1 1 Sign and ticket writing 1 8 Stationery manufacturing 1 2 Stay making 1 2 Sun bonnet making 1 1 Surgical appliances making 1 1 Surgical furniture making 1 1 Surgical instrument making 1 1 Surplice making 1 2 Swansdown sewing . 1 1 Tent making 1 1 Theatrical costume making 1 1 Toy making 2 Valentine making 1 3 Wax figure making 1 1 Wreath case making 1 2 Total 918 1,483 264 1911] Cleanliness.— During the year 82 workrooms were found in a dirty condition and a similar number were cleansed upon instruction. The degree of dirtiness varies considerably, but the average condition of the workshops in the borough is probably higher than that of dwelling-houses. Occupiers have reason to complain that the standard of personal cleanliness of their employees is very far below that which the local authority insists shall be upheld in regard to the premises. The remedy for this lies in the employer's hands. I have endeavoured to find out what attempts are being made by them to deal with the matter. I am usually informed that the girls are "watched," but the result varies with the employers' or forewomen's personal ideals. For instance, in one workshop the forewoman told me she frequently had to send girls home for uncleanliness, in another place the forewoman stated that she never had done so. In both places the same trade was carried on and about the same number of girls were employed, but I was struck with the general cleanly appearance of the employees in the one place and the dirty and untidy appearance in the other. The forewoman's statements made it clear that in the former the girls were " picked," while the casual supervision in the latter had failed to differentiate between the clean and the dirty. Ventilation.— Nuisances were recorded in 15 premises of insufficient ventilation and in 13 instances better use was made of the existing means of ventilation or additional inlets were provided. The rooms where young women are employed appear to be usually better ventilated than those rooms where older women are at work. This may be due to either or both of two reasons : firstly, that the younger women are not so susceptible to draught; secondly, that they are better equipped with the knowledge of the value of pure air. Without elaborate chemical apparatus it is impossible to accurately test the air in a room, and it is necessary to depend on sensations which differ widely with different persons; and, further, the degree of impurity varies with the number of occupants, the temperature and the time of day. Thus under present conditions of inspection it is not possible to definitely prove the state of the air in a room or to impose satisfactory ventilation, and the improvement can only grow in proportion to the knowledge and demands of the occupants of the workroom. The great efforts being made to educate the public in anti-tuberculosis precautions should assist in bringing about this demand. Overcrowding.—The number of premises found to be overcrowded was 17, and in 13 cases the nuisances thus caused were found to have been abated before the close of the year. As in the previous year in no case was there more than one above the number allowed. In one workshop the overcrowding was caused through the workroom being temporarily used as a bedroom. Sanitary Accommodation.—During the year nuisances were caused on 3 premises by insufficient accommodation, on 96 by foul pans and on 85 by defective apparatus. During that period additional w.c.'s were provided for 2 workshops, 100 pans were cleansed upon instruction, and 86 w.c.'s repaired. In one case the approaches to the conveniences, used by the males and famales respectively, were not separated, but the nuisance was abated by structural alterations. Miscellaneous defects.—These amounted to 113, of which 103 were remedied before the close of the year. As in previous years any nuisances found which were connected with the purely residential portions of the premises were reported to the district inspectors. Workroom Cards.—The number of workroom cards distributed was 231. These cards specify the number of persons who may be employed in the room in which the card is exhibited both during ordinary working hours and also during overtime (when allowed). Notices.—In respect to nuisances found, 70 intimation notices were served and one statutory notice. Seventeen of the intimation notices referred to nuisances in factories and 265 [1911 63 to those found in workshops. Nuisances caused by the act or default of occupiers are usually abated on verbal instruction, the majority of the above notices being served on owners. Workplaces notified to Home Office.—In accordance with the requirements of the Public Health (London) Act (sec. 27), the addresses of 138 workshops (employing 435 females and 4 male young persons) were forwarded to the Home Office. These were premises whose occupiers had failed to send notice of occupation to H.M. Inspector of Factories or in which the abstract of the Factory and Workshop Act was not affixed. I remain, Sir, Your obedient Servant, M. GWYNETH DAVIES, Sanitary Inspector of Workshops. The Medical Officer of Health cannot close this part of his report without expressing his appreciation of the exceedingly good work which both the female inspectors have accomplished during the year, and of the diligence with which they have pursued their duties. INSPECTION OF HOUSES LET IN LODGINGS. During last year there were 1,022 houses on the lists, which it was the duty of Inspectors Ward and Hancock to inspect. These premises are governed by the " Bye-laws relating to houses let in lodgings or occupied by the members of more than one family," which were adopted by the Council and approved by the Local Government Board in January, 1911. They were framed to meet the objections raised against the previous set of by-laws in the case of Arlidge v. the Islington Borough Council, decided in the High Court, who declared the old by-laws to be unreasonable because they required the landlord of a lodging-house to cause the work of cleansing to be done, although he might not be able to do it without committing a trespass; and they were also amended at the suggestion of the Local Government Board to meet their requirements in view of the pending legislation which was then under the consideration of the Govt rnment, and was afterwards embodied in the Housing and Town Planning Act, 1909. These by-laws are applicable to all houses let in the manner mentioned, although in practice in Islington they are only applied to such houses as require special attention, and to those whose owners have shown indifference as to the manner in which these properties were cared for. In the year under consideration there were 8,217 inspections and subsequent calls, to see how the owners were executing the work required under their notices. These inspections and calls were 2,863 less than those made in 266 1911] the preceding year. So large a deficiency was entirely due to the absence through illness of Inspector Ward, who was away during nearly the whole of the third quarter and the entire of the fourth, and who in the corresponding quarter of 1910 made 258 inspections and calls. His work had, therefore, to be undertaken by Inspector Hancock, who, owing to the much larger extent of area to be covered—the whole borough instead of one-half—could only pay 5,608 visits, as against 6,807 in the preceding year. This inspector, however, did his utmost to keep up the tale of inspections, and did, in fact, constantly visit the worst houses on the lists. The work performed included 1,364 inspections and 6,852 re-inspections and subsequent calls, while the notices numbered 908, of which 768 were intimations and 140 statutory notices. Synopsis of Inspector's Work.—In abating the nuisances the work set forth below became necessary :— Drains reconstructed ... 3 „ repaired 11 ,, traps supplied to 13 W.C.'s, extra provided 1 „ amended 48 „ water supply provided 194 Dustbins provided 52 „ repaired — Yards paved or re-paved 12 Water supply—cisterns (new) provided ... — cisterns, repaired and cleansed ... 28 Water supply provided 34 Rooms cleansed and limewashed 1,161 Walls and passages repaired, cleansed or limewashed 389 Floor space ventilated 2 Floors repaired 60 Overcrowding abated 65 Verminous rooms disinfected, &c. 103 Roofs repaired 144 Other improvements or nuisances abated 999 HOUSES LET IN LODGINGS. Table CXXXV. Summary of Sanitary Work carried out under Inspectors Ward and Hancock in Houses Let in Lodgings during the year 1911 Inspector Ward. Inspector Hancock. Total. 1st Quarter 2nd Quarter. 3rd Quarter 4th Quarter. Year. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Number of Houses inspected 152 106 3 .. 261 275 325 208 295 1,103 1,364 Re-inspections, Calls made. etc. 1,095 1,181 72 .. 2,348 1,360 1,387 1,441 1,317 4,505 6,853 Total inspections and calls 1,247 1,287 *75 .. 2,609 1,635 1,712 1,649 1,612 5,608 8,217 Notices Served. Intimation Statutory Personally 20 4 .. .. 24 92 46 62 71 271 295 By Post 31 32 .. .. 63 81 89 102 138 410 473 Personally .. .. .. .. .. 9 3 4 7 23 23 By Post .. 4 .. .. 4 13 6 72 22 113 117 Improvements. Drains— Constructed .. .. .. .. .. .. .. .. .. .. .. Re-constructed 1 .. .. .. 1 .. .. 1 1 2 3 Repaired 1 2 .. .. 3 1 4 l .. 6 9 Ventilated .. .. .. .. .. .. 1 .. 1 2 2 Gully and other Traps fixed 2 .. .. .. 2 .. 2 4 5 11 13 Urinals— Water supplied—cleansed .. 1 .. .. 1 4 .. .. .. 4 5 Cesspools— Abolished .. .. .. .. .. .. .. .. .. .. .. Water Closets— W.C. erected with pan, trap and water supply .. .. .. .. .. .. .. 1 .. 1 1 Pan and trap only provided .. 2 .. .. 3 5 2 4 5 16 19 Water supply provided 58 57 2 .. 117 22 15 28 12 77 194 Ventilated 11 .. .. Inspector absent through illness. 11 18 18 29 Position altered .. .. .. .. .. .. .. .. .. .. Dust Bins— Provided .. 5 .. 5 19 20 8 .. 47 52 Repaired .. .. .. .. .. .. .. .. .. .. Areas— Constructed .. .. .. .. .. .. .. .. .. .. Yards— Paved .. .. .. .. 1 .. .. .. 1 1 Re-paved 4 3 .. 7 4 .. .. .. 4 11 Sinks— Provided 1 .. .. 1 3 .. 2 4 9 10 Domestic Water Supply— Cisterns provided .. .. .. .. .. .. .. .. .. .. Cisterns repaired and cleansed 2 3 .. 5 5 5 7 6 23 28 Water supply provided to dwelling house 2 3 .. 5 .. .. .. .. .. 5 Water supply provided for tenement house .. 1 .. .. 1 4 .. 2 22 28 29 Other Improvements- Rooms cleansed or limewashed 61 113 28 .. 202 34 536 298 91 959 1,161 Walls and passages repaired, cleansed and whitewashed 7 28 2 .. 37 3 249 97 3 352 389 Floor space ventilated 2 .. .. .. 2 .. .. .. .. .. 2 Floors repaired 29 7 .. .. 36 3 7 8 6 24 60 Roofs repaired 17 14 2 .. 33 24 19 30 38 111 144 Overcrowding abated 1 .. .. .. 1 13 21 8 22 64 65 Illegal use of underground rooms for sleeping discontinued .. .. .. .. .. 1 .. .. 1 2 2 Other Improvements or Nuisances abated 107 239 16 .. 362 191 127 127 175 620 982 Rooms Disinfected 93 2 .. .. 95 .. .. 8 .. 8 103 Total Improvements 399 480 51 .. 930 337 1,008 634 410 2,389 3,319 Total Premises Improved 219 238 15 .. 472 142 322 261 204 929 1,401 * Inspector Ward was absent during the greater part of the quarter owing to ??? 268 19111 DISTRICT INSPECTION. The largest portion of the work of the Public Health Department devolves on the District Inspectors, for it is their duty not only to inspect all those places enumerated in Table CXXXVI,, but also to make enquiries respecting the cases of infectious disease, whether notified by the medical profession, under the Public Health (London) Act, 1891, or by the teachers of the London County Council schools by order of that body. They are also required to undertake the house to house inspection of the borough as required by the provisions of the Housing and Town Planning Act, while they are also the persons on whom devolve the duty of making enquiries (such as they are) respecting p???lmonary tuberculosis, ophthalmia neonatorum, and other diseases notifiable either by an Order of the Local Government Board or the London County Council. And, finally, they have to make enquiries under the Notification of Births Act, although naturally they make no attempt, nor would they be allowed, to instruct mothers as to the rearing of their infants. Of course no man can make more than a certain number of visits in his usual working day, and as there is no reason to suppose that, hitherto, each has not done a fair day's work, but every reason to suppose that he has, it is clear that the additional duties cast on the staff by modern legislation can only be undertaken by neglecting their sanitary proper work, to perform duties for some of which they come very inadequately equipped, and which can only be efficiently undertaken by highly trained women. The views of the Medica' Officer of Health on these matters are so well known to the Public Health Committee, and, indeed, to the Council, that he will not reiterate them. Altogether 66,466 inspections and calls were made to the various premises specified in Table CXXXVI., of which 5,980 related to separate houses. To these separate houses they subsequently paid 55,298 visits. They also made 134 inspections of places where ice creams are made, 1,661 to milk shops, 419 to stables, 1,393 to yards, 88 to manure depots, 188 to vacant lands and courts, 771 to public house urinals, 5 to houses in respect to which certificates under the Customs and Inland Revenue Acts were required, 7 to houses respecting the water supply, and 355 inspections on Saturday evenings, which entailed many thousand visits to shops, stalls and markets, where food of all sorts is sold. They also made 161 observations of factory chimneys issuing black smoke. This is a long tale of work, which on the whole was admirably done. A synopsis of it is set out on p. 270. 269 [1911 House to House Inspections.—701 houses were examined in this manner. For several years an inspection of this character has been undertaken, and a map showing the premises inspected has been kept. This work is very important, and is made on the sound principle that it is the duty of a sanitary authority to prevent sickness by seeking for the nuisances which are likely to cause it. Hence the Medical Officer of Health has since 1899 endeavoured to have such inspections made. During the last three years, however, they have decreased, owing to the increased duties which have devolved on the staff through recent legislation. Up to now there was no compulsion to make these inspections, although the Local Government Board recommend them, yet in the future this will not be so, for the Housing and Town Planning Act leaves no option to sanitary authorities, while the Insurance Committees appointed under the National Insurance Act are certain to see that the work is done. How it is to be done by the present staff in Islington without relief in other directions, in the manner pointed out by the Medical Officer of Health, is a problem which remains to be solved. The following statement indicates the house to house inspections made annually since 1899, towards the middle of which year it was begun :— Years. House to House Inspections. Years. House to House Inspections. 1899 387 1906 2,088 1900 883 1907 1,696 1901 821 1908 1,202 1902 807 1909 783 1903 1,999 1910 934 1904 1,903 1911 701 1905 1,725 Total 15,939 These figures represent a large amount of work, and show that at least two-fifths of the houses in Islington were inspected systematically during the last thirteen years. The Housing and Town Planning Act will expect considerably more to be done, for it will have to be undertaken as part of the everyday work of the Inspectors, and not, as in the past, spasmodically, which means when other work permitted. Records, also, are to be kept in a specified manner, which will show the defects that have been discovered, besides other details. This work has not, however, been seriously begun up to now, but probably before this report is in print it shall have been commenced in the manner required by the Act. The necessary register 270 1911] cards are nearly ready, and the register files have been ordered. Still it is well that in the past so much of this class of work was undertaken in the borough, for it places the Council in a much better position than they probably anticipated. Some years ago the Medical Officer prepared a map, based on the census returns for each enumeration area, which showed these areas, coloured according to the degree of crowding in them. It is a very instructive cartoon, as it shows at a glance those parts of the borough which are most likely to require attention. When the most crowded areas have been inspected it is then proposed to turn attention to those which are less crowded, and so on. There is, however, an enormous amount of work to be undertaken, for Islington, with its ten miles circumference, is no small place—but a large compact area, with more people living on each of its acres than on the acres of any provincial town in the kingdom. This house to house inspection will take a long while for its accomplishment, and unless special means be adopted, for it must be recollected that there are some 40,000 houses in the borough, it will be a work of years. Whether this will satisfy the requirements of the Housing and Town Planning Act remains to be seen. If it should not, then it might, indeed probably would, become necessary to appoint a special staff to carry out the inspection. It is to be hoped that they will not be required, for it cannot be truly said by any one that even the majority of the houses of Islington require more than the inspection which the Medical Officer of Health has indicated in his. remarks. In support of this contention he would mention the f emarkable fact that in the last twenty years one million two hundred and forty-three thousand one hundred and twenty-two inspections and visits (1.243,122) have been made to the houses in Islington, which represent 32 visits to every house. Of course every house was not visited, but houses which required it were visited more frequently. Synopsis of the Inspector's Work.-The following statement gives a brief synopsis of the district inspectors' work in 1911 :— House to house inspections 701 Other inspections of dwelling houses 52,279 Re-inspections and calls made 55,298 Visits of inquiry re notifiable infectious diseases 1,759 „ school cases of „ 4,876 Butchers' shops, stalls, etc. (Saturday nights) 355 271 [1911 Ice cream shops and factories 134 Dairies and milkshops 1,661 Stables and yards 1,812 Manure depots 88 Certificates under the Customs and Inland Revenue Acts 5 Water certificates for newly erected houses or flats 7 Smoke observations 161 Notices Served— There were 2,916 intimation notices served by the inspectors with respect to nuisances, of which 1,548 were delivered personally and 1,368 by post. In 366 instances it became necessary, as the intimations had not been attended to, to report to the Public Health Committee, who ordered statutory notices to be served, of which 53 were delivered personally and 313 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 991 Damp 226 Out of repair 430 Water Closets Foul 405 Without water supply 166 With deficient water supply 241 Improperly constructed 338 Defective 294 Stopped 95 Improperly situated 29 Insufficient external ventilation 70 Insufficient in number 79 Soil Pipes. Defective 105 Unventilated 64 Improperly ventilated 76 272 19111 Yards. Improperly paved 605 Dirty 114 Undrained 33 Drains. Foul 16 Defective 703 Choked or stopped 255 Unventilated 132 Overcrowding 96 Underground Rooms 35 Other Nuisances 5,176 Total Nuisances 10,774 NOTICES SERVED FOR THE ABATEMENT OF SMOKE NUISANCES DURING 1911. 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. Plaistowe's, Wharfdale Road. Smethurst's, 91a, Fonthill Road (2). Mayfield Laundry, Gillespie Road. 69, Holloway Road. Poulton & Noel's, 62, Brewery Road. Green's Factory, Dagmar Terrace. Highbury Steam Laundry, 87, Holloway Road. Westinghouse Brake Co., 82, York Road. Gt. Northern Electric Light Station, Drayton Park (3) Times Laundry, York Road. Provender Stores, Wellington Road. 59, Junction Road. Lead Works, Southgate Road. Engine, situated in Torrens Street. Northern Polytechnic, Holloway Road. 239 Junction Road. 114, Duncombe Road. Hornsey Road Baths. Bottling Factory, Northampton Grove. 273 [1911 One can say with some certainty that the amount of black smoke now given off by factory and workshop chimneys in Islington, and indeed in London as a whole, is not nearly so great as formerly, owing to the more firm administration of the smoke clauses of the London Public Health Act; and were it not for the apparently lax administration of the law in some of the boroughs on the borders of the County this great nuisance would not be as great as it is. The abatement of smoke nuisances is of vital importance to London, not only on account of their effect on health and vegetation, but also because of the very material injury which they cause to our ancient buildings. Recent experimenters (Drs. H. A. des Vceuex and J. S. Owens) reported their observations on the London soot-fall in the Lanctt of January G, 1912. They collected rain water in soot-gauges (large rectangular hoppers of 4 square feet area connected with large bottles), from June 1910 to June 1911, and analysed the contents at intervals of a month, and they found in the 192 litres of rain collected at Old Street the following matters:— Total deposit 92.81 grams. Ammonia (NH3) 7.54 grams. Insoluble (soot) 60-92 „ Chlorine (CI.) 4.05 „ Dissolved Solids 31.89 „ Lime (Ca O) 1.26 „ Sulphate (SO4) 10.04 „ They also found that the total deposit per square mile was 650 tons, and for London 76,050 tons. These figures afford some indication as to the amount of scot and noxious gases deposited annually in London, but perhaps they will be better understood if summarised:—Of the 76,050 tons total deposit which fell on the 117 square miles of the London area 6,000 tons were present as Ammonia, 800 tons as sulphates, and 3,000 tons as chlorides. The greatest amount of insoluble deposit (soot) fell in the City during October, on days when fog was prevalent; an 1 in the S.W. district during January and February; the minimum deposit fell in the City in September and October, and in the S.W. district in September and October. From September 1st, 1902, to March 31st, 1903, 39 fogs occurred in London, of which 27 were radiation and contact fogs, 4 were cloud fogs, and 8 were smoke fogs, that is 20 per cent, of London fogs were artificially induced and preventable (Cohen and Ruston's " Smoke: A Study of Town Air," page 62). There seems little hope of ridding London of fogs until the enormous amount of smoke that is now sent forth by the chimneys of private T 274 1911] houses is checked. It would be true economy to do so, for the value of soot, as a manure, owing to the nitrogen it contains, may be taken at about £2.10s. per ton. On this basis the value of the soot, deposited in London annually is worth £190,125, which is entirely lost as a heat factor owing to the imperfect combustion of the ordinary firegrates and even factory flues. SYNOPSIS OF THE DISTRICT INSPECTORS' SANITARY WORK FROM 1891 to 1911 (21 years). Houses inspected and visited - 1,243,122 Drains Constructed 20,714 „ Improved and repaired 18,618 „ Traps fixed 101,154 Water closets, pan, trap, etc., furnished 21,664 „ Pan and trap only, furnished 20,642 „ Water only, furnished 8,987 Soil pipe, defective, renewed or remedied 4,117 „ Insufficiently ventilated, fully ventilated 3,555 „ Unventilated, ventilation supplied 5,973 Dust Bins, Provided 18,727 „ Repaired 4,003 Surface drainage, Constructed 11,977 ,, Relaid 24,566 Water supply, new cisterns provided 4,327 „ Cisterns repaired and cleansed 12,264 „ New supply 8,008 Houses generally Repaired 10,897 „ Cleansed 19,952 „ Ventilated 13,562 Other Improvements 141.570 Total Improvements 475,277 Table cxxxvi. Showing summary of Sanitary Work from Inspectors' reports for the Year 1911. DISTRICTS. Totals.[/ ###] 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14 House to House Inspections 128 10 59 55 8 12 125 42 19 81 67 22 36 37 701 Other premises inspected 332 451 212 440 257 318 339 338 375 415 464 516 370 452 5279 Re-inspections, Calls made, etc. 3919 3985 j368 4036 1093 3871 *840 4134 3011 1674 4359 3975 4323 4715 55298 Ice Cream Factories inspected 3 11 32 6 2; 13 7 4 20 20 1 10 5 134 Dairies and Milkshops ,, 120 107 90 208 125 77 167 121 135 89 144 71 155 52 1661 Stables „ 47 27 10 33 78 45 63 7 5 22 10 10 6 56 419 Yards ,, 53 114 331 67 85 119 132 19 43 207 19 74 78 52 1393 Manure Depots 86 .. .. .. .. 1 .. .. .. .. .. 1 .. .. 88 Vacant land, Passages and Courts inspected 70 7 20 .. .. 1 25 1 1 29 7 9 8 10 188 Urinals attached to P.H.'s inspected 15 74 74 36 185 33 59 41 3 203 21 1 2 24 771 Premises (re Certificate Customs and Inland Revenue Acts) inspected .. 1 .. 2 .. 2 .. .. .. .. .. .. .. .. 5 Premises (re Water Certificates) inspected 1 .. 3 .. .. 2 1 .. .. .. .. .. .. .. 7 Visits re Sale of Food and Drugs Acts .. .. 2 1 .. 2 .. .. .. .. .. .. .. 1 6 Smoke observations 3 23 .. 19 2 9 15 1 13 42 13 11 2 8 161 Shops, Stalls and Markets (Saturday evening) 26 26 22 25 27 24 26 27 23 24 31 25 27 22 355 Total Inspections and calls 4803 4836 4218 4928 4862 4516 4805 00 CO 3632 CO o GO 5155 4716 5017 5131 66466 Notices Served. Intimation — Personally 225 46 100 169 83 20 141 85 101 62 134 24 66 292 1548 By Post 9 6 2 225 91 3 191 118 26 99 77 247 113 161 1368 Statutory—Personally 8 .. 1 15 4 .. 1 .. 2 .. 2 4 8 8 53 By Post 19 9 4 53 37 16 16 17 9 38 20 17 22 36 313 Improvements. Drains- Constructed 1 .. 1 7 1 .. 3 1 .. 1 .. .. 4 1 20 Re-constructed 40 56 19 39 29 29 46 47 13 54 22 36 73 32 535 Repaired 36 24 20 41 17 12 23 8 28 38 58 30 23 40 398 Ventilated 28 51 8 24 25 19 36 38 6 37 8 35 57 25 397 Gully and other traps fixed 327 297 105 161 183 91 331 243 125 217 93 165 272 201 2811 Urinals—Water supplied, cleansed 3 1 4 7 0 .. 1 5 1 1 8 .. 1 7 44 Cesspools—Abolished .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. Water Closets— W.C. erected with pan, trap and water supply 2 1 6 8 2 10 9 1 4 5 1 7 5 5 66 Pan and trap only provided 79 107 26 59 51 26 97 92 68 76 39 74 114 64 972 Water supply provided 32 44 20 35 36 19 32 20 56 43 38 15 39 76 505 Ventilated 4 3 2 3 2 .. 6 4 6 18 1 1 10 60 Position altered .. 1 7 4 1 .. 1 1 1 2 18 Dust Bins—Provided 105 57 34 154 88 23 109 85 58 147 151 43 48 170 1272 Repaired 3 .. 3 4 5 .. 3 .. .. 2 33 .. .. 8 61 Areas—constructed .... .. .. .. .. 3 3 .. 1 .. .. 2 2 6 17 Yards—Paved 1 2 7 18 11 i4 8 i6 2 4 11 13 109 Re paved 63 84 14 72 50 16 102 53 42 47 104 120 77 101 945 Sinks—provided 70 28 3 12 10 4 25 8 38 29 24 26 27 31 335 Domestic Water Supply— Cisterns provided .. .. .. 2 .. 1 .. 1 .. .. 1 .. .. 3 8 Cisterns repaired and cleansed 25 28 51 53 8 15 31 8 29 22 41 29 16 35 391 Water Supply provided to dwelling house 9 19 7 21 9 13 5 37 6 24 20 18 9 14 211 Water supply provided to ten ment house 91 14 4 16 13 25 2 12 29 65 25 14 43 358 Other Improvements— Rooms cleansed and limewashed 159 32 130 198 64 100 145 64 202 95 255 416 232 281 2373 Walls and passages repaired cleansed and limewashed 18 8 9 56 22 11 22 10 30 15 116 90 44 82 533 Floor space ventilated 1 4 1 14 21 7 11 2 3 7 15 20 23 128 Floors repaired 14 12 7 39 10 34 25 19 21 13 69 39 64 44 410 Roofs repaired 44 25 13 67 12 31 34 19 19 14 80 73 31 37 499 Overcrowding abated 2 1 1 4 7 .. 4 3 4 4 7 3 7 47 Illegal use of underground Rooms for sleeping discontinued .. .. .. .. .. .. 3 .. .. .. 8 .. 2 7 20 Other Improvements, or Nuisances abated 178 154 68 17b 58 70 129 47 149 202 174 200 161 261 2037 Rooms Disinfected 141 202 196 191 152 68 62 71 150 156 89 65 228 163 1934 Total Improvements 1476 1255 761 1474 863 645 1326 912 1071 1297 1529 1535 1580 1790 17524 Total Premises Improved 493 419 334 590 306 148 373 269 378 520 574 360 410 55-5 5729 276 1911] Table CXXXVII. Giving a Summary of the Nuisances discovered by the District Sanitary Inspectors during the Four Quarters and for the Year 1911, 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 241 254 276 220 991 2. „ ,, in a damp condition 60 47 35 84 226 3. ,, in a dilapidated condition 128 84 114 104 430 4. The inlet of surface drain improperly trapped 58 13 18 32 121 5. The water-closet so foul as to be a nuisance 125 81 98 101 405 6. ,, without a water supply 34 37 65 30 166 7 „ with a deficient supply of water 51 61 72 57 241 8. ,, ,, improperly constructed so as to be a nuisance 113 79 82 64 338 9. ,, ,, so defective as to be a nuisance 75 63 86 70 294 10. „ „ stopped 35 21 20 19 95 11. ,, ,, placed in an improper position Insufficient external ventilation to water-closets 10 6 5 8 29 12. 13 12 23 22 70 13. Insufficient water-closet accommodation 14 19 25 21 79 14. The soil pipe defective 24 23 33 25 105 15. „ unventilated 21 12 18 13 64 16. ,, improperly ventilated 19 13 26 18 76 17. The yard in a condition injurious to health by reason of the want of proper paving 198 107 111 189 605 18. The yard dirty 41 21 21 31 114 19. undrained 4 15 4 10 33 20. A gully trap improperly placed within the house 52 36 33 44 165 21. The waste pipe of sink directly connected with the drain 36 12 24 13 85 22. ,, „ improperly trapped 4 2 18 2 26 23. ,, ,, untrapped 158 129 117 154 558 24. „ of lavatory directly connected with the drain 2 1 2 3 8 25. „ ,, improperly trapped .. 1 2 .. 3 26. „ „ untrapped 20 17 10 17 64 27. „ of bath directly connected with the drain 8 2 .. 2 12 28. „ ,, improperly trapped .. .. .. 1 1 29. „ ,, untrapped 32 19 15 18 84 30. The water cistern so foul as to be a nuisance 97 78 93 89 357 31. „ „ being without a close fitting cover 89 84 103 83 359 32. „ „ being placed in an improper position 15 16 32 35 98 33. „ „ defective 9 13 10 6 38 277 [1911 TABLE CXXXVII.—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 77 70 49 61 257 35. The dustbin or ashpit defective 218 307 260 312 1 097 36. ,, „ placed in an improper position .. 3 6 2 11 37. The drain foul 6 5 5 16 38. ,, defective 212 159 138 194 703 39 „ choked or stopped 50 63 81 61 255 40. ,, unventilated 49 24 28 31 132 41. The rain-water pipe in direct communication with the drain 37 14 23 32 106 42. ,, ,, in direct communication with the soil-pipe 1 3 3 1 8 43. „ defective 46 36 33 75 190 44. The water supply used for domestic purposes connected with the cistern which is used for flushing the W.C. .. .. 17 .. 17 45. The house without a proper water supply 119 121 103 112 455 46. The roof defective 85 87 88 186 446 47. The guttering defective 66 31 33 70 200 48. The area improperly paved 14 11 6 15 46 49. „ dirty 3 3 5 4 15 50. „ undrained .. 8 2 4 14 51. The paving of the washhouse defective 33 31 33 24 121 52. The back addition walls defective 1 .. .. 1 2 53. The want of a proper manure receptacle 1 1 9 2 13 54. The bakehouse walls dirty .. .. .. .. .. 55. An animal kept in such a manner as to be a nuisance 9 12 21 24 66 56. The house or part of a house so overcrowded as to be injurious or dangerous to the health of the inmates 27 16 32 21 96 57. An underground room occupied as a dwelling contrary to the provisions of the Act 12 9 10 4 35 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 .... 1 .. 1 2 59. The space below floor in the basement or ground floor being unventilated 5 9 5 5 24 60. The space below floor in the basement or ground floor being improperly or insufficiently ventilated 44 26 19 18 107 All Nuisances 2.901 2,428 2.600 2,845 10,774 1911] 278 Table CXXXVIII. Giving a Summary of the Sanitary Work performed by the District Inspectors in 1911. Inspections. QUARTERS. The Year. First. Second. Third. Fourth. House to House Inspections 304 180 117 100 701 Number of Houses Inspected 1,172 1,259 1,420 1,428 5,279 Re-inspections, Calls made, &c. 15,246 13,725 11,704 14,623 55,298 Total Visits 16,722 15,164 13,241 16,151 61,278 Visits to Ice Cream Factories 2 70 62 .. 134 Do. Dairies and Milkshops 342 341 549 429 1,661 Do. Stables and Yards 511 444 463 394 1,812 Do. Manure Deôpts 24 24 17 23 88 Do. Vacant Land Passages and Courts 47 51 33 57 188 Do. Urinals attached to P.H.'s 189 188 201 193 771 Do. Under Customs and Inland Revenue Acts 4 1 .. .. 5 Do. re Water Certificates 3 3 1 .. 7 Do. Shops and Stalls on Saturday Nights .. 91 88 88 88 355 Do. Sale of Food and Drugs Act 2 4 .. .. 6 Smoke Observations 40 51 30 40 161 All Inspections, Visits, &c. 17,977 16,429 14,685 17,375 66,466 279 [1911 REMOVAL OF DUST. The removal of household dust, which is of an infinite variety, coal ashes, sweepings, tea-leaves, vegetable refuse, bones, milk tins, and a host of other material more or less of a putrescible nature, is one of the most important duties delegated to a sanitary authority; for as it is performed well or ill, so there will or will not be an unhealthy deposit in the vicinity of our houses. This work is now all the more important since the relationship of the fly to disease has become better understood. He is known to breed in such refuse; and as the period of his hatching out from the egg to the larva, and from the larva to the pupa, and from the pupa to the full-blown fly is short, it becomes of still further moment, not only to the immediate householder, but to his neighbours and even to people living at a distance. Collections of stale refuse teem with microbes; and as flies can convey them on their feet and wings, and in their stomachs, it is well to afford them no feeding places, especially foul feeding places where they can also breed. As a single flyspeck may contain three thousand typhoid bacilli it is very apparent that they are a decided danger. It is, therefore, satisfactory to find that few complaints have been received respecting the manner in which the dust has been removed during the year. That the time will arrive sooner or later when all household dust shall be removed at least twice a week is certain ; and what is also certain is that one or more destructors will be required for incinerating it. Rural authorities will not always permit putrescible, or semi-putrescible matter to be dumped in their districts, for where there are heaps of refuse there are flies; and where there are flies the contamination of dairy produce is certain. It is, therefore, well to be prepared for such an event. At present the borough gets rid of this refuse cheaply, and so far as Islington is concerned, satisfactorily. The particulars for each year since 1891 are as follows:— Applications to Remove Dust. Applications to Remove Dust. 1891 10,138 1902 198 1892 9,964 1903 152 1893 4,986 1904 116 1894 4,506 1905 89 1895 4,596 1906 58 1896 4,245 I907 55 1897 312 1908 64 1898 303 1909 67 1899 262 1910 44 1900 234 1911 52 1901 157 Dust Receptacles Provided.—During the year 1,324 dust receptacles were provided, while 61 were repaired 280 h-k cd I—i Table CXXXIX. Summary of Applications for the Removal of Dust during the Year 1911. Ward. 1st Quarter 2nd Quarter. 3rd Quarter 4th Quarter. Year. Number of Assessments Michaelmas, 191: Number of Applications to every 100 Assessments. 1 1 2 5 — 8 4,925 0.l62 2 — 2 1 — 3 4,799 0.062 3 1 — — — 1 4.508 0.022 4 1 — 2 — 3 5,49.3 0 055 5 — 1 1 — 2 5,758 0.035 6 1 9 5 2 17 4.126 0.412 7 — — — — — 4,018 — 8 — 1 — 1 2 2,736 0.073 9 2 — 2 — 4 2,910 0.137 10 — 2 3 1 6 3,553 0.169 11 4 1 1 — 6 4,706 0.127 Totals 10 18 20 4 52 47,532 0.109 281 1011 STATE OF PAUPERISM IN THE BOROUGH. Last year the Medical Officer of Health commented on the increasing number of paupers in the borough, as judged by the returns of the Board of (iuardians. This year he has to note a slight falling off for the average number of persons relieved in each week of its weeks shows a decrease from 10,773 in 1910, to 9,553. This is almost identical with the figure for 1907 9,599. Compared, however, with 1899 it shows an increase of 39 per cent., and with 1901, eleven years ago, 30 per cent. It is not for him to discover the cause of this large increase; indeed, he does not know it, but whatever the cause it is most regrettable, and one that should engage the very serious attention of the Board of Guardians, as doubtless it does. 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 9599 1908 10,349 1909 10,476 1910 10,773 Average 8,699 1911 9,553 ,, Indoor Paupers. — The average number relieved each week was 4,974, or 43 less than the average which obtained in the preceding year, and as contrasted with a weekly average of 4,186 in the decennium 1901-1910. Outdoor Paupers.—On an average 4,579 persons were relieved in each week, as compared with 5,755 in 1910, with 5,612 in 1909, and with a decennial weekly average of 4,877. Of these paupers, the average number of adults was 2,573, and of children under 16 years of age 2,006. Vagrants.—No vagrants were relieved, as the wards were closed in January, 1909. 282 1911] Children Boarded out.—On a weekly average, these numbered 102, as compared with 106 in the preceding year. They were also '2'2 less than the decennial weekly average of the year 1901-11)10. Table CXL. Showing the State of Pauperism in the Borough during the years 1901-1910 and 1911. Average number Relieved during each week. Years. 1 Indoor Paupers, Adults and Children. 2 Outdoor Paupers. T otals Outdoor. 5 Totals. All paupers relieved, cols. 2 & 5. 6 Vagrantst Relieved. 7 Children Boarded out. 8 Deathrates. 9 Adults. 3 Children under 16. 4 1931 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 1393 1909 4,864 3,649 1,963 5,612 10,476 Wards closed 107 14.96 1910 5,017 3,721 2,035 5,755 10,773 ,, 106 13.79 Average 4,180 3,223 1,654 4,877 9,057 26 124 15.16 1911 4,974 2,573 2,006 4,579 9,553 No Wards 102 14.70 Table CXLI. Showing the State of Pauperism in the Borough during the year 1911 Average number Relieved during each week. Quarters. 1 Indoor Paupers, Adults and Children. 2 Outdoor Paupers. Totals. 5 Totals corresponding periods 6 Vagrants Relieved. 7 Children Boarded out. 8 Deat rates. Adults. 3 Children under 16. 4 1st Qr. 5,156 2,618 2,117 9,391 11,020 No Wards. 107 17.01 2nd ,, 4,841 2,395 1,880 9,116 10,420 104 12.87 3rd „ 4,796 2,538 1,963 9,297 10,473 104 14.96 4th ,, 5,103 2,743 2,062 9,908 11,179 95 13.94 TheYear 4,974 2,573 2,006 9,553 10,773 — 102 14.70 283 [1911 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 CXLII. 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 27 M. Wm. Norman. 14, 16. Barnsbury Street 51 M. Ellen Maples 18, 20 & 22, Barnsbury Slreet 91 M. „ 47a, Campbell Road 71 M. Wm. Jno. 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 63 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. 104 & 106, George's Road 30 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. Mrs. Mary Jane Somerville. 29, Hornsey Road 88 M. Sidney Allen. 8a, Hornsey Street 48 M. Rev. Wilson Carlile. 10, Milton Place 22 M. Lewis Henry Levy 4 & 6, Queensland Road 34 M. Margaret Jones. 8 & 10, Queensland Road 18 M.C. „ 23 & 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. 284 1911] ARTIZANS AND OTHER DWELLINGS. Under this heading are included, not only houses or blocks of dwellings devoted to the artizan classes, but also to those that are occupied by the people of the clerical and similar classes. They are steadily increasing in number. I here are now some 442 dwellings, containing 5,109 separate flats or tenements, in the borough, and they are occupied for the most part by the working classes. As remarked last year, 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. Tutnell Wessex Buildings Wed mo re 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. 21 and 26, Pemberton Gardens Holloway Road 3 7 „ *Fulford Mansions.. Fairmead Road 2 14 „ *10, St. John's Park Holloway Road 1 3 „ *47, Hargrave Paik 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 Read Horcsey 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 Marsions Tollington Park 4 16 „ *Tollirgton Park, Nos. 14, 16,20, 22,24, 26, 28 and 30 „ 8 16 „ *Albert 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 „ Camden Dwellings York Road 1 44 * These fiat tenements are occupied by the better middle-class people. 285 [1911 ARTISANS AND OTHER DWELLINGS—continued. WARD. Name of Dwellings Where situated. No. of Blocks. No. of separate Dwellings. Lower Holloway North London Cottages Market Ro.id 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 Buildirgs 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 „ * I .orame Mansions Widdenham Road 38 160 „ *Morgan Mansions Holloway Road 8 64 „ L.C.C. Dwellings Caledonian Road „ Burns 1 30 „ Scott 1 30 „ Wallace 1 70 „ Knox 1 66 „ Bruce 1 76 Highbury Lome Buildings Ben well 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 Aberdf en 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 „ *3, Highbury Hill Highbury 1 5 „ *15, Highbury Crescent Highbury Crescent 1 4 „ *16, „ 1 4 „ *55, Highbury Park Highbury 1 10 „ *01, Highbury Park „ 1 5 „ *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 * These flat tenements are occupied by the belter middle-class people 286 1911 ARTISANS AND OTHER DWELLINGS—continued. WARD. Name of Dwellings. Where situated. No. of Blocks. No. of separate Dwellings. Barnsbury Halliford House Upper Park Street 1 12 ,, Thanet House „ 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 Canonbury Road 1 4 ,, Canonbury Avenue 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 Palmerston Buildings City Garden Row 3 72 ,, Torren's Buildings Torren's Street 0 83 ,, Myddelton Buildings High Street 5 80 ,, Albany Cottages Popham Street 1 98 ,, Cornwall Cottages „ 1 94 ,, Edinburgh Cottages Queen's Cottages „ 1 86 ,, „ 1 86 ,, Quinn Buildings „ 13 240 ,, f'eabody Buildings Greenman Street 10 294 ,, Dibden Street Buildings Dibden Street 4 32 ,, Pickering Street Buildings Pickering Street .. 11 83 ,, Nos. 10a, 11a, 12 a, 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 12 442 5,109 * These flat tenements are occupied by the better middle-class people. 287 [1911 ADMINISTRATION OF THE HOUSING, TOWN PLANNING. Etc., ACT, 1909. In a general Order made under Section 17 (1) of this Act, the duties of the local authorities and their officers are fully set forth, and as these duties are very important, it is necessary that the Council should have the Regulations before them. They are as follows:— HOUSING OF THE WORKING CLASSES, ENGLAND. Unhealthy Houses. The Housing (Inspection of District) Regulations, 1910. Dated September 2nd, 1910. To the several Local Authorities in England and Wales for the purposes of Part II. of the Housing of the Working Classes Act, 1890; — And to all others whom it may concern. Whereas by sub-section (1) of Section 17 of the Housing, Town Planning, &c., Act, 1909, it is enacted that it shall be the duty of every local authority within the meaning of Part II. of the Housing of the Working Classes Act, 1890 (hereinafter referred to as "the local authority") to cause to be made from time to time inspection of their district, with a view to ascertain whether any dwelling-house therein is in a state so dangerous or injurious to health as to be unfit for human habitation, and that for that purpose it shall be the duty of the local authority, and of every officer of the local authority, to comply with such regulations and to keep such records as may be prescribed by the Local Government Board. Now therefore, We, the Local Government Board, in pursuance of the powers given to Us in that behalf, by this Order, prescribe the following Regulations; that is to say:— Article I.—(1) The local authority shall as early as practicable after the date of this Order take into consideration the provisions of sub-section (1) of Section 17 of the Act of 1909, and shall determine the procedure to be adopted under these Regulations, to give effect to the requirements of that sub-section in regard to the inspection of their district from time to time. 288 19111 (2) The local authority shall as part of their procedure make provision for a thorough inspection to be carried out from time to time according to the varying needs or circumstances of the dwelling-houses or localities in the district of the local authority. (3) The local authority shall cause to be prepared from time to time by the Medical Officer of Health, or by an officer designated by them but acting under his direction and supervision, a list or lists of dwelling-houses the early inspection of which is, in the opinion of the Medical Officer of Health, desirable. The list or lists may, if thought fit, relate to the dwelling-houses within a defined area of the district without specifying each house separately therein. Article II.—The inspection under and for the purposes of sub-section (1) of Section 17 of the Act of 1909 shall be made by the Medical Officer of Health, or by an Officer designated by the local authority but acting under his direction and supervision, and the Officer making inspection of any dwelling-house shall examine the state of the dwelling-house to the following matters, namely:— (1) The arrangements for preventing the contamination of the water supply. (2) Closet accommodation. (3) Drainage. (4) The condition of the dwelling-house in regard to light, the free circulation of air, dampness, and cleanliness. (5) The paving, drainage, and sanitary condition of any yard or houses belonging to or occupied with the dwelling-house. (C>) The arrangements for the deposit of refuse and ashes. (7) The existence of any room which would in pursuance of sub-section (7) of Section 17 of the Act of 1909 be a dwelling-house so dangerous or injurious to health as to be unfit for human habitation. (8) Any defects in other matters which may tend to render the dwelling- house dangerous or injurious to the health of an inhabitant. Article III.— Records of the inspection of dwelling-houses made under and for the purposes of sub-section (1) of Section 17 of the Act of 1909 shall be prepared under the direction and supervision of the Medical Officer of Health, and shall be kept by the Officer of the local authority making the inspection or by some other Officer appointed or employed for the purpose by the local authority. 289 [1911 The records may be kept in a book or books or on separate sheets or cards, and shall contain information, under appropriate headings, as to:— 1. The situation of the dwelling-house, and its name or number. 2. The name of the Officer who made the inspection, 3. The date when the dwelling-house was inspected, 4. The date of the last previous inspection and a reference to the record thereof. 5. The state of the dwelling-house in regard to each of the matters referred to in Article II. of these Regulations, 6. Any action taken by the Medical Officer of Health, or other Officer of the local authority, either independently or on the directions of the local authority, 7. The result of any action so taken, 8. Any further action which should be taken in respect of the dwelling- house. Article IV.—The local authority shall, as far as may be necessary, take into consideration at each of their ordinary meetings the records kept in pursuance of Article III. of these Regulations, and shall give all such directions and take all such action within their powers as may be necessary or desirable in regard to any dwelling-house to which the records relate, and a note of any directions so given and the result of any action taken shall be added to the records. Article V.—The Medical Officer of Health shall include in his Annual Report information and particulars in tabular form in regard to the number of dwelling-houses inspected under and for the purposes of Section 17 of the Act of 1909, the number of dwelling-houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation, the number of representations made to the local authority with a view to the making of closing orders, the number of closing orders made, the number of dwelling-houses the defects in which were remedied without the making of closing orders, the number of dwelling-houses which after the making of closing orders were put into a fit state for human habitation, and the general character of the defects found to exist. He shall also include any other information and particulars which he may consider desirable in regard to the work of inspection under the said Section. Article VI.—The Medical Officer of Health and any other Officer of the local authority shall observe and execute all lawful orders and directions of U 290 1011] the local authority in regard to or incidental to the inspection of the district of the local authority under and for the purposes of Section 17 of the Act of 1909, and the execution of these Regulations. Article VII. In these Regulations " the Act of 1909 " means the Housing, Town Planning, &c., Act, 1909. Article VIII.—These Regulations may be cited as the Housing (Inspection of District) Regulations, 1910. Given under the Seal of Office of the Local Government Board, this Second day of September, in the year One thousand nine hundred and ten. (l.s.) John Burns, President. H. C. Monro, Secretary. Particulars as to property dealt with under the Housing and Town Planning Act 1909. Property. Closing Order made. Closing Order determined. Demolition Order made. Demolition completed. 1910. 48 Queensland Rd. 18th November 19th Jan. 1912 1st March, 1912 50 „ „ „ „ 52 „ „ „ „ 54 „ „ „ „ 10 Henshall Street „ 9th June 1911 12 „ „ „ 14 „ „ „ 16 „ „ — 27 Orchard Street „ 9th June 1911 29 „ „ „ 1911. 1 Rice Place 2 „ 2nd February 17th Nov. 1911 3 „ „ „ „ 4 ,, „ „ 5 „ „ „ 6 ,, 7 „ „ „ „ 8 ,, „ „ 1 Bratton Street „ 6th Oct. 1911 3 „ „ 17th Nov. 1911 5 „ „ 6th Oct. 1911 7 „ „ 17th Nov. 1911 9 „ „ „ 11 „ „ „ 13 „ „ 6th Oct. 1911 15 „ „ „ 8 Hope Place „ 17th Nov. 1911 291 [1911 All these houses had got into a very bad state, and would never have been properly repaired, if it were not for the Housing and Town Planning Act. The procedure adopted in Islington is for the Medical Officer of Health to report informally to the Public Health Committee that certain houses were in such a state as to require that an Order to close them should be made under the Act. The Committee then visit, and as usually happens, decide to recommend the Council to make such an Order, which has been done in every instance. In the case of some houses, however, the Medical Officer of Health has been directed to write to the owners of the properties, stating that the Public Health Committee had visited them, and had decided to recommend their Council to enforce the provisions of the Act, if immediate steps were not taken to put the houses into a habitable state. This threat has been entirely successful and effective; so that in every instance workmen were immediately employed to repair the properties thoroughly, and to put them into a condition to meet the Committee's requirements so that they should no longer endanger the health of the people who might live in them. It must be a satisfaction to the Council to learn that there was in no instance any serious opposition made by the owners. Only once did it become necessary to serve an Order on an occupier to quit a house. Whether or not these happy compliances with the Act will continue when its provisions are more fully exercised is a problem that time alone can solve. As a result of communications addressed by the Medical Officer of Health to the owners of No. 175, Fairbridge Road, 8, 13, 14 and 15, Caledonian Crescent, 13 and 15, Gifford Street, and 29 and 31, Campbell Road, threatening proceedings under the Act, these houses have been put into a habitable condition. Proceedings were instituted against the owner of No. 12, Henshall Street for a contravention of the Closing Order made in respect of these premises by allowing their occupation, and the magistrate fined him 20s. and ordered him to pay £2 2s. costs, or, in default, imprisonment for 7 days. u 2 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. 294 1911] INSPECTION OF FOOD. The inspector appointed for this duty is Mr. Wilkinson, who, himself a butcher by trade and holding a certificate as an Inspector of Meat, is well qualified for the work. His chief duty is to inspect the meat supply of the borough, although he also supervises other foods, such as fish, vegetables, fruits, &c., on sale for human food. Unsound Food. — Altogether 4 tons 13 cwt. 3 qrs. and 7 lbs. of food stuffs were condemned during the twelve months, of which more than two tons were fruit and vegetables, which were removed from shops and stalls and destroyed during the third quarter. They comprised the following articles of food:— Tons cwts. qrs. lbs. Meat and offal in slaughterhouses 1 12 0 11 „ butchers' shops 0 11 0 1 Fish 0 5 2 17 Vegetables and fruits 2 5 0 4 Bread 0 00 2 Tons 4 13 3 7 In the preceding year 4 tons 1 cwt. 1 qr. 25 lbs. were seized or surrendered, so that practically the amount was the same now as then, although it exceeded the average quantity dealt with annually in the ten years during which Mr. Wilkinson was an inspector. Tons. cwts. qrs. lbs. Tons. cwts. qrs. lbs. 1902 3 17 3 16 1909 2 4 3 18 1903 3 5 3 4 1910 4 1 1 25 1904 5 8 3 17 1911 4 13 3 7 1905 1 11 1 4 1906 2 1 1 2 1902-11 34 12 3 12 1907 2 1 0 9 1908 5 7 1 22 Average 3 9 1 4 These figures show that the inspections have been well maintained, and that there has been no slackness in the work. It is true that so much food is 295 [1911 not actually seized as formerly, although there is more surrendered, because the vendors have learned wisdom, and as a rule now either put their unsound supplies on one tide for the inspector to examine when he calls, when it is surrendered to him, or he is sent for to examine it. When he has inspected it he gives them a note stating what is wrong with it, so as to enable them, when it is possible to do so, to get compensation from the original wholesale merchant. When one considers what mischief this large amount of unsound food might have caused if consumed, the necessity for continued vigilance becomes apparent, and the necessity for inspection. Indeed, if this were to cease, it is almost a certainty that we would revert to those days when there was no proper inspection made in the borough. Considering that the number of slaughterhouses has decreased from 42 in 1902 to 30 last year, and that the slaughter of cows, so many of which were condemned, has fallen from 402 to nil, the results of the inspections must be considered very good. At one time some of the private slaughterhouses in Islington were the favourite dumping grounds for these old and, too often, diseased animals, and it must, therefore, be a matter of congratulation that none are sent to them now. Inspection of Shops, Street Markets, Stalls, &c.—To these places, which comprise 238 shops of butchers, provision dealers, &c., 5 meat stalls, 9 businesses where meat is prepared, 104 fish shops, 4 fish stalls, 211 fruit shops, and 20 fruit stalls, 12,011 visits were made by Inspector Wilkinson alone, while the district inspectors visited large numbers of them on Saturday nights, so that altogether they were kept under strict supervision. Unsound Fish.—There was less fish condemned than in the preceding year, the total quantity being 673 lbs., as compared with 1,195 lbs. There is no doubt that greater care is now taken at Billingsgate than was formerly the case, because the Fishmongers Company have bestirred themselves. Indeed, not very lung since a communication, addressed to the Medical Officer of Health, was received from them, in which they requested him to communicate to them information respecting any unsound fish that had been sold at Billingsgate. Fewer costers than usual brought fish to the Town Hall to be seen by the Inspector or the Medical Officer of Health, the much hotter summer notwithstanding. A full list of the articles destroyed is set out in Table "A" of Inspector Wilkinson's report. 296 1911] The following list shows the articles destroyed in each quarter of the year:— ist Quarter. Tons cwts. qrs. lbs. Diseased meat and organs from slaughterhouses — 12 1 26 Unsound fish surrendered — 1 3 15 Unsound vegetables, &c., surrendered — — 3 11 Diseased and unsound meat, &c., from shops — 1 2 23 Unsound loaf of bread — — — 2 Total — 16 3 21 2nd Quarter. Diseased meat and organs from slaughterhouses — 11 3 16 Diseased meat and organs from shops — 2 2 21 Unsound fish from shops and stalls — — 3 6 Unsound rabbits from stall — — — 10 Total — 15 1 25 3rd Quarter. Diseased meat and organs from slaughterhouses — 3 1 23 Meat unsound by decomposition from shops — 5 2 14 Unsound fish from shops and stalls — 1 2 26 Unsound fruit and vegetables from shops and stalls 2 3 3 25 Unsound fowl — — — 5 Total 2 14 3 9 4th Quarter. Diseased and unsound meat and organs from slaughterhouses — 4 1 2 Unsound grapes from shops — — — 24 Unsound fish from shops — — 4 26 Unsound turkeys — — 3 12 Total — 6 2 8 Total for the Year 4 13 3 7 297 [1911 Open Window Stalls and Costers' Stalls.—Last year attention was drawn to the exposure of meat in the open windows of butchers' shops. The remarks then made apply with equal, indeed, with greater force to the open windows of fruiterers' shops, as well as to costers' stalls, for most of the fruits exposed in or on them are consumed in their raw state, and, therefore, the dust of the streets, which contains so many dangerous microbes, and which has been blown on them, is swallowed by the consumers of the articles. To these dangers must be added the danger caused by flies, who are often to be seen in large numbers sipping the juices of the fruits and vegetables exposed for sale, in the process of which they cast off bacteria of dangerous types from the feet and wings, or deposit them in their fly specks. They are known to have conveyed the bacteria of tuberculosis and typhoid fever, which, however, are not the only diseases that may be conveyed in this manner. Up to now in England few or no attempts have been made to protect the food sold in such places from either dust or flies, and, therefore, a very serious nuisance continues. It is clear that if vendors will not protect their food stuffs the aid of the legislature must be invoked to protect the public from a dangerous practice. Again and again the Medical Officer of Health has vainly attempted to trace the origin of cases of enteric fever, so that he has been compelled to enter it in his record books as unknown. He has very little doubt, however, that many of them must have originated through eating contaminated food stuffs. Indeed, with respect to two cases of this disease which some years ago occurred simultaneously in his own family he arrived at the conclusion that they were caused by the contamination of food by flies. Medical Officers of Health are now fully alive to this danger, so that there is great hope that the public will before long be protected from dangers which can be so obviously and easily avoided. Bread. —Flies are generally to be found in large numbers in bakers' shops, to which they are attracted not only by the bread but also by the confectionery which is frequently sold in them. Bread and confectionery are favourite foods, of which they partake greedily; and naturally where they eat greedily they deposit their specks in greatest number; and, therefore, in such places they are a real danger. In the early part of the year Mr. Leggatt, the Chief Inspector, noticed a woman in a baker's shop placing paper bands around brown loaves, which she did by licking the gummed end of the band, with which she afterwards encircled the loaf. No sanitarian requires to be told that such a practice is not only 1911] 298 disgusting but dangerous; for at the best it is possible for the saliva from the operator's mouth to smear the crust of the loaf, while, at its worst, it is possible to convey through the saliva dangerous diseases of the mouth, throat and chest. The Medical Officer of Health desired that his Public Health Committee should send a cautionary notice to each baker in the borough, but, doubtless not appreciating the danger as he did, no action was taken, which is to be regretted. The Decline of the Private Slaughterhouse.—These places now number only 30 in Islington, whereas when the Medical Officer of Health first commenced his duties here, in 1892, there were 62. Thus in twenty years there was a decrease of 52 per cent. Many of the butchers, who formerly slaughtered their animals in their own slaughterhouses, now prefer to buy dead meat at the Central Market; firstly, because they are not so liable to monetary loss, and, secondly. because they can more easily see what it is they are actually buying. So long as there was no systematic inspection in Islington by a qualified inspector, the loss due to the seizure of the whole or part of the carcase was small, and the butchers ran little or no risk in the ultimate sale of the flesh or offal. Indeed, the experience of the Medical Officer of Health during an active career of more than thirty years has taught him that many vendors of meat are absolutely unable to distinguish diseased from sound flesh, unless in the most pronounced cases, and sometimes not even then. This feature has become more marked in recent years, during which the butcher's trade has been taken up by untrained and inexperienced persons as a trade speculation. Such people do not require slaughterhouses; they prefer to buy their meat direct from a meat salesman, on whose integrity they rely, as much as on the inspection which is made at Smithfield Central Market. The slaughter of Canadian and other animals on landing at Deptford has placed enormous quantities of freshly killed meat on the market, from which they can choose; and this larger field of choice, together with the monetary saving and trouble entailed in driving the animals from the cattle markets, and in slaughtering them, have had, each in its own way, an influence on their actions. One cannot help concluding, judging by the large decrease of private slaughterhouses in this borough, that their entire extinction is only a matter of time. The subsequent statement, prepared to show the number of animals annually slaughtered in Islington, bears remarkable evidence of the fact that the slaughter of large cattle (oxen and cows) has decreased steadily from the time when the first record was made. 299 [1911 Year. Oxen. Cows. Calves. Sheep Pigs. Total Lambs. 1899* 2,436* 402* 436* 43,252* 903* 47,429* 1900 3,019 668 356 52,760 464 57,267 1901‡ .1,507‡ 440‡ 195‡ 23,324‡ 125‡ 25,595‡ 1902 2,996 498 195 41,024 72 44,785 1903 2,445 173 141 38,090 46 40,895 1904 2,360 4 154 32,973 25 35,516 1905 2,195 17 127 30,686 48 33,073 1906 2,172 — 143 30,668 11 32,994 1907 2,146 4 142 24,380 2 26,374 1908 1,941 — 86 28,476 4 30,507 1909 ] ,763 6 100 36,481‡ — 38,350 1910 1,691 — 91 36,176 — 37,958 1911 1,448 — 73 38,009§ — 39,530 * These returns are for 9 months ‡ The returns are for 6 months. § Includes 8 goats. ‡ Includes 2 goats. These figures are very instructive, for they show in detail the direction in which slaughtering in private slaughterhouses has decreased. If a comparison is made between the returns of 1900, the first year for which these are complete for twelve months, and with those of last year, it appears that:— The slaughter of oxen has decreased by 52.0 per cent. „ cows „ 100.0 „ ,, calves „ 79.5 „ „ sheep „ 28.0 „ pigs „ 100.0 „ „ All animals „ 31.0 „ The slaughter of cows, nearly all of which were old and emaciated, and more or less tuberculous, was prevented in our slaughterhouses by the rigid enforcement of the tuberculosis regulations, so that they are now killed elsewhere, but where it is impossible to say, although it may be taken as a fact that they are slaughtered somewhere, which is a misfortune to the public, who will still have foisted on them food which is diseased, as is similarly the case with the tuberculous milk, which is shut out from such large towns as Manchester and Liverpool. 1911 300 LICENSED SLAUGHTER-HOUSES. Registered No. Name of Licensee. Situation of Premises. Condition of Licence. 119 Gayes, W. J. D. 4, Athelstane Mews 121 Clarke, Ino. 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 Allday, Fredk... (Between) 185-7, Church Road 132 Toop, Frederick John (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 Horsey, Arthur W. 498, Holloway Road 142 Walson, R. C. 576, Holloway Road 143 Tuck, Wallace.. 152, Hornsey Road 144 Worboys, Richd. 410, Hornsey Road 145 Webber, J no. 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, Mary Ann 280, Seven Sisters Road 157 Fothergill, H. 79, Stroud Green Road Cattle received upon the mises 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 Total 30 Slaughterhouses. 801 [1911 Cowhouses.—There are only 5 cowhouses now on the register, one of which has not been occupied during the year, and to them 56 visits were paid. They are well conducted, although on one occasion some decomposing feeding stuffs were found in one of them. These were, however, speedily removed on attention being drawn to them. During his visits the inspector discovered three cows suffering from tuberculosis, one of which had her udder affected, while two suffered with generalised tuberculosis. Now, if these cows had belonged to a country farmer, it is quite probable that the owners would have continued to send their milk to London, whereas being in Islington the cows were at once removed from the cowsheds and slaughtered. This is one of the reasons why the Medical Officer of Health regrets the great decrease in the number of cowkeepers in the borough, which in twenty years has fallen from 31 to 4. Soon there will be none. 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 1900 13 1910 5 1901 13 1911 5 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 32 Total 5 Cowhousrs. 1911] 802 INSPECTOR WILKINSON'S REPORT. Public Health Department, Town Hall, Upper Street, N. March 26th, 1912. To the Medical Officer of Health. Hear Sis, I have pleasure in submitting the following report of my work for the year ending December 30th, 1911. Slaughterhouses.—There were during the greater part of the year 32 slaughterhouses on the register, but this number was further reduced by two at the annual licencing session of the London County Council owing to an objection by their inspector to the renewal of the licence of premises situate at 53, Southgate Road, being successful, and to the fact that no application was made for the renewal of the licence to the premises situate at 34, Palls Pond Road, which were then unoccupied. A total of 1,759 visits have been paid to the slaughterhouses during the year, and no complaint as to the conduct thereof can be made against them. The number of animals slaughtered was as follows :— Oxen Calves Sheep and Lambs Goats Total 1,448 73 38,001 8 39,530 as compared with— Oxen Calves Sheep and Lambs Goats Total 1,691 91 30,176 Nil 37,958 in the preceding year. The quality and soundness of the animals generally was very good. Only three cases of tuberculosis in bovine animals were detected, which is in itself proof of the generally excellent quality of the animals purchased by those traders holding slaughterhouse licences within the Borough. Two, however, of these were found to be so far affected as to render necessary in the interests of public health the rejection of the entire carcase and all organs. One of the animals was a heifer,, to which the owner called the attention of this department, during my absence through illness, which District Inspector Bridel inspected and found the disease to be generalised so that the carcase and all the organs were surrendered for destruction. I may here add that since this occasion only sheep have been slaughtered on these premises, the licencee having been supplied with beef from the slaugh:erhouses at the Metropolitan Cattle Market; although prior to that he usually 303 [1911 slaughtered two bovine animals weekly, which circumstance will account for nearly half the lessened number in the total of bovines slaughtered. The other instance in which the entire carcase and organs were surrendered for destruction was that of a well nourished ox in which the disease was found to be of a generalised nature. The butcher, fortunately for himself, had previously insured the animal against such risk, and consequently was compensated, although there was a commercial loss of £20 or more. The third instance was a localised affection of the liver and lungs, which necessitated only their destruction. There were four instances in which a sheep was found dead or in a moribund condition, which resulted in the surrender of the carcases and organs for destruction. One sheep was found to be in such an emaciated condition as to be unsound, and was surrendered for destruction. It is strong proof of the generally good quality of the sheep slaughtered, that only one carcase out of thirty-eight thousand was found to be of unsound quality, the four carcases previously referred to, being in each case well nourished, but rendered unsound through accidental circumstances Parasitic diseases were, as usual,, responsible for the greater amount of internal organs surrendered, the number of oxen livers destroyed through these causes being 88, or approximately 6 per cent. of the animals slaughtered, as against 60, or about 3.5 per cent., in the previous year. The number of sheep livers, as will be seen from Table " A," which follows, surrendered owing to parasitic affection were only about 3.1 per 1,000, whilst those of the previous year approximated 10.8 per 1,000. It is thus apparent that whilst there was a considerable decrease in the proportion of parasitic sheep livers, there was a substantial increase in the number of diseased oxen livers, due to the presence in each case of the same parasite, viz., " Distomum Hepaticum " This, however, is readily accounted for by the fact that the bulk of the sheep slaughtered within the Borough are taken during the first year of their life, whilst oxen as a rule are one year or more older when slaughtered, consequently the effects of this disease, which are always more marked after wet grazing seasons, such as was experienced in the year 1910, in which an abnormal number of affected sheep livers were found, would not appear in oxen that were being then grazed as "stores" until the year following or whenever they might be slaughtered. Further particulars as to these and other organs surrendered in slaughterhouses will be found in Table " A," which follows 911] 304 TABLE A. No. of Ceases Description of Animals Affected. Extent of Disease or Affection. Nature of Affection. How disposed of. 1 Ox Carcase and all organs Tuberculosis Council's Destructor 1 Heifer Carcase and all organs (per Inspector Bridel) do. do. do. 1 Ox Liver and lungs do. do. do. 4 Sheep Carcase and all organs Moribund. do. do. 1 do. Carcase Emaciation do. do. 2 Oxen Portion of head and tongue ... Actinomycosis do. do. 1 Ox Tripe Decomposition do. do. 1 do. do External violence do. do. 88 Oxen Livers Parasitic (Dis. Hep.) do. do. 7 do. d° Abscess do. do. 113 Sheep do. Parasitic do. do. 2 Oxen Hearts Pericarditis do. do. 1 Ox Lungs Abscess do, do. 17 Sheep Liver or lungs, or both Parasitic (various) Council's Destructor or on copper fire 1 do. Liver and Lungs Abscess Council's Destructor 1 Ox Liver (portion) Parasitic Copper fire 1 do. Heart (portion of tripe and spleen) Injury during life Council's Destructor Shops, etc., Inspection of.—There are some 238 shops where meat foods are sold,, including butchers, provision dealers, etc., 5 meat, etc., stalls, 9 premises where meats are prepared for human food (sausage factories, etc.), 104 fish shops, 4 fish stalls, 211 fruit shops, and about 20 fruit stalls. To these a total of 12,011 visits have been recorded by your inspector, independent of the visits of the 14 district inspectors on Saturday evenings and Sunday mornings, of which I have no particulars—made up as follows, viz. :— To Butcher's, &c., Shops 5,803 visits. To Sausage Factories, &c. 149 ,, To Butcher's Stalls 469 ,, To Fish Shops 1,458 „ To Fish Stalls .539 ,, To Fruit Shops 2,502 „ To Fruit Stalls 1,091 „ Total 12,011 The quality and condition of the foodstuffs generally, coming under observation during such visits has been very satisfactory; this is borne out by the comparatively small amount of foodstuffs dealt with as unsound, which is fully set forth in Table " B " of this report given below, the bulk of which was examined by request and surrendered. A reference to this table shows the amount and particulars of the unsound foods dealt with from shops etc. 805 [1911 TABLE B. Number of cases. Description of Food. Nature of Unsoundness. Conditions under which found. Weight in lbs. How disposed of. Observations. 1 Carcase of a pig Tuberculosis Examined by request 243 Council's destructor Surrendered at a Sausage Factory. Condemnation Note given. 1 Pig's head do. do. do. 34 do. do. do. do. 1 60 bags of green peas Decomposition do. do. 4,860 do. do. Inspector summoned by telephone. Surrendered. Condemnation Note given. 9 Fish (various) do. do. do. (1 lot per Inspector Fortune) 633 do. do. Surrendered by fishmongers and Condemnation Notes given. 3 Oranges, apples and grapes (respectively) do. Examined by request 153 do. do. Surrendered by fruiterers and Condemnation Notes given. 3 Oxen tongues Various Affections do. do. 41 do. do. Surrendered at meat packing works and Condemnation Notes given. 3 Oxen & sheep livers Parasitic (Dis. Hep.) do. do. 164 do. do. From Country consignments surrendered and Condemnation Notes given. 1 4 foreign rabbits Decomposition Seized on coster's barrow 10 do. do. Prosecution ordered, but offender who gave wrong address has not since been traced. 1 Tomatoes & oranges do. Seized in fruiterers shop window 5 do. do. Prosecution ordered. Defendant fined 10s. and 4s. costs. 1911] 806 TABLE B.— continued. Number of cases. Description of Food. Nature of Unsoundness. Conditions under which found. Weight in lbs. How disposed of. Observations. 1 Tomatoes Decomposition Seized by Inspector Jeffery 26 Council's destructor Legal proceedings ordered, but stayed on the advice of Council's Solicitor. 1 Beef, mutton and lamb do. Seized on butcher's back premises 88 do. do. Summons issued. Magistrate accepted the evidence of the defence that the meat was not intended for sale and dismissed summons. 2 Quantities of fat and bones do. Surrendered for destruction 542 do. do. Accumulations on butcher's premises owing to strike of carmen. 2 16 turkeys and 1 fowl do. Examined by request 101 do. do. Surrendered for destruction and Condemnation Notes given. 1 Loaf of bread Over-run with ants Brought to Town Hall 2 Placed on heating apparatus fire Brought with complaint, but not sufficient evidence to show where the ants had gained access to the bread. 1 2J cooked ducks and 12 sheep hearts Decomposition Coster's dwelling house (per Inspector Jeffery) 10 Council's destructor Surrendered to Inspector when paying a visit to a dwelling house for other Sanitary purposes. 807 [1911 The amount of unsound food stuffs destroyed was as under, viz.:— Tons cwts. qrs. lbs. From Slaughterhouses (as per Table A)— 1 12 0 11 From Shops, &c. (as per Table B)— 3 1 2 24 Tons 4 13 3 7 Cowsheds, Inspection of.—Of the 5 cowsheds on the register only 4 have been in actual use as such during the year; to these 56 visits were paid and, generally speaking, they have been well conducted. In one exception to this a quantity of decomposing roots and grass, intended for feeding the cows, was found inside a cowshed and giving off an offensive odour. Steps were taken to have them removed speedily, and the licencee was cautioned as to a possible objection to the renewal of his license in the event! of a recurrence of any similar nuisance within the shed. One case of an indurated cow's udder was telephoned at once to the London County Council, and received the attention of their Veterinary Inspector. In another instance I reported to the same authority regarding a cow suspected of being in an advanced stage of tuberculosis, although no affection of the udder was detected. The Veterinary Inspector, on visiting, corroborated my diagnosis, but reported that under the Special Powers of the London County Council, in the absence of affection of the udder, no action could be taken. I then paid a further visit to the cowshed with the object of advising the destruction of the animal on the grounds of its presence in the shed being a menace to the health of other animals kept therein, but found that it had already collapsed and died, and had been removed to the knacker's yard. Offensive Trade Establishments.—These comprise three tripe boilers, one of which has been in disuse for most of the year, two gutscrapers and a knacker's yard. To these 89 visits have been made, and they have been generally well conducted. I am, Sir, Yours obediently, H. WILKINSON, Inspector of Foods, &-c. Milkshops and Dairies.—At the end of the year there were 516 milkshops and dairies on the register, to which 1,661 visits were paid by the district inspectors. They were also visited during the months of September and October by the Chief Inspector, Mr. J. R. Leggatt, who reported to me as follows:— 21st October, 1911. Dear Sir, As a result of my annual inspection of the whole of the milkshops and dairies in the borough (516), I am glad to report that, although oil and other domestic requisites are still being sold in some general shops where milk is purveyed, I found them in very fair condition. w 2 1911] 308 There were several cases of non-registration, which I ascertained was due to the erroneous idea that it was the shop and not the individual which required to be registered. It frequently happens that the tenancy of a shop changes several times during the year, and probably if a registration fee was imposed not only would intending purveyors of milk hesitate before making application for registration, but if registration was an annual event, with the fee, a great many of the occupiers of small general shops would discontinue selling milk rather than pay the fee, and thereby the very large number of shops already registered would be considerably reduced. I have still to complain of the inattention of purveyors of milk in not protecting it from contamination, by always covering the counter pans or vessels in which the milk is stored with a cover of muslin or some other suitable material. When I ask the question, " Where is the muslin cover ? " it is either being washed or it cannot be found. To have one in reserve is hardly ever a consideration. It is not unusual to find a cover to consist of cardboard, wood, or a piece of paper. The sterilisation of the hand cans is satisfactorily carried out, and the conditions under which the work is performed gives little cause for complaint. I am, Yours faithfully, James R. Leggatt, Superintendent and Chief Sanitary Inspector. 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.—There were at the end of the year 229 of these places on the register, as contrasted with 235 in 1910. Altogether 134 visits were made to them, as against 136 in the preceding year, in consequence of which 18 intimation notices were served on the premises. The general conditions, however, are better than at anytime since the passing oi che London County Council (General Powers) Act, 1902. 809 [1911 THE ADULTERATION OF FOODS AND DRUGS. Samples analysed in 1911.—During the year 1,200 samples were examined, of which 1,105 were genuine, and 95, or 7.9 per cent., were adulterated or sold contrary to the provisions of the Adulteration Acts. This is the lowest percentage of adulteration since 1907, when 6.7 per cent. were reported against by the Public Analyst, and it also compared with an average of 11.4 in the twenty years 1891-1910. The detection of adulteration is becoming more and more difficult, and is due in the first place to the astuteness of the vendors of adulterated articles; and in the second to the more highly scientific means now practised. In the latter case, however, the adulteration is effected by the original makers of the article or by the wholesale vendors. It has been pointed out in preceding reports that the vendors of milk "tone" it, or, in plain English, adulterate it, with separated milk; but they take great care that they do not " tone " it below the standard set up by Somerset House. The addition of separated milk to new milk has become almost a fine art with some milk purveyors, who, although they are known to receive large quantities of separated milk which they do not sell, yet mix it so skilfully that it is impossible to bring them within the four corners of the Adulteration Acts. The Medical Officer of Health has in his mind, as he writes, several firms who daily receive two or more churns of separated milk; who do not sell that milk ; who are known to add it to the whole milk which they subsequently sell, and although samples have been taken from them again and again, yet their analyses have failed to show what they had done. There can be no gainsaying the fact that at the present time there is no fraud, or one so inimical to the general health interests of the community, especially of the children, which calls so loudly for legislative measures with which to put an end to it. The Medical Officer of Health has before now made suggestions as to what should be done; he believes the Government Departments are fully aware of what is going on, and that they are anxious that this fraud should be put down. But there the matter ends, for neither the Minister of the Board of Agriculture or the Local Government Board have yet introduced a Bill into Parliament to put an end to the wholesale fraudulent dealings that are daily practised with respect to milk throughout the country, especially in the large towns. It should be made a penal offence for any person, master or servants, either to tone the milk themselves or to assist in toning it by the addition ot separated milk, because it is as much a robbery to reduce the fat contained in the milk 19 1I 310 by the addition of separated milk to it, as it is to pick a pocket, and if there be any difference of degree between the two offences, the toning of the new milk is the more serious, because it is an article of diet on which the lives of invalids and children depend for their nourishment. It is sincerely to be hoped that before another year comes to an end something will be done that will put a stop to the shameless adulterations that are at present practised. The word " shameless " is used advisedly, because at the present time in London there is a firm of milk purveyors who in the early morning convey their new milk and their separated milk from the railway stations in their carts, deposit them outside their doors, and then actually mix them in the street tinder the very noses of the police. In the following Table is given the number of samples analysed in each year since 1901, and shows the number that were genuine and adulterated and the percentage adulterated :— Table CXLIII. Showing the Number of Samples of Foods and Drugs Analysed, with the Result of the Analyses for the Year 1911 and for the preceding Twenty 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 6l 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 11.6 1903 1,016 898 118 8.5 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 1910 1,204 1,076 128 10.6 Totals 18,038 15,987 2,051 11.4 1911 1,200 1,105 95 7.9 311 [19ll 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 299 269 30 10.0 2nd „ 312 284 28 9.0 3rd „ 288 264 24 8.3 4th „ 301 288 t3 4.3 The Year 1,200 1,105 95 7.9 Milk, Butter and Oleaginous Foods —900 samples of these foods, which are set out in the Table given below, were analysed by the Public Analyst during the year, and of these 76, or 8'4 per cent., were adulterated, as compared with 10'2 in the preceding year. Since 1905 the percentages of these foods found to be adulterated were as follows:— 1905 7.2 per cent 1909 8.7 per cent. 1906 10.2 „ 1910 10.2 1907 6.5 „ 1911 8.4 1908 9.5 „ Samples. Adulterated. Percentage Adulterated in 1911, Percentage Adulterated in 1910. Percentage Adulterated in 1909. Milk 601 59 9.8 9.3 6.8 Cream 1 ... ... ... ... Milk (Separated) ... ... ... ... 50.0 Butter 198 10 50 5.0 12.5 Margarine 40 7 17.5 70.0 30.0 Cheese 40 ... ... ... ... Lard 20 ... ... ... 5'° 900 76 8.4 10.2 8.7 1911] 312 Milk.—601 samples were submitted to the Public Analyst, of which 59, or 9.8 per cent., were adulterated. This percentage is slightly above that of 1910, when it was 9.3, and is considerably above the figure for 1909, when it was 6.9. The apparent increase in the adulteration is probably due to the method of private sampling now adopted. Perhaps the better way to express it would be to say the adulteration detected was 9.8 per cent. 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 - I50 18 12.0 2nd „ 162 14 8.6 3rd „ 138 18 13.0 4th „ 151 9 5.9 601 59 9-8 The record of the detected 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 17'9 1895 413 343 70 l6.9 1896 468 418 50 10.6 1897 513 464 49 9.5 1898 543 492 5i 9.4 1899 532 477 55 10.3 1900 541 485 56 10.3 1901 632 556 76 12.0 1902 586 528 58 9.9 1903 508 458 50 9.8 1904 600 553 47 7.8 1905 594 549 45 7.6 1906 634 560 74 11.8 1907 597 557 40 6.7 1908 604 552 52 8.6 1909 605 563 42 6.9 1910 621 563 58 9.3 Totals 9,581 8,599 982 10.2 1911 601 542 59 9.8 313 1911 A considerable difference was as usual noticeable in the percentages of adulteration of milk sold on Sunday, on a week-day, and procured in transit at the railway stations. Sunday Milks.—160 samples were purchased on Sundays, of which 11, or 6'9 per cent., were adulterated. This compares with 8'7 per cent, in 1910; 8.8 per cent. in 1909, and 74 per cent. in 1908. Week-day Milks.—320 samples were submittd to the Public Analyst, of which 43, or 13.4 per cent., were certified to be adulterated. This percentage compared with 13T per cent. in 1910; with 6.7 in 1909 with 10.2 in 1908, and 8.2 in 1907. It will be noticed that the percentage of these milks which were adulterated was almost double that of the Sunday milks. Now this is a very extraordinary fact for at one time the figures were entirely reversed, the greatest amount of adulteration being practised on Sundays. Owing, however, to the knowledge that samples are taken nearly every Sunday, the vendors of milk have been more careful, and consequently they prefer to run the risk of being detected during the week-days. Farmers' Milk.—121 samples were procured at the railway stations in transit, and of these only 5, or 4T per cent., were adulterated. There is no doubt that the English farmers, as pointed out last year, are honest men, and only very rarely adulterate their milk. Quality of the Milk.—As usual, the analyses of .milks were tabulated so that the average percentages of the fat and the solids not fat contained in the milks might be ascertained. milks might be ascertained. They are to be seen in the following Table:— Obtained. No of Samples Analysed. Average Percentage of Fat. Average Percentage of Solids, not Fat. Average Percentage of Total Solids. On Sundays 160 3.63 8.57 12.20 On Week-days 320 3.65 8.54 12.19 At Railway Stations 121 3.92 8.71 12.63 Official Minimum Standard — 3.00 8.50 11.50 From this Table we see that the fat content of the farmers' milk was 3.92 per cent., while that of the milk purchased on Sundays and on week-days was respectively 3.63 and 3.65 per cent. 1911] 314 The high figure for the farmers' milk shows that fraudulent dealers could abstract nearly one quarter of the fat and then sell it as genuine milk, for it would not even then be below the minimum standard. Table CXLIV. Showing the analyses of 8,171 milks examined in Islington during the thirteen years 1898-1910 and 1911, and distinguishing those purchased on Sundays, on Weekdays, 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). •saidtobs jo -on •spijos xjjej-uou jo • ju90 •jbj jo -ju33 •sajdmBs jo 'on •spnos Ajjbj-uou jo juao jaj jbj jo -juao iaj •saidoiBs jo -oN spnos Ajjbj-uou jo -juao jaj •vej jo '1u30 j9d 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 8-59 360 274 8-64 3-51 90 8-76 3-85 1903 167 8-42 386 218 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 161 855 3-68 323 8-51 3-72 112 8-66 3-87 1906 195 8-49 3-58 332 8-52 3-59 110 8-75 3-69 1907 150 8 64 3-63 327 8-65 3-76 120 8-77 3-96 1908 160 8-58 3'69 324 8-58 3 52 120 8-73 3 88 1909 159 8-66 3-67 326 8.85 3-62 120 8-74 3-86 1910 160 8-57 3-55 336 8'50 3-44 125 8-76 3 74 Total Thirteen Years 2,274 8-55 3-64 3,757 8'57 3-62 1,539 8'74 3-89 1911 160 8-57 3-63 320 8-54 365 121 8-71 3-92 315 1911 From these analyses the following averages for the years 1898-1911 have been deduced:— Solids not fat. Fat Total solids. 2,434 Sunday Milks 8.55 3.4 12.19 4,077 Week-day Milks 8.57 3.61 12.l8 1,660 Farmers' Milks 874 3.89 12.63 8,171 Total Milks - 8.60 3.67 12.27 Table CXLV. Giving the particulars of the Milk taken during each quarter of 1911 on Sundays, on Week days, and at the Railway Stations. 1911. 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 80 30 150 38 64 30 132 2 16 18 5 0 20.0 .. 12.0 2nd ,, 40 92 30 162 37 84 27 148 3 8 3 14 75 8.7 10.0 8. 6 3rd „ 40 68 30 138 35 56 29 120 5 12 1 18 12 5 17.6 3.3 13.0 4th ,, 40 80 31 151 39 73 30 142 1 7 1 9 25 8.7 3 .2 5.9 The Year 160 320 121 601 149 277 116 542 11 43 5 59 69 13. 4 4.1 9.8 1911] 316 Table CXLVI. Showing the Samples of Milk Analysed, the number found adulterated, with the percentage of Samples adulterated for the past fourteen 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 18. 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 1.6 8.6 1909 159 326 120 605 145 304 114 563 14 22 6 42 8.8 6.7 5.0 6.9 1910 160 336 125 621 146 292 125 563 14 44 .. 58 8.7 13.1 .. 9.3 1911 160 320 121 601 149 277 116 •542 11 43 5 59 6.9 13.4 4.1 9.8 Totals 2,434 4 077 1,660 8,171 2,184 3,593 1,030 7.407 250 484 30 764 10.3 11. 9 1.8 9.3 817 [1911 Butter and Margarine.—198 samples of butter and 40 samples of margarine were examined, and of these 10 samples of butter, or 5 per cent., were adulterated, and 7 samples of margarine, or 17.5 per cent., were sold contrary to the provisions of the Margarine Act. The adulteration of butter is generally practised by substituting margarine for the genuine article. It is only with great difficulty that the vendors of adulterated butter are detected, because they are so wary that they will not serve a customer until they have assured themselves positively that he or she is not an agent of the Inspector appointed under the Sale of Food and Drugs Acts. This fact has been pointed out frequeutly, and, therefore, it is unnecessary to enlarge further on it now. Cheese.—40 samples of cheese, all of which were declared to be genuine, were examined. Lard.—20 samples of lard were submitted to the Analyst, and were reported as genuine. Groceries.—185 samples of articles usually described as groceries were submitted to the Public Analyst, and of these 12, or 6.5 per cent., were adulterated, as compared with 162 in 1910. and 28.3 per cent. in 1909. There was nothing of special interest" connected with these samples, the record of the adulteration of which was as follows :— No. cf Samples. No. Adulterated. Percentage Adulterated. Percentage Adulterated in 1910. Coffee . 21 4 I9.0 l6.6 Cocoa - 28 — — 3.5 Demerara Sugar — — — 43.0 Pepper 19 — — — Mustard 19 — — — Golden Syrup — — — 21.4 Honey - 7 — — — Arrowroot 10 — — — Sauces - 7 1 14.3 71.4 Malt Vinegar - 14 2 14.3 65.0 Sausages — — — 14.3 Ground Ginger 7 — — — Yeast ... - 11 — — — Standard Bread 1 — — — Isinglass 5 — — — Self- Raising Flour 7 1 14.3 — Baking Powder 7 4 57.1 — Ginger Wine - 1 — — — Dripping 21 — — — 185 12 6.5 16.2 19111 818 Alcoholic Drinks.—60 samples were examined by the Public Analyst of which 2, or 3 per cent., were adulterated. No. ol Samples. No. Adulterated. Percentage Adulterated. Whiskey (Scotch) 12 — — Whiskey (Irish) 12 — — Rum 12 I 8.3 Gin 12 I 8.3 Brandy 12 — — Total - 6o 2 3.0 Drugs.—55 samples of various drugs were examined, of which 5, or 9 per cent., were returned as adulterated. Olive Oil No. of Samples. 3 No. Adulterated. Percentage Adulterated. Oil of Turpentine 10 — — Blaud's Pills 10 — — Gregory's Powder 10 4 40.0 Solution of Hydrogen Peroxide 5 i 20.0 Lime Water 7 — — Glycerine 5 — — Prescriptions 5 — — 55 5 9.0 Table CXLVII. Showing the Samples of Foods and Drugs submitted to the Public Analyst during the year 1911. 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 150 162 138 151 601 132 148 120 142 542 18 14 18 9 59 Cream 1 .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. Butter 48 50 50 50 198 45 47 47 49 188 3 3 3 1 10 Cheese 10 10 10 10 40 10 10 10 10 40 .. .. .. .. .. Dripping 7 7 7 .. 21 7 7 7 .. 21 .. .. .. .. Lard 5 5 5 5 20 5 5 5 5 20 .. .. .. .. • • Coffee 4 7 3 7 21 .. 7 3 7 17 4 .. .. .. 4 Cocoa 7 7 7 7 28 7 7 7 7 28 .. .. .. .. .. Sauce .. .. .. 7 7 .. .. .. 6 6 .. .. .. 1 1 Self-Raising Flour .. .. 7 .. 7 .. .. 6 .. 6 .. .. 1 .. 1 Pepper 7 .. 7 5 19 7 .. 7 5 19 .. .. .. .. .. Mustard 7 .. 7 5 19 7 .. 7 5 19 .. .. .. .. .. Ground Ginger .. .. 7 .. 7 .. .. 7 .. 7 .. .. .. .. .. Yeast 4 7 .. .. 11 4 7 .. .. 11 .. .. .. .. • • Standard Bread 1 .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. Isinglass .. .. .. 5 5 .. .. .. 5 5 .. .. .. .. .. Olive Oil .. .. 3 .. 3 .. .. 3 .. 3 .. .. .. .. .. Arrowroot 7 3 .. .. 10 7 3 .. .. 10 .. .. .. .. .. Baking Powder .. 7 .. .. 7 .. 3 .. .. 3 .. .. .. .. 4 Honey .. .. .. 7 7 .. .. .. 7 7 .. .. .. .. .. Vinegar (Malt) .. 7 .. 7 14 .. 5 .. 7 12 .. .. .. .. 2 Irish Whiskey 3 3 3 3 12 3 3 3 3 12 .. .. .. .. .. Scotch Whiskey 3 3 3 3 12 3 3 3 3 12 .. .. .. .. •• Rum 3 3 3 3 12 3 3 3 2 11 .. .. .. .. 1 Gin 3 3 3 3 12 2 3 3 3 11 1 .. .. .. 1 Brandy 3 3 3 3 12 3 3 3 3 12 .. .. .. .. .. Ginger Wine.. 1 .. .. .. 1 1 .. .. .. 1 .. .. .. .. Oil of Turpentine 5 5 •• .. 10 5 5 • • .. 10 .. .. .. .. .. 1161 * Examined for strength only. 1911]320 Table CXLVII.—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 5 .. 5 .. 10 5 .. 5 .. 10 .. .. .. .. .. Gregory's Powder 5 5 .. .. 10 3 3 .. .. 6 2 2 .. .. 4 Solution of Hydrogen Peroxide .. 5 .. .. 5 .. 4 .. .. 4 .. 1 .. .. 1 Lime Water .. .. 7 .. 7 .. .. 7 .. 7 .. .. .. .. .. Glycerine .. .. .. 5 5 .. .. .. 5 5 .. .. .. .. .. Prescriptions .. .. .. 5 5 .. .. .. 5 5 .. .. .. .. .. 289 302 278 291 1,160 261 276 256 279 1,072 28 26 22 12 88 MARGARINE ACT. Margarine 10 10 10 10 40 8 8 8 9 33 2 2 2 1 7 321 [1911 Abstracts from the Public Analyst's Returns, together with the proceedings taken during the Quarters of the Year 1911. ADULTERATED SAMPLES.— First Quarter, 1911. 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. 669 T.L.B. Milk* Inspector 10 per cent. of added water Ordered to pay 12/6 costs. 670 T.L.B. do. * do. 15 do. do. Fined £5 and £2 2s. costs, or one month's imprisonment. 682 T.L.B. Butter do. 100 per cent. of Margarine Fined £5 with alternative of one month's imprisonment. 687 T.L.B. Margarine do. 100 do. do. Ordered to pay 12/6 costs. 693 T.L.B. Milk * do. 8 per cent. of added water. Fined £1 and 12/6 costs. 697 T.L.B. do. * do. 9 do. do. Fined 10/- and 12/6 costs, or 3 days' imprisonment. 729 T.L.B. do.* do. 4 do. do. Cautioned by letter. 740 T.L.B. Butter do. 90 per cent. of Margarine Fined £5 and 12/6 costs. 765 T.L.B. Gin do. 38 6 degrees under proof Fined 5/- and £2 2s. costs. 783 T.L.B. Milk do. 4 per cent. of added water and 2 do. of the original fat abstracted Cautioned by letter. 786 T.L B. Gregory's Powder do. Powdered Rhubarb Ordered to pay 12/6 costs. 788 T.L.B. do. do. 69 per cent. of Carbonate of Magnesia Fined 1/- and 32/6 costs. 789 T.L.B. Milk * do. 12 per cent. of added water Fined £1 and 12/6 costs. 800 T.L.B. do. * do 9 per cent. of added water and 3 do. of the original fat abstracted Fined £1 and 12/6 costs. 804 T.L B. do. * do 10 per cent. of added water Fined £1 and 12/6 costs, or 7 days' imprisonment. 808 T.L.B. do. • do 6 do. do. Fined £1 and 12/6 costs, or 7 days' imprisonment. 1911] 322 ADULTERATED SAMPLES.— First Quarter, 1911—(continued). State whether the sample was submitted to the Anilysis by an Result of Analysis. Sample Article submitted for Officer acting under directions of Showing whether the sample was Action taken, with result of Numbered Analysis. a Local Authority, under Section Genuine or Adulterated, and, if prosecution. 13 of Act, and if so, the name of terated, what were the nature and such Authority. extent of the Adulteration. 813 T.L.B. Coffee Inspector 42 per cent, of Chicory Fined £2 2s. and £1 Is. costs. 819 T.L.B. do. do. 39 do. do. Fined £4 and 12/6 costs. 820 T.L.B. Milk* do. 6 per cent, of added water Fined 5/- and 12/6 costs, or 7 days. imprisonment. 827 T.L.B. do. * do. 9 do. do. Summons dismissed.‡ 828 T.L.B. do. * do. 8 do. do. Fined £1 and 12/6 costs. 834 T.L.B. do. * do. 4 do. do. Cautioned by letter. 839 T.L.B. 1/- Salt do. 58 per cent. Butter and 42 ,, Margarine Fined £5 and 12/6 costs. 940 T.L.B. Margarine do. 55 per cent. Butter and 45 „ Margarine No proceedings. See No. 839. 848 T.L.B. Milk * do. 17 per cent, original fat abstracted .. Ordered to pav 12/6 costs. 853 T.L.B. do. * do. 15 do. do. 864 T.L.B. do. " do. 12 per cent, added water Fined £3 and 12/6 costs. 907 T L B. do. * do. 12 „ „ Ordered to pay 12/6 costs. 914 T.L.B. Coffee .„ do. 38 per cent, of Chicory Summons not served. Defendant absconded. 915 T.L.B. „ do. 38 Fined £2 and 12/6 costs. " Boric Acid and Formalin absent ‡ Warranty successfully pleaded. Total number of samples analysed during the Quarter, 299. 323 X 2 ADULTERATED SAMPLES.—Second Quarter, 1911. 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. 980 T.L.B. Butter Inspector 90 per cent. of Margarine Fined £1 and 12/6 costs. 2 T.L.B. Milk do 20 per cent. of original fat abstracted and 2 per cent. of added water Cautioned by letter. 5 T.L.B. 1/- Salt do. 90 per cent. of Margarine Fined £3 and 12/6 costs. 23 T.L.B. Milk do. 3 per cent. of original fat abstracted Cautioned by letter. 36 T.L.B. do do. 10 do. do do. Fined £1 and 12/6 costs. 42 T.L.B. do do. 7 per cent. of added water Ordered to pay 12/6 costs. 43 T.L.B. do do. 9 per cent. of original fat abstracted Fined £1 and 12/6 costs 51 T.L.B. do do. 12 per cent. of original fat abstracted and 4 per cent. added water Fined 2/6 and 12/6 costs. 58 T.L.B. Margarine do. 100 per cent. of Margarine Cautioned by letter. 59 T.L.B. do do. 100 do. do. Fined £1 and 12/6 costs. 87 T.L.B. Milk do. 10 per cent. of added water Fined £2 and 12/6 costs. 95 T.L.B. do do. 8 do. do. Fined £1 and £1 15s. 6d. cssts. 102 T.L.B. do do. 19 per cent. of original fat abstracted Fined £5 and 12/6 costs. 144 T.L.B. do do. 7 do. do. do. Fined £50 and £5 5s. costs. 151 T.LB. do do. 13 do. do. do. Summons dismissed. 153 T.L.B. do do. 24 do. do do. Fined £2 and 12/6 costs. 155 T.L.B. Gregory's Powder do. 67 per cent, of Magnesium Carbonate Fined £5 and £1 13s. 6d. costs. 158 T.L.B. do. do. 29 do. do. do. Fined 1/- and 12/6 costs. [1911 324 1911] ADULTERATED SAMPLES (Second Quarter, 1911)—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. 159 T.L.B. Milk Inspector 4 per cent. original fat abstracted ... Cautioned by letter. 194 T.L.B. do do. 12 do. do. do. Fined 40/- and 2/- costs. 201 T.L.B. Malt Vinegar do. Vinegar other than Malt Fined £3 and £1 Is. costs. 204 T.L.B. do. do. do. do. To pay £1 Is. costs. 213 T.L.B. Baking Powder do. 12.2 per cent. of Calcium Sulphate Cautioned by letter. 215 T.L.B. do. do. 12.2 do. do. do. do. do. 216 T.L.B. do. do. 2.4 do. do. do. No proceedings. 218 T.L.B. do. do. 1.3 do. do. do. 247 T.L.B. Solution of Hydrogen Peroxide do. 22 per cent. of Hydrogen Peroxide deficient Cautioned by letter. 251 T.L.B. Butter do. 100 per cent. Margarine Fined £5 and £1 Is. costs. Total number of Samples analysed during the Quarter, 311. 325 ADULTERATED SAMPLES (Third Quarter, 1911). 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. 314 T.L.B. Milk * Inspector 9 per cent. of added water Fined £5 and £1 1s. costs, or 14 days imprisonment 815 T.L.B. ,, * ... ... ... ,, ... ... ... ... 19 per cent. of original fat abstracted Fined £1 and £1 Is. costs, or 7 days imprisonment. 331 T.L.B. ,, * ... ... ... ,, ... ... ... ... 7 ,, ,, ,, Ordered to pay £1 Is. costs 332 T.L.B. ,, * ... ... ... ,, ... ... ... ... 4 per cent. of added water Cautioned by letter. 333 T L B. ,, * ... ... ... ,, ... ... ... ... 4 „ ,, Cautioned by letter. 361 T.L.B. Self-Raising Flour ,, ... ... ... ... 0. 7 per cent. of Calcium Sulphate No action taken. 366 T.L B. Margariue ,, ... ... ... ... 100 per cent. of Margarine Fined £1 and 12s. 6d. costs. 368 T.L.B. Milk * ,, ... ... ... ... 10 per cent. of added water Summons withdrawn upon payment of £1 Is. costs. Defendant's carrier successfully prosecuted. 383 T.L.B. ,, * ... ... ... ,, ... ... ... ... 10 „ „ Fined £1 and 12s. 6d. costs. 392 T.L.B. Butter ,,, ... ... ... ... 100 per cent. of Margarine Fined £2 and l'2s. 6d. costs. 404 T.L.B. Milk ,, ... ... ... ... 14 per cent. of added water Fined £1 and 12s. 6d. costs. 405 T.L.B. ,, * ... ... ... ,, ... ... ... ... 10 ,, ,, Fined £1 and 12s. 6d. costs. 409 T.L.B Bitter ,, ... ... ... ... 35 per cent. of Margarine Fined £3 and 12s. 6d costs, or one month in default of distress. 455 T L B. Milk † ,, ... ... ... ... 32 per cent. of added water and 34 grains per gallon of Boric Acid Fined £2 10s. and £1 13s. 6d. costs, or 15 days' imprisonment. [1911 326 1911] ADULTERATED SAMPLES (Third Quarter, 1911)—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. 456 T.L.B. Milk † Inspector 32 per cent. of added water and 27 grains per gallon of Boric Acid Fined £5 and £1 13s 6d. costs, or one 459 T.L.B. ,, * ... ... ... ,, ... ... ... ... 32 per cent. of added water No action taken, the vendor declaring the article to be an admixture of milk and water. 464 T.L.B. ,, * .... ... ... ,, ... ... ... ... 4 „ ,, ... ... No action taken 470 T.L.B. ,, §... ... ... ,, ... ... ... ... Trace of Formalin No action taken. 473 T.L.B ,, * ... ... ... ,, ... ... ... ... 3 per cent, of added water No action taken 482 T.B.L. Butter ,, ... ... ... ... 100 per cent. of Margarine Fined £5 and £2 10s. costs, or one month's imprisonment 484 T.B.L. Milk * ,, ... ... ... ... 8 per cent, of added water Fined £8 and 12s. 6d. costs, or one 488 T.BL. ,, ... ... ... ,, ... ... ... ... 8 ,, „ ... ... Summons dismissed. Warranty successfully pleaded. 492 T.B.L. Margarine 100 per cent. of Margarine Cautioned by letter. 496 T.B.L. Milk * ,, ... ... ... ... 14 per cent. of added starch Fined £2 and 12s. 6d. costs. Total number of Samples analysed during the Quarter, 288. Number adulterated 24 * Boric Acid and Formalin absent. t Formalin absent. § Boric Acid absent. 327 ADULTERATED SAMPLES (.Fourth Quarter, 1911. 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. 585 T.L.B. Butter Inspector 100 per cent. of Margarine Fined £5 and £1 1s. costs. 604 T.L.B. Rum .. .. .. ,, .. .. .. .. 26 9 per cent. under proof Ordered to pay £2 2s. costs 631 T.L.B. Milk * ,, .. .. .. .. 4 per cent. of added water Cautioned by letter. 644 T.L.B. ,, * .. .. ... ,, .. .. .. .. 6 ,, .. .. Fined £5 and £1 Is. costs 655 T.L.B. ,, * .. .. ,, .. .. .. .. 8 ,, .. .. Fined 10/- and 12/6 costs. In default 7 days imprisonment. 657 T. L B. ,, * .. .. .. ,, .. .. .. .. 33 per cent of added water (sample coloured with Annatto) Fined £10 and £1 Is. costs. In default one month's imprisonment. 658 T.L.B. ,, * .. .. .. ,, .. .. .. .. 17 per cent. of added water Fined £5 and £1 Is. costs. In default 14 days' imprisonment. 663 T.L.B. ,, * .. .. .. ,, .. .. .. .. 79 ,, original fat abstracted Summons dismissed, magistrate holding sample was sold as " skimmed milk." 677 T.L.B. ,, * .. .. .. ,, .. .. .. .. 7 ,, added water Ordered to pay 12/6 costs. 793 T.L.B. Margarine ,, .. .. .. .. 100 ,, Margarine Cautioned by letter. 823 T.L.B. Milk * ,, .. .. .. .. 6 per cent. of original fat abstracted and 2 per cent. of added water Fined £10. 828 T.L .B. ,, * .. .. .. ,, .. .. .. .. 4 per cent. of added water Cautioned by letter. 837 T.L.B. Tomato Sauce ,, .. .. .. .. ‡0.003 per cent. of Copper No proceedings. * Boric Acid and Formalin absent. ‡ Less than the recommendation in the Preservatives Committee's Minority Report. Total Number of Samples analysed during the Quarter, 301. Number adulterated 13 [1911 328 1911] INFORMAL SAMPLING OF FOODS. Inspector Burrell, who for the past four years has been privately sampling several of the more common foods, such as milk, butter, margarine, demerara sugar, coffee, and malt vinegar, Has presented the Medical Officer of Health with a report on his work during the year, from which it appears that he examined qualitatively 663 samples, of which the composition of 10 were declared by the vendor at the time of sale, and 68 were adulterated, the percentage of adulteration thus discovered being 10.2. Inspector Burrell of course does not pretend to take the place of the Public Analyst, nor does he pretend to make quantitative analyses, but nevertheless, his private sampling has led to the detection of a considerable amount of fraud. The work has been exceedingly well done, for Mr. Burrell is not only a man of a distinct scientific turn of mind which enables him to understand the underlying principles of chemical analysis, but is also a most able microscopist, as anyone can readily understand who has seen some of his entomological work, or the hundred preparations of the sediments of milk which he has made for the Medical Officer of Health, and which are, in the opinion of persons who have seen them, and they are not a few, of exceeding merit. Public Health Department, Town Hall, Islington. 16th January, 1912. To Dr. A. E. Harris, Medical Officer of Health. Dear Sir, In compliance with your instructions, I have pleasure in submitting for your consideration the following report on the testing of informal samples for the year ending 31st December, 1911. During the year 663 samples of food were tested and examined, of which number 585 were found to be genuine, 10 were sold with a declaration imprinted on the wrappers, while 68, or 10.2 per cent., were adulterated. The adulterated samples include repetition samples purchased at the same premises over a course of several days, and samples purchased by young children. 329 [1911 Thirty-four samples were re-purchased and submitted to the Public Analyst n the usual manner, who reported 30 for prosecution—3 samples of milk as containing 4 per cent, of added water, and one milk sample as genuine. Of the thirty prosecutions which followed, 29 were successful, and one summons was dismissed, a defence of warranty having been successfully pleaded. It will thus be seen that the informal sampling work was directly responsible for 41.6 per cent. of the total prosecutions under the Sale of Food and Drugs Acts for the year, while the fines resulting from the same amounted to £97 6s. 6d. The several foods examined were as follows:— Milk.—I have carefully followed your instructions and given this most important food special attention, having during the year tested 424 samples. Of this number 29, or 6.6 per cent., were adulterated; not including samples adulterated to an extent less than 4 per cent. As in previous years, the greater portion of the samples were purchased at milkshops or dairies, but in the case of two prosecutions against milkmen suspected of selling adulterated milk, but whose methods had defeated the ordinary system of purchase, their conviction was secured by testing samples procured by their private customers. Coffee.— Seventy-two samples of coffee were examined, of which number 58 were found to be genuine ; 10 were sold with printed declarations that the contents of the packets consisted of chicory and coffee, and 4, or 5.5 per cent. were adulterated. Butter.—The butter samples were for the most part purchased from those dealers against whom there had been previous convictions. Of the 119 samples tested, 88 were genuine, and 31, or 26 per cent., were found to be adulterated. The high percentage of adulteration is partly accounted for by the fact that in several instances, in order to make quite certain of the final result, the agent purchased samples over a course of several days. It is also in part due to having made use of quite young children from the street as agents for purchasing some of the test samples. 330 1911] Among those vendors against whom there are several convictions, the latter style of sampling shows an exceptionally high percentage of adulteration, and it would seem that there is a tendency in several cases to confine their fraudulent practices to young children. Margarine.—The greater number of margarine samples were purchased from dairies. Forty-seven samples were examined, 44 of which were genuine, while 3, or 6.5 per cent. were sold in a manner contravening the Act. Malt Vinegar.—One sample purchased as malt vinegar was examined and found to be adulterated. For comparison, I insert the following table showing the result of the test work since its commencement in 1908:— ALL SAMPLES. Year. No. of Samples. Declared. Adulterated. Percentage of Adulteration. 1908 340 38 47 13.8 1909 471 96 88 187 1910 633 8l 73 11.5 1911 663 10 68 I0.2 2,107 225 276 13.55 I am, Your obedient Servant, T. L. BURRELL, Food and Drugs Inspector. 331 [1911 Table CXLVIII. SUMMARY OF PROSECUTIONS.—During year 1911. Total Prosecutions. Successful Dismissed. Withdrawn. Amount of Penalties Received. £ s. d. " Public Health (London) Act, 1891 " 31 28 ‡2 1 47 5 6 " Sale of Food and Drugs Acts, 1875-99 " 68 58 *5 5 228 19 6 " Margarine Act, 1887 " 4 4 .. ... 9 10 0 " Factory and Workshops Acts " 1 . §1 ... ... " Housing of Working Classes Acts " 1 1 ... 3 2 0 " London County Council General Powers Acts" 7 7 ... ... 10 19 0 " London County Council By-laws" 1 1 ... ... 1 12 6 Total 113 99 8 6 301 8 6 { Summonses dismissed on points of law. * In 4 instances warranties were successfully pleaded. The other was dismissed on technical point, the defendant proving he had sold business prior to purchase of sample, and was servant of vendor. § Dismissed on point of law. 332 1911] WATER SUPPLY. The following are the particulars els 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:— 1909-10 1910-11 Houses Supplied 216,494 218,225 Houses on constant system 216,426 218,225 Houses not on constant system 68 Nil Percentage of houses on constant system 99.9 100.0 Population supplied 1,415,215 1,426,401 Average daily supply (gallons) 43,434,947 44,293,400 Quantity of water supplied during the year (gals.) - 15,853,755,570 16,167,080,000 Average daily supply per house (gals.) 201.31 203.46 „ „ „ head (gals.) 30.69 10.5 Average number of persons supplied per house 6.56 6.55 Capacity of subsidence reservoirs 468,100,000 468,100,000 No. of days supply 10.78 10.57 APPENDIX. VITAL AND SANITARY STATISTICS, 1911. together with the PRESCRIBED RETURNS OF THE LOCAL GOVERNMENT BOARD AND Abstracts for Previous Years. 884 1911] Table A. Showing the Deaths from All Causes in Islington during the Year 1911. Deaths of Non-Residenls in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. Deaths in Institutions within Borough. I DISEASES. AGES. Under 5 Over 5 DISTRICTS. Males. Females. Totals 0- 1- 5- 10- 15- 20- 25- 35- , 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H. B. S E. Small Pox (a)Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (b) Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (c) No Statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 19 Measles 28 94 1 .. 1 .. .. .. .. .. .. .. 122 2 6 18 8 17 15 27 33 69 55 124 1 Scarlet Fever .. 12 6 1 .. 1 .. .. .. .. .. .. 12 8 2 3 2 1 .. 7 5 17 3 20 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Epidemic Influenza 1 2 .. .. .. 1 4 2 6 3 1U 7 1 3 34 5 6 .. 2 11 4 9 22 15 37 1 Whooping Cough 31 38 1 .. .. .. .. .. .. .. .. .. 69 1 4 10 6 6 8 13 23 34 36 70 3 Diphtheria 2 26 20 2 .. .. 1 1 1 .. .. .. 28 25 2 7 8 6 6 10 14 28 25 53 5 Enteric Fever .. .. .. 1 .. 3 5 .. 3 .. .. .. .. 12 1 .. 1 1 2 4 3 6 6 12 Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 35 Diarrhoea, Dysentery 163 41 .. .. .. 2 4 4 5 10 11 .. 204 36 19 25 23 36 32 68 37 120 120 240 9 Epidemic Enteritis 64 14 .. .. .. .. .. 1 .. 2 1 2 .. 78 6 3 5 8 17 6 19 26 54 30 84 3 Other A llied Diseases *7 *1 *2 .. .. *1 .. .. .. .. 1 .. 8 4 1 .. .. 4 1 3 3 8 4 12 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tetanus .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 1 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis 4 2 .. .. .. .. .. .. .. .. .. .. 6 .. .. 1 .. 3 1 .. 1 4 2 6 3 Gonorrhoea .. .. .. .. .. .. .. 1 2 2 2 .. .. .. 7 .. .. .. 3 1 1 2 7 .. 7 Phagedena .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 1 .. 1 .. 1 8 Erysipelas .. .. .. .. 1 1 .. 1 3 .. 3 2 1 .. 12 2 1 1 1 2 4 1 7 5 12 Puerperal Fever .. .. .. .. .. 2 2 3 .. .. .. .. .. 7 1 .. .. 3 1 1 1 .. 7 7 3 Paæmia .. 2 .. .. 1 .. 1 2 2 2 1 .. 2 11 1 3 1 1 3 .. 4 5 8 13 Infective Endocarditis .. .. .. .. .. 2 1 1 1 1 .. .. .. 6 .. .. .. .. 3 .. 3 4 2 6 5 Other Allid Diseases 4 1 .. .. .. .. .. .. .. 3 4 1 .. 5 8 1 .. 3 1 .. 3 5 4 9 17 Malaria Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rheumatic Fever .. 2 .. 1 3 1 2 .. .. .. .. .. 2 7 1 2 1 1 1 .. 3 5 4 9 1 Rheumatism of Heart .. 1 .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. 1 .. 1 1 1 2 4 Tuberculosis of Brain 19 23 5 1 1 .. 1 .. .. .. .. .. 42 8 3 10 3 6 4 10 14 27 23 50 4 Tuberculosis of Larynx .. .. 1 .. .. .. 4 3 .. 2 .. .. .. 10 .. 3 1 1 2 3 .. 5 5 10 136 Phthisis 4 7 3 6 21 23 74 108 71 44 17 1 .. 11 368 34 37 38 54 60 71 85 223 156 379 8 Abdominal Tuberculosis 11 8 3 2 1 2 3 2 1 .. .. .. 19 14 3 1 5 6 8 5 5 17 16 33 5 General Tuberculosis 10 6 2 1 1 .. 3 1 1 .. .. .. 16 9 2 3 3 2 2 3 10 13 12 25 8 Other forms Tuberculosis 2 1 1 3 1 1 1 1 1 1 .. .. 3 12 .. 4 1 1 2 2 5 9 6 15 Other Infective Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Thrush 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 1 Actinomycosis .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 1 Hydatid Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases due to Altered Food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Chronic Alcoholism .. .. .. .. .. .. .. 1 .. 3 .. .. .. 4 1 1 .. .. 2 .. .. 2 2 4 Chronic Industrial Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Osteo-arthritis .. .. .. .. .. .. .. .. 2 2 1 6 .. .. 7 1 3 1 2 6 1 3 3 14 17 Gout .. .. .. .. .. .. .. .. .. 2 3 .. .. .. 5 .. 1 1 1 1 .. 1 3 2 5 87 Cancer 1 .. 2 1 2 2 5 32 67 92 87 31 7 1 328 38 46 27 45 65 33 75 143 186 329 1 Diabetes Mellitus .. .. .. .. .. 1 1 3 4 9 8 1 .. .. 27 2 3 3 4 5 7 3 13 14 27 Purpura Haemorrhagica 1 .. .. .. .. .. .. 1 .. .. .. .. 1 1 .. .. .. 1 .. 1 .. 1 1 2 Haemophilia .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 .. 1 Anaemia .. 1 2 .. 2 2 2 1 1 9 .. .. 1 21 5 2 2 5 3 2 3 11 11 22 Lymphadenoina .. .. .. 2 .. .. 1 1 2 1 .. .. .. 7 1 .. 2 1 1 .. 2 5 2 7 1 Premature Birth 149 .. .. .. .. .. .. .. .. .. .. .. 149 .. 9 10 11 23 18 43 35 75 74 149 Injury at Birth 4 .. .. .. .. .. .. .. .. .. .. .. 4 .. 1 .. 1 1 1 .. .. 3 1 4 Debility at Birth 24 .. .. .. .. .. .. .. .. .. .. .. 24 .. 1 3 .. 4 8 4 4 14 10 24 Atelectasis 10 .. .. .. .. .. .. .. .. .. .. .. 10 .. .. 1 1 .. 1 5 2 8 2 10 Congenital Defects 35 .. .. .. .. .. .. .. .. .. .. .. 35 .. 6 3 4 4 4 7 7 19 16 35 Want of Breast Milk 14 .. .. .. .. .. .. .. .. .. .. .. 14 .. 2 1 .. 3 .. 4 4 3 11 14 Atrophy, Debility, Marasmus 91 4 .. 1 .. .. .. .. .. .. .. .. 95 1 7 12 10 21 12 17 17 58 38 96 * Cerebrospinal Fever accounted for 6 deaths under 1 year ot age ; 1 death 1-5 ; 1 death 5-10; also 1 death 20-25 years. 835 [1911 Table A.—Continued. Deaths in Institutions within Borough. DISEASES. AGES. Under 5. Over 5. DISTRICTS. Males. Females. Total 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H B. S.E. Dentition 5 4 •• •• •• •• •• •• •• •• •• •• •• 9 •• 2 1 •• 2 3 •• 1 4 5 9 Rickets 6 4 •• •• •• •• •• •• •• •• •• •• •• 10 •• 1 2 •• •• 1 4 2 4 6 10 Old Age, Senile Decay •• •• •• •• •• •• •• •• •• 4 36 114 75 •• 229 26 36 13 24 36 45 49 71 158 229 Convulsions 17 1 •• •• •• •• •• •• •• •• •• •• •• 18 •• 2 6 1 1 3 2 3 8 10 18 Meningitis 10 9 4 •• •• 1 2 1 •• •• •• •• •• 19 8 5 2 5 3 4 5 3 17 10 27 Encephalitis •• 1 •• •• •• 2 1 1 1 1 1 •• •• 1 7 1 • • 1 •• 2 •• 4 5 3 8 Apoplexy •• •• •• •• •• •• •• •• 8 8 12 4 3 •• 35 2 2 4 3 6 10 8 15 20 35 Softening of Brain •• •• •• •• •• •• •• •• 1 5 8 7 •• •• 21 5 2 1 1 3 3 6 7 14 21 Hemiplegia •• •• •• •• •• •• •• •• 1 7 5 5 3 •• 21 •• 5 1 2 5 2 6 9 12 21 General Paralysis of the Insane •• •• •• •• •• 1 3 12 7 2 2 1 •• •• 28 2 6 3 5 2 6 4 23 5 28 Other froms of Insanity •• •• •• •• •• •• 4 3 4 2 6 3 2 •• 24 3 9 1 2 1 4 4 7 17 24 Chorea •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Cerebral Tumour •• 1 •• 1 •• 1 3 2 3 •• •• •• •• 1 10 •• 3 1 •• 1 4 2 7 4 11 Epilepsy •• 1 •• •• •• 2 1 6 2 1 4 1 •• 1 17 3 6 1 3 1 •• 4 9 9 18 Laryngismus Stridulus 2 •• •• •• •• •• •• •• •• •• •• •• 2 •• •• •• •• 1 •• 1 •• 1 1 2 Locomotor Ataxy •• •• •• •• •• •• •• 2 4 3 2 •• •• •• 11 •• 3 2 •• 1 1 4 9 2 11 Paraplegia •• •• 2 •• •• 2 2 4 2 2 17 4 1 •• 36 1 8 2 3 4 9 9 18 18 36 Other forms, Brain Diseases •• 2 •• •• •• •• 1 1 3 6 1 1 •• 2 13 •• 3 2 2 4 2 2 6 9 15 Otitis 1 2 •• 3 •• 1 3 •• •• 2 1 •• •• 3 10 1 •• 1 2 4 •• 5 6 7 13 Disease of Nose, Epistaxis •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Disease of Eye •• •• •• •• •• •• •• •• •• •• •• 1 •• •• 1 •• •• •• •• •• 1 • • •• 1 1 Pericarditis •• •• 1 •• •• •• •• •• 1 1 1 1 •• •• 5 •• •• 1 1 1 1 1 4 1 5 1 Endocarditis 1 •• •• •• •• 1 2 1 2 2 1 •• •• 1 9 •• 1 1 1 4 •• 3 4 6 10 Hypertrophy of Heart •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• • • •• 1 Angina Pectoris •• •• •• •• •• •• 1 •• 1 3 1 3 •• •• 9 •• 2 1 •• 3 •• 3 6 3 9 1 Aneurism •• •• •• •• •• •• •• 3 3 4 1 •• •• •• 11 1 •• 2 1 2 1 5 10 1 11 9 Senile Gangrene •• •• •• •• •• •• •• •• •• 2 7 3 •• •• 12 •• 5 •• 3 •• 1 5 8 4 12 12 Embolism, Thrombosis 1 •• •• •• 1 •• 1 2 8 6 5 5 3 1 31 5 4 1 •• 8 5 6 14 18 32 Phlebitis •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Varicose Veins •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 138 Other Diseases, Heart and Vessels 5 •• 5 3 10 9 19 62 92 107 146 83 13 5 549 50 86 38 74 96 86 124 268 286 554 2 Laryngitis 1 4 2 •• •• •• •• •• 1 1 •• •• •• 5 4 1 1 1 1 2 2 1 4 5 9 Croup •• 2 •• •• •• •• •• •• •• •• •• •• •• 2 •• •• •• •• 1 •• 1 •• 2 •• 2 Other Diseases, Larynx and Trachea •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 9 Acute Bronchitis 51 18 1 •• 1 •• •• 4 8 18 31 18 7 69 88 9 18 14 23 22 34 37 58 99 157 66 Chronic Bronchitis •• •• 1 •• 1 2 6 5 18 43 82 71 18 •• 247 23 16 22 21 45 55 65 116 131 247 12 Lobar Pneumonia •• 2 •• 1 1 3 8 8 11 3 1 •• 2 36 2 1 7 3 6 8 11 24 14 38 24 Lobular Pneumonia 68 62 1 1 •• •• 1 6 11 11 8 7 1 130 47 9 20 10 28 23 48 39 94 83 177 33 Pneumonia 32 32 4 5 2 2 10 15 19 24 22 10 3 64 116 12 17 14 15 28 28 66 97 83 180 3 Emphysema,Asthma •• •• •• •• •• •• •• •• 1 3 3 •• 1 •• 8 •• 1 2 •• 1 2 2 6 2 8 5 Pleurisy 5 4 •• •• •• 1 3 2 4 2 3 3 •• 9 18 2 7 2 6 4 1 5 17 10 27 1 Other Diseases, Respiratory System •• •• •• •• •• •• •• 1 •• 5 3 1 •• •• 10 1 2 2 1 1 3 •• 3 7 10 Diseases of Mouth and Annexa 1 1 •• 1 1 •• •• •• •• •• •• •• •• 2 2 •• 1 1 •• 1 1 •• •• 4 4 Diseases of Pharynx •• •• •• •• •• •• 1 •• 1 •• •• •• •• •• 2 1 •• •• •• •• •• 1 1 1 2 Diseases of Œsophagus •• •• •• •• •• •• •• •• •• •• •• 1 •• •• 1 •• •• •• •• •• •• 1 1 •• 1 1 Ulcer of Stomach and Duodenum •• •• •• •• 1 1 5 10 8 6 2 •• •• •• 33 6 4 3 1 7 7 5 9 14 33 2 Other Diseases of Stomach 9 1 1 •• •• •• 1 •• 4 1 4 4 •• 10 15 2 6 •• 4 5 5 3 11 14 25 9 Enteritis 73 18 1 •• 1 •• 1 3 •• 3 5 7 •• 91 21 2 19 13 23 11 17 27 68 44 112 5 Appendicitis •• •• 3 2 4 2 4 3 •• 3 1 2 •• •• 24 1 4 4 3 5 2 5 16 8 24 Obstruction of Intestine 5 1 2 •• 2 1 1 2 3 1 6 8 1 6 27 4 1 5 3 9 3 8 19 14 33 Other Diseases of Intestine 3 •• •• •• •• •• •• 1 1 2 2 1 •• 3 7 •• 3 •• 3 1 3 •• 5 5 10 14 Cirrhosis of Liver •• •• •• •• 1 •• 1 4 20 14 7 1 •• •• 48 6 3 2 8 4 9 16 21 27 48 Other Diseases of Liver 4 •• •• •• •• •• •• •• 1 2 5 2 •• 4 10 3 3 2 2 1 1 2 4 10 14 Peritonitis 1 2 2 •• 1 •• 1 1 1 •• •• •• •• 3 6 1 1 2 • • 3 1 1 2 7 9 Other Diseases, Digestive System 6 •• •• •• •• •• 2 •• •• 2 2 1 •• 6 7 1 2 •• 1 1 6 2 7 6 13 Diseases, Lymphatic System and Glands 1 •• •• •• •• 1 3 1 2 2 •• •• •• 1 9 •• 1 •• 1 2 •• 6 5 5 10 8 Acute Nephritis •• •• 1 1 1 2 5 4 4 5 2 •• •• •• 25 2 3 1 3 6 4 6 16 9 25 36 Bright's Disease •• •• 1 1 •• 4 7 19 27 46 34 12 •• •• 151 15 15 9 16 27 29 40 79 72 151 Calculus •• •• •• •• •• •• •• 1 •• 1 1 1 •• •• 4 •• •• •• •• 3 1 •• 3 1 4 1 Diseases of Bladder and Prostate •• •• •• •• •• •• 1 •• 2 4 9 8 3 •• 27 1 3 2 6 1 3 11 24 3 27 Other Diseases, Urinary System 1 1 •• •• •• 1 1 •• •• 2 1 2 1 2 8 1 3 •• •• 2 1 3 6 4 10 Diseases of Testis and Penis •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Diseases of Ovaries •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Diseases of Uterus and Appen- dages •• •• •• •• •• •• •• 2 •• •• •• •• •• •• 2 1 •• •• •• •• •• 1 •• 2 2 Diseases of Vagina and External Genitals •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Diseases of Breast •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Abortion, Miscarriage •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Puerperal Mania •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Puerperal Convulsions •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Placenta Prævia, Flooding •• •• •• •• •• •• •• 2 •• •• •• •• •• •• 2 •• 1 •• •• 1 •• •• •• 2 2 386 1911] Table A.—Continued. Deaths in Institutions within Borough. DISEASES. AGES. Under 5. Over 5. DISTRICTS. Males. Females. Totals 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H. B. S.K. Puerperal Thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases, Pregnancy and Childbirth .. .. .. .. 1 1 5 1 .. .. .. .. .. .. 8 3 .. 1 .. 1 1 2 .. 8 8 Arthritis, Ostitis, Periostitis .. .. .. .. 1 .. 1 .. .. .. .. 1 .. .. 3 1 1 .. .. .. .. 1 1 2 3 Other Diseases, Osseous System .. .. 2 4 4 .. .. .. .. 5 .. 1 .. .. l6 .. 4 2 3 3 3 1 6 10 16 Ulcer, Bedsore .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Eczema 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. 1 1 Pemphigus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases, Integumentary System 1 .. .. .. .. .. .. .. 1 .. 1 1 .. 1 3 .. 1 1 1 .. .. 1 1 3 4 Accidents and Negligence. In Mines and Quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 In Vehicular Traffic .. 3 7 3 1 1 1 1 1 2 3 4 1 3 25 3 3 1 3 2 8 8 22 6 28 On Railways .. .. .. .. .. .. 1 1 1 .. .. .. .. .. 3 .. 1 1 .. .. 1 .. 3 .. 3 On Ships, Boats, etc. (not drowning) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. In Building Operations .. .. .. .. .. .. .. 2 .. 1 1 .. .. .. 4 .. 2 .. 1 1 .. 4 .. 4 By Machinery .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 2 .. .. .. .. 1 1 .. 2 .. 2 1 By Weapons and Implements .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 2 .. .. .. .. .. 1 1 2 .. 2 4 Burns and Scalds 3 8 5 .. .. .. .. .. 1 1 2 .. .. 11 9 1 3 1 4 1 4 6 8 12 20 Poisons, Poisonous Vapours .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. 2 .. .. 1 .. .. 1 .. .. 2 2 3 Surgical Narcosis .. .. .. 2 .. 1 1 1 1 1 1 .. .. .. 8 1 .. .. 1 4 1 1 2 6 8 Effect of Electric Shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Corrosions by Chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Drowning .. .. .. .. .. 1 .. 2 .. .. .. .. .. .. 3 .. .. 1 1 .. .. 1 3 .. 3 Suffocation, Overlaid in Bed 20 .. .. .. .. .. .. .. .. .. .. .. .. 20 .. .. 1 4 3 2 5 5 9 11 20 ,, Otherwise 11 .. .. .. 1 .. .. .. .. .. .. .. .. 11 1 .. .. 4 2 .. 4 2 4 8 12 22 Falls not specified 2 2 1 1 .. 2 1 1 5 4 8 12 4 4 39 3 1 2 4 9 8 16 23 20 43 Weather Agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Otherwise, not stated 3 1 .. .. .. 1 1 2 1 2 1 I .. 4 9 .. 1 3 3 .. 2 4 7 6 13 Homicide 2 .. .. .. .. .. 1 .. 1 .. .. .. .. 2 2 .. .. 1 .. 1 2 .. 2 2 4 Suicide. By Poison .. .. .. .. .. .. .. 3 3 3 .. .. .. .. 9 2 2 .. .. 1 2 2 2 7 9 By Asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Hanging and Strangulation .. .. .. .. .. .. 1 2 5 .. 1 .. .. .. 9 .. 1 1 .. 3 1 3 8 1 9 By Drowning .. .. .. .. .. 1 1 1 .. 1 1 1 .. .. 6 1 1 .. 1 1 2 .. 6 .. 6 By Shooting .. .. .. .. .. 1 1 .. .. 2 .. .. .. .. 4 2 1 .. .. .. 1 .. 4 .. 4 2 By Cut or Stab .. .. .. .. .. .. .. .. 2 4 1 .. .. .. 7 .. .. 2 .. 2 .. 3 4 3 7 By Precipitation from Elevated Places .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 1 By Crushing .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 2 .. .. .. .. 1 1 .. 2 .. 2 By other and unspecified methods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Execution .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sudden Death, cause not ascertained 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. 1 .. 1 Ill-defined and unspecified causes .. 1 .. .. .. .. .. .. .. .. 1 .. .. 1 1 .. 1 .. .. .. .. 1 1 1 2 Males 566 259 56 28 34 43 120 212 264 322 316 190 39 825 1624 191 297 196 347 372 466 580 .. .. 2449 Females 467 216 40 23 37 47 112 169 222 269 357 292 110 683 1678 208 302 207 276 377 435 556 .. .. 2361 787 TOTAL DEATHS 1033 476 96 51 71 90 232 381 486 591 673 482 149 1508 3302 399 599 403 623 749 901 1136 2449 2361 4810 837 [1911 Table B. Showing the Deaths from All Causes registered during the Quarters of the Year 1911 at three periods of life. DISEASES. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total for Year Under 1 1 to 50 Over 5 Total. Under 1 1 to 5 Over 5 Total. Under 1 l to 5 Over 5 Total. Uuder 1 1 to 5 Over 5 Total. Small Pox— (a) Vaccinated •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• (b) Unvaccinated •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• (c) No Statement •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Measles 17 64 2 83 9 24 •• 33 1 4 •• 5 1 2 •• 3 124 Scarlet Fever •• 4 •• 4 •• 1 2 3 •• 4 4 8 •• 3 2 5 20 Typhus Fever •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Epidemic Influenza •• •• 18 18 •• 2 7 9 •• •• 1 1 1 •• 8 9 37 Whooping Cough 13 18 1 32 11 15 •• 26 6 5 •• 11 1 •• •• 1 70 Diphtheria 1 5 5 11 •• 6 2 8 •• 5 8 13 1 10 10 21 53 Enteric Fever •• •• 3 3 •• •• 1 1 •• •• 4 4 •• •• 4 4 12 Asiatic Cholera •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Diarrhoea, Dysentery 4 2 3 9 6 •• 1 7 141 35 22 198 12 4 10 26 240 Epidemic Enteritis •• •• 1 1 1 1 1 3 60 12 4 76 3 1 •• 4 84 Other Allied Diseases 2† 3 •• 2† 3 6 1† 1† •• 2 2† •• 1 3 1 •• •• 1 12 Hydrophobia •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Glanders •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Tetanus •• •• •• •• •• 1 •• 1 •• •• •• •• •• •• •• •• 1 Anthrax •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Cow Pox •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Syphilis •• •• •• •• 2 •• •• 2 •• 2 •• 3 1 •• •• 1 6 Gonorrhoea •• •• 3 3 •• •• 1 1 •• •• 1 1 •• •• 2 2 7 Phagedena •• •• 1 1 •• •• •• •• •• •• •• •• •• •• •• •• 1 Erysipelas •• •• 1 1 •• •• 1 1 •• •• 3 3 •• •• 7 7 12 Puerperal Fever •• •• 2 2 •• •• 1 1 •• •• •• •• •• •• 4 •• 7 Paæmia •• 2 5 7 •• •• 1 1 •• •• 2 2 •• •• 3 3 13 Infective Endocarditis •• •• 3 3 •• •• 1 1 •• •• 2 2 •• 1 •• •• 6 Other A llied Diseases 3 •• 3 6 •• •• 1 •• 1 •• •• 1 •• 1 5 6 13 Malarial Fever •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Rheumatic Fever •• 1 1 2 •• •• 2 2 •• •• 2 2 •• 1 2 3 9 Rheumatism of Heart •• •• •• •• •• •• •• •• •• 1 1 2 •• •• •• •• 2 Tuberculosis of Brain 6 7 3 16 3 9 •• 12 6 4 4 14 4 3 1 8 50 Tuberculosis of Larynx •• •• 1 1 •• •• 4 4 •• •• 4 4 •• •• 1 1 10 Phthisis •• 3 106 109 3 1 94 98 •• 2 77 79 1 1 91 93 379 Abdominal Tuberculosis 4 3 4 11 2 1 2 5 3 2 3 8 2 2 5 9 33 General Tuberculosis 2 4 2 8 2 •• 3 5 6 2 1 9 •• •• 3 3 25 Other Forms Tuberculosis 1 1 3 5 •• •• 6 6 1 •• 3 4 •• •• •• •• 15 Other Infective Diseases •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Thrush •• •• •• •• 1 •• •• 1 •• •• •• •• •• •• •• •• 1 Actinomycosis •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 1 1 Hydatid Diseases •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Scurvy •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Other Diseases due to Altered F od •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Acute Alcoholism •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Chronic Alcoholism •• •• 1 1 •• •• 1 1 •• •• 2 2 •• •• •• •• 4 Chronic Industrial Poisonings •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Other Chronic Poisonings •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Osteo-arthritis •• •• 7 7 •• •• 5 5 •• •• 4 4 •• •• 1 1 17 Gout •• •• 4 4 •• •• 1 1 •• •• •• •• •• •• •• •• 5 Cancer •• •• 76 76 •• •• 82 82 1 •• 89 90 •• •• 81 81 329 Diabetes Mellitus •• •• 7 7 •• •• 7 7 •• •• 6 6 •• •• 7 7 27 Purpura Hemorrhagica •• •• •• •• •• •• 1 1 •• •• •• •• 1 •• •• 1 2 Haemophilia •• •• •• •• •• •• •• •• •• •• 4 •• •• •• 1 1 1 Anaemia •• 1 1 2 •• •• 7 7 •• •• •• 4 •• •• 9 9 22 Lymphadenoina •• •• 4 4 •• •• 2 2 •• •• •• •• •• •• 1 1 7 Premature Birth 32 •• •• 32 39 •• •• 39 36 •• •• 36 42 •• •• 42 149 Injury at Birth 2 •• •• 2 •• •• •• •• •• •• •• •• 2 •• •• 2 4 Debility at Birth 7 •• •• 7 5 •• •• 5 5 •• •• 5 7 •• •• 7 24 Atelectasis 3 •• •• 3 2 •• •• 2 3 •• •• 3 2 •• •• 2 10 Congenital Defects 4 •• •• 4 8 •• •• 8 13 •• •• 13 10 •• •• 10 35 Want of Breast Milk 3 •• •• 3 •• •• •• •• 9 •• •• 9 2 •• •• 2 14 Atrophy, Debility, Marasmus 28 2 •• 30 25 •• •• 25 24 1 •• 25 14 1 1 16 96 †Cerebro-Spinal Fever. 338 1911] Table B.—Continued. DISEASES. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total for Year Under 1 Wot— Over 5 Total. Under 1 j cn £ h- Over 5 Total. Under 1 oio »- Over 5 Total. Under 1 | Over 5 Total. Dentition 3 Q b 2 2 4 9 Rickets 4 4 1 1 2 1 1 2 ? ? 10 Old Age, Senile Decay .. 62 62 52 52 4y 4y 66 66 229 Convulsions 4 4 2 1 3 4 4 7 7 18 Meningitis 3 3 q 1 3 1 6 4 1 l 6 ? ? Encephalitis .. 2 2 3 3 1 1 ?, 2 8 Apoplexy .. 11 li 5 5 7 7 1?, 1? 35 Softening of Brain .. 3 3 4 4 y y 5 5 21 Hemiplegia .. y y 3 3 2 2 7 7 21 General Paralysis of Insane .. b b 7 7 12 12 4 4 28 Other forms of Insanity .. 10 10 b 5 8 8 1 1 24 Chorea .. Cerebral Tumour .. 3 3 3 4 i 1 s 3 11 Epilepsy .. 7 7 4 4 3 4 3 I 18 Laryngismus Stridulus 1 1 1 Locomotor Ataxy .. 2 2 4 4 1 1 4 4 11 Paraplegia .. 13 13 10 10 5 5 8 8 36 Other forms, Brain Diseases .. b b i 4 5 1 2 3 3 15 Otitis .. 4 4 1 1 2 2 3 3 4 13 Disease of Nose,Epistaxis .. Disease of Eye .. i 1 1 Pericarditis .. i 1 1 1 1 1 ?, ?, 5 Endocarditis 1 i 2 3 3 2 2 5 ft 10 Hypertrophy of Heart .. Angina Pectoris .. 3 3 3 2 2 1 1 y Aneurism .. 4 4 2 2 2 2 Senile Gangrene .. b b 4 4 3 3 12 Embolism, Thrombosis .. 8 8 6 6 11 11 6 7 32 Phlebitis .. Varicose Veins .. Other Diseases, Heart and Vessels 1 170 171 122 123 107 ioy 1 160 151 554 Laryngitis .. i 1 2 1 2 i 1 2 1 1 3 9 Croup .. 1 1 i i 2 Other Diseases, Larynx and Trachea .. Acute Bronchitis 22 10 38 70 17 30 2 6 12 16 28 4b 157 Chronic Bronchitis .. yy yy 67 67 21 21 70 70 247 Lobar Pneumonia .. 2 ib 18 b b 3 3 11 11 38 Lobular Pneumonia 24 27 14 bb 21 ib 14 51 7 4 5 lb 16 lb 14 4b Pneumonia 14 12 37 b3 b b 28 38 4 2 18 24 y 13 33 bb Emphysema, Asthma .. 3 3 1 1 3 3 1 1 8 Pleurisy 3 2 4 9 2 i b 8 4 4 S 6 27 Other Diseases, Respiratory System .. 4 4 4 4 1 1 1 1 10 Diseases of Mouth and Annex a 1 1 2 2 1 4 Diseases of Pharynx .. 2 2 2 Diseases Œsophagus .. 1 1 1 Ulcer of Stomach and Duodenum .. 8 8 y y 6 b 10 10 33 Other Diseases of Stomach I 3 4 2 i 4 7 3 b 3 5 8 25 Enteritis 10 b 17 y 2 4 15 43 y 62 11 3 18 112 Appendicitis .. 4 4 y y 7 I 4 4 24 Obstruction of Intestine 2 b 8 7 7 1 10 11 2 5 7 33 Other Diseases of Intestine .. 2 2 i 1 2 1 2 3 1 2 3 10 Cirrhosis of Liver .. 11 11 b b 13 13 18 18 48 Other Diseases of Liver .. 1 1 2 b 7 1 2 3 1 2 3 14 Peritonitis .. 1 2 1 1 2 1 1 3 4 9 Other Diseases, Digestive System 1 2 3 1 2 3 4 1 5 2 2 13 Diseases, Lymphatic System &> Glands 1 3 4 1 1 5 5 10 Aute Nephritis .. b b 1 1 .. 11 11 7 7 25 Bright's Disease .. 42 42 36 36 38 38 3b 3b 151 Calculus .. 2 2 2 2 4 Diseases of Bladder and Prostate .. 7 7 5 b y y 6 6 27 Other Diseases, iJnnary System .. 2 3 2 2 2 2 i 2 3 10 Diseases of Testis and Penis .. Diseases of Ovaries .. Diseases of Uterus and Appendages .. 1 I 1 1 2 Dis of Vagina and External Genitals .. Diseases of Breast .. Abortion, Miscarriage .. Puerperal Mania .. Puerperal Convulsions .. Plaenta Praevia, Flooding .. 1 1 1 1 2 Puerperal Thrombosis .. Other Dis., Pregnancy and Childbirth. .. 3 3 2 2 3 3 8 Arthritis. Ostitis, Periostitis .. 1 1 2 2 3 Other Diseases. Osseous System .. 3 3 h 5 2 2 6 6 16 Ulcer, Bedsore .. 839 [1911 Table B.—Continued DISEASES. 1st Quarter 2nd Quarter. 3rd Quarter. 4th Quarter. 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 Total. Eczema •• •• •• •• •• •• •• •• •• •• •• 1 •• •• 1 1 Pemphigus •• •• •• •••• •• •• •• •• •• •• •• •• •• •• •• •• •• Other Diseases, Integumentary System •• •• 2 2 •• •• •• •• 1 •• 1 2 •• •• •• •• 4 Accidents and Negligence. In Mines and Quarries •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• In Vehicular Traffic •• •• 3 3 •• 1 7 8 •• 1 8 9 •• 1 7 8 28 On Railways •• •• 1 1 •• •• •• •• •• •• 1 1 •• •• 1 1 3 On Ships, Boats, &c. (not drowning) •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• In Building Operation •• •• •• •• •• •• 1 1 •• •• 1 1 •• •• 2 2 4 By Machinery •• •• 1 1 •• •• •• •• •• •• •• •• •• •• I 1 2 By Weapons and Implements •• •• 1 1 •• •• •• •• •• •• •• •• •• •• •• •• •• Burns and Scalds 3 4 2 9 •• •• 2 2 •• 4 1 5 •• •• 4 4 20 Poisons, Poisonous Vapours •• •• •• •• •• •• 2 2 •• •• •• •• •• •• •• •• 2 Surgical Narcosis •• •• 1 1 •• •• 3 3 •• •• 1 1 •• •• •• •• 8 Effects of Electric Shock •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Corrosions by Chemicals •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Drowning •• •• •• •• •• •• 1 1 •• •• 2 2 •• •• •• •• 3 Suffocation, Overlaid in Bed 5 •• •• 5 4 •• •• 4 2 •• •• 2 9 •• •• 9 20 Otherwise 3 •• •• 3 4 •• •• 4 3 •• •• 3 1 •• 1 2 12 Falls not specified 1 •• 12 13 •• 1 6 7 1 1 9 11 •• •• 12 12 43 Weather Agencies •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Otherwise, not stated •• •• 1 1 3 •• 5 8 •• 1 2 3 •• •• 1 1 13 Homicide 1 •• •• 1 •• •• •• •• •• •• 2 2 1 •• •• 1 4 Suicide. By Poison •• •• 4 4 •• •• 2 2 .. •• 2 2 •• •• 1 1 9 By Asphyxia •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• By Hanging and Strangulatio •• •• •• •• •• •• 3 3 •• •• 4 4 •• •• 2 2 9 By Drownin •• •• 3 3 •• •• 1 1 •• •• 1 1 •• •• 1 1 6 By Shootin •• •• 1 1 •• •• 1 1 •• •• 1 1 •• •• 1 1 4 By Cut or Sta •• •• 2 2 •• •• 1 1 •• •• 3 3 •• •• 1 1 7 By Precipitation from Elevated Places •• •• •• •• •• •• 1 1 •• •• •• •• •• •• •• •• 1 By Crushing •• •• •• •• •• •• •• •• •• •• 2 2 •• •• •• •• 2 By other and unspecified methods •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Execution •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Sudden Death, cause not ascertained •• •• •• •• 1 •• •• 1 •• •• •• •• •• •• •• •• 1 Ill- defined and unspecified cause •• •• •• •• •• 1 1 2 •• •• •• •• •• •• •• •• 2 Males 126 98 481 705 105 62 381 548 235 66 367 668 100 33 395 528 2449 Females 116 88 483 687 86 44 375 505 172 45 339 556 93 39 481 613 2361 TOTAL DEATHS 242 186 964 1392 191 106 756 1053 407 111 706 1224 193 72 876 1141 4810 840 1911] Table C. Showing the Population, Inhabited Houses Marriages, Births and Deaths for the year 1911, 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 live I 2 3 4 5 6 7 8 9 1911 327247 39,920 2,843 8,113 4,866 1,040 1,508 1,941 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 4,955 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 1,541 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 1910 327,985 39,949 2,870 8,201 4,523 777 1,292 1,801 Average of 10 years. 331,434 39,778 2,943 8,736 5,027 1,045 1,612 1,650 341 [1911 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 1911, and 10 years preceding. Year. Birth-rates per 1,000 of the population. Deathrates per 1,000 of the population. tCorrected 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. I 2 3 4 5 6 7 8 1911 24.79 14.88 15.46 128 214 310 399 1901 27.6 16.0 16.6 139 241 360 286 1902 27.1 16.5 17.1 132 216 338 292 1903 26.9 14.5 13.1 126 233 346 318 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 I25 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 1910 25.0 13.8 14.3 95 170 286 398 Average of 10 years. 26.4 14.7 15.7 119 208 320 328 t 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 KcgUnd. 342 1911] Table E. Showing the Births, Deaths, Infantile Mortality, the Deaths from the Principal Epidemic Diseases, and from Influenza Cancer, Phthisis, and Puerperal Fever occurring in the Year 1911, 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. Diarrhoeal Diseases. Deaths. Death-rates. Deaths. Death-rates. Deaths. Death-rates. Deaths. Deaths per 1,000 births. 190I 9,264 27.6 5,361 16.0 1,290 139 628 8 151 30 134 85 .. 47 I 172 I.87 46 0.14 289 0.86 545 1.63 15 1.62 1902 9,214 27.1 5,635 16.5 1,219 132 608 53 114 40 104 152 .. 45 I 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 I 109 1.41 40 0.12 350 I .05 492 1.48 9 1.00 1904 8,890 26.7 5,236 15.7 1,140 128 606 1 l8l 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 i5.4 996 117 432 .. i30 24 42 120 .. 13 103 13.1 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 lI7 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 .2I 353 1.07 424 1.29 7 0.85 1910 8,201 25.0 4,523 13.8 777 95 428 .. 166 11 34 124 .. 17 76 1. 30 36 0.11 361 I.I0 390 1.19 8 0.97 Corrected average. 8,625 26.35 4,963 15.16 1,031 119 497 6 143 29 53 103 .. 23 140 1.52 59 0.l8 337 1.03 456 1.39 9 1.04 1911 8,113 24 79 4.810 14.70 1,040 128 603 .. 124 20 53 70 .. 12 324 1 .84 37 0 .11 329 1.00 379 1.16 7 0.86 Departure from Average. -512 -1.56 -153 — 0 .46 +9 +9 +106 -6 -19 -9 - -33 .. -11 +184 +0.32 —22 - 0.07 — 12 — 0.03 -77 — 0.23 — 2 — 0.18 343 [1911 TABLE F. Showing the Births and Birth Rates of Islington from 1841 to 1911. Years. Births. Birth Rates. Years. Births. Birth Rates. Years. Bi rths. Birth Rates. Year-. Births. Birth Rates 1841 1446 25.58 1861 5530 35.31 1881 9894 34.87 1901 9264 27.62 1842* 1508 25.28 1862 5619 34.76 1882 9991 34.79 1902* 9214 27.06 1843 1627 25.86 1863 6091 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 1911 8113 24.79 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 1871-80 89627 36.60 1891-1900 97278 29.31 * These years contained 53 weeks. 344 1911] Table G. Showing the Illegitimate Births in Islington from 1841 to 1911. Years. Births. Years. Births. Years. Births. Years. Births. Years. Births.j Years. Births. Years. Births Years. Births. 1841 * 1851 100 1861 184 1871 280 1881 380 1891 265 1901 228 1911 248 1842 33 1852 100 1862 207 1872 346 1882 353 1892 298 1902 248 1843 * 1853 95 1863 224 1873 335 1883 370 1893 267 1903 242 1844 9 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 1851 1861 1871 1881 1891 1901 7 yrs. 449 to 1335 to 2651 to 3429 to 3475 to 2719 to 2413 1860 1870 1880 1890 1900 1910 * The births in these years cannot be ascertained. 345 [1911 TABLE H. Showing the Deaths and Death Rates of Islington from 1841 to 1911. Years. Deaths. Death Rates. Years. Deaths. Death Rates. Years. Deaths Death Rates. Years. Deaths. Death Rates. 1841 1013 17.91 1861 3123 19.94 1881 5617 19.79 1901 5361 15.98 1842 * 1101 18.46 1862 3496 21.62 1882 5643 19.65 1902* 5635 16.55 1843 1115 17.72 1863 4340 26.00 1883 5561 19 .12 1903 4839 14.52 1844 1294 19.49 1864 4594 26.65 1884* 5515 18.74 1904 5236 15.74 1845 1258 17.96 1865 4617 25.94 1885 5740 19.27 1905 4955 14.93 1846 1383 18.72 1866* 5154 28.06 1886 5434 18 .02 1906 5050 15.26 1847 1624 20.83 1867 4509 24.55 1887 5699 18.67 1907 5079 15.38 1848* 1745 21.22 1868 4886 24.95 1888 5197 16.82 1908* 4679 13.93 1849 1891 21. 80 1869 4937 24.42 1889 5035 16.10 1909 4918 14.96 1850 1609 17.58 1870 5078 24.33 1890* 6152 19.43 1910 4523 13.79 1841-50 14033 19.28 1861-70 44734 24.64 1881-90 55593 18.55 1901-10 50275 15 .17 1851 2082 21.59 1871 5048 23.44 1891 6326 19.77 1911 4866 14.88 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 1860* 3028 21.21 1880 5716 20.65 1900 5721 17.03 1851-60 26009 21.43 1871-80 49677 20 28 1891-1900 58813 17.72 * These years contain 53 weeks. 846 1911] 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, and in 1911. Yeas. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. 1841 190 131 l86l 748 135 188l 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 1,387 143 I905 1,074 123 1846 330 153 1866* 1,170 169 1886 1,5i7 154 1906 1,083 125 1847 348 150 1867 1,119 152 1887 1,557 160 1907 996 117 1848* 386 152 1868 1,266 164 1888 1,271 132 1908* 894 103 1849 441 168 1869 1.234 165 1889 1,261 131 1909 841 103 1850 360 119 1870 1.J35 149 1890* 1,488 161 1910 777 95 1841-50 (8 years) 2,546 146 1861-70 10.360 153 1881-90 14,102 145 1901-10 10,450 120 1851 457 151 1871 1.179 154 1891 1,481 151 1911 1,033 127 1852 457 132 1872* 1,200 150 1892 1,417 145 1853 371 154 1873 1,172 138 1893 1,595 164 1654* 604 152 1874 1,278 147 1894 1,229 127 1855 605 146 1875 1.306 145 1895 t,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 1860* 747 144 1880 1.517 154 I900 1,344 145 1851-60 6,008 143 1871-80 13.144 147 I89I-OO 14,362 148 *these years contained 53 weeks 347 1911 Table J. Showing the Cases of Infectious Diseases in Islington in Quinquennial Periods, 1891—1910 and tn 1911. 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 1 728 756 189 2 343 33 6 1 .. 2059 6.43 1892 42 1709 718 219 .. 550 51 6 .. 3 3318 10.26 1893 118 2880 885 251 1 672 18 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 14 3 .. .. 2852 8.51 1902 276 1372 878 257 .. 357 19 5 .. .. 3164 9 .29 1903 9 865 455 130 .. 227 19 2 .. .. 1707 5.12 1904 17 1146 347 126 1 280 24 .. .. .. 1941 5.84 1905 3 1198 351 100 .. 252 24 .. .. .. 1928 5.81 1901-05 355 5867 2942 894 3 1401 120 10 .. .. 11.592 6.96 1906 1 1386 439 149 1 274 24 1 .. .. 2275 6.87 1907 .. 1216 481 92 .. 252 21 1 .. .. 2063 6.25 1908 .. 1409 530 97 .. 235 17 1 .. .. 2289 6.82 1909 3 1285 430 95 1 221 14 .. .. .. 2049 6 .23 1910 1 730 471 89 1 212 20 1 .. .. 1525 4.65 1906-10 5 6026 2351 522 3 1194 96 4 .. .. 10201 6-i9 1911 .. 804 593 73 .. 275 14 .. .. .. 1759 5 37 1 348 1911] Table K. Showing the Cases of Small Pox that occurred in the several Wards from 1891 to 1911. Year. Tufnell. *Upper Holloway. Tollington. Lower Holloway. Highbury. f Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. .. .. 1 .. .. .. .. .. .. .. 1 1892 .. 12 .. 12 .. 7 .. .. 9 1 1 42 1893 .. 41 .. 28 6 3 14 6 6 5 9 118 1894 17 8 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 .. .. .. .. .. 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 .. .. .. .. .. .. .. .. .. .. .. .. 1908 .. .. .. .. .. .. .. .. .. .. .. .. 1909 .. .. 3 .. .. .. .. .. .. .. 3 1910 .. .. 1 .. .. .. .. .. .. .. .. 1 1911 .. .. .. .. .. .. .. .. .. .. * The figures for 1891-2-3 are inclusive of Tufnell and Tollington Wards, †The figures for 1891-2 are inclusive of Highbury. Table L. Showing the Cases of Scarlet Fever that occurred in ths several Wards from 1891 to 1911. 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 20i 187 2880 1894 176 235 114 196 152 67 163 116 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 i07 120 1074 1901 97 109 129 172 178 83 137 86 61 93 141 1 286 1902 140 147 160 187 121 88 187 67 45 94 136 1372 I903 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 1911 60 69 69 113 40 47 138 63 61 79 65 804 * The figures for 1891-2-3 are inclusive of Tufnell and Tollington Wards, f The figures for 1891-2-3 are inclusive of Highbury. 349 [1911 Table M. Showing the Cases of Diphtheria that occurred in the several Wards from 1891 to 1911. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Miidmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. 305 .. 43 .. 112 37 44 44 54 73 712 1892 .. 299 .. 43 .. 95 49 43 54 37 75 695 1893 .. 283 .. 57 .. 140 94 46 55 62 117 855 1894 86 91 177 131 93 40 81 37 45 25 97 843 1895 64 77 50 67 80 21 46 28 21 34 76 564 1896 129 177 84 89 87 46 200 95 29 49 82 1067 1897 71 77 118 66 43 60 81 43 30 52 59 700 1898 44 52 50 36 41 64 54 30 26 92 42 531 1899 148 99 88 56 62 28 28 29 39 52 59 688 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 40 34 24 46 34 l8 27 50 425 1910 48 92 62 31 18 22 87 20 22 21 40 463 1911 64 99 95 56 41 22 67 35 40 27 54 590 Table N. Showing the Cases of Membranous Croup that occurred in the several Wards from 1891 to 1911. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Miidmay. Thornhill, Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 .. 20 .. 2 .. 5 .. 1 1 7 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 4 18 1896 3 3 .. 4 4 1 3 1 i 1 3 24 1897 2 4 2 5 1 3 3 3 29 1898 2 4 1 1 4 1 .. 13 1899 2 1 1 2 1 1 3 2 1 .. 3 17 1900 2 .. .. 1 1 .. 11 2 .. 1 1 9 1901 1 .. 1 1 2 1 2 .. 1 9 1902 .. 1 .. 3 1 1 1 .. .. 7 1903 .. .. 1 .. .. 1 .. .. .. 1 3 1904 .. .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. 1 .. .. .. 1 .. .. .. .. 2 1907 .. .. .. .. .. .. .. .. 1 .. 1 1 1908 .. 2 3 1 .. 1 .. .. .. .. 8 1909 1 2 1 .. 1 .. .. .. 5 1910 1 2 1 i .. 1 2 .. .. .. 8 1911 1 .. .. 1 .. .. 1 .. .. .. .. 3 350 1911] Table O. • Showing the Cases of Typhoid Fever that occurred in the several Wards from 1891 to 1911. Year. Tufnell. 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 2 259 1901 32 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 1911 7 8 7 3 4 9 6 9 7 5 8 73 Table P. Showing Cases of Typhus Fever that occurred in the several Wards from 1891 to 1911. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals. 1891 1 2 1892 1893 1 1 1894 1 1 1895 3 2 5 1896 1897 2 1898 1 1 1899 1 1900 1 2 1901 1 1 2 1902 1903 1904 1 1 1905 1906 1 1 1907 1908 1909 1 1 1910 1 1 1911 851 [1911 Table Q. Showing the Gases of Erysipelas that occurred in the several Wards from 1891 to 1911. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. j Barnsbury. 8t. 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 5i 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 15 l7 13 22 40 2 79 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 19 n 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 1911 31 34 33 27 9 13 26 22 18 28 34 275 Table R. Showing the Cases of Puerperal Fever that occurred in the several Wards from 1891 to 1911. Year. Tufnell. Upper Holioway. 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 1 .. 1 .. .. 1 19 1904 5 4 3 .. 2 1 5 1 1 1 1 24 1905 • • 1 1 3 9 2 1 3 .. 1 2 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 i .. 2 17 1909 2 .. 3 2 2 1 1 .. i 1 1 14 1910 2 4 1 3 2 1 3 1 I 1 1 20 1911 .. 2 1 1 4 1 .. 3 .. .. 2 •• 14 352 1911] Table S. Showing the Cases of Continued Fever that occurred in the several Wards from 1891 to 1911. ♦ 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 .. .. .. .. .. .. .. .. .. .. .. .. 1900 .. .. .. .. .. .. 1 .. .. .. 1 1907 .. .. .. .. .. 1 .. .. .. .. .. 1 1908 .. 1 .. .. .. .. .. .. .. .. .. 1 1909 .. .. .. .. .. .. .. .. .. .. .. .. 1910 .. .. 1 .. .. .. .. .. .. .. .. 1 1911 •• .. .. .. .. .. .. .. .. .. .. .. Table T. Showing the Cases of Relapsing Fever that occurrcd in the several Wards from 1891 to 1911. 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 .. .. .. .. .. .. .. .. .. .. .. .. 1911 .. .. .. .. .. .. .. .. .. .. .. .. .. Table U. Showing the Gases of Cholera that occurred in the several Wards from 1891 to 1911. 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 1898 .. .. .. .. .. .. .. .. .. .. .. 1899 .. .. 2 1 .. .. .. .. .. .. .. 3 1900 .. .. .. .. .. .. .. .. .. .. .. .. 1901 .. .. .. .. .. .. .. .. .. .. .. .. 1902 .. .. .. .. .. .. .. .. .. .. .. .. 1903 .. .. .. .. .. .. .. .. .. .. .. .. 1904 .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. .. .. .. .. .. .. .. .. .. .. .. 1907 .. .. .. .. .. .. .. .. .. .. .. .. 1908 .. .. .. .. .. .. .. .. .. .. .. .. 1909 .. .. .. .. .. .. .. .. .. .. .. .. 1910 .. .. .. .. .. .. .. .. .. .. .. .. 1911 .. .. .. .. .. .. .. .. .. .. .. .. .Asiatic Cholera. 853 [1911 854 1911] 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 6412 .. 1895 3086 .. .. 3086 8409 3756 151 72382 40 .. 6309 1672 3039 6231 .. 1896 4149 .. .. 4149 8218 4600 147 67801 5996 .. 7077 1690 4540 4862 232 1897 3133 .. .. 3133 9062 4722 324 69098 6761 .. 6674 1728 3859 5586 573 1898 2571 .. .. 2571 8344 4039 978 70540 6882 .. 6011 1683 3391 5878 608 1899 3164 829 .. 3164 7160 3562 1650 64551 7233 4501 5505 1341 4051 4544 471 1900 2442 3066 .. 2442 6084 3311 1517 60936 7411 6086 5673 1095 3515 4432 316 1901 3054 3395 .. 3054 6486 37i8 1690 58407 7371 * 4461 843 3304 3955 328 1902 3447 2307 .. 3447 6872 5247 2092 63701 8060 4000 5827 1426 4464 4363 275 1903 2215 2298 .. 2215 6131 4409 1255 72140 7846 4889 6756 1711 2157 5153 372 1904 2068 2425 .. 2068 5738 3565 1319 68182 7463 4690 5411 1201 2587 5464 451 1905 2189 3397 .. 2189 5829 3518 1497 76418 7914 4955 7061 1132 2945 5157 630 1906 2550 4135 .. 2550 5911 3438 1774 83168 698O 6968 6004 1043 3220 5847 669 1907 2335 5829 .. 2335 6131 3358 1648 81628 10727 9938 6038 1259 3162 5624 518 1908 2483 4359 1943 2483 6318 4469 1914 86371 11565 13148 6332 1346 3351 5757 789 1909 3228 4605 1924 3228 5880 4'97 1852 76416 11476 11093 7276 990 3281 5304 709 1910 2860 6077 1249 2860 6433 4229 1208 77445 I IOO4 11280 6919 1078 2870 5443 716 1911 2291 4876 1530 2291 6636 4421 1441 74683 3892 I20II 7130 965 3517 5118 707 * Meat Inspector left Borough service for an appointment under City Corporation, and the appointment was vacant some time. Table W. BATHS AND WASHHOUSES. Table showing the Number of Persons using the Swimming Baths, Private Baths, and the Washhouses during 1911 Swimming Baths. Bathers. Caledonian Road. Hornsey Road. Essex Road. Total. Public. 1st class Males I3,761 45,550 19,759 79,070 Females 866 17,802 1,976 20,644 2nd class Males 25,248 30,243 23,199 78,690 Females 3.725 7,769 4,329 15,823 Schools. 1 st class Boys 3 5,389 117 5,509 Girls ... 3,862 ... 3,862 2nd class Boys 43,624 47,651 52,703 143,978 Girls 26,614 30,818 25,603 83,035 Totals 113,841 189,084 127,686 430,611 Private (Slipper Baths.) ist class ... Males 15.294 29,655 18,028 62,977 Females .. 1,564 4,920 2,373 8,857 2nd class ... Males 48,770 48,588 53,113 I5°,47I Females ... 17,059 23,382 24,389 64,830 Totals 82,687 106,545 97,903 287,135 Washhouses. Washers 28,111 : 25,396 40,787 94,294 Total Persons using the Establishments. Total admissions at each establishment in 1911 224,639 321,025 266,376 812,040 355 [1911 356 1911] LOCAL GOVERNMENT BOARD RETURN.—TABLE I. Metropolitan Borough of Islington. VITAL STATISTICS OF WHOLE DISTRICT DURING 1911 AND PREVIOUS YEARS. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths.† Nett Deaths belonging to the District. Uncorrected Number. Nett. Of Non-Residents registered in the District. Of Residents not registered in the District. Under 1 Year of Age At all Ages. Number. Rate. Number.* Rate. Number.* Rate per 1,000 nett Births. Number.* Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13[\###] 1906 330.996 8,659 — 26.I 5,000 15.1 634 684 1,083 125 5.050 1.52 1907 330,241 8.531 — 25.8 4.987 15.1 593 685 996 117 5.079 15.4 1908 329.487 8,665 — 25.8 4.530 13.7 568 717 894 103 4.679 I3.9 1909 328,735 8,198 — 24.9 4,782 14.5 634 770 841 103 4,918 14.9 1910 327.985 8,201 — 25.0 4.376 13.3 563 710 777 95 4.523 13.8 1911 327.247 7.729 8,113 248 4.643 14.2 640 863 1,040 128. 4,366 149 Notes.—This Table is arranged to show the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per iooo of the estimated gross population. * In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the district. In Column 12 is entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. f " Transferable Deaths " are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided The deaths of persons without fixed or usual residence, eg., casuals, must not be included in Columns 8 or 9, except in certain instances under 3 (b) below. In Column 8 the number of transferable deaths of "non-residents" are deducted, and in Column 9 the number of deaths of " residents " registered outside the district are added in calculating the nett death-rate of the district. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) are regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such Institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement is referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are referred (a) to the district of residence, under the general rule; (b) it this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known; and (d) failing this, to the district where the body was found. Area of District in Total population at all ages, 327,434 acres (exclusive of At Census area covered by ' 3,085 Number of inhabited houses, 39.920* • of 1911 water) Average number af persons per house, 8 2 * Estimated. 357 LOCAL GOVERNMENT BOARD RETURN.—TABLE II. Cases of Infectious Disease notified during the year 1911 in the Metropolitan Borough of Islington. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. Total cases removed to Hospital. At Ages—Years. 1 2 3 4 5 6 7 At all Ages Under 1. 1 to 5. 5 to 15 . 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Tufnell. Upper Holloway Tollington. Lower Holloway. Highbury. Barnsbury. Islington South-East Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 593 6 201 315 43 26 2 .. 55 99 95 57 68 103 116 526 Erysipelas 275 7 17 18 18 98 78 39 31 34 33 27 26 48 76 62 Scarlet Fever 804 5 235 480 54 28 2 .. 60 69 69 "3 93 201 199 766 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 73 .. .. 19 28 J7 9 .. 7 8 7 3 14 15 19 56 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 14 .. .. .. 5 9 .. .. 2 1 1 4 1 3 2 5 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis- Under Tuberculosis Regulations, 1908 555 .. 8 37 48 246 189 27 40 198 36 52 56 75 98 367 Under Tuberculosis Regulations, 1911 515 1 2 36 111 290 71 4 37 40 38 59 83 100 158 35 vOthers 54 6 6 28 io - 4 2 5 2 4 9 18 14 7 Totals 2883 19 463 911 313 742 361 74 234 454 281 319 350 563 682 1.924 358 1911] LOCAL GOVERNMENT BOARD RETURN.—TABLE III. Metropolitan Borough of Islington. CAUSES OF, AND AGES AT DEATH DURING YEAR, 1911. Causes of Death Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the District. Total Deaths whether of Residents" or " Nonresidents" in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 yrs 5 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and upwards. I 2 3 4 5 6 7 8 9 10 11 All causes Certified 4864 1038 279 199 151 163 622 1097 1315 1427 Uncertified 2 2 .. .. .. " .. .. .. .. Enteric Fever 12 .. .. .. I 3 5 3 .. 7 Small-pox .. .. .. .. .. .. .. .. .. Measles 124 28 54 40 1 1 .. .. .. 44 Scarlet Fever 20 .. 2 10 7 1 .. .. .. 4 Whooping Cough 71 31 21 18 1 .. .. .. .. 4 Diphtheria and Croup 56 2 9 19 23 .. 2 1 .. 3 Influenza 37 1 .. 2 .. 1 6 9 18 3 Erysipelas 12 .. .. .. .. 2 1 3 6 14 Cerebro-Spinal Fever 9 6 1 .. 1 1 .. .. 2 Chicken Pox 1 1 .. .. .. .. .. .. .. .. Phthisis (Pulrr onary Tuberculosis) 387 4 4 3 9 45 186 117 19 251 Tuberculous Meningitis 50 19 9 14 6 1 1 .. .. 10 Other Tuberculous Diseases 84 23 8 8 13 6 18 6 2 33 Rheumatic Fever .. 10 .. .. 2 1 4 3 .. .. 3 Cancer, Malignant Disease 332 1 .. .. 3 4 37 160 127 168 Brorchitis .. 406 51 13 .. 3 4 15 87 228 141 Bror.cho-Pneumonia 177 68 38 24 2 .. 7 22 16 54 Pneumonia (all other forms) 219 33 20 14 9 6 36 62 39 66 Other Diseases of Respiratory Organs 54 6 6 2 2 1 6 17 14 16 Diarrhoea and Enteritis 438 302 60 13 1 1 11 14 36 77 Appendicitis and Typhlitis 26 .. .. .. 5 6 7 5 3 13 Alcoholism 4 .. .. .. .. .. 1 3 .. 1 Cirrhosis of Liver 48 .. .. .. .. 1 5 34 8 21 Nephritis and Bri»ht's Diseases 179 .. .. .. 4 7 35 85 48 59 Puerperal Fever 7 .. .. .. .. 2 5 .. .. .. Other accidents and diseases of Pregnancy and Parturition 12 .. .. .. .. 2 10 .. .. .. Congenial Debility and Malformation, including Premature Birth 320 315 4 .. 1 .. .. .. .. 10 Violent Deaths, excluding Suicide 167 39 5 9 20 7 16 32 39 55 Suicides 41 .. .. .. .. 2 12 22 5 2 Homicides 4 2 .. .. .. .. 1 1 .. .. Other Defined Diseases .. I556 107 24 16 38 55 196 4I4 706 366 Diseases ill-defined or unknown .. .. .. 3 / 1 1 .. .. .. .. .. 1 .. 4866 1040 279 199 151 163 622 IO97 1315 1427 LOCAL GOVERNMENT BOARD RETURN.—TABLE IV. Metropolitan Borough of Islington. INFANTILE MORTALITY DURING THE YEAR 1911. Nett Deaths from stated Causes at Various Ages under One Year of Age. [###F DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under One Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year.[/### All Causes Certified 169 52 34 37 292 207 201 170 168 1,038 Uncertified 1 .. .. .. I .. .. i 2 Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. 1 .. I Measles .. .. .. .. .. 1 3 6 18 28 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. 1 1 2 Whooping Cough .. .. .. .. .. 3 5 9 14 31 Diarrhoea .. 1 4 3 8 40 69 58 54 229 Enteritis .. 4 3 2 9 18 24 12 10 73 Tuberculous Meningitis .. I .. .. .1 1 3 7 7 19 Abdominal Tuberculosis .. .. .. 1 1 4 2 3 1 11 Other Tuberculosis Diseases .. .. .. .. .. 3 8 .. .. 16 Congenital Malformations 13 3 2 .. 18 9 4 3 1 35 Premature Birth 105 19 4 10 138 10 1 .. .. 149 Atrophy, Debility and Marasmus 28 11 6 7 52 39 27 9 4 131 Atelectasis 8 I 1 .. 10 .. .. .. .. 10 Injury and Birth 1 .. .. .. 1 1 2 .. .. 4 Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis 1 I .. .. .. .. .. 2 .. 4 Rickets .. .. .. .. .. 1 3 1 1 6 Meningitis (not Tuberculous) .. .. .. .. .. 2 .. 3 .. 10 Convulsions 4 2 3 .. 9 5 2 1 .. 17 Gastritis .. .. .. 1 1 5 2 1 .. 9 laryngitis .. .. .. .. .. I .. .. .. 1 Bronchitis .. 3 4 3 10 15 7 10 9 51 Pneumonia (all forms) 1 2 1 3 7 23 21 27 23 101 Suffocation, overlying .. .. 1 .. 1 13 4 2 1 21 Other Causes 9 4 5 7 25 13 14 1 4 81 Totals 170 52 34 37 293 201 171 168 1,040 Nett Births in the year legitimate 7,825 Nett Deaths in the year of legitimate infants 944 illegitimate 288 illegitimate infants 96 859 [1911 8G0 1911] LOCAL GOVERNMENT BOARD RETURN. PHTHISIS : SANATORIUM AND HOSPITAL ACCOMMODATION. Classes for which accommodation is provided. By whom provided. Where situated. Total number of Beds. How are patients selected ? Are patients under the care of a resident Medical Officer ? What charge, if any, is made for the use of Beds. Do the Sanitary Authority use— (1) their Isolation Hospital, or (2) their small-pox Hospital, for cases of Phthisis ? Do the Sanitary Authority reserve beds in any Phthisis Sanatorium: If so, how many, and in what Sanatorium ? Do the Sanitary Authority provide portable open-air Shelters or Tents ? (a) Early cases - None — — — — — (b) Intermediate cases None — — — — — There are no hospitals under control of Borough Council. / No No (c) Advanced cases Islington Workhouse Infirmary Highgate I20 Patients are admitted upon Order of the Relieving Officer. Yes None Have the Council, or any Private Body, provided) a Dispensary ? If so, give particulars. 1 361 [1911 LONDON COUNTY COUNCIL RETURN. Borough of Islington. PROCEEDINGS DURING 1911. PREMISES. Number of Places— Number of inspections, 1911. Number of Notices. 1911. Number of Prosecutions 1911. On Register at end of 1910. Added in 1911. Removed in 1911. On Register at end 01 1911. Milk premises 565 28 25 568 1661 242 Nil Cowsheds 5 ... .. 5 ... ... " Slaughter-houses 32 ... 2 30 ... ... " Other offensive trade premises 6 ... ... 6 ... ... " Ice cream premises 236 35 41 229 134 18 " Registered houses let in lodgings ‡... ... ... ... 8217 (a)* 65 (a)* Nil (b)† S43 (b)† 1 * (a) For overcrowding. t (b) For other conditions. J No Register now kept under new By-Laws. Total number of intimation notices served for all purposes 5118 Overcrowding, 1911. Number of dwelling rooms overcrowded 112 Number remedied 112 Number of prosecutions Nil Underground rooms— Illegal occupation dealt with during year 22 N umber of rooms closed 22 Number of prosecutions Nil Insanitary houses— Number closed under the Public Health (London) Act, 1891 Nil Number closed under the Housing of the Working Classes Acts... 17 Number of premises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 ... 3i3 362 1911] Shelters provided under see. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 32 Revenue Acts— Number of houses for which applications were received during year 2 Number of tenements comprised therein 4 Number of tenements for which certificates were (a) granted 3 (b) refused 1 (c) deferred Nil Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. Nil (b) For prevention of nuisance arising from offensive matter ning out of any manufactory, etc. Nil (c) For the prevention of keeping of animals in such a manner as to be injurious to health Nil (d) As to paving of yards, etc., of dwelling houses Nil (e) In connection with the removal of offensive matter, etc. 9 (/) As to cesspools and privies, removal and disposal of refuse, etc. Nil (g) For securing the cleanliness of tanks, cisterns, etc. Nil (It) With respect to water closets, earth closets, etc. 1 (i) With respect to sufficiency of water supply to water closets Nil (j) With respect to drainage, etc. (Metropolis Management Act, section 202) Nil (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 2 Number of prosecutions under L.C.C. General Powers Act, 1907— (/) With respect to Water Supply to Tenement Houses 5 Mortuaries— Total number of bodies removed 646 Total number of infectious bodies removed 5