ISL 60 1912. FIFTY-SEVENTH 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 Codncil, 170, Farringdon Road, E.C. 1913. MEMBERS OF THE PUBLIC HEALTH COMMITTEE. (November, 1911, to November, 1912.) Mayor. Alderman GEORGE SAMUEL ELLIOTT, J.P Aldtrmen. CHARLES CROLE-REES 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.P. 2. THOMAS B. MADGETT 10. FRANSIS BANNING 3. WILLIAM J. SMITH 11. WALTER E. MARKHAM 4. FRANK HALLAM 11. SARAH KATE K. HASLAM M,D. (Brux 5. THOS. LUKE HARWOOD L.S.A. Chairman Councillor THOMAS LUKE HARWOOD Vice Chairman Councillor WM. J. SMITH OFFICERS OF THE Public Health Department. Medical Officer of Health. ALFRED EDWIN HARRIS, L.R.C.S., L.R.C.P.Edin. Public A nalyst. FRANK LITHERLAND TEED, D.Sc., F.I.C., F.C.S. Solicitor. ARTHUR MELLOR BRAMALL. Superintendent of Public Health Depai tment and Chief Sanitary Inspector. JAMES RICHARD LEGGATT. Inspector of Meat. HARGREAVES WILKINSON, Cert. Sanit. Inst. Inspector oj Workshops and Bakehouses. GEORGE WEST. Inspectors of Workshops S-c., in which Females are employed. *ANNIE CATHERINE YOUNG, Cert. Sanit. Insp. Ex. Bd. MARIAN GWYNETH PARKER DAVIES, Cert. Sanit. Insp. Ex. Bd. † EMILY GROVES MOYNIHAN-NYMAN, Cert. Sanit. Insp. Ex. Bd. Inspectors of Houses let in Lodgings. §WILLIAM WALTER WARD. THOMAS HENRY HANCOCK, Cert. Sanit. Insp. Ex. Bd. HARRY JOHN JAMES WATSON, Cert. Sanit. Inst. 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 BICKNELL, Cert. Sanit. Inst. „ 3 ALLEN BAGSHAW, Cert. Sanit. Inst. 4 GEORGE JAMES BRIDEL. Cert. Sanit. Insp. Ex. Bd 5 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 SAMUEL JEFFERY, Cert. Sanit. Inst. 11 WILLIAM HENRY WOOD, Cert. Sanit. Insp. Ex. Bd. 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 BOOKER. * Resigned 5th October 1912. † Appointed 6th December 1912. § Resigned 3rd May 1912. iv. INDEX. Page Adulteration of Food 277 Ages at Death 39,43,44 Alcoholism 109 Analyst's quarterly reports, abstracts from 290-296 Annual Birth and Death rates, and Death-rates of Children 311 Appendicitis 91 Area of Borough 14, 15, 16 Artizans' and other Dwellings 253 Bacteriological Diagnoses 191 Bakehouses 207-212 Baths and Washhouses 325 Births 28 „ in Decennial periods from 1841 313 „ notification of 30 Butcher's Shops and Shops where food is sold 268 Butchers' open window stalls 268 Butter and Margarine 286, 299 Cancer 94 Census Returns 12, 13 ; 18-21; 27, 28 Common Lodging Houses 252 Constitutional Diseases 94 Continued Fever 81 Cow Houses 265,272 Deaths 39 „ from Classified Causes 50, 51 „ at different age periods 39, 43, 44 ,, in the Quarters 41, 45, 47, 49 „ „ Sub-Districts 46 ,, „ Wards 45 ,, „ Encircling Boroughs 52, 87 „ from Epidemic Diseases 67-87 Deaths registered from all causes during the Year 304 Deaths registered from all causes in each Quarter 307 Deaths in Decennial periods from 1841 315 Deaths in Public Institutions 110 Death-rates of Populous Towns 52, 87 Density of Borough 14-15 Diabetes Mellitus 106 Diarrhceal Diseases 81 Diphtheria 78 „ Notification of 130, 133 ,, Fatality from 131 Diphtheria and Croup 132 Disinfectants distributed and used 201 Disinfecting Station 199 Disinfection Work 155, 198 District Inspection 238 Dust, removal of 248 Enteric Fever 80 „ Notification of 134 „ Fatality from 135 Epidemic Diseases 67-87 ,, Cerebro-Spinal Meningitis 156 Erysipelas 92 Notification 136 ,, Fatality from 136 V. Pag Factories and Workshops 204 Fatality from Infectious Diseases 124, 170 Food, Adulteration of 277 ,, Informal sampling of 297 Food Inspection 260 Health Visitors 32, 54 Hospital Isolation of Infectious Diseases 126, 171 Houses Let in Lodgings 230 House to house inspection 239 Housing, Town Planning, &c., Act, 1909 256 Illegitimate Births 30 „ ,, in Decennial periods from 1841 314 Infantile Mortality 53-67 „ ,, in Decennial periods from 1841 316 Infectious Diseases on Business Premises 175 ,, ,, in Streets 178-190 ,, ,, in Schools 160, 162 ,, ,, (Non-notifiable) in Schools 163, 164, 168 Infectious Sickness in the several Wards from 1891 318-323 „ „ in Quinquennial periods from 1891 317 Informal Sampling of Foods 297 Influenza 88 Inhabited houses and buildings at Census 1911 18-20 Inspection of Food 260 ,, Kitchens of Restaurants 213 „ Slaughter Houses and Cow Houses 264-267, 272 Houses let in Lodgings 230 Inquests 120 Isolation of Infectious Diseases 169 Local Government Board Returns 326-329 London County Council Return of Sanitary Work 330, 331 Margarine Act 289 Marriages 24 Measles 73 „ Notification of 163 „ Children excluded from Schools 165 Meat Inspection 160 Midwives attending Disinfecting Station 202 Milkshops, Registration of 274 Milk, Quality of 282 Milkshopsand Dairies 273 Mortality in Sub-Registration Districts 46 Mortuary and Coroner's Court 120 National Insurance Act 1911, Sanatorium Benefit 233 Notification of Infectious Diseases 122, 141, 142 ., „ „ „ in Registration Sub-Districts 123,143,144 „ „ ,, „ in the Sanitary Inspectors' Districts 147 ,, „ „ „ in the Wards 123, 145, 146 „ „ „ „ during the several Months 148 „ „ „ „ in the Encircling Boroughs 149, 150 „ „ „ „ in Metropolitan Boroughs 151, 152 „ ,, Phthisis 153 ,, ,, Births Act 30 Non-notifiable Infectious Diseases in Schools 163, 164, 168 Occupation of persons attacked with Infectious Disease 171 Offensive Trades 273 Ophthalmia Neonatorum 157 Outworkers' Premises 212 Pauperism 250 vi. Page Persons to an Acre 14-15 Phthisis 101 „ Notification of 153 ,, Sanatoria Accommodation 233 Places where Food is prepared 213 Pneumonia 108 Population—Estimated in 1912 9 ,, at Census 1911 11-21 „ in Sub-Districts 14 „ and Density of Wards 15 Population, Inhabited Houses, Marriages, Hirths, and Deaths 310 Prosecutions, Summary of 300 Puerperal Septic Diseases 93 Puerperal Fever 93 „ „ Notification of 138 „ „ Fatality from 138 Polio-myelitis and Polio-encephalitis 160 Pulmonary Tuberculosis 101, 153 Registered Lodging Houses 230 Regulations, Tuberculosis 153 Report on Tuberculosis Dispensary 332 Respiratory Diseases 107 Restaurant Kitchens 213 Samples analysed in 1912 277 Sanatorium Benefit (National Insurance Act 1911) 233 Sanitary Inspectors' Work 238 Scarlet Fever 77 „ Notification of 127 „ Fatality from 128 Seasonal Mortality 41 Septic Diseases 92 Shelter House 202 Slaughter Houses 264 Small Pox 73 Notification of 126 Smoke Nuisances 242 Street Markets 268 Streets where Infectious Diseases occurred 178-190 Summary of Sanitary Work in fourteen Districts 244 ,, Nuisances Discovered 245 ,, „ Applications for Removal of Dust 249 Trades carried on in Houses where Infectious Diseases have occurred 175 Transferable Deaths in Outlying Institutions 117 Tubercular Diseases 101 Tuberculosis Dispensary, Report on 332 Tuberculosis Regulations (Public Health) 153 Tuberculosis, Pulmonary, Notification of 153 Typhus Fever 81-136 Unsound Food 260 Unsound Fish 260 Vaccination 192 Venereal Diseases 109 Verminous Persons 202 Water Certificates 247 Water Supply 301 ,, to Tenement Houses 244 Whooping Cough 79 Workshops and Factories, Inspection of 204 Work of Public Health Department, Summary of 324 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1912. To the Worshipful the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. Mk. Mayor, Aldermen and Councillors. I have pleasure in submitting the fifty-seventh annual report of the Medical Officer of Health on the Health and Sanitary Condition of Islington, which deals with the year 191'2, and in doing so I have once more to congratulate you on its satisfactory state. The mortality has been low, not only from those general diseases which cause the deaths of the great majority of the people, but ;.lso from the principal epidemic diseases, and from those which usually affect infants. The deaths from cancer, however, continue to increase, and although scientific men are continually making research into its cause, yet no prophylactic has up to now been discovered, although much most valuable knowledge has been obtained about the disease itself, so that there is a legitimate hope that one day a cure may be discovered for it, and possibly a method for its prevention. The year has been notable by the issue of an order of the Local Government Board making all forms of tuberculosis compulsorily notifiable, and by the passing of the National Insurance Act, both of which measures will, it is hoped, prove of great value in the staying of the ravages of what is rightly termed the " Great White Plague of the North," the mortality from which, it may be stated, exhibits a slight tendency to decrease in the borough. viii. The work of the staff of the Public Health Department continues to increase owing to the tendency of modern legislation to place new duties and responsibilities on sanitary authorities; and, generally, it may be stated that it has been performed satisfactorily with the exception of those which deal with newly born infants and tuberculous persons, for which work female Inspectors, who alone are suitable and qualified to undertake such work, are required. I have no doubt, however, that when this matter comes before you again that you will give it that favourable consideration which it deserves. I cannot conclude without thanking the members of the Council— particularly those who constitute the Public Health Committee, and especially their Chairman, Councillor Harwood—for the great courtesy they have at all times shown to me, and for the willing assistance they have invariably afforded me in the discharge of the, at times, very onerous duties which must of necessity devolve on anyone who holds the responsible position of Medical Officer of Health for a great borough like Islington. I am, Your faithful servant, Medical Officer of Health. July 1st, 1918. ix. SUMMARY of Vital Statistics, 1912. Population (Enumerated at Census) 327,403 persons ,, (Estimated at middle of year) 1912 326,398 persons Estimated decrease on population, 1911 849 persons Mean Population, ten years (1902-1911) 330,625 persons Area 3,092 acres Density 105 persons per acre Marriages 3,091 Persons married 6,182 Persons married rate 18.94 Per 1,000 inhabitants Births Males 4,267 Persons 8,211 Females 3,944 Birthrate 25.15 per 1,000 inhabitants Deaths from All Causes Males 2,420 Persons 4,682 Females 2,262 Death rate 14.34 per 1,000 inhabitants Deaths from Principal Epidemic Diseas Males 143 296 persons Females 153 Death rate 0.90 per 1,000 inhabitants Infantile Deaths under 1 year Males 396 Total 710 Females 314 Infantile mortality rate 86 per 1,000 births Excess of Births over Deaths 3,529 PART I. INTRODUCTORY. THE POPULATIONS, AREAS AND DENSITIES OF THE SUB-REGISTRATION DISTRICTS, THE WARDS AND THE BOROUGH. 3 1912 REPORT OF THE Medical Officer of Health FOR THE YEAR 1912. INTRODUCTORY. It is a fact, which it is almost impossible to gainsay, that as the separate entities, wliich form the great County of London, become closer and closer knit together through the extension of their buildings, so that it. is no longer possible to recognise where one borough begins and another ends, the great body of their residents take less and less interest in them. Thus, to mention only the older of these places, the citizens of London, the residents of Westminster, or of Chelsea, or of Islington, take less pride in the place in which they were born, or in which they dwell, than preceding generations of their dwellers did. They have become more and more citizens of the great commune known generically as London, and less and less Londoners, Westminsterians, Chelseans, or Islingtonians; and consequently their interest in the great localities in which they dwell become of less importance to them in their historical, archaeological, and political associations than they were to their forefathers. Nevertheless, the history of these places is full of the deepest interest, and well deserves the study and attention of their citizens, for it is not only closely connected with the material progress of London itself, but with that of the nation. But when it is admitted that the interest of Londoners is mainly concentrated on London as a whole, yet even such interest falls far short of that which the Novocastrian takes in Newcastle, the Manchester man in Manchester, the Liverpudlian in Liverpool, the Bristolian in Bristol, or the citizen of any great town of the country in the city of which he is a native, and whose pride B2 4 1912 in his birthplace is not lost even when he migrates to London, where he becomes a cypher among its teeming millions. His birthplace is for him something to be proud of: it is part of his nature, and he can no more forget it than he can the parents who begot him. Pity it is that the same cannot be said of Islingtonians and other people dwelling in the various boroughs which constitute our great metropolis. Were it otherwise, more interest would be taken in their municipal and parochial affairs, and more of their citizens would show that interest by coming forward to participate in the management of those local institutions which are rightly deemed of such great importance in provincial towns, and to establish literary and other kindred associations which are of such advantage in arousing those intellectual and scientific activities which do so much good in other places. " Let us not forget," as one of the greatest of the ancient Roman sages* wrote centuries ago, " that there is such a thing as a fellowship or society between all men in general; the bond or cement that holds them together is reason and discourse, which by teaching, learning, communicating one with another, easily make men agree together, and unite them all in one natural sort of conjunction and community." Such institutions, therefore, do untold good. They educate the young in literature, in science, and in art; they teach them to think, and to express their thoughts in words; while above all they cause them to search authoritative sources for the knowledge which they themselves would impart to other persons, so that when in the course of time any one of them enters on public life, he shall be able to comply with the dictum of the same sage, " that a man who has taken on him a public trust should not only look that the business be honest, but that he himself be qualified for the management of it." In Islington, however, these institutions are only noticeable by their absence: and yet Islington is the seventh greatest aggregation of human beings in England and Wales, the eighth in Great Britain, and the ninth in Great Britain and Ireland. The Medical Officer of Health, as he writes, has in his mind one city in this kingdom in which a literary and scientific society has held its meetings regularly week by week for seven months in the year for fully one hundred and fifty years; and there will be found a most highly educated middle class, and as a consequence a school of art and a school of music, as well as other institutions intended for the advancement of its citizens. * Cicero. De Officiis Book 1, XVI. 5 1912 These institutions are sadly lacking in the boroughs of London, and, as a result, there is wanting that local and municipal patriotism which is created and fostered by them, and which alone makes all men proud of their place of birth or of their adopted home. But there is perhaps another reason. The London daily press does not cater for local news. It concentrates all its enterprise on the supply of information respecting imperial politics, and on the great events that are passing day by day throughout the world, and, to a very small extent, on the doings of the London County Council and one or two other central bodies, and only on them when questions of political interest are involved, so that the inhabitants of the boroughs look in vain in their columns for intelligence as to the things that ought to matter which are taking place in the metropolitan boroughs. It is true that many boroughs are provided with weekly local papers, and at least one with a daily paper, which, to their credit, supply full information about local affairs, but, unfortunately, these are only read by the comparatively few who are interested in local politics or in the proceedings of their local municipal bodies. Your busy London business man will tell you that he has no time to waste on more than one paper a day, and consequently he does not buy the local paper. Such men can never be true citizens, nor can they vote, if they do vote—and sad to say the majority do not—with that knowledge of affairs which they ought to possess, and which the citizens of great provincial boroughs do possess. But then these boroughs publish papers—daily papers—which not only give them all the news of the world, and of the kingdom, but also of the towns in which they are published. Surely every Londoner should subscribe to at least one local weekly paper, and to a daily paper if such be published. It is said that politics should not enter into local affairs, and they should not, but if ever they are justified they are in the case of the metropolitan boroughs, for they are the one thing which in the main induces people to take an interest in local matters and to register their votes. Indeed without them even fewer people than now do so would vote at all. All this may seem an exaggeration, but after these paragraphs were written a well-known writer for a London evening paper confessed in it that he knew very little of the doings of the London County Council, and that so far as the council of the metropolitan borough in which he dwells was concerned that his cruse was empty; that he does not know its shape or extent; and that he once voted for a County Councillor about whom he knew nothing beyond the fact, as he was told, that he was blameless. Is it any wonder that ordinary people know so little about the boroughs in which they live when such a man 6 1912 as this writer—a press man—publicly confesses his ignorance, although no doubt he directly or indirectly pays rates to the Council of his borough. It is, indeed, sad to find that so many people know so little about Islington ; and yet there is much within its boundaries to interest them if they would only take the trouble to enquire into its extent or its history. It will come as a surprise probably to many to know that the mere perambulation of the borough boundary would mean a walk of nearly ten and a half miles ; and yet this great place had but a very small beginning, for so far as history can tell us, it was the merest hamlet in its early days. It is difficult to say whether it existed at the time of the Roman occupation when they built an encampment somewhere near what is now Barnsbury Square, the remains of which still exist, but which, extraordinary to state, are known to few Islingtonians. It was on the high ground here that the Romans kept watch over London prior to attacking it, and it was in this neighbourhood probably that the huge army led in person by Boadicea, the Queen of the Iceni, attacked them and was driven off, to be finally annihilated in the rout which followed as her soldiers fled to Colchester. How few people know that in its early days Islington was situate on the verge of a forest in which the citizens of London had the right to hunt, although the villagers had not. Even in those days there was considerable traffic from the City northwards, and it will be found that a new gate—Newgate—was erected about the time of the reign of Henry and Stephen; and that its construction became necessary owing to the enclosing of ground for the Churchyard of the new St. Paul's, its predecessor having been burnt down, the result of which was that the street stretching from Aldgate in the east to Ludgate in west was so crowded and stopped up that the carriage of merchandise from the City westward was forced to pass without the churchyard wall on the north side, through Paternoster Row and other streets, which caused such congestion of traffic " that for remedy thereto a new gate was made and so called by which men and rattle with all manner of carriages might pass more directly through Westcheap by St. Paul's on the north side ; through Nicholas Shambles and Newgate Market to Newgate, and from thence to any part westward over Holborn Bridge or turning without the gate into Smithfield and through lsledon to any part north and by west." This shows, therefore, that the traffic to the north from London passed through the village of lsledon, which must have reaped considerable benefit from its unceasing flow. 7 1912 In a description which Sir Walter Besant gives of London in 1210, he says: "Leaving London, and walking along the straight line of wall running nearly east and west, we look upon the open moor, dotted with ponds, and intersected with streams and ditches. Here are kennels belonging to the City Hunt and to rich citizens, from which all day can be heard .the barking of dogs. From here stretches waste and uncultured moorland covered with rank grass and weeds and marsh flowers. The marsh is in itself a regular area measuring level 400 yards from east to west by 300 yards north to south. The few buildings here must be erected upon piles driven into the London clay. There is talk of the construction of a postern opening upon the moor, and of a causeway across the moor, which would be a great convenience to people wishing to go to Tsledon or on a pilgrimage to Our Lady of Muswell Hill." Hence we see that this new road from the moor gate—afterwards contracted into Moorgate—was erected as a means of communication between the then growing village and the City. That lsledon at the time was a popular resort of the citizens of London there can be no doubt, and, indeed, so much so that at times the villagers must have suffered very much from the depredations of the men, women, and apprentices of London, for it is found that certainly once a year on Mayday Eve—and it may be stated that at this time this great holiday was celebrated on what is now May 12th*—when the keen east winds had passed away and Spring had really begun ; the leaves of the trees and blossoms are out; the days are longer; it is light until nine o'clock and twilight all the night through. New life was everywhere, and young men and maidens were not to be denied their pleasure. They all went out to enjoy themselves on Mayday Eve. " They passed over the marshy and muddy plain of Moorfields till they came to the little village of lsledon or Isleden, where the great forest began. There grew the whitethorn and the blackthorn, the broom and the gorse blossom. There the wild crab was covered with a garment of pink and white and the wild rose was glorious to behold. The people came home bearing boughs of these sweet blossoms, singing and dancing as they went. There they set up their maypoles adorned with ribbons and garlands, and they danced around it, singing hand in hand, right hand with left hand, leit hand with right, covered with chaplets of wild rose and wild apple blossom. They had tomfools, mummers, hobby horses, Robin Hood, Maid Marion, Little John, and they had feasting and drinking; 'twas the most joyous festival of all the year." And the despoilation of little lsledon contributed largely to their amusement! * In 1752 the Gregorian Calendar was adopted when the 11 days between September 2nd and 14th were omitted. No doubt this will largely account for the falling off in the celebration of May Day, as the earlier period is colder and less bright. 8 1912 Mention has been made of a shrine at Muswell Hill. In those days there were of course many shrines in England. There were local shrines in London and there was one at Greenwich, that of "Our Lady of Crome's Hill, Greenwich." At Bermondsey one of the " Holy Rood," of "Our Lady of Willesden" or that of " Our Lady of Muswell." There was also that of " Our Lady that standeth in the Oke," which place of pilgrimage, it is stated, was situated somewhere between Highgate and lsledon. The shrines at these places were much frequented by persons attracted thereto by religious or other reasons, for unfortunately a religious spirit was not the only inducement to visit them. A modern writer says that the three shrines north of London lay in the heart of the great Middlesex Forest. Each of the miraculous images was probably a " Lady of the Oak." There was " Our Lady of the Oak " all over Europe ; the miraculous figure is always found in an oak, and is always, it is said, black. The local shrines were near enough for a single day's journey, a pleasant summer's ride through the gardens and orchards of lsledon where the forest began, and so over the greensward and under the branches of the wood to the clearing at the top of Muswell Hill, where now stands Alexandra Palace, and there stood the chapel containing the black image, swathed with linen, crowned, decked with gold and jewels, before which stood the altar and burned the lamp day and night. It was here the pilgrims came daily, sick people, and those jovial pilgrims who only wanted a plea for indulgence, and who, when they knelt at the shrine and went round it on their knees and prayed, came happily away. Unfortunately, in the neighbourhood of this shrine there were also taverns and merry making places, and consequently it is to be feared, in the words of Sir Walter Besant, that "the religious act finished, there was pleasure and merriment, which only ceased when, having passed through lsledon, they again found themselves in their homes." One could desire to pursue more fully this most interesting study of old Islington, which is only mentioned here as an inducement to Islingtonians to take a deeper interest in the old parish in which they live, and also to study the history, the topography and archaeology of the place, as well as the various authors, poets and playwrights, who from time to time have mentioned it in their writings. Perhaps, at another time, this latter aspect of the old parish may be touched on, for it is full of interest. 9 1912 POPULATION OF THE BOROUGH, THE SUB-REGISTRATION DISTRICTS, THEIR AREAS AND DENSITIES. Population.—The population of the Borough in 1912, estimated on the decrease which occurred in it during the intercensal period 1901-11, was 326,398 persons, of whom 155,419 were males and 170,979 females. These figures show a decrease of 482 males and 523 females, or a total of 1,005 persons as compared with those of the preceding year. It is very difficult, however, to aver positively that they are exact; because, indeed, it seems probable that they are not. The fact that more houses are now occupied in Islington than at the time the census was taken causes them to be looked upon with suspicion. This is very unfortunate, as it is most unsatisfactory that there should be a doubt as to the exact number of the population so early in the intercensal period (1911-20), for such uncertainty must grow more and more, as the years pass, before the next census is taken ; and consequently a suspicion may be cast on the correctness of the death, marriage and birth rates, which are all based on population. The Registrar-General, will, however, continue to found his calculations on a decreasing population, unless some very strong evidence can be produced to show that such is not the case. The fact is, that a ten years' interval between the censuses is too long, at least where great communities are concerned, and it would be well that in such cases a quinquennial numbering of the people should be made. If this were done—and it was done in London in 1896—all doubts would be allayed, and we would then be able to know with almost absolute certainty how the health matters of the borough stood. If it should turn out at the end of ten years that the population of Islington is not deceasing, then clearly all the death, birth and other rates that had been recorded would have been too high, and the good record of Islington would suffer. The question of taking a merely numerical census in 1916 is well worth the consideration of the Local Government Board, It need only show the numbers, sexes and ages of the population. It was understood in 1896 that a quinquennial census would be made in London in future, but for some reason the resolve was not followed up. As the equalization of the rates is based on the populations of the Metropolitan Boroughs, as estimated by the Registrar-General, this question may prove of importance to Islington. These remarks have been prompted by the fact that whereas just previous to the taking of the last census, i.e., on the night of March 31st, 1911, there were only 2,114 empty houses; on March 31st, 1913, this figure was reduced to 1,741, and it is daily becoming less. These are remarkable figures, which clearly indicate that the tide of adversity 10 1912 which seemed a few years since to be about to affect Islington, has been dammed, and that the borough is now fast recovering from its unexpected check The signs of a returned prosperity are to be seen everywhere; and no where more than in Upper Street, where empty shops are becoming fewer and fewer Last year the Medical Officer of Health wrote that "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 empty shops. That they will not long remain so is certain, for there are not wanting signs that they will by-and-bye be reoccupied, although possibly not by businesses of the same high class as formally, 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 carriage people and similarly wealthy folks and good middle-class persons.'' This prophecy is becoming so true, that he expects that before another year has elapsed that Upper Street will present as busy and animated an appearance as it ever did in olden days, albeit by a less wealthy class of people. The Tables immediately succeeding give full information respecting the sex, age and distribution of the population in the several sub-registration districts and wards, together with information respecting their areas and densities, as well as details of importance which have been abstracted from the census returns recently issued. 11 1912 Table I. Showing the Estimated Number of Persons living in Islington at the middle of 1912, at Nine Age Periods, and distinguishing Males xnd Females, together with the Number of Persons at Census 1911. Ages. Males. Females. Persons. Persons at Census 1911 Increase or Decrease. 0—5 16,970 16,647 33,617 33,711 -94 5—15 29,158 29,057 58,215 58,373 -158 15—25 27,930 30,780 58,710 58,905 -195 25—35 27,397 30,458 57,855 58,032 -177 35—45 21,301 23,749 45,050 45,207 -157 45—55 15,573 17,673 33,246 33,371 -125 55—65 10,138 12,044 22,182 22,237 -55 65—75 5,408 7,465 12,873 12,905 -32 75 and upwards 1,544 3,106 4,650 4,662 - 12 All ages 155,419 170,979 326,398 327,403 -1,005 12 1912 Table Ia. CENSUS RETURN. Sex and Age Constitution per 100,000 of the Population at Census 1911. Ages. Males. Females. All ages 47,617 52,383 Under 5 years 5,199 5,100 5 and under 10 years 4,639 4,631 10 ,, „ 15 „ 4,294 4,270 15 „ „ 20 „ 4,192 4,455 20 ,, „ 25 „ 4,364 4,976 25 „ „ 30 „ 4,400 4,956 30 „ „ 35 „ 3,994 4,375 35 „ „ 40 „ 3,502 3,886 40 „ „ 45 „ 3,024 3,390 45 „ „ 50 „ 2,618 2,956 50 „ „ 55 „ 2,154 2,459 55 „ „ 60 „ 1,718 2,019 60 ,, „ 65 „ 1,388 1,671 65 „ „ 70 „ 1,042 1,322 70 „ „ 75 „ 615 965 75 „ „ 80 „ 294 555 80 ,, ,, 85 „ 131 267 85 „ „ 90 „ 39 100 90 and upwards 10 30 13 1912 Table Ib. census return. Proportion of Male and Female Population in Islington at each Quinquennial Age Group compared with the corresponding proportions in England and Wales taken as 100. Ages. Males. Females. All ages 98 101 Under 5 years 97 96 5 and under 10 years 91 90 10 „ „ 15 „ 89 88 15 „ „ 20 „ 91 96 20 ,, ,, 25 „ 105 107 25 „ „ 30 „ 109 110 30 „ „ 35 „ 105 105 35 „ „ 40 „ 100 104 40 „ „ 45 „ 101 106 45 „ „ 50 „ 102 107 50 „ „ 55 „ 101 106 55 „ „ 60 „ 102 109 60 „ „ 65 „ 105 111 65 „ „ 70 „ 103 108 70 „ „ 75 „ 94 110 75 „ „ 80 „ 83 110 80 ,, „ 85 „ 84 110 85 „ „ 90 „ 76 112 90 and upwards 83 120 14 1912 Table II. Showing the Areas, Densities, and Estimated Populations of the Sub-registration Districts at the middle of the year 1912. Sub-Districts. Area in Acres Estimated Acres to a person, 1912. Estimated Persons to an Acre, 1912. Estimated Population Mid-year 1912. Population at Census 1911. Increase or Decrease on Census. Tufnell 411 0.0122 82 33,738 33,526 + 212 Upper Holloway 299 0.0079 126 37,558 37,116 + 442 Tollington 315 0.0104 96 30,162 30,609 -447 Lower Holloway 415 0.0106 94 39,082 39,302 - 280 Highbury 799 0.0129 77 61,755 62,004 -259 Barnsbury 310 0.0059 170 52,821 53,011 - 190 South-East Islington 543 0.0076 131 71,292 71,775 -483 The Borough 3,092 0.0095 105 326,398 327,403 -1,005 15 1912 Table III. Showing the Areas, Densities and Estimated Populations of the Wards at the middle of the year 1912, together with the Populations at Census 1911 WARDS. Area in Acres. Estimated Persons to an Acre, or Density of Population, 1912. Estimated Population Mid-year, 1912. Population at Census 1911. Increase or Decrease. No. 1—Tufnell 411 82 33,738 33,526 + 212 2—Upper Holloway 299 126 37,558 37,116 + 442 3—Tollington 315 96 30,162 30,609 —447 4—Lower Holloway 415 94 39,082 39,352 —270 5—Highbury 417 81 33,674 33,805 —131 6—Mildmay 337 71 23,807 23,923 —116 7—Thornhill 172 182 31,282 31,522 —240 8—Barnsbury 137 157 21,539 21,499 +40 9—St. Mary's 148 114 16,863 16,908 —45 10—Canonbury 286 101 28,793 28,921 —128 11—St. Peter's 155 193 29,900 30,222 —322 The Borough 3,092 105 326,398 327,403 —1,005 16 1912] Area.— Islington contains 3,092 acres, of which 292 are parks, open spaces, or water, or railways, or markets, 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 IV. shows how this space is distributed:— Table IV. Sub-Districts. 1 Gross Area (Acres). 2 Water. 3 Railways. 4 Markets. 5 Parks and Open Spaces. 6 Total Unavailable Space. 7 Net Area. 8 Tufnell 417 7.4 20.8 ... 6.2 34.4 382.6 Upper Holloway 290 ... 7.3 ... ... 7.3 282.7 Tollington 320 ... 21.9 ... ... 21.9 298.1 Lower Holloway 413 ... 33.0 14.9 11.0 58.9 354.1 Highbury 798 ... 76.1 ... 32.4 108.5 689.5 Barnsbury 309 5.1 22.0 ... 4.7 31.8 277.2 South-East Islington 545 4.7 15.8 ... 8.5 29.0 516.0 The Borough 3,092 17.2 196.9 14.9 62.8 291.8 2,800.2 17 1912 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 133 206 193 172 122 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 Table VI. 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 107 200 180 165 134 98 64 38 14 Urban Districts .. 107 198 183 170 136 97 62 35 12 Rural ,, 105 205 172 149 128 101 71 48 21 London 103 185 184 176 139 101 63 36 13 Islington 103 178 180 177 138 102 68 40 14 c 18 1912] Table VII. CENSUS 1911. Average Number of Persons per Inhabited Building, and of Persons per Family, 1901 and 1911. Average Numbei of Persons per Inhabited Building. Average Number of Persons per Family. 1901. 1911. 1901. 1911. All Dwellings. All Dwellings. Ordinary Dwelling Houses. London 7.93 7.89 4.45 4.37 4.24 Battersea 7.20 6.90 4.33 4.24 4.21 Bermondsey 8.27 8.41 4.50 4.49 4.43 Bethnal Green 9.26 9.39 4.60 4.62 4.50 Camberwell 7.07 7.15 4.55 4.45 4.33 Chelsea 8.55 8.85 4.23 4.17 3.95 Deptford 6.98 6.80 4.48 4.37 4.31 Finsbury 10.93 11.52 4.21 4.14 3.97 Fulham 7.41 7.70 4.27 4.21 4.21 Greenwich 6.73 6.52 4.86 4.64 4.38 Hackney 7.16 7.16 4.49 4.40 4.29 Hammersmith 7.39 7.54 4.35 4.27 4.10 Hampstead 7.26 7.14 4.82 4.59 4.61 Holborn 12.63 13.15 4.31 4.47 4.34 Islington 8.67 8.90 4.23 4.10 3.96 Kensington 7.98 8.05 4.61 4.49 4.41 Lambeth 7.27 7.52 4.26 4.21 4.11 Lewisham 5.60 5.60 4.60 4.35 4.32 Paddington 8.14 8.54 4.28 4.20 4.16 Poplar 7.47 7.70 4.72 4.62 4.51 St. Marylebone 9.85 9.86 4.22 4.15 4.04 St. Pancras 9.92 9.82 4.13 4.12 3.85 Shoreditch 9.31 9.66 4.39 4.49 4.31 Southwark 9.88 10.48 4.31 4.32 4.07 Stepney 9.49 9.59 4.89 4.91 4.61 Stoke Newington 6.64 6.78 4.33 4.17 4.11 Wandsworth 6.14 6.43 4.66 4.44 4.38 Westminster, City of 9.96 9.14 4.43 4.45 4.13 Woolwich 6.48 5.73 4.77 4.58 4.27 City of London 6.97 7.06 5.04 4.92 3.82 19 1912 Table VIII. census returns. Showing the number of Inhabited Houses and Buildings, the Separate Occupiers, and Populations in ISLINGTON at the Census 1911. 1901. 1911. Total. Total (Cols. 4-11). Buildings used as Dwellings. Vessels, Sheds, Vagrants, &c. Separate Flats (included in Col. 5). Buildings not used as Dwellings. Ordinary Dwelling Houses. Blocks of Flats. Shops. Hotels, Inns and Public Houses. Offices, Warehouses, Workshops, Factories. Institutions. Others. Kind of Building, No. Cols. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ISLINGTON (Metropolitan Borough) Places of Worship 126 Number inhabited 38,645 36,778 31,484 407 3,983 324 129 214 237 — 4,875 Government and Municipal Buildings 25 Separate occupiers 79,129 79,902 67.760 4,924 6,233 334 153 214 281 3 4,924 864 Population 334,991 327,403 268,031 19,974 24,548 2,228 622 10,573 1,423 4 19,974 88 Warehouses, Workshops and Factories 597 Uninhabited 1,517 1,953 1,463 3 413 4 18 — 52 549 Being built 45 6 4 — 2 — — — — — — Theatres and other places of amusement 16 c2 20 1912 Table IX. census returns. Showing the number of Inhabited Houses and Buildings, the Separate Occupiers, ana the Population in LONDON at the Census 1911. 1901. 1911. Total. Total (Cols. 4-11.) Buildings used as Dwellings, — Vessels, Sheds, Vagrants. &c. Separate Flats (included in Col. 5). Buildings not used as Dwellings. Ordinary Dwelling Houses. Blocks of Flats. Shops. Hotels, Inns and Public Houses. Offices, Warehouses, Workshops, Factories. Institutions. Others. Kind of Building. No, Cols. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 LONDON. Places of Worship 2,030 Number inhabited .. 571,717 573,265 478,024 15,600 56,070 6.502 4,957 2,479 9,633 — 121,047 Government and Municipal Buildings 608 Separate occupiers .. 1,019,588 1,033,861 805,967 122,672 78,024 6,762 5,672 3,112 10,710 942 122,672 20,330 Population 4,536,267 4,521,685 3.413,576 471,219 327,552 59,223 21,235 171,954 51.797 5,129 471,219 Offices 4,381 Uninhabited .. 40,068 32,006 23,962 251 5,684 82 411 45 2,571 – 14,505 Warehouses, Workshops and Factories 18,090 Being built 4,624 1,583 1,201 52 228 12 57 4 29 —– 693 Theatres and other places of amusement 275 21 [1912 Table X. CENSUS RETURNS. INSTITUTIONS. Persons enumerated at the Census 1911 in Workhouse Establishments, in Lunatic Asylums, Prisons, Hospitals, Certified Reformatory and Industrial Schools, etc. Civil Parish. Sub-District of Islington Registration District. Institution. - fecial Inmates (Puients, Paupers, Lunatics, &c.). Officials and their Families. Total. Persons. Males. Females. Persons. Males. Females. Persons. Islington Metropolitan Borough 2. Upper Hollo way Workhouse, St. John's Road 1,884 977 907 88 29 59 1,972 '' '' Workhouse, Cornwallis Road 924 661 263 30 13 17 954 1. Tufnell Workhouse Infirmary Highgate Hill 678 363 315 140 12 128 818 3. Tollington '' Workhouse Receiving Homes 63 27 36 9 9 72 Workhouse Schools 432 254 178 32 6 26 464 2. Upper Holloway Workhouse Infirmary (Holborn Union) 629 444 185 86 10 76 715 3. Tollington Workhouse (Shoreditch Parish) 243 116 127 9 4 5 252 1. Tufnel . H.M. Prison, Holloway 660 — 660 148 30 118 808 4. Lower Holloway H.M. Prison, Pentonville 1,029 1,029 2 2 1,031 2. Upper Holloway Great Northern Central Hospital 154 79 75 94 11 83 248 3 Tollington Winifred House Convalescent Home 14 6 8 8 _ 8 22 6. Islington, South East London Fever Hospital 84 51 33 65 4 61 149 7. Highbury Mildmay Memorial Cottage Hospital 25 12 13 21 2 19 46 '' Mildmay Memorial Hospital Isolation House _ _ _ 1 _ 1 1 Home for Confirmed Invalids, Aubert Park and Highbury Terrace 66 _ 66 30 _ 30 96 '' L.C.C. Highbury Industrial School for Boys 199 199 _ 16 7 9 215 1. Tufnel Dudley Stuart Training Home for Girls 26 — 26 4 — 4 30 PART II. MARRIAGES, BIRTHS AND DEATHS. 24 1912] MARRIAGES. There were 6,182 persons married in 1912, and the marriage late was therefore 18.94 per 1,000 of the estimated population, which is the highest, with six exceptions, this Borough has ever known; and they indicate more powerfully than any words can express that Islington is in a prosperous condition. Last year the Medical Officer of Health pointed out that it could not be in the parlous state that pessimists asserted; for if so, the marriage rate would not be so high as it were then, viz:—17.37 per 1,000 of the population. The still higher, and remarkable, rate now reported indicates beyond cavil that the Borough must be prospering else its young people could not have married in such large numbers ; and particularly in an age when people are marrying at a later period of life than formerly. Why even in the twenty years 1841-60—when Islington was advancing by leaps and bounds, when its population was increasing almost in a manner similar to that which to-day is only to be found in the western states and districts of the United States and Canada—on only two occasions did the marriage rate reach the high level which it attained in the year under consideration, while in the seventy-three years 1841-1911, it has been higher on only six occasions. The plain fact is that the outcry as to the state of Islington has been much too loud; and as it has not been based on a reality, it should now cease, for it is calculated to do serious damage to business and to property. No doubt a certain, but comparatively small, number of businesses have been affected owing to the movement of population in certain of its districts; but this movement has only affected a small part of the Borough; indeed, as a proof of this statement, it may be related that the Secretary of one of the largest businesses in it, recently informed the Medical Officer of Health that at no previous time in his firm's history had it been so busy as during the last twelve months. Hitherto no record of the marriages in Islington, beyond that of a decennial period, has been published by the Medical Officer of Health, and therefore he has considered it desirable that one should now be given in support of his contention. It is to be found in Table XI., which gives the number of marriages, as well as the marriage rates, since 1841. The figures have been carefully abstracted from various returns of the Registrar General by the Medical Officer of Health. Persons married, Decennial average 1902-11 5,856 17.71 per 1,000 in 1912 6,182 18.94 '' Increase 326 1.23 „ 25 [1912 There was a remarkable feature in the return, namely that the marriage rate in the third quarter reached the very high figure of 23.11 per 1,000 of the population, which is undoubtedly one of the highest rates, if not the highest, hitherto recorded- homing the number of Persons Married and the Marriage Rate: in each quarter of 1912 and in 1911. Quarters No. persons married. Persons married per 1,ooo inhabitants. 1912. 1911. 1912. 1911. First 946 788 11.59 9.63 Second 1,554 1,512 19.°4 18.48 Third 1,886 1,784 23.11 2i.8o Fourth 1,796 1,602 22.01 19.58 The Year 6,182 5,686 18.94 17.37 1912] 26 Table XI. Shewing the Marriages and Marriage Rates of Islington from 1841 to 1912. The marriage rates for the years in which they were above that of 1912 are printed in heavy type. Years. Marriages. Marriage Rates. Years. Marriages. Marriage Rates. Years. Marriages. Marriage Rates. Years. Marriages. Marriage Rates. 1841 533 1886 1861 1,236 15.79 1881 2,306 16.25 1901 2,994 17.88 1842 458 15.36 1862 1,399 17.31 1882 2,367 16.48 1902 3,108 18.26 1843 489 15.54 1863 1,400 16. 77 1883 2,370 16.30 1903 3,053 18.32 1844 524 15.79 1864 1,630 18.92 1884 2,393 15. 95 1904 2,948 17. 73 1845 632 18.05 1865 1,759 19. 77 1885 2,278 15.92 1905 2,984 17 .99 1846 640 17.32 1866 1,805 19 .65 1886 2,176 14.43 1906 2,964 17.91 1847 657 16.86 1867 1,740 18.35 1887 2,241 14. 69 1907 2,962 17.94 1848 661 16.08 1868 1,766 18.04 1888 2,270 14 69 1908 2,781 16.56 1849 695 16.02 1869 1,665 16. 47 1889 2,436 15.57 1909 2,769 16.84 1850 820 17.92 1870 1,794* 17.20 1890 2,485 15.40 1910 2,870 17. 50 1841.50 6,109 16.79 1861.70 16,194 17.84 1881.90 23,322 15.55 1901.10 29,433 17.76 1851 895 18.56 1871 1,744 16.20 1891 2,741 17.13 1911 2,843 17.37 1852 982 19. 40 1872 1,952 17.63 1892 2,783 17.21 1912 3,091 18.94 1853 1.025 19 28 1873 1,998 17.55 1893 2,653 16.23 1854 1,054 18.88 1874 2,080 17.77 1894 2,694 16.30 1855 1,000 17.06 1876 2,162 17.96 1895 2,680 16.04 1856 1,098 17.83 1876 2,187 17.67 1896 2,969 17.25 1857 1,108 17.13 1877 2,188 17.19 1897 3,000 17.80 1858 1,152 16 .96 1878 2,191 16.74 1898 3,205 19 04 1859 1,280 17.95 1879 2,195 16.31 1899 3,254 19 35 1860 1,307 17.45 1880 2,192 15.83 1900 2,968 17.67 1851.60 10,901 17.96 1871.80 20,889 1706 1891.1900 28,947 17.44 27 [1912 Table XIa. census return. Condition as to Marriage and Ages, in Islington at Census 1911. Ages. Unmarried. Married, Widowed. Males. Females. Males. Females. Males. Females. Under 15 years 46,271 45,840 — — — — 15 „ 2,864 2,868 — — — — 16 „ 2,749 2,859 — 2 — — 17,, 2,696 2,897 — 8 — — 18 ,, 2,698 2,959 5 37 — — 19 „ 2,679 2,843 34 113 — — . 20 ,, 2,638 2,807 94 296 — 1 15 and under 20 years 13,686 14,426 39 160 — — 20 „ „ 25 „ 12,108 12,234 2,172 4,032 9 26 25 „ „ 30 „ 7,124 6,977 7,223 9,105 60 144 30 „ „ 35 3,704 4,031 9,245 9,934 126 359 35 „ „ 40 „ 2,104 2,863 9,140 9,197 222 664 40 „ „ 45 „ 1,567 2,118 7,964 8,026 369 955 45 „ „ 50 „ 1,062 1,722 7,045 6,642 464 1,313 50 „ 55 „ 777 1,274 5,672 5,126 602 1,651 55 „ „ 60 ,f 520 938 4,372 3,729 733 1,943 60 „ „ 65 „ 503 852 3,187 2,524 855 2,095 65 „ 70 „ 321 636 2,174 1,465 916 2,228 70 „ 75 „ 200 512 1,097 733 718 1,914 75 ,, ,, 80 ,, 77 284 428 264 456 1,269 80 „ „ 85 „ 32 133 154 64 242 677 85 „ „ 90 „ 14 55 34 21 81 250 90 „ „ 95 „ 1 16 7 3 17 69 95 „ „ 100 „ — 1 — — 6 8 100 years and upwards 1 — — — — — All Ages 90,072 94,912 59,953 61,025 5,876 15,565 184,984 Persons. 120,978 Persons. 21,441 Persons. 28 1912] Table XIb. census return. Condition as to Marriage of Persons, Males and Females, distinguishing the. number of Females aged 15.45 years at Census 1911. Married Persons.. 120,978 Males 59,953 Females 61,025 Females 15.45 years .. 40,454 Widowed Persons 21,441 Males 5,876 Femal 15,565 Females 15.45 years 2,148 Unmarried Persons 184,984 Males 90,072 Females 94,912 Females 15-45 years 42,649 BIRTHS. Altogether 8,211 births were registered, of which 4,267 were those of males, and 3,944 of females. Of these births, 7,787 occurred in the Borough, 264 in the Lying-in Hospital, Finsbury, and 160 in various other places, the information about which was forwarded to the Medical Officer of Health by the Registrar General. By the Islington Registrar's returns 7,787 „ Finsbury Registrar 264 8,051 Transferred from other places by Registrar General 160 8,211 This is the second year in succession in which the Registrar General has forwarded returns of the births which occurred in other places, outside the 29 [1912 Borough ; the object, as pointed out last year by the Medical Officer of Health, being to enable the local authorities to reach the mothers, when they returned to their homes with their babies, so as to instruct them how their infants should be fed and cared for. These returns have been prompted by the Notification of Births Act, 1907, which was passed by Parliament so that timely information might be given to the Sanitary Authorities of the births of children to their inhabitants that they may be taught the best means whereby strong strong and healthy progeny shall result. The 8,211 births represent a birth rate of 2515 per 1,000 of the inhabitants of the Borough. This birth-rate, although an improvement on the rates recorded in 1910 and 1911, when they were respectively 25 01 and 24 79 per 1,000 of our population, is still considerably below the rates registered in former years, as may be seen by a reference to Table F. in the Appendix, in which are given the returns for each year since 1841. The chief cause of the reduction in the birth-rate is now so fully recognized, that no person dare deny that it is due mainly to the deliberate action of modern married men and women. The subject has been discussed in these reports from time to time, and therefore, on the present occasion it will not be dwelt on, beyond this one remark, that it will be a sad day for the nation if the shrinkage of the population should ever become as great as it is in France to-day—should this country, which does not believe in conscription, have to rely on its volunteers; for clearly with a diminished population at the military age there must be a decreased number of volunteers; and these volunteers, we know, are not so numerous as they used to be. The birth-rate varied considerably in the various sub-registration districts. Thus, in Highbury it was as low as 19 01, whereas in Barnsbury it was 28.75 per 1,000 of the inhabitants. The other sub-districts have intermediate birthrates, as shown below:— Births. Birth-rate. Tufnell 749 22.20 Upper Holloway 1,021 27.18 Tollington 660 21.88 Lower Holloway 1,027 26.28 Highbury 1,211 19.61 Barnsbury 1,519 28.75 Islington, South East 1,864 26.14 The Borough 8,2.11 25.15 The 8,211 births include the 160 undistributed births notified by the Registrar-General. 30 1912] The birth-rate, based on the estimated number of women living in the Borough, at the child-bearing period of life, 15—45 years of age, was 114.2, as compared with 116.4 in 1891, 102.5 in 1901, and 111.5 in 1911. The inference to be drawn from birth.rates calculated in this—the more correct— manner was discussed in the Medical Officer of Health's report for 1911, pages 29 and 30, as well as in his report for 1904. Sex.—Of the 8,211 infants born, 4,199 were males and 3,852 females, while the sex of 160 was not reported by the Registrar General. ILLEGITIMATE BIRTHS. There were 333 illegitimate births registered, or 85 more than in the preceding year, and 92 more than the average of the ten preceding years. They represented 4.05 per cent, of the total births. Notwithstanding that there was an increase in the number of these births in 1912, it is nevertheless a fact that there has been on the whole a decrease in such births since the decennial period 1881.90, although just now they seem to be again approaching the earlier figures. Indeed, the proportions of these births to the total is is now higher than it has been for many years. 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 87,361 2.76 1911 248 8,113 3.0 1912 333 8,211 4.05 Table G. in the Appendix gives a return for each year since 1841 of the illegitimate births registered in Islington, which have been abstracted by the Medical Officer of Health from the annual and other reports of the Registrar General. The Notification of Births —There were 7,238 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 88.1 per cent of the entire number of the registered births. 31 (1912 These figures contrast with the four preceding years as follows:— Births. Notifications. Failures to notify. Per cent, notified. Per cent, of Failures to notify 1908 (From July 16th) 3,967 3,211 756 80.9 19.1 1909 8,198 6,983 1,215 85.2 14.8 1910 8,201 7,407 794 90.3 9.7 1911 8,113 7,232 881 89.1 10.9 1912 8,211 7,238 973 88.1 11.9 During the last two years there has been a falling off in the percentage of births that have been notified, and this has occurred mainly in the cases attended by medical practitioners. No doubt, they relied on the parents, on whom in the first instance the responsibility falls, to notify. In any case those non-notifications are not so important as when there is no medical practitioner in attendance. An analysis of the returns shows that of the 7,238 notifications:— 1,059 were notified by medical practitioners 3,412 „ „ midwives. 2,767 „ „ parents and other persons. These left a deficiency of 973, of which, in 63G cases, the mother was attended by a doctor, in 43 the father was not at home within six hours of the birth ; in 50 by a midwife, in 6 of which the father was not at home within six hours; and in 15 cases by other persons. In 123 cases no information could be obtained for the reasons stated below:— Information refused. Wrong address (no such house, a former address given and present one not traceable.) Many futile calls made. Moved away since birth of child. House empty. Child's death before registration. The notifications in preceding years by doctors, midwives and parents, etc., are shown in the following statement:— 32 1912]  By Medical Practitioners. By Mid wives. 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 1912 1,059 3,412 2,767 7,238 The Object of the Notification of Births Act, 1907.—When the Notification of Births Bill was passing through the Houses of Parliament one of the chief arguments used in favour of its becoming law was that it would give local authorities an early intimation of all the births occurring in their districts, and thereby enable them to reach the mothers, the majority of whom do not receive medical attendance, so that they might be instructed as to the best means of caring and rearing their infants. The Act was hailed with enthusiasm by most Sanitary Authorities, because they had long perceived that many infants lost their lives through improper feeding, and that many others from the same cause grew up weaklings, who would probably succumb on the first attack of serious illness, or later on become derelicts, who would find their way to the workhouses at a comparatively early period of life. They perceived, to use Sir Lauder Brunton's terse phrase, that it would be " a great deal cheaper to spend pence on children than pounds on paupers." They therefore, at all'events for the most part, appointed Health Visitors whose usefulness has now been widely recognised throughout the United Kingdom. They have done and are doing a great and beneficent and wonderful work- They not only induce mothers to suckle their children, which is the best of all methods of feeding, but when these mothers are unable to suckle they teach them by ocular demonstration—which is the only way to teach untrained and uninformed minds—how to feed their infants, and on what to feed them, at the varying weeks or months of their young lives. But they do more. They often create a wholesome rivalry among mothers, and as a result we are finding baby shows occurring all over the country, at which mothers exhibit their children with a wholesome pride. Where they are to be found, you will also now frequently find that a school for mothers has been established at which the mothers seek advice either about their infants or themselves. These visitors and these institutions are now more required than at any previous time in our history, because owing to the lower birth-rate it is more necessary to save the lives of those that have been born; and not only to save their lives but to so feed them that they may grow up to be bodily " fit" for all the stresses, worries, and strains of modern life. 33 [1912 Not long before his death Dr. James Grey Glover, who for long years was a worthy citizen of Islington, said to the writer " It has been my aim throughout my life to leave the world, in some respects at least, better than I found it." This is the aim of all really good men, and if it be the aim of such men to do good, how much more should it be the aim of all Sanitary Authorities? When the law explicitly declares that they can spend money on supplying the necessary means and instruments for dispelling the dark ignorance of the mothers of the children committed to their charge respecting the rearing and caring, the clothing and feeding, of their children so that their lives may be saved to their parents and to their country, and that they may grow up to be stout and lusty men and women, fully prepared for the battle of life. That every child should have an equal chance of life, for within the body of every one of them there runs the same vital blood. " The same old blood! The same red running blood! There swells and jets a heart, there all passions, desires, Teachings, aspirations, (Do you think they are not there because they are not expressed in parlours and lecture rooms?) This is not only one man, this the father of those who shall be fathers in their turns, In him the start of populous states and rich republics, Of him countless immortal lives with countless embodiments and enjoyments, How do you know who shall come from the offspring of his offspring through the centuries ? " And what of the female? " She too is not only herself, she is the teeming mother of mothers, She is the bearer of them that shall grow and be mates to the mothers." Do not these strong words of the American poet convey to every thinking man and woman reasons, the most grave and potent, that children should be cared for ? They require no comment: they are the embodiment of a great truth. The children born to-day are to be the future men and women of this kingdom, and we, the people of to-day are their joint trustees, whose duty it is to see that their affairs are properly administered for them. Indeed, the trust that devolves on us is the most sacred of all trusts, for " if anything is D 34 1912] sacred the human body is sacred," and the bodies of these children are given in trust to every Sanitary Authority, every one of which possesses the power to assist in the preservation of the health and lives of the children born within its district. It is true that no act of Parliament declares that they "must" care for them ; but then, to use the words of Mr. F. P. Willis, one of the Assistant Secretaries of the Local Government Board, " we have got beyond the day when it is necessary to say you shall do it." Parliament and the Local Government Boaxd trust the Sanitary Authorities to do the right and proper thing for those communities committed to their charge, believing that the great moral obligation, which most assuredly rests on them, will be quite sufficient to induce them to discharge their plain and undoubted duty. So far as Islington is concerned, nothing has been done up to now; and yet the Notification of Births Act was passed six years ago. It is not because of the cost of the Health Visitors—that is too trivial to be a real objection—but because of a mistaken notion that their visits would be looked on as a most objectionable interference with maternal rights, and an intrusion on the household. No such fears need possess the minds of the members of the Borough Council, for these objections have not been found in the innumerable places—great towns, small towns, and rural districts—where Health Visitors have been appointed; but on the contrary their services have been cheerfully received and readily accepted, and, indeed, even much sought after by thousands of poor mothers, who, not having been brought up with a knowledge of child life, or of maternal duties, are for the most part only too pleased to avail themselves readily, if not greedily, of the valuable assistance which their Sanitary Authorities have placed at their disposal. The ignorance displayed in the rearing of children has been recognised for ages, and long yeare ago Euripides declared that " the gods turned the errors of parents to the undoing of their children." It is our duty to see that these errors do not occur, and that the knowledge gained by past generations should so serve the present, that future generations shall benefit by what we have done; benefit in the possession of a manly, healthy, vigorous human stock, and in the possession, not only of a sound body, but a sound mind. This is what is expected of those who in civil life to-day hold the destinies of this country in their hands; and less will not be accepted of them; for the days have come when children can no longer be allowed to be doomed to a premature death or to drag out a life of lingering sickness and sorrow owing to maternal want of knowledge or other cause, if by any practical means such evils can be prevented; and hence the concentration of modern methods on the infants by Sanitary Authorities and on the children by the School Authorities- This is the age of the protection of childhood and the endowment of motherhood. 35 [1912 TABLE XII. Showing the number of Births registered in the Sub-Registration Districts, 1902-1912. Sub-District. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 Tufnell 745 740 799 758 746 745 816 759 741 763 749 Upper Hollo way Tollington 1,131 849 1,108 850 1,066 815 1,067 809 1,061 747 1,023 755 1,027 728 993 7°5 985 724 945 739 1,021 660 Lower Hol- loway Highbury 1,122 1,126 1,114 1,118 1,118 1,094 1,067 1,084 1,050 986 1,027 1,488 1,460 1,423 1,303 1,348 1,278 1,43:6 1,301 1,271 1,349 1,211 Barnsbury... 1,757 1,648 1,672 1,706 1,679 1,709 1,625 1,493 1,545 1,498 1,519 Islington South-East 2,122 2,051 2,001 1,995 1,960 1,927 1,986 1,863 1,885 1,793 1,864 Borough 9,214 8,983 8,890 8,756 8,659 8,531 8,665 8,198 8,201 7,973* 8,051* * Not including "Transferable Births" forwarded by Registrar-General, whose mothers' place of residence cannot be located. 36 1912] Table XIII. Showing the Births (distinguishing Males and Females) and Birth-rates of Islington in 1912, and in the four quarters of the year and of the County of London and the Great Towns during the same period; also in the year 1911 ; together with the mean Borough Birth-rates for the years 1902-1911. Quarter. Males. Females. Total. Birth Rates. Islington, 1912. Islington 1902-11. London, 1912 95 Great Towns, 1912. 1st 1,149 1,018 2,167 26.55 26.96 25.8 25.7 2nd 1,057 912 1,969 24.13 26.17 24.7 25.0 3rd 1,049 966 2,015 24.69 25.58 24.6 24.8 4th 944 956 1,900 23.28 25.39 23.9 24.0 The Year 1912 4,199 3,852 8,051* 24.67 26.07 24.7 24.9 1911 4,126 3,987 8,113 24.79 24.67 25.0 25.6 Increase or decrease +73 -135 -62 -0.12 -1.40 -0.3 -0.7 * In addition to these 8,051 births the Registrar-General transferred 160 to Islington The total births are therefore 8,211 = 25.I5 per 1,000 inhabitants. 37 [1912 Table XIV. Showing the Births of Males and Females in each quarter and for the year, 1912, and in the several Sub-registration Districts. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington South-East. The Borough Males. Females. Total. Males. Females. Tota1. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Qr. 97 96 193 137 134 271 106 86 192 143 124 267 187 145 332 227 201 428 252 232 484 1,149 1,018 2,167 2nd „ 107 79 186 136 10S 244 89 82 171 118 116 264 157 133 290 199 182 381 221 212 433 1,057 912 1,969 3rd „ 96 91 187 135 143 278 90 76 166 135 119 254 148 149 297 181 171 35? 264 217 481 1,049 966 2,015 4th „ 87 96 183 110 118 228 67 64 131 122 120 242 154 138 292 174 184 358 230 236 466 944 956 1,900 Year 38-7 362 749 518 503 1.021 352 308 660 548 479 1.027 616 565 1,211 781 738 1,519 967 897 1,864 4,199 3 852 5,051* * Vide note to Table XIII. 38 1912] Table XV. Showing the Birth-rates for each quarter and for the year 1912. of the several Sub-registration Districts and of the Borough. Sub-Districts I St Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Tufnell 22.88 22.05 22.l6 21.70 22.20 Upper Holloway 28.86 25.99 29.61 24.28 27.18 Tollington 25.46 22.67 22.01 17.37 21.88 Lower Holloway 27.32 27.01 25'99 24.77 26.28 Highbury 21.51 18.79 19.24 18.92 19.61 Barnsbury 32.41 28.85 26.65 27.10 28.75 Islington, S. East 27.15 24.29 26.99 26.15 26.14 The Borough 26.55 24.13 24.69 23.28 24.67 Table xvi. Showing the Population, Births, and Birth-rates in Seven Decennial Periods, 1841 to 1910, and in 1912. Periods. Mean Population inceach Decade. Number of Births in each Period. Birth-rates. Average Yearly Number of Births, corrected on the basis of the population of 1912. 1 2 3 4 5 1841-50 72.767 20,850 28.65 9,350 1851-60 121.353 41,915 34 .54 11,274 1861-70 181.529 67,520 37.20 12,142 1871-80 244,884 89,627 36.60 11,947 1881-90 299.857 97.420 32.49 10,605 1891-1900 331,868 97,278 29 .31 9,567 1901-10 331,434 87.361 26.36 8.603 1912 326,398 8,211 25. 15 8,211 39 [1912 DEATHS. Once more the death toll of this great Borough has been most satisfactory for the number of deaths registered was only 4,682, and the death-rate 14.34 per 1,000 of the estimated population. Only on two occasions during the seventy-one years for which accurate mortality returns are available, has the death-rate been so low, namely in 1908, when it was 13.93, and in 1910, when it was 13.79. The figures for this long period are to be found in Table H.m the appendix to this report, which should be consulted. Such low rates in a borough like Islington, practically during the last five years, during which they never reached 15.0 per 1,000, with its very mixed and teeming population, are matters for sincere congratulation, and tell more plainly than any words, however graphic, that its sanitary administration has been good. This, however, is not to be an excuse for slackness, or for the failure to adopt new preventive measures, but on the contrary should be a great incentive to increased efforts, especially in the direction of combating child mortality and tuberculosis, against which all wise authorities are now waging a great and ever increasing fight. The Medical Officer of Health in his annual report for 1911, dwelt at very great length on the saving of life effected in Islington during recent years through its good sanitary administration, and he gave several Tables to illustrate his remarks. These may be consulted with great advantage by persons who are desirous of understanding this complex subject-for deathrates are influenced, not only by sanitary administration, but also by the age and sex distribution of the population, subjects which are unfortunately not easily comprehended by the ordinary lay mind. He will not now discuss the matter but will content himself with saying that any changes which have occurred in these directions in the Borough have had, unfortunately, a detrimental effect on the death-rate; and that, therefore, it is most satisfactory that it should not only have remained so low, but that it has actually much improved of late years. Before quitting this subject he would like to make one further observation, namely, that the saving in human lives effected in Islington as compared with 20 years ago has been nearly 2,000 per annum and as compared with 10 years ago over 700. These are figures of which any Medical Officer of Health might well be proud, and at which any community might well rejoice. Ages at Death. -It was only to be expected that in a population which of late years has exhibited an increase in the number of persons who are thirty-five years old and over, there should also be a corresponding increase in the number of deaths at these later periods of life and a decrease at the earlier periods (consult Table XVII. page 43). 40 1912] The increases and decreases are best seen in tabular form. Age. Mean number of deaths in ten years, 1902 to 1911. Deaths in 1912. Increase+ or Decn ase— 0—5 1,571 1,133 —438 5—15 152 140 — 12 15—25 176 158 — 18 25—35 283 271 — 12 35—45 401 347 — 54 45—55 511 518 + 7 55—65 607 645 + 38 65—75 658 754 + 96 75—85 477 563 + 86 85 and upwards 142 153 + 11 Although the actual number of deaths among adult persons has been more yet the death-rate, owing to the increase in the number of persons living at advanced ages, has actually been less. This is well seen by comparing the death-rates of the Borough with those of ten years ago:— Age. 1902 1912. Increase + or Decreas : — 0—5 51.57 33.71 -17.86 5—15 3.12 2.40 — 0.72 15—25 3.24 2.69 — 0.55 25—35 5.41 4.68 — 0.73 35—45 10.50 7.70 — 2.80 45—55 17.86 15.57 — 2.29 55—65 32.01 29.10 — 2.91 65—75 62.27 58.58 — 3.69 75 & upwards 142.90 153.98 + 11.08 All ages 16.39 14.34 — 2.05 Here we find this satisfactory feature that not only has the total deathrate improved but that the death-rate for each period of life, with one exception, has also improved. This is, therefore, a complete proof that the improved conditions under which people now live have affected the health of the popula tion as a whole, and not its junior members only. 41 [1912 SEASONAL MORTALITY. The mortality which obtained in the several quarters of the year as usual varied considerably. Almost as an invariable rule the highest mortality of any year occurs in its first quarter and the least in the third; while that of the fourth usually exhibits a death-rate only slightly below that of the first. The sequence then of the death-rates of the quarters from highest to lowest mortality is first quarter, fourth quarter, second quarter, third quarter. In 1912 the deaths and death-rates are shown in the following tabular statement, which gives also the mean decennial death-rates as well as those for the 26 years 1886-1911. Death-rates per 1,000 inhabitants. Quarter. 1912. 1902-11. 1886-1911. First 16.22 17.72 19.49 Second 12.96 13.65 15.06 Third 12.36 12.86 14.80 Fourth 15.67 15.92 17.10 These figures speak for themselves, for in every instance they show that the death-rates for the several quarters last year were not only below the mean rates for the preceding 26 years, 1886-1911, but also below that for the 10 years, 1902-11. Thus the progressive improvement in the mortality returns has not been confined to any particular quarter of the year, but has been common to all. First Quarter.—The deaths numbered 1,324, as compared with the corrected average of 1,446 in the ten years, 1902-1911, and were equivalent to an annual death-rate of 16.22 per 1,000 of the population, as compared with a mean decennial death-rate of 17.72. Only on two occasions, namely, in 1905 and 1910, has the death-rate been so low, while it has been as high as 27.13. Second Quarter.—The number of registered deaths was 1,058 while their resulting death-rate was 12.96 per 1,000 of the population. In this quarter also the death-rate compared with other similar quarters was very low, for only in 1908 and 1911 has it been so good, when it was respectively 12.26 and 13 00 per 1,000. Third Quarter.—1,009 deaths were registered, or 201 below the corrected average for 26 years. These deaths were equal to an annual deathrate of 12.36 per 1,000, as compared with a mean decennial rate of 12.86. 42 1912] This rate was 0.41 below the mean death-rate of 26 years at this time of the year. The death-rate was, however, lower on four previous occasions, but these were the exceptional four years, 1907 to 1910, when owing to abnormal climatic conditions, which caused a reduced infantile mortality, the death-rates were unusually low. Fourth Quarter.—In this quarter also the mortality was below the corrected average, the number of deaths recorded being 1,291, and the deathrate 15.82 per 1,000. On various occasions, however, the death-rates have been lower, namely in 1894, 1898, 1900, 1903, 1907, 1908, 1909 and 1911. Nevertheless it was below the mean decennial rate from 1902-1911, during which it averaged 15.92 per 1,000 of the population. Particulars as to the mortality at the four seasons of the year are also to be found in Tables XIX., XXI., XXII., XXIII., and XXV.; as well as in Table B in the appendix, in addition to which very full details have been given in the quarterly reports of the Medical Officer of Health. DEATHS IN REGISTRATION SUB-DISTRICTS. The number of deaths recorded in the several sub-districts varied from 390 in Tufnell, to 1,083 in Islington South-East, while the death-rates ranged from 11.56 per 1,000 of the population in Tufnell to 15.68 in Lower Holloway. Tufnell (Population 33,738).—There were 390 deaths registered in this sub-district as compared with 442 in the preceding seven years. These deaths represented the low death-rate of 11.56 per 1,000 of the inhabitants as contrasted with 13.35, the rate which obtained from 1905 to 1911. Upper Holloway (Population 37,558).—Here the number of deaths recorded was 579, as against 549 in the seven years immediately preceding, while the death-rate was 15.41 per 1,000 in contrast with a mean rate of 15.13 in the years 1905-1911. Tollington (Population 30,162).—394 deaths were returned, or 29 less than the average of the seven years preceding, while the death-rate was 13.06 per 1,000, as compared with 13.42. Lower Holloway (Population 39,082)—The 613 deaths registered show a decrease of 20 on the average of 633 which occurred in the seven years, 1905-1911; while the death-rate was 15.68 per 1,000, or 0.08, above the mean rate of these years. 43 [1912 Highbury (Population 61,745).—803 deaths were reported, or an increase of 9 on the average returns of 1905-1911, and the death-rate, 13 0 per 1,000, consequently showed an increase of 0.3 on the mean rate of the seven years. Barnsbury (Population 52,821).—The death returns showed that 820 people died, or 76 less than the average of the preceding seven years, and that these deaths represented a death-rate of 15.52 per 1,000 of the population as against the mean rate of 16.77, which obtained in the years 1905-1911. Islington South East (Population 71,292).-—Here the deaths numbered 1,083, which is 53 below the septennial average. They were equal to a death-rate of 15-19 per 1,000, which is 0-33 below the mean rate of the years 1905-1911. Table XVII. Showing the Estimated Poplations, together with the Deaths! and Deathrates from All Causes, at Nine Aga-periods of life amon% Males, Females, and Persons. Males. Females. Persons. Ages. Population. Deaths. Death Rates. Population. Deaths. DeathHates. Population. Deaths, DeathRates. 0-5 16,962 624 36.79 16,642 509 30.59 33,604 1,133 33. 71 5—15 29 150 70 2.40 29,045 70 2.41 58,195 140 2.40 15—25 27,938 81 2. 90 30.787 77 2.50 58,725 158 2.69 25 -35 27,402 150 5.47 30,453 121 3. 97 57,855 271 4.68 35—45 21,307 214 1004 23,758 133 5.59 45 065 347 7.70 45-55 15,579 280 17.97 17,691 238 13.45 33,270 518 15. 57 55—65 10,132 366 36. 12 12,030 279 23.19 22,162 645 29.10 65—75 5,405 362 66. 97 7,467 392 52. 49 12,872 754 58.58 75 and upwards 1,544 273 176.81 3,106 443 142. 65 4,650 716 153.98 All ages 155,419 2,420 15. 57 170,979 2,262 13.23 326,398 4,682 14.34 †The deaths of 509 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 861 residents who had died in Institutions, &c., outside the district are included. 44 1912] Table XVIII. Showing the Ages at Death during the Years 1902—1911 and in 1912. Years. AGES. Totals. 0—1 1—5 All under 5 yrs- 5—i5 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85 upwards All above 5 yrs. 1902 1,219 687 1,906 198 222 339 470 571 664 656 468 141 3,729 5,635 1903 1,136 538 1,674 139 201 299 390 491 533 577 423 112 3,165 4,839 1904 1,140 603 1,743 165 197 295 439 521 603 666 496 111 3,493 5,236 1905 1,074 565 1,639 116 188 318 380 527 590 648 396 153 3,316 4,955 1906 1,083 589 1,672 141 167 273 377 528 611 654 490 137 3,378 5,050 1907 996 545 1,541 162 167 310 398 492 659 730 463 157 3,538 5,079 1908 894 426 1,320 161 170 257 408 471 597 637 510 148 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 1911 1,040 478 1,518 151 163 234 388 494 603 681 483 151 3,348 4,866 Mean. 1,020 551 1,571 152 176 283 401 511 607 658 477 142 3,407 4,978 1912 710 423 1,133 140 158 271 347 518 645 754 563 153 3,549 4,682 Increase or Decrease -310 — 128 1 — 438 — 12 -18 — 12 -54 +7 †38 +96 †86 + 11 †142 — 296 45 1912 Table XIX. Showing the Deaths and Death Rates from All Causes in the Wards during the Four Quarters oj 1912. Wards. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 135 16.00 73 8.65 85 10.07 97 11.50 39° 11.56 Upper Holloway 188 20.02 141 15.01 99 10.54 151 16.08 579 15.41 Tollington 123 16.31 94 12.46 74 9 81 103 13.66 394 13.06 Lower Holloway l6l 16.47 145 14.84 130 13.30 177 18.11. 613 15.68 Highbury 117 13.90 109 12.95 106 12.59 117 13.89 449 13.33 Mildmay 70 11. 76 71 11.93 72 12.10 79 13.27 292 12.26 Thornhill 123 15.73 109 13.93 107 13.68 130 16.62 469 14.99 Barnsbury 96 17.82 69 12.81 88 16.34 98 18.20 351 16.30 St. Mary's 62 14.70 54 i2.8l 59 14.00 66 15.65 241 14.29 Canonbury 128 17.78 77 10.70 94 13.06 128 17.78 427 14.83 St. Peter's 121 16.18 116 15.52 95 12.71 145 19.40 477 15.95 The Borough 1,324 16.22 1,058 12.96 1,009 12.36 1,291 15.82 4,682 14.34 N.B.—The heavy figures show the healthiest Ward in the several periods to which they refer. TABLE XX. Showing the Deaths and Death Rates together with the mean Mortality of the Sub-Districts for the Seven Years, 1905-11 and during the Year, 1912 DEATHS. DEATH-RATES. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Average 1905 11 1912 1905. 1906. 1907. 1908. 1909. 1910. 1911. Average 1905-11. 1912 Tufnell 483 432 482 425 440 424 408 442 390 14.79 13.17. 14.62 12.59 13.23 12.69 12.15 13.35 11.56 Upper Holloway 550 542 559 485 558 535 610 549 579 15.57 I5.20 15.54 I3.I2 15.25 14.50 16.39 15.13 15.41 Tollington 428 425 480 396 430 392 412 423 394 13.16 13.21 15.07 12.32 13.79 12.70 13.49 13.42 13.06 Lower Holloway 644 721 644 571 617 599 631 633 613 15.88 17.87 16.04 14.03 15.53 15.16 16.05 15.60 15.68 Highbury 837 779 816 816 793 759 760 794 803 13.28 12.39 13.02 I2.8l 12.73 12.21 12.27 12.70 13.00 Barnshury 897 967 949 885 872 802 902 896 820 16.65 18.oo 17.72 16.25 16.37 15.09 17.02 16.77 15.52 Islington, S. East 1,116 1,184 1,149 1,101 1,208 1,012 1,143 1,130 1,083 15.11 16.11 15.71 14.84 16.68 14.04 15.94 15.52 15.19 The Borough 4.955 5,050 5.079 4,679 4,918 4,523 4,866 4,867 4,682 14.93 15.25 15.37 13.93 14.96 13.79 14.87 14.78 14.34 47 1912 Table XXI Showing the Deaths and Death-Rates of Islington in 1912, 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 1902-11, and the deaths and death-rates in the year 1911. Quarter. Males Females. Total. Death Rates. Islington, 1912. Islington, 1902-11. London, 1912. 95 Great Towns, 1912. First 657 667 1,324 16.22 17.72 15.3 16.2 Second 557 501 1,058 12.96 13.65 12.4 13.1 Third 525 484 1,009 12. 36 12.86 11.5 11.4 Fourth 681 610 1,291 15. 82 15. 92 15.0 14. 5 The Year 1912 2.420 2,262 4, 682 14. 34 15.05 13. 6 13.8 1911 2,479 2,387 4,866 14.87 14.34 15.0 15.5 Increase —59 —125 -184 —0.53 -0.71 —1.4 —1.7 48 1912] Table XXII. 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 Kates. Deaths. Death Kates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates First Quarter 135 16.00 188 20.02 123 16. 31 161 16.47 208 13.47 319 16.58 290 16.27 1,324 16.22 Second Quarter .. 73 8 65 141 15. 01 94 12. 46 145 14. 84 192 12.44 178 13.48 235 13.18 1,058 12.96 Third Quarter 85 10.07 99 10. 54 74 9.81 130 13. 30 190 12 .31 195 14.77 236 13.24 1,009 12.36 Fourth Quarter .. 97 11 50 151 16.08 103 13. 66 177 18.11 213 13.80 228 17.27 322 18 07 1,291 15. 82 The Year 390 11.56 579 15.41 394 13.06 613 15.68 803 13.00 820 15.52 .1,083 15.19 4,682 14.34 N.B.—The heavy figures show which was the healthiest sub.district in the quarters to which they refer. 49 [1912 Table XXIII. Showing the Deaths and Death-Rates from All Causes for each Quarter since 1888. (The Lowest Death Rate in each quarter since 1888 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 Rates. 1888 1,629 21.09 1,163 15.05 1,072 13.88 1,333 17.26 5,197 16.82 1889 1,440 18.42 1,186 15.17 1,101 14.08 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 14.50 1,481 17.69 5,361 15.98 1902 1,796 21.50 1,220 14.61 1,149 13.76 1,470 16.35 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 13.30 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 13.90 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 1911 1,402 17.13 1,064 13.00 1,245 15.21 1,155 14.11 4,866 14.87 Corrected Mean 24 years 1,583 19.40 1,223 14.99 1,187 14.55 1,393 17.08 5,386 16.50 1912 1,324 16.22 1,058 12.96 1,009 12.36 1,291 15.82 4,682 14.34 Increase or Decrease –259 –3.18 –165 –2 .03 –178 –2.19 –102 –1.26 –704 –2.16 1912] 50 Table XXIV. 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. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Deaths. Death Rates. Miasmatic 22 0.65 32 0.85 22 0.73 53 1.36 40 0.65 73 1.38 58 0.81 300 0.92 Diarrhœal 2 0.06 3 0.08 2 0.06 3 0.07 6 0.09 10 0.19 10 0.14 36 0.11 Constitutional 91 2.70 113 3.01 83 2.75 140 3.58 182 2.95 173 3.27 241 3.38 1,023 3.13 Developmental 33 0.98 45 1.20 37 1.23 48 1.23 74 1.20 68 1.29 91 1.28 396 1.21 Nervous 24 0.71 32 0.85 15 0.49 37 0.94 48 0.78 45 0.91 60 0.84 261 0.79 Circulation 72 2.13 97 2.5 54 1.79 89 2.28 154 2.49 121 2.29 167 2.34 754 2.31 Respiration 76 2.25 141 3.75 81 2.69 122 3.12 128 2.07 191 3.62 241 3.38 980 3.01 Digestive Organs 22 0.65 34 0.90 32 1.06 33 0.84 44 0.71 53 1.00 72 1.01 290 0.88 Urinary System 10 0.29 15 0.39 20 0.66 21 0.54 41 0.66 20 0.38 39 0.55 166 0.51 Violence 19 0.56 30 0.79 24 0.79 33 0.84 35 0.56 33 0.62 53 0.74 227 0.69 Ill-defined 8 0.24 24 0.64 11 0.36 20 0.51 19 0.31 14 0.26 23 0.32 119 0.36 The heavy figures denote that these death-rates were the highest experienced in the several districts during the year from the diseases mentioned. 51 1912] Table XXV. 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.. 97 81 93 126 397 1. Miasmatic Diseases 74 62 58 106 300 2. Diarrhœal ,, 5 5 21 5 36 3. Malarial ,, .. 1 .. .. 1 4. Zoogenous ,, .. .. .. .. .. 5. Venereal ,, 5 3 6 4 17 6. Septic ,, 13 10 9 11 43 II. Parasitic Diseases .. .. .. .. .. III. Dietic 8 5 3 3 19 IV. Constitutional Diseases 269 247 225 282 1023 V. Developmental 132 90 92 82 396 VI. Local 737 564 505 694 2,501 1. Diseases of Nervous System 73 59 70 58 261 2. ,, Organs of Special Sense 1 1 .. 2 4 3. ,, Circulatory System 206 183 177 188 754 4. ,, Respiratory „ 345 208 133 294 980 5. „ Digestive „ 57 66 69 98 290 6. „ Lymphatic „ 2 1 1 2 6 7. ,, Urinary ,, 41 38 47 40 166 8. Reproductive „ 9 3 7 6 25 9. „ Bones and Joints 2 3 1 4 10 10. ,, Integumentary System 1 2 .. 2 5 VII. Violence 60 43 71 53 227 1. Accident or Negligence 46 33 51 47 177 2. Homicide.. 2 1 2 .. 5 3. Suicide 12 8 18 6 44 4. Execution .. 1 .. .. 1 VIII. Ill-defined Causes 21 28 20 51 119 All Causes 1,324 1,058 1,009 1,291 4,682 Note—The heavy figures denote that the diseases to which they are applied were most fatal in the Quarter to which they refer. 1912] 52 Table XXVI. 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 1912. England and Wales 15.9 12.7 11.0 13.6 13.3 95 Great Towns 16.2 13.1 11.4 14.5 13.8 146 Smaller Towns 15.2 11.9 10.2 12.5 12.4 England and Wales less) the 241 Towns 15.7 12.5 10.9 12.7 12.9 County of London 15.3 12.4 11.5 15.0 13.6 Bristol 17.4 13.3 10.6 12.1 13.3 Birmingham 16.4 12.6 11.0 16.2 14.1 Liverpool 19.2 17.9 16.2 19.3 18.1 Manchester 20.5 16.0 12.4 15.2 16.0 Leeds 16.1 14.1 12.2 14 .4 14.2 Sheffield 17.1 13.3 11.3 15.1 14.2 The Encircling Boroughs 15.0 12.8 11.5 16. 0 14.1 St. Pancras 15.8 14.3 13.2 15.0 14.6 Stoke Newington 13.7 10.5 10.2 13.9 12.1 Hackney 13.1 10.7 10.7 13.9 12.1 Hornsey 10.8 9.3 7.0 10.9 9.3 Finsbury 19.8 17.2 16. 7 21.2 18.8 Shoreditch 17.8 14.7 16. 6 23.4 18.1 Islington 16.22 12.96 12.36 15.82 14.34 53 1912] INFANTILE MORTALITY. The infantile mortality during the year was lower than any hitherto experienced in the Borough ; indeed, it approached a figure which might be almost considered ideal in a large population such as that of Islington. The records show that only 710 deaths of infants were registered in the Borough during 1912, as contrasted with 1,033 in the preceding year. The infantile mortality is not, however, gauged so much by the number of deaths as by the proportion of those deaths to the total number of children born in a period, for of course if there be few births there will naturally be fewer deaths. It is, then, with great satisfaction that the Medical Officer of Health can report that the infantile mortality rate was only 86 per 1,000 infant births. In 1911 the rate was 127, while the average rate for the five years, 1906-1910, was 109, and of the five years, 1901-1905, 130. In 1910, the lowest infantile mortality rate hitherto chronicled in the Borough was recorded (95 per 1,000), but the rate in 1912 was as low as 86. A mortality rate such as this must be considered satisfactory, although the rate to be desired would be somewhat lower. Still, if it could be kept as low as that now recorded, there would be very little to grumble at, for the great wastage of infant life would have been greatly checked. When it is recollected that the mean infantile mortality rate which obtains here is 143 per 1,000 births, it may well be considered to be very good, being 57 below it. Its most extraordinary feature is that not only was it low for the whole year, but also for each quarter. Thus in the first quarter it was only 87 per 1,000 births; in the second 86 per 1,000; in the third 81, and in the fourth 98. Another unusual and extraordinary aspect of these figures is that in the third quarter, when the infantile mortality is very frequently as high as 200 per 1,000 births—indeed, in 1911 it was 204—it was only 81. During the last few years, however, some very low rates have obtained at this season, for in 1910 it was only 67, and in 1907, 79; while in the quinquennial period 1906-1910 it averaged 99. If Table XXXII. be consulted it will be found that almost without exception the highest mortality has usually occurred in the third quarters of the year, which is mainly due to the meteorological conditions which prevail at that season. In 1912, however, nature stepped in and afforded her kindly protection to the infants of this country. That this is so locally is beyond cavil, because if the meteorological records that prevailed in that year be consulted, it will be found that although in the first week of July 1912] 64 the average temperature was nearly a degree and a half above the mean temperature of 65 years, yet in August it was 4.8 degrees, and in September 4.2 degrees below it. Again, the rainfall was considerable, for in July it fell on 15 days, in August on 24 days, and in September on 12 days, which makes a total of 51 days in the three months. In July the total rainfall was about three quarters of an inch, but in August it was 4.30 inches, while in September it was 1.58 inches, making a total of 5.64 inches for the quarter. This rain kept the surface of the earth cool, so that its temperature was considerably below the average. These factors, in addition to the cool winds which prevailed for the most part during the quarter, reduced the diarrhœal deaths very considerably, and as these are the principal cause of infant mortality at this particular season, the deaths were naturally very few. The meteorological conditions which prevailed last summer are thus seen to have been exceptionally favourable to children, for at no period were they extreme. As a matter of fact the year itself was probably one of the most equable we have known for some time, and consequently it was favourable to infant life. The Medical Officer of Health can very well imagine that the opponents of health visitors in the Borough will seize on the low infantile mortality as a reason why these officials should not be appointed; but if they learn the lessons of the year aright, they will see that instead of being an argument in their favour, it is entirely against them. As a matter of fact nature, especially in the summer quarter, has been teaching these great lessons to the community, to keep their infants cool; to keep the food intended for their use cool; to keep down the dust; and to keep the surroundings of their houses as well as the houses themselves clean. The elements have for once been doing these things, for the low temperature prevented the fermentation of foods; the rain kept down the dust in the yards and in the streets, so that the food was not contaminated by it, nor did the dust from the curtilege of the houses gain access to them; while the cooling breezes kept the air in the houses sweet. These are the great factors in infantile mortality, and if the lessons from nature of last year could be inculcated into the minds of the people, there would be fewer deaths among the infants of the Borough. But every person who has studied this great question knows perfectly well that it is to the mother alone we must look for that permanent improvement in this class of mortality, 55 [1912 for on her devolves the responsibility of rearing the children. It is she who has to bring them up sound in mind and body, and therefore, unless she knows how to feed them, care for them, and clothe them, she will of necessity fail in her duty. Only the other day the Duchess of Marlborough, presiding at a meeting of the St. Pancras School for Mothers, said:— "The present system of education had failed to turn out better workmen, more competent mothers, or more reliant men and women. Boys and girls were until quite recently turned out of school at the age of fourteen absolutely unprepared for the duties of life. It was owing to these defects in the educational system that voluntary agencies such as the St. Pancras School for Mothers, were instituted to help and instruct mothers in the proper care of their children. Lessons in mothercraft were supplemented by rudimentary instruction in cooking and housework. She did not wish them to think that schools for mothers would be unnecessary if it was possible to extend the years of school life and to intruct girls in domestic science and hygiene, but she believed that until such instruction was universal, schools for mothers would be necessary to enable girls to take their proper place and to fulfil their natural function. They must remember that the present generation of mothers left school with no knowledge of domestic science, nor were they able to obtain any useful training in their own homes, as the intervening years between school and marriage were usually spent in factory or workshop. She was speaking of the London girl. In consequence of such want of training they were incapable of cooking a wholesome meal. She believed that a well-cooked meal provided a better antidote to drink than any amount of legislation." The Duchess, who is an American woman, in whose native land so much is being done for the care of children, rightly thinks that their welfare depends greatly on the proper education of the mothers, and that this can only be done by getting into actual touch with them and teaching them as you would a child. The ignorance of the modern working man's wife is something appalling; indeed, persons whose duty it is to inquire into the cause of child mortality, on probing into the matter invariably find that it is some neglectful act on the part of the mother, the result of want of knowledge, which causes the commencement of the child's illness. How can they expect otherwise when they find the young girl leaving school—without any conception whatsoever of the management of a house, without the faintest idea of the care of children, or the duties of motherhood—going straight to work in a workshop or workplace, 1912] 56 or laundry, and then getting married. Is it any wonder that we find so many working men's homes in the muddled condition in which they are so frequently to be found? It is most painful to see the untidy conditions which prevail in their homes, and if untidiness were the only factor, it might possibly be ignored, but when to this is added dirt and neglect, and the inability of the wife to cook the plainest food, the husband's state is not to be envied. It is true that latterly these conditions have been somewhat better, but there are far too many men who enjoy good wages living in homes that are most unsatisfactory in every way Schools for mothers are the latest outcome of our modern civilization; and it is pleasant to think that there are many young women who avail themselves of the opportunities they afford of gaining instruction, not only in the care of children, but of other things which matter a great deal in home life. The low infantile mortality of last year can hardly be expected to occur again unless some special effort is made on behalf of the Council. That such a low rate will sometime obtain throughout England the Medical Officer of Health has very little doubt, for the work of health visitors is inducing young mothers to take a special interest in the rearing of their children, and causing a wholesome rivalry among them with regard to the up-bringing of their progeny. One result is that Baby Shows, which a few years ago were looked upon with derision, are now becoming general, which is an indication of the greater and deep interest which the mothers are taking in the welfare of their little ones. Such a rivalry should be fostered in every way, and it is, therefore, pleasing to find that there have been a few such shows, although on a small scale, within the Borough, which Church workers have held, and that the people have taken an interest in them. In other places these shows are fostered by the local authorities, and only recently a very successful one was held in the adjacent borough of Finsbury. It is to be hoped that Islington will soon have one of its own on a scale commensurate with its size. Perhaps some of the Ladies Leagues of the Borough would take the hint. They could not be engaged in more useful or better work. Let us see for a moment what is done at Birmingham—and what is done there is also done elsewhere—for the preservation of infants and children, and for the education of their mothers. The information is taken from an article in "The Child" (vol. 3, p. 852), by Miss M. C. Matheson, Warden of Birmingham's Women's Settlement, who tells us that "The Health Visitors of the City Council visit the great majority of infants born in the City; all cases of 57 [1912 measles and consumption, and children who are reported by the School Medical Officers or teachers to be in an uncleanly condition. They are responsible for propaganda work in connection with epidemics of summer diarrhoea, whooping cough, etc., and do in these and other ways a great deal of good to raise the standard of home care in the poorest districts of the City. In addition, in one of the most crowded wards of the City, a woman doctor, assisted by a special staff of Health Visitors, keeps watch on every infant during the first twelve months of its life. Infant consultations are held weekly, when the babes are weighed, medical advice given, and the progress of mother and child is noted." Then Miss Matheson proceeds to tell us what is done by the Education Committee of the Council, and how it has established a municipal system of medical care, so that the children's teeth, eyes, tonsils, throat and skin are looked after; how the 'Children's Court,' the pioneer in this country, was established in 1905; how the voluntary institutions look after the crippled children; how the working people themselves out of their Hospital Saturday Fund maintain a free convalescent home for children; how 'Schools for mothers' have been established in two of the most unhealthy wards, and that the Health Committee contribute to their upkeep; how the Charity Organisation Society combines with the Women's Settlement to work three Committees which deal only with cases of children requiring medical help, and arrangements for hospital treatment, etc., are made for many who would not otherwise succeed in obtaining help. Finally Miss Matheson says in closing her most interesting paper; "Space forbids a complete enumeration of the children's agencies, but the above sketch may suffice to prove that Birmingham is not behind other cities in concern for the welfare of the children. A great deal remains to be done, and there are astonishingly many children who are at present not reached; but help is promised in some directions, and for the rest we look to the city and the university to stimulate the sense of public responsibility and to give a civic education to the citizens." In all earnestness the Medical Officer of Health asks the members of his Council to contrast the work that is done in Birmingham with what is done here, which is nothing, and then to put to themselves the plain question, "Are we dealing fairly with our children ? " Particulars of the mortalities which have obtained in the various parts of the Borough are to be seen in the following statement:— 1912] 58  Deaths. Deaths per 1,000 Births. 1912. 1911. Tufnell 46 61 85 Upper Holloway 87 85 115 Tollington 58 88 131 Lower Holloway 97 94 162 Highbury 97 80 104 Barnsbury 149 98 162 Islington South-East 176 94 128 The Borough 710 86 129 The infant mortality record of the borough from 1841 to 1912, is shown in decennial periods in the following Table:— Death-rates from All Causes Infant deaths per 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 1912 14.34 86 59 [1912 TABLE XXVII. Showing the Deaths among Infants per 1,000 Births during the year 1912, and also the mortality rates for the years 1902-11. Sub-Districts. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Mean 1902 -11. 1912. Increase or decrease on mean. Tufnell 123 112 141 127 122 127 81 107 78 85 110 61 – 49 Upper Holloway 103 125 92 101 105 88 74 77 88 115 97 85 – 12 Tollington 144 124 128 117 127 132 117 96 88 131 120 88 – 32 Lower Holloway 156 141 161 151 155 148 125 101 108 162 141 94 – 47 Highbury 114 122 98 117 95 107 101 93 82 104 103 80 – 23 Barnsbury 151 127 142 124 138 123 119 111 111 162 131 98 – 33 Islington South East 130 128 134 121 129 104 99 117 94 128 118 94 – 24 The Borough 132 126 128 123 125 117 103 103 95 129 118 86 – 32 1912] 60 TABLE XXVIII. Showing the Mortality per 1,000 Births among Infants under one year of age in the three years 1901-03; in the ten years 1902-11 ; and in 1912 from certain specified causes. Causes of Death. Mean rate of 3 years 1901-2-3 per 1,000 Births. 1912. Mean rate 10 years 1902-11 per 1,000 Births.[/##3] Premature Birth and Congenital Defects 24.25 21.31 24.09 Bronchitis and Pneumonia 25.67 16.80 21.73 Atrophy and Marasmus 20.54 14.49 16.92 Diarrhœal Diseases (all forms) 19.01 8.77 20.91 Convulsions 6.66 2.07 3.64 Whooping Cough 6.44 2.07 5.41 Measles 3.27 3.53 3.53 Phthisis 1.85 — 0.82 Other forms of Tuberculosis 5.68 3.41 5.29 Diphtheria 0.43 0.73 0.24 Total of above 113.80 73.18 102.58 All, other causes 18.91 13.27 17.28 Total 132.71 86.45 119.86 61 [1912 TABLE XXIX. Particulars of Investigations into the Deaths of Infants from Diarrhoea during the six years 1907-12. Ages of Infants in three monthly periods. Total under twelve months. Total for 6 years. 0—3. 3—6. 6—9. 9—12. 1907 1908 1909 1910 1911 1912 1907 1908 1909 1910 1911 1912 1907 1908 1909 1910 1911 1912 1907 1908 1909 1910 1911 1912 1907 1908 1909 1910 1911 1912 1907-12 Food of Infants. Breast milk only 3 3 .. 1 6 .. 1 2 1 2 2 2 .. .. .. .. 4 .. 1 1 1 1 7 .. 5 6 2 7 19 2 41 Cows' milk only 4 9 3 1 11 .. 6 14 5 3 20 3 7 11 6 .. 18 .. 6 .. 1 2 11 1 23 34 15 9 60 4 145 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 Breast & cows' milk 1 3 .. .. 3 1 2 1 .. 3 5 .. .. 2 1 .. 1 .. 2 .. .. 1 5 .. 5 6 1 4 14 1 31 ,, condensed milk .. 1 .. .. 4 .. .. .. .. .. 4 1 .. .. .. .. 4 .. .. .. 1 .. 9 .. .. 1 1 .. 14 1 17 ,, artificial foods .. .. .. .. .. .. .. 1 .. 1 6 2 .. 1 1 .. 2 .. .. .. 1 .. 6 1 .. 2 2 1 14 3 22 Mixed foods .. .. .. .. .. 1 1 1 .. .. .. 1 .. .. 1 .. 8 .. .. 3 .. .. 2 .. 1 4 1 .. 10 2 18 Not stated .. .. .. .. .. .. .. .. .. .. 6 .. .. 1 1 1 4 .. .. .. .. 1 4 .. .. 1 1 2 17 .. 21 8 18 5 2 35 2 12 20 10 9 64 9 8 21 12 7 55 .. 13 4 6 7 47 2 41 63 33 25 201 13 376 State of Mother's Health. Good health 3 16 4 1 24 1 7 11 5 7 34 6 8 13 9 5 34 .. 10 3 5 4 35 .. 28 43 23 17 127 7 245 Moderate 3 1 1 .. 3 .. 2 4 1 1 9 2 .. 4 2 1 10 .. .. 1 .. 1 6 .. 5 10 4 3 28 3 53 Bad 2 1 .. 1 5 1 3 5 4 1 14 1 .. 3 .. 1 5 .. 3 .. 1 1 3 1 8 9 5 4 27 3 56 Not stated .. .. .. .. 3 .. .. .. .. .. 7 .. .. 1 1 .. 6 .. .. .. .. 1 3 .. .. 1 1 1 19 .. 22 8 18 5 2 35 2 12 20 10 9 64 9 8 21 12 7 55 .. 13 4 6 7 47 2 41 63 33 25 201 13 376 Mother's State as to Occupation. No occupation 6 15 4 .. 27 2 6 16 7 .. 43 5 7 15 6 1 36 .. 5 .. 5 .. 34 2 24 46 22 1 140 9 242 Occupied at work 2 3 1 .. 5 .. 6 4 3 8 15 4 1 5 5 5 15 .. 7 4 1 6 10 .. 16 16 10 19 45 4 110 Unknown .. .. .. 2 3 .. .. .. .. 1 6 .. .. 1 1 1 4 .. 1 .. .. 1 3 .. 1 1 1 5 16 .. 24 8 18 5 2 35 2 12 20 10 9 64 9 8 21 12 7 55 .. 13 4 6 7 47 2 41 63 33 25 201 13 376 Method of Feeding. Breast 3 3 .. 1 6 .. 1 2 1 2 2 2 .. .. .. 3 4 .. 1 1 1 1 7 .. 5 6 2 7 19 2 41 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 2 6 8 4 4 49 6 5 6 3 1 37 .. 3 .. 1 2 25 1 16 21 10 8 133 9 197 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 1 5 .. .. .. .. 1 6 1 .. 1 1 2 20 2 26 8 18 5 2 35 2 12 20 10 9 64 9 8 21 12 7 55 .. 13 4 6 7 47 2 41 63 33 25 201 13 376 1912] 62 Table XXIX.—continued, Ages of Infants in three monthly periods. Total under twelve months. Total for 6 years. 0—3. 3—6. 6—9. 9—12. 1907 1908 1909 1910 1911 1912 1907 1908 1909 1910 1911 1912 1907 1908 1909 1910 1911 1912 1907 1908 1909 1910 1911 1912 1907 1908 1909 1910 1911 1912 1907-12 Method used to cleanse Feeding Apparatus. Scalding water 2 2 .. .. 6 .. 6 3 3 2 15 2 1 5 3 .. 9 .. 5 .. 1 1 5 .. 14 10 7 3 35 2 71 Hot 1 4 .. .. 1 1 .. 1 3 .. 2 1 1 3 1 1 2 .. .. .. 1 .. 1 .. 2 8 5 1 6 2 24 Hot water and soda 1 3 2 .. 12 .. 2 9 2 2 21 1 3 6 2 2 20 .. .. .. 2 1 15 .. 6 18 8 5 68 1 106 Cold water .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. 1 1 3 Brush and hot water .. 3 2 1 4 1 3 4 1 2 14 1 3 4 4 .. 8 .. 6 .. 1 3 9 1 12 11 8 6 35 3 75 Otherwise 1 .. 1 .. .. .. .. 1 .. .. 1 .. .. .. 1 .. 2 .. 1 .. .. .. .. .. 2 1 2 .. 3 .. 8 Not stated (including 41 at breast) 3 6 •• 1 12 .. 1 2 1 3 11 3 .. 2 1 4 13 .. 1 4 1 2 17 1 5 14 3 10 53 4 89 8 18 5 2 35 2 12 20 10 9 64 9 8 21 12 7 55 .. 13 4 6 7 47 2 41 63 33 25 201 13 376 No. of Rooms occupied by Family. 1 room .. 3 .. .. 6 1 .. 5 1 3 18 2 .. 2 4 .. 3 .. .. 1 2 1 7 .. .. 11 7 4 34 3 59 2 rooms .. 6 2 1 16 .. .. 8 6 2 16 3 .. 8 5 2 22 .. .. 1 2 2 19 1 .. 23 15 7 73 4 122 3 ,, .. 7 2 .. 3 1 .. 3 1 3 8 2 .. 5 2 5 16 .. .. .. 2 2 12 1 .. 15 7 10 39 4 75 4 ,, .. .. .. 1 6 .. .. .. .. .. 10 2 .. 2 .. .. 4 .. .. 1 .. 1 5 .. .. 3 .. 2 25 2 32 5 ,, or more .. 2 1 .. 1 .. .. 1 2 1 6 .. .. 1 .. .. 5 .. .. .. .. .. .. .. .. 4 3 1 12 .. 20 Not stated .. .. .. .. .. .. .. 3 .. .. .. .. .. 2 .. .. 1 .. .. 1 .. .. 3 .. .. 6 .. .. 4 .. 10 Unknown .. .. .. .. 3 .. .. .. .. .. 6 .. .. 1 1 .. 4 .. .. .. .. 1 1 .. .. 1 1 1 14 .. 17 .. 18 5 2 35 2 •• 20 10 9 64 9 .. 21 12 7 55 .. .. 4 6 7 47 2 .. 63 33 25 201 13 335 State of Rooms as to Cleanliness. Clean 8 13 5 2 28 2 12 15 8 7 52 8 8 16 6 5 44 .. 12 2 3 6 36 1 40 46 22 20 160 11 299 Dirty .. 4 .. .. 1 .. .. 3 1 1 4 .. .. 3 3 .. 3 .. 1 2 2 .. 5 1 1 12 6 1 13 1 34 Unwholesome .. .. .. .. 2 .. .. 1 .. 1 2 1 .. .. .. 1 2 .. .. .. 1 .. 3 .. .. 1 1 2 9 1 14 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 8 18 5 2 35 2 12 20 10 9 64 9 8 21 12 7 55 .. 13 4 6 7 47 2 41 63 33 25 201 13 376 Prevalence of Flies. Numerous .. 2 .. .. 14 .. .. 3 4 2 30 .. 5 1 1 30 .. .. .. 1 .. 25 .. .. 10 6 8 99 .. 118 Moderate .. .. .. .. 3 .. .. .. 1 .. 4 .. .. 4 1 .. 3 .. .. .. .. 1 2 .. .. 4 9, 1 12 .. 19 Few .. 2 3 1 12 2 .. 6 3 2 17 3 .. 3 5 2 11 .. .. .. 2 9, 15 1 .. 11 13 7 55 6 92 None noted .. 14 2 1 6 .. .. 11 2 5 13 6 .. 9 5 4 11 .. •• 4 3 4 5 1 .. 38 12 14 35 7 106 .. 18 5 2 35 2 .. 20 10 9 64 9 .. 21 12 7 55 .. .. 4 6 7 47 2 .. 63 33 25 201 13 335 63 [1912 XXX. Summary of Investigations into the Deaths of Infants from Diarrhœa during the six years 1907-12. 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 10 7 11 41 Cows' milk only 28 51 45 21 145 Condensed milk only 11 25 15 10 61 Artificial foods only 1 3 8 8 20 Breast and cows' milk 8 11 4 8 31 „ condensed milk 5 5 4 3 17 „ artificial foods .. 10 4 8 22 Mixed foods 1 3 9 5 18 Not stated 3 6 7 5 21 70 124 103 79 376 State of Mother's Health. Good health 49 70 69 57 245 Moderate 8 19 17 9 53 Bad 10 28 9 9 56 Not stated 3 7 8 4 22 70 124 103 79 376 Mother's state as to occupation, No occupation 54 77 65 46 242 Occupied at work 11 40 31 28 110 Unknown 5 7 7 5 24 70 124 103 79 376 Method of Feeding. Breast 13 10 7 11 41 Bottle with tube 13 26 30 21 90 Bottle (boat shape) without tube 36 77 52 32 197 Spoon 5 3 3 4 15 Otherwise .. 1 3 3 7 Not stated 3 7 8 8 26 70 124 103 79 376 Method used to cleanse Feeding Apparatus. Scalding water 10 31 18 12 71 Hot 7 7 8 2 24 Hot water and soda 18 37 33 18 106 Cold water .. 1 2 •. 3 Brush and hot water 11 25 19 20 75 Otherwise 2 2 3 1 8 Not stated (including 41 at breast) 22 21 20 26 89 70 124 103 79 376 No. of Rooms Occupied by the Family. 1 rooms 10 29 9 11 59 2 rooms 25 35 37 25 122 3 „ 13 17 28 17 75 4 ,, 7 12 6 7 32 5 ,, or more 4 10 6 .. 20 Not stated .. 3 3 4 10 Unknown 3 6 6 2 17 62 112 95 66 335 State of Rooms as to Cleanliness. Clean 58 102 79 60 299 Dirty 5 9 9 11 34 Unwholesome 2 5 3 4 14 Not stated 2 2 6 2 12 Unknown 3 6 6 2 17 70 124 103 79 376 Prevalence of Flies. Numerous 16 39 37 26 118 Moderate 3 5 8 3 19 Few 20 31 21 20 92 None noted 23 37 29 17 106 62 112 95 66 335 1912] 64 TABLE XXXI. 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 1905-1912. Ages at Death. Deaths. Deaths per 1,000 Births 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Total 8 years. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Total 8 years. Under 1 week 185 182 187 186 156 163 170 190 1,419 21.13 21.01 21.91 21.46 19.02 19.87 20.96 23.14 21.08 1—2 weeks 61 42 58 52 52 45 52 41 403 6.96 4.85 6.80 6.00 6.34 5.49 6.41 4.99 5.98 2—3 ,, 54 49 51 33 26 41 34 25 313 6.17 5.66 5.98 3.81 3.17 5.00 4.19 3.04 4.65 3—4 „ 36 35 34 39 35 29 37 24 269 4.11 4.04 3.98 4.50 4.27 3.54 4.56 2.92 3.99 Total under a month 336 308 330 310 269 278 293 280 2,404 38.37 35.56 38.67 35.77 32.80 33.90 36.12 34.l0 35.70 1—3 months 215 228 189 180 147 131 207 133 1,430 24.55 26.32 22.14 20.78 17.92 15.97 25.51 16.20 21.23 Total under 3 months 551 536 519 490 416 409 500 413 3,834 62.92 61.88 60.81 56.55 50.72 49.87 61.63 50.30 56.94 3-6 months 196 230 169 151 148 144 201 121 1,360 22.38 26.56 19.81 17.43 1805 17.56 24.78 14.73 20.20 6—9 months 164 162 167 126 144 106 171 81 1,121 18.73 18.71 19.57 14.54 17.57 12.92 21.08 9.86 16.65 9—12 months 163 155 141 127 133 118 168 95 1,100 18.61 17.90 16.52 14.76 16.22 14.38 20.70 11.56 16.34 Total under 1 year 1,074 1,083 996 894 841 777 1,040 710 7,415 122.64 125.05 116.71 103.28 102.56 94.73 128.19 86.45 110.13 65 [1912 Table XXXII. 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 1888 288 326 117 132 323 270 132 115 580 359 239 152 366 316 153 132 1.557 1,271 160 132 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 338 129 319 144 397 165 397 169 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 1912 189 87 169 86 165 81 187 98 710 86 Note:—The lowest infantile mortality rates in the periods of the year to which they refer are printed in heavy type. 1912] 66 Table XXXIII. Shewing the Chief Causes of Infantile Mortality in the fourteen years, 1898-1911 and in 1912. Cause of Death. Years. Mean 14 years. 1912 Difference. 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 i. Common Infectious Diseases. Small-pox .. .. .. 1 4 .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. Measles 65 27 42 37 24 29 51 27 36 27 24 31 21 28 34 29 — 5 Scarlet Fever 2 .. 2 2 1 1 1 .. 1 .. 3 1 .. .. 1 .. — 1 Diphtheria (including Membranous Croup 6 3 5 7 1 4 2 2 3 1 4 1 1 2 3 6 + 3 Whooping Cough 67 66 68 38 76 63 30 51 30 53 29 36 61 31 50 17 — 33 ii. Diarrhœal Diseases. Diarrhoea, all forms 220 208 148 143 72 83 200 149 171 73 80 46 33 229 133 23 —110 Enteritis, Muco-enteritis,| Gastro-enteritis 105 159 67 70 43 46 20 53 92 49 52 26 38 73 64 49 — 15 Gastritis, Gastrointestinal Catarrh 9 13 21 21 23 22 18 15 14 9 7 23 15 9 15 8 — 7 iii. Wasting Diseases. Premature Birth 191 187 176 169 194 174 178 163 144 164 167 136 121 149 165 128 — 37 Congenital Defects 30 21 36 48 33 47 43 48 59 47 51 52 46 35 43 34 — 9 Injury at Birth .. .. .. .. .. 1 .. .. .. .. .. .. 1 4 .. 3 + 3 Want of Breast-milk, Starvation 2 2 1 5 2 7 6 4 5 8 4 4 .. 14 5 5 •• Atrophy, Debility, Marasmus 244 285 221 188 192 183 177 138 134 137 138 133 94 117 170 114 — 56 iv. Tuberculous Diseases. Tuberculous Meningitis 29 30 25 24 20 20 10 19 20 17 13 18 24 19 21 15 — 6 Tuberculous Peritonitis Tabes Mesenterica 48 30 25 26 25 20 20 24 17 17 14 20 14 11 22 8 — 14 Other Tuberculous Diseases 20 27 28 19 23 30 16 12 12 23 13 8 8 16 18 5 — 13 v. Other Causes. Erysipelas .. 6 3 2 3 4 3 1 3 3 4 4 3 .. 3 .. — 3 Syphilis 12 7 17 10 11 10 11 13 9 5 13 10 8 4 10 8 — 2 Rickets 4 8 2 5 3 1 4 3 5 .. 2 1 .. 6 3 1 — 2 Meningitis (not Tuberculous) 25 16 19 23 16 18 10 19 18 10 13 11 14 10 16 9 — 11 Convulsions 46 62 57 68 69 47 47 38 24 16 15 14 22 17 39 17 — 22 Bronchitis 129 124 119 104 116 90 78 77 82 83 39 55 50 51 85 41 — 44 Laryngitis 5 2 4 5 2 4 1 3 .. 1 .. 1 .. 1 2 1 — 1 Pneumonia 87 112 118 123 134 109 101 107 103 153 106 106 110 101 112 97 — 15 Suffocation, overlying 48 45 43 39 46 15 25 14 22 23 23 27 26 21 30 23 — 7 Other Causes 110 108 97 113 86 108 88 94 79 77 80 77 64 91 91 73 — 18 1.504 1,548 1,344 1,290 1,219 1,136 1,140 1,074 1,083 996 894 841 777 1,040 1,135 710 — 425 67 [1912 In England and Wales, in the ninety-five great towns, in the seven greatest towns, and in the boroughs surrounding Islington, the infantile mortality was as follows:— England and Wales 95 per 1,000 births 95 Great Towns 101 „ 146 Smaller Towns 98 „ Rural Districts 86 „ London 91 „ Birmingham 112 „ Liverpool 125 „ Manchester 121 „ Leeds 101 „ Bristol 103 „ Sheffield 106 „ The Encircling Boroughs. Hornsey 77 „ Stoke Newington 72 „ Hackney 80 „ Shoreditch 123 „ Finsbury 114 „ St. Pancras 88 „ The Encircling Boroughs 94 „ Islington 86 „ 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 only 296 deaths registered from the principal epidemic Dseases, or 308 less than the number registered in 1911 The resulting death-rate was 0.90 per 1,000 inhabitants, which is far and away the lowest hitherto chronicled in the Borough. In Tables XXXIV. and XXXV. the records from 1885 to the present day are given, and from these it will be seen that the present record has never been approached; thus there was no death from small pox, as contrasted with an average of 7; there were only 150 deaths from measles, as compared with 173; 9 deaths from scarlet fever, as contrasted with 33 ; 38 deaths from 148; 8 deaths from enteric fever, as against 36; 36 deaths from diarrhoea, as against 186. Thus in each of the diseases there was a considerably diminished mortality, which is a matter for congratulation. 1912] 68 Table XXXIV. Showing the Deaths from the principal Epidemic Diseases for the Twenty-seven years 1885-1911 and in 1912, 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. Diarrhœal Diseases. Totals. Death-Rate. 1885 129 294 36 167 210 3 63 — 197 1099 3.69 1886 3 63 26 72 214 2 60 — 320 760 2.52 1887 — 335 59 46 240 2 45 — 309 1036 3.39 1888 — 147 64 50 231 1 59 •— 162 714 2.31 1889 — 177 40 62 86 — 61 — 178 604 2.01 1890 — 202 65 81 204 — 39 — 180 771 2.44 1891 — 224 50 †178 255 1 32 — 159 899 2.81 1892 3 179 53 170 161 — 41 1 189 797 2.47 1893 2 119 94 200 181 1 48 2 237 884 2.70 1894 3 199 69 218 188 — 36 — 95 808 2.44 1895 1 135 66 144 81 1 30 3 189 650 1.94 1896 1 288 57 257 234 — 46 2 153 1038 3.07 1897 1 97 61 131 130 — 44 — 174 638 1.89 1808 — 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 71 — 12 — 324 604 1.84 1912 — 151 9 38 54 — 8 — 36 296 0.90 † From this date Membranous Croup was included. 69 [1912 Table XXXV. Showing the Corrected Mean Number of Deaths from the Principal Epidemic Diseases 1885-1911 and in 1912 Diseases. Corrected Average Number of Deaths 1885-1911. 1912. Decrease. Small pox 7 .. – 7 Measles 173 151 – 22 Scarlet Fever 42 9 – 33 Diphtheria 100 38 – 62 Whooping Cough 148 54 – 94 Typhus Fever .. .. .. Enteric Fever 36 8 – 28 Continued & Ill-defined Fevers 1 .. – 1 Diarrhoea 186 36 – 150 The above Diseases 693 296 – 397 The usual statement showing the position occupied by Islington with respect to the Epidemic Diseases in the country and in the neighbouring metropolitan boroughs cannot be given because the Registrar in his annual statement does not give the necessary information. 1912] 70 Table XXXVI. Deaths and Death-Rates from each of the principal Epidemic Diseases during the year 1912, inclusive of the Deaths of Borough Patients in Hospitals outside the Borough. SUBREGISTRATION. DISTRICTS. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea. TOTALS. Deaths. Deathrates. Deaths, i Deathrates. Deaths. Deathrates. " Deaths. Deathrates. j Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 1 0.03 ... ... 12 0.36 1 0.03 3 0.09 4 0.12 2 0.05 23 0.68 Upper Holloway ... ... ... ... 9 0.24 ... ... 15 0.40 4 0.10 3 0.08 31 0.82 Tollington ... ... ... ... 8 0.26 ... ... 7 0.23 2 0.07 2 0.07 19 0.63 Lower Holloway ... ... ... ... 34 0.87 4 0.10 7 0.18 5 0.13 3 0.08 53 1.36 Highbury 2 0.03 ... ... 13 0.21 1 0.10 3 0.05 14 0.23 6 0.10 39 0.63 Barnsbury 2 0.04 ... ... 45 0.85 2 0.04 11 0.21 6 0.11 10 0.19 75 1.14 Islington S. East 3 0.04 ... ... 30 0.42 1 0.02 8 0.11' 3 0.04 10 0.14 55 0.77 The Borough 8 0.02 ... ... 151 0.46 9 0.03 54 0.16 38 0.12 36 0.11 296 0.90 Preceding year, 1911. 12 0.04 ... ... 124 0.38 20 0.06 71 0.22 54 0.16 325 0.99 606 1.85 71 [1912 Table XXXVII. Shewing the Deaths and Death-rates from the Principal Epidemic Diseases in the Wards during the Four Quarters of 1912. WARDS. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths Deathrates. Tufnell 8 0.95 6 0.71 6 0.71 3 0.35 23 0.68 Upper Holloway 18 1.92 10 1.06 2 0.21 1 0.10 31 0.82 Tollington 11 1.46 5 0.66 3 0.39 — — 19 0.63 Lower Holloway 15 1.53 11 1.12 9 0.92 18 1.84 53 1.36 Highbury 2 0.24 5 0.59 6 0.71 12 1.4 2 25 0.74 Mildmay 3 0.50 3 0.50 1 0.16 7 1.18 14 0.59 Thornhill 2 0.25 10 1.28 19 2.43 12 1.53 43 1.37 Barnsbury 3 0.55 3 1.56 11 2.04 16 2.97 33 1.53 St. Mary's 1 0.24 1 0.24 5 1.18 8 1.90 15 0.89 Canonbury 1 0.72 2 0.28 3 0.42 9 1.25 15 0.52 St. Peter's — — 2 0.26 8 1.07 15 2.01 25 0.83 Totals 64 0.78 58 0.71 73 0.89 101 1.24 296 0.90 1912] 72 Table XXXVIII. Showing the Deaths and Death-rates from each of the Principal Epidemic Diseases in the several Wards during the Year 1912. WARDS. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea. Totals. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 1 0.03 ... ... 12 0.36 1 0.03 3 0.09 4 0.12 2 0.05 23 0.68 Upper Holloway ... ... ... ... 9 0.24 ... ... 15 0.40 4 0.10 3 0.08 31 0.82 Tollington ... ... ... ... 8 0.26 ... ... 7 0.23 2 0.07 2 0.07 19 0.63 Lower Holloway ... ... ... 34 0.87 4 0.10 7 0.l8 5 0.13 3 0.08 53 1.36 Highbury 2 0.06 ... ... 5 0.15 1 0.03 2 0.06 9 0.26 6 0.18 25 0.74 Mildmay ... ... ... ... 8 0.34 ... ... 1 0.04 5 0.21 ... ... 14 0.59 Thornhill 1 0.03 ... ... 28 0.90 1 0.03 5 0.06 2 0.0 6 0.19 43 1.37 Barnsbury 1 0.04 ... ... 17 0.79 1 0.04 6 0.28 4 0.19 4 0.19 33 1.53 St. Mary's 2 0.12 ... ... 7 0.41 1 0.06 2 0.12 2 0.12 1 0.06 15 0.89 Canonbury 1 0.03 ... ... 6 0.21 ... ... 2 0.07 1 0.03 5 0.17 15 0.52 St. Peter's ... ... ... ... 17 0.57 ... ... 4 0.13 ... ... 4 0.13 25 0.83 The Borough 8 0.02 ... ... 151 0.46 9 0.03 54 0.16 38 0.12 36 0.11 296 0.90 73 [1912 SMALL POX. There was no death from Small Pox registered during the year, nor was any case notified. MEASLES. 151 deaths were registered from this disease, as contrasted with an average of 173 during the last 26 years. In the preceding year the number was 12.4, and in 1910, 166. The deaths were equal to an annual death-rate of 0.46 per 1,000 inhabitants, but this is hardly the correct way of stating the mortality from this disease, as the deaths are confined almost entirely to juveniles; indeed, last year there were only five deaths over the age of five years; hence a more correct way would probably be to state the rate in terms proportional to the number of children living under five years of age. If this were done, the mortality rate would be found to be 4.49 per 1,000 children under five years. This of course is a very serious toll on young lives, which is all the more to be regretted because of the fact that too frequently want of care, more often want of knowledge as how to manage the patient, has resulted in the deaths of children from the many secondary causes which are to be found in Table XLI. of this report. The fact only wants to be stated that 116 of the deceased had pneumonia as a contributory secondary cause to show how comparatively few succumb to measles alone. This matter has been frequently discussed in the various reports of the Medical Officer of Health, who cannot help feeling that if young mothers were taught how to nurse their children in health and sickness, much of this loss of life would never have occurred. Table XXXIX. Showing the Deaths and Death-rates from Measles in the Sub-Districts for each Quarter and the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Deaths. Deathrates. Deaths. Deathrates Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 4 0.47 5 0.59 2 0.24 1 0.12 12 0.35 Upper Holloway 5 0.53 4 0.43 .. .. .. •• 9 0.24 Tollington 5 0.66 2 0.27 1 0.13 .. •• 8 0.26 Lower Holloway 8 0.82 6 0.61 4 0.41 16 1.64 34 0.87 Highbury 2 0.13 2 0.13 .. .. 9 0.58 13 0.21 Barnsbury .. .. 9 0.68 16 1.21 20 1.51 45 0.85 Islington, South East .. .. 1 0.06 6 0.34 23 1.29 30 0.42 The Borough 24 0.29 29 0.36 29 0.36 69 0.84 151 0.46 1912] 74 Table XL. Showing the Death-Rates of the Encircling Boroughs from Measles in the Four Quarters of 1912. Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. St. Pancras 0.04 0.89 0.58 0.26 0.44 Stoke Newington .. 0.08 0.08 0.24 0.10 Hackney .. 0.05 0.18 0.11 0.09 Hornsey • • 0.05 0.09 0.09 0.06 Finsbury 0.05 0.23 1.58 4.15 1.50 Shoreditch 0.07 .. 0.25 3.89 1.05 The above Districts 0.02 0.30 0.44 1.14 0.47 Islington 0.29 0.36 0.36 0.84 0.46 Table XLI. Showing the Secondary Causes of the Deaths from Measles. Secondary Causes. Quarters. The Year 1912. 1 2 3 4 Males. Females. Totals. Pneumonia 15 26 22 53 60 56 116 Bronchitis 3 1 1 2 5 2 7 Convulsions 2 .. .. 2 3 1 4 Empyema .. -• 1 •• 1 .. 1 Tubercular Meningitis .. .. 1 .. .. 1 1 Whooping Cough • • .. .. 2 2 .. 2 Enteritis 2 1 .. 1 2 2 4 Laryngitis .. .. .. 1 1 .. 1 Otitis Media 1 .. .. .. .. 1 1 Meningitis .. .. .. 1 1 .. 1 Marasmus .. .. 3 .. 1 2 3 Heart, etc. •• 1 .. 1 1 1 2 Total Secondary Causes 23 29 28 63 77 66 143 Deaths where no secondary cause was entered 1 .. 1 6 5 3 8 Total Deaths 24 29 29 69 82 69 151 76 [1912 Table XLII. Showing the Deaths from Measles during each Week of 1912. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Week. Deaths. Week. Deaths. Week. Deaths Week. Deaths. 1 1 14 1 27 5 40 ... 2 2 15 1 28 4 41 6 3 2 16 2 29 3 42 3 4 3 17 ... 30 3 43 4 5 ... 18 3 31 2 44 3 6 1 19 2 32 45 7 7 3 20 1 33 2 46 6 8 ... 21 2 34 3 47 8 9 4 22 2 35 1 48 2 10 3 23 3 36 2 49 7 11 3 24 3 37 2 50 10 12 2 25 4 38 1 51 7 13 ... 26 5 39 1 52 6 13 weeks 24 13 weeks 29 13 weeks 29 13 weeks 69 1912 76 Table XLIII. Showing the deaths from Measles in the Quarters, 1902-11 and 1912. Years. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter Whole Year. 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 1911 83 33 5 3 124 Corrected average number of deaths 41 46 20 33 140 1912. 24 29 29 69 151 Increase or Decrease – 17 – 17 + 9 + 36 + 11 77 [1912 SCARLET FEVER. The return of deaths from Scarlet Fever may almost be said to be phenominal, for in a population of nearly one-third of a million of people there were only 9 deaths. This is lower than any return which has been hitherto known; and it shows how insignificant a factor this once formidable disease is in the general mortality of the Borough. It is not possible to say exactly why it has become so mild in form as to cause so few deaths. One cannot help wondering if the germ has become weakened in the course of time by having passed during so many years through a soil which, having become exhausted, at last does not afford it sufficient nourishment to promote virulent growth. We know that plant life will not flourish in an exhausted soil, and, therefore, the questions suggested are "Is the soil in which the germ has for long years flourished at last become exhausted of the properties which promoted its growth." "Is the germ only waiting to be restored to strength by cultivation in some new soil such as that of a race which hitherto has not been attacked, thence to return to us with restored and youthful vigor." It is fervently hoped that this will not happen, because it would be a calamity to the nation if the disease once more assumed its former virulent form. Particulars with respect to the incidence of the disease in the sub-registration district are to be found in the Table which follows:— Table XLIV. Showing the Deaths and Death-rates from Scarlet Fever in the Sub-Districts for each Quarter and the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell .. .. .. .. .. .. 1 012 1 0.03 Upper Holloway .. .. .. .. .. .. .. .. .. .. Tollington .. •• .. .. .. .. .. .. .. .. Lower Holloway 1 0.10 1 0.10 2 0.20 .. .. 4 0.10 Highbury .. .. .. .. .. .. 1 0.06 1 0.01 Barnsbury .. .. .. .. .. .. 2 0.15 2 0.04 Islington, South East •• .. •• .. .. .. 1 0.05 1 0.02 The Borough 1 0.01 1 0.01 2 0.02 5 0.06 9 0.03 1912] 78 DIPHTHERIA. Thirty-eight deaths were registered, as contrasted with an average of 100 during the years 1885-1911, and with an average in the preceding 10 years of 45. These deaths were equal to an annual death-rate of 012 per 1,000 inhabitants. The largest number of deaths occurred in Highbury, where 14 were registered, while the death-rate there was almost double that of any other sub-district. The mortality from Diphtheria in the Borough is somewhat below that experienced in 1911, when the deaths registered numbered 53. Compared with past years there was a decided decrease in the number of deaths that occur annually, for if the history of the disease be studied, it will be found that the records now only run into tens, whereas from 1891 to 1900 they amounted to hundreds. Thus from 1891-1895 the average number of deaths registered was 168, 1896-1900, 136; 1901-1905, 69. This number further fell to 40 in 1906-1910. Its history so far as the records in Islington show is given in the following statement, which gives the number of deaths in each quinquennial period, as well as the average number for each year in those periods. Year. Total Deaths. Annual Deaths. Average 1861—1865 194 39 1866—1870 137 27 1871—1875 115 23 1876—1880 165 33 1881—1885 418 84 1886—1890 311 62 1891—1895 842 168 1896—1900 678 136 1901—1905 343 69 1906—1910 199 40 Table XLV, Showing the Deaths and Death-rates from Diphtheria in the Sub-Districts for each Quarter and the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Qnarter. 4th Quarter. Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Death- rates. Deaths. Deathrates. Tufnell .. .. 1 0.12 3 0.36 .. .. 4 0.12 Upper Holloway 3 0.32 1 0.10 .. .. .. •• 4 0.10 Tollington 1 0.13 .. .. 1 0.13 .. .. 2 0.07 Lower Holloway 1 0.10 1 0.10 2 0.20 1 0.10 5 0.13 Highbury 2 0.13 4 0.26 1 0.06 7 0.45 14 0.23 Barnsbury 1 0.07 1 0.07 2 0.15 2 0.15 6 0.11 Islington, South East 1 0.05 .. .. .. •• 2 0.11 3 0.04 The Borough 9 0.11 8 0.10 9 0.11 12 0.15 38 0.12 79 [1912 WHOOPING COUGH. The return of deaths from Whooping Cough was the best hitherto recorded in the Borough. The number was 54, which is a decrease of 94 on the average which obtained from 1885-1911. Only once before did the deaths from this disease approach this figure; namely in 1908 when they numbered 55. The general tendency of the disease is to decline, and as pointed out last year in a tabulated statement showing the mortality in quinquennial periods, the deaths fell from an average of 195 per annum in the five years, 1886-1890 to 92 in the five years, 1906-1910. This decrease is all the more satisfactory when it is recollected that scarcely any human being escapes the disease in the early days of his life. Why this reduction in the deaths has taken place it is impossible to say, but probably it is that the children live under better conditions and in well ventilated rooms and amidst cleaner surroundings, together with the absence of dust and overcrowding, which are some of the factors necessary for the prevention of this disease; therefore it may reasonably be assumed that it is owing to the exertions of sanitary authorities throughout the country that this state of affairs has been brought about. To this cause may be added also the better class of school with their large and well-ventilated rooms, which are now provided by the Education Authorities. Table XLVI. Showing the Deaths and Death-rates from Whooping Cough in the Sub-Districts for each Quarter and the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 3 0.36 .. .. .. .. .. .. 3 0.09 Upper Holloway 10 1.07 4 0.43 1 0.11 .. .. 15 0.40 Tollington 3 0.40 3 0.39 1 0.13 .. .. 7 0.23 Lower Holloway 5 0.51 1 0.10 1 0.10 .. .. 7 0.18 Highbury 1 0.06 2 0.13 .. .. .. .. 3 0.05 Barnsbury 3 0.23 3 0.23 3 0.23 2 0.15 11 0.21 Islington, South East .. .. 1 0.06 4 0.22 3 0.17 8 0.11 The Borough 25 0.31 14 0.17 10 0.12 5 0.06 54 0.16 1912] 80 ENTERIC FEVER. The eight deaths entered against this disease is the smallest number hitherto registered in any one year in the Borough, as may be seen in Table XXXIV. The average number of deaths in the several quinquennial periods since 1886 has been as follows:— 1886—1890 53 1901—1905 30 1891—1895 37 1906—1910 15 1896—1900 44 Thus we see that there has been an almost continuous decline in the deaths from Enteric Fever since the year 1885. There is hardly any factor in the general mortality of the Borough, the diminution of which is so pleasant to record as that of Enteric Fever, which has always been considered the worst of filth diseases. One cannot, however, close his eyes to the fact that whatever effect the improved sanitary state of the Borough may have had in the reduction of the disease, it must be admitted that the unusual meteorological conditions during the last four or five years have also had their influence. Nevertheless there can be no doubt that the great improvement which has occurred everywhere in the country in sanitation has played a large part in reducing the disease. It should be stated that the number of cases of Enteric Fever has also considerably fallen, for whereas in no year between 1891, when the notification of infectious diseases was commenced, and 1905 were fewer than 100 cases notified; indeed, in some years they were as high as 281, while during the last six years the highest number recorded did not reach 100, while it has been as low as 49. It would be well if the virulence of the disease had decreased at the same time, but unfortunately it did not, for it is practically as high to-day as it was in 1891-1900, when it averaged 16.9 per cent. of the cases, while last year and the year before it was 16.4 and 16.3 respectively. 81 [1912 Table XLVII. Showing the Deaths and Death-rates from Enteric Fever in the Sub-Districts for each Quarter and the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell .. .. .. .. .. .. 1 0.12 1 0.03 Upper Holloway .. .. .. .. .. .. .. .. •• •• Tollington .. .. .. .. .. .. .. .. .. •• Lower Holloway .. .. .. .. .. .. .. .. •• •• Highbury .. .. .. .. 1 0.06 1 0.06 2 0.03 Barnsbury .. .. .. .. 1 0.07 1 0.08 2 0.04 Islington, South East .. .. 1 0.06 •• .. 2 0.11 3 0.04 The Borough .. .. 1 0.01 2 0.02 5 0.06 8 0.02 TYPHUS FEVER. Nil return. CONTINUED AND ILL-DEFINED FEVERS. Nil return. DIARRHCEAL DISEASES. These include Diarrhoea, Dysentery, Choleriac Diarrhœa, Zymotic Enteritis, Epidemic Enteritis, Infective Enteritis, Enteric Catarrh, Gastro-intestinal Catarrh and Gastro-enteric Catarrh. Diarrhoea and Epidemic Enteritis have, however, been classified separately, and between them caused only 36 deaths, which is far and away the best return the Borough has ever known. In 1911 these deaths numbered 324, and in the preceding year 76. An examination of the figures onwards from 1885 shows that the average number of deaths in each of the quinquennial periods were as follows:— 1886—1890 230 1901—1905 169 1891—1895 173 1906—1910 113 1896—1900 200 g 1912] 82 Thus we see that it has been with these diseases as with Enteric Fever which is what one might reasonably expect, because similar factors are at work in its causation. The improvement in the sanitation can hardly, however, account for the very great decrease in the number of deaths last year; and we must look to the meteorological conditions which prevailed as one of the greatest of them. These have already been gone into when dealing with Infantile Mortality. It is an extraordinary fact that only 21 deaths were registered in the third quarter, whereas as a rule they very seldom fall below 100, although from 1907 to 1910 they varied from 72 to 28. The appended Tables give full particulars as to these diseases in the several districts of the Borough. Table XLV1II. Showing the Deaths and Death-rates from Diarrhcea in the Sub-Districts for each Quarter and the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Deaths. Deathrates. Tufnell 1 0.12 •• •• 1 0.12 .. .. 2 0.05 Upper Holloway •• •• 1 0.10 1 •• 1 0.10 3 0.08 Tollington 2 0.27 •• •• •• •• •• • • 2 0.07 Lower Holloway •• •• 2 0.21 •• •• 1 0.10 3 0.08 Highbury •• •• •• •• 5 0.32 1 0.06 6 0.10 Barnsbury 1 0.07 •• •• 8 0.60 1 0.08 10 0.19 Islington, South East 1 0.05 2 0.11 6 0.34 1 0.05 10 0.14 The Borough 5 0.06 5 0.06 21 0.26 5 0.06 36 0.11 83 [1912 Table XLIX. 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. Ages. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Diarrhoea. Enteritis, etc. Totals. Under 1 year 5 10 15 3 13 l6 13 19 32 2 15 17 23 57 80 1 to 5 years ... 3 3 ... 1 1 3 1 4 1 8 9 4 13 17 Over 5 years ... 7 7 2 7 9 5 5 10 2 9 11 9 28 37 Totals 5 20 25 5 21 26 21 25 46 5 32 37 36 98 134 Note.—In this Table the deaths under Enteritis include only those which are not epidemic or zymotic. 1912] 84 TABLE L. Showing the Diarrhceal Deaths including those from Epidemic Enteritis in the Third Quarter, 1912. 1912. Deaths. Meteorology. Temperature 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 6th .. .. .. .. .. .. 1 1 58.7 -3.2 59.73 0.36 4 ,, 13th. .. .. .. .. 1 1 .. 2 67.0 + 4.4 60.75 0.20 5 ,, 20th .. .. .. .. 1 .. 2 3 65.8 +2.5 63.65 0.04 2 ,, 27 th .. .. .. .. .. .. .. .. 64.8 + 1.9 63.22 0.16 4 .. .. .. .. 2 1 3 6 64.1 +1.4 61.84 0.76 15 August 3rd 1 .. .. .. .. .. .. 1 57.8 -4.4 63.09 0.54 5 „ 10 th .. .. .. .. .. 1 1 2 57.6 -4.6 61.57 1.26 6 ,, 17th .. .. .. .. 1 1 .. 2 56.2 -6.2 60.48 0.23 6 „ 24 th .. .. .. .. .. 2 .. 2 57.2 -4.1 60.22 1.27 7 1 .. .. .. 1 4 1 7 57.2 -4.8 61.34 3.30 24 August 31st .. .. .. .. .. 1 .. 1 56.9 -3.4 59.74 1.33 3 Sept. 7th .. .. .. .. .. .. .. .. 54.8 -4.7 59.08 0.21 4 ,, 14th .. .. .. .. 2 .. 1 3 52.4 -5.8 58.01 0.02 3 ,, 21st .. .. .. .. .. 1 .. 1 53.6 -3.2 57.38 0.00 1 ,, 28th .. 1 .. .. .. 1 1 3 51.5 -3.8 56.20 0.02 1 .. 1 .. .. 2 3 2 8 53.8 -4. 2 58 .10 1.58 12 3rd Quarter 1 1 .. .. 5 8 6 21 58.4 -2.5 56.43 5.64 51 85 [1912 Table LI. Showing the Deaths occurring in Islington and in the several Encircling Boroughs from All Causes. from the principal Epidemic Diseases, and from Pulmonary Tuberculosis in the year 1912. THE ENCIRCLING BOROUGHS. Estimated Populations, 1912. Total Deaths from all Causes. Deaths from principal Epidemic Diseases. Pulmonary Tuberculosis. Deaths of infants under 1 year of age. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis (under 2 yr's) 1 2 3 4 5 6 7 8 9 10 11 12 St. Pancras 216,145 3,148 3 ... 95 5 44 25 37 341 472 Stoke Newington 50,581 611 ... ... 5 ... 3 ... 3 44 74 Hackney 222,986 2,691 3 ... 19 8 33 12 60 303 421 Hornsey 86,252 816 2 ... 5 3 2 1 14 26 105 Finsbury 86,130 1,612 1 ... 129 5 29 13 44 165 294 Shoreditch 110,430 1,997 4 ... 116 5 47 19 94 231 439 The above Boroughs 772,524 10,875 13 ... 369 26 158 70 252 1,110 1,805 Islington 326,398 4,682 8 ... 151 9 54 38 84 427 710 1912] 86 LII. Showing the Death Rates of Islington and of the several Encircling Boroughs from All Causes, from the principal Epidemic Diseases, and from Pulmonary Tuberculosis in the year 1912. THE ENCIRCLING BOROUGHS Estimated Populations, 1913. Total Deathrates from All Causes. Death-rates per 1,000 persons living. Rate per 1,000 Births. Enteric Fever. Small Pox Measles. Scarlet Fever. Whooping Cough. Diphtheria Pulmonary Tuberculosis. Diarrhoea and Enteritis under 2yrp.) Deaths under 1 year. 1 2 3 4 5 6 7 8 9 10 11 12 St. Pancras 216,145 14.6 0.01 ... 0.44 0.02 0.20 0.12 1.58 6.89 88 Stoke Newington 50,581 12.1 ... ... 0.10 ... 0.06 ... 0.87 2.90 72 Hackney 222,986 12.1 0.01 ... 0.09 0.04 0.15 0.05 1.36 11.39 80 Hornsey 86,252 9.3 0.02 ... 0.06 0.03 0.02 0.01 0.30 10.23 77 Finsbury 86,130 18.8 0.01 ... 1.50 0.06 0.34 0.15 1.92 17.09 114 Shoreditch 110,430 18.1 0.04 ... 1.05 0.05 0.43 0.17 2.10 26.39 123 The above Boroughs 772,524 14.1 0.01 ... 0.48 0.03 0.20 0.09 1.44 1.14 94 Islington 326,398 14.34 0.02 ... 0.46 0.03 0.16 0.12 13.1 10.96 86 87 [1912 Table LIII. 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. Per 1,000 Persons Living. Rate per 1,000 Births. All Causes. Enteric Fever. Small-Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Diarrhoea and Enteritis (under 2 years). Deaths under 1 Year. Cols. 1. 2. 3. 4. 5 6. 7. 8. 9. England and Wales 13.3 0.04 .. 0.35 0.05 0.23 0.11 8.53 95 95 Great Towns 13.8 0.04 .. 0.47 0.06 0.26 0.13 10.88 101 146 Smaller Towns 12.4 0.05 .. 0.35 0.05 0.24 0.11 80.3 98 England and Wales less the 241 Towns 12 .9 0.04 .. 0.20 0.04 0.17 0.10 5.54 86 London 13.6 0.03 .. 0.40 0.04 0.22 0.10 12.42 91 Bristol 13.3 0.01 0.00 0.43 0.02 0.19 0.13 7.30 103 Birmingham 14.1 0.03 .. 0.66 0.18 0.39 0.11 10.36 112 Liverpool 18.1 0.03 .. 1.15 0.11 0.35 0.14 20.42 125 Manchester 16.0 0.06 0.00 0.67 0.07 0.41 0.13 14.18 121 Leeds 14.2 0.04 .. 0.36 0.09 0.12 0.20 9.74 101 Sheffield 14.2 0.08 .. 0.39 0.07 0.41 0.10 10.72 106 St. Pancras 14.6 0.01 .. 0.44 0.02 0.20 0.12 6.89 88 Stoke Newington 12.1 .. .. 0.10 •• 0.06 .. 2.90 72 Hackney 12.1 0.01 .. 0.09 0.04 0.15 0.05 11.39 80 Hornsey 9.3 0.02 .. 0.06 0.03 0.02 0.01 10.23 77 Finsbury 18.8 0.01 .. 1.50 0.06 0.34 0.15 17.09 114 Shoreditch 18.1 0.04 .. 1.05 0.05 0.43 0.17 26.39 123 Encircling Boroughs 14.1 0.01 .. 0.48 0.03 0.20 0.09 13.14 94 Islington 14.34 0.02 .. 0.46 0.03 •16 0.12 10.96 86 1912] 88 INFLUENZA. It is well to be able to report that only 28 deaths were known in the Borough from this disease, as contrasted with an average of 70 which obtained in the 14 years, 1898-1911. The deaths are also less than those registered in any one of these years, as may be seen in the following statement:— Ages. 1898. 1899. 1900. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Average, 18981911. 1912. Departure from average 0-5 8 6 3 4 4 3 4 4 4 5 3 1 2 3 4 1 - 3 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 1 3 2 - 1 25-35 4 12 7 2 7 3 2 3 5 10 3 4 2 4 5 1 - 4 35-45 5 17 16 5 13 5 7 5 4 19 8 8 3 2 8 5 - 3 45-55 9 15 18 5 14 9 7 7 10 5 14 10 5 6 10 1 - 9 55-65 15 28 28 12 6 8 6 9 13 6 16 9 5 3 12 4 - 8 65-75 11 24 36 12 17 6 11 12 16 12 14 20 5 10 15 7 - 8 75-85 6 14 25 5 15 3 7 12 8 12 14 11 8 7 10 5 - 5 85 and up wards 1 4 4 — 4 — 1 1 2 1 4 4 4 1 2 2 - — 65 126 149 46 83 40 48 54 67 75 81 70 36 37 70 28 42 The general tendency of the mortality is undoubtedly to decrease, as may be seen from the fact that since 1898 there has been a steady diminution in the returns. The record of cases since 1856 are given below in quinquennial periods: 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 55.2 1905-10 329 65.8 89 [1912 Table LIV. Showing the Deaths from Influenza in the Quarters of the Year 1912, together with the corrected averages of the corresponding periods 1902-1911. Years. Quarters. Totals. First. Second. Third. Fourth. 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 1911 18 9 1 9 37 Corrected Averages 29 13 3 13 581 1912 14 4 2 8 28 Increase or Decrease -15 -9 -1 -6 -30 Table LV Showing the Secondary Causes of Death from Influenza in the Four Quarters of the Year 1912. Tufnell. Upper Holloway. Tollington Lower Holloway. Highbury. Barnsbury. Islington, South-East. Totals for Year. Quarters. Quarters. Quarters. Quarters. Quarters. Quarters. Quarters. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th 1st 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4th. 1st. 2nd. 3rd. 4 th. Pneumonia .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 1 .. 1 .. .. 1 2 .. .. 3 11 Bronchitis .. 1 .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. 5 Heart Disease, etc. .. .. .. .. 1 .. .. 1 2 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. 7 Phthisis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 Purpura .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 Apoplexy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Paralysis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 All Secondary Causes .. 1 •• .. 2 .. .. 1 2 1 .. 1 .. .. .. 1 2 1 2 1 1 •• •• 1 6 1 .. 8 27 No Secondary Causes .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Totals .. 1 .. •• 2 .. .. 1 3 1 .. 1 .. .. .. 1 2 1 2 1 1 .. .. 1 6 1 .. 3 28 1912] 90 91 [1912 APPENDICITIS. This disease, of which we read so much in the papers and hear so much in our private life, shows a considerably decreased mortality, for whereas the average number of deaths recorded from 1902 to 1911 had been 24, there were only 13 in 1912. This is the best return in the ten years mentioned. As no figures are available as to the actual number of cases that have occurred, it is impossible to state whether or not they, as well as the mortality, have decreased. The improvement in modern surgery has enabled surgeons to effect a very great saving of life by the removal of the appendix by an operation, and such operations seem to be almost invariably successful. It would be interesting to learn, if the date were available, how much of th's saving of life has been due to the greater successes of operations. This is, however, impossible, and the question must be left undecided. The ages at which people died from the disease is shown in the following statement:— Ages. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Average [902-11. 1912. 0-5 — 1 — 1 — 1 2 2 3 — 1 1 5-10 2 4 2 4 3 — 7 7 2 3 3 1 10-15 7 3 5 1 2 7 1 2 3 2 3 — 15-20 1 4 3 6 3 3 3 3 4 4 3 — 20-25 1 7 2 3 1 2 3 1 5 2 3 4 25-35 3 5 8 3 2 2 2 1 1 4 3 1 35-45 2 3 2 4 5 — 4 4 2 3 3 1 45-55 3 2 1 4 1 1 2 1 5 — 2 4 55-65 — 1 3 2 2 3 1 2 — 3 2 1 65-75 1 2 1 1 1 — — 2 2 1 1 — 75-85 — — — — — — — — — — — — 85 and upwards — — — — — — — — — — — — 20 32 27 29 20 19 25 25 27 24 24 13 92 1912] The following statement shows the percentage of the deaths which occurred last year in the several age periods. 7'7 per cent. of the deaths during 1912 occurred at the age period 0-5 7.7,, ,, ,, ,, 5-10 - ,, ,, ,, ,, 10-15 - ,, ,, ,, ,, 15-20 30.7 ,, ,, ,, ,, 20-25 7.7 ,, ,, ,, ,, 25-35 7.7,, ,, ,, ,, 35-45 30.8 ,, ,, ,, ,, 45-55 7.7 ,, ,, ,, ,, 55-65 - ,, ,, ,, ,, 65-75 - ,, ,, ,, ,, 75-85 100 ,, ,, ,, ,, All ages SEPTIC DISEASES. These are Erysipelas, Pyaemia, Septicaemia, and so-called Puerperal Fever. Taken together, they caused 43 deaths during the year, as against 52 in 1911, 43 in 1910, and 40 in 1909. Erysipelas.—This disease, like many of those already discussed, also exhibited the lowest mortality hitherto recorded in the Borough, for the five deaths which are entered against it, are 8 below the average of 13, which obtained from 1897 to 1911. The particulars respecting its behaviour are shown in the following statement:— Table LVI. Deaths from Erysipelas in the Sub-Districts during the Year 1912. Deaths. Death Rates. Tufnell ... per 1,000 inhabitants. Upper Holloway ... ... ,, ,, Tollington 1 0.03 ,, ,, Lower Holloway ... ... ,, ,, Highbury 1 0.01 ,, ,, Barnsbury 1 0.02 ,, ,,,, ,, Islington, South-East 2 0.03 The Borough 5 0.01 ,, ,, 93 [1912 Puerperal Septic Diseases.—Under this heading are included Puerperal Pyaemia, Septicaemia, Septic Intoxication, and Puerperal Fever (socalled). This formidable array of ailments only caused two deaths between them, which is seven below the corrected average. They were in proportion of 0.24 to every 1,000 births, as contrasted with 1.06 in the preceding 10 years. It is exceedingly satisfactory to find that these diseases of child-birth show a diminution, and it is sincerely to be hoped that the improvement will continue, because deaths from them are certainly the saddest of all deaths; for surely there can be nothing more pitiable than a newly-born infant child deprived of the care and nurture of its mother. The returns for the last eleven years are given below:— Years. Deaths. Deaths per 1,000 births 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 1911 7 0.87 Corrected average 9 1.06 1912 2 0.24 LVII. Showing the Deaths from Puerperal Fever per 1,000 Births in the Sub Districts for each Quarter and the Year 1912. Sub-districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Deaths. Deaths per 1,000 Births. Deaths. Deaths per 1,000 Births. Deaths. Deaths per 1,000 Births Deaths Deaths per 1,000 Births. Deaths. Deaths per 1,000 Births. Tufnell .. .. .. .. .. .. 1 5 46 1 1.33 Upper Holloway .. .. .. •• .. .. .. .. .. .. Tollington .. •• •• •• .. •• .. •• .. .. Lower Holloway .. •• .. .. .. •• .. .. .. .. Highbury .. .. .. .. .. .. .. .. .. .. Barnsbury .. .. .. .. .. .. .. .. .. .. Islington, South East 1 2.06 .. •• .. •• .. .. 1 0.53 The Borough 1 0.46 .. .. •• .. 1 0.52 2 0.24 1912] 94 CONSTITUTIONAL DISEASES. These include Cancer, Rheumatic Fever, Rheumatism, Rickets, Diabetes, Gout, Anaemia, Gangrene, Purpura and Tuberculosis, which are some of the most important diseases that afflict mankind. Although the number of deaths registered is 38 lower than the average of the 22 years, 1891-1911, yet they are more numerous than in 1910 or 1911, when they numbered respectively 989 and 943. The 1,023 deaths now registered were equal to an annual death-rate of 313 per 1,000 inhabitants; as contrasted with a mean rate of 318 in the 22 years above mentioned. The following statement gives the particulars for each of the 22 years, in which it will be seen that the death-rate varied very little from year to year. Only in 1911 did it fall below 3 0 per 1,000 of the population; the highest recorded rate being 3.36, and (with the exception of 1911) the lowest 302. Deaths Death rates. Deaths. Death-rates. 1891 1,064 3.32 1901 1,080 3.22 1892 1,037 3.21 1902 1,101 3.23 1893 1,093 3.18 1903 1,070 3.21 1894 997 3.02 1904 1,116 3.36 1895 1,114 3.33 1905 1,007 3.03 1896 1,122 3.26 1906 1,042 3.15 1897 1,084 3.21 1907 1,041 3.15 1898 1,067 3.17 1908 1,048 3.12 1899 1,115 3.32 1909 1,032 3.14 1900 1,119 3.33 1910 989 3.01 1911 943 2.88 Average 1,061 3.18 1912 1,023 3.13 CANCER. It is most regrettable to have to report that there were 382 deaths from this disease during the year, of which 160 were those of males and 222 of females, while the death-rate was 117 per 1,000 of the population. This is the highest record the Borough has ever known, as shown in the following statement, which gives the mortality among males and females in each year since 1891. 95 [1912 Year. Males Females. Persons. Death-rate. 1891 74 144 218 0.68 1892 70 149 219 0.68 1893 82 156 238 0.73 1894 78 161 239 0.72 1895 96 170 266 0.79 1891-95 400 780 1180 0.72 1896 104 187 291 0.85 1897 112 192 304 0.90 1898 106 177 283 0.84 1899 104 166 270 0.80 1900 115 188 303 0.90 1896-00 541 910 1451 0.86 1901 103 186 289 0.86 1902 133 193 326 0.95 1903 155 195 350 1.05 1904 147 176 323 0.97 1905 138 190 328 0.99 1901-05 676 940 1616 0.96 1906 154 209 363 1.10 1907 177 171 348 1.05 1908 157 210 367 1.09 1909 146 207 353 1.07 1910 158 203 361 1.10 1906-10 792 1000 1792 1.08 1911 143 186 329 1.00 1912 160 222 382 1.17 Here it may be seen that since 1891 the deaths from Cancer have risen from 218, equal to a death-rate of 0.68 per 1,000, in 1891 to 382, equal to a death-rate of 1T7 per 1,000, in 1912. The mortality rate has therefore risen 72 per cent. In the quinquennial period 1891-1895. the average number of deaths in each year was 236, and the death-rate 0'72. In In the following quinquennium, 1896-1900, it was 290, and the death-rate was 0.86 ; in the next period, 1901-1905, it was 323, equal to a death-rate of 0.96, while in the succeeding five years, 1906-1910, it reached 358 per annum, representing a deaths rate of 1.08. 1912] 96 From these figures we see that there was a steady upward tendency through these years, which was noticeable, not only among males, but also among females; for whereas in 1891 the deaths of males numbered only 74, in 1912 they were 160. In a similar manner the deaths of females, which were 144 in 1891, were as many as 222 in 1912. These figures represent an increased mortality of 116 per cent. among males, and 54 per cent. among females. Ages at Death.—In the statement which follows, it will be seen that while there were comparatively few deaths from the disease up to the age of 25 years, yet after that period they increased rapidly, so that among persons 25-35 years old, there were 7 deaths. During the next ten years, 35-45, there were 25; in the next decade there was an enormous increase, as the number rose nearly threefold, being 71, while in the following ten years of life, 55-65, they were almost double those of the preceding period of life, being 130; then they gradually decreased to 86, 51 and 5 in the several decennial periods between 65 to 95 years of age. It is difficult to explain the largely increased number of deaths between 55 and 65, for while the average for the ten years had been 98, they increased to 130 in 1912. Of these 130 deaths 60 were those of males and 70 of females, as contrasted with 46 and 46 respectively in the preceding year. This shows that there was an increased mortality at this period of life, both among males and females, and, indeed, the death-rate among each sex was nearly equal, being 5.9 per 1,000 among males, and 5.8 per 1,000 among females, living at this time of life. The particulars of the death-rate at the several age periods among males and females are set out in Table LIX. Ages. 1902. 1903. 1904. 1905. 1906. 1907. 1908 1909. 1910. 1911. Average. 1902-1911. 1912 0-5 3 4 1 2 1 1 1 — 2 1 2 1 5-15 3 3 2 1 3 3 2 3 1 3 2 2 15-25 5 7 5 3 3 3 8 3 5 4 5 4 25-35 8 5 10 11 7 6 6 10 6 5 7 7 35-45 29 43 43 22 35 39 41 27 40 32 35 25 45-55 75 75 61 74 90 64 63 79 72 67 72 71 55-65 103 95 84 95 110 95 112 96 100 92 98 130 65-75 70 83 90 92 74 102 93 94 85 87 87 86 75-85 27 34 22 25 38 27 39 34 47 31 32 51 85 &upwards 3 1 5 3 2 8 2 7 3 7 4 5 326 350 323 328 363 348 367 353 361 329 344 382 97 [1912 Table LVIII. Showing the Deaths from Cancer or Malignant Disease in the several Sub-Districts during the Quarters and the Year 1912. Quarters. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South-East The Borough. 1st 10 9 7 9 17 12 21 85 2nd 3 13 7 12 19 15 27 96 3rd 5 10 7 10 29 12 20 93 4th 11 8 11 18 11 18 31 108 The Year 29 40 32 49 76 57 99 382 Death-rate per 1,000 of the population 0.86 1.08 1.06 1.25 1.23 1.08 1.39 1.17 Table LIX. 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 2 0.27 5 0.65 7 0.46 25-35 2 0.73 5 1-64 7 1.21 35-45 9 4.22 16 6.73 25 5.55 45-55 28 17.97 43 24.30 71 21.34 55-65 60 59.22 70 38.18 130 58.65 65-75 39 72.15 47 62.93 86 66.81 75 & upwards 20 129.52 36 115.91 56 120.43 All Ages 160 10.29 222 12.98 382 11.70 h 1912] 98 Of the several diseases which caused deaths from Cancer there are some which stand out prominently. These are cancer of the stomach, of the rectum, of the breast, of the uterus, of the liver, of the intestines, and of the tongue. Cancer of the Stomach was responsible for 49 deaths, of which 25 occurred among males and 24 among females. Thirty-nine of these deaths were among persons who had passed their 55th year. Cancer of the Rectum was responsible for the deaths of 36 persons, 21 males and 15 females, and in this group all except two occurred in persons over 45 years of age. Cancer of the Breast, which caused 42 deaths, is of course a disease which is entirely confined to females. All these deaths occurred after the 35th years of life, 8 of the deceased being aged 35-45, 10 between 45-55, 11 between 55-65, 8 between 65-75, and five over 75 years. Cancer of the Uterus was responsible for 39 deaths, all of which occurred among women who were over 35 years of age, the numbers at the seven age periods being as follows:- 35-45, 5; 45-55, 9; 55-65, 16; 65-75, 6; and above 75, 3. Cancer of the Liver caused 29 deaths, of which 7 were those of males and 22 of females, which is a remarkable difference in the mortality. Cancer of the Intestines caused 18 deaths, 13 males and 5 females. Cancer of the Tongue caused 17 deaths, all of which were men. 99 [1912 Table LX. Mortality from Cancer or Malignant Disease during the. Year 1912. ORGANS AFFECTED. Sex. Age at Death. Males. Females. Totals. 0—5 —15 —25 —86 —45 —55 —65 —75 —75 upwards. Diseases of Nervous System Brain M. .. .. .. .. .. .. .. .. .. .. .. .. F. .. .. .. .. .. .. .. .. .. .. .. .. Organs of Special Sense— Eye M. .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. .. 1 .. .. .. 1 Nose M. .. .. .. .. .. .. .. 1 .. .. .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Diseases of Heart, etc — M .. .. .. .. .. .. .. .. .. .. .. 3 Endocarditis F. .. 1 2 .. .. .. .. .. .. .. 3 Respiratory System- Larynx M. .. .. .. .. .. .. 3 3 .. 6 .. 7 F .. .. .. .. .. .. 1 .. .. .. 1 Lung M. .. .. 1 .. 2 .. 1 .. .. 4 .. 10 F. .. .. .. 1 .. 1 1 3 .. .. 6 Throat M .. .. .. .. 1 .. 1 .. .. 2 .. 2 F. .. .. .. .. .. .. .. .. .. .. .. Bronchus M. .. 1 1 1 F. .. .. .. .. .. .. .. .. .. .. .. Digestive System— Rectum M. .. .. .. .. 1 6 7 6 1 21 .. 36 F. .. .. .. .. 1 2 7 1 4 .. 15 Pylorus M .. .. .. .. .. 3 3 1 1 8 .. 13 F. .. .. .. .. .. 1 1 2 1 .. 5 Pancreas M. .. .. .. .. .. .. 2 .. .. 2 .. 8 F. .. .. .. .. .. 1 4 1 .. .. 6 Liver M. .. .. .. .. .. .. 5 2 .. 7 .. 29 F. .. .. .. .. .. 7 7 5 3 .. 22 (Esophagus M. .. .. .. .. 1 1 2 1 .. 5 .. 7 F. .. .. .. .. .. .. .. .. 2 .. 2 Stomach M. .. .. .. .. 1 4 10 6 4 25 .. 49 F. .. .. .. .. .. 5 6 7 6 .. 24 Peritoneum M. .. .. .. .. .. 1 .. .. .. 1 .. 3 F. .. .. .. 1 .. .. .. .. 1 .. 2 Gall Bladder M. .. .. .. .. .. .. .. .. .. .. .. 3 F. .. .. .. .. .. .. 1 1 1 .. 3 Abdomen M. .. .. .. .. .. .. .. .. 1 1 .. 4 F. .. .. .. .. .. 1 1 1 .. .. 3 Colon M .. 1 .. .. .. .. 2 3 3 9 .. 15 F. .. .. .. .. .. .. 1 3 2 .. 6 Jaw M. .. .. .. .. .. 1 1 2 .. 4 .. 4 F. .. .. .. .. .. .. .. .. .. .. .. Intestines (parts not specified) M. .. .. .. .. .. 3 4 5 1 13 .. 18 F. .. .. .. .. 1 .. .. 3 1 .. 5 Omentum M. .. .. .. .. .. .. .. .. .. .. .. 1 F .. .. .. .. .. .. 1 .. .. .. 1 Tongue M. .. .. .. .. 1 4 9 3 .. 17 .. 17 F. .. .. .. .. .. .. .. .. .. .. .. Caecum M. .. .. .. .. .. .. .. .. .. .. .. 2 F. .. .. .. .. .. .. 2 .. .. .. 2 Duodenum M. .. .. .. .. .. 1 .. .. 1 2 .. 2 F .. .. .. .. .. .. .. .. .. .. .. Ventriculi M. .. .. .. .. .. .. 1 .. .. 1 .. 2 F .. .. .. .. .. .. 1 .. .. .. 1 Lips M. .. .. .. .. .. .. .. 2 1 3 .. 3 F. .. .. .. .. .. .. .. .. .. .. .. 1912] 100 Table LX.—continued. ORGANS AFFECTED. Age at Death. Males. Females. Totals. Sex. —6 —15 —25 35 —45 —55 —65 —75 —75 upwards. Digestive System—continued. Pharynx M. .. .. .. .. .. .. 2 .. 1 3 .. 4 F. .. .. .. .. .. .. 1 .. .. .. 1 Mouth M. .. .. .. .. .. 1 .. .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Lymphatic System— Prostate Gland M. .. .. .. .. .. .. .. .. 1 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Thyroid Gland M. .. .. .. .. .. .. .. .. .. .. .. 3 F. .. .. .. .. .. .. 1 1 .. .. .. Mediastinum M .. .. .. .. .. 1 .. .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Mesenteric Gland M .. .. .. .. .. .. 1 .. .. 1 .. 2 F. .. .. .. .. .. .. .. 1 .. .. .. Cervical Gland M. .. .. .. .. .. .. .. 1 .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Urinary System— Kidney M. .. .. .. .. .. .. .. .. .. .. .. 3 F. .. .. .. .. .. 2 .. 1 .. .. .. Bladder M. .. .. .. .. .. .. 1 2 2 5 .. 10 F. .. .. .. .. .. 1 3 .. 1 .. .. Prostate M .. .. .. .. .. .. 2 1 1 4 .. 4 F. .. .. .. .. .. .. .. .. .. .. .. Generative System— Breast F. .. .. .. .. 8 10 11 8 5 .. 42 42 Uterus F .. .. .. .. 5 .. 16 6 8 .. 39 39 Ovary F. .. .. 1 1 1 .. .. .. 1 .. 4 4 Pelvis F. .. .. .. 1 .. .. .. .. .. .. 1 1 Vulva F. .. .. .. 1 .. .. .. 1 .. .. 9. 2 Fallopian Tube F .. .. .. .. .. .. .. .. 1 .. 1 1 Vagina F. .. .. .. .. .. .. 1 .. .. .. 1 1 Organs of Locomotion— Neck M. .. .. .. .. 1 .. .. .. 1 2 .. 4 F. .. .. .. .. .. 1 1 .. .. .. 2 Arm M. .. .. .. .. .. .. .. .. 1 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Leg M .. .. .. .. .. .. 1 .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Bones and Joints— Spine M. .. .. .. 1 .. .. .. .. .. 1 .. 1 F .. .. .. .. .. .. .. .. .. .. .. Femur M. .. .. .. 1 .. 1 .. .. .. 2 .. 2 F. .. .. .. .. .. .. .. .. .. .. .. Ethmoid M. .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. .. .. .. 1 .. 1 Humerus M. .. .. .. .. .. .. .. .. .. .. .. 1 F. .. .. .. .. .. 1 .. .. .. .. 1 Iliac Bone M .. .. .. .. .. .. 1 .. .. 1 .. 1 F. .. .. .. .. .. .. .. .. .. .. .. Unspecified M. .. .. .. .. .. 1 1 .. .. 2 .. 9 F. 1 .. .. .. .. 1 1 2 2 .. 7 Total Males and Females for Year M. .. 1 1 2 9 28 60 39 20 .. .. 160 F. 1 1 3 5 16 43 70 47 36 .. .. 222 Total Deaths 1 2 4 7 25 71 130 86 56 .. .. 382 CHART. Showing Deaths from ALL Forms of TUBERCULOSIS per lOO Deaths from ALL DISEASES at each age. 1901-1910, and 1912. 101 [1912 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, taken together, form the great group known as Tuberculosis, and during the year caused 553 deaths, which were equal to a deathrate of 1.69 per 1,000 of the population. They compare with an average of 598 deaths per annum during the 10 years 1902-1911, and a mean death-rate of 1.81 per 1,000. The deaths and death-rates from the combined tuberculous diseases are shown in the following statement:— Deaths. Death-rates. Deaths. Death-rales. 1902 672 2.01 1907 608 1.84 1903 632 1.90 1908 604 1.38 1904 682 2.05 1909 582 1.77 1905 580 1.75 1910 539 1.64 1906 578 1.74 1911 512 1.56 Average 598 1.81 1912 553 1.69 Decrease 45 0.12 The general tendency of tuberculosis is to decrease, although in 1912 it increased to 553, from 512 in 1911. This in itself is not a very serious increase, but unfortunately the majority of these deaths (427 in number) occurred from pulmonary tuberculosis, and at an age when life is very valuable. During the last few years it has been the duty of the Medical Officer of Health to dilate at very great length on the subject of this disease, and therefore, it is not proposed now to discuss it at length, particularly as within the last three months he presented a long report to the Council respecting the need of a Tuberculosis Dispensary, while he also presented a series of five reports, dealing with its various causes and aspects, to the Public Health Committee in the early months of the year. Pulmonary Phthisis—427 deaths were registered, as contrasted with 379 in 1911, 390 in 1910, and 424 in 1909. The death-rate for the year was 1.31 per 1,000, as contrasted with a mean rate during 22 years of 1.48 The deaths represented 9.12 per cent. of those from all causes. The particulars 1912] 102 for each year since 1891 are again given, and it will be noticed that as contrasted with the three preceding years, there was an increase of 48 deaths in 1912, as compared with 1911. It is to be hoped that this excess is only temporary, and that the reduction in the number of registered deaths, which has been fairly continuous since 1891, will continue in future years. Years, Pulmonary Phthisis. Proportion of Deaths from Phthisis per 100 Deaths from All Causes. Death rates from All Causee per 1,000 inhabitants. Deaths. Death rates 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 1.62 10.16 15.9 1902 515 1.51 9.14 16.5 1903 492 1.48 10.16 14.5 1904 533 1.60 10.18 15.7 1905 438 1.32 8.84 14.9 1906 411 1.24 8.14 15.3 1907 436 1.32 8.58 15.4 1908 432 1.29 9.23 13.9 1909 424 1.29 8.62 14.9 1910 390 1.19 8.62 13.8 1911 379 1.16 7.88 14.9 Corrected average 491 1.48 9.19 16.4 1912 427 1.31 9.12 14.3 The following return shows the deaths at each age period:— Age periods. Deaths. Age periods. Deaths. 0- 5 6 55-65 52 5-15 10 65-75 12 15-25 57 75-85 3 25-35 102 Total 427 35-45 106 45-55 79 103 [1912 Table LXI. Showing the Deaths from Phthisis in the Sub Districts during the Four Quarters of the Year 1912 Quarters Tufnell. Upper Holloway. Tollingtcn. Lower Holloway. Highbury Barnsbury. Islington, South-East. The Borough 1st 9 16 11 19 20 16 30 121 2nd 9 9 8 15 21 24 16 102 3rd 11 4 6 14 15 17 21 88 4th 7 16 8 19 11 21 34 116 The Year .. 36 45 33 67 67 78 101 427 Abdominal Tuberculosis.—20 deaths were attributed to this disease, which principally affects child life, and they represent a death-rate of 0 06 per 1,000 of the population. Of the deaths 11 were those of males and 9 of females, while 10 were under five years of age, and 10 over that time of life Tubercular Meningitis.— This disease of the meninges of the brain caused 67 deaths, 37 of males and 30 of females, which were equal to a deathrate of 1.20 per 1,000 of the population. The deaths among children, of whom 49 were under five years old, caused a death-rate of 1.46 of those living at that period of life. Tuberculosis of the Larynx.— There were 2 deaths from it, both of which occurred among males. These deaths represented a death-rate of 0 01 per 1,000 inhabitants. General Tuberculosis.—Twenty-three deaths were attributed to this cause, 15 being those of males and 8 of females; and the death-rate was 0 07 per 1,000 of the population. Five of the deceased were under one year of age, 7 between 1 and 5, and only 11 at all other ages. Other forms of Tuberculosis.— Altogether there were only 16 deaths, 9 males and 7 females. With the exception of 1, all were over five years old. The death-rate was 0 05 per 1,000 inhabitants. Table LXII. Showing the Deaths from the Tuberculous Diseases during 1912. 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 — 6 419 253 172 36 45 33 66 66 78 101 425 0.18 0.17 1.30 Tuberculosis of the Larynx — — 2 2 — — — — 1 1 2 — — 0.01 Tubercular Meningitis 15 34 18 37 30 9 8 7 5 9 14 15 67 1.46 0.22 0.20 Abdominal Tuberculosis 8 2 10 11 9 1 4 2 4 1 5 3 20 0.30 0.07 0.06 General Tuberculosis 5 7 11 15 8 4 1 3 2 5 7 23 0.36 0.08 0.07 Other Forms of Tuberculosis — 1 15 9 7 3 — 2 3 3 2 3 16 0.02 0.07 0.05 All Tubercular Diseases 28 50 475 327 226 50 61 45 82 82 104 129 553 2.32 0.61 1.69 1912] 104 105 [1912 Table LXIII. Mortality from Tuberculosis of the Lung (including Phthisis) and other Forms of Tuberculosis. Years. Number of Deaths. Death Rates. Tuberculosis of the Lung (including 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). 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 60 119 93 1 39 0.84 1.19 0.53 0.32 0.45 2.45 1911 223 156 379 71 62 133 80 1-43 0.91 1.16 0.45 0.36 0.40 2.37 Average 263 182 445 83 71 154 105 1 61 1.01 1.34 0.50 0.39 0.46 2.86 1912 255 172 427 72 54 126 72 1 64 1.00 1.31 0.46 0.31 0.38 2.14 Increase or Decrease on Average 8 10 18 11 17 28 33 +0 03 0.01 0.03 0.04 0.08 0.08 0.72 1912] 106 DIABETES MELLITUS. This disease caused 29 deaths, which although two more than those which Were registered in 1911, are nevertheless the same as the average for the preceding 10 years- Of the deceased, 19 were males and 10 females, which shows an excess of four males and a similar decrease of females when compared with the decennial average. More than one-third of the deaths occurred at the age period 55-65, and slightly more than one-fourth from 65-75. It will, therefore, be seen that it is a disease of elderly people. Table LXIV. Showing the Deaths from Diabetes Mellitus at ten age periods during the years 1902-1911, and in 1912. Ages at Death. Years. Mean 10 years. 1912. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 0- 5 — — — — — — — — — — — — 5-15 1 1 — — — 1 — — 1 — — — 15-25 — 1 3 1 1 1 — 4 3 1 1 1 25-35 2 2 2 3 3 1 1 2 1 1 2 3 35-45 7 2 3 2 3 1 2 1 3 3 3 4 45-55 4 2 5 4 3 2 4 1O 7 4 4 2 55-65 9 8 11 6 7 7 7 8 7 9 8 10 65-75 2 7 9 11 14 5 5 5 10 8 8 7 75-85 3 3 1 1 1 2 1 3 2 1 2 2 85 upwards — — 1 — — 1 I 3 — — 1 — All Ages 28 26 35 28 32 21 21 36 34 27 29 29 Males 12 11 19 15 13 11 10 22 20 13 15 19 Females 16 15 16 13 19 10 11 14 14 14 14 10 107 [1912 TABLE LXV. Showing the Deaths from the several Constitutional Diseases during the Years 1902-1911, also the Corrected Mean Number of Deaths for these Years, together with the Deaths in 1912. 1902. 1903. 1904. 1905. 1906. 1907. 1908 1909. 1910. 1911. Corrected Means 19021911. 1912. Increase or Decrease. Tuberculosis. Rheumatic Fever 17 16 13 18 15 11 9 10 15 10 13 19 + 2 Rheumatism 15 21 21 11 19 13 14 28 15 18 17 20 + 3 Gout 11 6 11 7 6 13 7 4 2 5 7 3 - 4 Rickets 17 9 11 11 11 5 5 3 4 10 9 1 - 8 Cancer 326 350 323 328 363 348 367 353 361 332 340 382 + 42 Abdominal Tuberculosis 43 40 40 39 35 26 45 41 36 33 37 20 -17 Tubercular Meningitis 77 71 74 63 80 74 63 72 72 50 68 67 - 1 Phthisis 515 492 533 438 411 436 432 424 390 387 440 427 -13 Other Tubercular and Scrofulous Diseases 37 29 35 40 52 72 64 45 41 51 46 39 - 7 Purpura 2 1 1 2 1 3 3 1 2 2 2 — Anaemia. Chlorosis. Leucocythaemia 7 8 14 15 16 15 14 13 16 22 14 11 - 3 Diabetes 28 26 35 28 32 21 21 36 34 27 29 29 — Other Diseases 2 1 5 7 1 4 4 3 2 10 4 7 + 3 Totals 1,097 1,070 1,116 1,007 1,042 1,041 1,048 1,032 989 957 1,026 1,023 - 3 DEATHS OF THE RESPIRATORY ORGANS. Under this heading are included Bronchitis, chronic and acute, Pneumonia, Pleurisy and Asthma. Together they caused 980 deaths, and were equal to a death-rate of 3.0 per 1,000 of the population. They also represent 20.9 per cent, of the total deaths registered during the year. Taken as a class, and from year to year, they caused one death in every 10 which occur in the Borough, although it may be admitted that during the last few years there has been a decrease in the deaths from them. From 1891-1895 they averaged 1,254; in the five years 1896-1900, 1,096; in the five years 1901-1905, 1,021; and from 1900-1910 they averaged 987. In 1911 they) caused 855 deaths, while in 1912 there was a slight increase, the number rising to 980. 108 1912] Acute Bronchitis.—164 deaths were ascribed to this disease, of which 88 were those of males and 76 of females. This return is 7 above that of 1911. It is very unsatisfactory to find that 40 deaths, or just one-fourth of the entire mortality from this disease, occurred among infants who had not attained the end of their first year of life, and that 20 were aged 1 to 5 years. Thus we see that 60 children when they succumbed to th s ailment had not reached their fifth year. Acute Bronchitis caused 28 deaths in the Public Institutions of the Borough Chronic Bronchitis.—As many as 307 deaths were registered as compared with 247 in the preceding year. 157 of the deaths were of males and 150 of females. Pneumonia —This very serious ailment caused the deaths of 439 persons, of whom 237 were males and 202 females. These deaths were 44 above those registered in 1911. It was fatal to infants under one year old, causing no less than 97 deaths, and also to 95 young children aged between one and five yeais. It also caused 12 deaths among children between 5 and 10 years of age. In the public institutions there occurred 81 deaths, as contrasted with 69 in the preceding year; the majority as usual came from the Workhouse Infirmaries. Pleurisy.—25 deaths were attributed to it, one being a child 5 years old. Eight deaths were registered in public institutions. Asthma and Emphysema—To these diseases were ascribed the deaths of 25 persons, all of whom were adults. Other Diseases of tha Respiratory System —20 deaths were attributed to them, as compared with 22 in 1911. Deaths among Infants —As it is interesting to note the deaths among infants, they are given herewith:— Acute Bronchitis. Pneumonia. Total. 1st quarter 17 36 53 2nd 11 24 35 3rd „ 2 8 10 4th „ 10 29 39 40 97 137 CHART. Showing the Mean Weekly number of Deaths from PNEUMONIA during each week of the seventeen years 1896-1912. 109 [1912 ALCOHOLISM. The deaths caused by alcoholism numbered 11, which is an increase of 7 on the return of the preceding year. It is, however, nearly 50 per cent, below the average record of the preceding 11 years viz.-21 deaths per annum. The return showed that five of the deaths occurred among males and 6 among females- It is a notable fact that the records of the last 12 years show that a larger number of females than males have died from this cause, the actual figures being 109 males and 134 females. Since 1907 there has been on the whole a decrease year by year in these deaths, which are caused by the drinking habits of the people, and this decrease has been particularly marked among females. This no doubt is due to the undoubted change in the habits of rich and poor alike as regards alcoholic drinks, which have in the past been the cause, not only of so many deaths, but of so much misery in the homes of the people. The number of deaths during each year since 1901 is as follows :— Acute. Chronic. Total. Males. Females. 1901 T 27 - 27 7 20 1902 9 - 29 38 20 18 1903 3 - 23 26 13 13 1904 4 - 18 22 12 10 I905 4 - 21 25 9 16 1906 3 - 13 16 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 1912 3 - 8 11 5 6 243 109 134 VENEREAL DISEASES. These diseases, the chief of which are syphilis and gonorrhoea, caused 17 deaths in 1912, which was exactly the average of the preceding 10 years, although four above the return for 1911, and two above those for 1910 and 1909. Seven deaths were those of adults and eight of infants under one year old. There were also two deaths of children aged 1 to 5 years. 110 1912]  Under 1 year. 1—5 years. Adults. Total. 1902 11 — IO 21 1903 10 1 8 19 1904 12 2 6 20 1905 13 — 5 18 1906 9 1 6 16 1907 5 — 11 16 1908 13 I 6 20 1909 10 — 5 15 1910 8 — 7 15 1911 6 — 7 13 1902-11 97 5 71 173 1912 8 2 7 17 DEATHS IN PUBLIC INSTITUTIONS. Within the Borough. 1,693 persons died in the Public Institutions located in Islington, of whom 1,184 belonged to this Borough, the remaining 509 having come here for treatment or relief. Among the latter were 338 persons who died in the Holborn Infirmary, and 101 in the Great Northern Central Hospital, 13 in the Islington Infirmary, 3 in the London Fever Hospital, 5 in St. Pelagia's Creche, and 10 in the Memorial Cottage Hospital. Of the 1,184 deaths of inhabitants, 846 occurred in the Islington Infirmary, 177 in the Islington Workhouses and Schools, and 127 in the Great Northern Central Hospital. The proportion which the 1,184 deaths bore to the Borough mortality was 25.3 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, 56 in the North-Eastern Fever Hospital, 53 in the Children's Hospital, Great Ormond Street, 82 in St. Bartholomew's Hospital, 53 in the Colney Hatch Asylum, 41 in the Royal Free Hospital, 32 in the University College Hospital, and 17 in Claybury Asylum. These 760 deaths represented 16.2 per cent, of all the deaths registered in the year. Within and without the Borough.—The deaths of Islingtonians in Public Institutions numbered 1,944, and were equal to 41.5 per cent, of the total deaths registered during the year. Fatal accidents or sudden deaths outside the Borough.— One hundred and one inhabitants died from accidental deaths, or suddenly, in places outside Islington. 111 [1912 Table LXVI. Showing the Deaths of Inhabitants in Local Institutions and in Institutions outside the Borough, also the Deaths of Non-Inhabitants in Local Institutions during the ten years 1902-1911 and in 1912. Years Total Deaths in Local Institutions (cols. 3 and 4). Inhabitants of Islington in Local Institutions, NonInhabitants of Islington in Local Institutions. Inhabitants in Islington Infirmary. Inhabitants of Islington in G.N.C. Hospital. Inhabitants of Islington in Institutions outside the Borough. Total Deaths of Inhabitants in all Institutions (cols. 3 and 7). Proportion per 100 deaths trom all causes (col. 8). 1 2 3 4 5 6 7 8 9 1902 1,531 909 622 587 130 737 1,646 29.2 1903 1,467 912 555 654 122 627 1.539 31.8 1904 1,619 987 632 719 132 589 1,576 30.1 1905 1,526 962 564 680 126 619 1,581 31.9 1906 1,574 955 619 717 I06 648 1,603 31.5 1907 1.675 1,082 593 760 130 656 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 1911 1,804 1,181 623 817 113 760 i.941 39.9 Average 1,612 1,018 594 728 119 673 1,691 34.4 1912 1,693 1,184 509 846 127 760 1,944 41.5 112 1912] Table LXVII. 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 1912. public institution. Tufnell Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South East. Total Inhabitants. NonInhabitants. Islington Infirmary 53 128 65 113 99 162 226 846 13 Islington Workhouses 9 36 16 23 28 22 43 177 6 Workhouse Schools — — — — — — — — — Gt. Northern Hospital 16 38 20 14 24 6 9 127 101 Holborn Infirmary — — — 1 — — — 1 338 Aged Pilgrims' Asylum 1 — 2 — 1 — — 4 7 St. Pelagia's Creche — — — — — — — — 5 Aged Blind Home — — — — 1 — 1 2 2 Medical and Surgical Home — — — — — — — — — Children's Nursing Home — — — — — — — — — St. John's Nursing Institute — — — — — — — — — Kingsdown Orphanage — — — — . — — — — — Shoreditch Infirmary — — — — — — — — — Whittington College — 1 — — — — — 1 2 Tufnell Park Nursing Institution — — — — — — — — — Alexandra Nursing Home, Turle Road — — 1 — — — — 1 2 Nightingale Nursing Home, Hanley Road — — — — — — — — —I Nursing Home, HornseyLane — — — — — — — — — St. Andrew's Nursing Home — — — — — — — — — H.M. Prison, Holloway — — — — — — — — 1 H.M. Prison, Pentonville — — 1 — — — — 1 4 Drovers' Almshouses — — — 1 — — — 1 — London Fever Hospital 1 — — — 1 — — 2 3 Memorial Cottage Hospital — 1 — 1 5 — _7 14 10 Invalid Home, Aubert Park — — — — 2 — — 2 6 Invalid Home, Highbury Terrace — — — — 1 — — 1 1 Highbury Nursing Home — — — — — — — — 3 Bookbinders' Asylum — — — — — 1 — 1 1 Metropolitan Benefit Societies' Asylum — — — — 2 — — 2 2 Bricklayers' and Tilers' Almshouses — — — — — — — — 1 Dyers' Almshouses — — — — — — — — — Pennefather Memorial Home — — — — — — — — — Clothworkers' Almshouses — — — — — — 1 1 — Totals 80 204 105 153 164 191 287 1,184 509 *Also 13 at other places not in above list. 113 [1912 Table LXVIII. 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 1912. Sub-Registration Districts. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total.[/### Tufnell 8 14 22 4 10 14 13 8 21 7 4 11 32 36 68 Upper Holloway 16 19 35 9 17 26 15 5 20 12 7 19 52 48 100 Tollington 5 8 13 4 7 11 3 5 8 5 4 9 17 24 41 Lower Holloway 13 8 21 15 8 23 15 10 25 16 8 24 59 34 93 Highbury 16 14 30 21 17 38 28 13 41 13 17 35 83 61 144 Barnsbury 19 15 34 33 15 48 29 26 55 28 20 48 109 76 185 Islington, South-East 30 25 55 31 15 46 30 23 53 43 33 76 134 96 230 Borough 107 103 210 117 89 206 133 90 223 129 93 222 486 375 861 114 1912] Table LXIX. Showing the Deaths of Inhabitants in Public and Charitable Institutions situated without the Borough, also Accidental Deaths in Outlying Places during the Year 1912. Institutions. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Middlesex Hospital 6 2 10 4 22 Friedenheim (Home of Peace), N.W. 2 1 1 4 8 North Western Fever Hospital 2 4 .. 17 23 University College Hospital 9 6 8 9 32 Eastern Fever Hospital 7 9 3 9 28 Children's Hospital, Gt. Ormond Street 11 15 20 7 53 Banstead Asylum 2 2 1 3 8 Manor Asylum (Epsom) .. 1 1 .. 2 Darenth Asylum 2 .. .. .. 2 Hanwell Asylum 6 3 2 7 18 New Hospital for Women (Euston Road) 1 1 2 1 5 Metropolitan Hospital 7 9 5 5 26 German Hospital 2 .. 3 10 15 St. Bartholomew's Hospital 24 13 20 25 82 Royal Chest Hospital 4 2 3 .. 9 King's College Hospital 2 2 3 1 8 Guy's Hospital 1 .. .. 1 2 Colney Hatch Asylum 16 17 11 9 53 North Eastern Fever Hospital 15 14 13 14 56 Leavesden Asylum 2 3 4 3 12 St. Thomas's Hospital .. .. .. 2 2 Cane Hill Asylum .. .. .. 1 1 Royal Free Hospital 5 18 8 10 41 London Temperance Hospital 6 2 2 5 15 Cancer Hospital (Chelsea) 1 1 1 1 5 London Hospital 1 2 3 7 13 Mildmay Hospital 1 2 .. 2 5 Homoeopathic Hospital, Gt. Ormond Street 1 .. 2 1 4 Claybury Asylum 2 5 5 5 17 St. George's Hospital 2 2 1 5 Hackney Infirmary 3 1 .. 1 5 St. Pancras Infirmary .. 3 .. 4 7 City of London Lying-in Hospital 1 1 2 1 5 Marylebone Infirmary .. .. .. 1 1 Westminster Hospital .. .. 1 .. 1 St. Mary's Hospital .. .. 1 .. 1 Tooting Bee Asylum 5 4 4 1 14 Charing Cross Hospital .. 2 2 2 6 National Hospital, Queen's Square, W,C. 3 .. .. .. 3 St. Luke's House, Pembridge Square, S.W. .. 3 1 1 5 Holborn Workhouse, Hoxton 3 1 .. 1 5 Caterham Asylum 2 2 .. .. 4 Shoreditch Infirmarv 3 1 2 1 7 Horton Asylum 1 1 1 2 5 Heart Hospital, Soho Square .. 1 .. .. 1 Long Grove Asylum 2 2 .. .. 4 Belmont Workhouse .. .. 1 .. 1 Park Hospital 5 1 1 2 9 East London Hospital .. 1 1 .. 2 Queen's Hospital, Bethnal Green 3 .. 3 .. 6 Royal Hospital, Waterloo Road .. 2 .. 1 3 Mount Vernon Hospital 1 1 .. .. 2 Hampstead General Hospital 1 2 1 .. 4 115 [1912 Table LXIX.—continued. Institutions. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. City of London Asylum, Stone .. .. 1 .. 1 Bethlem House .. .. .. 1 1 South Eastern Fever Hospital .. .. 1 1 2 samaritan Free Hospital .. .. .. 1 1 Western Ophthalmic Hospital .. .. .. 1 1 Home of Good Shepherd, Shoreditch .. 2 .. 1 3 Hampstead Home Hospital 1 .. .. .. 1 Bethnal House Asylum 1 .. .. .. 1 Epileptic Colony, Epsom 2 .. .. .. Cheyne Hospital, Chelsea 1 .. .. .. 1 Nursing Home, Southwold Road, Upper Clapton 1 .. .. .. 1 Fountain Asylum, Tooting 1 .. .. .. 1 Middlesex Asylum .. 1 .. .. 1 Hospital for Women Soho .. 1 1 .. 2 Chelsea Hospital for Women .. 1 .. .. 1 Queen Mary's Hospital .. 3 .. 1 4 St. Joseph's Hospice, Hackney .. 2 1 1 4 Western Fever Hospital .. 1 .. 3 4 British Lying-in Hospital .. .. 3 .. 3 Italian Hospital .. .. .. 1 1 Brompton Hospital .. 1 .. 1 2 Central London Sick Asylum, St. Pancras .. 1 .. 1 2 North London Nursing Institution, Stoke Newington .. 2 .. .. 2 The Babies' Home, Brunswick Place, Shoreditch .. 1 1 .. 2 City of London Workhouse, Hackney 1 .. .. .. 1 Queen Charlotte Hospital .. 1 1 .. 2 Camberwell Workhouse .. .. .. 1 1 Central London Throat and Ear Hospital .. .. .. .. 1 Brook Hospital .. .. 1 1 2 St. Giles' Infirmary .. 1 .. .. 1 French Hospital 1 .. 1 .. 2 St. Mark's Hospital 1 .. 1 1 3 Lambeth Infirmary .. 1 .. .. 1 H.M. Prison, Brixton .. .. 1 .. 1 St. Luke's Hospital .. .. 1 .. 1 Royal National Orthopaedic Hospital .. .. 1 .. 1 Peckham House Asylum .. .. 1 1 2 184 184 170 198 736 Accidental and other Deaths :— In Public Lavatory, High Holborn 1 .. .. .. 1 At 75, Harley Street, W.C. 1 .. .. .. ] In river Lea cut, Hackney 1 .. .. .. 1 At 5, Trinity Square, Stockwell 1 .. .. .. 1 At 7, The Terrace, St. Pancras 1 .. .. .. 6 At 64, Warwick Street, Belgravia 1 .. .. .. 1 At North Side, C'.apham Common 1 .. .. .. 1 At 165, Adelaide Road, Hampstead 1 .. .. .. 1 Near King's College Hospital 1 .. .. .. 1 In carriage outside No. 1, Dorset Square 1 .. .. .. 1 Near corner of York Road, King's Cross 1 .. .. .. 1 In Public Lavatory, High Street, St. Pancras .. 1 .. .. 1 At Police Station, Hunter Street, n.w .. 1 .. .. 1 .. 1 .. .. 1 116 1912] Table LXIX.—continued. Institutions. 1st Quarter. 2nd Quarter, 3rd Quarter. 4th Quarter. Year. In van on way to St. Bartholomew's Hospital .. 1 .. .. 1 In ambulance near Royal Free Hospital .. 1 .. .. 1 At King's Cross Station (London Electric Railway) .. 1 .. .. 1 At Whitbread's Brewery, Chiswell Street, E.C. .. .. 1 .. 1 At 76, Broomwood Road, Battersea .. .. 1 .. 1 At Signal Box, G.N.R. Station, York Road, St. Pancras .. .. 1 .. 1 In Euston Road, near St. Pancras Station .. .. 1 .. 1 Near Charing Cross Hospital .. .. 1 .. 1 At 72, Upper Park Road, Hampstead .. .. 1 .. 1 In Pancras Road, St. Pancras .. .. 1 .. 1 At 21, Moor Lane, e.C. .. .. 1 .. 1 On Ambulance, near London Temperance Hospital .. .. 1 .. 1 In Regent's Canal, Shoreditch .. .. 1 .. 1 At 94, Brooke Road, Dalston .. .. 1 .. 1 Off Battle Bridge Stairs, River Thames .. .. 1 .. 1 Near St. George's Hospital .. .. 1 .. 1 Near No. 3 Pond, Hampstead Heath .. .. 1 .. 1 In Dalston Lane, near Amhurst Road corner .. .. 1 .. 1 In Gray's Inn Road, near Manchester Street, N.W. .. .. 1 .. 1 In Gray's Inn Road, near King's Cross Metropolitan Station .. .. 1 .. 1 In Oxford Street, near Oxford Circus, W. .. .. 1 .. 1 On the way to Metropolitan Hospital .. .. 1 .. 1 In Bridport Place, Hoxton .. .. .. 1 1 In River Thames, off St. Bride's Wharf, Shadwell .. .. .. 1 1 On the way to St. Bartholomew's Hospital .. .. .. 1 1 At 73, Belsize Park Gardens, Hampstead .. .. .. 1 1 In Clissold Park, Stoke Newington .. .. .. 1 1 In Tramcar in Camden Road, near Great College Street .. .. .. 1 1 At 6, The Terrace, St. Pancras .. .. .. 1 1 At 59, Whitfield Street, St. Pancras .. .. .. 1 1 On Platform, Marylebone Station, Great Central Railway .. .. .. 1 1 Total Deaths 195 190 191 210 786 117 [1912 Table LXX. Showing the Transferable Deaths of Inhabitants in Outlying Public Institutions during the Year 1912. (Forwarded by the Registrar General.) PUBLIC INSTITUTIONS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. The Schiff, House of Recovery, Cobham 1 .. .. .. 1 Napsbury Asylum, St. Alban's 1 .. .. .. 1 Home of Jewish Incurables, Tottenham 1 .. .. .. 1 St. Catherine's Home, Ventnor, I.W. 1 .. .. .. 1 Portsmouth Infirmary 1 .. .. .. 1 Pembroke Infirmary 1 .. .. .. 1 Kent County Asylum .. 2 .. .. 2 St. Alban's Hospital .. 1 .. .. 1 Royal Naval Hospital, Gillingham .. .. 1 .. 1 Royal National Hospital, St. Lawrence, I.W. .. .. 1 .. 1 Cottage Hospital, Potter's Bar .. .. 1 .. 1 Prince of Wales' General Hospital, Tottenham .. .. 1 2 3 Edmonton Union .. .. 1 1 2 West Herts Hospital, Hemel Hempstead .. .. 1 .. 1 Henley-on-Thames Workhouse Infirmary .. .. 1 .. 1 Forest Hospital, Buckhurst Hill.. .. .. 1 .. 1 St. John's Nursing Home, Merton .. .. 1 .. 1 Newcastle City Lunatic Asylum .. .. .. 1 1 Royal Victoria Hospital, Bournemouth .. .. .. 1 1 Middlesex County Asylum, Wandsworth .. .. .. 1 1 Holborn Infirmary .. .. .. 1 1 Accidental and other Deaths :— At 11, Grand Junction Road, Brighton 1 .. .. .. 1 On Great Northern Railway, Crouch End Station, Hornsey 1 .. .. .. 1 On Midland Railway, Luton Station 1 .. .. .. 1 At 108, Palmer's Road, New Southgate 1 .. .. .. 1 At Downhills Recreation Ground, Tottenham 1 .. .. .. 1 At 18, Woodland Villas, Muswell Hill 1 .. .. .. 1 At 3 Russell street Hastings 1 .. .. .. 1 At " Harcourt," Derby Road, Bournemouth 1 .. .. .. 1 On Midland Railway, Harpenden 1 .. .. .. 1 At Twyford Abbey, Greenford .. 1 .. 1 2 At 14, Delemere Road, Wimbledon .. 1 .. .. 1 At 32, Alexandra Street, Folkestone .. 1 .. .. 1 At Clay Lane, Mile End, Colchester .. 1 .. .. 1 At Lowther Hotel, Newgate Street, Newcastle-uponTyne .. 1 .. .. 1 At 39, Orchard Road, Twickenham .. 1 .. .. 1 At 49, Compton Road, Preston, Brighton .. 1 .. .. 1 At 13, Augusta Road, Ramsgate .. 1 .. .. 1 At " The Oaks,'Fernleigh Drive, Southend .. 1 .. .. 1 At Gipsy Hill, Hornsey .. 1 .. .. 1 At 5, Meads Read, Wood Green .. 1 .. .. 1 At 18, Woodlands Villas, Muswell Hill .. 1 .. .. 1 At Holford Villa, St. Paul's Crescent, Shanklin, I.W. .. 1 .. .. 1 In river Thames, Richmond .. .. 1 .. 1 At 10, St. George's Terrace, Heme Bay .. .. 1 .. 1 At 14, Waterloo Road, Whitstable .. .. 1 .. 1 At 34, Bouverie Square, Folkestone .. .. 1 .. 1 At 25, College Road, Brighton .. .. 1 .. 1 118 1912] Table LXX.—continued. PUBLIC INSTITUTIONS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. At 27, Cheltenham Place, Brighton .. .. 1 .. 1 At 104, King's Road, Brighton .. .. 1 .. 1 At 8, East Street, Littlehampton .. .. 1 .. 1 At Milverton, Appley, St. Helens .. .. 1 .. 1 At Rose Villa, Hadley Road, East Barnet .. .. 1 .. 1 At 58, Cromwell Avenue, Hornsey .. .. 1 .. 1 At 53, Cecile Park, Crouch End .. .. 1 .. 1 At 29, Lealand Road, Tottenham .. .. 1 .. 1 In river Lea, near Stonebridge Lock, Tottenham .. .. 1 .. 1 In river Lea, near Walthi m Holy Cross .. .. 1 .. 1 At Hill Farm, Brigstock, Thrapston .. .. 1 .. 1 At 77, Capworth Street, Leyton .. .. 1 .. 1 At London, Tilbury, Southend Railway Station .. .. 1 .. 1 At 12, Coniston Square, Great Yarmouth .. .. 1 .. 1 At porton, Wilts .. .. 1 .. 1 In the sea, Porthcawl .. .. 1 .. 1 At Post Office, Corris Talyllyn, Dolgelly .. .. 1 1 In moat at Stokes Bay, Gosport .. .. 1 .. 1 At 48, George Street, Cleckheaton .. .. .. 1 1 In river Thames, Barnes .. .. .. 1 1 In West Green Road, Tottenham .. .. .. 1 1 At 150, Sackville Road, Hove .. .. 1 1 Totals 15 16 32 12 75 119 [1912 Table LXXI. Showing the Deaths of Inhabitants and Non-Inhabitants in Public and Charitable Institutions situated within the Borough during the Four Quarters Mid in the Year 1912. PUBLIC INSTITUTIONS. Inhabitants. Non-Inhabitants Totals. 1st qr. 2nd qr. 3rd qr. 4th qr. Year. 1 st qr. 2nd qr. 3rd qr. 4th qr. Year. 1st qr. 2nd qr. 3rd qr, 4th qr. Year, Islington Infirmary 242 188 150 266 846 1 6 2 4 13 243 194 152 270 859 Islington Workhouses and Schools 50 38 43 46 177 2 2 2 .. 6 52 40 45 46 183 Great Northern Central Hospital 26 34 30 37 127 20 22 26 33 101 46 56 56 70 228 Holborn Infirmary .. .. 1 .. 1 95 65 83 95 338 95 65 84 95 339 St. John's Nursing Institute .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tufnell Park Nursing Institute .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. London Fever Hospital .. .. .. 2 2 1 .. 1 1 3 1 .. 1 3 5 Aged Pilgrims' Asylum 3 1 .. .. 4 1 3 2 1 7 4 4 2 1 11 St. Pelagia's Creche. .. .. .. .. .. 1 1 1 2 5 1 1 1 2 5 Memorial Cottage Hospital 3 7 1 3 14 4 3 .. 3 10 7 10 1 6 24 Alexandra NursingHome.Turle Road .. .. 1 .. 1 .. .. .. 2 2 .. .. 1 2 3 Aged Blind Home .. 1 1 .. 2 1 .. 1 .. 2 .. .. 2 .. 4 Medical and Surgical Home .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Invalid Home, Aubert Park 1 .. 1 .. 2 5 .. .. .. 6 6 .. 1 8 H.M. Prison, Holloway .. .. .. .. .. .. .. 1 .. 1 .. .. 1 .. 1 H.M. Prison, Pentonville .. .. .. .. 1 2 1 1 .. 4 2 2 1 .. 5 Children's Nursing Home .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Kingsdown Orphanage .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whittington College .. .. .. 1 .. 2 .. .. 2 .. 2 1 .. 3 Metropltn. Benefit Societies' Asylum 2 2 .. 1 2 2 1 l 4 Shoreditch Workhouse .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Drovers' Almshouses 1 .. .. .. 1 .. .. .. .. 1 .. .. .. 1 Bookbinders' Asylum 1 .. .. .. 1 .. 1 .. .. 1 1 1 .. .. 2 Invalid Home, Highbury Terrace .. 1 .. .. 1 .. 1 .. .. 1 .. 2 .. .. 2 Dyers' Almshouses .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Highbury Nursing Home .. .. .. .. .. 1 .. 1 1 3 1 1 .. 3 Bricklayers' and Tilers' Almshouses .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 Cloth workers' Almshouses.. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 St. Andrew's Nursing Home .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nightingale Nursing Home, Hanley .. .. .. .. .. 1 .. .. .. 1 1 .. .. .. 1 Road Totals 829 271 229 355 1184 135 108 123 143 509 464 379 352 498 1693 120 1912] INQUESTS AND MORTUARY. During the year 634 bodies were received into the Mortuary, as compared with an average of 641 in the preceding 10 years. The daily average number of bodies received into the Mortuary was 1.7, as compared with 1.8 in 1911. In 443 cases inquests were held, as contrasted with an average of 418 in the years 1902-1911. Bodies received into Mortuary. Inquests. 1902 745 458 1903 681 393 1904 660 424 1905 625 4J9 1906 642 433 1907 644 441 1908 563 396 1909 592 407 1910 609 385 1911 646 425 Average 641 418 1912 634 443 The following Table gives a return of the bodies received into the Mortuary and the inquests held by the Coroner during the years 1911 and 1912. 1911. No. of bodies received. Daily Average. No. of Inquests held. 1912. No. of bodies received. Daily Average. No. of Inquests held. 1st Quarter 171 1.9 126 1st Quarter 173 1.9 117 2nd „ 144 1.6 97 2nd „ 147 1.6 94 3rd „ 177 2 .0 95 3rd „ 144 1.5 112 4th ,, 154 1.7 107 4th „ 170 1.8 120 Total for Year 646 1.8 425 Total for Year 634 1.7 443 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. 122 l9l2] THE NOTIFICATION OF INFECTIOUS DISEASES. Small Pox, Diphtheria, Membranous Croups Enteric or Typhoid Fever, Typhus Fever, Erysipelas, Continued Fever, Relapsing Fever, and Cholera. During 1912, 1,577 cases of these epidemic diseases were notified to the Medical Officer of Health, and they represent an attack rate of 4.8 per 1,000 of the inhabitants. The return is extremely satisfactory, for it compares most favourably with an annual average during the last 21 years of 2,576, and an attack rate of 7.77 per 1,000 inhabitants. Only on one previous occasion have the notifications been so few, namely in 1910, when they numbered 1,525. It is very gratifying to find that these diseases caused a diminished amount of sickness in the borough. How great this is may be understood when it is stated that there has been a decrease of 999 cases on the average of the years 1891.11. If these years be split up into decennial periods it will be found that from 1891 to 1900 there were 30,557 cases notified, and from 1901 to 1910, 21,793 cases. The returns for the preceding 21 years are given in the following statement :— Years Cases. Attack.rates per i.ooo 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 1,941 5.84 1894 3,121 9.44 1905 1,928 5.81 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 I900 2,276 6.78 1911 1,759 5.37 I90I 2,852 8.52 - - - 1891-1911 54,109 7.77 1912 1,577 4.83 CHART. Showing the number of cases of Notifiable INFECTIOUS DISEASES and the Fatality from them since 1892. 123 [1912 Sub-Registration Districts.—The incidence of the notifiable infectious diseases in the several sub-registration districts varied from 5.03 per 1,000 of the inhabitants in Lower Holloway to 4.16 in Barnsbury. It is rather a remarkable fact that this sub-registration district, which is so crowded, should exhibit so low an attack rate. Usually the incidence of these diseases is heavier there than in other parts of the borough. The cases and attack-rates for each sub-district are given in the following statement Cases. Attack-rates. Tufnell 156 4.62 Upper Holloway 180 4.79 Tollington 161 5.34 Lower Hollo way 220 5.63 Highbury 273 4.42 Barnsbury 220 4.16 Islington South East 367 5.15 Total 1,577 4.83 Wards.—The cases referred to the several wards were as follows:— Cases. Attack-Rates. Tufnell 156 4.62 per 1,000 inhabitants. Upper Holloway 180 4.79 „ „ Tollington l6l 5.34 „ „ Lower Holloway 220 5.63 „ „ Highbury 165 4 .90 „ „ Mildmay 8l 3.40 „ „ Thornhill 140 4.47 „ „ Barnsbury 80 3.71 „ „ St. Mary 91 5 .39 „ „ Canonbury 163 5.66 „ „ St. Peter 140 4.68 „ „ Total 1,577 4.83 Seasonal Attacks.— These diseases as the year advanced greatly increased. Thus in the first quarter 319 cases were notified; in the second, 335; in the third, 422; and in the fourth, 501. 124 1912] First Quarter.—The 319 cases notified were equal to an attack-rate of 3.91 per 1,000, and they contrasted with a decennial average of 461 cases, so that the return showed a decrease of 142. Second Quarter.—There were 335 cases notified, or 106 fewer than the average for the decennial period. They represent an attack-rate of 4.10 per 1,000 inhabitants. Third Quarter.—422 cases were known, which is 112 below the average that obtained in the corresponding quarters of the 10 years, 1901-1910. They were equal to an annual attack-rate of 5.17 per 1,000 of the population. Fourth Quarter.—501 cases were notified, as contrasted with a decennial average of 608. There has, therefore, been a decrease of 107 attacks. These cases represent an attack-rate of 5.14 per 1,000 of the population- The following statement gives the particulars for each quarter:— Quarters. Cases. Attack-rates. Decennial average. Decrease. First 319 3.91 461 —142 Second 335 4.10 441 —106 Third 422 5.17 534 —112 Fourth 501 6.14 608 —107 FATALITY FROM THE INFECTIOUS DISEASES. By this phrase is meant the percentage proportion of deaths to attacks. Thus if there were 100 attacks and 5 deaths the fatality would be 5 per cent. It is very satisfactory to note that only 62 deaths occurred among the 1,577 cases notified, and consequently the fatality was only 3.9 per cent., which is the lowest known in the borough since these diseases were made compulsorily notifiable. In the chart which accompanies this part of the report it will be seen that as the number of cases decreases so almost invariably does the fatality rate. 125 [1912 This is, perhaps, what one might expect, because very frequently, but not always, when there is a serious spread of disease, it is found that the more virulent its attack on an individual, the more likely is it to attack others in a severe form. In other words the type of the disease is more severe than usual. Years 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 Cases. 2,059 3318 4-853 3,121 2,839 3,824 2,906 2,418 2,943 2,276 2,852 3,164 1,707 i.941 1,928 2,275 2,063 2,289 2,049 1,525 1,759 1,577 Deaths. 258 291 383 339 266 390 258 173 238 202 250 268 108 119 107 115 100 126 87 79 104 62 Fatality. 12.5 8.7 7.9 10.8 9.3 10.2 8.8 7.1 8.1 8.8 8.7 8.4 6.3 6.1 5.5 5.0 4.8 5.5 4.2 5.2 5.9 3.9 Total 55,686 4,323 7.7 126 19121 The great reduction in the fatality is better seen in the following statement:— Years. Average No. of cases per annum. Average No. of deaths per annum. Mean Fatality. 1891—1900 3.055 292 9.5 I90I—I91O 2,179 136 6.2 1911 1,759 104 5.9 1912 1,577 62 3.9 Hospital Isolation.—1,327 out of the 1,577 cases were isolated in hospital. In other words, 84.1 per cent, were removed from their homes, which is the highest percentage hitherto known in the borough. In 1896 it was only 48.4, so that the increase in the proportion has been enormous. At the same time it must be recollected that the number of notified cases has been less. The following tabular statement has been prepared to show the growth of the percentage number of cases treated in the various public institutions— mainly the M.A.B. Hospitals—connected with the borough:— Year. Cases treated in Hospital. Percentage of cases treated. Year. Cases treated in Hospital. Percentage of cases treated. 1896 1,862 48.4 1905 1,466 76 .1 1897 1,620 55.7 1906 1,755 77.1 1898 1,413 58.4 1907 1,651 80.0 1899 1,901 64.6 1908 1,842 80.4 1900 1,552 68.2 1909 1,705 83.2 1901 1,987 69.6 1910 1,247 81.8 1002 2,276 71.9 1911 1,416 80.5 1913 1,241 72.6 1912 1 577 84.1 1904 1,467 75.5 SMALL POX. No case was notified, although 4 cases were known in the following London districts:—Poplar 1, and Woolwich 3. Showing the cases of SCARLET FEVER notified in each week in 1912, and the averages for the corresponding weeks in the ten years 1902-1911. RED LINES = Weekly Notifications. GREEN LINES = Ten years' averages. 127 [1912 SCARLET FEVER. 811 cases were notified, which were 315 below the corrected average of the decennial period, 1902-11, and represented an attack-rate of 2.49 per 1,000 of the inhabihants, as contrasted with a mean rate of 3.45 in the 10 years mentioned. A chart is given on the opposite page which shows how the cases contrasted from week to week with the decennial weekly average. It will be noticed that they were almost invariably below it. The subsequent Table shows that 688 houses were infected, as contrasted with 650 in 1911, and 584 in 1910. Of these 688 infectcd houses, 592 had only one case of scarlet fever in each of them, 78 houses had two cases, 15 had three. 2 had four, and 1 had five. Number of cases of Scarlet 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. No. of houses infected. 1910 499 65 12 5 3 — — — 1 584 1911 546 80 19 3 1 — — 1 650 11912 592 78 15 2 1 — — — 688 No. of cases occurring: in Public Institutions. Public Institutions Infected Cases. /Islington Infirmary 2 London Fever Hospital 1 St. John's Road Workhouse 1 Great Northern Hospital ... 1 5 128 1912] 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. 1912. Percentage of houses in which 1 case occurred 85.45 8402 86.1 ,, ,, ,, 2 cases ,, 11.13 12.30 11.3 ,, ,, ,, 3 „ ,, 2.05 2.92 2.2 ,, ,, ,, 4 „ „ 0.86 0.46 0.3 ,, ,, ,,5 ,, ,, 0.51 0.15 0.1 ,, ,, ,, 6 ,, ,, — — — ,, ,, ,, 7 — — — ,, ,, ,, 8 ,, „ — 0.15 — 100.00 100.00 100.0 Hospital Isolation.—Of the 811 cases that were notified, 768, or 94.7 per cent., were isolated in hospital, which, high though the figure be, is slightly below that of 1911, when it was 95.3 per cent. It is a very rare circumstance, when this disease occurs at home, for any objection to be made to the removal of the patient There can be no doubt that the public, especially the working classes, recognise more and more the necessity of having the patient removed to hospital, because they feel that they cannot do so well for the child as it would be done by in hospital, and that its non.removal may mean an interference with the work of all the persons residing in the premises as well as with the attendance at school of the children. Fatality.—As the total number of deaths that occurred among the 311 cases was 9, the fatality rate was only 11 per cent., which is. the lowest that has hitherto been known in the borough. The particulars for each quarter and for each of the sub-registration districts, which in former years were shown in three separate Tables, have now been condensed into one. They are as below:— 129 [1912 Table LXXII. Showing the Sickness, Attack.rate and Fatality from Scarlet Fever in the Sub.Districts for each Quarter and for the Year. Sub.Districts. 1st Quarter. 2nd Quarter. 8rd Quarter. 4th Quarter. Year. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrat*. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Tufnell 18 2.13 .. 23 2.73 .. 23 2.73 .. 27 3.20 3.7 91 2.70 1.1 Upper Holloway 16 1.70 .. 11 1.17 .. 25 2.66 .. 29 3.09 .. 81 2.16 .. Tollington 14 1.86 .. 12 1 59 .. 17 2.25 .. 40 5.30 .. 83 2.75 .. Lower Holloway 18 1.84 5 5 27 2.76 3.7 47 4.81 4.2 49 5 .01 .. 141 3.61 2.8 Highbury 17 1.10 .. 26 1.68 .. 54 3.50 .. 66 4.28 1.5 163 2.64 0.6 Barnsbury 21 1.59 .. 19 1.44 .. 23 1.74 .. 32 2.42 6.2 95 1.80 2.1 Islington, South East 24 1.35 .. 37 2.08 .. 37 2.08 .. 59 3.31 1.7 157 2.20 0.6 The Borough 128 1.57 08 155 1 90 0.6 226 2.77 0.9 302 3.70 1.6 811 2.49 1.1 k 130 1912] DIPHTHERIA. To Diphtheria, including 4 cases of Membranous Croup, were attributed 516 cases, or 25 more than the decennial average (1902-11) of 491. The return is, however, less than that of the preceding year, when 593 cases were notified. That there were so many is to be regretted; but it will be found that in the neighbouring borough of St. Pancras they were even more numerous, and in a smaller population, than in Islington. It is difficult to ascribe a reason for the increase. The following statement gives the attack-rate for London, for the provincial towns, the great and smaller towns of England, and for the various boroughs which encircle Islington :— Cases. Attack-rate. London 7,101 1.58 240 Provincial Towns 29,659 1.28 94 Great Towns 24,437 1.33 146 Smaller Towns 5,222 1.15 St. Pancras 550 2.55 Stoke Newington 55 1.09 Hackney 252 1.13 Hornsey 87 1.01 Finsbury 144 1.68 Shoreditch 139 1.26 The Encircling Boroughs 1,227 1.59 Houses infected.—The 512 cases of Diphtheria occurred in 441 houses, of which 402 were infected with only one case, while 24 houses had two cases, 10 houses three cases, 4 houses four cases, and in 1 house five cases. Number of cases of Diphtheria occurring in one house. 1 case in house. 2 cases in house. 3 cases in house. 4 cases in house. 5 cases in house. No. of houses infected No. of cases in 1912. 402 24 10 4 1 441 501 Number of cases occurring in Public Institutions. Cases. Great Northern Hospital 4 Islington Infirmary 3 London Fever Hospital 3 St. John's Road Workhouse 1 11 Hospital Isolation.—466 cases, or 90.3 per cent., were removed to hospital, and of these 353 were received into the institutions of the Metropolitan Asylums Board. Showing the cases of DIPHTHERIA (including Membraneous Croup) notified in each week in 1912, and the averages for the corresponding weeks in the ten years 1902-1911. RED LINES = Weekly Notifications. GREEN LINES = Ten years' averages. 131 [1912 Fatality —The 38 deaths represented a fatality of 7.3 per cent., which is 2.0 below that of the average which obtained during the preceding 10 years. K 2 Table LXXIII. Showing the Sickness, Attack-rate and Fatality from Diphtheria in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Tufnell 5 0.59 .. 16 1.89 6.2 11 1.31 27.3 14 1.66 .. 46 1.36 8.7 Upper Holloway 23 2.45 13.0 20 2.13 5.0 20 2.13 .. 19 2.02 .. 82 2.18 4.9 Tollington 14 1.86 7.1 13 1.72 .. 16 2.12 6.2 18 2.39 .. 61 2.02 3.3 Lower Holloway 7 0.72 14.3 15 1.53 6.6 22 2.25 9.1 12 1.23 8.3 56 1.43 0.9 Highbury 15 0.97 12.1 13 0.84 30.7 16 1.04 6.2 22 1.42 31.8 66 1.07 21.2 Barnsbury 20 1.51 5.0 18 1.36 5.5 27 2.04 7.4 12 0.91 16.6 77 1.46 7.8 Islington, South East 40 2.24 2.5 34 1.90 .. 22 1.23 .. 32 1.80 6.2 128 1.79 2.3 The Borough 124 1.052 7.2 129 1.58 6.2 134 1.64 6.7 129 1.58 9.3 516 1.58 7.3 * (Including Membranous Croup.) 132 1912] Table LXXIV. 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 1902-1911, and 1912. Cases. Deaths. Fatality. Year. 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.* 1902 871 7 878 101 3 104 11.8 - 8.8 1903 452 3 455 41 2 43 9.4 - 10.0 1904 347 .. 347 27 1 28 8.1 - 10.3 1905 351 .. 351 33 1 34 9.7 - 7.3 1906 437 2 439 30 2 32 7.3 - 8.6 1907 480 1 481 41 1 42 8.7 - 5.2 1908 522 8 530 59 1 60 11.3 - 1.6 1909 425 5 430 30 1 31 7.2 - 5.2 1910 463 8 471 34 — 34 7.2 - 4.1 1911 590 3 593 53 — 53 8.9 - 1.3 1902-11 4,938 37 4,975 449 12 461 9.3 — 1912 512 4 516 38 — 38 7.3 - 2.0 * The last column shows the departure from the average fatality of the ten years preceding the year indicated. Table LXXV. Showing the Cases, Deaths and Fatality from Diphtheria at Home and in Hospitals. Quarter. Cases Nursed at Home. Cases Nursed at Hospitals. Cases. Deaths. Percentage Fatality. Cases. Deaths. Percentage Fatality. 1 2 3 4 5 6 1st 10 3 30.0 114 6 5.2 2nd 9 1 11.1 120 5.5 3rd 13 — — 121 9 7.4 4th 18 1 5.5 111 11 9.9 Year 50 5 10.0 466 33 7.0 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. 133 [1912 Table LXXVI. Showing the Fatality from Diphtheria0 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 6 2 33 2 1 50 1 1 100 4 2 50 13 6 46 1—2 6 1 16 8 ... ... 16 1 6 6 2 33 36 4 11 2— 3 20 1 5 13 1 8 12 2 17 12 ... ... 57 4 7 3— 4 9 3 33 17 2 12 10 1 10 14 1 7 50 7 14 4— 5 10 1 10 21 1 5 17 1 6 20 1 5 68 4 5 5— 6 16 ... ... 14 ... ... 11 ... ... 13 ... ... 54 ... ... 6— 7 10 ... ... 14 1 7 14 1 7 11 1 9 49 3 6 7— 8 10 ... ... 12 1 8 9 1 11 9 2 22 40 4 10 8— 9 6 ... ... 4 1 25 10 ... ... 5 ... ... 25 1 4 9—10 2 ... ... 2 ... ... 4 ... ... 5 1 20 13 1 8 10—11 3 ... ... 1 ... ... 4 ... ... 6 ... ... 14 ... ... 11—12 1 ... ... 3 ... ... 3 ... ... 5 ... 20 12 1 8 12—13 4 1 25 2 ... ... 2 ... ... 4 ... ... 12 1 8 13—14 2 ... ... 1 ... ... 5 ... ... 1 ... ... 9 ... 14—15 ... ... ... 1 ... ... 1 ... ... 1 ... ... 3 ... ... 15—25 14 ... ... 9 ... ... 9 ... ... 7 1 14 39 1 2 25—35 4 ... ... 3 ... ... 4 ... 25 4 ... ... 15 1 7 35—45 ... ... ... 1 ... ... 2 ... ... 1 ... ... 4 ... ... 45—55 ... ... ... 1 ... ... ... ... ... ... ... 1 ... 55—65 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 65 upwards ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... Totals 124 9 7 129 8 6 134 9 6 129 12 9 516 38 7 * Inclusive of Membranous Croup. 134 1912] ENTERIC FEVER. Only 49 cases of Enteric Fever were notified during the year, as contrasted with an average of 120 in the preceding 10 years. There has, therefore, been a decrease of 71 cases. This is the best record known since the compulsory notification of infectious diseases came into force, for during the 10 years, 1891-1900, they ranged annually from 184 to 353, the corrected average for the period being 245. In the decade, 1901-10, they averaged 140, varying from 89 to 281. In 1911 they numbered 73, and now the record is only 49. The attack-rate was equal to only 015 per 1,000 of the inhabitants. It is not, however, pretended that this low rate was peculiar to Islington, for as the following figures show, the incidence of the disease was also low in the Encircling Boroughs. In the Provincial Towns it was higher, being 0.26 per 1,000, while the rate for the County of London was 0.16 per 1,000. Cases. Attack-rate. St. Pancras 29 0.13 Stoke Newington 3 0.06 Hackney 27 0.12 Hornsey 7 0.08 Finsbury 8 0.09 Shoreditch 14 0.13 The Encircling Boroughs 88 0.11 Islington 49 0.15 Showing the cases of ENTERIC FEVER notified in each week in 1912, and the averages for the corresponding weeks in the ten years 1902-1911. RED LINES = Weekly Notifications. GREEN LINES = Ten years' averages. 135 [1912 TABLE LXXVII. Showing the Sickness, Attack-rates and Fatality from Enteric Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Tufnell 2 0.24 .. 1 0.12 .. 1 0.12 .. 1 0.12 100.0 5 0.15 20.0 Upper Holloway 2 0.21 .. .. .. .. .. .. .. 1 0.11 .. 3 0.08 •• Tollington 2 0.26 .. .. .. .. .. .. .. .. .. .. 2 0.07 •• Lower Holloway 1 0.10 .. .. .. .. 1 0.10 .. 1 0.10 .. 3 0.08 •• Highbury 2 0.13 .. .. .. .. 3 0.19 33.3 5 0.32 20.0 10 0.16 20.0 Barnsbury 1 0.08 .. 1 0.07 .. 3 0.23 33.3 1 0.08 100.0 6 0.11 33.3 Islington, South East 4 0.22 .. 7 0.39 14.3 4 0.22 .. 5 0.28 40.0 20 0.28 15.0 The Borough 14 0.17 .. 9 0.11 11.1 12 0.15 16.7 14 0.17 35.7 49 0.15 16.3 136 1912] TYPHUS FEVER. No case was known. ERYSIPELAS Erysipelas was the cause of 185 cases, which were equal to an attack-rate of 0.57 per 1,000 inhabitants. This rate is 0.70 below the mean rate of the 10 years, 1902-11. It is also lower than any rate recorded in those years, and indeed, since 1891; for on referring to the returns of past years the Medical Officer of Health finds that in the decennial period, 1891-1900, the corrected average number of cases was 245; while the lowest return for any year was 184, and the highest 353. In the succeeding decennium, 1901-10, the cases averaged 256 per annum, while the lowest number of cases notified in any of these years was 212, and the largest 357. In 1911 they numbered 275. Hospital Isolation —Of the 185 cases notified, 45 were treated in hospital, so that only 24.3 per cent. were isolated. This figure is, however, slightly more than the percentage isolated in the preceding year, when it was 22.6. Fatality.— As only 5 deaths were registered, the fatality was 2.7 per 100 cases. Showing the cases of ERYSIPELAS notified in each week in 1912, and the averages for the corresponding weeks in the ten years 1902-1911. RED LINES = Weekly Notifications. GREEN LINES = Ten years' average. 137 [1912 Table LXXVIII. Showing the Sickness, Attack-rate and Fatality from Erysipelas in the Sub-District; for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Cases. Attackrate. Fatality Cases. Attackrate. Fatality, Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Tufnell 5 0.59 .. .. .. .. 2 0.23 .. 5 0.59 .. 12 0.35 .. Upper Holloway 4 0.43 .. 5 0.53 .. 2 0.21 .. 2 0.21 .. 13 0.34 .. Tollington 5 066 .. 4 0.53 25.0 4 0.53 .. 2 0.26 .. 15 0.50 6.6 Lower Holloway 3 0.31 .. 3 0.31 •• 5 0.51 .. 8 0.82 .. 19 0.49 .. Highbury 12 0.78 8.3 8 0 52 .. 5 0 32 .. 7 045 .. 32 0.52 3.1 Barnsbury 9 0.68 .. 7 0.53 .. 10 0.76 10.0 11 0.83 .. 37 0.70 2.7 Islington, South East 11 0.62 9.1 9 0.51 .. 19 1.07 .. 18 1.01 5.5 57 0.80 3.5 The Borough 49 0.60 41 36 0.44 2.8 47 0.57 2.1 53 0.65 185 0.57 2.7 138 1912] PUERPERAL FEVER. Sixteen cases were notified, as compared with 14 in 1911, 20 in 1910. and 14 in 1909. The return is 4 below the corrected average of the preceding 10 years, during which time only on two occasions was the record so good, viz:—in 1909 and 1911, when the returns showed 14 cases for each year. From 1891 to 1900 the cases averaged 29, as contrasted with 16, as already stated, in the 10 years 1902-11. There has, therefore, been a decrease in the number of attacks of this terrible disease of late years. One cannot help thinking that it is probable that they would become fewer if there were such an institution in the borough as a School for Mothers, at which women about to become mothers could attend, and where they would receive good advice as to the care of themselves and their surroundings during the time of their lying-in. Hospital Isolation —9, or 11.1 per cent., of the puerperal cases were removed to hospital for treatment, while 7 remained at home. Fatality.—2 deaths occurred among the 16 cases, and represented a fatality rate of 12.5 per cent. This is a very low rate, for in the preceding year it amounted to 50.0 per cent. It has never fallen so low. 139 [1912 Table LXXIX. Showing the Sickness, Attack-rate* and Fatality from Puerperal Fever in the Sub-Districts for each Quarter and for the Year. Sub-Districts. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality. Cases. Attackrate. Fatality, Cases. Attackrate. Fatality. Tufnell .. .. .. 1 5.37 .. .. .. .. 1 5.46 100.0 2 2.67 50.0 Upper Holloway 1 3.69 .. .. .. .. .. .. .. .. .. .. 1 0.98 .. Tollington .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lower Holloway .. .. .. 1 3.79 .. .. .. .. .. .. .. 1 0.97 .. Highbury .. .. .. .. .. .. .. .. .. 2 6.85 .. 2 1.65 .. Barnsbury 1 2.34 .. 4 1.38 .. .. .. .. .. .. 5 3.29 .. Islington, South East 2 4.13 50.0 .. •• .. 3 6.23 .. .. .. .. 5 2.68 20.0 The Borough 4 1.84 25.0 6 3.05 .. 3 1.49 •• 3 1.58 33.3 16 1.95 12.5 * Per 1,000 Registered Births. 140 1912] Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Barnsbury. Islington, South-East. The Borough. Cases notified by Doctor 1 2 — 1 2 5 5 16 Patient delivered by Doctor — 1 — 1 2 4 4 *12 ,, „ by Midwife 1 — — — — 1 1 3 Cases inquired into 1 2 — 1 2 5 5 16 „ treated in Hospital 1 2 — 1 1 3 1 9 „ treated at home — — — — 1 2 4 7 *One patient was confined unattended. The following statement gives the number of the cases and deaths, together with the fatality rate during the last twenty-two years:— Years. Cases. Deaths. Fatality. 1891 33 8 24.2 1892 51 23 45.1 1893 38 13 34.2 1894 23 8 34.8 1895 22 12 54.5 1896 30 11 36.7 1897 27 10 37.0 1898 19 7 36.8 1899 33 14 42.4 1900 16 6 37.5 1901 34 15 44.1 1902 22 12 54.5 1903 19 9 47.3 1904 25 14 56.0 1905 24 6 25.0 1906 25 11 44.0 1907 21 8 38.1 1908 17 4 23.5 1909 14 7 50.0 1910 20 8 40.0 1911 14 7 50.0 1912 16 2 12.5 SUMMARY IN QUINQUENNIAL PERIODS. Years. Cases. Deaths. Fatality. 1891—1895 167 64 38.3 1896—1900 125 48 38.4 1901—1905 124 56 45.1 1906—1910 97 38 39.1 141 [1912 Table LXXX. Showing the number of Cases of the several Notifiable Infectious Diseases which occurred during each of the Ten Years 1902-11 and in 1912. diseases. years. Corrected average number of cases. — Increase or Decrease. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1902-1911. 1912 Small Pox 276 9 17 34 1 ... ... 3 1 ... 30 ... —30 Scarlet Fever 1372 865 1146 1198 1386 12l6 1409 1285 730 804 1126 811 —315 Diphtheria 871 452 347 351 437 480 522 425 463 590 487 512 +25 Membranous Croup 7 3 ... ... 2 1 8 5 8 3 4 4 ... Enteric Fever 257 130 126 100 149 92 97 95 89 73 120 49 —71 Typhus Fever ... ... 1 ... 1 ... ... 1 1 ... ... ... ... Erysipelas 357 227 280 252 274 252 235 221 212 275 255 185 —70 Puerperal Fever 19 19 24 24 24 21 17 14 20 14 20 16 —4 Continued Fever 5 2 ... ... 1 1 1 ... 1 ... 1 ... —1 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 3164 1707 1941 1928 2275 2063 2289 2049 1525 1759 2043 1577 —466 † 1 Case returned after a few days not Small Pox. 142 1912] Table LXXXI. Showing the Attack-Rates of the several Notifiable Infectious Diseases during the Ten Years 1902-11 and in 1912. diseases. years. Mean Attack Kates. Attack Rate. Increase or Decrease 1902. 1903 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1902-1911 1912. Small Pox 0.81 0.03 0.05 0.01 0.00 ... ... 0.01 0.00 ... 0.09 ... —0.09 Scarlet Fever 4.03 2.60 3.45 3.61 4.18 3.68 4.20 3.91 2.22 2.46 3.45 2.49 —0.96 Diphtheria ... 2.56 1.36 1.04 1.06 1.32 1.45 1.64 1.29 1.41 1.80 1.50 1.57 + 0.07 Membranous Croup.. 0.02 0.01 ... ... 0.00 0.00 0.02 0.01 0.03 0.01 0.01 0.01 ... Enteric Fever 0.75 0.39 0.38 0.30 0.45 0.28 0.29 0.29 0.27 0.22 0.37 0.15 —0.22 Typhus Fever ... ... 0.00 ... 0.00 ... ... 0.00 0.00 ... 0.00 ... 0.00 Erysipelas ... 1.05 0.68 0.84 0.76 0.83 0.76 0.70 0.67 0.84 0.84 0.78 0.57 —0.21 *Puerperal Fever 2.06 2.11 2.70 2.74 2.79 2.46 1.96 1.71 2.44 1.76 2.35 1.95 —0.40 Continued Fever 0.01 0.00 •• ... 0.00 0.00 0.00 ... 0.00 ... 0.00 ... 0.00 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 9.29 5.12 5.84 5.81 6.87 6.25 6.82 6.23 4.65 5.37 6.26 4.83 —1.43 * These figures are calculated as per 1,000 Registered Births. 143 [1912 TABLE LXXXII. Showing the number of Cases of Infectious Diseases notified in the Sub-Registration Districts during 1912. Sub-Registration District. Small Pox. Scarlet Fever. 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 ... 91 46 ... 5 ... 12 2 ... ... ... 156 4.62 Upper Holloway - ... 8l 82 ... 3 ... 13 1 ... ... ... 180 4.79 Tollington - ... 83 61 ... 2 ... 15 ... ... ... ... 161 5.34 Lower Holloway - ... 141 55 1 3 ... 19 1 ... ... 220 5.63 Highbury - 163 64 2 10 ... 32 2 ... ... ... 273 4.42 Barnsbury - 95 77 ... 6 ... 37 5 ... ... ... 220 4.16 Islington South East 157 127 1 20 ... 57 5 ... ... ... 367 5.15 The Borough ... 811 512 4 49 ... 185 16 ... ... ... 1577 4.83 (All Duplicates have been deducted) 144 1912] TABLE LXXXIII. Showing the AttacK-rates of Infectious Diseases notified in the Sub-Registration Districts during 1912. Sub-Registration Districts. Small Pox. Scarlet Fever. 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 ... 2.70 1.36 ... 0.15 ... 0.35 2.67 ... ... ... 4.62 Upper Holloway ... 2.l6 2l8 ... 0.08 ... 0.34 0.98 ... ... ... 4.79 Tollington ... 3.75 2.02 ... 0.07 ... 0.50 ... ... ... ... 5.34 Lower Holloway ... 3.61 1.41 0.02 0.08 ... 0.49 0.97 ... ... ... 5.63 Highbury ... 2.64 1.04 0.03 0.16 ... 0.52 1.65 ... ... ... 4.42 Barnsbury ... 1.80 1.46 ... 0.11 ... 0.70 3.29 ... ... ... 4.16 Islington, South East ... 2.20 1.78 0.01 0.28 ... 0.80 2.68 ... ... ... 5.15 The Borough ... 2.49 1.57 0.01 0.15 ... 0.57 1.95 ... ... ... 4.83 * Per 1,000 Registered Births. 145 [1912 TABLE LXXXIV. Showing the number of Cases of Infectious Disease notified in the Wards during the year 1912. Also the total cases in 1910 and 1911. (N.B.— Duplicate notifications have been deducted). WARDS. Small Pox. Scarlet Fever. 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 ... 91 46 ... 5 ... 12 2 ... ... ... 156 4.62 Upper Holloway ... 81 82 ... 3 ... 13 1 ... ... ... 180 4.79 Tollington ... 83 61 ... 2 ... 15 ... ... ... ... 161 5.34 Lower Holloway ... 141 55 1 3 ... 19 1 ... ... ... 220 5.63 Highbury - ... 100 39 2 6 ... 16 2 ... ... ... 165 4.90 Mildmay - ... 45 18 ... 4 ... 14 ... ... ... ... 81 3.40 Thornhill - ... 60 48 ... 4 ... 23 5 ... ... ... 140 4.47 Barnsbury - ... 35 29 ... 2 ... 14 ... ... ... ... 80 3.71 St. Mary's - ... 38 30 1 7 ... 15 ... ... ... ... 91 5.39 Canonbury- ... 73 57 ... 5 ... 26 2 ... ... ... 163 5.66 St. Peter's - ... 64 47 ... 8 ... 18 3 ... ... ... 140 4.68 Totals - ... 811 512 4 49 ... 185 16 ... ... ... 1577 4.83 1910 1 730 463 8 89 1 212 20 1 ... ... 1525 4.65 1910 ... 804 590 3 73 ... 275 14 ... •• ... 1759 5.37 146 1912] Table LXXXV. Showing the Attack-Rates of the Notifiable Infectious Diseases notified in the Wards during the Year 1912. WARDS. Small Pox. Scarlet Fever. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever.* Continued Fever. Relapsing Fever. Cholera. Total AttackRates. Tufnell ... 2.70 1.36 ... 0.15 ... 0.35 0.06 .. ... ... 4.62 Upper Holloway ... 2.16 2.18 ... 0.08 ... 0.34 0.03 ... ... ... 4.79 Tollington - ... 2.75 2.02 ... 0.07 ... 0.50 ... ... ... ... 5.34 Lower Holloway ... 3.6i 1.41 0.02 0.08 ... 0.49 0.02 ... ... ... 5.63 Highbury - ... 2.97 1.16 0.06 0.18 ... 0.47 0.06 ... ... ... 4.90 Mildmay ... 1.89 0.75 ... 0.17 ... 0.59 ... ... ... ... 3.40 Thornhill ... 1.92 0.53 ... 0.13 ... 0.73 0.16 ... ... ... 4.47 Barnsbury - ... 1.62 1.35 ... 0.09 ... 0.65 ... ... ... ... 3.71 St. Mary's - ... 2.25 1.78 0.06 0.41 ... 0.89 ... ... ... ... 5.39 Canonbury - ... 2.54 1.98 ... 0.17 ... 0.90 0.07 ... ... ... 5.66 St. Peter's - ... 2.14 1.57 ... 0.27 ... 0.60 0.10 ... ... ... 4.68 Totals ... 2.49 1.57 0.01 0.15 ... 0.57 0.05 ... ... ... 4.83 * Per 1,000 population. 147 11912 Table LXXXVI. Showing the Number of Cases of Infectious Diseases which were investigated by the District Sanitary Inspectors during the Year 1912. Sanitary Inspectors. Number of the Sanitary District. Small Pox. Scarlet Fever Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cerebro Spinal Fever. Total. Mr. Cook 1 ... 69 36 ... 1 ... 7 2 ... ... ... 115 „ Bicknell 2 ... 81 79 ... 3 ... 15 1 ... ... ... 179 ,, Bagshaw 3 ... 36 26 ... 1 ... 5 ... ... ... ... 68 ,, Bridel 4 ... 70 46 ... 3 ... 15 ... ... ... ... 134 „ Flood 5 ... 46 27 1 5 ... 5 ... ... ... ... 84 „ Horsman 6 ... 82 33 2 2 ... 18 ... ... ... ... 137 „ Fortune 7 ... 69 19 ... 4 ... 6 2 ... ... ... 100 ,, Metcalf 8 ... 41 15 ... 3 ... 10 1 ... ... ... 70 „ Irving 9 ... 59 44 ... 3 ... 14 5 ... ... ... 125 ,, Watson 10 ... 60 39 ... 3 ... 21 2 ... ... ... 125 „ Jeffery 11 ... 47 46 ... 4 ... 16 2 ... ... ... 115 ,, Canham 12 ... 46 38 1 3 ... 23 ... ... ... ... 111 ,, Agar 13 ... 59 26 ... 4 ... 12 ... ... ... ... 101 ,, Callow 14 ... 46 38 ... 10 ... 18 1 ... ... ... 113 Totals ... 811 512 4 49 ... 185 16 ... ... ... 1,577 148 1912] Table LXXXVII. Showing the Cases of Infectious Disease which were notified in the several Months during the Year 1912. N.B.—(Duplicate Notifications have been deducted.) Month. Small Pox. Scarlet Fever. Diphtheria. Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Relapsing Fever. Cholera. Total each month. January ... 55 35 1 5 ... 13 2 ... ... ... ill February ... 45 45 1 4 ... 15 1 ... ... ... iii March ... 28 42 5 ... 21 1 ... ... ... 97 April ... 45 37 1 5 ... 9 ... ... ... ... 97 May ... 55 39 ... 3 ... l6 3 ... ... ... 116 June ... 55 51 1 1 ... 11 3 ... ... ... 122 July ... 66 32 ... 2 ... 12 ... ... ... ... 112 August ... 39 34 ... 1 ... 18 2 ... ... ... 94 September ... 121 68 ... 9 ... 17 1 ... ... ... 216 October ... 119 38 ... 3 ... 25 3 ... ... ... 188 November ... 99 40 ... 6 ... 15 ... ... ... ... 160 December ... 84 51 ... 5 ... 13 ... ... ... ... 153 Total ... 811 512 4 49 ... 185 16 ... ... ... 1,577 149 [1912 Table LXXXVIII. Showing the Cases of Infectious Disease notified during the Year 1912 in Islington and in the Encircling Boroughs. The Encircling Boroughs. Estimated Populations, 1912. Small Pox. Scarlet Fever. Diphtheria (including Membranous Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever. Other Continued Fevers. Cerebro Spinal Meningitis, Poliomyelitis. Total Cases. St. Pancras 216,145 ... 597 550 29 ... 189 20 ... 3 3 1,390 Stoke Newington 50,581 ... 90 55 3 ... 33 3 ... 1 5 190 Hackney 222,986 ... 515 252 27 ... 210 27 ... 7 8 1,046 Hornsey 86,252 ... 138 88 9 ... 39 3 ... 1 1 279 Finsbury 86,130 ... 157 144 8 1 144 12 ... 1 3 470 Shoreditch 110,430 ... 153 139 14 1 148 8 ... 5 ... 468 The Encircling Boroughs 772,524 ... 1,650 1,228 90 2 763 73 ... 18 20 3,844 Islington 326,398 ... 811 516 49 ... 185 16 ... 13 11 1,601 150 1912] Table LXXXI X.. Showing the Attack-Rates per 1,000 inhabitants of the Infectious Diseases notified during the Year 1912 in Islington and in the Encircling Boroughs. The Encircling Boroughs. Estimated Populations, 1912. Small Pox. Scarlet Fever or Scarlatina. Diphtheria (including Membranous) Croup. Enteric (Typhoid) Fever. Typhus Fever. Erysipelas. Puerperal Fever.* Other Continued Fevers. Cerebro Spinal Meningitis. Poliomyelitis. Total Attack-Rates. 1 2 3 4 5 6 7 8 9 10 11 12 13 St. Pancras 216,145 ... 2.77 2.55 0.13 ... o.88 0.09 ... 0.01 0.01 6.44 Stoke Newington 50,581 ... 1.78 1.09 0.06 ... 0.65 0.06 ... 0.02 0.01 3.76 Hackney 222,986 ... 2.32 1.13 0.12 ... 0.94 0.12 ... 0.03 0.04 4.70 Hornsey 86,252 ... 1.60 1.02 0.10 ... 0.45 0.04 ... 0.01 0.01 3.23 Finsbury 86,130 ... 1.83 1.68 0.09 0.01 1.68 0.14 ... 0.01 0.04 5.48 Shoreditch 110,430 ... 1.39 1.26 0.13 0.00 1.34 0.07 ... 0.04 ... 4.23 The Encircling Borough. 772,524 ... 2.14 1.59 0.12 0.00 0.99 0.09 ... 0.02 0.02 4.97 Islington 326,398 ... 2.49 1.58 0.15 ... 0.57 0.05 ... 0.04 0.03 4.91 Increase or Decrease ... ... +0.35 — 0.01 +0.03 ... — 0.42 — 0.04 ... + 0.02 + 0.01 —0.06 • Per 1,000 of the population. 151 [1912 Table XC. Showing the Cases of Infectious Disease notified in the several Metropolitan Cities and Boroughs during the year 1912. Cities and Boroughs. Estimated population in the middle of 1912. Notified Cases of Infectious Disease. Small Pox Scarlet Fever. Diphtheria.* Typhus Fever. Enteric Fever. Other continued Fevers. Puerperal Fever. Erysipelas. Cerebro-spinal meningitis. Other Notifiable In???ectious Diseases. Total. london 4,510,754 6 11,312 7,101 3 704 7 380 4 098 105 833 24,549 West Districts. Paddington 142,362 .. 269 254 .. 15 .. 11 117 7 37 710 Kensington 171,746 .. 304 180 .. 15 2 8 116 .. 23 648 Hammersmith 122,750 .. 333 176 .. 11 .. 7 102 2 19 650 Fulham 155,402 .. 485 233 .. 26 .. 30 115 2 19 910 Chelsea 65,397 .. 126 89 .. 10 .. 7 30 .. 4 266 livl • • • • City of Westminster 157,248 .. 238 160 .. 17 .. 19 92 3 19 548 North Districts. St. Marylebone 116,155 .. 259 149 .. 11 .. 5 89 1 22 536 Hampstead 85,966 .. 107 161 .. 10 .. 3 44 1 7 333 St. Pancras 216,154 †1 597 550 .. 29 .. 20 189 3 21 1410 Islington 326398 .. 811 517 .. 49 .. 16 186 13 43 1635 Stoke Newington 50,581 .. 90 55 .. 3 .. 3 33 1 6 191 Hackney 222,986 .. 515 252 .. 27 .. 27 210 7 30 1 068 Central Districts. Holborn 48,026 .. 114 89 .. 12 .. .. 47 1 5 268 Finsbury 86,130 .. 157 144 1 8 .. 12 144 1 10 477 City of London 18,695 .. 33 17 .. 2 .. .. 14 1 1 68 East Districts. Shoreditch 110,430 .. 153 139 1 14 .. 8 148 5 20 488 Bethnal Green 127,985 .. 283 220 .. 30 .. 16 192 6 35 782 Stepney 277,315 .. 929 363 .. 56 1 31 342 11 60 1793 Poplar 161,597 1 314 253 .. 36 .. 20 198 6 40 868 South Districts. Southwark 190,017 .. 500 283 .. 39 .. 18 265 8 80 1,193 Bermondsey 125,260 .. 418 218 1 37 .. 19 164 4 51 912 Lambeth 297,550 .. 596 336 .. 61 .. 24 223 7 87 1,334 Battersea 167,589 .. 462 232 .. 21 .. 7 133 2 30 887 Wandsworth 321,881 .. 812 428 .. 69 2 29 207 3 40 1590 Camberwell 261,591 .. 634 318 .. 29 1 17 216 5 41 1261 Deptford 109,377 .. 404 169 .. 9 1 8 191 4 31 817 Greenwich 95,994 .. 439 254 .. 11 .. 5 98 .. 22 829 Lewisham 165,249 .. 457 436 .. 26 .. 7 103 1 7 1,037 Woolwich 121,932 3 472 424 .. 20 .. 3 90 .. 23 1,035 Port of London •• † 1 1 2 .. 1 .. .. .. .. .. 5 * Including Membranous Croup, f Found not to be cases of Smallpox. 152 1912] Table XCI. Showing the Attack-Rates of the Infectious Diseases notified in the several Metropolitan Cities and Boroughs during the year 1912. Cities and Boroughs. Small Pox. Scarlet Fever. Diphtheria. * Typhus Fever. Enteric Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Attack-Rates per 1,000. County of London 0 00 2.51 1.58 0.00 0.16 0.00 0.08 0.91 5.24 West Districts. Paddington .. 1.90 1.79 .. 0.11 .. 0.08 0.82 4.70 Kensington .. 1.77 1.05 .. 0.09 0.01 0.05 0.68 3.65 Hammersmith .. 2.72 1.44 .. 0.09 .. 0.06 0.83 5.14 Fulham .. 3.13 1.50 .. 0.17 .. 0.19 0.74 5.73 Chelsea .. 1.93 1.35 .. 0.15 .. 0.11 0.46 4.01 City of Westminster .. 1.52 1.02 .. 0.11 .. 0.12 0.59 3.36 North Districts. St. Marylebone .. 2.24 1.29 .. 0.10 .. 0.04 0.77 4.44 Hampstead .. 1.25 1.88 .. 0.12 .. 0.04 0.51 3.80 St. Pancras 0.00 2.77 2.55 .. 0.13 .. 0.09 0.88 6.42 Islington .. 2.49 1.59 .. 0.15 .. 0.05 0.57 4.85 Stoke Newington .. 1.78 1.09 .. 0.06 .. 0.06 0.65 3.64 Hackney .. 2.32 1.13 .. 0.12 .. 0.12 0.94 4.63 Central Districts. Holborn .. 2.38 1.86 .. 0.25 .. .. 0.98 5.47 Finsbury .. 1.83 1.68 0.01 0.09 .. 0.14 1.68 5.43 City of London .. 1.77 0.91 .. 0.11 .. .. 0.75 3.64 East Districts Shoreditch .. 1.39 1.26 0.00 0.13 .. 0.07 1.34 4.19 Bethnal Green .. 2.22 1.72 .. 0.24 .. 0.13 1.50 5.81 Stepney .. 336 1.31 .. 0.20 0.00 0.11 1.24 6.22 Poplar 0.01 1.95 1.57 .. 0.22 .. 0.12 1.23 5.10 South Districts. Southwark .. 2.64 1.49 .. 0.21 .. 0.10 1.40 5.84 Bermondsey .. 3.35 1.75 0.01 0.30 .. 0.15 1.31 6.87 Lambeth .. 2.01 1.13 .. 0.21 .. 0.08 0.75 4.18 Battersea .. 2.77 1.39 .. 0.13 .. 0.04 0.80 5.13 Wandsworth .. 2.53 1.38 .. 0.21 0.01 0.09 0.64 4.81 Camberwell .. 2.43 1.22 .. 0 11 0.01 0.07 0.83 4.66 Deptford .. 3.70 1.55 .. 0.08 0.01 0.07 1.75 7.16 Greenwich .. 4.59 2.65 .. 0.11 .. 0.05 1.02 8.42 Lewisham .. 2.77 2.65 .. 0.16 .. 0.04 0.63 6.25 Woolwich 0.02 3.88 3.49 .. 0.16 .. 0.02 0.74 8.31 * Including Membranous Croup. 153 [1912 OTHER NOTIFIABLE DISEASES. These include Pulmonary Tuberculosis, Plague, Cholera, Acute Poliomyelitis, Polio Encephalitis, Epidemic Cerebro Spinal Meningitis, Opthalmia Neonatorum. PULMONARY TUBERCULOSIS. Pulmonary tuberculosis was notifiable in 1912 under three orders of the Local Government Board, viz:—(a) The Public Health Tuberculosis Regulations, 1908, (b) The Public Health (Tuberculosis in Hospitals) Regulations, 1911, and the Public Health (Tuberculosis) Regulations, 1911. It is necessary to deal with each Order separately. Notifications under the Public Health (Tuberculosis) Regulations, 1908.— Under these regulations 1,282 notifications were received, as compared with 1,341 in 1911, and with 1,277 in 1910, so that there was a decrease of 59 on the return of 1911, and an increase of 5 on that or 1910. The 1,282 notifications related, however, to only 661 persons, of whom only 442 were Islingtonians; while those of 1911 related to only 735 persons, of whom 484 were Islingtonians, and those of 1910 related to 696 persons, of whom 478 were Islingtonians. Notifications. Persons. Islingtonians. 1909 1,582 808 574 1910 1,277 696 478 1911 1,341 735 484 1912 1,282 661 442 Notifications received. Form A. Medical Officers of Poor Law Institutions 516 Form B. Medical Officers of Poor Law Districts 238 Form C. Superintending Officers of Public Institutions 525 Form D. Relieving Officers of Poor Law Districts 3 Total Notifications 1,282 154 1912] Of the total number of notifications received (1,282) during the year under the Regulations, 405, or 31.6 per cent., related to the transfer of patients from one institution to another. Thus from Holborn Workhouse, Shepherdess Walk, which is without this borough, 281 cases were transferred to Holborn Infirmary within this borough; 106 cases were transferred from the Islington Workhouse to the Islington Infirmary, both within this borough; and 18 cases were transferred from the Cornwallis Road Workhouse to the Islington Infirmary both within this borough. As in previous years, there was some difficulty in dealing with the notifications owing to the duplication of certificates respecting the same individual. Altogether notifications on four sets of forms were received from the various officers of the Poor Law Guardians. In the following statement the officials from whom the certificates were received during the year, are shown:— Islington Infirmary Medical Officers 324 „ Workhouse „ „ 130 „ District „ „ 238 „ Relieving Officers 3 Holborn Infirmary Medical Officers — „ Workhouse „ „ 25 Superintending Officers of Institutions within the Borough 230 „ „ „ without „ 295 Other sources 37 1,282 Public Health (Tuberculosis in Hospitals) Regulations, 1911. —During the year 611 notifications were received under these Regulations. Public Health (Tuberculosis) Regulations, 1911.— The Public Health (Tuberculosis) Regulations, 1911, came into force on the 1st January, 1912, and under them the medical practitioners of the Borough notified 611 cases of Pulmonary Tuberculosis. 155 [1912 Thus for the first time in the history of this country as a whole was this disease made compulsorily notifiable. It was with peculiar pleasure that the Medical Officer of Health welcomed this Order of the Local Government ' Board, for so long ago as 1891 at a Conference held at Portsmouth he advocated the compulsory notification of this disease. His advocacy, however, met with strenuous opposition, and, indeed, his was the only voict that was raised in favour of the proposal. But times have changed since then, and as he warned the Conference, so has it turned out, that the notification of pulmonary tuberculosis would assuredly be one day made compulsory ; and, indeed, not only has this come to pass but in fact at the present moment, all forms of tuberculosis, are now so notifiable. It is strange but nevertheless true that several Medical Officers of Health present at that meeting have since become fervent supporters of the notification of tuberculosis, while the Secretary of that meeting is at the present time the Medical Officer of the Local Government Board, although, in all fairness, it should be said that at that time he expressed no opinion on the subject. During the year 611 notifications were received under this set of Regulations. Disinfection of Houses and Rooms after Phthisis.—For many years it has been customary to disinfect premises after cases of Pulmonary Tuberculosis, but as there was no notification of the disease, its presence was not known in innumerable instances, and therefore houses were only disinfected at the request of the head of the family to which the patient belonged. For some years, however, it has been customary to abstract from the death returns the addresses in which deaths from consumption had occurred, and to offer to the head of the family the services of the Council's staff to disinfect the rooms, bedding and clothing. This offer was usually accepted, but strange though it may appear, in some cases it was refused. During 1912, the number of houses disinfected was 554, and of rooms 798. In 1905, the number of houses disinfected was 283, and of rooms 380 There has, therefore, been a gradual and progressive increase in the number of these disinfections. 156 1912] The following are the particulars for the year:— Houses. Rooms. 1st quarter 172 240 2nd „ 136 189 3rd ,, 114 197 4th „ 132 172 Total 554 798 The figures for the year contrast with those of the preceding six yeaxs as follows:— Houses. Rooms. 1905 283 380 1906 258 369 1907 296 411 1908 281 361 1909 514 672 1910 481 645 1911 426 579 1912 554 798 EPIDEMIC CEREBRO-SPINAL MENINGITIS. The returns show that 13 cases were notified during the year, which is the same number as in the preceding year. The disease has now been notified since 1907, and altogether 69 cases have been notified, of which 41 have died. The fatality is, therefore, 59.4 per cent It is no wonder that the disease is dreaded by most people. 157 [1912 1907. 1908. 1909. 1910. 1911. 1912. Total Cases. Total Deaths 1907-12 1st quarter 2 2 3 4 1 12 8 2nd „ 3 2 3 7 4 6 25 10 3rd „ 5 2 1 3 3 14 11 4th „ 3 3 3 4 2 3 18 12 11 7 10 15 13 13 69 41 OPHTHALMIA NEONATORUM. Thirty-two cases of this ailment, which is so fruitful a cause of blindness in young persons, were notified. Indeed, it was for the purpose of bringing home to persons their responsibility in this matter that this disease was made notifiable. One shudders to think of the enormous amount of blindness which, in the past, has been caused by the neglect of this disease, not merely in this country, but throughout the world. It, therefore, became a burning question everywhere as to what could be done to prevent so much unnecessary blindness, and now at last the disease has been made notifiable in England and in some parts of the United States; indeed, some of the Health Authorities of the United States make extraordinary efforts to combat it, as they feel that no stone should be left unturned to prevent these unfortunate infants being deprived of the blessing of sight. What such a deprivation means can only be appreciated by those who have lost it or never seen.the light. In every instance when a birth is notified, or when a case of Ophthalmia Neonatorum is notified, a document, of which the following is a copy, is left with the mother of the infant:— PUBLIC HEALTH DEPARTMENT. DIRECTION S respecting The Sore Eyes of New-Born Infants (Ophthalmia Neonatorum), by THE MEDICAL OFFICER OF HEALTH 2 Purulent Eye Disease of New-Born Infants. The Purulent eye disease of infants, often called " Blight," and sometimes known as " Baby Sore Eyes," is the most terrible disease which can afflict infants, and is the most common cause of blindness among children. Indeed, this has been found to be the case in 36 out of every 100 children in our schools for blind and partially blind children. Great, however, as this percentage is, it is probably understated, for reliable authorities assert that it is actually nearer to 40 per cent. Jn Germany, Austria Denmark and Holland, it is calculated to be the cause of the blindness of 40 in every 100 blind children, and in Paris of 46. In the United States the ill results of this disease are much the same, while in the State of Indiana it has been stated by the State Board of Health that 72 cases of blindness in every 100 blind infants under a year old are due to this preventable disease. It is lamentable to think that mothers as a rule are very ignorant about it, although there is one place, the State of Connecticut in the United States, where it is said they are so well informed as to the terrible results of neglecting " Baby sore eyes" or "Blight ' that they demand that the doctor or midwife shall use the "drops," which is a one per cent. solution of nitrate of silver, in every baby's eyes when born. The disease usually makes its appearance from two to three days after birth, but it may make it earlier, especially when there has been a long and lingering labour. 1912] 158 METROPOLITAN 3 It is caused either through material in the maternal passages, which contains the germ of the disease, clinging to the eyelashes, whence it is carried to the eyes after birth by the blinking of the infant, or by the sponges, water or other articles used in the first bath. The first symptom is the appearance of a thin discharge from the eyes like whey, which later becomes like tnick yellowish cream. If the disease is not at once treated, an ulcer will quickly form, and the infant's eyesight will be lost beyond recall—a calamity which is probably more terrible than any which can befall a human being. Recollect that there is nothing more precious than eyesight, the loss of which is regarded by most people as equivalent to the loss of life itself. Treatment is, therefore, more urgently required than in almost any other known disease and consequently a doctor, if not already in attendance, should be summoned at once. Caution. MOTHERS AND NURSES SHOULD RECOLLECT THAT IT IS A VERY INFECTIOUS DISEASE, AND, THEREFORE, CAN BE CONVEYED FROM ONE PERSON TO ANOTHER BY THE FINGERS OF THE MOTHER, NURSE OR OTHER PERSON IN CHARGE OF THE BABY. CONSEQUENTLY THE PATIENT SHOULD NOT BE GIVEN TO YOUNG CHILDREN TO NURSE, NOR, INDEED, SHOULD THEY BE ALLOWED TO KISS OR FONDLE, OR EVEN TOUCH THE BABY, LEST THEY SHOULD CONVEY THE INFECTION TO THEIR 4 OWN EYES, IN SHORT, ALL MODES OF IMMEDIATE CONTACT WITH THE PATIENT OFFER OPPORTUNITIES FOR THE INFECTION OF THE HEALTHY AND MUST BE AVOIDED. THE CLOTHING, PILLOWS AND BEDDING, WHICH MAY QUITE POSSIBLY HAVE BECOME INFECTED, SHOULD ON NO ACCOUNT BE USED BY ANY OTHER PERSON UNTIL DISINFECTED. Recommendations. The following recommendations with one slight addition have been issued by the Metropolitan Union of Blind Charities, and are fully endorsed by your Medical Officer of Health : — 1. When a child is born, insist that the nurse or midwife washes out the eyes thoroughly, as she was taught to do. 2. Examine the eyes daily yourself in the first week of the little one's life, and if there is the slightest redness on the lids, swelling or discharge, send for the doctor at once, and follow his instructions minutely. 3. In the meantime wash the child's eye or eyes about every ten minutes with a soft clean rag or cotton-wool wrung out of plain cold or tepid water, or better still, water in which boracic acid (one ounce to a pint) has been dissolved, gently wiping from the temple towards the nose. 4. Never use the same rag or cotton rag twice, but burn it at once ; be particularly careful not to touch both eyes with the same piece; also that in the act of cleansing nothing gets into your own eyes. 159 [1912 1912] 160 Ophthalmia Neonatorum was responsible for 32 cases, which are given in the following Table:— Tufnell. Upper Holloway, Tollington. Lower Holloway. Highbury. Barns bury. Islington, South-East, The Borough. Cases notified by Doctor 3 1 4 6 4 9 5 32 ,, ,, by Midwife .. .. .. .. .. .. .. .. Cases inquired into 3 1 4 6 4 8* 5 31 ,, treated in Hospital 2 1 3 3 3 4 4 20 ,, treated at Home 1 1 3 1 5 1 12 ,, attended by Murse .. .. •• 1 2 3 1 7 *One illegitimate child was also born in Lying in hospital. Polio-Myelitis and Polio-Encephalitis.—11 cases of these diseases were notified during the year. INFECTIOUS DISEASES IN PUBLIC ELEMENTARY SCHOOLS. It was found that 638 cases of the infectious diseases, notified under the Public Health (London) Act, 1891, occurred among scholars attending the public elementary schools. These cases represented 40.5 per cent. of all the cases notified. These figures contrast with an average of 866 in the 10 years, 1902-11, and represent 42.0 per cent. of all the notifications. Scarlet Fever.—430 of the notifications of Scarlet Fever occurred among scholars, as contrasted with a decennial average of 612, so that there was a decrease of 182. Diphtheria was accountable for 201 cases among scholars, as compared with 217 in the 10 years, 1902-11; consequently there was a decrease of 16 cases. Enteric Fever.—This disease attacked only 7 scholars, which is the lowest number hitherto recorded. The annual average had been 26, but during the last four years the number has gradually diminished. Thus in 1908 there were 19 cases, in 1909, 16; in 1910, 13; and in 1911, 14. Of course, where so many cases of infectious disease occurred among children 161 1912 attending the various schools it became necessary to prevent a large number of other children from attendance at them; thus 1,391 children were excluded because of Scarlet Fever in their homes or in the houses in which they resided; 909 children were excluded because of Diphtheria, and 9 because of Enteric Fever. Altogether 2,309 children were ordered to remain away from school on account of these diseases in their homes. A full statement as to the number of scholars attacked by these notifiable infectious diseases, together with the number of scholars excluded, are giver in Table XCIII. Table XCII. Showing the Scholars attacked by the Notifiable Infectious Diseases in the Public Elementary Schools. Year. By Small Pox. By Scarlet Fever. By Diphtheria. By Enteric Fever. By Other Diseases. Total Scholars attacked. Proportion to every 100 cases notified. 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 1911 .. 424 272 14 .. 710 40.4 Ten years' Average 1 612 217 26 10 866 42.0 1912 .. 430 201 7 .. 638 40.5 Increase or Decrease on Average -1 -182 -16 -19 -10 -228 -1.5 M 1912] 162 Table XCIII. Showing the cases of Notifiable Infectious Diseases occurring in Public Elementary Schools during the Year 1912. 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 4 •• •• 6 •• 2 13 •• •• 15 Ambler Road •• 16 •• •• •• 16 •• 45 4 •• •• 49 Barnsbury Park •• 8 1 •• •• 9 •• 11 11 •• •• 22 Blackstock Road •• 3 •• •• •• 3 •• 14 9 •• •• 23 Blundell Street •• 1 4 •• •• 5 •• 16 18 •• •• 34 " Brecknock," York Road •• 3 1 •• •• 4 •• 19 12 •• •• 31 Buckingham Street •• 5 2 •• •• 7 •• 26 15 •• •• 41 Burghley Road •• 10 5 •• •• 15 •• 50 13 •• •• 63 Caledonian Road •• 17 6 •• •• 23 •• 54 19 •• •• 73 Canonbury Road •• 17 15 •• •• 32 •• 18 26 •• •• 44 Catholic School, Eden Grove •• 4 4 •• •• 8 •• 12 16 •• •• 28 Chapel of Ease •• 13 2 •• •• 15 •• 30 5 •• •• 35 Coitenham Road •• 7 3 •• •• 10 •• 32 29 •• •• 61 Drayton Park •• 3 2 •• •• 5 •• 14 5 •• •• 19 Duncombe Road •• 8 10 1 •• 19 •• 25 36 •• •• 61 Ecclesbourne Road •• 20 7 2 •• 29 •• 37 30 3 •• 70 " Forster," Hornsey Road •• 8 4 •• •• 12 •• 38 26 •• •• 64 Gifford Street •• 2 3 1 •• 6 •• 14 29 2 •• 45 Gillespie Road •• 18 4 •• •• 22 •• 24 8 •• •• 32 Grafton Road •• 8 9 •• •• 17 •• 38 36 •• •• 74 Hanover Street •• 5 3 •• •• 8 •• 28 13 •• •• 41 Hargrave Park •• 6 2 •• •• 8 •• 84 12 •• •• 96 Holy Trinity •• 1 1 •• •• 2 •• 1 9 •• •• 10 Hungerford Road •• 21 2 •• •• 23 •• 84 17 •• •• 101 Montem Street •• 17 9 •• •• 26 •• 46 27 •• •• 73 Newington Green •• 6 3 •• •• 9 •• 23 10 •• •• 33 Pakeman Street •• 12 6 •• •• 18 •• 45 21 •• •• 66 Poole's Park (Lennox Road) •• 6 5 •• •• 11 •• 21 25 •• •• 46 Popham Road •• 5 5 •• •• 10 •• 8 19 •• •• 27 Queen's Head Street •• 11 10 •• •• 21 •• 31 37 •• •• 68 Richard Street •• 4 4 •• •• 8 •• 21 30 •• •• 51 Risinghill Street •• 2 •• •• •• 2 •• 18 9 •• •• 27 Rotherfield Street •• 4 1 •• •• 5 •• 16 13 •• •• 29 St. Bartholomew's •• •• •• •• •• •• •• •• •• •• •• •• St. Clement's, Cumberland Street •• 8 •• •• •• 8 •• 43 5 •• •• 48 St. James', George's Road •• 1 1 •• •• 2 •• 3 7 •• •• 10 St. John's, Conewood Street •• 11 1 •• •• 12 •• 5 6 •• •• 11 St. John's, Duncan Terrace •• 5 2 •• •• 7 •• 19 12 •• •• 31 St. John's, Holloway Road •• 5 8 •• •• 13 •• 16 18 •• •• 34 St. Joseph's, Highgate •• 1 3 •• •• 4 •• 3 13 •• •• 16 St. lude's, Mildmay Park •• 5 •• •• •• 5 •• 4 •• •• •• 4 St. Mark's, Mitford Road •• 8 4 •• •• 12 •• 21 12 •• •• 33 St. Matthew's, City Road •• 2 •• •• •• 2 •• 8 3 •• •• 11 St. Matthias (Hackney) •• •• 1 •• •• 1 •• 1 2 •• •• 3 St. Maty's, Cross Street •• 2 6 1 •• 9 •• 5 18 1 •• 24 St. Paul's, Dorset Street •• 4 •• •• 4 •• 6 4 •• •• 10 St. Philip's •• •• •• •• •• •• •• •• •• •• •• St. Thomas, Everilda Street •• 1 3 •• •• 4 •• 15 9 •• •• 24 Shelburne Road •• 6 2 2 •• 10 •• 4 5 3 •• 12 Shepperton Road •• 2 2 •• •• 4 •• 10 7 •• •• 17 Station Road .. 11 2 •• •• 13 •• 34 13 •• •• 47 Thornhill Road .. 11 4 •• •• 15 •• 31 11 •• •• 42 Tottenham Road .. 7 2 •• •• 9 •• 13 3 •• •• 16 Upper Hornsey Road .. 10 8 •• •• 18 •• 21 48 •• •• 69 Vittoria Place .. 2 3 •• •• 5 •• 12 20 •• •• 32 Westbourne Road .. 19 2 •• •• 21 •• 62 13 •• •• 75 White Lion Street .. 1 1 •• •• 2 •• 3 3 •• •• 6 Whittington, Highgate Hill .. 9 2 •• •• 11 •• 32 3 •• •• 35 Winchester Street .. 3 1 •• •• 4 •• 4 30 •• •• 34 Yerbury Road .. 5 2 •• •• 7 •• 31 15 •• •• 46 York Road .. 18 4 •• •• 22 •• 40 27 •• •• 67 Total .. 430 201 7 •• 638 •• 1391 909 9 •• 2309 163 [1912 NON-NOTIFIABLE INFECTIOUS DISEASES AMONG THE CHILDREN ATTENDING THE PUBLIC ELEMENTARY SCHOOLS. For a long time it had been very difficult to get the teachers to report the non-notifiable infectious diseases that occurred from time to time among the children attending these schools, but since the London County Council took over their management from the late School Board for London there has been a gradual improvement, so that now the notification of these diseases is extremely good. During the year 1912, no less than 5,968 cases were notified by the teachers of the various schools, as contrasted with the decennial average of 4,030. The notifications for the year shows an increase of 1,092 on those reported in 1911, the chief increase being due to Chicken Pox and Whooping Cough. Measles.—The teachers notified 1,377 cases, as contrasted with 1,698 in 1911, and an average of 1,427 in the preceding 10 years. The return was lower than any since 1908. Chicken Pox.—This disease showed a very large increase; indeed, the tale is greater than any that has been recorded during the last 10 years, for the returns show that the cases numbered 1,156, as contrasted with an average of 560. No school in the borough seems to have escaped, although the incidence of the disease in them varied very much; thus in Duncombe Road School there were 120 cases, while in the Shelburne Road School there were only 4, and in St. Paul's School only 2. Whooping Cough.—894 cases were notified, or 266 more than the average of the preceding 10 years. The largest number of cases in any one school was 61 in Montem Street School, which was closely followed by Canonbury Road School with 58. Particulars for all the schools are given in Table XCV. m 2 1912] 164 Table XCIV. Non-notifiable Diseases among Children attending the Public Elementary Schools. Year. Measles. Chicken Pox. Whooping Cough. Other Diseases. Totals. 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 19II 1,698 585 533 2,060 4,876 Totals 10 years 14,271 5.598 6,277 14,154 40,300 Average 1,427 560 628 1,415 4,030 1912 1,377 1,156 894 2,541 5,968 Increase or Decrease on Average -50 + 596 + 266 + 1,126 + 1,938 165 [1912 Statement showing number of Children excluded from various Schools on account of Measles in their Homes. Note.—I. = Infants' Department; B. = Boys'; J.B. = Junior Boys'; G. = Girls'; J. G. = Junior Girls; Mxd. = Mixed; J.M. = Junior Mixed; S.M. = Senior Mixed; M.D. = Mentally Deficient; P.D. = Physically Deficient; Spec. — Special School. Name of School. Dept. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total in Dept. Total for School. Ambler Road 1. ... ... 5 1 6 14 Mxd. ... 1 2 5 8 All Saints 1. 1 ... ... 3 4 4 Angler's Gdns., Popham Road 1. ... ... 2 26 28 28 Barnsbury Park 1. ... 20 2 2 24 26 Mxd. ... 2 ... ... 2 Blackstock Road B. ... ... ... 4 4 4 Blundell Street 1 ... 1 1 23 25 25 Buckingham Street 1 5 32 9 14 60 60 Burghley Road 1. ... 2 ... ... 2 3 G. ... ... 1 ... 1 Caledonian Road 1. 3 10 1 2 16 16 Canonbury Road 1. 5 4 ... 6 15 15 Cloudesley Street 1. 1 ... ... 3 4 7 G. ... ... 3 ... 3 Cottenham Road 1. 20 1 ... 2 23 23 Dowrey Street P.D.(B.) 1 ... ... ... 1| 2 G. ... ... ... 1 1 Drayton Park 1. ... ... 1 4 5 6 G. ... ... ... 1 1 Duncombe Road 1. 6 5 2 1 14 23 J. B. 1 3 ... ... 4 S.M. ... 2 ... ... 2 J. G. 1 ... ... ... 1 G. 1 1 ... ... 2 Ecclesbourne Road 1. ... ... ... 17 17 21 B. ... ... ... 2 2 G. ... 2 ... ... 2 Eden Grove 1. ... ... ... 5 5 6 G. 1 ... ... ... l Forster 1. ... ... 6 15 21 21 Gifford Street 1. ... 27 20 9 56 59 G. ... 3 ... ... 3 Gillespie Road 1 ... 4 3 9 16 18 G. ... 1 1 ... 2 1912] 166 Name of School. Dept. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total in Dept. Total for School. Grafton Road 1. 3 1 ... ... 4 8 G. ... 1 ... 1 B. ... ... 3 ... 3 Hanover Street 1. 1 1 3 28 33 33 Hargrave Park 1. 1 17 22 3 43 48 G. ... 3 ... ... 3 B. ... 1 ... 1 2 Hornsey Road Spec. ... ... ... 1 1 1 Hungerford Road B. ... 3 ... ... 3 5 G. 1 ... 1 ... 2 Montem Street 1. 23 1 ... ... 24 30 G. 2 ... ... ... 2 B. 2 ... 1 1 4 Newington Green 1. ... 1 1 24 26 28 G. ... ... ... 2 2 Offord Road M.D. ... 1 ... ... 1 1 Pakeman Street 1. 2 15 ... 4 21 21 Poole's Park B. ... ... 1 ... 1 1 Queen's Head Street 1. ... 1 3 8 12 12 Richard Street 1. 1 1 9 27 38 38 Rotherfield Street 1 1 3 3 11 18 18 St. Clement's 1. ... 1 1 1 3 3 St. James' 1. 6 17 ... 3 26 26 St. John's, Conewood Street 1. ... ... ... 1 1 1 ,, Duncan Place 1. ... ... 4 3 7 7 St. Joseph's B. 1 ... ... ... I 1 St. Jude's 1. ... 2 1 3 6 6 St. Mark's 1. 8 ... ... ... 8 8 St Mary Magdalene 1. ... 16 ... ... 16 17 G. ... 1 ... ... 1 St. Mary's, Fowler Road 1. ... ... ... 4 4 4 St. Matthew's 1. ... ... 1 ... 1 1 Shelburne Road 1. 1 4 ... ... 5 6 Mxd ... ... 1 ... 1 Shepperton Road 1 ... 1 ... 16 17 17 167 [1912 Name of School. Dept. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total in Dept. Total for School. St. Thomas' 1. ... 1 2 5 8 11 G. ... ... 1 ... 1 B. ... ... 2 ... 2 Station Road 1. ... 4 2 4 10 14 G. ... 2 ... 2 B. ... 1 1 ... 2 Thornhill Road B. ... 5 ... 1 6 6 Tottenham Road 1. ... ... ... 3 3 3 Upper Hornsey Road 1. 17 4 2 1 24 33 G. 8 1 ... ... 9 Vittoria Place 1. 5 13 15 6 39 39 Westbourne Road 1. 2 6 6 7 21 21 Whittington 1. 1 12 ... ... 13 13 Yerbury Road 1. 23 19 ... 1 43 43 York Road 1. ... 5 1 8 14 15 G. ... ... 1 1 155 286 147 332 920 920 SUMMARY. Department 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. Infants 136 252 128 313 829 Mixed •• 3 3 5 11 Senior Mixed •• 2 •• •• 2 Boys 3 10 8 9 30 Junior Boys 1 3 •• •• 4 Mentally Deficient •• 1 •• •• 1 Physically Deficient (Boys) 1 •• •• •• 1 Girls 13 15 8 4 40 Junior Girls 1 •• •• •• 1 Special •• ... •• 1 1 155 28 147 332 920 1912] 168 Table XCV. Showing the Infectious Diseases notified during the year 1912 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', Muriel Street 6 5 5 8 24 Ambler Road 1 30 4 52 87 Barnsbury Park 45 28 25 112 210 Blackstock Road 3 8 1 62 74 Blundell Street 10 29 2 83 124 Brecknock, York Road 9 2 1 11 23 Buckingham Street 67 43 4 32 146 Burghley Road 10 28 13 32 83 Caledonian Road 30 10 19 10 69 Canonbury Road 40 12 58 111 221 Catholic School, Eden Grove 14 7 3 12 36 Chapel of Ease 33 17 26 42 118 Cottenham Road 25 24 40 18 107 Drayton Park 11 .. 4 15 30 Duncombe Road 42 120 46 48 256 Ecclesbourne Road 53 63 9 54 179 Forster, Hornsey Road 13 6 15 110 144 Gifford Street 51 49 37 192 329 Gillespie Road 52 45 38 62 197 Grafton Road 13 16 27 30 86 Hanover Street 33 17 25 42 117 Hargrave Park 32 13 11 22 78 Holy Trinity 11 21 7 10 49 Hungerford Road 19 40 4 26 89 Montem Street 66 43 61 84 254 Newington Green 52 13 3 31 99 Pakeman Street 19_ 20 16 31 86 Poole's Park 2 22 16 136 176 Popham Road 32 15 19 96 162 Queen's Head Street 19 4 5 73 101 Richard Street 50 13 43 45 151 Risinghill Street .. .. .. .. .. Rotherfield Street 11 20 20 46 97 St. Bartholomew's .. .. .. .. .. St. Clement's 7 1 .. 2 10 St. James' 27 12 10 27 76 St. John's, Conewood Street 15 7 16 9 47 St John's, Duncan race 17 .. .. 9 26 St. John's, Holloway Road 4 44 13 37 98 St. Joseph's .. 6 16 6 28 St. Jude's 22 13 2 6 43 St. Mark's 17 .. 1 13 31 St. Matthew's, City Road 9 : 14 18 14 55 St. Matthias (Hackney) 3 .. .. .. 3 St. Mary's 17 7 3 16 43 St. Paul's, Dorset Street 6 2 6 8 22 St. Philip's .. .. .. .. .. St. Thomas' 10 18 12 23 63 Shelburne Road 51 4 10 22 87 Shepperton Road 40 27 13 51 131 Station Road 59 21 18 132 230 Thornhill Road 11 12 1 23 47 Tottenham Road 8 5 3 4 20 Upper Hornsey Road 29 28 21 119 197 Vittoria Place 28 34 41 39 142 Westbourne Road 18 59 20 43 140 White Lion Street .. .. .. .. .. Whittington 34 23 8 17 82 Winchester Street 17 .. 1 4 22 Yerbury Road 27 19 53 138 237 York Road 27 17 1 41 86 Total 1,377 1,156 894 2,541 5,968 109 [1912 ISOLATION OF INFECTIOUS DISEASES. The proportion of cases isolated during the year was larger than at any time in the history of the Borough, for 1,327 cases out of the 1,577 notified under the Public Health (London) Act, 1891, 84T per cent. were isolated in hospital. The following statement gives the percentages for each year from 1896, in which it will be seen that the percentage has gradually increased from 48.4 in 1896, to 77.1 in 1906, and to 84.1 in 1912. 1896 48.4 per cent. 1905 76.1 per cent. 1897 55 .7 „ 1906 77.1 „ 1898 58.4 „ 1907 80.0 „ 1899 64.6 „ 1908 80.4 „ 1900 68.2 „ 1909 83.2 „ 1901 69.6 „ 1910 81.6 „ 1902 71.9 „ .911 80.5 „ 1903 72.6 „ 1912 84.1 „ 1904 75.5 „ „ The particulars for each disease have been given under their various headings in that part of the report relating to the notification of infectious diseases, but they are tabulated below for easy reference:— Disease. Cases. Removed to Hospital. Percentage removed to Hospital. Scarlet Fever 811 768 94.7 Diphtheria 516 466 90.3 Enteric Fever 49 39 79.6 Erysipelas 185 45 24.3 Puerperal Fever 16 9 56.2 Total 1,577 1,327 84.1 Table XCVI. 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 1912. 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 768 43 811 94.7 5.3 6 3 9 0.8 6.9 11 Diphtheria 466 50 516 90.3 9.7 33 5 38 7.1 10.0 73 Enteric (Typhoid Fever) 39 10 49 79.6 20.4 4 4 8 10 .2 40.0 16.3 Typhus Fever .. •• .. ... .. .. .. .. .. .. .. Erysipelas 45 140 185 24.3 75.7 3 2 5 6.6 1.4 2.7 Puerperal Fever 9 7 16 56.2 43.8 1 1 2 11.1 14.3 12 .5 Continued Fever .. .. •• .. •• .. .. .. .. .. .. Relapsing Fever .. • • .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. •• •• .. .. .. .. .. Total 1,327 250 1,577 84.1 15.9 47 15 62 3.5 6.0 3.9 1912] 170 171 [1912 Table XCVII. Showing the Cases of Infectious Disease removed to the Metropolitan Asylums Board's Hospitals for treatment and isolation during 1912. Metropolitan Asylums Board's Hospitals. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Diseases. Total Admissions. Total Deaths. Eastern •• 12 33 •• •• 224 269 25 North Eastern •• 551 229 5 •• 315 1,100 52 North western •• 85 84 10 •• 165 344 28 Western •• .. • • •• •• 44 44 4 South Western •• 1 2 •• •• 6 9 •• The Grove •• 1 •• •• •• 6 7 •• Brook Hospital •• 1 4 •• •• 6 11 2 South Eastern •• •• 1 •• •• 24 25 1 Convalescent Hospital •• •• •• •• •• •• •• •• Small Pox •• •• •• •• •• •• •• •• Totals •• 651 353 15 •• 790 1,809 112 * Including cases of Measles, Whooping Cough, Puerperal Fever, Cerebro-Spinal Fever and Polio-Myelitis. OCCUPATIONS OF PERSONS ATTACKED WITH INFECTIOUS DISEASES. This return is of an interesting character, because it shows us the many ways in which infectious diseases might be conveyed to the public if precautions to prevent their spread were not taken; thus 2 makers of boxes were attacked, and recollecting that these card-board boxes are used for the packing of hosiery or other similar goods, one can understand how easily infection can be conveyed from a patient to the public. It is not necessary to discuss each of these items separately, but any person who interests himself in this subject will find in Table XCVIII. a list of the occupations of the patients who suffered from the various diseases that were notified during 1912. 1912] 172 Table XCVIII. Showing the Occupations of Patients suffering from the several notifiable Infectious Diseases during the year 1912. Occupations. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Artificial Florist ... ... 1 ... ... ... ... ... ... 1 1 Actress ... ... 1 ... ... ... ... ... ... 1 Accountant ... ... ... ... ... ... 1 ... ... 1 Boarding House Keeper ... ... ... ... 1 ... ... ... ... 2 Blouse Maker ... ... 1 ... 1 ... ... ... ... 2 Brush Maker ... 1 1 ... ... ... ... ... ... 1 Butcher ... ... ... ... ... ... 1 ... ... 2 Box Maker ... 2 ... ... ... ... 1 ... ... 1 Bookfolder ... ... ... ... ... ... I... ... ... 1 Bath Attendant ... 1 ... ... ... ... ... ... ... 1 Bottler ... ... 1 ... ... ... ... ... ... 1 Blacksmith ... ... 1 ... ... ... ... ... ... 1 Builder ... ... ... ... 1 ... 2 ... ... 2 Bricklayer ... ... ... ... ... ... 1 ... ... 1 Barrowman ... ... ... ... ... ... 1 ... ... 1 Boot Repairer ... ... ... ... ... ... 1 ... ... 1 Braid Worker ... ... ... ... 6 ... 3 ... ... 22 Clerk ... 8 5 ... ... 1 ... ... 2 Carpenter ... 1 ... ... 1 ... 3 ... ... 5 Charwoman ... ... 1 ... ... ... ... ... ... 1 Cornchandler ... 1 ... ... ... ... ... ... ... 1 Cook ... 1 ... ... ... ... ... ... 2 Capsule Maker ... ... 2 ... ... ... ... ... ... 1 Confectioner ... ... ... ... ... ... 1 ... ... 1 Contractor ... ... ... ... ... ... 4 ... ... 4 Carman ... ... ... ... ... ... 1 ... ... 1 Conductor ... ... ... ... ... ... 1 ... ... 1 Cab Driver ... ... ... ... ... ... 1 ... ... 1 Costumier ... ... ... ... ... ... 1 ... ... 1 Draper ... ... ... ... ... ... 1 ... ... 1 Drover ... ... ... ... ... ... 1 ... ... 3 Dressmaker ... ... 2 ... ... ... ... ... ... 1 Errand Boy ... 1 ... ... ... ... ... ... ... 2 Engineer's Labourer ... 1 1 ... ... ... 2 ... ... 5 Electrician ... 1 2 ... ... ... 1 ... ... 1 Engraver ... ... ... ... ... ... ... ... ... 2 Embroiderer ... 2 ... ... ... ... 2 ... ... 3 Feather Trade ... 1 ... ... ... ... ... ... 1 French Polisher ... 1 ... ... ... ... ... ... ... 173 [1912 Table XCVII[.—continued. Occupations. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total.  Factory Hand ... ... 2 ... I ... ... ... ... 3 Flower Seller ... ... 1 ... ... ... ... ... 1 Furrier ... ... ... ... ... ... 1 ... ... 1 Greengrocer ... ... ... ... 1 ... ... ... ... 1 Gas Meter Maker ... 1 ... ... ... ... ... ... ... 1 Gold Stamper ... ... 1 ... ... ... ... ... ... 1 Glass Blower ... ... ... ... 1 ... 2 ... ... 2 Housewife ... 3 ... ... ... ... 11 16 ... 34 Housekeeper ... ... ... ... ... ... I ... ... 1 Insurance Agent ... 2 1 ... ... ... 2 ... ... 5 Labourer ... 1 3 ... 4 ... 5 ... ... 9 Laundress ... ... 1 ... ... ... ... ... ... 1 Locksmith ... ... ... ... ... 1 ... ... 1 Music Hall Artist ... ... 1 ... ... ... ... ... ... 1 Manageress ... ... 1 ... ... ... ... ... ... 1 Marine Store Dealer ... ... ... ... ... ... 1 ... ... 1 Metal Worker ... ... ... ... ... ... 1 ... ... 1 Messenger ... 4 ... ... ... ... 1 ... ... 5 Machinist ... 1 ... ... ... ... 1 ... ... 2 Mother's Help ... 1 ... ... ... ... ... ... ... 1 Manager ... ... ... ... 1 ... ... ... ... 1 Machine Minder ... 1 ... ... ... ... ... ... ... 1 Milliner ... 1 1 ... ... ... 1 ... ... 3 Mantle Maker ... 1 ... ... ... ... ... ... ... 1 Medical Student ... 1 ... ... ... ... ... ... ... 1 Meat Factory Assistant ... 1 ... ... ... ... ... ... ... 1 Matron ... ... 1 ... ... ... 1 ... ... 2 Nurse ... 3 4 ... 1 ... 1 ... ... 9 Nursemaid ... 1 ... 1 ... ... ... ... 2 Newsagent ... ... ... ... ... ... 1 ... ... 1 Organ Builder ... ... ... ... ... ... 1 ... ... 1 Packer ... 1 1 ... ... ... 1 ... ... 3 Printer ... ... ... ... ... ... 2 ... ... 2 Photographic Assistant ... ... 1 ... ... ... ... ... ... 1 Porter ... ... 1 ... 1 ... 2 ... ... 4 Paper Stainer ... 1 ... ... ... ... ... ... ... 1 Perfumer ... ... ... ... ... ... 1 ... ... 1 Postman ... ... ... ... ... ... 1 ... ... 1 Publican ... ... ... ... ... ... 1 ... ... 1 Police Constable ... 1 ... ... ... ... 2 ... ... 3 Painter ... ... ... ... ... ... 2 ... ... 2 Pianoforte Player ... ... ... ... 1 ... ... ... ... 1 Plumber ... ... ... ... ... ... 1 ... ... 1 Scholar ... 480 227 ... 8 ... 12 ... ... 727 1912] 174 Table XCVIII.—continued. Occupations. Small Pox. Scarlet Fever. Diphtheria. Memb. Croup. Typhoid Fever. Typhus Fever. Erysipelas. Puerperal Fever. Continued Fever. Total. Sorter ... ... ... ... 1 ... ... ... ... 1 Servant ... 4 4 ... ... ... 5 ... ... 13 Shop Assistant ... 3 1 ... ... ... 2 ... ... 6 Screw Cutter ... 1 ... ... ... ... ... ... ... 1 Stationer ... ... ... ... 1 ... ... ... ... 1 Soldier ... ... ... ... ... ... 1 ... ... 1 Silversmith ... ... ... ... ... ... 1 ... ... 1 Tobacconist ... ... ... ... ... ... 1 ... ... 1 Tram Driver ... ... ... ... ... ... 1 ... ... 1 Tin Smith ... ... ... ... ... ... 1 ... ... 1 Typist ... 3 ... ... ... ... ... ... ... 3 Tailor ... 1 ... ... ... ... ... ... ... 1 Teacher ... 1 ... ... ... ... ... ... 1 Tennis Bat Maker ... ... ... ... ... 1 ... ... 1 Traveller ... 1 ... ... 1 ... ... ... ... 3 Van Boy ... ... ... ... 1 ... ... ... 1 Warehouseman ... 1 ... ... ... ... 1 ... ... 2 Waitress ... 1 ... ... ... ... ... ... 1 Ward Maid ... ... 2 ... ... ... ... ... ... 2 Wheelwright ... 1 ... ... ... ... ... ... 1 Window Dresser ... ... ... ... ... ... 1 ... ... 1 Total ... 544 273 ... 34 ... 104 l6 ... 971 175 [1912 TRADES AND BUSINESSES CARRIED ON IN THE HOMES OF PATIENTS. Another very important return is that which shows the various trades and businesses carried on in the houses in which infectious diseases occurred. A study of Table XCIX. will probably surprise many people, for it shows very plainly how easily infection can be carried from one home to another in the mere matter of trading if precautions were not taken. During the year infectious disease was discovered in 184 houses in which businesses were carried on, the most important of which, from a public health point of view, were the following:— Box making 7 Boot making 9 Blouse making 2 Baby Carriage making 1 Butchers 3 Bakers 2 Confectioners 9 Clothiers 1 Coffee house 1 Dress and Costume making 6 Drapers 4 Dairy 4 Flower making .1 Furniture dealers 5 Florists 3 Greengrocers 7 Tailor 7 Mantle making 4 Millinery 3 Mangling 1 Newsagent 4 Tiemaking 2 Such a list as this shows that if these cases of infection were left unisolated, much mischief to the public might accrue; and, therefore, when cases of infectious disease occur on business premises a strong effort is made to have them removed to hospital. The powers under section 109 of the Factory and Workshop Act have been of great assistance in the past in dealing with premises on which cases of Small Pox or Scarlet Fever are found, for they provide that if the occupier of a factory or workshop or any place from which work is given out, or any contractor employed by any such occupier causes or allow wearing apparel to be made, cleansed, or repaired in *any dwelling house or building occupied therewith whilst any inmate of the dwelling house is suffering from Scarlet Fever or Small Pox, unless he proves that he was unaware of the existence of the illness in the dwelling house, and could not reasonably be expected to have become aware of it, he shall be liable to a fine not exceeding £10. This stringent enactment when quoted to the proprietors of businesses which it affects, usually has an immediate effect. A full list of the trades and businesses affected during the year is given in the following Table:— 1912] 17f> Table XCIX. List of Trades and Businesses carried on in Houses wherein Infectious Diseases have occurred during 1912. trades AND BUSINESSES. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Memb. Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Building ... 4 4 ... ... ... 1 ... ... 9 Box Making ... 3 4 ... ... ... ... ... ... 7 Bootmaking ... 4 4 ... ... ... 1 ... ... 9 Beer House ... 1 ... ... ... ... ... ... ... 1 Baby Carriage Making ... 1 ... ... ... ... ... ... ... 2 Blouse Making ... 1 ... ... 1 ... ... ... ... 2 Butchers ... 1 2 ... ... ... ... ... ... 3 Boarding House ... 2 ... ... 3 ... ... ... ... 5 Brush Manufacturers ... ... 4 ... ... ... ... ... ... 4 Bank ... ... 1 ... ... ... ... ... ... 1 Bakery ... ... 2 ... ... ... ... ... ... 2 Block Letter Making ... ... 1 ... ... ... ... ... ... 1 Baby Linen Manufactory ... ... 1 ... ... ... ... ... ... 1 Confectionery ... 3 3 ... 1 ... 2 ... ... 9 Clothiers ... 1 ... ... ... ... ... ... 1 Cycle Repairing ... 1 i ... ... ... 1 ... ... 3 Chimney Sweeping 1 1 ... ... ... ... ... ... 2 Club ... 1 ... ... ... ... ... ... 1 Coffee Shop ... ... 1 ... ... ... ... ... ... 1 Case Making ... ... ... ... 1 ... ... ... ... 2 Cornchandlers ... ... ... ... 1 ... ... ... ... 1 Costumiers ... ... ... ... ... ... 1 ... ... 1 Dressmaking ... 4 ... ... ... ... 1 ... ... 5 Dining Rooms ... 1 ... ... ... ... ... ... ... 1 Drapers ... 3 1 ... ... ... ... ... ... 4 Dairy ... 3 1 ... ... ... ... ... ... 4 Dealers ... ... 1 ... ... ... ... ... ... 1 Flower Making ... 1 ... ... ... ... ... ... ... 1 Fly Cages ... 1 ... ... ... ... ... ... ... 1 Fishmongers ... 1 1 ... ... ... ... ... ... 2 Furniture Dealing ... 4 ... ... 1 ... 1 ... ... 5 Fruiterers ... 2 1 ... ... ... ... ... ... 4 Florists ... 3 ... ... 2 ... ... ... ... 3 Fire Station ... ... 1 ... ... ... ... ... ... 1 Furriers ... ... ... ... ... ... 2 ... ... 2 Greengrocers ... 3 2 ... 2 ... ... ... ... 7 General Shop ... 3 3 ... ... ... 1 ... ... 7 Glass Blowing ... 1 ... ... ... ... ... ... ... 1 Grocers ... 1 ... ... 1 ... 1 ... ... 3 Gas Meter Balances ... 1 ... ... ... ... ... ... ... 1 Hardware ... 1 1 ... ... ... ... ... ... 2 Hairdressing ... ... 1 ... ... ... 1 ... ... 2 Home for Girls ... ... 1 ... ... ... ... ... ... 1 Haberdashery ... ... 1 ... ... ... ... ... ... 1 Hospital ... ... 2 ... ... ... ... ... ... 2 177 [1912 Table XCIX.—continued. trades and businesses. Small Pox. Scarlet Fever or Scarlatina. Diphtheria. Memb. Croup. Enteric (Typhoid Fever). Typhus Fever. Erysipelas. Puerperal Fever. Cholera. Total. Insurance Agency ...- ... 1 ... ... ... ... ... ... 1 Licensed Victuallers ... ... 2 ... 2 ... 2. ... ... 8 Laundries ... 1 1 ... ... ... ... ... ... 2 Mantle Making ... 3 1 ... ... ... ... ... ... 4 Machining ... 1 1 ... ... ... ... ... ... 2 Medical Mission ... 1 ... ... ... ... ... ... ... 1 Marine Store ... 1 ... ... ... ... ... ... ... 1 Millinery ... ... ... ... ... ... ... ... 3 Mangling ... 1 ... ... ... ... ... ... ... 1 Newsagents ... ... ... ... ... ... 2 ... 4 Nursing Home ... ... ... ... 1 ... ... ... ... 1 Orphanage ... 1 2 ... ... ... ... ... ... 3 Oil Stores ... ... 2 ... ... ... ... ... ... 2 Pianoforte Manufacturing ... 1 2 ... ... ... ... ... ... 3 Pawnbrokers ... 1 ... ... ... ... ... ... ... 1 Provision Dealers ... 1 1 ... ... ... ... ... ... 6 Restaurant ... ... 1 ... ... ... ... ... ... 1 Surgeon ... 1 ... ... ... ... ... ... ... 1 Schools (Private) ... 1 1 ... ... ... ... ... ... 2 Tie Making ... ... ... ... ... ... ... ... ... 2 Tent Manufacturers ... 1 ... ... ... ... ... ... ... 1 Tailoring ... 1 ... ... ... ... ... ... ... 1 Tarpauling Works ... 1 ... ... ... ... ... ... ... 1 Tax Collecting ... 1 ... ... ... ... ... ... ... 1 Tablecloth Manufacturers ... ... 1 ... ... ... ... ... ... 1 Undertakers ... ... ... ... ... ... 1 ... ... 1 Waterproof Clothing ... ... ... ... ... ... ... ... ... 1 Wardrobe Dealers ... 1 ... ... ... ... ... ... ... 1 Walking Stick Finishers ... 1 ... ... ... ... ... ... ... 1 Watchmaking ... 1 ... ... ... ... ... ... ... 1 Wood Chopping ... ... 2 ... ... ... ... ... ... 2 Totals 86 65 ... 14 ... 19 ... ... 184 N 1912] 178 Table C. Showing the Stree`ts in which the several cases of Infectious Disease occurred during 1912. 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. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Almington Street ... 53 11 11 ... ... ... ... ... 74 Albert Street ... ... 11 ... 11 ... ... 11 ... 33 Alexander Road ... 43 ... 11 11 ... ... ... ... 65 Aubert Park ... 11 ... 11 ... ... ... ... ... 22 Arlington Street ... ... 76 ... ... ... ... ... ... 76 Alwyne Square ... ... 11 ... ... ... ... ... ... 11 Arlington Square ... 11 11 ... ... ... ... ... ... 22 Alwyne Place ... ... 11 ... ... ... ... ... ... 11 All Saints Street ... ... 22 ... ... ... ... ... ... 22 And over Street ... ... ... ... 11 ... ... ... ... 11 Alwyne Villas ... 22 ... ... 11 ... ... ... ... 33 Andover Road ... ... 22 ... 11 ... ... ... ... 55 Astey's Row ... ... 33 ... ... ... ... ... ... 33 Aberdeen Road ... 22 ... ... ... ... ... ... ... 22 Anatola Road ... 21 ... ... ... ... ... ... ... 21 Alpha Place ... ... 11 ... ... ... ... ... ... 11 Arundel Street ... ... 11 ... ... ... ... ... ... 11 Ashburton Grove ... 22 ... ... ... ... ... ... ... 22 Anson Road ... ... 11 ... ... ... ... ... ... 11 Ashby Road ... ... ... ... 11 ... ... ... ... 11 Annette Road ... 11 ... ... ... ... ... ... ... 11 Almorah Road ... ... ... 11 ... ... ... ... ... 11 Albany Cottages, Popham ... ... ... ... ... ... ... ... ... Street ... 22 ... ... ... ... ... ... ... 22 Alsen Road ... 11 ... ... ... ... ... ... ... 22 Avenell Road ... 11 ... ... ... ... ... ... ... 11 Adelaide Square ... ... ... ... 11 ... ... ... ... 11 Albion Street ... 11 ... ... ... ... ... ... ... 11 Andover Row ... ... ... ... 11 ... ... ... ... 11 Arthur Road ... 22 ... ... ... ... ... ... ... 22 Albion Grove ... 11 ... ... ... ... ... ... ... 11 Ambler Road ... 21 ... ... ... ... ... ... ... 21 Alma Terrace ... ... 11 ... ... ... ... ... ... 11 Blundell Street ... 11 22 ... 11 ... ... ... ... 44 Bingfield Street ... 32 22 ... ... 11 ... ... ... 64 Barnsbury Road ... 22 33 ... 22 ... ... ... ... 77 Baxter Road ... 3 3 11 ... ... 11 ... ... ... 56 Belitha Villas ... ... 11 ... ... ... ... ... ... 11 179 [1912 Table C,—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Brandon Road ... ... 11 ... ... ... ... ... ... 11 Birnam Road ... 11 22 ... ... ... ... ... ... 33 Blenheim Boad ... 11 22 ... ... ... ... ... ... 33 Brunswick Street ... 11 11 ... ... ... ... ... ... 21 Ben well Boad ... 11 11 ... 11 ... ... ... ... 33 Beaconsfield Buildings ... 54 22 ... ... ... ... ... ... 75 Bracey Street ... 43 ... ... ... ... ... ... ... 43 Brooksby Street ... 22 11 ... ... ... ... ... ... 32 Baring Street ... ... ... ... ... ... ... ... ... 11 Bemerton Street ... 11 ... ... ... 11 ... ... ... 54 Balls Pond Road ... 11 ... ... 11 ... ... ... ... 22 Beresford Boad ... 11 ... ... 11 ... ... ... ... 22 Blackstock Boad ... 42 ... ... ... 11 ... ... ... 53 Barbara Street ... 33 ... ... ... ... ... 11 ... 43 Barusbury Street ... 11 11. ... 11 ... ... ... ... 33 Bratton Street ... 11 ... ... 11 ... ... ... ... 22 Balmoral Grove ... ... ... ... 11 ... ... ... ... 11 Beversbrook Boad ... 11 ... ... ... ... ... ... ... 11 Bickerton Boad ... 11 11 ... ... 11 ... ... ... 33 Bardolph Boad ... 11 11 ... ... ... ... ... ... 22 Barnsbury Square ... ... ... ... 11 ... ... ... ... 11 Barnsbury Grove ... 11 11 ... ... ... ... ... ... 22 Bride Street ... 64 11 ... ... ... 11 ... ... 86 Battledean Boad ... ... 22 ... 11 ... ... ... ... 33 Britannia Row ... 22 ... ... 11 ... ... ... 32 Burns Buildings, Caledonian Boad ... 22 ... ... ... ... ... ... ... 22 Blythwood Boad ... 33 ... ... ... ... ... ... ... 31 Brewery Boad ... ... 42 ... ... ... ... ... ... 42 Bedford Terrace ... ... 11 ... ... ... ... ... ... 11 Brunswick Road ... 21 11 ... ... ... ... ... ... 32 Brecknock Road ... 11 11 ... ... ... ... ... ... 22 Boleyn Road ... ... 11 ... ... ... ... ... ... 11 Burnard Place ... ... 11 ... ... ... ... ... ... 11 Brookside Boad ... 11 11 ... 11 ... ... ... ... 22 Bryan Street ... 21 ... ... ... ... ... ... ... 21 Beaumont Boad ... 22 ... ... ... ... ... ... ... 22 Bryett Boad ... ... 11 ... ... ... ... ... ... 11 Boothby Boad ... ... 41 ... ... ... ... ... ... 41 Bismarck Boad ... 11 ... ... ... ... ... ... ... Bookbinders' Asylum, Balls Pond Boad ... ... ... ... 11 ... ... ... ... 11 Beacon Hill ... 21 ... ... ... ... ... ... ... 21 Buckingham Street ... ... ... ... 11 ... ... ... ... l1 N 2 1912] 180 Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Bryantwood Road ... ... 11 ... ... ... ... ... ... 11 Campbell Boad ... 33 11 ... 11 ... ... ... ... 55 Cloudesley Boad ... 44 22 ... 33 ... ... ... ... 99 Citizen Boad ... 22 22 ... ... ... ... ... ... 44 Corinne Boad ... ... ... ... ... ... 11 ... 11 Chatterton Boad ... 54 11 ... ... ... ... ... ... 66 Canterbury Road ... ... 11 ... 11 ... ... ... ... 22 Cottenham Boad ... 33 44 ... ... ... ... ... 11 87 Corbyn Street ... 11 22 ... ... ... ... ... ... 33 Clifton Terrace ... 53 ... ... ... ... ... ... ... 53 Clarence Street ... 22 ... ... 11 ... ... ... ... 33 Caledonian Road ... 97 44 ... 11 ... ... ... ... 1412 Canonbury Grove ... ... ... ... 11 ... ... ... ... i1 Cumberland Street ... 62 22 ... 11 ... ... 11 ... 11 Carleton Boad ... 22 ... 11 21 ... ... ... ... 53 Cottenham Terrace ... 11 ... ... 11 ... ... ... ... 22 Cromwell Road ... 43 ... ... ... ... ... ... ... 43 Cressida Road ... ... ... ... ... ... 11 ... ... 11 Cornwallis Boad ... 11 58 ... ... ... ... ... ... 74 Compton Boad ... 32 11 ... ... ... ... ... ... / 42 Cathcart Hill ... 21 ... ... ... ... ... ... ... 21 Canon Street ... ... 11 ... ... ... ... ... ... 11 Canonbury Square ... 11 ... 11 ... ... ... ... ... 22 Courtney Boad ... 11 ... ... ... ... ... ... ... 11 Canonbury Boad ... 22 11 ... 11 ... ... 11 ... 55 Camden Boad ... 33 22 ... ... ... ... ... ... 55 Cross Street ... 21 11 ... ... ... ... ... ... 32 Canonbury Avenue ... 11 76 ... 11 ... ... ... ... 96 College Street ... 11 11 ... ... ... ... ... ... 22 Camden Street ... 21 11 ... 11 ... ... ... ... 48 Cloudesley Square ... ... ... ... 11 ... ... ... ... 11 Colebrooke Row ... 11 ... ... 11 ... ... ... ... 22 Conewood Street ... 43 ... 11 ... ... ... ... ... 54 Canning Road ... 11 41 ... ... ... ... ... ... 52 City Road ... 33 ... ... ... ... ... ... ... 33 Compton Street ... 11 ... ... ... ... ... ... 11 22 Cheverton Boad ... 22 ... ... ... ... ... ... ... 22 Charlotte Terrace ... 11 ... ... ... ... 22 ... ... 33 Crayford Boad ... 11 11 ... 11 ... ... ... ... 33 Calverley Grove ... 33 22 ... ... ... ... ... ... 54 Clayton Street ... ... ... ... ... 11 ... ... ... 11 Charlton Crescent ... ... ... 11 ... ... ... ... ... 11 Coleman Street ... 11 ... ... 11 ... ... ... ... 22 Charlotte Street ... ... 11 ... ... ... ... ... ... 11 181 [1912 Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Cardale Street ... ... ... ... ... ... ... 11 ... 11 Copenhagen Street ... 22 22 ... 11 ... ... ... ... 52 Cleveland Road ... 11 22 ... ... ... ... ... ... 33 Church Road ... 22 11 ... ... ... ... 11 ... 44 Clialfont Road ... 33 ... ... ... ... ... ... ... 38 Crouch Hill ... ... ... ... 11 ... ... ... ... 11 Caledonian Crescent ... ... 11 ... ... ... ... ... ... 11 Corinth Road ... 54 ... ... ... ... ... ... ... 54 Canonbury Park North ... 11 ... ... ... ... ... ... ... 11 Canal Terrace ... 11 ... ... ... ... ... ...... ... 11 Cornwall Cottages, Popham Street ... ... 22 ... ... ... ... ... ... 22 City Arms Buildings, North Road ... 11 41 ... ... ... ... ... ... Caledonia Street ... 31 21 ... ... ... ... ... ... 62 Corporation Street ... 21 11 ... ... ... ... ... ... 32 Charles worth Street ... ... 11 ... ... ... ... ... ... 11 Crossley Street ... 64 11 ... 11 ... ... ... ... 86 Charlotte Street ... ... ... ... 11 ... ... ... ... 11 Church Street ... 11 ... ... ... ... ... ... ... 11 Compton Avenue ... ... 11 ... ... ... ... ... ... 11 Church Lane ... ... ... ... 11 ... ... ... ... 11 Cornelia Street ... 54 ... ... ... ... ... ... ... Compton Cottages, Canoubury Road ... 11 ... ... ... ... ... ... ... 11 Canonbury Street ... ... 11 ... ... ... ... ... ... 11 Charteris Road ... ... ... ... ... ... ... 11 ... 11 Cornwall Cottages, Eden Grove ... 11 ... ... ... ... ... ... ... 11 Cloudesley Place ... ... ... ... 11 ... ... ... ... 11 Cruden Street ... 22 ... ... ... ... ... ... ... 22 Canonbury Park South ... ... ... 11 ... ... ... ... ... 11 Canonbury Street ... ... ... 11 ... ... ... ... ... 11 Canonbury Lane ... 11 ... ... ... ... ... ... ... 11 City Garden Row ... ... 11 ... ... ... ... ... ... 11 Cromartie Road ... ... 11 ... ... ... ... ... ... 11 Dean Street ... 33 ... ... 11 ... ... ... ... 44 Durham Road ... 22 22 ... ... ... ... 11 ... 44 Dame Street ... 11 22 ... 11 11 ... ... ... Downham Road ... ... 42 ... 11 ... ... 11 ... 55 64 Delhi Street ... 32 11 ... ... ... ... ... ... 42 Dorset Street ... 11 11 ... ... ... 11 ... ... 33 Denmark Grove ... 22 11 ... ... ... ... ... ... 33 Dorinda Street ... ... 11 ... ... ... ... ... ... 11 Denmark Road ... ... 11 ... ... ... ... ... ... 11 1912] 182 Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Devonshire Street ... ... 11 ... ... ... ... ... ... 11 Delhi Street ... ... 11 11 ... ... ... ... ... 22 Duncan Terrace ... 22 11 ...... 11 ... ... ... ... 44 Douglas Road ... 22 ... 11 ... ... ... ... ... 33 Devonshire Road ... 21 32 ... 11 ... ... ... ... 64 DunFord Road ... 11 11 ... ... ... ... ... ... 22 Dagmar Terrace ... ... 11 11 ... ... ... ... ... 22 Dillon Place ... 11 ... ... ... ... ... ... ... 11 Duncombe Road ... ... 42 ... ... ... ... ... ... 42 Dalmeny Avenue ... 11 ... ... ... ... ... ... ... 11 Despard Road ... 11 ... ... ... ... ... ... ... 11 Danbury Street ... ... 11 ... ... ... ... ... ... 11 Dalmeny Road ... l1 ... ... ... ... ... ... ... 11 Dagmar House, Cross Street ... ... 22 ... ... ... ... ... ... 22 Davenant Road ... 11 ... ... ... ... ... ... ... 11 Drayton Park ... ... 11 ... ... ... ... ... ... 11 Eden Grove ... ... 22 ... ... ... ... ... ... 22 Essex Road ... 33 75 32 22 ... ... ... ... 1512 Elmore Street ... 74 22 ... l1 11 ... ... ... 116 Edward Square ... 21 22 ... ... ... ... ... ... 43 Englefield Road ... 22 ... ... 22 ... ... ... ... 44 Ellenborough Road ... ... 31 ... 11 ... ... ... ... 42 Elfort Road ... l1 33 ... 11 11 ... ... ... 66 Elthorne Road ... 43 22 ... ... ... ... ... ... 65 Elton Place ... ... ... ... 11 ... ... ... ... 11 Enkel Street ... ... ... ... 11 ... ... ... ... 11 Ecclesbourne Road ... ... 22 ... ... ... ... ... ... 22 Ebury Street ... ... 11 ... ... ... ... 11 ... 22 Elton Street ... 11 11 ... ... ... ... ... ... 22 Everilda Street ... 11 ... ... ... ... ... ... ... 11 Ebenezer Buildings, Rotherfield Street ... ... 11 ... ... ... ... ... ... 11 East Street ... ... ... ... 11 ... ... ... ... 11 Evershot Road ... ... ... ... 11 ... ... ... ... l1 Electric Parade ... 21 ... ... ... ... ... ... ... 21 Elwood Street ... 22 ... ... ... ... ... ... ... 22 Ellington Street ... 11 ... ... ... ... ... ... ... 11 Elliott's Gardens ... 11 ... ... ... ... ... 11 ... 11 Fairbridge Road ... 66 66 11 11 ... ... ... ... 1513 Fonthill Road ... 33 11 11 ... ... ... 22 ... 77 Fieldway Crescent ... 11 ... ... ... ... ... ... ... . 11 Fairmead Road ... ... 11 ... 11 ... ... ... ... 22 Fife Terrace ... 11 ... ... ... ... ... ... ... 11 Foxham Road ... 31 ... ... ... ... ... ... ... 31 183 [1912 Table C,-~-continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Florence Street ... 11 22 ... ... ... ... ... ... 33 Framfield Road ... ... 11 ... ... ... ... ... ... 11 Freeling Street ... ... 11 ... ... 11 ... 11 ... 33 Fakenham Street ... ... ... ... ... ... 11 ... ... 11 Frederick Street ... 22 ... ... ... ... ... ... ... 22 Freegrove Road ... 11 11 ... ... ... ... ... ... 22 Fern tower Road ... 11 ... ... ... ... ... ... ... 11 Frome Street ... 11 ... ... ... ... ... ... ... 11 Furlong Road ... 11 ... ... ... ... ... ... ... 11 . Fowler House, Halton Road ... 11 ... ... ... ... ... ... ... 11 Grosvenor Street ... ... ... 11 ... ... ... ... 22 Grafton Road ... 33 43 ... ... ... ... ... 11 87 Gifford Street ... 33 33 ... 11 11 ... 11 ... 98 Great Northern Hospital, Holloway Road ... 11 41 ... ... ... ... ... ... 51 Garden Villas ... ... 11 ... ... ... ... ... ... 11 Grosvenor Road ... 11 ... ... 11 ... ... ... ... 22 Graham Street ... ... ... ... 22 ... ... ... ... 22 Gillespie Road ... 64 ... ... 11 ... ... ... ... 75 Gladsmuir Road ... 31 ... ... ... ... ... ... ... 31 Green Lanes ... 21 ... ... ... ... ... ... ... 21 George's Road ... 11 33 ... 11 ... ... ... ... 55 Grantbridge Street ... 33 11 ... ... ... ... ... ... 44 Goodinge Road ... 73 11 ... ... ... ... ... ... 84 Grove Road ... 22 ... ... ... ... ... ... ... 86 Gainford Street ... 22 11 ... ... ... ... ... ... 33 Grace Street ... 11 ... ... ... ... ... ... ... 11 Goldsmith Place ... 22 ... ... ... ... ... ... ... 22 Gerrard Street ... 22 ... ... ... ... ... ... ... 22 Goodwin Street ... 11 11 ... ... ... ... ... ... 21 Gordon Street ... 11 ... ... ... ... ... ... ... 11 Gibson Square ... 22 ... ... ... ... ... ... ... 33 Gloucester Road ... 11 ... ... ... ... ... ... ... 11 Gordon Place ... ... ... ... ... ... ... ... ... 11 Guardian Schools, Hornsey Road ... ... ... ... ... ... ... ... 11 11 Grovedale Road ... 11 ... ... ... ... ... ... ... 11 Holloway Road ... ... 53 11 ... ... ... 11 ... I210 Havelock Street ... ... 53 ... ... ... ... ... ... 64 Hornsey Road ... 88 1210 ... ... ... ... 11 ... 2219 Hemingford Road ... 32 22 11 ... ... ... ... ... 66 Hanley Road ... 32 22 ... ... ... ... ... ... 55 Hillmarton Road ... 11 ... ... ... ... ... ... ... 11 Hilldrop Road ... 11 ... ... ... ... ... ... ... 11 1912] 184 Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Halton Road ... 11 33 ... 22 ... ... ... ... 66 Hargrave Park ... 33 11 ... ... ... ... ... ... 44 Henry Place ... ... ... ... ... ... ... 11 ... 11 Hornsey Rise ... ... 64 ... ... ... ... ... ... 64 Hertslet Road ... 11 11 ... ... ... ... ... ... 22 Hanover Street ... 11 22 ... 11 ... ... ... ... 44 Horsell Road ... ... ... ... 11 ... ... ... ... 11 Highbury New Park ... 22 ... ... ... ... ... ... ... 22 Halliford Street ... 33 11 ... ... ... ... ... ... 44 Hardinge Street ... ... ... 11 ... ... ... ... ... 11 Hampden Road ... 11 22 11 ... 11 ... ... 11 65 Hazellville Road ... ... ... ... 11 ... ... ... ... 11 High Street ... ... ... 11 ... ... ... ... ... 11 Hartham Road ... 22 ... 11 ... ... ... ... ... 22 Hatchard Road ... ... 22 ... ... ... ... ... ... 22 Hyde Place East ... ... 11 ... ... ... ... ... ... 11 Hornsey Street ... 33 44 ... 11 ... ... ... ... 86 Highbury Quadrant ... ... ... ... ... ... ... ... 11 11 Halton Cross Street ... ... 11 ... ... ... ... ...... ... 11 Highgate Hill ... ... 11 ... ... ... ... ... ... 11 Highbury Park ... 11 ... ... ... ... ... ... ... 11 Hugo Road ... 11 ... ... ... ... ... ... ... 11 Harvest Road ... 22 ... ... ... ... ... ... ... 22 Halliford House, Upper Park Street ... 11 ... ... ... ... ... ... ... 11 Highbury Place ... 11 ... 11 ... ... ... ... ... 22 Hurlock Street ... 33 ... ... ... ... ... ... ... 33 Hargrave Road ... 32 ... ... ... ... ... ... ... 32 Holling worth Street ... 11 11 ... ... ... ... ... ... 22 Highbury Hill ... 75 11 ... ... ... ... ... ... 86 Hatley Road ... 11 11 ... ... ... ... ... ... 22 Herrick Road ... 52 ... ... ... ... ... ... ... 52 Hyde Street ... 11 ... ... ... ... ... ... ... 11 Hanley Road ... 11 ... ... ... ... ... ... ... 11 Huddlestone Road ... 22 11 11 ... ... ... ... ... 44 Hope Place ... ... 11 ... ... ... ... ... ... 11 Hamilton Mews ... 11 ... ... ... ... ... ... ... 11 Harberton Road ... 11 ... ... ... ... ... ... ... 11 Hilldrop Crescent ... 11 ... ... ... ... ... ... ... 11 Islington Infirmary ... 2 3 ... 4 ... ... ... ... 91 Isledon Road ... 33 32 ... 11 ... ... ... ... 76 Islington Workhouse, St. John's Road ... ... 1 ... 1 ... ... ... ... 21 Islington Green ... 11 ... ... ... ... ... ... ... 11 185 [1912 Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonaiorum. Polio-Myelitis. Totals. Ingleby Road ... 44 ... ... ... ... ... ... ... 43 Junction Road ... 44 ... ... ... ... ... ... ... 44 Jackson Road. ... 22 22 ... ... ... ... ... ... 43 King Henry Street ... ... 48 11 ... ... ... ... ... 54 King Henry's Walk ... 22 11 ... ... ... ... ... ... 38 Kelross Road ... 11 ... ... 11 ... ... ... ... 22 Kiver Road ... l1 11 ... ... ... ... ... ... 22 Kelvin Road ... 51 ... ... ... ... ... ... ... 54 Kingsbury Road ... ... ... ... 11 ... ... ... ... l1 Kingsdown Road ... 22 33 ... ... ... ... ... ... 55 King Edward's Buildings, Brewery Road ... 11 ... ... ... ... ... ... ... 11 King Edward Street ... 21 ... ... ... ... ... ... 21 Keystone Crescent ... ... 21 ... ... ... ... ... ... 21 Knox Buildings, Caledonian road ... 21 ... ... ... ... ... ... ... 21 Liverpool Road ... 149 22 ... 55 ... 11 11 ... 2317 Lesly Street ... 53 11 ... 11 ... ... ... ... 75 Linton. Street ... 11 11 ... ... ... ... ... ... 22 London Street ... 22 ... ... ... ... ... ... ... 22 Leconfield Road ... 11 ... ... 22 ... ... ... ... 33 Lofting Road ... 33 ... ... ... ... ... 11 ... 41 Lysander Grove ... ... 11 ... ... ... ... ... 11 London Fever Hospital ... 1 3 ... ... ... ... ... ... 4 Lonsdale Square ... 11 ... ... 11 ... ... ... ... 22 Landseer Road ... 11 11 ... ... ... ... ... ... 22 Lidyard Road ••• 11 11 ... ... ... ... ... ... 22 Lennox Road ... 21 32 ... ... ... ... ... ... 52 Lyon Street ... ... 22 ... ... ... ... ... ... 22 Luard Street ... ... ... ... ... ... ... 11 ... 11 Lady Margaret Road ... ... 22 ... ... ... ... ... ... 22 Langdon Road ... 44 22 ... ... ... ... ... ... 66 Liverpool Buildings, Liverpool Road ... 11 11 ... ... ... ... ... ... 22 Lambton Road ... 11 ... ... ... ... ... ... ... 11 Lavina Grove ... ... 11 ... 11 ... ... ... ... 22 Lucerne Road ... 22 ... ... ... ... ... ... ... 22 Little Cross Street ... 11 ... ... ... ... ... ... ... 11 Loraine Road ... ... 11 ... ... ... ... ... ... 11 Leigh Road ... 11 ... ... ... ... ... ... ... 11 Milton Grove ... 11 11 ... ... ... ... ... ... 22 Mitford Road ... 32 ... ... ... 11 ... ... ... 54 Moray Road ... 51 76 ... ... ... ... 1l ... 1311 Marquess Road ... 38 ... 11 11 ... ... ... ... 55 186 1912] Table C.—continued. NAME OF STREET Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Mulkern Road ... 33 11 ... ... ... ... ... 11 54 Montem Street ... 22 ... ... ... ... ... ... ... 22 Marlborough Road ... 56 33 ... 11 ... ... ... ... 99 Mayville Street ... 44 ... ... ... ... ... ... ... 44 Mildmay Street ... 76 33 ... ... ... ... ... ... 108 Mildmay Park ... 11 ... ... 11 ... ... ... ... 22 Market Street ... 22 11 ... 11 ... ... ... ... 44 Mildmay Road ... 11 11 ... 11 ... ... ... ... 38 Martineau Road ... 11 ... ... ... ... ... ... ... 11 Milner Square ... 32 ... ... 11 ... ... ... ... 48 Maygcod Street ... ... 11 ... 11 ... 11 ... ... 38 Morton Road ... 11 ... ... ... ... ... ... ... 11 Melgund Road ... 33 ... ... ... ... ... ... ... 38 May ton Street ... 44 ... ... 22 ... ... ... 11 76 Middlesex Street ... ... 11 ... ... ... ... ... ... 11 Mildmay Grove ... ... 11 ... ... ... ... ... ... 11 Moreland Street ... 11 ... ... ... ... ... ... ... 11 Milton Place ... 11 11 ... ... ... ... ... ... 22 Morgan Mansions ... ... ... ... ... 11 ... ... ... 11 Moon Street ... 11 ... ... ... ... ... ... ... 11 Matthias Road ... 11 ... ... ... ... ... ... ... 11 Mercers Road ... 11 ... ... ... ... ... ... ... 11 Magdala Road ... 11 ... ... ... ... ... ... 11 Marcellus Road ... 11 ... ... ... ... ... ... ... 11 Muriel Street ... ... 11 ... ... ... ... 11 ... 22 Miranda Road ... 11 ... ... ... ... ... ... ... 11 Monsell Road ... 11 ... ... ... ... ... ... 11 Myddleton Buildings, High Street ... ... ... 11 ... ... ... ... ... 11 Marriott Road ... 22 ... ... 11 ... ... ... ... 38 Mayville Grove ... ... ... ... ... ... 11 ... ... 11 Matilda Street ... ... ... ... 11 ... ... ... ... 11 New North Road ... ... 11 ... 11 ... ... ... ... 86 Northdown Street ... 33 ... ... 38 ... ... ... ... 65 Newington Green Road ... 21 ... ... ... ... ... ... ... 21 Nicholay Road ... ... 11 ... ... ... ... ... ... 11 Norfolk Road ... 63 ... ... ... ... ... ... ... 68 Noel Street ... 22 ... ... ... ... ... ... ... 22 North Road ... 11 31 ... ... ... ... ... ... 42 North Avenue ... 22 11 ... ... ... ... 11 ... 48 Newington Green ... ... l1 l1 ... ... ... ... ... 22 Nailour Street ... ... • • • 11 ... ... ... ... ... 11 Outram Street ... 21 ... ... 11 ... ... ... ... 32 Oxtord Road ... ... ... ... 11 ... ... ... ... 11 187 [1912 Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Orpingley Road ... 22 44 ... ... ... ... ... ... 64 Ockenden Road ... 11 33 ... 11 ... ... ... ... 53 Ormonde Road ... ... 11 ... ... ... ... ... ... 11 Oakley Road ... ... 11 ... ... ... ... ... ... 11 Oftord Road ... 33 ... 11 11 ... ... ... ... 55 Orchard Street ... ... 11 ... ... ... ... ... ... 11 Offord Street ... 11 ... ... ... ... ... ... ... 11 Pulteney Street ... 31 22 ... 11 ... ... ... ... 64 Prebend Street ... 22 22 .... ... 11 ... ... ... 55 Park Street ... 22 22 ... 11 ... ... ... ... 54 Paddington Street ... 11 ... ... ... ... ... ... ... 11 Petherton Road ... ... ... ... 11 ... 11 ... ... 22 Poynings Road ... 11 11 ... ... ... ... ... ... 22 Pickering Street ... ... 22 ... 11 ... ... ... ... 33 Pemberton Gardens ... 43 ... ... ... ... ... ... ... 43 Packington Street ... 1l 11 ... ... ... ... ... ... 22 Providence Row ... ... ... ... 11 ... ... ... ... 11 Prospero Road ... ... ... ... 21 ... ... ... ... 21 Pembroke Street ... 22 54 11 11 ... 11 ... ... 108 Popham Road ... 22 11 ... 11 ... ... ... ... 44 Poole's Paik ... 43 22 ... 11 ... ... ... ... 74 Payne Street ... 11 11 ... ... ... ... ... ... 23 Parkfield Street ... 11 21 ... ... ... ... 11 ... 43 Pyrland Road ... ... ... ... 11 ... ... ... ... 11 Peabody Buildings, Green mail Street ... 22 ... ... ... ... ... ... ... 22 Pentonville Prison ... 1 1 ... ... ... ... ... ... 21 Parkhurst Road ... 11 22 ... ... ... ... ... ... 33 Pulteney Terrace ... ... 11 ... ... ... ... ... ... 11 Palmerston Buildings, City Garden Row ... 11 ... ... ... ... ... ... ... 11 Pleasant Place ... 21 ... ... ... ... ... ... ... 2l Plimsoll Road ... 33 ... ... 11 ... ... ... ... 44 Prospect Row, Balls Pond Road ... 22 ... ... ... ... ... ... ... 22 Playford Rnad ... 11 22 ... ... ... ... ... ... 33 Pemberton Terrace ... 11 11 ... ... ... ... ... ... 22 Popham Street ... ... 11 ... ... ... ... ... ... 11 Pakeman Street ... 11 ... ... ... ... ... ... ... 11 Poets' Road ... ... 11 ... ... ... ... ... ... 11 Queen's Cottages, Popham Street ... ... 43 ... 11 ... ... ... ... 54 Queen's Square ... 22 ... ... ... ... ... ... ... 22 Queensland Road ... 33 11 ... ... ... ... 22 ... 65 Queen's Head Street ... 11 11 ... ... ... ... ... ... 22 1912] 188 Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Queensbury Street ... 33 ... ... 11 ... ... ... 44 Qainn Buildings, Popham Street ... 11 11 ... 11 ... ... ... ... 38 Queen's Arms Buildings, North Road ... ... ... ... 11 ... ... ... ... 11 Queen Margaret's Grove ... ... 11 ... ... ... ... ... ... 11 Boden Street ... 11 22 11 ... ... ... ... 44 Rotherfield Street ... 22 11 ... 22 ... ... ... ... 55 Rosemary Street ... ... ... ... 11 ... ... ... ... 11 Randalls Road ... 11 ... ... ... ... ... ... ... 11 Regina Road ... 11 11 ... ... ... ... ... ... 23 Rock Street ... ... 11 ... ... ... ... ... ... 11 Ronald's Road ... 22 11 ... ... ... ... ... ... 33 Rupert Road ... ... 38 ... ... ... ... ... ... 33 Roman Road ... 1210 11 ... ... ... ... ... ... 64 Riversdale Road ... 64 ... ... ... ... ... ... ... Raynor Place ... ... 11 ... ... ... ... ... ... 11 River Street ... ... ... ... 11 ... ... ... ... 11 Rhodes Street ... 44 11 ... 11 ... ... ... ... 65 Ralph Street ... ... ... ... 11 ... ... ... ... 11 Russell Road ... ... ... 21 ... ... ... ... ... 21 Rheidol Terrace ... ... 31 11 ... ... ... ... ... 42 Rosa Alba Mews, Kelross Road ... 11 ... ... ... ... ... ... ... 11 Rufford Street ... ... ... ... 11 ... ... ... ... 11 Stavordale Road ... 11 22 ... ... ... ... ... ... 33 Sonning Street ... 64 ... ... ... ... ... 11 ... 75 South Street ... 33 ... ... 11 ... ... ... ......44 Stanley Terrace ... 11 ... ... ... ... ... ... ......11 Stanley Road ... 22 11 ... ... ... ... ... ... 33 Shepperton Road ... ... 44 ... 11 ... ... ... ... 55 St. Clement's Street ... 21 11 ... ... ... ... ... ... 32 Stroud Green Road ... 11 ... ... ... ... ... ... ... 11 Sudeley Street ... 11 ... 11 ... ... ... ... ... 22 Sable Street ... ... 11 ... ... ... ... ... ... 11 Fam Lewis' Buildings, Liverpool Road ... 66 11 ... 11 ... ... ... ... 88 Scholefield Road ... ... 43 11 ... ... ... ... ... 54 St. John's Park Mansions ... 43 ... ... ... ... ... ... ... 43 Shaftesbury Road ... 11 21 ... ... ... ... ... ... 32 St. John's Villas ... ... 11 ... ... ... ... ... ... 11 St. Alban's Place Upper Street ... ... 11 ... ... ... ... ... ... 11 St. James Road ... 65 22 ... 22 ... ... ... ... 109 Stanmore Street ... 22 ... ... ... ... ... ... ... 22 Falisbury Road ... 48 ... ... ... ... ... ... ... 48 St. Peter Street ... ... 22 ... I1 ... ... ... ... 38 189 [1912 Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Story Street ... ... 22 ... 22 ... ... ... ... 44 Sheen Grove ... 11 32 ... ... ... ... ... ... 42 St. Paul's Road ... 53 22 ... 11 ... ... ... ... 85 Sussex Road ... 54 22 ... 11 ... ... ... ... 87 Studd Street ... ... 11 ... 11 ... ... ... ... 22 Stonefield Street ... ... 22 ... ... ... ... ... ... 22 St. George's Avenue ... ... ... 11 ... ... ... ... ... 11 St. Jude Street ... ... ... ... ... ... ... 11 ... 11 Stock Orchard Crescent ... 32 ... 11 11 ... ... ... ... 54 St. John's Park ... 11 42 ... ... ... ... ... ... 53 St. Paul's Street ... 21 22 ... ... ... ... ... ... 43 Station Road, Highbury ... 21 ... ... ... ... 11 ... ... 32 St. Peter's Road ... 11 ... ... ... ... ... ... ... 11 Scott's Buildings, Caledonian Road ... 21 11 ... ... ... ... ... ... 32 Spencer Street ... ... ... ... 11 ... ... ... ... 11 St. John's Road ... 33 11 ... ... ... ... ... ... 44 St. Thomas' Road ... 76 11 11 ... ... ... ... ... 98 Sonderberg Road ... 22 ... ... 11 ... ... ... ... 33 Sutterton Street ... 11 11 ... ... ... ... 11 ... 33 Salisbury House, Holloway Road ... 11 ... ... ... ... ... ... ... 11 Southgate Road ... ... 22 ... 22 ... ... ... ... 44 Sun Row ... ... ... ... 11 ... ... ... ... 11 Southcote Road ... 31 ... ... ... ... ... ... ... 31 Stonenest Street ... 11 ... ... ... ... ... ... ... 11 Sebbon Street ... 11 ... ... ... ... ... ... ... 11 Seven Sisters' Road ... 55 ... ... ... ... ... ... ... 55 Sheringham Road ... ... ... ... 11 ... ... ... ... 11 Sotheby Road ... 11 ... ... ... ... ... ... ... 11 St. James Mansions, St. James' Road ... ... ... ... 11 ... ... ... ... 11 Sparsholt Road ... 11 ... ... ... ... ... ... ... 11 Surr Street ... 11 ... ... ... ... ... ... 11 Sherbourne Street ... ... ... ... 11 ... ... ... ... 11 Thorpedale Road ... 54 43 ... ... ... ... ... ... 97 Tremlett Grove ... ... 63 ... 11 ... ... ... ... 74 Tufnell Park Road ... 22 33 11 ... ... ... ... ... 66 Thane Villas ... 11 11 ... ... ... ... ... ... 22 Tollington Road ... ... 11 ... 11 ... ... ... ... 22 Tavistock Terrace ... 11 ... 11 ... ... ... ... 22 Thornhill Square ... ... 22 ... ... ... ... ... ... 22 Tollington Park ... 38 21 ... 22 ... ... ... ... 76 Thornhill Road ... ... 22 ... ... ... ... ... ... 22 Trinity Street ... ... 11 11 ... ... 11 ... ... 33 190 1912] Table C.—continued. NAME OF STREET. Small Pox. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Erysipelas. Puerperal Fever. Cerebro-Spinal Fever. Ophthalmia Neonatorum. Polio-Myelitis. Totals. Tibberton Square ... ... 11 ... ... ... ... ... ... 11 Tabley Road ... 54 ... ... ... ... ... ... ... 54 Theberton Street ... 32 ... ... 11 ... ... ... ... 43 Torrens Buildings, City Road ... ... 11 11 ... 11 ... ... ... 38 Tiber Street ... 22 ... ... ... ... ... ... ... 22 Twyford Street ... ... 22 ... 11 ... ... ... ... 33 Tollington Place ... 21 51 ... ... ... ... ... ... 72 Thornliill Houses, Tliornliill Road ... 11 ... ... ... ... ... ... ... 11 Tiverton House, Pleasant Place ... ... ... ... 11 ... ... ... ... 11 Tyler's Cottages, King Henry's Walk ... ... ... ... 11 ... ... ... ... 11 Upper Street ... 22 22 22 ... ... ... ... ... 66 Upper Park Street ... 11 ... ... ... ... ... ... ... 11 Victor Road ... 21 22 ... ... ... ... ... ... 43 Yorley Road ... 44 11 ... ... ... ... ... ... 54 Victoria Place ... 11 11 ... ... ... ... ... ... 22 Victoria Road ... ... ... ... 11 ... ... ... ... 11 Vincent Terrace ... 11 ... ... ... ... ... ... ... 11 Warrender Eoad ... 21 11 ... ... ... ... ... ... 32 Westbourne Road ... 53 11 ... ... ... ... 11 ... 73 Windsor Street ... 22 11 ... ... ... ... ... ... 33 Wellinrton Road ... 22 22 ... 11 ... ... 11 ... 66 Wessex Buildings, Weamore Street ... 11 22 ... ... ... ... ... 22 54 Whistler Street ... 11 ... ... ... ... ... ... ... 11 Windsor Road ... ... 11 ... 22 ... ... ... ... 33 Warner Street ... 22 ... ... ... ... ... ... ... 22 Wall Street ... 32 11 ... 11 ... ... ... ... 54 Wharfdale Boad ... 22 ... ... 11 ... ... ... • •• 33 Winchester Street ... ... ... ... 33 ... 11 ... ... 44 Wallace Buildings, Caledonian Boad ... 11 ... ... ... ... ... ... ... 11 William Street ... 22 ... ... ... ... ... ... ... 2 Wilton Square ... 11 ... ... ... ... ... ... ... 11 Whewell Boad ... 11 ... ... ... ... ... ... ... 11 Woodville Grove ... 22 ... ... ... ... ... ... ... 22 Wallace Road ... 11 ... ... ... ... ... ... ... 11 Witley Boad ... 11 ... ... ... ... ... ... ... 11 Williamson Street ... 11 ... ... ... ... ... ... ... 11 Witherington Eoad ... 11 ... ... ... ... ... ... ... 11 Wedmore Street ... ... 11 ... ... ... ... ... ... 11 Yonge Park ... ... ... ... 11 ... ... ... ... 11 Yerbury Road ... 31 ... ... ... ... ... ... ... 31 York Road ... ... ... 11 ... ... ... ... ... 11 191 [1912 BACTERIOLOGICAL EXAMINATIONS. A larger number of these examinations were made for the medical profession during 1912 than in any year since the Council undertook the work, for altogether 945 specimens of sputum or blood were examined. These figures contrast with 788 in 1911, 682 in 1910, and 577 in 1909. The work is much appreciated and has been most useful. Diphtheria.—435 swabs of mucus taken from the throats of patients suspected to be suffering from Diphtheria were examined, as contrasted with 484 in 1911. 137 positive results were obtained ; and the cases were afterwards duly notified by the practitioners. Enteric Fever.—50 specimens of blood were examined, 23 being positive and 27 negative. Phthisis.—460 specimens of sputum were examined, which is an increase of 208 on the record for 1911. This increase was without doubt due to two causes, the first of which was the compulsory notification of the disease under the Public Health (Tuberculosis) Regulations, 1911, and the second to the advent of the National Insurance Act. Of the 460 specimens, 119 gave positive results, and 341 negative. As usual, the examinations were made by the Lister Institute, which during the last 13 years has made no less than 6,666 examinations for this Council. Of these 3,127 were of specimens from the throats of diphtheritic patients 998 were of blood from suspected enteric fever patients, and 2,541 were of sputa from suspected phthisical cases. The following Tables give the results of the examinations that have been made during the last 14½ years. Diseases. Total Examinations. Positive Results. Negative Results. Percentage of Positive Results. Diphtheria 3,127 1,068 2,059 34.1 Enteric Fever 998 443 555 44.4 Phthisis 2,541 813 1,728 32.0 Total 6,666 2,324 4,342 34.9 192 1912] Table CI. Showing the result of the Bacteriological Examinations made for thi Diagnosis of Diphtheria, Enteric Fever and Phthisis, 1898 1912. Periods. Diphtheria. Enteric Frver. Phthisis. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Positive Results. Negative Results. Total Examined. Totals. 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 1912 137 298 435 23 27 50 119 341 460 945 Totals (for 14J years) .. 1068 2059 3127 413 555 998 813 1728 2541 6666 VACCINATION, OR THE STATE OF PREPAREDNESS OF THE BOROUGH TO MEET SMALL POX. To any man who has seen the ravages of Small Pox such as the Medical Officer of Health has beheld, the vaccination returns of the last seven years have been melancholy reading, for it will be noticed in the Table immediately following that the vaccinations have gradually declined from 1888 to the present time. In the former year they represented 82.3 per cent, of the births, while in the latter they figure at 62.3 per cent. It is much to be feared that this diminishing percentage will go on still further decreasing and the possibility 193 [1912 of a serious epidemic of Small Pox increasing, until the Government once more take up a strong position in this matter, for in the opinion of those who are best able to judge, the country will one day have to pay a terrible reckoning for the policy of those responsible for the guidance of the nation. It has been the lot of few Medical Officers of Health to have seen so much Small Pox as the writer, and, consequently, the dreadful consequences which follow on the neglect of vaccination. He would, therefore, raise a warning voice and beg of those, whose duty it is to ward off this terrible affliction from these islands by the one sure method known to science, to do their duty:— 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 8o.o 1887 90.4 1903 81.2 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 1911 62.3 In the year 1911, which is the year under consideration, so far as vaccination is concerned, it was found that of the 7,723 children born, 619 died unvaccinated, so that there remained 7,104 who were liable to the operation, and of these only 4427, or 62.3 per cent, were vaccinated. Insusceptibility—36 infants were said to be insusceptible to vaccination. Died Unvaccinated.—As already stated, 619 infants died before vaccination could be performed. This number shows an increase on that of the preceding 4 years, as may be seen in Table CI1. 011 page 195, which gives o 194 1912] the state of vaccination in Islington from 1880 to the end of the first six months of 1912. Certificates of Exemption.—1,241 of these certificates, or statutory declarations, were sent to the Vaccination Officers, which is by far the largest number hitherto recorded. How large the increase is may be seen in the following statement, which shows that whereas in 1897 the exemptions only numbered 14, in 1911 they had increased to 1,241:— 1897 ... 14 1905 ... 110 1898 ... 103 1906 ... 123 1899 ... 101 1907 ... 259 1900 .,. 127 1908 ... 588 1901 ... 106 1909 ... 824 1902 ... 73 1910 ... 1,080 1903 ... 103 1911 ... 1,241 1904 ... 89 If these years be divided into quinquennial periods, the exemptions will be possibly more clearly appreciated:— 1897—1901 ... 451 1902—1906 ... 498 1907—1911 ... 3,992 Thus we see that these exemptions from vaccination increased by 885 per cent, from the first of these quinquennial periods. The following Table shows how the exemptions were distributed throughout the borough and the percentages they bore to the births, less the children who died unvaccinated:— Registration Sub-District. Births, less Infants died unvaccinated Exemptions. Percentage of Exemption Certificates to Births. . Tufnell 704 141 200 Upper Holloway 857 127 14-8 T ollington 662 122 18-4 Highbury 1,141 260 22-8 Lower Holloway 863 120 13-9 Barnsbury 1,328 171 12-9 Islington, South-East 1,549 300 19-4 The Borough 7,104 1,241 17-4 195 [1912 It is much to be regretted that such districts as Highbury, Tufnell, and Tollington, instead of showing by their actions an appreciation of vaccination, did the reverse by getting a less percentage of their children vaccinated than did the other districts. This is not what one would have expected from districts in which the population is rather of a better class than in the rest of the borough. Table CII. Showing the State of Vaccination in Islington, 1880-1912, also in London and in England and Wales, 1880-1910. Years. No. of Births. Successfully Vaccinated. Insusceptible to Vaccination. Died Unvaccinated. No. of exemption certificates. Postponed by medical certificate. Remaining. Cases (cols. 6, 7, & 8), not finally vaccinated per 100 births. Ditto in London. Ditto in Rest of England. 1 2 3 4 5 6 7 8 9 10 11 1880 9,931 8,123 26 885 Not granted for years previous to 1897. 118 779 90 7.0 4.5 1881 9,993 8,339 21 812 89 730 8.2 5.7 4.3 1882 10,000 8,360 22 819 155 644 8.0 6.6 4.5 1883 9,950 8,192 25 890 194 644 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 7,581 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 7,251 38 1.222 132 1,114 12.7 18.2 15.7 1894 9,574 7,151 39 1,067 101 1,216 13.7 20.6 19.0 1895 9,959 7,079 50 975 237 1,618 18.7 24.9 19.8 1896 9,752 6,575 46 854 223 2,054 23.4 26.4 22.3 1897 9,878 6,539 30 954 14 220 2,121 23.8 29.1 21.6 1898 9,478 5,422 44 1,068 103 251 2,590 31.1 34.4 26.6 1899 9,631 5,698 81 1,048 101 333 2,370 29.1 28.7 20.8 1900 9,316 5,777 30 812 127 298 2,272 28.9 26.8 19.9 1901 9,266 6,382 29 852 106 107 1,790 21.6 25.2 17.3 1902 9,055 6,593 39 818 73 98 1,434 17.7 22.1 15.2 1903 8,959 6,673 23 739 103 62 1,359 17.0 21. 7 14.7 1904 8,956 6,774 26 729 89 50 1,288 15.9 20.2 14.5 1905 8,603 6,360 28 709 110 66 1,330 17.5 20.1 14.8 1906 8,534 6,260 22 696 123 100 1,333 18.2 22.7 16.8 1907 8,372 5,976 15 609 259 65 1,448 21. 2 25.8 20.4 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 available. 1911 7,723 4,427 36 619 1,241 32 1,368 34.2 1912 (6 m'ths) 4,012 2,029 8 226 744 45 960 43.6 * 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. o 2 196 1912] Table CIII. Return furnished by the Vaccination Officers respecting the Vaccination of Children m the Sub-Registration Districts durine the year 1911. REGISTRATION SUB-DISTRICTS. Number of Births registered in 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 Total Number of Certificates of Primary Vaccination at All Ages received during year 1912. 1 2 3 4 5 6 7 8 9 10 11 Tufnell 755 445 3 ... 141 51 2 31 56 26 2,227 Upper Hollow ay 931 607 2 ... 127 74 2 25 79 15 Tollington 714 423 2 ... 122 52 2 9 76 28 Highbury 1,219 706 9 ... 260 78 ... 17 100 49 Lower Holloway 959 542 7 ... 120 96 9 9 104 72 2,275 Barnsbury 1,454 837 2 ... 171 126 7 4 221 86 Islington, South East 1,691 867 11 ... 300 142 10 8 252 101 The Borough 7,723 4,427 36 ... 1,241 619 32 103 888 377 4,502 197 [1912 Table CIV. Return furnished by the Vaccination Officers respecting the Vaccination of Children m the Sub-Registration Districts during the period, January to June, 1912. REGISTRATION SUB-DISTRICT. Number of Births registered from 1st January to 30th June, 1912. 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. Number of Statutory Declarations of Conscientious Objections received during the year 1912 1 2 3 4 5 6 7 8 9 10 11 Tufnell 377 182 1 ... 95 18 4 20 39 18 177 Upper Holloway 504 309 o ... 76 32 4 10 48 23 167 Tollington 352 192 ... ... 66 18 2 5 43 26 129 Highbury 611 294 3 ... 150 31 4 22 61 46 321 Lower Holloway 516 266 ... ... 84 34 5 1 71 55 800 Barnsbury 787 385 1 ... 115 44 10 4 145 83 Islington, South East 865 401 1 ... 158 49 16 2 155 83 The Borough 4,012 2,029 8 ... 744 226 45 64 562 334 1,594 198 1012] DISINFECTION. This important work continues to increase, both by reason of the increase in the number of diseases now notified as well as through the increase in the number of verminous rooms, bedding, etc., which have to be dealt with. Disinfection of Rooms.'—2,377 rooms were disinfected, as contrasted with 2,295 in 1911. For this purpose formaldehyde, either in its vaporous form or in solution, is generally employed, although it is sometimes augmented by sulphur dioxide, when it is necessary to reach vermin. The Cleansing and Stripping of Rooms.—As many as 1,272 rooms, as contrasted with 1,222 in 1911, were cleansed and sprayed. 1911. 1912. 1st Quarter 351 363 2nd „ 214 493 3rd „ 269 267 4th „ 388 336 Disinfection of Schools and Institutions—Class-rooms in 14 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. The following statement shows the Class-rooms, etc., disinfected:— 1st Quarter. Yerbury Road L.C.C. Schools (Measles and Whooping Cough). Queen's Head Street L.C.C. Schools (Diphtheria). Richard Street L.C.C. Schools (Whooping Cough). 2nd Quarter. Barnsbury Park L.C.C. Schools (Measles). Shelburne Road L.C.C. Schools (Measles). Station Road L.C.C. Schools (Scarlet Fever). 3rd Quarter. Nil. 4th Quarter. Guardians School (Poliomyelitis). Gillespie Road L.C.C. Schools (Scarlet Fever). Conewood Street L.C.C. Schools (Scarlet Fever). Ecclesbourne Road L.C.C. Schools (Chicken Pox). St. James', George's Road L.C.C. Schools (Diphtheria) Montem Street L.C.C. Schools (Scarlet Fever). Thornhill Road L.C.C. Schools (Measles). Barnsbury Park L.C.C. Schools (Mumps). Wards were also disinfected in the— St. John's Road Workhouse (Chicken Pox). 199 [1912 Table CV. Showing the Disinfection of Rooms by Formaldehyde Gas after Infectious Disease, in the Sanitary Inspectors' Districts, during the year 1912. Sanitary Inspectors' Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total 1912. 1911 1st Q'rter 63 81 30 39 14 22 14 18 29 27 37 36 33 29 472 548 2nd do. 53 45 17 44 34 56 24 31 53 17 42 44 70 48 578 493 3rd do. 44 76 12 41 43 34 34 25 62 49 33 48 30 44 575 564 4th do. 43 51 25 72 32 63 56 38 62 53 58 53 79 67 752 690 Year 203 253 84 196 123 175 128 112 206 146 170 181 212 188 2377 2295 Table CVI. Showing the Cleansing and Spraying of Rooms after Infectious Disease, in the Sanitary Inspectors' Districts, during the year 1912. Sanitary Inspectors Districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total 1912 1911 1st Q'rter 17 25 52 33 41 22 15 8 21 20 43 14 21 31 363 351 2nd do. 23 31 9 14 47 12 12 12 12 6 27 15 52 31 306 214 3rd do. 19 10 44 20 13 41 17 22 18 18 18 8 8 11 267 269 4th do. 28 29 28 22 30 10 45 18 21 15 16 10 45 19 336 388 Year 87 95 133 89 131 85 89 60 72 59 104 47 126 95 1272 1222 Disinfecting Station.—The amount of work done at the Disinfecting Station was considerable, for no less than 69,509 large articles were disinfected, as compared with 88,999 in 1911, 83,786 in 1910, 68,860 in 1909, 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 condemned military uniforms, mostly the latter, have had their goods disinfected by the Council, paying for the work, to entitle them to a certificate, required by foreign or Dominion Governments, that they have been disinfected. 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 37,217, as compared with 37,600 in 1911, 27 168 in 1910, 37,273 in 1909, and 36,106 in 1908. 200 1912] TABLE CVII. Summary of the chief articles of Clothing, Bedding, &c., disinfected during the year 1912, and also in the preceding year 1911. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year 1912 1911. Beds 479 447 512 769 2,207 2,307 Blankets 1,103 1,106 1,150 1,801 5,160 4,703 Bolsters 525 529 58 + 747 2,385 2,325 Carpets 29 50 106 142 327 476 Chair Bed Cushions 116 93 158 234 601 891 Mattresses 444 446 497 806 2,193 2,064 Palliasses 118 138 244 325 825 981 Pillows 1,136 1,162 1,358 1,805 5,461 5,307 Quilts 537 512 555 807 2,411 2,278 Sheets 867 845 1,016 1,298 4,026 4,314 Other Articles 2,056 2,237 2,692 4,636 1 1,621 11,954 Totals 7,410 7,565 8,872 13,370 37,217 37,600 The nature of the articles disinfected for the clothing contractors is shown aelow:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Soldiers' Overcoats- 2,510 3,932 2,957 1,405 10,804 „ Jackets 1,320 1,711 971 2,052 6,054 „ Tunics 677 4,000 2,111 3,278 10,066 Trousers 62 24 ... ... 86 Vests 350 194 150 ... 694 Other Articles 242 628 3,530 188 4,588 5,l6l 10,489 9,719 6,923 32,292 201 [1912 The following statement is a record of the work performed by the Steam Disinfectors during the past eighteen years. It, however, includes only large articles, and bundles of small ones. 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 „ 1912 69,509 „ Total for eighteen years - 719,708 „ 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 4 700 Disinfection of Premises — — 1 2 0 42 Cost = £67 15s. 3d. 202 1912] Verminous persons cleansed at the Shelter House under the " Cleansing of Persons Act, 1897." Date of Admittance. Address. Number of Persons. Cause. 1912. 15th Jan. 29, Halton Road 1 Verminous. 30th „ 29, Hornsey Road 1 Do. 30th „ 16, Barnsbury Street 1 Do. 12th Feb. 8a, Hornsey Street 1 Do. 11th March 301, Holloway Road 1 Do. 15th April Lodging House, George's Road 1 Do. 25th „ 29, Hornsey Road 1 Do. 11th June 47, Campbell Road 1 Do. 13th „ 87, Essex Road 1 Do. 1st July 12, Gordon Place 1 Do. 8th „ 154, Gillespie Road 1 Do. 15th Aug. 6, Queensland Road 1 Do. 22nd „ 18, Canonbury Square 1 Do. 4th Sept. 6, Queensland Road 1 Do. 26th „ 194, Fairbridge Road 1 Do. 30th „ 41, St. John's Villas 1 Do. 9th Oct. 68, Essex Road 2 Do. 18th Nov. 41, St. John's Villas 1 Do. 21st „ 6, Queensland Road 1 Do. 30th „ 260, Caledonian Road 1 Do. 2nd Dec. 40, Queensland Road 1 Do. 14th „ 8a, Hornsey Street 1 Do. 18th „ 10, Campbell Road 1 Do. 19th „ 47A, Campbell Road 1 Do. Midwives attending Shelter House for the purpose of disinfection after attendance on cases of Puerperal Fever. Date of Attendance. Name. Address. 1912. 28th March Mrs. B. I, St. Peter's Square, N.E. 4th June Nurse D. 92, Mildmay Road. 8th „ Mrs. I. 149, Bemberton Street. 8th „ Nurse R. 123, Do. do. 13th „ Nurse R. 96, Bingfield Street. 8th Aug. Mrs. K. 19, Elmore Street. 19th „ Mrs. P. 67, Linton Street. PART IV. SANITATION. ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901. INSPECTION OF WORKSHOPS, WORKPLACES, LAUNDRIES AND BAKEHOUSES. HOUSES LET IN LODGINGS. DISTRICT INSPECTIONS. STATE OF PAUPERISM. COMMON LODGING HOUSES. DUST REMOVAL. 204 1912] FACTORY AND WORKSHOP ADMINISTRATION. In compliance with the Factory and Workshop Act, Medical Officers of Health are required to report annually on the manner in which the Act is administered in the district of which they have charge. Furthermore, the various sanitary authorities are required to keep registers of the workshops, to transmit copies of the annual reports of their Medical Officers of Health on the subject to the Secretary of State, as well as to the Local Government Board and the London County Council. The work performed under the Factory and Workshops Act, 1901 is not second in importance to any other work performed by the Council's staff in as much as the cleanliness, the proper ventilation, the provision of sanitary accommodation, are matters of vital consequence to the well-being of the workers in the factories, workplaces, laundries, bakehouses, and similar premises in which men and women earn their daily bread. Inspectors. The work devolving on the borough council under the Act is undertaken by one male and two female inspectors, the former of whom inspects all factories and workplaces in which males are employed, while the duty of examining factories and workplaces, which include laundries, where women are employed, devolves on one of the female inspectors, and on the other that of inspecting the homes of outworkers, the kitchens of restaurants and places where food is prepared. It will thus be seen that these inspections are of a most important character, and that they involve matters, the neglect of which may affect, not only the workers themselves, but the public. Inspections and Visits. -The number of inspections and visits paid was 10,655, as compared with 9,892 in the preceding year, and 11,004 in 1910. The particulars of these inspections are as follows:—Factories (including factory laundries), 484 ; workshops (including workshop laundries), 2,558; workplaces other than outworkers' premises, 269; bakehouses, 536; kitchens of restaurants, 342; outworkers' premises, 637 ; miscellaneous re-inspections and calls, 5,829; total, 10,655 . Notices served.—Arising out of these inspections, 371 intimation notices and IT statutory notices were served for various causes. These notices related to 1,433 defects, of which 1,415 had been remedied at the close of the year. In addition, 26 notices were served in respect to outworkers' rooms which were found in an unwholesome state. 205 [1912 Registers.—5,180 workshops are at present on the registers. Th s number includes 496 workshops where men are employed, 811 workplaces where women are employed, 100 laundries, 241 bakehouses, 730 kitchens of restaurants and eating houses, or of places where food is prepared, and 2,802 outworkers' premises. The following tabular statement gives the figures for the year as well as for 1911. Workshops and Workplaces. 1911. 1912. Workshops on Register. Workrooms on Register. Number added during Year. Number removed during Year. Total number of Workshops on Register. Total Number of Workrooms en Register. Workshops where Men are employed 532 748 100 136 496 710 Workshops where Women are employed 812 1,483 123 124 811 1,524 Laundries 106 3 9 100 Bakehouses 249 259 — 8 241 251 Restaurant Kitchens 746 1,031 6 22 730 1,013 Outworkers' Premises 2,493 2,493 594 285 2,802 2,802 Total 4,938 6,014 826 584 5,180 6,300 Sanitation.—1,433 sanitary defects were discovered, of which 492 related to want of cleanliness, 33 to want of ventilation, 14 to overcrowding, 35 to insufficient, or want of, drainage to the floors, and 187 to other nuisances. In 60 instances dustbins were wanting or defective, in 44 the w.c. accommodation was insufficient, in 280 it was foul, in 252 it was unsuitable or defective ,and in 14 the sexes had not been provided with separate accommodation, while in 16 a water supply was provided. Of these sanitary defects, 1,415 had been remedied at the close of the year. In addition to these, nuisances were found in 50 instances in the homes of outworkers, from which 24 cases of infectious diseases had been reported. It is interesting to note that since 1896 as many as 18,047 nuisances which were of a more oi less serious character have been dealt with in the factories, workshops and workplaces of the Borough by the Inspectors. There were of course innumerable nuisances of minor importance which were discovered and remedied. Some of these dealt with are to be seen in the following Table, which gives particulars for each year since 1896. 206 19121 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912  Overcrowding 26 12 15 14 22 14 4 13 4 13 30 9 8 9 24 14 14 245 Ventilation 14 13 2 5 4 3 5 8 11 4 8 31 12 29 20 23 33 225 Dirty Premises 311 195 109 99 217 218 231 423 630 412 448 970 719 425 505 449 476 6,837 Drains 554 458 375 313 216 177 90 50 19 15 4 19 261 6l * * * 2,612 W.C.'s 420 325 341 355 411 375 154 161 165 151 190 620 573 677 522 471 517 6,428 Water supplies 79 41 35 20 19 13 83 54 18 38 17 23 45 40 46 53 16 64O Surface drains 79 109 87 51 78 81 2 53 40 34 39 45 72 99 116 47 28 1,060 * Now included in District Inspector's summary. Cleanliness.—492 premises were found in an uncleanly state, and 476 were remedied. The numbers of preceding years, 1906-11, have been 449, 505, 425, 719, 970 and 448. Effluvium Nuisances.—None were found. Ventilation.—Insufficient ventilation was discovered in 33 instances, and these were all remedied before the close of the year. Overcrowding. 14 instances of overcrowding came under the observation of the Inspectors, and all of these had been abated before the year terminated. In the preceding year the numbers were 30 in 1906, 9 in 1907, 8 in 1908, 9 in 1909, 24 in 1910, and 14 in 1911. Overcrowding in the workshops in Islington is not unduly prevalent. Want of Drainage of Floors —In 35 instances the floors of workshops, chiefly laundries, were found to be insufficiently draired, and consequently a notice was served in each instance, and 28 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 207 [1912 in 14 instances; whilst 15 had been provided before the close of the year, which includes one remaining over from 1911. Forty-four nuisances due to insufficient accommodation were found, and 47, which include some remaining over from 1911., were abated. 247 foul w.c. pans were cleansed, and 208 that were unsuitable or defective were remedied. Miss Davies, in her annual report on her work, once more calls attention to the condition of the sanitary conveniences generally, which she says showed a good deal of improvement, but she adds that "some premises appear hopeless, defects being found on every visit. The nuisance complained of is always abated immediately on instruction, but on the next visit a fresh nuisance will be in evidence. This condition, 'she feels convinced,' is due either to the absence or inefficiency of the forewoman. This continual fault-finding is irritating both to the occupier and to the inspector, and can be, and is, avoided by s.ound business management." The Medical Officer of Health is in entire sympathy with these views, as he believes that by a little daily attention to the w.c.'s by some one directed to do so as a matter of routine, there would be no more complaints of this character. That such nuisances exist at all is a distinct slur on the management of the factories and workshops in which they occur. Bakehouses.—There are 241 bakehouses on the register, of which 99 are situated above and 96 below ground, the remaining 46 are not at present in use, although they are kept under observation lest they should be surreptitiously occupied. The Chief Inspector, Mr. James R. Leggatt, inspected these and reported that in only a few instances did he notice clothes being dried or aired in them. This is so far satisfactory, because a few years ago the practice was not unusual. Town Hall, Upper Street, N., 4th May, 1912. 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 195, and that I found a distinct improvement in their condition. 1912] 208 There seems to he a desire on the part of the occupiers to systematically keep them in a cleanly state, and there were only a few instances of clothes being either dried or aired in the Bakehouses. The fact of the Workshops Inspector having been able to keep the Bakehouses under constant supervision has, in a great measure, brought about the satisfactory report which I have pleasure in submitting. Yours faithfully, JAMES R. LEGGATT, Superintendent &• Chief Sanitary Inspector. LIST OF BAKEHOUSES. Upper Holloway District. Bakehouses above ground. 104, Andover Road 88, Andover Road 19, Archway Road [6, Brecknock Road 62, Cottenham Road 29, Cottenham Road 49, Campbell Road 130, Devonshire Road 67, Durham Road 103, Elihorne 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, Hazellville 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 29, Highgate Hill 81, Junction Road 127, Marlborough Road 110, Marlborough Road 163, Seven Sisters Road 131, Stroud Green Road 51, Stroud Green Road 144, Tollington Park 5, Tollington Park (Factory) 209 [1912 Certified underground Bakehouses. 51, Archway Road 84, Ashbrook Road 33, Bedford Terrace 26, Blenheim Road 10, Campdale Road 3, Card well Terrace 144, Elthorne Road 87, Hazellville 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 84, Yerbury Road Bakehouses not in use. 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) Lower Holloway District. Bakehouses aboveground. V.V. Bakery, Brewery Road (Factory) Kemp's Bakery, Brevery Road (Factory) 421a, Caledonian Road 25, Cornelia Street 261, Holloway Road (Factory) 251, Hollowav Road 85, Holloway Road 69, Holloway Road 463, Liverpool Road 72, Rhodes Street 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 „ p 92, Wellington Road (underground) 210 1912] Highbury District. Bakehouses aboveground. 17, Annette Road (Factory) 53, Boleyn Road 10, Blackstock Road 112a, Drayton Park (Factory) 3, Highbury Park 232, Holloway Road 370, Holloway Road (Factory) 132, Holloway Road 56, Hornsey Road 100, Hornsey Road 154, Hornsey Road 123, Newington Green Road 190, Seven Sisters Road 258, Seven Sisters Road 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 (Factory) Bakehouses not in use. 98, Balls Pond Road (underground) 202, Blackstock Road (aboveground) 77, Boleyn Road (underground) 182, Drayton Park „ 225, Blackstock Road (aboveground) 13, Highbury Place (underground) 25, Lowman Road ,, 2, Queen's Square „ 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 U2, Copenhagen Street 211 [1912 Certified underground Bakehouses. 21, Barnsbury Road 68, Barnsbury Road 100, 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 (underground) 279, Liverpool Road „ 123, Offord Road ,, 29, Offord Road ,, 86, Thornhill Road ,, 120, York Road „ South-East District. Bakehouses aboveground. 76, Baxter Road 229, Balls Pond Road 5, Charlton Place (Factory) 52, City Garden Row 38, Coleman Street 40, Cross Street 8, Danbury Street 226, Essex Road 172, Essex Road 361, New North Road P 2 313, New North Road 126, Packington Street 20, Popham Road 50, Popham Road 69, St. Peter Street 84, St. Peter Street 129, Upper Street 137. Upper Street 51, Windsor Street 212 1912] 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 121, Packington Street 33, Park Street 16, Rheidol Terrace 32, Shepperton Road 1, Shepperton Road Oxford House, Sherborne Street 51, Southgate Road 1, Theberton Street West 14, Upper Street 102, Upper Street Bakehouses 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 (underground) 38, 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) Outworkers' Premises.-—There were 2,802 outworkers' premises on the register. This is aji increase of 309 on the return of the previous year. On the lists received from the employers in Islington there were 2,560 entries, in addition to which 2,746 were received from other borough councils both within and without London. From the lists provided by local employers, 1,228 were forwarded to other borough councils. Mrs. Young in her interesting report refers particularly to these places, about which she says that the general conditions under which the homeworkers carry on their work is surprisingly satisfactory in view of the rates of wages paid. There is no doubt that the strenuous work of inspection which has been carried out in the Borough for several years past has had a very wholesome effect in compelling the ordinary outworker to keep her premises clean, although as Mrs. Young well states, " if it takes a woman 14 hours a day working six 213 [1912 days a week to earn a mere subsistence, the performance of any additional duties on her part becomes an act of heroism." She also writes, "In my previous report I drew attention to the pathetic circumstances under which many women are struggling to maintain their independence, with the result that certain newspapers have commented on the need of more drastic legislative measures designed to stop this evil of sweating." Anyone who has studied this question, and who has visited the homes of some of these poor outworkers, cannot fail to come to the conclusion that something should be done to stop what is nothing less than a national scandal. We hear from time to time of strikes which tend to paralyse the work of the nation being undertaken on behalf of a single individual, but unfortunately for these poor women they have no union or organisation which can step in and interfere to obtain a living wage for them. The writer of this report is certainly no socialist, but he cannot close his eyes to what is taking place, and, indeed, no man in his position, who studies this question, can avoid coming to the conclusion that it is time for the State to interfere to prevent the sweating of these poor unfortunate women. Just think of it ! "Elaborately trimmed blouses, 1s. 6d• per doz.; Camisoles more than half-composed of fine insertion and lace trimming, Is. (id. per doz.; heavy cloth mantles, full length, with smart finish, including buttons and button holes, 7d. each; bathing costumes, with braided jackets and knickers, 1 \d. each, and so on, in a painful repetition.'' 1 hese are the facts that Mrs. Young, the Inspector of the homes of these people, reported last year. They are almost incredible. The days of "The Song of the Shirt" are evidently not dead yet. In her report for this year she tells us—and this may be one of the reasons for such sweating prices—that "the years between 60 and 70 are the most difficult; women are then willing to take any work, at any price; and they become the prey of every unscrupulous employer who cares to exploit them." Restaurants and kitchens where food is prepared.—There are at present on the register the addresses of 730 restaurant kitchens and places where food is prepared, containing 1,013 rooms, and to these 342 visits were paid. The work of their inspection was performed by Mrs. Young, and in reporting on it she says that " there is a marked improvement in the conditions found in places where food is prepared, and it is now generally understood by the occupier, that, in Islington, such places are kept under regular inspection, and that due cleanliness must be observed in them." And then she goes on to state that " in many instances these inspections are welcomed as affording a guarantee of cleanliness to the public and also that certificates as to their cleanliness have been requested." 214 1912] 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. 149 workshops were reported during the year in accordance with this section. Workshops notified to Home Office, 1912. Trade. Number of Workshops. Protected Persons Employed. Females. Male Young Persons. Total. Dress Making 24 145 .. 145 Tailoring 14 73 2 75 Blouse Making 13 42 .. 42 Millinery 9 65 .. 65 Mantle Making 8 24 .. 24 Tie Making 8 18 .. 18 Laundry 7 35 .. 35 Underclothing 6 16 .. 16 Furrier 4 9 .. 9 Artificial Flower Making 3 22 1 23 Boot Repairing 3 .. 3 3 Cycle Making 3 .. 3 3 Trouser Making 3 7 .. 7 Comb Mounting 2 12 5 17 Brush Making 2 4 5 9 Dressmakers' Stands Making 2 7 .. 7 Children's Pelisse Making 2 9 .. 9 Toy Making 2 41 .. 41 Trunk Making 2 7 1 8 Alteration Work 1 2 .. 2 Boot Upper Making 1 1 .. 1 Cabinet Making 1 .. 1 1 Chemical Works 1 3 .. 3 Children's Frock Making 1 6 .. 6 Christmas Card Work 1 3 .. 3 Cork Helmet Making 1 .. 1 1 Embroidery 1 6 .. 6 Engraving 1 .. 2 2 Exhibition Stall Fitting 1 1 .. 1 French Polishing 1 .. 1 1 Fur Lining 1 1 .. 1 Glass Cutting 1 2 .. 2 Hat Shape Making 1 2 .. 2 Imitation Marble Work 1 9 .. 9 Lace Curtain Making 1 10 .. 10 Mica Goods Making 1 2 .. 2 Packing 1 3 .. 3 Paper Sorting 1 3 .. 3 Perambulator Hood Making 1 1 .. 1 Perforating 1 1 .. 1 Pianoforte Making 1 .. 1 1 Picture framing 1 .. 1 1 Rag Sorting 1 1 .. 1 Skirt Making 1 3 .. 3 Sun Bonnet Making 1 1 .. 1 Tin Work 1 .. 1 1 Tyre Making 1 .. 1 1 U pholstery 1 3 .. 3 Varnishing 1 3 .. 3 Watch Making 1 .. 1 1 Whalebone Cutting 1 •• 1 1 Total 149 603 31 634 215 [1912 SECRETARY OF STATE'S RETURNS on the administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries) 484 34 Nil Workshops (Including Workshop Laundries) 2,558 120 „ Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 1,147 232 4 Miscellaneous Re-inspections 5,829 .. •• Total 10,018 386 4 2 -DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts: - * Want of cleanliness 492 476 1 4 Want of ventilation 33 33 .. Nil Overcrowding 14 14 .. „ Want of drainage of floors 35 28 .. „ Other nuisances 247 331 .. „ insufficient 44 47 .. „ Sanitary Accommodation unsuitable or defective 538 455 .. „ not separate for sexes 14 15 .. „ water supply provided 16 16 .. „ Offences under the Factory and Workshop Act:— .. „ Illegal occupation of underground bakehouse (s. 101) Nil 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 1,433 1,415 3 4 . * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 1912] 216 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, 1891. 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. Outworkers.† Outworkers Lists.† Contractors. Workmen. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) making, &c. 250 64 1,982 48 17 85 417 1 1 26 26 .. 24 .. .. (2) cleaning and washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Household linen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Curtains and furniture hangings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Electro-plate .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. File making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur pulling 16 16 26 3 3 3 .. .. .. .. .. .. .. .. .. Cables and chains .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Artificial Flowers 12 .. 78 .. .. .. .. .. .. .. .. .. .. .. .. Nets, other than wire nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tents .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Sacks .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Racquet and Tennis Balls .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper Bags and Boxes .. 8 222 4 4 4 .. .. .. .. .. .. .. .. .. Brush making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pea picking .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carding, &c., of buttons, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Stuffed toys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Basket making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 296 88 2,308 55 24 92 417 1 1 26§ 26 Nil 24 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. f 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 wo lists each year and of the entries of names of outworkers in those lists. § 26 instances of unwholesome premises because of unsatisfactory domestic conditions. 217 [1912 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Workshops where men are employed 496 Workshops where women are employed 811 Laundries 100 Bakehouses 241 Restaurant kitchens 730 Total Number of Workshops on Registers 2,378 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) 197 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 9 Reports (of action taken) sent to H.M. Inspector. 7 Other Nil. Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 195 Mr. WEST'S REPORT. Town Hall, Upper Street, Islington, N. 2nd April, 1913. To the Medical Officer of Health. Sir, I have pleasure in submitting my report for the year ending 28th December, 1912. During which time I have made 4,264 visits to the various places of business (factories, workshops and workplaces) on the register, comprising 2,477 inspections, and 1,787 re-inspections. 1912] 218 The visits to the various trade premises were as follows :—284 factories, 1,302 workshops, 203 workplaces, 536 bakehouses, 16 restaurant kitchens, 136 outworkers' premises, and 1,787 miscellaneous. No. of Workshops. No. of Workshops. Artificial flower makers 5 Fire escape maker 1 Automatic machine makers 3 File cutter 1 Bakers 241 Fish cleaner 1 Builders 9 Fish curers 2 Blacksmiths 6 French polishers 2 Basket maker 1 Fancy goods makers 2 Blind makers 4 Gun maker 1 Brush makers 8 Glove maker 1 Bamboo cane makers 2 Glass engravers 2 Baloon maker 1 Glass worker 1 Billiard table maker 1 Harness maker 7 Boot polish makers 2 Hat shape makers 4 Bust makers 4 Hair workers 2 Bedding maker 1 Iron plate worker 1 Confectioners 6 Imitation marble works 1 Cycle makers 16 Instrument maker (brass) 1 Cabinet makers 28 Japanner 1 Coppersmiths 1 Jewel case makers 2 Camera makers 2 Leather goods makers 7 Cardbox-box makers 5 Ladder makers, etc 2 Cap maker 1 Limelight works 1 Clay pipe maker 1 Lamp makers 4 Cork cutter 1 Laundry 1 Coopers 2 Marquetaire workers 2 Cloth shrinker 1 Marking ink maker 1 Corset maker 1 Mineral water sundries X Cattle food maker 1 Marble masons 3 Carpenters 2 Metal workers 2 Coach painters 1 Machine maker 1 Carpet maker 1 Musical string makers 2 Coomb mounting 1 Mica goods maker 1 Cork helmet maker 1 Motor works 6 Dairy can maker 1 Mantle makers 6 Dentist 1 Machine ruler 6 Engineers 7 Organ makers (American) 2 Exhibition stall fitters 5 Pianoforte makers 40 Embroidery maker 1 Plaster block maker 1 Enamellers 1 Plumbers 4 Engravers 1 Perambulator makers 2 Farriers 23 Picture frame makers 11 Furriers 47 Photographers, etc 5 Fancy brooch maker 1 Paper sorters 2 Feather dressers 3 Pea packer 1 219 [1912  No. of Workshops. No. of Workshops. Rubber merchants 2 Ticket writers 6 Rag sorters 7 Tea sifter 1 Scale makers 3 Toy makers 3 Shoemakers 109 Undertakers 2 Scientific instrument makers 4 Umbrella maker 1 Shop fitters 2 Umbrella stick maker 1 Stick mounters 2 Upholsterers 11 Scene painter 1 Wood choppers 3 Sign writers 4 Watchmakers, etc 14 Soap maker 1 Whalebone cutter 1 Sealing wax maker 1 Work-basket fitter 1 Saddle tree maker 1 Wheelwrights 34 Surgical appliance makers 3 Wire workers 3 Stationer 1 Wood letter maker 1 Sack mending 1 Wreath case makers 2 Trunk makers 9 Wax-figure maker 1 Tailors 62 Tarpaulin and tent maker 1 Total 896 Tinsmiths 4 Sanitary Improvements.—During the year 99 notices have been served for the abatement of nuisances, 222 workshops have been cleansed and lime-whited, 42 w.c's. have been provided (30 for males and 12 for females) at various workshops, 195 w.c's. which were in a foul condition have been cleansed, 106 w.c's. which were defective have been amended, 16 water supplies have been provided, also 97 other improvements were carried out under my supervision; 41 workroom cards were distributed showing the cubic capacity and the number of employees allowed in each workroom. One drain which was found to be in a defective condition was transferred to the District Inspector. Bakehouses.—During the year 536 inspections have been made to bakehouses, besides a number of other calls to same. I am pleased to say that the occupiers generally do their utmost to give as little trouble as possible in keeping them in a cleanly condition. At the end of the year there were 99 bakehouses in use above ground, 96 below ground, and 46 not in use, making a total of 241. I have notified through you to H.M. Inspector of Factories the names and addresses of 63 factories and workshops in the Borough where young persons under the age of 18 years were employed, and where the abstract of the Factory Act was not affixed. Also 4 new factories have been reported in accordance with the Home Office Memorandum of March, 1912. Register.—During the year 127 workshops have been added to the Register, whilst 163 have been removed, so that at the present time there are 896 workshops, containing 1,311 workrooms, and 80 outworkers' premises now on the register, I am, Sir, Your obedient Servant, GEORGE WEST, Sanitary Inspector of Workshops, etc. 1912] 220 Mrs. YOUNG'S REPORT. Town Hall, Upper Street, 4th October, 1912. To the Medical Officer of Health. Sir, The following is a report of the work done by me during the period of nine months ending September 28th, 1912. Inspections and calls made.— Hotel and Restaurant Kitchens 326 Outworkers' premises 501 Domestic workshops 49 Re-inspections and calls 1,721 Attendance at Police Courts 8 2 605 Notices served.— Intimation notices 174 ,, courtesy notices 40 Statutory notices 7 Summonses served 6 227 Nuisances found and remedied under the Public Health Acts:— Found. Remedied. Want of cleanliness 158 158 ,, ventilation 3 3 Want of, or defective bins 46 43 Defective floors or yard paving... 6 9 Other nuisances 85 88 Sanitary accommodation insufficient 1 1 unsuitable or defective 17 17 not separate for sexes Nil Nil 316 319 Found. Remedied. Unsatisfactory storage conditions 20 15 Dirty utensils 10 6 Registers.—Hotel and Restaurant Kitchens.— Workshops. Workrooms. Total number at the beginning of the year 746 1,031 „ „ added during the period under report 6 10 „ „ closed „ „ ,, 22 28 Present Totals 730 1,013 221 [1912 Outworkers resident in the Borough.— Total number at the beginning of the year 2,493 „ „ added during the period under report 594 Less removals „ ,, ,, 285 Total number now registered 2,802 Outworkers:— Notifications received to date from employers in the Borough of Islington 2,560 Do. do. from other districts, per the Medical Officer of Health 2,746 Total number notified 5,306 Insanitary premises (Outworkers):— Notices served for statutory defects *26 Disinfection ot workrooms and work 24 * Including 2 cases of tuberculosis. Letters, etc. :— To employers failing to supply lists 417 Notification of outworkers to other districts 1,228 Workshop cards specifying cubic space of workrooms 119 Notifications to H.M. Inspector of Factories 20 Numbers of persons engaged in trades scheduled:— Making of wearing apparel 2,256 Artificial flower making 198 Furniture and upholstery 3 Paper bags and boxes 189 Brush making 120 Stuffed toys 6 Electro plate 6 Umbrellas 18 Chair making 6 2,802 At the North London Police Court on July the 26th the occupier of 35, Seven Sisters Road, was summoned under Sec. 107, Factory and Workshop Act (1901), for (a) failing to keep the prescribed list of outworkers, and (i)failing to notify the same to the Medical Officer of Health. A penalty of 21s. with 23s. costs on the first count, and 10s. with 23s. costs on the second was inflicted in accordance with the provisions of the Act. The general conditions under which homework is carried on are, in Islington, surprisingly satisfactory in view of the rates of wages paid. If it takes a woman fourteen hours a day, working six days a week to earn a mere subsistance, the performance of any additional duties on her part becomes an act of heroism. 1912] 222 In my previous report I drew your attention to the pathetic circumstances under which many women are struggling to maintain their independance, with the result that certain newspapers have commented on the need of a more drastic enforcement of the legislative measures designed to stop this evil of sweating. It is certain that any movement towards the prevention of consumption, or for the advancement of the health of the working classes can be of little ultimate value while it continues. A possible solution of the difficulty might be found in advancing the payment of the Old Age Pension to women who have been working for 40 years as employed persons when they reach the age of 60. The years between 60 and 70 are the most difficult; women are then willing to take any work at any price, and they become the prey of every unscrupulous employer who cares to exploit them. Hotel and Restaurant Kitchens.— General conditions found in premises inspected:— Satisfactory. Unsatisfactory. Hotels and restaurants 51 3 Coffee and dining rooms 79 13 Refreshments 14 2 Fried fish 37 5 Pork butchers 15 2 Provisions 84 12 Eels and eel pies 6 2 Oysters 1 — 287 39 There is a marked improvement in the conditions found in places where food is prepared, and it is now generally understood by the occupiers, that in Islington, such places are kept under regular inspection; and that due cleanliness must be observed in them. In many instances such inspection is welcomed as affording a guarantee to the public; and it has been frequently requested that a certificate of cleanliness might be issued to proprietors whose business is deemed to be suitably conducted. There is a constant menace to the public health in the accumulations of refuse which is necessarily connected with such trade; but as this has been decided to be of the nature of house refuse, the Council are consequently liable for its removal; such a nuisance need only be of brief duration. At present there is a certain amount of injustice connected with the matter. Some occupiers pay a weekly sum for an extra clearance; others have their refuse removed daily without any extra charge; but the majority, refusing to pay, have an accumulation stored in lime, which is both offensive and dangerous. A summons under Sec. 4 of the Public Health (London) Act, and three summonses under Sec. 8 of the London County Council General Powers Act, against the owners and 223 [1912 occupiers of 45, Essex Road (a provision shop selling cooked meat) were heard at Clerkenwell Police Court on the 26th June, and adjourned until July 3rd for separate service of the summonses on a joint occupier whose liability was previously denied. After three further hearings the magistrate imposed a fine of £l 0s. 0d. with £1 6s. Od. costs on the first summons, and adjourned the hearing of those under the London County Council General Powers Act for three months that the premises might be kept under observation. Having been appointed an Inspector under the National Health Insurance Commission (England) I have tendered my resignation of the position of Sanitary Inspector of Workshops in this Borough. I have the honour to remain, Your obedient Servant, CATHERINE YOUNG.' •Mrs. Young resigned her position in Islington on October, 1912, having been in the service of the Borough Council since November 1906 ; during which time she performed much valuable work. Miss DAVIES' REPORT. May 9th, 1913. To the Medical Officer of Health. Sir, 1 beg to submit to you the following report of my work during the year 1912. The following inspections and visits have been made during that period :— Inspections of Factories 210 Inspections of Workshops 1,256 Inspections of Workplaces 17 Miscellaneous re-inspections and visits 2,313 Total 3,796 Factories.—There were on the register at the end of the year 194 factories employing women, twenty having been added during that period and 17 removed. The following is a list of the factories (including steam laundries) on the register: Industry. Number Number of women employed. Laundry work 45 1728 Printing 18 176 Box-making 10 527 Book-binding 9 159 Confectionery 9 458 Blouse making 5 205 Dressmaking 5 325 Dyeing and cleaning 5 57 Toy-making 5 205 Packing 4 27 1912] 224 Industry. Number. Number of women employed. Chemists sundries making 3 85 Electrical engineering 3 50 Mantle making 3 198 Meat preserving 3 84 Bottling 2 59 Brush making 2 204 Cigarette making 2 36 French polishing 2 29 Fur work 2 27 Mangling 2 2 Mattress making 2 16 Millinery ... ... ... 2 350 Mineral waters, making 2 25 Photo, mounts making 2 33 Stay making 2 30 Apron making 1 28 Blind making 1 7 Boot uppers making 1 11 Bottle washing 1 8 Button making 1 25 Cabinet making 1 101 Camera making 1 4 Capsule making 1 150 Children's frock making 1 20 Collar and cuff making 1 6 Corset making 1 114 Cotton wool pressing 1 9 Electric lamp making 1 50 Embroidery work 1 12 Engineering 1 70 Fancy leather goods making 1 30 Feather dressing 1 12 Food preparing 1 35 Glass letter making 1 1 Glass work 1 3 Juvenile suit making 1 30 Leather work 1 150 Lock and safe making 1 9 Manufacturing stationery 1 32 Music roll making 1 38 Outdoor game requisites making 1 34 Overmantle making 1 7 Pattern card making 1 45 Perambulator hood making 1 19 Piano string making 1 3 Pickling 1 15 225 [1912 Industry. Number. Number of women employed. Picture framing 10 Pill making 1 5 Sack making 1 7 Sauce making 1 70 Seed packing 1 5 Surgical appliances making 1 5 Syphon manufacturing 1 350 Table stationery 1 28 Tooth brush making 1 9 Underclothing making 1 350 Underskirt making 1 36 Vinegar making 1 24 Washing powder making 1 6 White lead works 1 6 Total 194 7,084 It will be seen from the above figures that there has been a nett increase of 3 in the number of occupied factories during the year, but I would point out again as I have done previously, that such a figure in no way represents the actual amount of increased employment in the Borough. For the purpose of showing this increase it would be necessary to compare the number of hands employed during any two years. I have therefore instituted a record of the number employed in each factory, and these figures will be found set forth above. In the future, therefore, a more accurate comparison of the state of employment in those trades which come under my inspection will be available, and will, I think, prove interesting. Further, it must be pointed out that the figures of employment given both in the list above and in that which follows for workshops, are subject to almost daily changes. They represent an accurate average on the whole year, but in many of the trades are subject to considerable seasonal fluctuations. There is nothing of particular note to report on the sanitary accommodation of factories during the year. One new factory built provided almost ideal conditions, which it is hoped will be appreciated. The condition of the sanitary conveniences generally showed a good deal of improvement, a defective state either as to structure or cleanliness being observed in only 36 cases during 1912 as compared to 54 in 1911. Some premises appear hopeless, defects being found on every visit. The nuisance complained of is always abated immediately upon instruction, but on the next visit a fresh nuisance will be in evidence. This condition, I feel convinced, is due either to the absence or inefficiency of a forewoman. This continual fault-finding is irritating both to the occupier and to the inspector, and can certainly be avoided, and is avoided by sound business management. During the year two memoranda were received from the Home Office, dealing with (1) Structural Requirements of the Factory and Workshop. Acts and (2) Duties of the Local Authority under the Factory and Workshop Acts. These are annotated summaries of special sections of these Acts and of various Orders and Regulations which have been issued from time to time. Q 1912] 226 (1) This memorandum states that the height of doors to each closet should not be less than 6½ feet, and that in the calculation of air space, rooms separated by doors (even if usually open) or by high partitions should be counted as separate rooms. With these exceptions the requirements under this memorandum were already in force in the Borough. (2) This memorandum lays new duties upon the local authority, requiring them to notify domestic workshops and also to inform the Factory Inspector whenever plans of new faotories are submitted to them. It also suggests closer co-operation between the Surveyor's Department and the Public Health Department so as to obviate the expense and inconvenience caused to owners of factories who are called upon by the local authority or Factory Inspector to make alterations {e.g., as to sanitary accommodation) after the completion of their buildings. The Rag Flock Act came into operation during the year, and the necessary steps have been taken to carry it out. During the year five faotories which had not been visited by H.M. Inspector were notified to the Home Office. The following is a list of the trades carried on in the various workshops:— Nature of Business. Number of Workshops. Number of Workrooms. Number of Women employed. Dressmaking 230 329 1216 Laundry 100 249 375 Millinery 74 134 665 Furrier work 62 91 159 Tailoring 47 60 241 Mantle making 40 64 217 Blouse making 36 73 285 Tie making 35 40 141 Underclothing making 26 28 94 Artificial flower making 11 33 132 Children's frock making 11 17 48 Rag picking 11 14 14 Embroidery 9 13 89 Box making 8 21 21 Packing 8 12 30 Fancy leather goods making 7 12 33 Corset making 6 11 36 Fancy goods making 6 11 18 Trouser making 6 7 13 Wig making 6 8 12 Feather dressing 5 7 23 Shirt making 5 7 39 Skirt making 5 5 10 Artists' brush making 4 9 36 Boot upper making 4 6 19 Confectionery making 4 9 36 Dressmakers' stand making 4 8 23 Glass work 4 4 23 227 [1912 Nature of Business. Number of Workshops. Number of Workrooms. Number of Women employed Photography 4 12 15 Trunk making 4 10 16 Apron making 3 3 9 Card painting 3 3 5 Jewel box making 3 4 7 Mantle alterations 3 3 4 Opera cloak making 3 4 21 Paper sorting 3 5 12 Perambulator hood making 3 9 13 Sequin ornament making 3 4 34 Umbrella covering 3 3 4 Upholstery 3 11 3 Waterproof making 3 4 51 Wood chopping 3 3 4 Baby linen making 2 3 31 Boot polish making 2 3 4 Bottle washing 2 3 8 Cambric bow making 2 3 18 Chemists sundries making 2 13 79 Dressing-gown making 2 3 13 Exhibition stall fitting 2 2 2 Fancy shade making 2 2 10 Fancy lace goods making 2 2 7 French polishing 2 2 4 Hassock making 2 2 4 Hat-shape making 2 2 6 Imitation fur making 2 2 2 Ink making 2 3 5 Sack repairing 2 3 4 Surgical instrument making 2 3 2 Tea gown making 2 5 14 Waistcoat making 2 2 3 Wreath case making 2 4 7 Back support making 1 1 4 Balloon making 1 2 4 Blind making 1 1 2 Box lining 1 7 13 Brace making 1 2 4 Camera bellows making 1 2 1 Cap making 1 1 3 Carpet planning 1 1 8 Cleaning 1 1 1 Collar and cuff making 1 1 1 Comb mounting 1 2 7 Cushion making 1 1 i Doll dressing 1 1 1 Dolls' hair curling 1 7 18 Q 2 1912] 228 Nature of Business. Number of Workshops. Number of Workrooms. Number of Women employed. Dough weighing 1 1 2 Engineering 1 1 1 Fancy glass work 1 1 4 Framing 1 1 2 Frilling making 1 1 3 Fruit preserving 1 1 14 Funeral furnishings makings 1 1 2 Fur lining 1 2 1 Gold beater's skin making 1 4 5 Grease-proof paper making 1 2 3 Housemaids' cap and apron making 1 1 10 Housemaids' dresses making 1 2 11 Imitation marble making 1 5 9 Japanning 1 1 2 Jewel case lining 1 1 2 Kitchen jacket making 1 1 1 Lace curtain making 1 2 10 Leather work 1 1 2 Limelight making 1 1 1 Making of syphon sundries 1 2 4 Stationery making 1 2 2 Mica goods making 1 2 2 Music string preparing 1 2 13 Ornament making 1 1 7 Pelisse making 1 1 4 Perfume making 1 1 2 Piano key cover making 1 1 1 Pickling 1 1 12 Picture framing 1 1 1 Pincushion making 1 1 5 Purse making 1 4 15 Sausage skin making 1 4 29 Sign writing 1 8 1 Sun-bonnet making 1 1 2 Surgical furniture making 1 2 2 Surplice making 1 2 10 Swansdown sewing 1 1 1 Tarpaulin making 1 1 1 Theatrical outfitting 1 1 2 Toy making 1 2 28 Wax figure making 1 1 3 Total 911 1524 4769 229 [1912 As in factories, so in workshops, there is a very marked tendency towards the disappearance of the small workroom employing one or two in favour of the larger. This is especially noticeable in the laundry and dressmaking trades, and is to be attributed, in the former case, to the inability of the small hand laundry to compete in prices with the larger laundry employing power. In the case of the dressmaking trades, the enormous number of ready-made robes which are now on the market have very seriously damaged the trade of the smaller private dressmaker doing middle-class work, and I have been told by one of these that they depend almost entirely on a few old customers of long standing, and on "outsizes," for such trade as they still do. It must be borne in mind, however, that the state of things which is causing their loss of trade is yet economically good for trade in general. Women now find it possible to have many more dresses than in former years, since they are now much cheaper and more quickly obtained, and this naturally increases the amount of labour required. It is possible that this increasing demand for employees will bring about a much-needed rise in wages. There is no improvement in the attention which is paid to that section of the Factory and Workshop Act which requires that notice of occupation should be sent to the Home Office within one month of beginning work. It is difficult to see why such latitude is allowed in this respect. Up to the present a large number of new workshops were discovered by carefully watching advertisements for employees in the daily press, but as the Labour Bureaux are becoming more used this channel of information is not so helpful as formerly, and it is becoming more imperative that occupiers should be required to give the necessary notification. Under the present Acts these notifications are sent to the Home Office, who forward them to the local authority. 1 am of the opinion that it would be desirable that a duplicate form should be sent to the local authority direct and in the first instance, and thus avoid the delay of many months, which sometimes now occurs. Cleanliness.—During the year 91 premises were found in a dirty condition, and 96 workrooms were cleansed during that period. A large proportion of these were laundries, which require very frequent cleansing owing to the nature of the work and the deposits from the fires which are constantly required. There is no difficulty in getting the work done, and it is probable that in time the majority of those responsible for the cleansing will have the work done at regular intervals without waiting for the instructions of the inspectors. Want of Ventilation.—Seventeen instances of insufficient ventilation came under my notice during the year, and 15 were found to have been remedied before the close of the year. In all these cases the means of ventilation were ample, but were not used satisfactorily. It is curious to note that those engaged in certain trades seem to be peculiarly averse to fresh air, while other workrooms where the work is of a similar nature are on the whole well ventilated. Overcrowding.—Nuisances arising from this cause were found on 14 premises, but only in one case to a very serious degree. As this was a new workroom, which had not previously been measured, the occupier's plea of ignorance perhaps may be accepted. All nuisances due to overcrowding were abated during the year. Sanitary accommodation.—Nuisances were caused in 5 premises by insufficient accommodation, in 60 by foul pans, in 88 by defective or unsuitable accommodation, and in 3 premises by no separate accommodation being provided for the sexes. Additional 1912] 230 dation was provided for 4 workshops, 52 pans were cleansed upon instruction, and 85 waterclosets were repaired. Separate accommodation for the sexes was provided for 3 premises. Miscellaneous defects.—Forty-five other nuisances were observed, including defective or want of dust-bin accommodation, undrained wash-house floors, etc., and 49 defects of this nature were remedied during 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. Workshop Cards.—The number of workroom cards distributed was 293. These cards specify the cubic space of each workroom and the number of persons who may be employed in the room during ordinary working hours and during overtime (if allowed). Notices.—In respect to the above nuisances 62 Intimation Notices were served, and in 6 instances it was necessary to serve a Statutory Notice before the work was done. Twelve of the Intimation Notices were served on account of nuisances connected with factories and 56 in connection with workshops. In an increasing degree the majority of the nuisances are abated upon verbal instruction. Workshops notified to the Home Office.—In accordance with the requirements of the Public Health (London) Act (Sec. 7) the addresses of 114 workshops employing women were notified to the Home Office. These were premises whose occupiers had failed to send in notification of occupation to H.M. Inspector, or in which the abstract of the Factory and Workshop Acts was not exhibited. I remain, Sir, Your obedient Servant, m. gwyneth davies, Sanitary Inspector of Workshops. INSPECTION OF HOUSES LET IN LODGINGS. At the commencement of the year this duty devolved on Inspectors Ward and Hancock, but as the former Inspector was ill and unable to perform his work, the whole of the inspections were made during the first and second quarters by Inspector Hancock. However, at the beginning of the third quarter Inspector Ward, having been superannuated, Inspector Watson, the senior district inspector, was transferred to the district left vacant by him; and from that time forward joined forces with Inspector Hancock. Altogecher 9,037 inspections and calls were made to houses of this character, the actual number being 1,572, while the re-inspections and visits numbered 7,465. It became necessary in order to get the nuisances abated to serve 1 205 notices, of which 998 were intimation and 207 statutory notices. 231 [1912 Synopsis of Inspectors' Work.—In abating the nuisances the following work became necessary:— Drains reconstructed 4 „ repaired 10 „ traps supplied to 44 W.C.'s, extra provided 1 „ pan and trap only provided 22 „ water supply provided 148 Dustbins provided 14T „ repaired 8 Yards paved or re-paved 25 Water supply—cisterns (new) provided 1 „ cisterns, repaired and cleansed 62 Water supply provided ... 83 Rooms cleansed and limewashed 1,762 Walls and passages repaired, cleansed or limewashed 806 Floor space ventilated 9 Floors repaired 40 Overcrowding abated 77 Verminous rooms disinfected, etc. 38 Roofs repaired 129 Other improvements or nuisances abated 839 1912] 232 HOUSES LET IN LODGINGS. Table CVIII. Summary of Sanitary Work carried out under Inspectors Ward and Hancock in Houses Let in Lodgings during the year 1912. Inspector Ward.* Inspector Watson. Inspector Hancock. Total. 1st Quarter 1 2nd Quarter. 3rd Quarter 4th Quarter. Year. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Number of Houses inspected .. .. 248 272 520 307 304 231 210 1,052 1.572 Re-inspections, Calls made, etc. .. .. 564 1,089 1,653 1,551 1,335 1,448 1,478 5.812 7,465 Total inspections and calls .. .. 812 1,361 2,173 1,858 1 639 1,679 1,688 6,864 9,037 Notices Served. Intimation Personally .. .. 42 •29 71 96 61 72 64 293 364 By Post .. .. 93 132 225 132 101 99 77 409 634 Slatutory Personally .. .. 2 2 4 8 .. 7 10 25 29 By Post .. .. 1 21 22 25 28 89 14 156 178 Improvements. Drains— Constructed .. .. .. 1 1 .. .. .. .. .. 1 Re-constructed .. .. .. 2 2 1 .. 1 .. 2 4 Repaired .. .. .. 8 8 .. 1 .. 1 2 10 Ventilated.. .. .. .. 3 3 .. .. .. .. .. 3 Gully and other Traps fixed .. .. .. 14 14 14 4 2 10 30 44 Urinals— Water supplied—cleansed .. .. .. .. .. .. .. .. .. .. .. Cesspools— Abolished .. .. .. .. .. .. .. .. .. .. .. Water Closets — W.C. erected with pan, trap and water supply .. .. 1 1 .. .. .. .. .. 1 Pan and trap only provided .. .. 1 5 6 6 3 4 3 16 22 Water supply provided .. .. 18 23 41 35 24 29 19 107 148 Ventilated .. .. .. .. .. .. .. .. .. .. .. Position altered .. .. .. .. .. .. .. .. .. .. .. Dust Bins — Provided .. .. 11 40 51 28 21 25 22 96 147 Repaired .. .. .. 4 4 .. .. 4 .. 4 8 Areas— Constructed .. .. .. .. .. .. .. .. .. .. .. Yards— Paved .. .. .. .. .. .. .. .. .. .. .. Re paved .. .. 3 12 15 2 2 2 4 10 25 Sinks— Provided .. .. .. 1 1 10 3 .. 8 21 22 Domestic Water Supply— Cisterns provided.. .. .. .. 1 1 .. .. .. .. .. 1 Cisterns repaired and cleansed .. .. 13 21 34 8 5 8 7 28 62 Water supply provided to dwelling house .. .. .. 6 6 1 2 .. 1 9 4 10 Water supply provided for tenement house .. .. 3 20 23 18 12 4 16 50 73 Other Improvements- Rooms cleansed or limewashed .. .. 134 244 378 104 720 453 107 1,384 1.762 Walls and passages repaired, cleansed and whitewashed .. .. 175 172 347 20 279 137 23 459 806 Floor space ventilated .. .. .. 2 2 .. 3 1 3 7 9 Floors repaired .. .. .. 4 4 8 9 6 6 11 32 40 Roofs repaired .. .. 6 35 4] 45 12 15 16 88 129 Overcrowding abated .. .. 5 11 16 19 16 15 11 61 77 Illegal use of underground rooms for sleeping discontinued .. .. 2 4 6 4 1 4 .. 9 15 Other Improvements or Nuisances abated .. 68 159 227 176 160 110 125 571 798 Rooms Disinfected .. .. 2 1 3 2 24 6 3 35 38 Total Improvements .. .. 445 794 1,239 502 1,298 826 390 3,016 4,255 Total Premises Improved .. 178 255 433 220 409 304 155 1,088 1,521 * Inspector Ward was absent during the greater part of these quarters owing to illness, and resigned his office on 3rd May, 1912. 233 [1912 NATIONAL INSURANCE ACT, 1911. Sanatorium Benefit. It is hardly necessary to explain the provisions of this part of the Act, which during the last eighteen months have been so widely discussed in the public press. It may, however, be of interest to give a sketch of the work which the administration of sanatorium benefit threw on the Public Health Department of the Borough. It commenced in the early part of September, and the work of arranging for the administration of the Act locally devolved practically in its entirety on the Medical Officer of Health. During the month of September a letter was received from the then Acting Clerk to the London Insurance Committee inquiring if the Medical Officer of Health would undertake the duty of arranging for the domiciliary, dispensary, and hospital treatment of insured tuberculous persons living in Islington, who were recommended by the Committee's expert medical adviser for sanatorium benefit or home treatment, to which he replied in the affirmative. Accordingly, on 21st September, 1912, the first case was forwarded to him to make the necessary arrangements. This one was followed in quick succession by others, numbering in all 62, of which, however, 11 were recommended for sanatorium treatment, the documents received being merely notices of removal to an institution so that steps might be taken for the disinfection of the premises in which the patient resided, as the Insurance Committee for the County of London dealt with these cases themselves. As showing the amount of work entailed on the Public Health Department, it may be well to give an outline on the procedure adopted in the case of a patient recommended for domiciliary treatment, and as the first case dealt with is typical of those which followed, it may be quoted as an example. On the 21st September the following letter was received from the Clerk to the Insurance Committee for the County of London — 234 1912] NATIONAL INSURANCE ACT, 1911. County Hall, Spring Gardens, S.W. 21 st September, 1912. Dear Sir, I send herewith copies of the medical report forms regarding the application of Mr. A. J. B. for sanatorium benefit under the National Insurance Act, 1911. You will observe that the Council's expert medical adviser, Dr. J. E. S., recommends that the case should be dealt with by dispensary or domiciliary treatment. In certain similar cases the borough medical officer has been good enough to make arrangements for the treatment of the cases by a local practitioner, the usual fee being 2s. 6d. per visit at the patient's house or at the practitioner's consulting room, and 2s. 6d. in addition for each injection of tuberculin, the cost of the tuberculin to be defrayed by the Insurance Committee. I shall be glad if you will be good enough to inform me whether you would be prepared to make similar arrangements in the case now in question. The fees have to be approved by the Insurance Committee, and communicated to the Insurance Commissioners, and I shall, therefore, be glad, in the event of your being willing to deal with the case in the manner suggested, if you will be good enough to furnish me with particulars of the terms provisionally agreed, before definitely arranging for the treatment of the patient. Yours faithfully, LAWRENCE GOMME, Acting Clerk to the Committee. To this letter was attached the report of the medical practitioner in attendance on the patient, and that of Dr. S., the Council's medical expert adviser. The first step was to communicate with the medical adviser of the patient in the following terms:— NATIONAL INSURANCE ACT. 1911. Town Hall, Islington. 26th September, 1912, Dear Sir, A. J. B., 32, Bemerton Street, N. Your report on this man regarding his sanatorium benefit under the National Insurance Act, 1911, has been forwarded to me. The Council's expert medical adviser, Dr. S., recommends that the case should be dealt with by domiciliary treatment. I therefore write to you to ask if you will undertake the treatment at the fee of 2s. 6d. per visit at the patient's house or at your own consulting room, and 2s. 6d. in addition for each injection of tuberculin, the cost of the tuberculin being defrayed by the Insurance Committee. 235 [1912 Kindly reply quickly, as I have in turn to notify the Acting Clerk to the Insurance Committee if you will undertake the treatment. I am, Yours faithfully, A. E. HARRIS, Medical Officer of Health. The reply to this letter from the patient's medical adviser being in the affirmative, a letter was sent to the Clerk to the Committee notifying him of the willingness of the doctor to undertake the treatment. After the lapse of some days permission was received from the Insurance Committee consenting to the arrangement, and then the following letter was sent to the medical practitioner:— NATIONAL INSURANCE ACT, 1911. Town Hall, Islington. Dear Sir, A. J. B., 32, Bemerton Street, N. I duly forwarded your intimation of willingness to attend the above patient at the fees stated to the Insurance Committee for the County of London, and I have received their sanction to the arrangement. Will you therefore carry on the treatment of the patient as from this date ? I will give you due notice when a report on the condition of the patient and suggestions as to his future treatment are required. I am, Yours faithfully, A. E. HARRIS, Medical Officer of Health. At the end of the period stated for the re-consideration of the case by the Insurance Committee a letter was sent to the practitioner requesting him to forward a report on the state of the patient, which in the case under consideration was as follows :— 26th October, 1912. A. J. B,, 32, Bemerton Street, Islington. Age, 35 years. Male, married. One child, daughter, 7 years old. Has been under observation last two years. Present illness dated six months. Recommended to apply for sanatorium benefit September 18th, 1912. Recommended by Committee to receive sanatorium benefit 24th September, 1912. Placed under my care 28th September, 1912. Present condition, October 26th, 1912.—General health improved. Working capacity good. Present weight 10st. 21b. 7 oz. Greatest known weight 10st. 71b. No fever, night sweats, wasting dyspnoea, haemoptysis, hoarseness. Very little cough, very little expectoration. Appetite good. Some intes???inal indigestion. Occupation, builder's labourer. Away from work August, 1912, to September 24th, 1912 236 1912] Family History .— Father living. Mother dead—" tumours and wasting." Three sisters living and healthy. One sister dead—" operation." Two brothers living and healthy. One brother dead —"accident." No history of chest trouble in family. Wife, old scar of tubercular abscess. No evidence of active tubercular disease. Daughter, no evidence of active tubercular disease. Household arrangements.—Patient sleeps with wife. Child to be removed to other room. Window open day and night. Premises passed by Sanitary Inspector as satisfactory. Patient was placed under regular treatment on September 12th, tuberculin injections being 001 c.c. (first curative injection) general medical treatment. The treatment has been continued since patient was recommended for sanatorium benefit, and is showing good results. Although tubercle bacilli have now, for the first time, been demonstrated in sputum in small numbers, patient has had no undue reaction to injections, and is now (October 26th) receiving .05 c.c. I would, therefore, recommend that the present treatment be continued until the patient has received a final curative and immunizing dose of 1 c.c. Koch's 0 1 Tuberculin. The result of this report was that the expert adviser to the Committee recommended that the treatment be continued, and, so far as the Medical Officer of Health is aware, was still in process at the date of the termination of these duties by the Public Health Department, February, 1913. From this brief summary of the procedure adopted in the case of patients recommended for domiciliary treatment, it will be seen that considerable work devolved on the department, and in support of this statement it tnay be mentioned that it became necessary to write no less than 484 letters, to reply to numerous inquiries per telephone, to make copies of reports, and to write up case-records and diaries; most of which it was necessary to have done during the ordinary office hours. It was also necessary to visit patients late in the evening to ascertain their wishes as to the doctor they desired to attend them and as to the course of treatment recommended by their doctors, as they were away from home at business during the daytime, and could not be seen at any other time. Visits to medical practitioners also had to be made in some cases to ensure their immediate attendance on certain patients; and in at least three cases a message was received late in the afternoon from the Insurance Committee for London requesting that arrangements should be made for medical attention to be given to patients the same evening. The work, taken in its entirety, was carried out smoothly and without friction, although in several cases the patients openly expressed their disappointment at the recommendation of the medical adviser of the Insurance Committee for domiciliary treatment, when they expected to be sent to a 237 [1912 sanatorium, which in each instance was due to the patient being apparently under the impression that "sanatorium benefit" necessarily meant his or her treatment in a sanatorium. The use of this phrase has been a great mistake, and has, without doubt, led patients to expect that they would be taken to an institution of this character. In all, 62 cases were submitted to the Medical Officer of Health to make arrangements for treatment, and of these— 47 were recommended for domiciliary treatment; 3 „ „ dispensary treatment; 11 ,, „ sanatorium treatment; 1 was „ hospital (in-patient) treatment. In each of the three dispensary cases the patient preferred to continue in attendance at the tuberculin dispensary by whose medical officer he had been recommended for sanatorium benefit. These were the Kennington Tuberculin Dispensary (2) and Finsbury Tuberculosis Dispensary. The one patient recommended for hospital treatment had first to be attended at his home, and was afterwards admitted into Brompton Hospital. During the month of February, 1913, the Medical Officer of Health received an intimation from the Clerk to the Insurance Committee for the County of London that the arrangements previously made for the domiciliary treatment of insured persons suffering from tuberculosis would cease, and that in future all communications should be addressed direct to the Clerk of that Committee. In a report which the Medical Officer of Health submitted to the Public Health Committee respecting this work, he pointed out that the work that was then undertaken was only very small as compared with that which he anticipated would occur in the future, especially when sanatorium benefit was extended to the dependants of insured persons. Indeed, reference has only to be made to that portion of this report relating to Tuberculosis to verify his statement. 1912] 238 DISTRICT INSPECTION. This work, which is very heavy, devolves on 14 District Inspectors, to each of whom is allotted one of the 14 districts into which the Borough is divided for the purpose of sanitary inspection. It is their duty to inspect the houses in their districts; to attend to complaints as to insanitary conditions made by owners or occupiers; to inspect ice cream factories, dairies and milkshops, stables, yards, manure pits, passages and courts, vacant plots of land, urinals attached to public houses, premises for which certificates under the Customs and Inland Revenue Acts have been sought, and premises for which water certificates are required; to make observations of smoke nuisances; and to inspect the shops, stalls, and markets where food is sold on Saturday evenings. In addition to these multifarious duties they are required to inquire into the cause and circumstances of every case of infectious disease that is notified in the Borough under the Public Health (London) Act, 1891, and to make inquiries respecting similar diseases such as measles, whooping cough, etc., which are notified by the teachers of the public elementary schools; to make inquiries respecting the failure of persons to notify the births of children under the Notification of Births Act, 1907, and also respecting persons who have been notified under the Public Health (Tuberculosis) Regulations. It will thus be seen that the amount ot work devolving on the Inspectors is very great, and, therefore, at times it is with the greatest difficulty that they are able to perform it. Some of this work, in the opinion of the Medical Officer of Health and of medical men, is not such as should be performed by men, and there can be no doubt that so much of it as devolves on the staff under the Notification of Births Act and the Tuberculosis Orders, should be done by women who have had the necessary training and experience to enable them to undertake it. Unfortunately for Islington we have no Health Visitors. Last year the Medical Officer of Health in his Annual Report expressed himself as follows :— " 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 inspector 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, 239 [1912 " and which can only be efficiently undertaken by highly trained women. The " views of the Medical 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." They have not altered, but as years pass they become stronger. As many as 67,525 inspections and calls were made to the various premises which are mentioned in Table CIX. and related to 5,834 separate houses, to which the staff subsequently made 56,826 visits. Among the several calls which they made were 98 to places where ice creams are manufactured, 1,593 to dairies and milkshops, 452 to stables, 1,332 to yards, 92 to manure pits, 227 to vacant land, passages and courts, 629 to urinals attached to public houses, 10 to premises, the owners of which required certificates under the Customs and Inland Revenue Acts, 16 to premises for which water certificates had been applied, 41 to obtain samples under the Sale of Food and Drugs Acts, 158 with respect to smoke observations, and 217 rounds of inspection of the many stalls and market places where food is sold on Saturday evenings, during which an examination of the food sold at the many hundreds of these places was made. House to House Inspections.—With all the demandson the Inspectors mentioned in the previous paragraph, it can be seen that there is very little time for them to devote to the important work devolving on them under the Housing, Town Planning, etc., Act, 1909, under the provisions of which it is the duty of the Council to cause a house to house inspection to be made of their district. In the early part of the year the Medical Officer of Health prepared a plan of the Borough which showed the areas which were most crowded at the Census of 1901. Each area represented an enumeration district, each containing about 12,000 persons. Each of these areas was coloured according to the amount of crowding in it, and a plan of each Inspector's district coloured in this manner was given to him with instructions that he was to make a house to house inspection of the more crowded parts of his district first, and, when this had been accomplished, to proceed with the inspection of those houses next in order of crowding. This plan has worked very well and has been of great assistance to the Inspectors. During the year 910 houses were inspected, as contrasted with 701 in the preceding year. These inspections have always formed a regular part of the work of the Sanitary Inspectors, and in a statement which the Medical Officer of Health published last year, and which he again presents, it will be seen that from 1899 to 1911 a total of 15,939 house to house 1912] 240 tions were made, that from 1903 to 1908 these inspections were carried out very rigorously, and that it was only from 1909 onwards that there was a falling off of this work -a period which, of course, corresponds to the time during which so many additional duties have been cast on the staff through recent legislation and Local Government Board Orders. "Up to now," the Medical Officer of Health reported last year " there was no compulsion to make these inspections, although the Local Government Board recommend them, yet in future this will be so, for the Housing, Town Planning, etc., Act leaves no option to sanitary authorities, while the Insurance Com mittees 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 being relieved in other directions, in the manner pointed out by the Medical Officer of Health, is a problem which remcins to be solved. " What was necessary last year is even more necessary new. The following is the statement alluded to in the preceding paragraph:— Years House to House Inspections. Years. House to House Inspections. 1899 387 1907 1,696 1900 883 1908 1,202 1901 821 1909 783 1902 807 1910 934 1903 1,999 1911 701 1904 1,903 1912 910 1905 1906 1,725 2,088 Total 16,839 The total number of houses inspected in the Borough since 1899, as seen in the above statement, is 16,839, which represents a considerable proportion of those in the Borough. At the last census there were 36,778 inhabited buildings enumerated, containing 8.9 persons per building, which, strange though it may appear, is an increase of the return per inhabited building in 1901, the average then being 8.67. This is a strange circumstance, for in the meanwhile the population has decreased, and so far as can be ascertained there is certainly less overcrowding in the borough now than then. This seems to be all the more curious because in 1901 the average number of persons per family was 4.23, whereas in 1911 it had fallen to 4.10. Whether these figures be correct or not, the fact still remains that a heavy work devolves on the Council with respect to the house to house inspection of the Borough. 241 [1912 Synopsis of the Inspectors' Work. The following statement gives a brief synopsis of the district inspectors' work in 1912:— House to house inspections 910 Other inspections of dwelling houses 4,924 Re-inspections and calls made 56,826 Visits of inquiry re notifiable infectious diseases 1,577 „ school cases of „ 5,968 Butchers' shops, stalls, etc. (Saturday nights) 217 Ice cream shops and factories 98 Dairies and milkshops 1,593 Stables and yards 1,784 Manure depots 92 Certificates under the Customs and Inland Revenue Acts 10 Water certificates for newly erected houses or flats 16 Smoke observations 158 Notices Served,—There were 2,623 intimation notices served by the inspectors with respect to nuisances, of which 1,409 were delivered personally and 1,214 by post. In 322 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 72 were delivered personally and 250 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 986 Damp 378 Out of repair r 466 1912] 242 Water Closets. Foul 416 Without water supply 132 With deficient water supply 221 Improperly constructed 340 Defective 280 Stopped 69 Improperly situated 24 Insufficient external ventilation 96 Insufficient in number 64 Soil Pipes. Defective 102 Unventilated 48 Improperly ventilated 67 Yards. Improperly paved 689 Dirty 160 Undrained 44 Drains. Foul 10 Defective 569 Choked or stopped 176 Unventilated 131 Overcrowding 74 Underground Rooms 42 Other Nuisances 4,757 Total Nuisances 10,341 Notices were served during 1912 for the abatement of Smoke Nuisances at the following premises. Great Northern Electric Lighting Station, Drayton Park. Plaistowe's Factory, Wharfdale Road. Times Laundry, 20 and 22, York Road. 243 [1912 Mayfield Laundry, 93, Gillispie Road. Wilton Works, New North Road. Holloway Electric Supply Co., Bovay Street. Harrington's Factory, 114, Duncombe Road. Poulton & Noel's Factory, Brewery Road. (30, Bingfield Street. Textile Cleansing Co.'s Factory, 95, Fonthill Road. Hornsey Road Baths. Holborn Infirmary, Archway Road. Griffin Hygienic Laundry, 91a, Fonthill Road. SYNOPSIS OF THE DISTRICT INSPECTORS' SANITARY WORK FROM 1891 to 1912 (22 years). Houses inspected and visited 1,248,956 Drains constructed 20,736 ,, improved and repaired 19,711 „ traps fixed 103,240 Water closets, pan, trap, etc., supplied 21,712 ,, pan and trap only, supplied 21,537 „ water only, supplied 9,413 Soil pipe, defective, renewed or remedied 4,219 „ insufficiently ventilated, fully ventilated 3,622 „ unventilated, ventilation supplied 6,021 Dust bins, provided 20,000 „ repaired 4,038 Surface drainage, constructed 12,021 „ relaid 25,255 Water supply, new cisterns provided 4,333 „ cisterns repaired and cleansed 12,703 „ new supply 8,464 Houses generally repaired 12,144 „ cleansed 22,267 „ ventilated 13,761 Other improvements 146,518 Total improvements 491,721 R 2 1912] 244 Table CIX. Showing summary of Sanitary Work from Inspectors' reports for the Year 1912. DISTRICTS. Totals. 1 2 3 4 6 6 7 8 9 10 11 12 13 14 House to House Inspections 167 19 82 107 19 17 148 44 46 102 55 28 36 40 910 Other premises inspected 299 398 172 365 236 308 427 343 315 436 481 399 280 465 4924 Re-inspections, Calls made, etc. 3823 3951 3496 3998 4140 3313 4459 4218 3749 4156 4486 4743 4636 5058 56826 Ice Cream Factories inspected 12 3 11 2 1 1 11 6 15 24 4 5 3 98 Dairies and Milkshops ,, 95 110 74 214 126 78 114 65 120 64 142 120 141 130 1593 Stables ,, 38 11 20 42 140 67 36 10 5 10 9 6 22 36 452 Yards ,, 24 102 249 81 85 101 150 7 59 117 23 114 165 55 1332 Manure Depots „ 89 .. .. 2 .. .. .. .. .. .. .. 1 .. .. 92 Vacant land, Passages and Courts inspected 70 7 3 6 .. 3 7 3 2 33 6 8 61 18 227 Urinals attached to P.H.'s inspected 14 66 50 43 222 31 37 7 1 109 14 7 2 26 629 Premises (re Certificate Customs and Inland Revenue Acts) inspected .. 1 6 .. .. .. 2 1 .. .. .. .. .. .. 10 Premises (re Water Certificates) inspected 1 11 .. 1 .. .. .. .. .. .. .. 3 .. .. 16 Visits Sale of Food and Drugs Acts .. .. 16 13 .. 12 .. .. .. .. .. .. .. .. 41 Smoke observations 1 35 3 14 .. 11 15 4 11 14 23 13 13 1 158 Shops, Stalls and Markets (Saturday evening) 16 19 13 17 17 17 13 16 14 13 16 18 13 15 217 Total Inspections and calls 4649 4733 4195 4905 3986 3959 5419 4718 4328 5069 5279 5464 3974 5847 67525 Notices Served. Intimation—Personally 132 38 71 153 84 26 138 53 88 105 124 33 98 265 1409 By Post 6 1 3 233 15 4 302 18.1 3 23 8 214 31 187 1214 Statutory—Personally 5 1 13 2 2 5 1 10 2 7 .. 11 9 72 By Post 11 9 7 26 32 3 14 18 10 33 16 20 .. 39 250 Improvements. Drains— Constructed 2 1 3 4 1 2 1 2 1 1 1 2 .. 1 22 Re-constructed 32 34 30 39 26 35 34 49 26 30 16 19 32 32 434 Repaired 41 23 10 30 9 7 23 12 34 28 29 15 29 32 322 Ventilated 14 32 20 36 21 27 30 37 11 26 10 26 23 24 337 Gully and other traps fixed 200 188 84 210 139 84 270 223 109 122 71 78 135 179 2092 Urinals—Water supplied, cleansec 1 .. .. 8 .. .. 2 .. .. 1 2 .. 1 6 31 Cesspools—Abolished .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Water Closets— W.C. erected with pan, trap anc water supply 3 4 .. 7 2 10 3 1 1 3 3 6 .. 3 48 Pan and trap only provided 73 74 50 73 42 37 88 94 51 61 71 43 57 81 895 Water supply provided 27 45 14 51 23 11 35 34 35 31 44 8 17 51 426 Ventilated 2 4 3 4 .. 1 1 2 1 11 37 2 .. 29 99 Position altered .. 1 4 1 .. .. .. .. .. 2 .. 2 .. .. 10 Dust Bins—Provided 86 64 40 119 90 171 95 42 139 149 36 46 189 1273 Repaired 1 .. .. 1 9 .. 4 1 1 4 7 .. .. .. 35 Areas—constructed .. .. .. .. .. .. 1 .. 1 .. .. 2 1 .. 12 Yards—Paved 13 1 22 9 12 52 21 8 9 8 13 5 10 189 Re paved 69 63 24 110 47 17 137 50 71 82 86 99 40 82 977 Sinks— provided 14 30 1C 15 12 3 28 14 19 9 19 14 21 3C 238 Domestic Water Supply— Cisterns provided .. .. .. 1 .. .. 2 .. 1 .. .. .. 1 1 6 Cisterns repaired and cleansed 32 29 26 49 12 9 68 11 14 24 49 10 12 94 439 Water Supply provided to dwelling house 21 16 3 17 6 6 10 40 1 31 18 2 7 20 198 Water supply provided to tenement house 34 12 1 15 10 4 27 1 18 15 52 6 19 44 258 Other Improvements— Rooms cleansed and limewashed 82 49 76 206 147 64 269 89 164 153 311 271 189 245 2315 Walls and passages repaired, cleansed and limewashed 27 29 15 107 15 12 22 18 33 40 107 50 45 126 646 Floor space ventilated 7 8 7 24 . . 6 54 8 2 8 13 22 16 24 199 Floors repaired 17 17 11 54 10 15 36 18 22 31 48 43 32 33 387 Roofs repaired 39 44 10 79 21 11 59 24 24 33 78 37 34 63 556 Overcrowding abated 6 1 3 1 2 3 2 2 4 3 1 17 45 Illegal use of underground Rooms for sleeping discontinued .. .. .. .. .. .. 1 .. .. .. 6 1 1 7 16 Other Improvements, or Nuisances abated 124 118 69 210 61 60 145 87 141 192 195 119 103 360 1984 Rooms Disinfected 204 165 110 205 207 103 91 69 86 134 142 68 210 160 1954 Total Improvements 1171 1052 653 1687 912 547 1666 1011 919 1222 1576 997 1077 1954 16444 Total Premises Improved 508 384 257 601 336 175 480 346 296 503 556 282 355 574 5635 Table CX. Giving a Summary of the Nuisances discovered by the District Sanitary Inspectors during the Four Quarters and far the Year 1912, 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 209 245 275 257 986 2. ,, ,, in a damp condition 108 57 91 122 378 3. ,, in a dilapidated condition 108 114 126 118 466 4. The inlet of surface drain improperly trapped 19 9 6 12 46 5. The water-closet so foul as to be a nuisance 124 87 132 73 416 6. ,, ,, without a water supply 48 31 25 28 132 7. 8. „ ,, with a deficient supply of water 54 40 66 61 221 ,, ,, improperly constructed so as to be a nuisance 106 77 93 64 340 9. „ „ so defective as to be a nuisance 56 60 98 66 280 10. „ stopped 20 15 13 21 69 11. ,, „ placed in an improper position 3 11 5 5 24 12. Insufficient external ventilation to water-closets 33 21 27 15 96 13. Insufficient water-closet accommodation 11 20 20 13 64 14. The soil pipe defective 12 .13 25 22 102 15. „ unventilated 11 18 9 10 48 16. „ improperly ventilated 18 15 23 11 67 17. The yard in a condition injurious to health by reason of the want of proper paving 153 133 177 226 689 18. The yard dirty 56 25 28 51 160 19. undrained 13 10 9 12 44 20. A gully trap improperly placed within the house 47 33 27 23 130 21. The waste pipe of sink directly connected with the drain 26 11 7 8 52 22. „ „ improperly trapped 4 3 19 2 28 23. „ ,, untrapped 118 113 144 102 477 24. „ of lavatory directly connected with the drain 5 2 1 1 9 25. ,, ,, improperly trapped .. 1 .. .. 1 26. „ „ untrapped 27 13 7 6 53 27. „ of bath directly connected with the drain 4 2 1 2 9 28. „ ,, improperly trapped .. 1 .. .. 1 29. „ untrapped 16 4 11 9 40 30. The water cistern so foul as to be a nuisance 55 97 103 65 320 31. „ „ being without a close fitting cover 56 112 114 88 370 32. „ „ being placed in an improper position 18 25 30 16 89 33. „ „ defective.. 7 7 7 9 30 245 [1912 246 1912] TABLE CX.—continued. NUISANCES. QUARTERS. 1st Quarter 2nd Quarter. 3rd Quarter 4tli Quarter. The Year. 34. An accumulation or deposit of refuse injurious to health, by reason of the want of a proper dustbin or ashpit 78 66 49 51 244 35. The dustbin or ashpit defective 271 291 265 285 1,112 36. ,, „ placed in an improper position 2 .. 3 2 7 37. The drain foul 2 2 2 4 10 38. ,, defective 154 149 122 144 569 39 ,, choked or stopped 49 50 40 37 176 40. ,, . unventilated 27 29 37 38 131 41. The rain-water pipe in direct communication with the drain 29 18 17 7 71 42. ,, in direct communication with the soil-pipe 6 1 2 9 43. „ ,, defective 43 34 53 38 168 44. The water supply used for domestic purposes connected with the cistern which is used for flushing the W.C. 1 17 18 45. The house without a proper water supply 114 74 80 75 343 46. The roof defective 129 80 103 118 425 47. The guttering defective 57 41 63 53 214 48. The area improperly paved 13 9 9 14 45 49. „ dirty 8 9 11 4 32 50. „ undrained 5 .. 1 1 7 51. The paving of the washhouse defective 20 31 50 43 144 52. The back addition walls defective .. .. .. 1 1 53. The want of a proper manure receptacle 2 .. 3 1 6 54. The bakehouse walls dirty .. .. .. .. .. 55. An animal kept in such a manner as to be a nuisance io 8 22 19 59 56. The house or part of a house so overcrowded as to be injurious or dangerous to the health of the inmates 19 12 27 16 74 57. An underground room occupied as a dwelling contrary to the provisions of the Act 9 5 13 15 42 58. A tent, van, shed or similar structure used for human habitation which is in such a state as to be injurious or dangerous to the health of the inmates .. .. .. .. .. 59. The space below floor in the basement or ground 9oor being unventilated 6 5 9 ii 31 60. The space below floor in the basement or ground floor being improperly or insufficiently ventilated 28 30 44 64 166 All Nuisances 2,636 2,390 2,759 2,556 10,341 247 [1912 Table CXI. Giving a Summary of the Sanitary Work performed by the District Inspectors in 1912. Inspections. QUARTERS. The Year. First. Second. Third. Fourth. House to House Inspections 214 213 246 237 910 Number of Houses Inspected 1,219 1,255 1,205 1,245 4,924 Re-inspections, Calls made. &c. 15,910 14,304 11,728 14,884 56,826 Total Visits 17 343 15,772 13,179 16,366 62,660 Visits to Ice Cream Factories • • 58 40 • • 98 Do. Dairies and Milkshops 402 415 507 269 1,593 Do. Stables and Yards 503 528 356 397 1,784 Do. Manure Depdts 24 24 20 24 92 Do. Vacant Land Passages and Courts 79 65 29 54 227 Do. Urinals attached to P.H.'s 175 192 146 116 629 Do. Under Customs and Inland Revenue Acts 8 2 .. 10 Do. re Water Certificates 8 3 .. 5 16 Do. Shop-s and Stalls on Saturday Nights .. 73 48 46 50 217 Do. Sale of Food and Drugs Act 2 38 1 41 Smoke Observations 50 24 26 58 158 All Inspections, Visits, &c. 18,067 17 169 14,350 17 339 67,525 248 1912] REMOVAL OF DUST. The removal of the household refuse of a district is one of the utmost importance, as failure in this respect might have very serious results. It is, therefore, satisfactory to note that, as a rule, this work is very well carried out, and that so few complaints are received from the public. There is, however, a growing opinion among sanitarians and other persons interested in the health of the community that this refuse should be removed every day if possible, but most certainly not less than twice every week. The Medical Officer of Health has great sympathy with this view, as there can be no doubt that, owing to the decrease in the number of coal fires in kitchens for cooking, and the increase of gas cookers, the opportunity of destroying putrescible matter decreases. Of course, he knows very well that a state of absolute perfection in this as well as other subluminary matters cannot be obtained, but it is the clear duty of sanitary authorities to endeavour to keep their districts as clean as they possibly can. The large increase of late years in the number of restaurants to which so many people resort for their meals has to a certain extent decreased the accumulation of putrescible matter in the homes; while on the other hand it has created new centres where refuse is accumulated in large quantities, from which it should undoubtedly be removed every day* The question of course, is one entirely of cost; but, at the same time, this should not be the single factor to decide whether the more frequent removal of house refuse should be adopted. So far as the actual performance of the work is concerned, there is no doubt that in Islington it is creditably done, and that from 1891 to the present there has been a steady improvement in the work of the staff engaged in the removal of the household refuse. The number of applications for the removal of refuse received since 1891, has steadily decreased, so that whereas in that year they numbered 10,138, they only amounted in 1912 to 47, which is, of course, an insignificant figure. 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 Il6 1894 4,5°6 1905 89 1895 4,596 1906 58 1896 4,245 1907 55 1897 312 1908 64 1898 303 1909 67 1899 262 1910 44 1900 234 1911 52 1901 157 1912 47 Dust Receptacles Provided.—During the year 1,420 dust receptacles were provided, while 43 were repaired * Vide Mrs. Young's Report, p. 222. 249 [1912 Table CXII. Summary of Applications for the Removal of Dust during the Year 1912. Ward. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year. Number of Assessments Michaelmas, 1912 Number of Applications to every 100 Assessments. I — — 3 1 4 4.930 0.081 2 1 3 — 2 6 4,808 0.125 3 — — 2 — 2 4,505 0.044 4 2 — — 1 3 5,475 0.055 5 2 — 2 1 5 5,748 0.087 6 4 2 3 — 9 4,132 0.2l8 7 1 1 1 1 4 4,016 0.099 8 1 — 1 1 3 2,738 0.109 9 — 3 1 I 5 2,894 0-172 10 1 — 2 2 5 3,564 0.140 11 — — — 1 1 4,709 0 .021 Totals 12 9 15 11 47 47,519 0.099 250 1912] STATE OF PAUPERISM IN THE BOROUGH. It is unsatisfactory to find that the average number of poor persons relieved in each week during 1912, amounted to the large figure of 10,131. This return is 578 above that of the preceding year, and 1,367 above the weekly average which obtained from 1899-1911. Such an increase was hardly to be expected considering that the Old Age Pensions scheme had come into full operation. The following statement shows the average number of poor people relieved in each week in the last 13 years:— 1899 6,854 Per week relieved. 1900 6,956 „ 1901 7.327 „ 1902 7,668 „ 1903 8,004 „ 1904 8,086 „ 1905 9.224 1906 9,069 „ 1907 9.599 „ 1908 10,349 „ 1909 10,476 „ 1910 10,773 „ 1911 9,553 „ Average 8,764 1912 10,131 Indoor Paupers. — The average number relieved in each week was 5,030, or 56 more than that which obtained in the preceding year, and as contrasted with a weekly average of 4,325 in the decennium 1902-1911. Outdoor Paupers —On an average 5,101 poor persons were relieved in each week as compared with 4,579 in 1911, with 5,755 in 1910, and with a decennial weekly average of 4,955. Of the 5,101 poor persons, the average number of adults was 2,937, and of children under 16 years of age 2,164. Vagrants. No vagrants were relieved, as the wards were closed in January, 1909. Children Boarded out —On a weekly average, these numbered 99, as compared with 102 in the preceding year. They were also 22 less than the decennial weekly average of the years 1902-1911. 251 [1912 Table CXIII. Showing the State of Pauperism in the Borough during the years 1902-1911 and 1912. Years. Average number Relieved during each week. Deathrates. Indoor Paupers, Adults and Children. Outdoor Paupers. Totals Outdoor. Totals. All paupers relieved, cols. 2 & 5. Vagrants Relieved. Children Boarded out. Adults. Children 1 2 3 4 5 6 7 8 9 1902 3,594 2,662 1,412 4,074 7,668 10 125 16.55 1903 3,879 2,739 1,386 4,125 8,004 17 127 14.52 1904 3,622 3,069 1,395 4,464 8,086 65 122 15.74 1905 4,295 3,302 1,627 4,929 9,224 58 126 14.93 1906 4,189 3,335 1,545 4,880 9,069 12 134 15.26 1907 4,261 3,556 1,782 5,338 9,599 75 135 15.38 1908 4,558 3,752 2,039 5,791 10,349 13 125 13 .93 1909 4,864 3,649 1,963 5,612 10,476 Wards closed 107 14.96 1910 5,017 3,721 2,035 5,755 10,773 „ 106 13.79 1911 4,974 2,573 2,000 4,579 9,553 No Wards 102 14-87 Average 4,325 3,236 1,719 4,955 9,280 25 121 15.05 1912 5,030 2,937 2,164 5,101 10,131 No Wards 99 14.34 Table CXIV. Showing the State of Pauperism in the Borough during tne year 1912. Quarters. 1 Average number Relieved during each week. Death rates. Indoor Paupers, Adults and Children. 2 Outdoor Paupers. Totals. 5 Totals corresponding periods 1911 6 Vagrants Relieved. 7 Children Boarded out. 8 Adults. 3 Children under 16. 4 1st Qr. 5,212 2,929 2,254 10,395 9,891 No Wards 101 16 22 2nd ,, 4.976 2,836 2,057 9.869 9,116 104 12 96 3rd ,, 4,856 2,926 2,104 9,886 9,297 94 12 36 4th „ 5,077 3,059 2,242 10,378 9,908 97 15.82 TheYear 5,030 2,937 2,164 10,131 9,553 — 99 14.34 252 1912] COMMON LODGING HOUSES. The return given by the London County Council shows a decrease of 2 in the number of these places in Islington. They are not inspected by the Borough Council's Inspectors, except so far as their sanitary state is concerned, but by officials of the London County Council, who have power of inspection by day and by night. They are licensed annually, and are generally kept in a cleanly condition. One common lodging house at 55, Colebrooke Row, licensed for 71 women, ceased to be occupied during the year, so that there are now 47 common lodging houses in Islington, of which 36 are licensed for men and 8 for women, while two are for married couples. Table CXV. 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 Street 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. 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 Sc. 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, Gcrdon 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 52 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. 253 [1912 ARTIZANS' AND OTHER DWELLINGS. There are no additions to be made to the list of these buildings which was given in the report for 1911. They at present number 442 dwellings, containing some 5,109 sets of apartments. They are occupied for the most, part by the working classes, although clerks and persons of the middle class live in a considerable number of those of a better class. Some of the older buildings require constant attention, and, as stated by the Medical Officer of Health last year, are not nearly as full as in former days. There can be no doubt that working class families are seeking for small houses, so that they may have them entirely to themselves, and which are so common in the large towns in the north of England, but are so wanting in this great metropolis. In the Table which is appended herewith are given the names of some of the principal dwellings in the Borough:— WARD. Name of Dwellings. Where situated. No. of Blocks. No. of separate Dwellings. Tufnell Wessex Buildings Wedmore Street 3 225 „ •Lincoln House Dartmouth Park Hill 1 6 „ •Suffolk House „ „ 1 6 „ •Durham House „ „ 1 3 „ •Carlisle House „ „ 1 6 „ •No. 46 and 48, Dartmouth Park Hill „ „ 2 12 „ •Nos. 8, 9, 10, 11 and 12, Wyndham Mansions .. Wy dham Crescent 1 30 „ •Nos. 17, 18 19, 20, 21, 22, 23, 24, 25, 20, 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 Park Junction Road 1 3 „ •Nos. 49 to 67, Hargrave Park „ „ 10 30 Upper Holloway •Albermarle Mansions Holloway Road 3 24 „ Whitehall Mansions Archway Road 1 30 „ Elthorne House Elthorne Road 1 6 „ •Elthorne Mansions „ „ 1 12 •Nos. 34, 36, 38, 40, and 42, Dresden Road Dresdsn Road 5 15 „ •Nos. 27, 29, and 31, Cheverton Road Cheverton Road 3 9 „ Nos. 221 to 259, Hornsey Road Hornsey Road 38 114 „ Nos. 209 to 283, Hornsey Road „ „ 8 16 „ *473, Hornsey Road „ „ 1 3 Tollington Nos. 83 and 85, Alsen Road „ „ 2 8 „ •Turle Mansions Wray Crescent 1 11 „ •St. Mark's Mansions Tollington Park 4 16 „ •Tollington Park, Nos. 14, 16,20,22,24,26, 28 and 30 „ „ 8 16 „ •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 flat tenements are occupied by the better middle-class people. 254 1912] ARTISANS AND OTHER DWELLINGS—continued. WARD. Name of Dwellings Where situated. No. of Blocks. No. of separate Dwellings.[/##] Lower Holloway North London Cottages Market Road 1 8 „ "Crown Mansions Liverpool Road 2 24 „ Crown Mansions Paradise Passage, Liverpoo Road 1 10 „ St. James's Mansions St. James's Road 1 6 „ Pleasant Buildings York Road 3 27 „ Edinburgh Place Brewery Road 2 45 „. Aberdeen Place Brewery Road 2 35 „ Anchor Dwellings „ 2 15 „ *Nos. 24, 34 & 33, Arundel Square Offord Road 3 12 „ "Loraine Mansions Widdenham Road 38 160 „ "Morgan Mansions Holloway Road 8 64 „ L.C.C. Dwellings Caledonian Road Burns 1 30 Scott 1 30 Wallace 1 70 Knox 1 66 Bruce 1 76 Highbury Lome Buildings Benwell Road 4 26 „ Holloway House Hornsey Road 1 6 „ Highbury House „ 1 6 „ Hatton House „ 1 6 „ Drayton House „ 1 6 „ Ingram House „ 1 6 „ 23, Hornsey Road „ 1 3 „ 25, Hornsey Road „ 1 3 „ 27, Hornsey Road „ 1 3 „ "York House Highbury Crescent 1 24 „ "Thane Mansions Thane Villas 1 10 „ "Walton House Thane Villas 1 10 „ "Wilmington House Highbury Crescent 1 8 „ "Nos. 1 and 2, Fieldway Houses Fieldway Crescent 2 16 „ "17, Highbury Crescent Highbury 1 8 „ "Nos. 1 to 16, Aberdeen Court Aberdeen Park 2 16 „ "Nos. 1 to 6 Durham House Fieldway Crescent I 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 ,, "61, 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 better middle-class people 255 [1912 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 „ 1 4 „ Canonbury Avenue Canonbury Road 17 148 „ Lewis' Trust Buildings Liverpool Road 6 323 Canonbury Ebenezer Buildings Rotherfield Street 5 36 „ *1 to 6, Wallace Gardens Wallace Road 3 6 „ *7 to 15 Wallace Gardens „ 5 9 „ * Canonbury Mansions Canonbury Place 1 5 St. Peter's Palmerston Buildings City Garden Row 3 72 „ Torren's Buildings Torren's Street 6 83 „ Myddelton Buildings High Street 5 80 „ Albany Cottages Popham Street 1 98 „ Cornwall Cottages „ 1 94 „ Edinburgh Cottages „ 1 86 „ Queen's Cottages „ 1 86 „ Quinn Buildings „ 13 240 „ Peabody Buildings Greenman Street 10 294 „ Dibden Street Buildings Dibden Street 4 32 „ Pickering Street Buildings Pickering Street 11 83 „ Nos. 10a, 11a, 12a, 13a, Norfolk Street Essex Road 2 6 „ Nos. 16, to 30, Norfolk Street 15 30 „ Nos. 141 to 147, Shepperton Road New North Road 4 12 442 5,09 * These flat tenements are occupied by the better middle-class people. 256 1912] HOUSING, TOWN PLANNING, Etc., ACT, 1909. The administration of this Act is a very important duty which devolves on the Borough Council. In his report for 1911 the Medical Officer of Health gave a memorandum which the Local Government Board issued in 1910, one of the provisions of which requires that the Local Authority shall, as part of their procedure, cause 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; and that a 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. These Regulations have been duly complied with and a house to house visitation of areas, approved by the Public Health Committee, is now being carried out by the District Sanitary Inspectors. Since 1910 up to the present time, Closing Orders have been made with respect to many properties, particulars of which are given in the following tabulated statement:— 257 [1912 Particulars as to property dealt with under the Housing and Town Planning Act 1909, Sec. 17. Property. Closing Order made. Closing Order determined. Demolition Order made. Demolition completed by Owner. 1910 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. 1911. 1 Rice Place 2nd February 17th Nov. 1911 2 ,, „ „ 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 „ 15 „ „ 6th Oct. 1911 8 Hope Place „ 17th Nov. 1911 1912. 1912. 1, 2, 3, 4, 5, 6&7 Elliott's Place 19th January 4th October, 1912 April, 1913 I. 2, 3 Providence Row 4th October _ February, 1913 242 PentonvilleRd. „ — - „ 244a „ - - „ Amongst the properties against which Closing Orders were made were Nos. 1, 2, 3, 4, 5, 6 and 7, Elliott's Place. These houses have long been a source of trouble to the borough, for not only were they unhealthy owing ro the confined space in which they were built and to the lack of through ventilation, but they were also occupied by undesirable people. Closing Orders were, however, made against the premises on the 19th January, which were followed by demolition orders on the 4th October, and finally their demolition was accomplished by April of the current year. S 258 1912] It has also to be reported with respect to the house to house visitation that, as already stated in that part of this report dealing with district inspection, that 910 house to house inspections were made under the Act, as contrasted with 701 in 1911, and 934 in 1910. It is to be regretted that more work of this character could not be under taken, but inasmuch as the duties devolving on the inspectorial staff were very heavy, it was impossible for them to do more than they did. The work accomplished has, however, been satisfactory, and must be fruitful in good results. The Medical Officer of Health has already pointed out that house to house inspection has always been a great feature in the work of the Sanitary Inspectors of Islington, who have from 1899 to the present time examined in the course of these systematic inspections 16,849 houses. The Housing and Town Planning Act has undoubtedly proved a very great help to sanitary authorities in dealing with insanitary properties, and the Medical Officer of Health, while regretting that he has been unable to enforce its provisions more widely, yet hopes to accomplish much good by it during the years to come. 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 1912] 260 INSPECTION OF FOOD. This work is undertaken by one Inspector, Mr.Wilkinson, who is especially qualified for it, as he holds the certificate of an Inspector of Meat, and is by trade a butcher. During the year he made many thousands of inspections of the places where food is prepared, and altogether performed very satisfactory work. Unsound Food.—2 tons, 5 cwt., 2 qrs., 5 lbs. of unsound food were destroyed during the year after removal from shops and stalls. The greater part of this food was surrendered to the Inspector, for, as a matter of fact, the butchers of the Borough work in the greatest harmony with him. Indeed, it is a rare occurrence to find them wilfully exposing unsound meat; while on the other hand it is not unusual for them to send for Mr. Wilkinson when they are in doubt as to the soundness of their goods; and, indeed, at times even to surrender to him meat which they themselves have discovered to be unsound. The followng were the foodstuffs which were seized or surrendered and destroyed:— Tons. cwts. qrs. lbs. Meat and offal in slaughterhouses 0 14 2 13 „ butchers' shops 0 15 0 6 Fish 0 7 1 18 Vegetables and fruits 0 8 1 14 Kabbit 0 0 0 3 Condensed milk 0 0 0 7 Tons 2 5 2 5 In the preceding year 4 tons 13 cwt. 3 qrs. 7 lbs. were seized or surrendered. The quantity dealt with in the 10 years during which Mr. Wilkinson was an inspector was as follows:— 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 J7 1911 4 13 3 7 1905 1 11 1 4 1912 2 5 2 5 1906 2 1 1 2 1902-11 36 19 1 17 1907 2 1 0 9 1908 5 7 1 22 Average 3 7 0 24 261 [1912 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 — 6 2 16 Unsound fruit, vegetables, &c., surrendered — — 3 0 Unsound fruit seized - — — 2 11 Disease 1 and unsound meat, &c., from shops — — 1 1 Total — 8 1 0 2nd Quarter. Diseased meat and organs from slaughterhouses — 5 0 13 Diseased meat and organs from shops — — 3 17 Unsound fish from shops and stalls — 1 3 2 Total — 7 3 4 3rd Quarter. Diseased meat and organs from slaughterhouses — 1 2 16 Diseased shoulder of lamb (cooked) — — — 4 Meat unsound by decomposition from shops — 10 0 22 Unsouud potted meat from warehouse — — 2 4 Unsound fruit and vegetables from shops and stalls — 2 2 27 Unsound fish surrendered — 3 0 10 Unsound condensed milk — — — 7 Total — 18 1 6 4th Quarter. Diseased and unsound meat and organs from slaughterhouses — 1 0 24 Diseased meat and organ from shops — 3 0 14 Unsound fruit surrendered — — 3 27 Unsound nuts from stall—seized — 3 1 5 Unsound fish surrendered — 2 2 6 Unsound rabbit surrendered — — — 3 Total — 11 0 23 Total for the Year 2 5 2 5 262 1912] Year. Oxen. Cows. Calves. Sheep Lambs. Pigs. Total. 1899* 2,436* 402* 436* 43,252* 903* 47,429* 1900 3,019 668 356 52,760 464 57,267 19011 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 30,608 11 32,994 1907 2,146 4 142 24,380 2 26,374 1908 1,941 — 8* 28,476 4 30,507 1909 1,763 6 100 36,48 ‡ 1910 1,691 — 91 36,176 — 37,958 1911 1,448 — 73 38,009§ — 39,530 1912 1,085 — 40 29,310 — 30,435 * These returns are for 9 months † The returns are for 6 months. § Includes 8 goats. ‡ Includes 2 goats. One cannot examine this statement, which shows the number of oxen, cows, calves, sheep, lambs and pigs slaughtered in the Borough for food purposes since 1899, without being struck with the remarkable decrease which has taken place during recent years, for whereas in 1900 there were 3,019 oxen slaughtered, in 1912 there were only 1,085; again in 1900 there were 356 calves killed, whereas in 1912 there were only 40. The number of sheep and lambs has fallen from 52,760 in 1900, to 29,310 in 1912, while the slaughter ot pigs has fallen from 464 to nil. The most pleasant part of the return is that whereas in 1900 there were 668 cows slaughtered, in 1912 there was not one. The slaughter of these, for the most part miserable, animals have been driven away from the Borough. Altogether the number of animals slaughtered in Islington has fallen from 57,267 in 1900, to 30,435 in 1912. These results are mainly due to the large increase that has taken place in the importation of foreign meat, especially that coming from the Argentine States, which, however much it may be regretted, nevertheless supplies a very sound, wholesome food ; indeed, few people, at all events so far as beef is concerned, are able to detect the difference between it and good English or Scotch. Only a little time since a statement was made to the Medical Officer of Health that the beef which was sold by the butchers in London was for the most part Argentine produce, and, which is the serious part of the statement, that it was invariably sold as English or Scotch beef. However true this may be, it is very patent that 263 [1912 there is (at all events so far as Islington is concerned) an enormous decrease in the number of cattle, which were mainly English or Scotch, slaughtered in the local slaughterhouses for consumption by the inhabitants. There can be no doubt that the supply of meat to this country is one of the utmost importance, and, therefore the following facts respecting its importation into England are of interest. In 1905, 419,906 live animals (according to figures given in the Meat Trades Journal, and quoted in The Times of 24th June, 1913, were imported from the United States, while in 1912 there were only 39,987. Similarly those imported from Canada numbered 148,718 in 1905, and only 6,800 in 1912; while the number from other countries was 1,515 in 1905, and 2,125 in 1912. No live animals were imported from Argentina. The total imports of live animals were therefore 565,139 in 1905, and only 48,912 in 1912. On the other hand the imports of frozen and chilled meat as given in The Times were from the United States, 111,610 tons in 1905, and only 305 in 1912. Again, the importation from Australia was 137,765 tons in 1905, and 57,731 in 1912; while the imports from Argentina were 128,008 tons in 1905, and 340,679 in 1912. Various other imports were 1,565 tons in 1905, and 2,025 in 1912. Thus there was a total from these sources alone of 378,948 tons imported in 1905, as against 400,740 in 1912. The shortage in the importation of meat from the United States and from Australia has been more than met by the imports from Argentina. If this source, however, should fail, there would then undoubtedly be a shortage of meat in this country, and as a consequence an increase in the prices; indeed, the price of Argentine meat is increasing, which is stated to be due to three factors, which were given in The Times as follows:— 1. Greater consumption and smaller production in the United States market which was the principal provider of this product; the number of cattle in the United States has diminished noticeably, and this fact is again explained by the Ministry of Agriculture of that country which speaks as follows in its report for the year 1909:— "As it was not possible to consume or export all the cattle ousted from the plains of the west by dry farming, the course of development has been that the extensive production of cattle has given place to the intensive cultivation of small farms. In consequence of this, the price of maize rose 51 per cent. in 1908. On the other hand, the price of land rose 264 1912] in consequence of its better exploitation, and this increase has been as much as 81 per cent. in some of the States of the Union. A richer productivity has increased the value of the land, and it is clear that cheap meat cannot be the product of dear land." 2. The universal progress of industry, which attracts the rural population to the urban centres, and thus tends both to restrict and to increase the costliness of agricultural production, in spite of advanced methods of agritulture. 3. The increase, both relative and absolute, in the number of consumers of meat throughout the whole world, as a consequence of a general social evolution. The demand for meat in the United States has led to an agitation there for the abolition of the import duty on it, and the Medical Officer of Health understands from a source which he believes to be reliable, that it is not improbable that this duty will be removed. If so, then there can be no doubt that it will form another and very decisive factor in contributing to the increased price of meat in this country, for unquestionably if the United States be opened to Argentine meat, the imports into England will be greatly reduced. As showing the scarcity of meat in the United States, the Medical Officer of Health may state that while this portion of this report was passing through the press, the representative of a large American firm of meat canners, whose English factory is situate in Islington, applied to him for a certificate to enable his firm to export canned corned beef to the United States; and yet a few years ago, as we have seen by the figures given above, there were over 400,000 live animals imported from that country. It is clear, therefore, that the supply from the United States and from Canada also will in the future be a negligible quantity. Slaughter Houses.—These have now decreased to 28 from 57 in 1898. As the slaughtering of cattle locally grew less, so too did these places become fewer, as they were not in so much demand. Another factor has been the more strict enforcement of the regulations governing these places by the Council's Inspector, and also the unwillingness to renew licences unless the slaughter-houses are kept in good condition. 265 [1912 LICENSED SLAUGHTER-HOUSES. Registered No. Name of Licensee Situation of Premises. Condition of Licence. 119 Gayes, W. T. D. 4, Athelstane Mews 121 Clarke, Jno. 259, Balls Pond Road 122 Wood, Edward 53, Barnsbury Street To kill small cattle only and for purposes of own shop. 124 Hack, Thonas.. 40, Bingfield Street Small cattle only. 125 Guyer, Aubrey 18, Brecknock Road Small cattle only. 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, John 81, Highgate Hill 140 Stone, Sidney .. 234, Holloway Road 141 Horsey, Arthur W. 498, Holloway Road 142 Watson, R. C. 576, Holloway Road 143 Tuck, Wallace 152, Hornsey Road 144 Worboys, Richd. 410, Hornsey Road 145 Webber, Jno. 9, Junction Road, Upper Holloway 146 Buckingham, T. 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 158 Richardson, J. 149, Upper Street Small cattle only. 159 Luxton, John (E. side of) Wycombe Mews 160 Lidstone (Ltd) 398, York Road Total 28 Slaughterhouses. Cowhouses.—In 1892 there were 31 cowhouses in the Borough. To-day there are only 5, and to these 53 visits were made. It was found, however, that only 4 were in actual use. As a whole, the Inspector points out, they have been fairly well managed, yet there is a tendency to neglect the sanitary conditions where the premises are least used, and he quotes a case where the cowhouse, licensed for 12 cows, actually housed only 3, the remainder of the shed being occupied by lumber. The days of cowsheds in London are evidently numbered; and it cannot be long before Islington, once so noted for its cows, its milk and its milkmaids, will cease to have any more cows as it has long since ceased to have its milkmaids. 266 1912] The following statement shows the number of cowhouses licensed in the Borough in each year since 1892:— Years. Cowhouses Years. Cowhouses. 1892 31 1903 13 1893 31 1904 10 1894 25 1905 9 1895 19 1906 9 1896 19 1907 7 1897 19 1908 7 1898 *5 1909 7 1899 14 1910 5 I900 13 1911 5 I901 13 I912 5 I902 13 List of Licensed Cowhouses in the Borough of Islington. Registered No. Name of Licensee. Situation of Premises. No. of Cows licensed to hold. 108 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 Cowhouses. INSPECTOR WILKINSON'S REPORT. Public Health Department, Town Hall, Upper Street, N. 5th May, 1913. To the Medical Officer of Health. Dear Sir, I have pleasure in submitting the following report on the duties of meat inspection, etc., for the year ended December 28th, 1912:— Slaughterhouses.—The number of slaughterhouses on the register was further decreased from 30 to 28 at the annual licencing meetings of the London County Council in October and December last, owing to no application being made for the renewal of the licence 267 [1912 to premises situate at 41, Caledonian Road, and to an objection raised to the renewal of the licence to premises situate at the rear of 79, Stroud Green Road because no slaughtering had been done on the premises since December, 1911. The Chairman of the Committee expressed himself in eulogistic terms as to the satisfactory manner in which this particular work had been carried out by Islington. The Committee accordingly refused the renewal of this licence, thus reducing the total to 28. The total number of visits paid to slaughterhouses during the year was 1,599, and as a whole they have been well conducted. During the first quarter, however, a slaughterhouse, now seldom used, had been seriously neglected as regards general cleanliness, and had been used for the storage of various articles not required in the conduct of such premises. The licencee was warned that unless the premises were kept so as to be ready at all times for the conduct of slaughtering, opposition to the renewal of the licence would be lodged with the County Council. An improvement in the conduct of these premises has since been noted. During the fourth quarter, I was accompanied by Chief Inspector Leggatt on the occasion of the annual inspections, always made prior to the renewal of the licences, when slight defects to floor joints, etc., were noted and remedied in due course; the general sanitary condition being again satisfactory. The number of animals slaughtered was as follows, viz.:— Oxen Calves Sheep and Lambs Goats Pigs Total 1,085 40 29,310 Nil Nil 30,435 as compared with the year 1911:— Oxen Calves Sheep and Lambs Goats Pigs Total 1,448 73 38,001 8 Nil 39,530 It will thus be seen that there was a further reduction in the number of animals slaughtered of 363 oxen, 33 calves, 8,691 sheep and lambs, and 8 goats, making a total of 9,095 less than that of the previous year. The principal reason for this decrease, I believe to be due to a general reduction in the amount of live stock throughout the country and the restrictions on the movement of cattle during a considerable portion of the year owing to the prevalence of foot and mouth disease in various parts of the kingdom, causing a marked increase in prices. More than half of the reduction in the number of sheep slaughtered is accounted for by one firm alone who slaughter for the wholesale market, which is proof of the general shortage. The quality and condition of the animals generally was again of the highest order, in fact it would be impossible to find the same number of private slaughterhouses in any part of the country where a better class of meat was killed. Only 4 cases of bovine tuberculosis were found, and happily none of these were so generalised as to necessitate the destruction of the entire carcase, and in one case only was the affection sufficiently advanced to necessitate the rejection of a small portion of the carcase. Further particulars regarding these and also various other abnormal conditions found, principally due to parasite affections or accidental circumstances, will be seen in Table "A," which follows. I am glad to report that the practice of blowing meat by the mouth of the slaughterman, to which I have referred on several occasions, is less frequent, although not entirely abolished, and I have recently noticed that posters are exhibited at 268 1912] the Metropolitan Cattle Market slaughterhouses, stating that blowing meat by means of the mouth must not be done, although I think they, like us, have no statutory authority to prohibit the practice, whether the potting of such bills without due authority might be effectual in stopping the practice entirely is questionable, although doubtless it would be helpful. TABLE A. No. of Cases Description of Animal Affected. Extent of Disease or Affection. Nature of Affection. How disposed of. 1 Ox Lungs, liver, tripe and portion of flanks Tuberculosis Council's Destructor 3 Oxen Lungs and adjacent membranes do do. do. 2 Sheep Carcase and all organs Dead or moribund condition do. do. 2 do. Portions of carcase Bruised, etc. do. do. 1 Ox Head and tongue Actinomycosis do. do. 2 Oxen Head Abscess in throat do. do. 1 Ox Duodenum Abscess do. do. 1 do. Lungs and heart Inflammatory processes do. do. 1 do. Lungs Congestion do. do. 82 Oxen Livers Parasitic (Dis. Hep.) do. do. 11 do. do Abscess do. do. 32 Sheep do Parasitic (Dis. Hep.) do. do. 22 do. do Other Parasitic diseases do. do. 2 do. Liver and lungs do. do. do. 2 do. Lungs Abscess do. do. Shops, etc., Inspection of.—The number of shops, etc., where foodstuffs are disposed of varies somewhat from time to time, but may be approximated as follows:—Shops dealing in meat substances, butchers, provision dealers, etc., 240, meat and rabbit stalls 5, premises where meat substances are prepared (sausage factories, etc.) 9, 104 fish shops, 4 fish stalls, 210 fruit shops and about 20 fruit stalls. To these 12,893 visits were paid during the year, or, to be more correct, that number of separate observations were made; for while, of course, it would be impossible to make an observation without a visit, very many observations are included in a single visit to any particular marketing or business thoroughfare ; therefore, for want of a better term, each separate observation has been called a visit. The quality and soundness of foodstuffs generally, coming under the said observations must be regarded as very satisfactory on the whole. 269 [1912 TABLE B. Number of Cases. Description of Food. Nature of Unsoundness. Conditions under which found. Weight in lbs. How disposed of. Observations. 2 Tomatoes Decomposition Exposed for sale 67 Council's destructor Seized by Inspectors Cook and Jeffery. Summonses issued, and Defendants fined 10/- and 12/6 costs, and 20/and 23/- costs, respectively. 1 Salt beef do. do. do. 58 do. do. Seized. Legal proceedings taken, and Defendant fined £10 and 2/- costs. 1 Pig's head Tuberculosis Not detached from carcase 5 do. do. Seized. Public Health Committee enquire into circumstances, and order a letter of caution. 1 Condensed milk Blown tins On general dealers' premises 7 do. do Seized by Inspector West. Summons issued and dismissed, the Court being of opinion that the milk was not intended for sale. 1 Bananas Decomposing Costers' barrow,Cattle Market 1 do. do. Costermonger obstinate when requested to destroy them. Seized, and condemned by a Justice. Medical Officer of Health decides, under all the circumstances, on no further action. 1 Spanish nuts Decomposition do. do. 369 do. do Large percentage found bad. Seized, and J ustices' order obtained. Public Health Committee, on Medical Officer of Health's recommendation, decide to warn the offender. 1 Sheep's liver Parasitic Exposed for sale 1 do. do. Per Inspector Wood. Found on a stall. Owner, who has bad eyesight, cautioned. 1 Ox's liver (frozen) Degenerated cysts do. do. 12 do. do. Seized by Inspector Jeffery. Letter of caution sent to owner. 1 Cow's lungs Abscess (not tubercular) Hung in rear of shop 12 do. do. Surrendered for destruction, and caution given. 270 19121 TABLE B.—continued. Number of cases. Description of Food. Nature of Unsoundness. Conditions under which found. Weight in lbs. How d sposed of. Observations. 1 Sheep's liver Parasitic Submitted 4 Council's destructor Submitted to inspector Jeffery, and surrendered for destruction. 1 Pig's heads Decomposition Examined by request 679 do. do. Surrender accepted. Danish heads turned bad during transit. Condemnation Note given. 1 Various preserved meats, &c. do. do. (damaged packages) Provision warehouse 60 do. do. Damaged glassware packages, returned from retail shops. Surrender accepted. 1 Shoulder of Iamb Abscess Brought to Town Hall 4 do. do. Abscess near scapula joint, not noticed before cooking. Butcher refunds value. 1 Ostend rabbit Decomposition do. do. 3 do. do. Submitted Monday morning, purchased on previous Saturday night. Money refunded after caution from Medical Officer of Health through Food Inspector. 1 Ox's head and tongue Tuberculosis Examined by request 30 do. do. Part of consignment of butcher's offal from Ireland, Surrender accepted. 1 19 Oxen livers Parasitic (Dis. Hep.) do. do. 319 do. do. From two consignments of offal, Birkenhead and Ireland respectively. Surrender accepted. 1 Pig's head Tuberculosis Offal dealer's 22 do. do. See Report Note (a). 2 Pigs' heads do. Examined by request 61 do. do. See Note (6) of this Report. 1 Pig's head do. do. do. 14 do. do. See Note (c) of this Report. 1 Salt beef Decomposition Sausage factory 405 do. do. See Note (d) of this Report. 4 Fruit, etc. do. Submitted 501 do. do. Surrender accepted and Condemnation Note given. 7 Fish do. do. 830 do. do. do. do. 271 [1913 Only four summonses were taken out under the unsound food clauses during the year. One butcher, being found in possession of several pieces of salt beef exposed for sale in a state of decomposition rendering them unfit for human food, being prosecuted and fined £10 and 2s. costs. This shop was closed shortly after this prosecution and not since opened, although it had been occupied as a butcher's shop for many years previously. One costermonger and one fruiterer, occupying permanent premises, were prosecuted for exposing unsound tomatoes, and were at the instance of Inspectors Cook and Jeffrey ultimately fined 10s. and 12s. 6d. costs, and 20s. and 23s. costs respectively. In the fourth case Inspector West seized 7 tins of condensed milk which were blown and unsound; the defence, however, proving that they were not intended for sale, the summons was dismissed. Details of other unsound foodstuffs dealt with during the year will be found in Table " B " of this report. Some further explanation as to items in the Table specially noted, may however, be deemed necessary as follows:— (a) Your inspector in this case, on entering a tripe dresser's and offal dealer's premises, saw a pig's head which appeared along with other meat substances to have been recently deposited on the premises in the basement. This head was that of a well-nourished young sow; the glands of the throat had been incised for the purpose of examination, but it was noticed that one of the submaxillary glands, although cut and appearing sound where the incision was made, showed some abnormality in size and shape at the other end thereof, and on making a further incision at that point a tubercular nodule was revealed. The affection was slight, but sufficien to prevent the further preparation of .the head for purposes of human consumption. The facts were at once communicated to Inspector Young of the Smithfield Market (by telephone), from whence the head had come, with the necessary particulars for further investigation. The head was surrendered for destruction. (b) In this case two separate consignments of 50 and 48 pigs' heads respectively were sent to a brawn factory, from a bacon-curing factory near Bury St. Edmunds. Two heads from the first consignment and four from the Latter were found to have tuberculous glands in the throats. There appeared to have been no qualified examination made of any of the heads to ascertain whether they were sound, prior to their delivery at the factory in this district. As a consequence you communicated in each case with the consignors, stating the facts and cautioning them as to their liability in consigning heads that proved to be diseased, and you also called the attention of the Sanitary Authority of their district to the facts. The heads in question were surrendered for destruction. (c) In this case amongst a consignmen to the same brawn, etc., factory, from a Cirencester firm of bacon curers, from whom very considerable quantities at regular intervals for many years have been received, was one pig's head which showed a slight trace of tuberculosis, had escaped notice, as the incision revealing the nodule had been made prior to delivery in this district. Taking into consideration the very large number of pigs' heads consigned here by this firm, and the fact that they are invariably well examined prior to despatch, with the result that for many years previously no grounds for complaint had arisen, a formal surrender of the head by the consignees was deemed sufficient. (d) The item referred to under this note in the Table, was a quantity of salt meat found at the sausage factory of a big firm of meat importers and retail traders, which had 272 1912] just been received on the premises from their Cold Stores in the City, and was being examined by the factory manager piecemeal at the time of my visit, and such as were tainted were being thrown on the floor. I then made a careful examination of the whole of the consignment, and such parts as were in the least tainted were rejected. Ultimately 405 lbs. were surrendered and destroyed. I at once got into communication on the telephone with the firm at Smithfield Market, and told them that they must be prepared ,to take the responsibility for the soundness of all meat delivered at the sausage factory, which could not be regarded as a suitable place for the examination and sorting of meat of a doubtful condition, and that in future all meat delivered there would be looked on as being deposited for the purpose of preparation for sale and intended for the food of man. The responsible official of the company expressed regret that the meat had, contrary to his previous instructions, and entirely without his knowledge, been conveyed to this district before being properly examined, and promised to take such steps as would prevent any further misunderstanding. In concluding my remarks on the general inspection of foodstuffs, let me again call attention to the necessity of better protection thereof from the dust and dirt of the street and innumerable flies which gain access thereto through open windows of butchers, provision dealers, fruiterers, etc. There is reason to believe that any compulsory steps in this direction would be welcomed by a large percentage of the traders, but there seems to be a fear of loss of trade by any individual attempt in this direction, in view of the existing practice of touting outside open windows, although it is generally recognised in the two former trades named, at least, that considerable loss now exists by the effects of drying winds and the necessity of trimming goods disfigured by dust and dirt, due to the open exposure, and one is convinced that any distinct lead either compulsorily or voluntary would soon become popular. The following figures show the total weight of foodstuffs destroyed, as set forth in detail in the orecedinc Tables, viz.:— Tons. cwts. qrs. lbs. From Slaughterhouses as per Table A — 14 2 13 From Shops, etc., as per Table B 1 10 3 20 Total Tons 2 5 2 5 As compared with the amount destroyed in the last previous year, there is a falling off of over 54 per cent. under the former Table and nearly 50 per cent. under the latter. This, however, may be accounted for by the fact that in the said previous year the entire carcases of two bovine animals were destroyed owing to a generalised affection of tuberculosis, whilst, happily, no generalised case was found in the year now under consideration ; and also that under the latter Table in the previous year one surrender of 60 bags of green peas, weighing over 2 tons, alone accounts for the difference under that head. Cowsheds.—There are still 5 cowsheds on the register, to which 53 visits were paid; only 4 of these, however, were found to be in actual use during the year. They have as a whole been conducted fairly well, but in these, as in the slaughterhouses, there is the greatest tendency to neglect the sanitary condition where the premises are least used, and in one case, specially reported to you, complaint had to be made of the misuse of the shed, 273 [1912 which was licenced to keep 12 cows, when only 3 cows at the most were kept, the remainder of the shed being occupied by all sorts of lumber and articles not requisite in the conduct of a cowshed, and which were harbouring dust and filth. Considerable structural alterations are now being carried out here, the cowshed being lessened; for the time being, however, no cows are kept. In another shed, a waste of water owing to a defective water-cock was observed and notified to the Metroplitan Water Hoard, and in the same shed, on a later visit, there was occasion to complain to the licencee of the foul condition of the butts and flanks of one of the cows, and an improvement was afterwards noted. Offensive Trades.—These include 3 tripe boilers (one of which was scarcely used during the year), 2 gut scrapers and the knacker's yard. A total of 87 visits during the year was recorded, and observations generally were satisfactory; neither was any outside complaint regarding their conduct received. I am, Sir, Yours obediently, H. WILKINSON, Meat Inspector, etc. Milkshops and Dairies.—At the end of the year there were 493 milkshops and dairies on the register, to which 1,593 visits were paid by the Sanitary Inspectors. The inspection of these places is very necessary, for there is no article of food which is so easily contaminated as milk; indeed, one of the great sanitary problems, owing to the importance of our milk supply, is how to get it in a pure state, for contaminated milk means the deaths of many infants, invalids, and even of apparently healthy people. Everywhere throughout the civilized world sanitarians are devoting their energies to secure pure milk for the people, for it is not only the food of the rich, but of the poor also, of the very young and of the very old, as well as of those of persons in middle age. In fact all classes of the community, from the very young to the very old, consume it, and its consumption seems to increase year by year. It is unfortunately, however, a food which is easily contaminated and infected; and, therefore, it behoves sanitary authorities to adopt stringent measures to ensure its purity. The protection should begin at the cowshed, and not cease until it has been handed oyer to the consumer, who in turn should see that it is kept where dirt or dust or flies cannot reach it. We are told by some trade (not farmer's) papers that a very unnecessary outcry is being made by Medical Officers of Health, whom anyone might think on reading some of their vapourings, were rascals of the deepest dye, because in discharging a serious duty, they draw attention to the great dangers of a polluted milk T 274 1912] supply. Their recommendations are laughed to scorn, and they are told that they are interfering busy-bodies who know nothing whatsoever about the subject. The very coarseness and intensity of some of these attacks defeat their own purpose, for while they leave Medical Officers of Health unmoved, they show that they are made for purely trade purposes. There are, however, other papers devoted entirely to the best interests of the farmers, which never tire in pointing out how necessary it is that every precaution should be taken to secure the purity of the milk at its source of origin, and one can see, as a result, that there is undoubtedly an improvement in the state or cleanliness of milk as it arrives in the large towns from the farms. Still, much remains to be done, and an ideal pure milk supply is yet to be attained. A little time since the Medical Officer of Health jotted down in his notebook suggestions for the protection of milk supplies which were made in 1902, by the Health or Milk Inspectors of the United States Government, who at the time were making inquiry into the milk supply of a hundred cities, and while all the suggestions may not be suitable for England, yet so many of them are equally applicable to this country that he now gives them:— a. The registration of all dairies. b. The official endorsement of properly conducted dairies. c. The inspection of all herds, barns, dairy buildings, etc., once a month. , d. The better lighting, ventilation, drainage, and cleanliness of cows' stables. e. Whitewashing the interior of stables (cowshed). f. The eradication of tuberculosis from dairy herds. g. Branding of condemned cows. h. Cows not to be given swill feeds, etc. i. Cows to be regularly cleansed. j. Pasturage for city cows. k. Aeration of milk in pure air. l. Prompt cooling of milk and holding it at a low temperature until final delivery. m. Shipment of milk promptly from farms after milking. n. Delivery of milk and cream in sealed packages (glass bottles or small cans) so as to avoid unnecessary contamination by city dust. etc. o. Delivery of milk in cities at any hour of the day when it can be supplied in the best condition. p. Restriction upon the sale of milk in markets, candy stores, etc. 275 [1912 q. Delivery from such stores in bottles only. r. Mixing of herd milk to get an article of uniform composition. s. Bottling of the milk only at the dairy or place of general supply. t. Daily sterilization of milk utensils. u. More rigid inspection for preservatives in milk. v. Chemical and bacteriological examination of milk. w. Standards for cream and milk. x. The passage of no law that cannot be reasonably enforced. y. The publication of reports on inspection of dairies. z. Education of milk producers by a liberal distribution of circulars, leaflets, etc., bearing upon their work. Some of these suggestions may seem to some persons very drastic, but there is hardly one of them which cannot be fully justified. It will be noticed that the supply of milk in bottles to the public is insisted on, and anyone who has studied the matter in which milk is handled in course of its delivery to customers by roundsmen, whose hands, to put it mildly, are sometimes not too clean, and which cannot avoid being covered with bacteria, must come to the conclusion that milk requires protection then. It is, therefore, for these among many other reasons that the bottle delivery of milk in the United States has become so general. The practice has been introduced into this country, but up to the present only on a small scale. It is, however, on the increase, and no doubt will one day supersede the present method of delivery in cans or by direct measurement from a large handcan to the jug of the consumer. A great deal might be said on the protection of the milk supply, and, indeed, its importance would warrant it, but as it is no new one to the Borough Council of Islington, to whom the Medical Officer of Health has reported several times on the necessity for a pure milk supply, he will not pursue the matter further now. He would, however, warn persons who get milk in bottles to make sure that the bottles are filled at the dairy and not in the street by the roundsman, as the Medical Officer of Health has seen, who thus defeats the entire purpose for which the delivery of milk in bottles was intended; and yet this man was in the employment of a firm whose reputation is second to none in the milk trade of London. The Milk Bill which was introduced into the House of Commons two years ago still remains in a state of suspended animation, much to the discredit of those by whom the delay has been caused. Looking impartially on the matter, it seems to the Medical Officer of Health that this has not been due to the T 2 276 1912] apathy of the President of the Local Government Board, who, every Medical Officer of Health knows, has this subject at heart, but rather to the exigencies of the parliamentary situation. It is very apparent that the lives of the people are only of very secondary consideration when questions of high politics are to the fore. Our governors seem to think that the people are more concerned about votes than about the lives and health of themselves and their families. They may be right, although the Medical Officer of Health doubts it very much, for after all everything becomes a matter of very small consideration when a man's life or the lives of his family are endangered. It was said many years ago by a man holding a very prominent position in the parliamentary world that matters of public health were only undertaken by all Governments as " stop-gaps," because there were no votes in them, as all such legislation interfered with vested interests, and, therefore, raised enemies to the party. This seems to be the case in dealing with the milk supply, because the Bill introduced into Parliament has been shelved again and again, and yet there can be no doubt that its passing into law would result in the saving of thousands of infant and other lives annually. It is earnestly to be hoped that another year will not be allowed to glide by before this much needed legislation has been accomplished, and that the President of the Local Government Board, who is so much in sympathy with it, will see his ardent desires fulfilled. Mr. J. R. Leggatt, the Chief Inspector, visited the milkshops and dairies in the Borough during the year, and reported to me as follows:— 2nd October, 1912. To the Medical Officer of Health. Dear Sir,— I beg to report that I have recently completed my annual inspection of the dairies and milkshops, numbering 493, within the Borough. It is satisfactory to be able to state that the utensils in use in the shops were clean, and that the sterilization of the milk cans is still being carefully carried out. I have, however, to refer to purveyors of milk who neglect to keep the muslin or metal covers on the pans containing the milk. The reason frequently given is that a customer has just been served and they were just going to put the cover on again. I have, in every case, emphasized the great importance of always protecting the milk from contamination from flies, dust, etc., and it is a 277 [1912 matter of regret to me that we do not possess any power by which we can institute legal proceedings for such an omission. It is difficult to convince persons who are registered for the sale of milk, more particularly as the conditions to which I have previously referred with regard to those milkshops where paraffin oil, etc., is sold still prevail, that the utmost care should be exercised in the sale of milk. I am, Yours faithfully, JAMES R. LEGGATT. Superintendent and Chief Sanitary Inspector. ADULTERATION OF FOOD AND DRUGS. Samples analysed in 1912.—The total number of samples submitted to the Public Analyst was 1,207, of which 1,100 were declared to be genuine, and 97 adulterated. The percentage of adulteration was, therefore, 8 0. Of late years the Medical Officer of Health has felt it his duty to point out that the detection of adulteration has yearly become more difficult. He has now to report that last year was no different to its immediate predecessors. At one time adulteration, in the opinion of a certain school of politicians, was looked on as a form of trade competition, and that its prevention was entirely a matter for those who bought the goods. To-day, however, this is happily not the case. On the contrary it is looked on as a grave offence; that is to say, that the ordinary gross adulteration is so considered. When, however, the finer arts of the sophisticator are brought to bear and the added substances are said to be there only for the purpose of "improving" the article, then, indeed, the adulteration is winked at, if not encouraged, by the courts. For years similar practices had obtained widely in the United States; but things are not now what they were. Indeed, any person who has watched the passage of the Pure Food Bill through Congress, and, since then, the enforcement cf its provisions, cannot have failed to notice that it is causing what is little less than a revolution in the States. No longer is it possible to sell these " improved " foods unless there is a proper declaration of the fact attached to the food; and as a consequence their sales have greatly diminished, while the demand for genuine articles has largely increased. In this country for some reason or other there seems to be a reluctance to deal in a drastic manner with this question of adulteration; and yet no one 278 1912] denies that the purity of food is much to be desired for the sake of the health of the public. It is true that little by little something is being done, and one of the steps in the right direction was the issue of the Milk and Cream Regulations in 1911. They are, however, by no means satisfactory, for they put into the hands of sanitary authorities a power of dealing with offenders which should have remained in those of the judiciary. The particular clause in the Regulations to which reference is made reads as follows:— " Provided that before the local authority institute proceedings against "any person for a contravention of any of the Regulations in this part of the "Order the local authority shall afford him an opportunity of furnishing in "writing or otherwise as they may appoint, and shall duly consider such ex"planation and all the circumstances of the case " At the present time it is quite open to any person who is charged with an offence under tne Adulteration Acts to make a representation to the sanitary authorities, and in Islington that has been done; and if the person charged has been able to show clearly that he was not, and could not have been, the offender, the charge has not been pressed against him. In such cases there is always this difficulty to be faced:—the accused person is not sworn, and, therefore, what he says cannot be implicitly relied on. Indeed, it is difficult sometimes to believe some sophisticators of milk on their oath, for several cases are known to the staff of the Public Health Department of this Borough in which the accused deliberately perjured themselves to escape conviction; and only within a very recent period one such case occurred. The addition of preservatives to foods is a serious offence, which should be treated as other offences against the food laws are. As usual, the work of the taking of samples for analysis devolved on Inspector Burrell, who was appointed for the purpose under the Sale of Food and Drugs Acts, and it is not too much to say that he has performed his work with the very greatest assiduity, ability and intelligence. In the following Table is given the number of samples analysed in each year since 1891, and shows the number that were genuine and adulterated, and the percentage adulterated:— 279 [1912 Table CXVI. Showing the Number of Samples of Foods and Drugs Analysed, with the Result of the Analyses for the Year 1912 and for the preceding Twenty-one Years. Years. No. of Samples Examined. Genuine. Adulterated ent. 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 14.6 1903 1,016 898 118 11.6 1904 1,204 1,101 103 8.5 1905 1,200 1,101 99 8.2 1906 1,190 1,079 111 9.3 1907 1,213 1,131 82 6.7 1908 1,200 1,058 142 11.8 1909 1,201 1,060 141 11.7 1910 1,204 1,076 128 10.6 1911 1,200 1,105 95 7.9 Totals 19,238 17,092 2,146 11.1 1912 1,207 1,110 97 80 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 306 286 20 6.5 2nd „ 297 272 25 8.4 3^ 305 278 27 8.9 4th „ 299 274 25 8.4 The Year 1,207 1,110 97 8.0 Milk, Butter and Oleaginous Foods.— 906 samples of these foods, which are set out in the Table given below, were analysed by the Public 280 1912] Analyst during the year, and of these 65, or 7.2 per cent., were adulterated, as compared with 8.4 per cent. 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 1912 7.2 Samples. Adulterated. Percentage Adulterated in 1912. Percentage Adulterated in 1911. Percentage Adulterated in 1910. Milk 604 33 5.4 9-8 9.3 Milk (Separated) 2 ... ... ... ... Butter 200 7 3.5 5'° 5.0 Margarine 40 25 62.5 17-5 70.0 Cheese 40 ... ... ... ... Lard 19 ... ... ... ... Nut Lard 1 ... ... ... ... 906 65 7.2 00 10.2 Milk.— 606 samples were purchased or procured for analysis by the Public Analyst, of which 33, or 5.4 per cent. were adulterated. This is the smallest percentage of adulteration which has hitherto been recorded in the Borough with respect to milk. Indeed, it is only slightly more than half the percentage that had obtained from 1902 to 1911. The Medical Officer of Health does not, however, think that the actual adulteration is anything less than it has hitherto been, but that the vendors who resort to adulteration are more careful than they used to be in former years. They adulterate to-day, not with chalk and water, but with a by-product of the butter and cream trade, viz.:—separated milk, which, in all probability, would otherwise become waste matter, or in some country districts where pigs are bred, used as a food for them. There 281 [1912 are to-day in Islington, and, indeed, for that matter throughout London, numerous milk traders who receive large quantities of separated milk for which they have no demand, and which they rarely offer for sale. Indeed, frequently it is never intended to be sold as such, but as an adulterant of the high quality milk usually despatched to them by the farmers with whom they have entered into contracts. The Medical Officer of Health has seen many contracts made by purveyors of milk with farmers, in which he could not tail to notice that they all demanded a fairly high percentage of fat in the milks with which they were to be supplied. Milks containing these percentages are invariably supplied. These good class milks are then adulterated down to 3 per cent. of fat. The milk trade call it " toning," but for all that it is rank adulteration; and as milk at this figure passes the requirements of the Board of Agriculture, the; offenders cannot be prosecuted for their act. And yet it is a great fraud on the public, which is perpetrated by some offenders in the open daylight. Indeed, during the year at least one man who has a very large milk trade in Islington, openly mixed separated milk with pure milk in the street outside his premises. In the opinion of the Medical Officer of Health such frauds as this would be put an end to, certainly they would become less, if the Milk Bill which has so long been obstructed by other legislation in the House of Commons were passed. It is not creditable to the powers that be that a measure which so deeply concerns the health of the public should be delayed in this manner, for this Bill aims not only at preventing the milk from diseased animals being sold, but also that milk contaminated with impurities from whatever source they may come, as well as the prevention of its sophistication with a by-product called separated milk. 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. ist Quarter 156 9 5.8 2nd „ 150 13 8.6 3rd „ 151 7 4.6 4th „ 149 4 2.7 606 33 5.4 The record of the adulteration of milk in Islington since 1892, is as follows:— 282 1912J 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 16.9 1896 468 418 5° 10.6 1897 513 464 49 9.5 1898 543 492 51 9.4 1899 532 477 55 10.3 1900 54i 485 56 10.3 1901 632 556 76 12.0 I902 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 I910 621 563 58 9.3 19II 601 542 59 9.8 Totals 10,182 9,141 1,041 10.2 1912 606 573 33 5.1 Milks Purchased on Sundays.—Of the 160 samples of milk purchased on Sundays, 146 were found to be genuine, and 14, or 8.7 per cent. were adulterated. This figure compares with 6.9 per cent. in 1911, 8.7 in 1910, 8.8 in 1909, and 7.4 in 1908. Milks Purchased on Week-days.—326 samples were purchased or procured on week-days, of which 310 were returned as genuine; that is to say, they passed the standard of the Board of Agriculture; and 16, or 4.9 per cent., were declared to be adulterated. This is the lowest figure hitherto recorded in Islington, and it is so far satisfactory; but as pointed out in previous paragraphs it by no means represents the amount of adulteration that is occurring here. The fact is that it is not possible to detect the addition of separated milk, and until its mixture with pure milk is absolutely prohibited, and stringent provisions made as to its sale, so long will this form of adulteration continue. Milks Procured at Railway Stations in course of Transit.—120 samples were procured at the railway stations, and of these only 3, or 2.5 per cent., were returned by the Public Analyst as adulterated. This return is somewhat below that of the preceding year, when the percentage was 4.1. Quality of Milk.—During the last 15 years, although 1,780 samples of milk, arriving from farmers were examined, only 33 were found to be adulterated, and not only that, but in the same years the average percentage of their fat was 283 (1912 3.89, which contrasts with an average percentage of 3.64 as sold by purveyors of milk on Sundays, and 3.61 on week-days. In 1912 the quality of these various milks are given in the following tabulated statement:— Obtained. No of Samples Analysed. Average Percentage of Fat. Average Percentage of Solids, not Fat. Average Percentage of Total Solids. On Sundays 160 3.67 8.70 12.37 On Week-days 326 3.61 8.76 12.37 At Railway Stations 120 3.86 8.84 12.70 Official Minimum Standard — 3.00 8.50 11.50 Table CXVII. Showing the analyses of 8,777 milks examined in Islington during the fourteen years 1898-1911 and 1912, 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). No. of Samples. Per cent. of non-fatty solids. Per cent. of fat. No. of samples. Per cent. of non-fatty solids. Per cent. of fat. No. of samples. Per cent. of non-fatty solids. Per cent. of fat. 1898 193 8.50 3.50 230 8.56 3.69 120 8.84 4.04 1899 181 8..49 3.50 231 8.53 3.58 120 8.82 4.23 1900 196 8.64 3.62 224 8.55 3.53 121 8.75 3.93 1901 196 8.56 3.64 295 8.60 3.49 141 8.77 3.69 1902 192 8.59 3.60 274 8.64 3.51 90 8.76 3.85 1903 167 8.42 3.86 218 8.47 3.74 120 8.66 3.90 1904 164 8.52 3.78 317 8.48 3.74 120 8.62 3.97 1905 161 8.55 3.68 323 8.51 3.72 112 8.66 3.87 1906 195 8.49 3.58 332 8.52 3.59 110 8.75 3.69 1907 150 8.64 3.63 327 8.65 3.76 120 8.77 3.96 1908 160 8.58 3.69 324 8.58 3.52 120 8.73 3.88 1909 159 8.66 3.67 326 8.85 3.62 120 8.74 3.86 1910 160 8.57 3.55 336 8.50 3.44 125 8.76 3.74 1911 160 8.57 3.63 320 8.54 3.65 121 8.71 3.92 Total Fourteen Years 2,434 8.55 3.64 4,077 8.57 3.61 1,660 8.74 3.89 1912 160 8.70 3.67 326 8.76 3.61 120 8.84 3.86 284 1912] From these analyses the following averages for the years 1898-1912 have been deduced:— Solids not fat. Fat Total solids. 2,594 Sunday Milks 8.56 3.64 12.20 4,403 Week-day Milks 8.58 3.6l 12.19 1,780 Farmers' Milks 8.74 3.89 12.63 8,777 Total Milks 8.60 3.67 12.27 Table CXVIII. Giving the particulars of the Milk taken during each quarter of 1912 on Sundays, on Week days, and at the Railway Stations. 1912. 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 86 30 156 35 82 30 147 5 4 9 12.5 4 6 .. 5.8 2nd ,, 40 80 30 150 37 73 27 137 3 7 3 13 7.5 8-7 100 8.6 3rd „ 40 80 31 151 34 79 31 144 6 1 .. 7 15.0 1-2 .. 4.6 4th ,, 40 80 29 149 40 76 29 145 .. 4 .. 4 •• 5 0 .. 2.7 The Year 160 326 120 606 146 310 117 573 14 16 3 33 8.7 49 2 5 5.4 285 [1912 Table CXIX. Showing the Samples of Milk Analysed, the number found adulterated, with the percentage of Samples adulterated for the past fifteen years. Year. No. of Samples Taken. Genuine. Adulterated. Per cent. Adulterated. Sundays Week-days. Ry. Stations. All Milks. Sundays. Week-days. Ry. Stations. All Milks. Sundays. Week-days. Ry. Stations. All Milks. Sundays. Week-days. Ry. Stations. All Milks. 1898 193 230 120 543 165 207 120 492 28 23 .. 51 15.0 10.0 .. 9.4 1899 181 231 120 532 154 204 119 477 27 27 1 55 14.9 11.2 0.8 10.3 1900 196 224 121 541 170 194 121 485 26 30 .. 56 13.3 13.4 .. 10.3 1901 196 295 141 632 172 247 137 556 24 48 4 76 12.3 16.3 2.8 12.0 1902 192 274 90 556 172 238 88 498 20 36 2 58 10.4 13.1 2.2 10.4 1903 167 218 120 505 147 190 118 455 20 28 2 50 11.9 12.8 1.7 9.9 1904 164 317 120 601 158 276 120 554 6 41 .. 47 3.6 12.9 .. 7.8 1905 161 323 112 596 151 294 106 551 10 29 6 45 6.2 9.0 5.3 7.5 1906 195 332 110 637 173 281 108 562 22 51 2 75 11.3 15.4 1.8 11.8 1907 150 327 120 597 137 300 120 557 13 27 .. 40 8.7 8.2 .. 6.7 1908 160 324 120 604 145 289 118 552 15 35 2 52 9.4 10.8 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 1912 160 326 120 606 146 310 117 573 14 16 3 33 8.7 4.9 2.5 5.4 Totals 2,594 4,403 1,780 8,777 2,330 3,903 1,747 7,980 264 500 33 797 10.2 11.3 1.8 9.1 286 1912] Butter and Margarine.—240 samples were examined, of which 200 were butter and 40 margarine. Of these, 7 samples of butter, or 3.5 per cent., were adulterated; and of the margarine 25, or 62.5 per cent. The sale of margarine for butter is a practice which still obtains to a considerable extent,although it is confined to tradesmen of a low grade, and during the year a strong attempt was made to stop it. It was, however, with the very greatest difficulty that purchases of adulterated samples were effected, for before the sale was completed, as so frequently pointed out, the vendor most carefully scrutinises the purchaser to see if he or she is a regular customer. If not, in all probability, the article asked for will be provided ; but so soon, however, as the purchaser's face has become familiar, the chances are that margarine will be foisted on him or her for butter. Evidently the profits to be made are very great; for there are one or two persons engaged in this fraudulent trade who, although they have been heavily fined from time to time, still persist in their nefarious practice. Magistrates, however, are becoming more severe, and, indeed, one vendor who had been previously fined was penalized to the extent of £100. Cheese.—40 samples were examined, but none was adulterated. Lard.—20 samples of lard were submitted to the Public Analyst, and all were found to be genuine. Groceries.—187 samples of various foods, grouped together under this heading, were submitted to the Public Analyst, and of these 25 were declared to be adulterated, or 13.8 per cent. The several articles examined are set out in the following Table:— No. cf Samples. No. Adulterate Percentage H. Adulterated. Percentage Adulterated in 1911. Coffee 26 13 50.0 19.0 Cocoa 27 – — — Cocoa Mixture 11 – — — Pepper 11 – — — Mustard 26 1 3.8 — Golden Syrup 22 2 9.1 — Black Current Jam 5 — – — Arrowroot 14 1 7.1 — Sauces – — 14.3 Malt Vinegar 19 6 31.6 14.3 Milk Chocolate 2 2 100.0 – Sago 7 — — — Self-Raising Flour – — — 14.3 Baking Powder — — — 57.1 Dripping 21 — — – 181 25 13.8 6.5 287 [1912 Alcoholic Drinks.—60 samples were examined by the Public Analyst, of which 3, or 5 per cent., were adulterated. No. of Samples. No. Adulterated. Percentage Adulterated. Whiskey (Scotch) 12 1 8.3 Whiskey (Irish) 12 1 8.3 Rum 12 — — Gin 12 1 8.3 Brandy 12 — — Total 60 3 5.0 Drugs.—60 samples of various drugs were examined, of which 4, or 6 per cent., were returned as adulterated. No. of Samples. No. Adulterated Percentage Adulterated, Sal Volatile 10 2 20'0 Blaud's Pills 10 — — Ammoniated Tinct. of Quinine 5 — – Tincture of Quinine 5 1 20.0 Lime Water 5 — – Cod Liver Oil 5 — – Almond Oil 5 1 20.0 Tartaric Acid 5 — — Boracic Ointment 5 — — Cream of Tartar 5 — — 60 4 6.6 288 1912] Table CXX. Showing the Samples of Foods and Drugs submitted to the Public Analyst during the year 1912. 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 154 150 151 149 604 145 137 144 145 571 9 13 7 4 33 Milk Separated 2 •• •• •• 2 2 •• •• •• 2 •• •• •• •• •• Butter 50 50 50 50 200 48 49 50 46 198 2 1 •• 4 Cheese 10 10 10 10 40 10 10 10 10 40 •• •• •• •• •• Dripping 7 •• 7 7 21 7 •• 7 7 21 •• •• •• •• •• Lard 5 5 4 5 19 5 5 4 5 19 •• •• •• •• •• Nut Lard •• •• 1 •• 1 •• •• 1 •• 1 •• •• •• •• •• Cocoa Mixture •• •• 1 •• 1 •• •• ] •• 1 •• •• •• •• •• Coffee 5 7 7 7 26 1 6 2 4 13 4 1 5 3 13 Cocoa 7 7 6 7 27 7 7 6 7 27 •• •• •• •• •• Black Currant Jam •• 4 1 •• 5 •• 4 1 •• 5 •• •• •• •• •• Pepper •• 7 4 .. 11 •• 7 4 •• 11 •• •• •• •• •• Mustard 7 5 7 7 26 7 4 7 7 25 •• 1 •• •• 1 Golden Syrup 7 5 3 7 22 6 5 3 6 20 1 •• •• 1 2 Arrowroot 5 •• 6 3 14 4 •• 6 3 13 1 •• •• •• 1 Milk Chocolate •• •• 2 •• 2 •• •• •• •• •• •• •• 2 •• 2 Sago 7 •• •• •• 7 7 •• •• •• 7 •• •• •• •• •• Vinegar (Malt) •• 7 5 7 19 •• 7 2 4 3 •• •• 3 3 6 *Irish Whiskey 3 3 3 3 12 3 3 3 2 11 •• •• •• 1 1 *Scotch Whiskey 3 3 3 3 12 3 2 3 3 11 •• 1 •• •• 1 *Rum 3 3 3 3 12 3 3 3 3 12 •• •• •• •• •• *Gin 3 3 3 3 12 2 3 3 3 11 1 •• •• •• 1 *Brandy 3 3 3 3 12 3 3 3 3 12 •• •• •• •• •• Sal Volatile 5 •• •• 5 10 5 •• •• 3 8 •• •• •• 2 2 Blaud's Pills.. 5 •• •• 5 10 5 •• •• 5 10 •• •• •• •• •• Ammoniated Tinct. of 5 •• •• •• 5 5 •• •• •• 5 •• •• •• •• •• Quinine •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Tincture of Quinine •• 5 •• •• 5 •• 4 •• •• 4 •• 1 •• •• 1 * Examined for strength only. 289 1.1912 Table CXX.—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. Lime Water .. .. 5 .. 5 .. .. 5 .. 5 .. .. .. .. .. Cod Liver Oil .. 5 .. .. 5 .. 5 .. .. 5 .. .. .. .. .. Almond Oil .. 5 .. .. 5 .. 4 .. .. 4 .. 1 .. .. 1 Tartaric Acid .. .. 5 .. 5 .. .. 5 .. 5 .. .. .. .. .. Boracic Ointment .. .. 5 .. 5 .. .. 5 .. 5 .. .. .. .. .. Cream of Tartar .. .. .. 5 5 .. .. .. 5 5 .. .. .. .. .. 296 287 295 289 1,167 278 268 278 271 1,095 18 19 17 18 72 MARGARINE ACT. Margarine 1 10 10 10 40 8 4 .. .. 15 2 6 10 7 25 290 1912] Abstracts from the Public Analyst's Returns, together with the proceedings taken during the Quarters of the Year 1912. ADULTERATED SAMPLES.—First Quarter, 1912. 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. 950 T.L.B. Gin Inspector 38 6 degrees under proof Ordered to pay £1 13s. 6d. costs. 992 T.L.B. Golden Syrup do. 90 per cent. of Glucose Syrup Cautioned by letter. 1 T.L.B. *Milk do. 17 do. of added water Dismissed on ground of warranty. 11 T.L.B. * do. do. 8 do. do. Fined £2 and 12/6 costs. 13 T.L.B. * do. do. 17 do. of the original fat abstracted Fined £2 and 12/6 costs. 16 T.L.B. * do. do. 20 do. of added water Fined £2 and 12/6 costs. 49 T.L.B. Butter do. 90 per cent. of Margarine Cautioned by letter. 66 T.L.B. Margarine do. 100 do. do. Cautioned by letter. 88 T.L.B. * do do. 100 do. do. Cautioned by letter. 94 T.L.B. Butter do. 90 do. do. Ordered to pay 12/6 costs. 95 T.L.B. Coffee do. 57 do. of Chicory Ordered to pay 12/6 costs. 96 T.L.B. Arrowroot do. 100 do. of Tous les mois No proceedings, Vendor acquainted with result of analysis. 101 T.L.B. *Milk do. 5 per cent. of added water, 5 per cent. of original fat abstracted, and trace of nitrite. Fined £110s. and 12/6 costs. In default of distress 7 days' imprisonment. 108 T.L.B. * do. do. 3 per cent. of added water Cautioned by letter. 109 T.L.B. * do. do. 7 per cent. of original fat abstracted and 3 per cent. of added water. Fined £2 and 12/6 costs. 110 T.L.B. * do. do. 12 per cent. of original fat abstracted and 4 per cent. of added water. Fined £2 and 12/6 costs. 113 T.L.B. * do. do. 11 per cent. of added water Fined £1 and 12/6 costs. 125 T.L.B. Coffee do. 63 do. of Chicory Fined £1 and 12/6 costs. 128 T.L.B. do. do. 45 do. do. Fined £1 and 12/6 costs. 129 T.L.B. do. do. 41 do. do. No proceedings. Printed declaration on paper wrapper. * All free from Boric Acid and Formalin. Total number of samples analysed during the Quarter, 306 Number adulterated 20 291 [1912 U 2 ADULTERATED SAMPLES.—Second Quarter, 1912. 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. 170 T.L.B. *Milk Inspector 42 per cent. of original fat abstracted Summons dismissed on ground of warranty. 185 T.L.B. * do. do. 6 per cent. of added water Fined £2 and 12/6 costs. 206 T.L.B. * do. do. 12 per cent. of original fat abstracted Summons dismissed on ground of warranty. 228 T.L.B. Mustard do. 32 per cent. of Wheat Flour and 1 per cent. of Turmeric Fined 10/6 and 12/6 costs. 232 T.L.B. *Milk do. 9 per cent. of original fat abstracted Ordered to pay 12/6 costs. 240 T.L.B. Tincture of Quinine do. Ammoniated Tincture of Quinine Case dismissed with £3 3s. costs, the sample being labelled Ammoniated Tincture of Quinine 245 T.L.B. Almond oil do. 100 per cent. of Peach Kernel Oil Fined £3 and £2 2s. costs, or one month in default. 249 T.L.B. Margarine do. 100 per cent. Margarine Fined £1 and 12/6 costs. 289 T.L.B. *Milk do. 29 per cent. of original fat abstracted Fined 5s. and £1 3s. costs. 303 T.L.B. * do. do. Between 2 and 3 per cent. of added water Cautioned by letter. 318 T.L.B. † do. do. 6 per cent. of added water, trace of Formalin Fined £2 and £2 2s. costs. 337 T.L.B. Margarine do. 100 per cent. of Margarine Summons against defendant dismissed as he had successfully prosecuted his servant. 338 T.L.B. do. do. 100 do. do. Ordered to pay 12/6 costs. 361 T.L.B. *Milk do. 9 per cent. added water No proceedings as notice was exhibited in shop. 1912] 292 ADULTERATED SAMPLES (Second Quarter, 1912)—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. 363 T.L.B. *Milk Inspector 11 per cent, of original fat abstracted Summons withdrawn. Warranty proved, 365 T.L.B. * do. do. 14 per cent, of original fat abstracted Fined £1 and £1 3s. costs. 369 T.L.B. Margarine do. 100 do. of Margarine Ordered to pay 12/6 costs. 370 T.L.B. do. do. 100 do. do. Ordered to pay 12/6 costs. 371 T.L.B. *Milk do. 5 do. of added water Summons dismissed. 372 T.L.B. * do. do. 8 do. of original fat abstracted Fined £5 and £1 1s. costs. 373 T.L.B. * do. do. 4 do. of added water Summons dismissed. 374 T.L.B. Margarine do. 100 do. of Margarine Cautioned by letter. Wrapper partly stamped. 376 T.L.B. Coffee do. 52 do. of Chicory Ordered to pay 12/6 costs. 377 T.L.B. Butter do. 100 do. of Margarine Fined £40 and 12/6 costs, or three months in default of distress. 390 T.L.B. Scotch Whisky do.. 29'3 degrees under proof Cautioned by letter. * Free from Boric Acid and Formalin. † Free from Boric Acid. Total number of Samples analysed during the Quarter, 297. Number adulterated 25. 293 [1912 ADULTERATED SAMPLES (Third Quarter, 1912). 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. 448 T L B. *Milk Inspector 16 per cent. of original fat abstracted Ordered to pay 12s. 6d. costs. 449 T.L.B. ,, ,, 4 per cent. of added water Cautioned by letter. 450 T.L.B. * ,, ,, 7 per cent. of original fat abstracted Adjourned sine die. 478 T.L.B. Margarine ,, 100 per cent. of Margarine Improperly labelled. Fined £1 and 12s. 6d. costs. 479 T.L.B. ,, ,, 100 „ ,, Improperly labelled. Fined £1 and 12s. 6d. costs. 480 T.L.B. ,, 100 „ ,, Defendant absconded. 481 T.L.B. ,, ,, 100 ,, ,, Improperly labelled. Cautioned by letter. 504 T.L.B. Milk Chocolate ,, 14 6 per cent. of Cocoanut Stearin Summons withdrawn as it was found difficult to lay down standard for chololate. 505 T.L.B. Milk Chocolate Drops ,, 151 ,, ,, Summons withdrawn as it was found difficult to lay down standard for chocolate. 576 T.L.B. Margarine ,, 100 per cent. of Margarine Improperly labelled. Fined 5s. and 12s. 6d. costs. 539 T.L.B. *Milk ,, 12 per cent. of original fat abstracted Ordered to pay 12s. 6d. costs. 544 T.L.B. Margarine ,, 100 per cent. of Margarine Improperly labelled. Fined £1 and 12s. 6d. costs. 563 T.L.B. *Milk ,, 4 per cent. of added water Cautioned by letter. 596 T.L.B. Malt Vinegar ,, Vinegar other than Malt, and 12 per cent. deficiency in Acetic Acid Ordered to pay 12s. 6d. costs. Distress to issue if not paid within week. 597 T.L.B. Coffee ,, 33 per cent. of Chicory Fined £4 and 12s. 6d. costs. * Free from Boric Acid and Formalin. 294 1912] ADULTERATED SAMPLES (Third Quarter, 1912)—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. 598 T.L.B. Coffee Inspector 34 per cent, of chicory Fined £2 and 12s. 6d. costs. 633 T.L.B. Margarine ,, 100 ,, of Margarine Improperly labelled. Fined 5s. and 12s. (id. costs. Seven days in default of distress. 634 T.L.B. ,, ,, 100 „ ,, Improperly labelled. Fined 6s. and 12s. 6d. costs. 635 T.L.B. ,, ,, 100 ,, ,. Improperly labelled. Fined 10s. and 12s. 6d. costs. 636 T.L.B ,, ,, 100 „ ,, Improperly labelled. Fined 10s. and 12s. 6d. costs. 639 T.L.B. *Milk ,, 5 ,, of added water Cautioned by letter. 576 T.L.B. Malt Vinegar ,, Vinegar other than Malt, and 15 per cent. deficiency in Acetic Acid Fined 10s. and 12s. 6d. costs In default seven days' imprisonment. 578 T L.B. ,, ,, Vinegar other than Malt, and 40 per cent. deficiency in Acetic Acid Fined 7s. 6d. and 12s 6d. costs. 582 T.L.B. Coffee ,, 57 per cent. of Chicory Ordered to pay 12s. 6d. costs. 583 T.L.B. ,, ,, 65 ,, ,, Ordered to pay 12s. 6d. costs. 584 T.L.B. ,, ,, 55 „ ,, Fined £3 and 12s. 6d. costs, In default of distress one month's imprisonment. 620 T.L.B. *Milk ,, 4 ,, of added water Cautioned by letter. * Free from Boric Acid and Formalin. Total number of Samples analysed during the Quarter 305. Number adulterated 27. 295 [1912 ADULTERATED SAMPLES (Fourth Quarter, 1912). 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. n taken, with result of prosecution. 628 T.L.B. Margarine Inspector 100 per cent. of Margarine Fined £1 and 12/6 costs. 629 T.L.B. ,, ,, 100 „ .... Fined £1 and 12/6 costs. 635 T L B. ,, ,, 100 „ .... Fined £1 and 12/6 costs 640 T.L.B. *Milk ,, 21 ,, of added water Dismissed with £2 2/- costs on the ground that there was full disclosure before sale. 652 T.L.B. Margarine ,, 100 „ Margarine Summons not served. Defendant gone away. 653 T.L.B. ,, ,, . 100 „ Fined £1 and 12/6 costs. 654 T.L.B. Butter ,, 100 „ Fined £2 and 12/6 costs. 665 T.L.B. *Milk ,, 15 ,, added water . Ordered to pay 12/6 costs. 701 T.L.B. Sal Volatile ,, Slightly deficient in Alcohol No proceedings taken, adulteration too small. 704 T.L.B. ,, ,, ,, ,, Ammonia No proceedings taken, adulteration too small. 717 T.L.B. Irish Whiskey ,, 32 degrees under proof Ordered to pay 12/6 costs. 743 T.L.B Coffee ,, 38 per cent. of Chicory Defendant absconded. 770 T.L.B. Golden Syrup ,, 60 ,, of Glucose Syrup Fined £3 and £1 1/- costs. 778 T.L.B. Margarine ,, 100 ,, of Margarine Fined 10/- and 10/6 costs. In default 7 days' imprisonment. 781 T.L.B. *Milk ,, 92 ,, of the original fat abstracted No proceedings, the words "Separated Milk" being inscribed on milk barrow and vessel. * Boric Acid and Formalin absent in all cases. 296 1912] ADULTERATED SAMPLES.—(Fourth Quarter, 1912)—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. n taken, with result of prosecution. 792 T.L.B. Butter Inspector ,, •■• •• *• 100 per cent. of Margarine Fined £2 2s. and 12/6 costs. 798 T.L.B. do. do. 90 do. do. Ordered to pay 16/6 costs. 800 T.L.B. do. do. 90 do. do. Ordered to pay 16/6 costs. 820 T.L.B. *Milk do. 90 do. of the original fat abstracted Fined £1 1s. and 12/6 costs, or one week in default of distress. 839 T.L.B. Coffee do. 55 do. of Chicory Fined £1 and 12/6 costs. 844 T.L.B. do. do. 41 do. do. Fined £2 and 12/6 costs. 858 T.L.B. Malt Vinegar do. 33 do. deficient in Acetic Acid Ordered to pay 16/6 costs. 859 T.L.B. do. do. 6 do. do. do. No proceedings, adulteration too small 861 T.L.B. do. do. Vinegar other than Malt, and 37 per cent. deficient in Acetic Acid Summons dismissed, defendant given the benefit of the doubt. 865 T.L.B. Margarine do. 100 per cent. of Margarine Fined 10/6 and 12/6 costs, in default of distress 7 days' imprisonment. * Boric Acid and Formalin bsent in all cases. Total number of samples analysed during the Quarter 299. Number of samples adulterated 25. 297 [1912 INFORMAL SAMPLING OF FOODS. Inspector Burrell has now been engaged on this work for nearly five years, and without doubt has made a very considerable impression on the minds of persons who habitually. sophisticate their goods, especially fraudulent dealers in butter and milk, by whom there is no man more feared, which is all to his credit. As the Public Health Committee, and, indeed, the Council,thoroughly appreciate his services, there is no need to refer to them further. He has, as usual, submitted a report to the Medical Officer of Health for the information of the Public Health Committee, which is herewith appended. Public Health Department, Town Hall, N. 27th January, 1913 To the Medical Officer of Health. Dear Sir, As directed by you, and for the information of the Public Health Committee, I have pleasure in submitting for your consideration the following report on the testing of informal samples for the year ending 31st December, 1912:— During the fourth quarter of 1911 and the early part of the first quarter of 1912, the private inquiry work necessitated by important cases made it quite impossible for me to engage in the testing of preliminary samples, and if the figures for adulteration over this period be examined, it will be seen that the percentage fell to a trifle over 4 per cent., a figure which is, I believe, the lowest on record in the history of the Borough. In view of the wide range secured by our method of purchase, such a result, while being gratifying as indicating a considerable decline in the rate of adulteration generally, does not disclose a perfectly true state of affairs, as it must not be forgotten that those persons habitually practising adulteration are rarely caught by the simple purchase of an official sample, and especially is this the case where the offence is one of the substitution of margarine for butter. The decrease in the adulteration rate, therefore, while indicating a real decrease in adulteration, was also largely due to the suspension of the testing of preliminary samples over the period in question, a statement which is borne out by the fact that 55.5 per cent. of the total prosecutions for the year arose directly from this work. 298 1912] For the reason above stated I was unable to bring a wider range of articles under preliminary examination, but I hope to include some of the more commonly used foods in the near future. During the year, 783 informal samples were tested and examined, of which number 665 were found to be genuine, 49 were sold either with a declaration given verbally or imprinted upon the wrapper; while 67, or 8.7 per cent., were adulterated; the latter including repetition samples purchased at the same premises over a period of several days, and samples purchased by young children. In 42 cases samples were re-purchased and submitted to the Public Analyst in the usual manner, who reported 40 for prosecution, 1 sample of milk and 1 sample of coffee as genuine. In the two latter instances doubtless a change in the article had been effected between the purchase of the preliminary and official samples. In two instances the vendors were cautioned, and in the other 38 cases summonses were issued; while of the proceedings which followed, 36 were successful, and two remain in abeyance, the persons summoned having moved away. As already stated, the informal sampling work was directly responsible for.55.5 per cent. of the total prosecutions under the Sale of Food and Drugs Act for the year, while the fines resulting from them amounted to £102 9s. The several foods examined were as follows:— Milk.—As in previous years, the milk samples were for the most part obtained from milkshops or dairies, but in the case of two convictions, the preliminary samples were purchased from vendors in the street During the year 112 samples were tested, of which number 8, or 71 per cent. were adulterated, not including those samples adulterated to an extent of less than four per cent. Coffee.—Two hundred and fifty samples of coffee were tested; of which number 215 were found to be genuine; 51 were sold with either a verbal or printed declaration to the effect that the article was an admixture of Chicory and Coffee, and 17 were adulterated. In comparing the rates of adulteration, the conclusions arrived at are often misleading, owing to the dissimilar conditions of purchase. In the case of coffee, however, the risk of error in this direction is not so great, and it is interesting to note that whereas in 1908 the percentage of adulteration was 19.35, the figures for the past year were 6.2, or a decrease of 68 per cent. 299 [1912 Butter.—The butter samples were for the most part purchased from those dealers against whom there had been previous convictions. Forty-five samples were tested, of which thirty-three were genuine, and twelve, or 26.6 per cent. were adulterated. This high rate of adulteration is in some measure due to the inclusion of samples purchased by children, and the duplicate samples necessitated in order to make quite certain as to the final result when purchasing the official sample. It becomes increasingly difficult to secure prosecutions against those persons we know so well as carrying on a fraudulent trade, but during the year one such dealer made his seventh appearance at Court, and was fined £40. Margarine.—Of the 323 samples examined, 295 were found to have been sold in a manner complying with the Act, and 28, or 8.66 per cent. were sold in unstamped wrappers and were thus classed as adulterated. Malt Vinegar, I have been not a little surprised to discover vinegar offered for sale at such unlikely places as news and sweet shops, and as I have received complaints that the article is frequently sold as malt vinegar, when it is really artificial vinegar, I have, where possible, purchased samples at these establishments. Thirty samples were tested during the year, 23 of which were genuine, 4 were sold as wood vinegar, and 3, or 10 per cent, were adulterated. For purposes of comparison I insert the following Table showing the result of the test work since its conception in 1908:— ALL SAMPLES. Year. No of Samples. Declared. Adulterated. ntage of Adulteration. 1908 340 38 47 13.8 1909 471 96 88 18.7 1910 633 8l 73 11.5 1911 663 10 68 10.2 1912 783 49 67 8.7 2,890 274 343 12.5 I am, Your obedient Servant, TOM. L. BURRELL, Food and Drugs Inspector. 300 1912] Table CXXI. SUMMARY OF PROSECUTIONS.—During year 1912. Total Prosecutions. Successful. Dismissed. Withdrawn. Amount of Penalties Received "Public Health (London) Act, 1891 31 29 *1 1 £ s. d. 120 14 0 "Sale of Food and Drugs Acts, 1875-99" 47 38 †6 3 124 3 0 "Margarine Act, 1887" 17 17 ... ... 21 0 6 "Factory and Workshops Acts" 2 2 ... ... 3 17 0 "Dairies, Cowsheds and Milkshops Order, 1855" 6 5 ... 1 6 16 6 "London County Council General Powers Acts" 4 3 ... 1 14 8 6 "London County Council By-laws" 2 2 ... ... 4 3 0 "Metropolis Local Management Act" 1 1 ... ... 1 1 0 Total 110 97 7 6 296 3 6 * Held by Magistrate that the unsound food was not exposed for sale. † Warranties successfully pleaded in 4 instances. The other 2 casts were dismissed on their merits 301 [1912 WATER SUPPLY. The following are the particulars as to the water supply of the district receiving water from the New River, as abstracted from the last return of the Metropolitan Water Board. They are a continuation of those which have been given for some years past:— 1910-11 1911-12 Houses Supplied 218,225 219,165 Houses on constant system 218,225 220,021 Houses not on constant system Nil Nil Percentage of houses on constant system 100.0 100.0 Population supplied 1,426,401 1,434,771 Average daily supply (gallons) 44,293,400 47,665,300 Quantity of water supplied during the year (gals.) 16,167,080,000 17,445,510,000 Average daily supply per house (gals.) 203.46 217.49 » head (gals.) 31.05 33.22 Average number of persons supplied per house 6.55 6.55 Capacity of subsidence reservoirs 99,200,000 99,200,000 No. of days supply 10.57 10.57 APPENDIX. —o— VITAL AND SANITARY STATISTICS, 1912. together with the PRESCRIBED RET URNS OF THE LOCAL GOVERNMENT BOARD AND Abstracts for Previous Years. 304 1912] table a. Showing the Deaths from All Causes in Islington during the Year 1912. Deaths of Non-Residents in Hospitals are excluded. Deaths of Residents in Public Institutions are distributed. Deaths in Institutions within Borough. diseases. ages. Under 5 Over 5 DISTRICTS. Males. Females. 0- 1- 5- 10- l5- 20- 25- 3b- 4b- 55- 65- 75- 85- Tuf. u.h. Toll. l.h. h. B. S e. Small Pox (a) Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (b) Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (c) No Statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Measles 29 117 5 .. .. .. .. .. .. .. .. .. .. 146 5 12 9 8 34 13 45 30 81 70 151 1 Scarlet Fever .. 4 1 3 .. .. 1 .. .. .. .. .. .. 4 5 1 .. .. 4 1 2 1 7 2 9 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Epidemic Influenza 1 .. .. .. 1 1 1 5 1 4 7 5 2 1 27 1 3 5 1 6 2 10 14 14 28 2 Whooping Cough 17 3b 2 .. .. .. .. .. .. .. .. .. .. 52 2 3 lb 7 7 3 11 8 23 31 b4 2 Diphtheria 6 19 9 2 1 .. 1 .. .. .. .. .. .. 25 13 4 4 2 5 14 6 3 14 24 38 Enteric Fever .. .. .. .. 1 1 3 .. 2 .. 1 .. .. .. 8 1 .. .. .. 2 2 3 5 3 8 Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Diarrhoea, Dysentery 16 3 .. .. .. .. 2 .. .. 1 3 3 .. 19 9 1 2 2 2 4 8 9 11 17 28 2 Epidemic Enteritis 7 1 .. .. .. .. .. .. .. .. .. .. .. 8 .. 1 1 .. 1 2 2 1 2 5 8 3 Other A llied Diseases *4 '3 *1 *1 *1 *1 .. .. *1 .. .. .. .. 7 5 .. 1 .. 2 1 5 3 6 6 12 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Syphilis 8 2 1 .. .. .. .. .. 2 1 1 .. .. 10 5 1 1 1 1 3 4 4 8 7 l5 1 Gonorrhoea .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 2 .. .. .. .. 1 1 .. 2 .. 2 Phagedæna .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Erysipelas .. .. .. .. .. 1 .. .. .. 1 1 1 1 .. 5 .. .. 1 .. 1 1 2 1 4 5 Puerperal Fever .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 2 1 .. .. .. .. .. 1 .. 2 2 5 Pyaemia 3 3 .. .. .. 2 1 1 .. 3 .. .. .. 6 7 2 .. 1 1 4 3 2 7 6 13 Infective Endocarditis .. .. 1 1 2 4 4 3 .. 1 1 .. .. .. 17 1 2 1 3 8 1 1 10 7 17 2 Other Allied Diseases .. 1 .. .. .. .. .. 1 2 1 1 .. .. 1 5 1 2 .. 1 .. 1 1 5 1 6 Malarial Fever .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. 1 .. 1 Rheumatic Fever .. .. 3 2 .. .. 2 1 3 2 1 .. .. .. 15 1 1 1 3 5 2 2 6 9 15 Rheumatism of Heart .. .. 1 .. .. 1 1 1 .. .. 1 .. .. .. 5 .. .. .. .. 3 1 1 3 2 5 8 Tuberculosis of Brain 15 34 8 5 3 1 .. .. 1 .. .. .. .. 49 18 4 8 7 5 9 14 15 37 30 67 1 Tuberculosis of Laryns .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 2 .. .. .. 1 l .. .. 2 .. 2 154 Phthisis .. 6 4 6 16 41 100 106 79 52 12 3 .. 6 419 36 45 33 66 66 78 101 253 172 125 5 Abdominal Tuberculosis 8 2 3 1 .. .. 1 1 1 1 1 1 .. 10 10 1 4 2 4 1 5 3 11 9 20 4 General Tuberculosis 5 7 4 1 1 1 1 1 .. 2 .. .. .. 12 11 1 4 1 3 2 5 7 15 8 23 3 Other forms Tuberculosis .. 1 4 .. .. 2 1 .. 3 2 3 .. .. 1 15 3 .. 2 3 3 2 3 9 7 16 Other Infective Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Thrush .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Actinomycosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydatid Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases due to Altered Food .. 1 .. .. 1 1 .. .. .. .. .. .. 1 2 .. .. .. 1 1 .. 1 1 2 3 2 Acute Alcoholism .. .. .. .. .. .. 1 2 .. .. .. .. .. .. 3 .. .. .. 1 1 1 .. 2 1 3 1 Chronic Alcoholism .. .. .. .. .. .. .. 4 2 2 .. .. .. .. 8 .. .. 2 .. 3 .. 3 5 8 Chronic Industrial Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Osteo-arthritis .. .. 1 .. .. .. .. 1 .. 6 7 4 1 .. 20 2 2 1 1 6 2 6 7 13 20 Gout .. .. .. .. .. .. .. .. 1 1 .. 1 .. .. 3 1 .. .. 1 .. 1 .. 3 .. 3 89 Cancer .. 1 .. 2 .. 4 7 25 71 130 86 51 5 1 381 29 40 32 49 76 57 99 160 2222 382 2 Diabetes Mellitus .. .. .. .. 1 .. 3 4 2 10 7 2 .. .. 29 4 6 2 3 8 3 3 19 10 29 Purpura Hæmorrahgica .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 1 1 .. .. .. .. .. .. 2 2 Haemophilia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anaemia 1 2 2 .. .. 1 .. .. 2 2 1 .. .. 3 8 3 2 2 1 2 1 .. 5 6 11 Lymphadenoma .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 1 1 1 1 2 Premature Birth 128 .. .. .. .. .. .. .. .. .. .. .. .. 128 .. 11 8 11 16 19 34 29 70 58 128 Injury at Birth 3 .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. 1 .. 2 .. .. .. 3 .. 3 Debility at Birth 25 .. .. .. .. .. .. .. .. .. .. .. .. 25 .. 1 3 3 4 6 3 b 19 6 25 Atelectasis 10 .. .. .. .. .. .. .. .. .. .. .. .. 10 .. .. .. 1 1 1 3 4 5 5 10 1 Congenital Defects 34 .. .. .. .. .. .. .. .. .. .. .. .. 34 .. 2 2 2 4 7 8 9 21 13 34 1 Want of Breast Milk 5 .. .. .. .. .. .. .. .. .. .. .. .. 5 .. 1 1 .. .. .. 2 1 1 4 5 Atrophy, Debility, Marasmus 89 5 .. .. .. .. .. .. .. .. .. .. .. 94 .. 7 21 8 16 13 11 18 b2 42 94 * Cerebro-Spinal Fever. 305 [1912 1 ABLE A.—WMinuea. AGES. DISTRICTS = c . u ;.2.s-S u rt a ~|;2g 3'= i o DISEASES. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- T3 c D > 0 H X 6 "o H £ i J II B. in £ 0) fa O H 5 2 7 3 1 2 1 5 2 7 1 1 Old Age, Senile Decay 3 29 123 b6 221 20 4 34 23 ? 4 4 4 11 7 221 18 1 Encephalitis 1 8 13 17 7 3 1 49 8 5 3 8 b 8 12 23 27 50 Softening of Brain 2 2 1 5 3 9 10 2 4 1 21 19 1 3 2 1 3 5 4 5 3 3 9 10 19 1 Hemiplegia General Paralysis of the Insane 3 4 15 6 2 30 i b 4 2 4 7 ? 9 ? 6 4 23 10 7 7 30 17 Other forms of Insanity * ? ? t Chorea Cerebral Tumour 2 1 2 1 1 1 1 2 2 2 6 "2 1 8 17 4 3 2 1 1 1 3 3 1 5 5 7 3 10 8 17 1 1 Locomotor Ataxy 1 1 2 5 6 12 4 32 4 2 8 2 b 20 12 32 Other forms, Brain Diseases i 1 1 1 3 2 1 1 "2 10 2 1 1 1 3 3 1 1 1 2 Disease of Nose, Epistaxis 1 1 1 i 1 1 Pericarditis 3 1 2 2 3 13 1 2 3 2 4 2 7 9 16 2 Angina Pectoris 10 1 ? 2 ? 2 1 9 1 10 1 Aneurism 17 1 3 3 ?. 8 5 12 17 9 5 16 5 5 16 22 38 14 Embolism, Thrombosis 180 Varicose Veins Other Diseases, Heart and 4 2 6 2 8 6 30 35 83 134 J07 113 30 6 b54 bb 87 50 72 129 107 149 521 339 ubO Vessels fi ? 1 3 1 1 2 4 4 8 1 Laryngitis Croup Othet Diseases, Larynx and Trichea 40 20 3 1 5 3 15 22 23 27 5 60 104 23 29 15 14 14 34 35 88 7b lb4 1 2 1 12 22 53 109 88 19 L 30b iy 1 1 1 7 13 10 7 10 4 4 55 1 3 70 67 7 1 1 4 / 7 3 10 7 3 137 50 11 Ob 26 25 5 1 3 12 17 26 20 2b 23 4 51 11 15 4 Emphysema, Asthma 1 1 1 2 3 5 5 7 1 24 3 2 3 2 2 5 8 16 9 25 3 Other Diseases, Respiratory I 1 1 1 2 4 1 1 1 11 1 System Diseases of Mouth and Annexa 1 2 1 1 1 3 1 2 1 1 2 2 2 3 5 1 I I 1 1 3 Dicer of Stomach and Duo- b 9 8 3 7 1 1 34 4 b 3 5 5 4 7 20 14 34 2 22 Other Diseases of Stomach Enteritis 8 49 1 12 1 1 1 1 b 3 z 1 3 5 2 2 9 bl 1 15 13 1? 1 •?, 12 ?, 4 2 15 1 u 9 10 1 23 5 3b b 38 7 74 13 6 Appendicitis 4 ?,7 5 ? 5 1 8 3 9 12 21 33 7 Other Diseases of Intestine 2 1 9 18 14 5 2 1 48 2 3 b 5 8 13 12 23 26 49 14 V, 2 3 b II) 1 4 Peritonitis ■ ■ 9 ? 1 ? 3 2 7 5 12 Other Diseases, Digestive System ■ ■ 1 4 3 6 Diseases, Lymphatic System and Glands 11 1 ? 1 3 4 8 3 11 1 3 2 6 13 27 30 26 lb 2 b 1U 15 Calculus Diseases of Bladder and 3 3 7 5 2 20 2 4 3 5 2 4 19 1 20 tate 1 ?, 2 ? 4 Other Diseases, Urinary System 4 Diseases of Ovaries 5 Diseases of Uterus and Appendages Diseases of Vagina and External Genitals 1 3 •• 2 1 7 1 4 1 1 7 7 Diseases of Breast 1 1 1 Abortion, Miscarriage Puerperal Mania 1 1 Puerperal Convulsions 1 1 2 2 Placenta Praevia, Flooding w 306 1912 Table A.—Continued. Deaths in Institutions within Borough. DISEASES. AGES. Under 5. Over 5. DISTRICTS. Males. Females. |Totals  0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Tuf. U.H. Toll. L.H. H. B. S.E. Puerperal Thrombosis • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Other Diseases, Pregnancy, and Childbirth 1 • • • • • • • • 1 4 • • 1 • • • • • • • • 1 6 • • • • 2 2 1 • • 2 • • 7 7 Arthritis, Ostitis, Periostitis • • • • • • • • • • 1 • • • • 1 • • • • • • • • • • 2 1 • • • • • • 1 • • • • • • 2 2 Other Diseases, Osseous System • • 1 4 1 • • • • 1 • • • • • • • • 1 • • 1 7 • • 1 • • 1 2 3 I • • 1 8 Ulcer, Bedsore • • • • • • • • • • • • • • • • 1 1 • • • • • • • • 2 • • • • • • • • • • 1 1 1 1 2 Eczema 1 • • • • • • • • • • • • • • • • • • • • • • • • 1 • • • • • • • • • • • • 1 • • 1 • • 1 Pemphigus l • • • • • • • • • • • • • • • • • • • • • • • • 1 • • • • • • 1 • • • • • • • • 1 • • 1 Other Diseases, Integumentary System • • • • • • • • • • • • • • • • • • 1 • • • • • • • • 1 • • 1 • • • • • • • • • • • • 1 1 Accidents and Negligence.• • In Mines and Quarries • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 14 In Vehicular Traffic • • 4 5 1 • • 1 5 6 9 2 9 2 • • 4 40 3 7 2 4 8 10 10 33 11 44 1 On Railways • • • • • • • • • • • • 1 1 1 1 • • • • • • • • 4 1 1 • • • • • • 1 1 4 • • 4 3 On Ships, Boats, etc. (not • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • In Building Operations • • • • • • • • • • • • 1 2 2 • • 2 • • • • • • 7 • • • • • • 1 • • 1 • • • • • • 7 By Machinery • • • • • • • • 1 • • • • • • • • 2 • • • • • • • • 3 • • • • • • 1 1 1 • • • • • • 3 By Weapons and Implements • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 8 Burns and Scalds l 5 4 • • 1 • • • • 1 • • • • 5 1 • • 6 12 • • 2 2 4 1 2 6 9 9 18 2 Poisons, Poisonous Vapours. • • • • • • • • 1 • • 1 • • • • • • • • • • • • • • 5 • • • • 1 • • 1 1 2 3 2 5 3 Surgical Narcosis • • 1 • • • • • • • • 1 • • • • • • • • • • • • 2 2 • • 3 • • • • 1 • • • • 3 1 4 Effects of Electric Shock • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Corrosions by Chemicals • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Drowning • • • • • • •1 • • • • 2 • • 2 • • • • • • • • • • 5 1 • • • • • • • • 1 2 5 • • 5 Suflocation, Overlaid in Bed • • • • • • • • • • • • • • • • • • • • • • • • 23 • • 3 1 4 3 3 3 6 12 11 23 ,, Otherwise 10 • • • • • • • • • • 2 • • • • 2 • • • • • • 10 4 • • 3 • • 2 2 3 4 8 6 14 9 Falls not specified • • 2 • • • • 1 • • 2 4 3 4 9 5 3 2 31 3 4 5 3 5 3 10 18 15 33 Weather Agencies • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 5 Otherwise, not stated 6 1 • • • • • • 1 1 1 1 1 3 1 1 7 10 2 3 2 3 1 1 5 7 10 17 Suicide. 1 • • • • • • 1 • • • • • • • • • • • • • • • • 1 4 • • • • • • 2 • • 2 • • 2 3 5 1 By Poison • • • • • • • • • • 2 4 1 2 4 1 • • • • • • 14 2 1 • • 3 3 3 2 11 3 14 By Asphyxia • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • By Haneing and Strangulation • • • • • • • • • • • • 1 2 3 2 3 • • • • • • 11 • • • • 2 1 3 • • 5 9 2 11 By Drowning • • • • • • • • • • 1 1 1 2 • • 1 • • • • • • 6 •2 1 • • 2 1 • • • • 4 2 b By Shooting • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 6 By Cut or Stab • • • • • • • • • • • • 3 4 1 1 2 • • • • • • 11 1 3 1 3 2 • • • • 9 2 11 2 By Precipitation from Elevated Places • • • • • • • • • • • • 1 • • • • • • • • • • • • • • 1 • • 1 • • • • • • • • • • 1 • • 1 By Crushing • • • • • • • • • • • • • • • • • • 1 • • • • • • • • 1 • • • • 1 • • • • • • • • 1 • • 1 By other and unspecified methods • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1 Execution • • • • • • • • • • • • • • 1 • • • • • • • • • • • • 1 • • • • 1 • • • • • • • • 1 • • 1 Sudden Death, cause not tained • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Ill-defined and unspecified causes • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Males 396 228 49 21 23 58 150 214 280 366 362 228 45 624 1796 194 286 208 327 397 451 557 • • •• 2420 Females 314 195 81 19 35 42 121 133 238 279 392 335 108 509 1753 196 293 186 286 406 369 526 • • • • 2262 910 TOTAL DEATHS 710 423 100 40 58 100 271 347 518 645 754 563 153 1133 3549 390 579 394 613 803 820 1083 2420 2262 4682 307 1912 Table b. Showing the Deaths from All Causes registered during the Quarters of the Yeai 1912 at three periods of life. DISEASES. 1st Quarter. 2nd Quarter. 3rd Quarter. 4 th Quarter. Under 1 1 to 5 Over 5 Total. Under 1 | 1 to 5 Over 5 Total. Under 1 1 to 5 Over 5 Total. Uuder 1 1 to 5 Over 5 Total. Total for Year Small Pox— (a)Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (b) Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. (c) No Statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 5 19 .. 24 5 23 1 29 5 23 1 29 14 52 3 69 151 Scarlet Fever .. .. 1 1 .. .. l 1 .. 1 1 2 .. 3 2 5 9 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 1 .. 13 14 .. .. 4 4 .. .. 2 2 .. .. 8 8 28 Whooping Cough 7 16 2 25 4 10 .. 14 5 5 .. 10 1 4 .. 5 54 Diptheria 2 6 1 9 1 4 3 8 1 5 3 9 2 4 6 12 38 Entric Fever .. .. .. .. .. .. 1 1 .. .. 2 2 .. .. 5 5 8 Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery 4 .. .. 4 2 .. 2 4 9 3 5 17 1 .. 2 3 28 Epidemic Entritis 1 .. .. 1 1 .. .. 1 4 .. .. 4 1 1 .. 2 8 Other Allied Diseases .. .. 11 1 3† 2† 5 2† 2† 4 1† 1† .. 2 12 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cow Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis 2 .. 1 3 2 1 .. 3 2 .. 3 5 2 1 1 4 15 Gonorrhœa .. .. 2 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 Phagedsena .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. 2 2 .. .. 1 1 .. .. 1 .. .. .. 1 1 5 Puerperal Fever .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 1 2 Pyæmia 1 1 3 5 2 .. 2 4 .. 1 1 2 .. 1 1 2 13 Infective Endocarditis .. .. 2 2 .. .. 5 5 .. .. 5 5 .. .. 5 5 17 Other A Hied Diseases .. .. 3 3 .. .. .. .. .. 1 .. 1 .. .. 2 2 6 Malarial Fever .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 Rheumatic Fever .. .. 5 5 .. .. 2 2 .. .. 3 3 .. .. 5 5 15 Rheumatism of Heart .. .. 1 1 .. .. 2 2 .. .. 1 1 .. .. 1 1 5 Tuberculosis of Brain 5 14 3 22 3 6 5 14 6 4 2 12 1 10 8 14 67 Tuberculosis of Larynx .. .. 1 1 .. .. 1 1 .. .. .. .. .. .. .. .. 2 Phthisis .. 2 118 120 .. 1 100 101 .. 1 87 88 .. 2 114 116 425 Abdominal Tuberculosis 3 1 1 5 1 .. 2 3 4 .. 4 8 .. 1 3 4 20 General Tuberculosis 1 4 1 6 3 2 5 10 1 .. 2 3 .. 1 3 4 23 Other Forms Tuberculosis .. .. 2 2 .. .. 5 5 .. 1 5 6 .. .. 3 3 16 Other Infective Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Actinomycosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Hydatid Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Diseases due to A Itered Food .. 1 .. 1 .. .. 2 2 .. .. .. .. .. .. .. .. 3 Acute Alcoholism .. .. 2 2 .. .. .. .. .. .. 1 1 .. .. .. .. 3 Chronic Alcoholism .. .. 4 3 .. .. 2 2 .. .. 2 2 .. .. 1 1 8 Chronic Industrial Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Osteo-arthritis .. .. 4 4 .. .. 1 1 .. .. 4 4 .. .. 6 6 20 Gout .. .. .. .. .. .. 1 1 .. .. 1 1 .. .. 1 1 3 Cancer .. .. 85 85 .. .. 96 96 .. .. 93 93 .. 1 107 108 382 Diabetes Mellitus .. .. 7 7 .. .. 7 7 .. .. 5 5 .. .. 10 10 29 Purpura Hæmorrhagica .. .. 1 1 .. .. 1 1 .. .. .. .. .. .. .. .. 2 Hæmophilia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Anemia .. .. 4 4 .. 1 1 2 .. .. 1 1 1 1 2 4 11 Lymphadenoma .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 1 2 Premature Birth 34 .. .. 34 31 .. .. 31 40 .. .. 40 23 .. .. 23 128 Injury at Birth .. .. .. .. 2 .. .. 2 1 .. .. 1 .. .. .. .. 3 Debility at Birth 5 .. .. 5 8 .. .. 8 3 .. .. 3 9 .. .. 9 25 Atelectasis 3 .. .. 3 2 .. .. 2 1 .. .. 1 4 .. .. 4 10 Congenital Defects 9 .. .. 9 10 .. .. 10 8 .. .. 8 7 .. .. 7 34 Want of Breast Milk 2 .. .. 2 1 .. .. 1 .. .. .. .. 2 .. .. 2 5 Atrophy, Debility, Marasmus 16 .. .. 16 20 .. .. 20 15 2 .. 17 38 3 .. 41 94 w 2 † Cerebro-Spinal Fever. 308 1912 Table B.—Continued.  DISEASES. Lst Quarter. Total. 2nd Quarter' Total. 3rd Quarter. Total. 4th Quarter Total. for Year Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Dentition 1 1 ?, 1 7 Rickets 1 1 1 Old Age, Senile Decay 86 8b 45 45 42 42 48 48 221 Convulsions 5 2 1 3 b 6 4 4 18 Meningitis 1 1 4 8 1 ? 4 18 Encephalitis 1 I 1 ? ?, 15 15 q 1? 1? 14 14 7 7 4 4 7 7 21 b fi 8 8 ? 9 19 General Paralysis of Insane 6 6 7 7 9 9 8 8 30 Other forms of Insanity 4 4 5 5 4 4 4 4 17 Chorea 1 - 1 1 1 2 Cerebral Tumour 3 3 3 3 1 1 1 1 8 8 8 4 4 1 1 4 4 ? 1 1 ?, ? 9 ? 4 4 1?, 1? 7 fi b 7 7 Otherforms, Brain Diseases 1 1 5 5 2 2 2 2 10 1 1 Disease of Nose, Epistaxis 1 1 2 2 1 1 ? ?, 1 1 4 1 6 1 4 5 4 4 ? ? 1 1 ?, ?, 4 4 ? ? s 1 1 4 4 s 5 7 1 1 14 14 7 7 11 11 6 6 Phlebitis Other Diseases, Heart and Vessels 173 175 162 lb4 148 149 171 172 b60 1 1 ] 1 Croup Other Diseases, Larynx and Trachea Acute Bronchitis 9 51 77 11 12 28 2 9 12 5 32 47 lb4 Chronic Bronchitis 91 91 1 b2 b3 35 35 118 118 307 ? 1? 14 18 18 l IV, n 1 n 14 Lobular Pneumonia 27 19 21 67 19 14 8 41 5 14 9 28 19 20 12 51 187 Pneumonia y 9 55 73 5 4 36 45 2 b 25 32 10 7 2b 43 193 Emphysema, Asthma 13 13 4 4 1 1 7 7 25 7 7 7 8 Other Diseases, Respiratory System 1 1 2 1 1 4 4 5 5 12 Diseases of Mouth and Annex a 1 1 1 1 i i 2 I 1 5 Diseases of Pharynx 1 1 1 Diseases of (Esophagus 1 1 1 Ulcer of Stomach and Duodenum.... b A 7 7 7 7 14 14 34 Other Diseases of Stomach 4 1 2 7 4 4 2 4 6 2 .. 5 7 24 Enteritis b 2 5 13 3 17 17 1 1 19 13 4 25 74 1 ?, ?, ? Obstruction of Intestine 1 7 8 9 9 4 7 1 7 9 33 Other Diseases of Intestine 1 1 1 4 Cirrhosis of Liver 11 11 11 1?, 19 19 Other Diseases of Liver 5 5 ? 4 4 «> 8 9 Peritonitis 3 3 1 1 b 6 10 Other Diseases, Digestive System 2 3 1 2 2 4 3 12 Diseases, Lymphatic System &= Glands 2 2 1 1 1 1 2 2 6 Acute Nephritis ? ■?, 1 1 4 4 4 4 ^1 "S? 3? 3?, 3?, 32 3^ Calculus ?, ?, 1 1 3 Diseases of Bladder and Prostate 5 5 3 3 9 9 3 3 20 Other Diseases, Urinary System 3 3 1 1 4 Diseases of Testis and Penis Diseases of Ovaries 4 4 2 ?. 1 1 7 ?, ? 1 1 1 3 3 7 Dis of Vagina and External Genitals Diseases of Breast 1 1 Puerperal Convulsions 1 1 Placenta Praevia, Flooding 1 1 1 1 2 Other Dis., Pregnancy and Childbirth. 1 2 1 1 3 3 1 1 Arthritis, Ostitis, Periostitis 2 2 2 Other Diseases. (Osseous System 2 ? 1 1 1 1 4 4 3 Ulcer, Bedsore 1 1 1 1 2 309 [1912 Table B.—Continued DISEASES. 1st Quarter Total. 2nd Quarter. Total. 3rd Quarter. Total. 4th Quarter. Total. Total. Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Under 1 1 to 5 Over 5 Eczema .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 Pemphigus .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 Other Diseases, Integumentary System .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 Accidents and Negligence. In Mines and Quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. In Vehicular Traffic .. .. 8 8 .. 3 .. 9 .. .. 15 15 .. .. 11 12 44 On Railways .. .. 2 2 .. .. 1 1 .. .. 1 1 .. .. .. .. 4 On Ships, Boats, &c. (not drowning).. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. In Building Operations .. .. 1 1 .. .. 2 2 .. .. 3 3 .. .. 1 1 7 By Machinery .. .. .. .. .. .. 1 1 .. .. 2 2 .. .. .. .. 3 By Weapons and Implements .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Burns and Scalds .. 2 4 6 .. 1 2 3 .. .. 3 3 1 2 3 6 18 Poisons, Poisonous Vapours .. .. 2 2 .. .. .. .. .. .. 2 2 .. .. 1 1 5 Surgical Narcosis 1 .. .. 1 .. .. 1 1 .. .. .. 1 .. .. 1 1 4 Effects of Electric Shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Corrosions by Chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Drowning .. .. .. .. .. .. .. .. .. 3 3 .. .. 2 2 5 Suffocation, Overlaid in Bed 7 .. 7 5 .. .. 5 3 .. .. 4 8 .. .. 8 23 „ Otherwise 2 .. 1 3 1 .. 1 2 .. .. .. 5 2 .. 2 4 14 Falls not specified .. .. 9 10 .. .. 7 7 .. .. 7 8 .. .. 8 8 33 Weather Agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Otherwise, not stated 2 .. 4 6 .. 1 1 .. 4 .. 1 .. .. .. 4 4 17 Homicide 1 .. 1 2 .. .. 1 1 .. .. 2 2 .. .. .. .. 5 Suicide. By Poison .. .. 4 4 .. .. 2 2 .. .. 7 7 .. .. 1 1 14 By Asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Hanging and Strangulation .. .. 2 2 .. .. 4 4 .. .. 2 2 .. .. 3 3 11 By Drowning .. .. 1 1 .. .. .. .. .. .. 5 5 .. .. .. .. 6 By Shooting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Cut or Stab .. .. 4 4 .. .. 2 2 .. .. 3 3 .. .. 2 2 11 By Precipitation from Elevated Places .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 By Crushing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By other and unspecified methods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Execution .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. Sudden Death, cause not ascertained .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ill-defined and unspecified causes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Males 94 64 499 657 91 43 423 557 98 45 382 525 113 76 492 681 2420 Females 95 51 521 667 78 43 380 501 67 37 380 484 74 64 472 610 2262 TOTAL DEATHS 189 115 1020 1324 169 86 803 1058 165 82 762 1009 187 140 964 1291 4682 310 1912 Table c, Showing the Population, Inhabited Houses Marriages, Births and Deaths for the year 1912, and, 10 years preceding, gross numbers, Year, Estimated Population, No, of Inhabited Houses (estimated), Marriages Registered Births, Number of Deaths, Deaths of Residents in Public Institutions, Total all ages, Under one year, Under five 1 2 3 4 5 6 7 8 9 1912 326398 39,908 3,091 8 211 4,682 710 1,133 1,944 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 1,54' 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 1911 327,247 36,778 2,843 8,113 4,866 1,040 1,508 1,941 Average of 10 years, 330,625 39,592 2,928 8,621 4,978 1,020 1,569 1,691 311 1912 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 1912, 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 ot Total Deaths. 1 2 3 4 5 6 7 8 1912 25.15 14.34 1490 86 152 242 415 1902 27.1 16.5 17.1 132 216 338 292 1903 26.9 14.5 15.1 126 235 346 318 1904 26 .7 15.7 16.3 128 218 333 301 1905 26.4 14.9 15.5 123 217 331 319 1906 26.2 15.2 15.8 125 214 331 317 1907 25.8 15.4 16.0 117 196 303 342 1908 25.8 13.9 14.4 103 191 282 363 1909 24.9 14.9 15.5 103 171 285 363 1910 25.0 13.8 14.3 95 170 286 398 1911 24.8 14.9 15.4 128 214 310 399 Average of 10 years. 26.1 15.1 15.5 118 205 315 340 †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 England. 312 1912] 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 1912, and during the Ten Years preceding.  Year. Births. Birth-rates. Deaths. Death-rates. Dpaths 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. Phthisi? Puerperal Fever Totals. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Simple and undefined Fevers. Diarrhceal Diseases. Deaths. Death-rates. Deaths. Death-rates. Deaths. Death-rates. Deaths. Deaths per 1,000 births.  1902 9,214 27.1 5,635 16.5 1,219 132 608 53 114 40 104 152 .. 45 1 99 1.79 83 0.24 326 0.96 515 1.51 12 1.30 1903 8,983 26.9 4,839 i4.5 1,136 126 471 . 120 24 43 152 .. 22 1 109 1.41 40 0.12 350 1.05 492 1.48 9 1.00 1904 8,8go 26'.7 5,236 15.7 1,140 128 606 1 181 35 28 83 .. 18 .. 260 18.2 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 O.l6 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 1.11 411 1.24 11 1.27 1907 8,531 25.8 5,079 I5.4 996 117 432 .. 130 24 42 120 .. 13 .. 103 1.31 75 0.23 348 1.05 436 1.32 8 0.94 1908 8.665 25.8 4,679 13.9 894 103 358 .. 78 30 60 55 .. 18 .. 117 1.07 81 O.24 367 1.09 432 1.29 4 0.46 1909 8,198 24.9 4,918 14.9 841 103 418 .. 197 25 31 86 .. 12 .. 67 1.27 70 0.21 353 1.07 424 1.29 7 0.85 1910 8,201 25.0 4,523 13.8 777 95 428 .. 166 11 34 124 .. 17 .. 76 1.30 36 0.11 361 1.10 390 1.19 8 0.97 1911 8,113 24.8 4,866 14.9 1,040 128 603 .. 124 20 53 70 .. 12 .. 324 1.84 37 0.11 329 1.00 379 1.16 7 0.86 Corrected average. 8,510 26.07 4,914 15.05 1,007 118 494 6 140 28 45 102 .. 18 .. 155 1.51 58 0.l8 340 1.04 439 1.35 8 0.94 1912 8,211 25.15 4,682 14.34 710 86 296 .. 151 9 38 54 .. 8 .. 36 0.90 28 0.08 382 1.17 427 1.31 2 0.24 Departure from Average. -299 — 0.92 -232 — 071 -297 -32 —198 -6 + 11 -19 -7 -48 .. — 10 .. -119 — 061 -30 — 0.10 +42 +0.13 — 12 — 004 -6 — 0.70 313 [1912 TABLE F. Showing the Births and Birth Rates of Islington from 1841 to 1912. Years. Births. Birth Rates. Years. Births. Birth Rales. Years. Births. Birth Rates. Years. Births. Birth Rates.  1841 1446 25.58 1861 5530 35.31 1881 9894 34-87 1901 9264 27 62 1842* 1508 25.28 1862 5619 34.76 1882 9991 34-79 1902* 9214 27.06 1843 1627 25.86 1863 6094 36.51 1883 9940 3419 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 36.7 1890* 9230 2916 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 3012 1912 8211 25.15 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 430G 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 2807 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. 314 1912 Table G. Showing the Illegitimate Births in Islington from 1841 to 1912. Years. Births. Years. Births. Years. Births. Years. Births. Years. Births. Years. Births Years. Births Years. Births.  1841 * 1851 100 1861 184 1871 280 1881 380 1891 265 1901 228 1911 248 1842 33 1852 100 1862 207 1872 346 1882 353 1892 298 1902 248 1912 333 1843 * 1853 95 1863 224 1873 335 1883 370 1893 267 1903 242 1844 ♦ 1854 125 1864 248 1874 344 1884 341 1894 290 1904 273 1845 43 1855 126 1865 291 1875 363 1885 327 1895 286 1905 227 1846 53 1856 149 1866 272 1876 361 1886 331 1896 242 1906 244 1847 64 1857 151 1867 306 1877 337 1887 350 1897 269 1907 230 1848 85 1858 140 1868 317 1878 303 1888 345 1898 262 1908 231 1849 74 1859 174 1869 284 1879 401 1889 350 1899 279 1909 250 1850 97 1860 175 1870 318 1880 359 1890 328 1900 261 1910 240 7 yrs. 449 1851 to 1860 1335 1861 to 1870 2651 1871 to 1880 3429 1881 to 1890 3475 1891 to 1900 2719 1901 to 1910 2413 * The births in these years cannot be ascertained. 315 [1912 TABLE H. homing the Deaths and Death Rates of Islington from 1841 to 1912 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 1912 4682 14.34 1853 2395 22.52 1873 4156 18.25 1893 6391 19.55 1854* 2800 25.07 1874 4816 20.57 1894 5263 15.92 1855 2680 22.85 1875 4833 20.07 1895 5760 17.24 1856 2677 21.74 1876 4969 20.07 1896* 5884 17.42 1857 2586 20.00 1877 5111 20.07 1897 5395 16.00 1858 2777 20.44 1878* 5376 20.53 1898 5705 16.94 1859 2898 20.32 1879 5456 20.27 1899 6293 18.71 I860* 3028 21.21 1880 5716 20.65 1900 5721 17.03 1851-60 26009 21.43 1871-80 49677 20.28 1891-1900 58813 17.72 * These years contain 53 weeks. 316 1912 TABLE I. Infantile Mortality Returns, extracted from the Annual Reports of the Registrar-General, 1841-55, and fr»m the Annual Reports of the Medical Officer of Health of Islington, 1856-1910, and in 1912. Years. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1 )OOQ Births. Years. Deaths under 1 year old. Deaths per 1,000 Births. Years. Deaths under 1 year old. Deaths per 1,000 Births.  1841 190 131 1861 748 135 1881 1,400 140 1901 1,290 139 1842* 224 149 1862 725 130 1882 1,403 140 1902* 1,219 132 1843 — — 1863 906 147 1883 1,312 133 I903 1,136 126 1844 - — 1864 969 153 1884* 1,506 150 1904 1,140 128 1845 267 164 1865 1,088 161 1885 1,387 143 1905 1,074 123 1846 330 153 1866* 1,170 169 1886 1,517 154 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 84I 103 1850 360 119 1870 1,135 149 1890* 1,488 161 1910 777 95 1841-50 (8 years) 2,546 146 1861-70 10,360 153 1881-90 14,102 145 1901-10 10,450 120 1851 457 151 1871 1,179 154 1891 1,481 151 19II 1,040 128 1852 457 132 1872* 1,200 150 1892 1,417 145 1912 710 86 1853 571 154 1873 1,172 138 1893 1,595 164 1854 604 152 1874 1,278 147 1894 1,229 127 1855 605 146 1875 1,306 145 1895 1,416 139 1856 612 142 1876 1,397 152 1896* 1,490 150 1857 642 140 1877 1,302 140 1897 1,338 136 1858 648 142 1878* 1,453 154 1898 1,504 159 1859 665 133 1879 1,340 135 1899 1,548 160 1860* 747 144 1880 1,5I7 154 1900 1,344 145 1851-60 6,008 143 1871-80 13,144 147 1891-00 14,362 148 * These years contained 53 weeks. 317 l ' v-- - riM2 Table J. Showing the Cases of Infectious Diseases in Islington in Quinquennial Periods, 1891—1910 and in 1912. 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 738 219 .. 550 51 6 .. 3 3318 10.26 1893 118 2880 885 251 1 672 38 7 .. 1 4853 14.84 1894 90 1493 867 245 1 395 23 7 .. .. 3121 9.44 1S95 25 1692 582 184 5 320 22 9 .. .. 2839 8.50 1891-5 276 8502 3828 1088 9 2280 167 35 1 4 16,190 9.90 1896 50 2031 1091 229 .. 385 30 6 2 .. 3824 11.32 1897 3 1577 729 256 .. 312 27 1 .. 1 2906 8.62 1898 .. 1336 544 237 2 279 19 1 .. .. 2418 7.18 1899 3 1494 705 353 .. 350 33 2 .. 3 2943 8 .75 1900 2 1074 633 259 1 285 16 6 .. .. 2276 6.78 1896-00 58 7512 3702 1334 3 1611 125 16 2 4 14,367 8'.53 1901 50 1286 911 281 2 285 34 3 .. .. 2852 8.51 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 6.19 1911 .. 804 593 73 .. 275 14 .. .. .. 1759 5.37 1912 .. 811 516 49 .. 185 16 .. .. .. 1577 4.83 1912] 318 Showing the Cases oj Small Pox that occurred in the several Ward from 1891 to 1912. Year. Tufnell. * Upper Holloway. Tollington. Lower Holloway. Highbury. †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 io .. 15 2 .. 90 1895 1 6 3 1 1 1 2 4 1 .. 5 25 1896 8 3 25 1 6 5 1 1 .. .. .. 50 1897 1 1 .. .. .. .. .. .. .. 1 .. 3 1898 .. .. .. .. .. .. .. .. .. .. .. .. 1899 .. .. 2 .. .. .. .. .. .. .. 1 3 1900 .. .. .. 1 .. 1 .. .. .. .. .. 2 1901 3 .. .. 11 4 1 13 6 4 4 4 50 1902 9 34 28 32 17 13 25 33 7 16 62 276 1903 3 1 .. 2 .. .. .. .. .. 1 2 9 1904 .. .. .. 1 .. .. 12 .. 2 2 .. 17 1905 .. .. .. .. .. .. 2 .. .. .. 1 3 1906 .. .. .. .. .. 1 .. .. .. .. .. 1 1907 .. .. .. .. .. .. .. .. .. .. .. .. 1908 .. .. .. .. .. .. .. .. .. .. .. .. 1909 .. .. 3 .. .. .. .. .. .. .. .. 3 1910 .. .. 1 .. .. .. .. .. .. .. .. 1 1911 .. .. .. .. .. .. .. .. .. .. .. .. 1912. .. .. .. .. .. .. .. .. .. .. .. .. * 1 tie ngures tor 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 the several Wards from 1891 to 1912. Year. Tufnell. * Upper Holloway. Tollington. Lower Holloway. Highbury. †Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St.Peter's. Totals. 1891 .. 229 .. 108 .. 99 55 59 27 46 105 728 1892 .. 435 .. 225 .. 313 148 100 94 194 200 1709 1893 .. 790 .. 368 .. 633 355 209 136 201 187 2880 1894 176 235 114 196 152 67 165 116 91 90 91 I493 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 !37 126 155 91 76 113 202 1577 1898 159 151 152 182 151 102 114 38 58 107 122 1336 1899 100 172 183 178 176 118 117 102 79 98 171 1494 1900 78 85 102 138 152 90 85 66 51 107 120 1074 1901 97 109 129 172 178 83 137 86 61 93 141 1286 1902 140 147 160 187 121 88 187 67 45 94 136 1372 1903 76 78 113 129 130 70 88 42 28 36 75 865 1904 72 76 222 135 127 65 147 84 45 103 70 1146 1905 100 142 112 130 114 42 96 71 97 119 175 1198 1906 139 135 67 204 133 68 121 70 97 I55 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 1912 91 81 83 141 100 45 60 35 38 73 64 811 * The figures for 1891-2-3 are inclusive of Tufnell and Tollington Wards, † The figures for 1891-2-3 are inclusive of Highbury. 319 1912 Showing the Gases of Diphtheria that occurred in the several Wards from 1891 to 1912. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. St. Peter's. Totals.  1891 .. 305 .. 43 .. 112 37 44 44 54 73 712 1892 .. 299 .. 43 .. 95 49 43 54 37 75 695 1893 .. 283 .. 57 .. 140 94 46 55 62 117 855 1894 86 91 177 131 93 40 81 37 45 25 97 843 1855 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 190I 83 69 61 104 87 55 96 67 61 60 159 902 1902 128 100 62 !65 106 38 73 31 29 55 84 871 1903 43 45 47 120 37 17 34 17 21 36 35 452 I904 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 51 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 T9 60 47 522 1909 52 63 28 49 34 24 46 34 18 27 50 425 191O 48 92 62 31 18 22 87 20 22 21 40 463 1911 54 99 95 56 41 22 67 35 40 27 54 590 1912 46 82 61 55 39 18 48 29 30 57 47 512 Table N. Showing the Cases of Membranous Group that occurred in the several Wards from 1891 to 1912. year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury Mildmay. Thornhill, Barnsbury. St. Mary's. Canonbury. St. Peter's. totals.  1891 .. 20 .. 2 .. 5 .. 1 1 2 10 44 1892 .. 10 .. 3 .. 10 3 1 .. 8 6 43 !893 .. 10 .. 5 .. 3 3 3 1 5 30 1894 2 2 .. 5 .. 2 6 1 .. 5 i 24 1895 1 3 .. 3 3 1 1 .. 1 1 4 18 1896 3 3 .. 4 4 1 3 1 1 1 3 24 1897 2 4 .. 5 .. .. 1 .. .. 3 3 29 1898 2 4 .. 1 1 .. 4 .. 1 .. 13 1899 2 1 .. 2 1 .. 3 2 1 3 .. 1900 2 .. .. 1 1 .. 1 2 .. 1 1 9 1901 1 .. .. 1 .. .. 1 2 .. 1 .. 9 1902 .. 1 .. 3 1 .. 1 1 .. .. 7 1903 .. .. .. 1 .. .. 1 .. .. .. 3 1904 .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. 1906 .. 1 .. .. .. .. 1 .. .. .. 2 1907 .. .. .. .. .. .. .. .. .. .. .. 1908 .. 2 .. 3 .. .. .. .. .. .. 8 1909 1 2 1 .. .. .. .. .. .. .. 5 1910 1 2 1 1 .. .. 2 .. .. .. 8 1911 1 .. 1 .. .. 1 .. .. .. 3 1912 .. .. .. 1 2 .. .. .. 1 .. 4 320 1912] Table 0. Showing the Cases of Typhoid Fever that occurred in the several Wards from 1891 to 1912. Year. Tufnell. Upper Hollo way. Tollington. Lower Holloway. Highbury. Mi Id may. 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 '7 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 l6 11 353 1900 14 37 42 25 23 27 34 15 9 13 20 259 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 ]4 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 1912 5 3 2 3 6 4 4 2 7 5 8 49 Table P. Showing Cases of Typhus Fever that occurred in the several Wards from 1891 to 1912. Year. Tufnell. Upper Holloway. Tollington. Lower Hollowav. H ighbury. Mildmay. Thornhill. Barnsbury. St Mary's. Canonbury. St. Peter's. Totals. 1891 .. .. .. .. .. .. .. 1 .. .. 1 2 1892 .. .. .. .. .. .. .. .. .. .. .. .. 1893 .. 1 .. .. .. .. .. .. .. .. .. 1 1894 .. .. .. 1 .. .. .. .. .. .. .. 1 1895 3 .. .. .. .. .. .. - .. .. .. 5 1896 .. .. .. .. .. .. .. .. .. .. .. .. 1897 .. .. .. .. .. .. .. .. .. .. .. .. 1898 .. .. .. .. .. .. .. .. 1 .. .. 1899 .. .. .. .. .. .. .. .. .. .. .. .. 1900 .. .. .. .. .. .. .. .. .. .. .. 1901 .. .. .. .. .. .. 1 .. .. .. .. .. 1902 .. .. .. .. .. .. .. .. .. .. .. .. 1903 .. .. .. .. .. .. .. .. .. .. .. 1904 1 .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. .. .. .. 1 .. .. .. .. .. .. .. 1907 .. .. .. .. .. .. .. .. .. .. .. .. 1908 .. .. .. .. .. .. .. .. .. .. .. .. 1909 .. .. .. .. .. .. .. .. 1 .. .. .. 1910 .. .. .. .. .. .. .. 1 .. .. .. .. 1911 .. .. .. .. .. .. .. .. .. .. .. .. 1912 .. .. .. .. .. .. .. .. .. .. .. .. 321 1912 Table q. Showing the Cases of Erysipelas that occurred in the several Ward from 1891 to 1912. Year. Tufnell, Upper Holloway. Tollington* Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. 8t. Mary's. Canonbury. St. Peter's. Totals. 1891 .. 139 v 23 .. 42 30 28 13 23 45 343 1892 .. 194 .. 46 .. 80 35 39 44 39 73 550 1893 .. 244 .. 70 .. 75 63 51 49 41 79 672 1894 34 85 23 59 29 19 43 19 20 26 38 395 1895 29 62 23 38 36 24 26 21 16 12 33 320 1896 54 65 20 51 35 30 22 29 18 22 39 385 1897 24 66 21 38 25 26 19 15 16 19 43 312 1898 23 60 20 31 22 16 15 17 13 22 40 279 1899 15 70 36 47 25 12 39 23 22 19 42 350 1900 31 45 25 30 24 13 29 16 15 20 37 285 1901 24 52 30 16 18 14 37 10 15 25 44 285 1902 33 47 34 41 30 18 33 19 13 51 38 357 1903 23 28 22 25 16 10 25 10 12 31 25 227 1904 36 19 30 25 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 l6 22 21 J4 212 1911 31 34 33 27 9 13 26 22 18 28 34 275 1912 .. 12 13 15 19 16 14 23 14 15 26 18 185 Table R. Showing the Cases of Puerperal Fever that occurred in the severa Wards from 1891 to 1912. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Canonbury. S Peter's. Totals.  1891 .. 10 .. 9 .. 7 2 1 1 .. 3 33 1892 .. 28 .. 5 .. 7 5 2 2 .. 2 51 1893 3 5 4 7 5 3 3 3 2 .. 3 38 1894 1 3 6 4 3 2 2 1 1 .. .. 23 1895 1 2 1 2 6 2 3 1 1 3 .. 22 1896 3 2 3 5 2 1 5 2 1 3 3 30 1897 5 6 2 4 3 1 4 .. i 1 .. 27 1898 .. .. 2 2 .. 2 3 2 i 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 i 1 1 24 1905 1 1 3 9 2 1 3 .. 2 .. 24 1906 2 1 3 4 3 1 5 2 i 1 1 24 1907 3 5 .. 5 2 1 1 2 1 1 21 1908 2 .. 1 5 2 1 1 2 i .. .. 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 1912 2 1 .. 1 2 .. 5 .. 2 3 16 x 322 1912 Table S. Showing the Cases of Continued Fever that occurred in the several Wards from 1891 to 1912. Year. Tufnell. Upper Holloway. Tollington. Lower Holloway. Highbury. Mildmay. Thornhill. Barnsbury. St. Mary's. Can on bury. St. Peter's. Totals. 1891 .. 1 .. 2 .. .. 3 .. .. .. .. 6 1892 .. 2 .. .. .. 3 .. .. .. 1 .. 6 1893 .. .. .. .. 1 .. 1 .. .. 1 2 7 1894 .. .. 2 .. 3 .. .. .. .. 1 .. 7 1895 .. 4 1 .. 1 3 .. .. .. .. .. 9 1896 .. 2 .. .. .. 1 1 .. .. .. .. 6 1897 .. .. .. .. .. .. .. .. .. .. 1 1 1898 .. .. .. .. .. .. .. .. .. .. .. 1 1899 .. .. .. .. .. .. 1 .. .. .. 1 2 1900 .. .. .. .. .. .. .. .. .. .. .. 6 1901 .. .. .. .. .. .. 1 .. .. .. 1 3 1902 .. .. .. .. .. .. 5 .. .. .. .. 5 1903 .. .. .. .. .. .. .. .. .. .. .. 2 1904 .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. .. 1906 .. .. .. .. .. .. .. .. .. .. .. 1 1907 .. .. .. .. .. .. .. .. .. .. .. 1 1908 .. .. .. .. .. .. .. .. .. .. .. 1 1909 .. .. .. .. .. .. .. .. .. .. .. .. 1910 .. .. .. .. .. .. .. .. .. .. .. 1 1911 .. .. .. .. .. .. .. .. .. .. .. .. 1912 .. .. .. .. • • .. .. .. .. .. .. .. .. Table T. Showing the Cases of Relapsing Fever that occurrcd in the severa Wards from lf-91 to 1912. Year. Tufnell. Upper Holloway. 1 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 .. .. .. .. .. .. .. .. .. .. .. .. 1912 .. .. .. .. .. .. .. .. .. .. .. .. 323 1912 Table U. showing the Cases of Cholera that occurred, in the several Wards from 1891 to 1912. 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 .. .. .. .. .... .. .. .. .. 1900 .. .. .. .. .. .. .. .. .. .. .. 1901 .. .. .. .. .. .. .. .. .. .. .. 1902 .. .. .. .. .. .. .. .. .. .. .. 1903 .. .. .. .. .. .. .. .. .. .. .. 1904 .. .. .. .. .. .. .. .. .. .. .. 1905 .. .. .. .. .. .. .. .. .. .. .. 1906 .. .. .. .. .. .. .. .. .. .. .. 1907 .. .. .. .. .. .. .. .. .. .. .. 1908 .. .. .. .. .. .. .. .. .. .. 1909 .. .. .. .. .. .. .. .. .. .. .. 1910 .. .. .. .. .. .. .. .. .. .. .. 1911 .. .. .. .. .. .. .. .. .. .. 1912 .. .. .. .. .. .. .. .. .. .. .. *Asiatic Cholera 324 191] 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. r of Statutory Notices served./ 1891 2059 .. .. 2059 .. 1330 45059 17 .. 3382 177 1487 .. .. 1892 3478 .. .. 3478 .. 1617 5s786 57 .. 5001 293 2624 .. .. 1893 5187 .. .. 5187 2140 2050 .. 51861 34 .. .. 888 4t97 .. .. 1894 3338 .. .. 3318 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 454o 4862 232 1897 3133 .. .. 3133 9062 4722 324 69098 676 1 .. 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 741]1 6086 5673 1095 3515 4432 316 1901 3054 3395 .. 3054 6486 3718 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 6980 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 4197 1852 76416 11476 11093 7276 990 3281 5304 709 1910 2860 6077 1249 2860 6433 4229 1208 77445 11004 11280 6919 1078 2870 5443 716 1911 2291 4876 1530 2291 6636 4421 1441 74683 9892 12011 7130 965 4096 5118 707 1912 4083 5968 1351 4083 5989 4570 1466 76562 10018 12893 7156 1133 4447 5093 631 * Meat Inspector left Borough service for an appointment under City Corporation, and the appointment was vacant some time. 325 [1912 Table W. BATHS AND WASHHOUSES. Table showing the Number of Persons using the Swimming Baths, Private Baths, and the Washhouses during 1912. Swimming Baths. Bathers. Caledonian Road Hornsey Road. Essex Road. Total. Public.* 1st class Males 10,622 38,053 16,733 65,408 Females 891 16,059 2,077 19,027 2nd class f Males 17,385 23,690 18,347 59,422 Females 4,148 6,105 3,095 13,348 Schools. 1st class Boys ... 3,817 471 4,288 1 Girls 5 4,563 ... 4,568 2nd class j Boys 39,362 45,939 51,237 136,538 1 Girls 24,351 30,584 26,391 81,326 Totals 96,764 168,810 118,351 383,925 Private (Slipper Baths.) 1st class Males 14,321 30,590 16,788 61,699 Females 1,353 5,447 2,398 9,198 2nd class Males 46,827 49,529 53,140 149,496 Females 17,415 24,173 23,813 65,401 Totals 79,916 109,739 96,139 285,794 Washhouses. Washers ... 30,192 26,787 40,992 97,971 Total Persons using the Establishments. Total admissions at each establishment in 1912 206,872 305,336 255,482 767,690 326 1912] LOCAL GOVERNMENT BOARD RETURN.—TABLE I. Metropolitan Borough of Islington. VITAL STATISTICS OF WHOLE DISTRICT DURING 1912 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. Neit. 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 1907 330.241 8,531 —- 258 4.987 151 593 685 996 117 5.079 15.4 1908 329,487 8,665 —- 258 1.530 137 568 717 894 103 4.679 13.9 1909 328,735 8,198 —- 249 4.782 14 5 634 77 0 841 103 4,918 14.9 1910 327.985 8,201 —- 250 4.376 133 563 710 777 95 4.523 13.8 1911 327.247 7.729 8,113 248 4.643 I4'2 640 863 1,040 128 4,866 14.9 1912 326,398 8,051 8,211 251 4.343 133 509 861 710 86 4,682 14.3 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 g. Deaths in Column io are similarly corrected by subtraction of the deaths under i, included in the number given in Column 8, and by addition of the deaths under i included in the number given in Column g. †"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 g, 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 he 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 (6) ii this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if kr.own; (c) failing this, to the district where death occurred, if known; and (d) failing this to the district where the bodv was found. Area of District in acres (land and r inland water) ... 3,092 Total population at all ages, 327,403 Number of inhabited houses, 36,778 Average number of persons per house, 8 9 At Census of 1911. 327 [1912 LOCAL GOVERNMENT BOARD RETURN—TABLE II. Cases of Infectious Disease notified during the year 1912 in the Metropolitan Borough of Islington. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Registration Sub-District. Total cases removed to Hospital. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 Under 1. 1 to 5. 5 to 15 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Tufnell. Upper Rolloway Tollin ,'ton. Lower Holloway. Highbury. Barnsbury. Islington South-East Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 5i6 13 208 233 39 20 2 1 46 82 61 56 66 77 128 466 Erysipelas 185 2 7 19 24 53 61 19 12 13 15 19 32 37 57 45 Scarlet Fever 811 10 222 491 59 29 .. .. 91 81 83 141 163 95 J57 768 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 49 2 9 11 21 5 1 5 3 2 3 10 6 20 39 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 16 .. .. .. 4 12 .. .. 2 1 .. 1 2 5 5 9 Cerebro-spinal Meningitis 13 5 3 2 2 .. 1 .. .. 1 .. 2 1 6 3 .. Poliomyelitis 11 .. 7 4 .. .. .. .. 3 4 1 .. 3 .. .. .. Pulmonary Tuberculosis 1382 1 12 122 216 668 332 31 138 125 109 162 223 279 346 53 Ophthalmia Neonatorum 32 32 .. .. .. .. .. .. 3 1 4 6 4 9 5 12 Totals 3015 63 461 880 355 803 401 52 300 311 275 390 504 514 721 1,492 Isolation Hospital or Hospitals, Sanatoria &c.—Metropolitan Asylums Boird Hospitals. 328 1912 LOCAL GOVERNMENT BOARD RETURN.—TABLE III. Metropolitan Borough of Islington. CAUSES OF, AND AGES AT DEATH DURING YEAR, 1912. Causes of Death. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the District. 1 otal Deaths whether ot " Residents" or " Nonresidents" in Institutions in the District.  All ages. Under 1 year. "1 and under 2 years. 2 and under 5 years. 6 and under 15 yrs 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and up- wards. I 2 3 4 5 6 7 8 9 10 11 All causes Certified 4682 710 224 199 140 158 618 1163 1470 1665 Uncertified .. .. .. .. .. •• .. •• .. .. Enteric Fever 8 .. .. .. .. 2 3 2 1 .. Small-pox .. .. .. .. .. .. .. .. .. .. Measles I5I 29 65 52 5 .. .. .. .. 10 Scarlet Fever 9 2 2 4 .. 1 .. .. 2 Whooping Cough 54 17 23 12 2 3 Diphtheria and Croup 38 6 4 I5 11 1 1 .. .. 3 Influenza 28 1 .. .. .. 2 6 5 14 2 Erysipelas 5 .. .. .. .. 1 .. 1 3 4 Phthisis (Pulir onary Tuberculosis) 427 .. 2 4 10 57 208 131 15 266 Tuberculous Meningitis 67 15 17 17 13 4 .. 1 • • 18 Other T uberculous Diseases 59 13 1 9 13 4 5 9 5 16 Cancer, Malignant Disease 382 .. 1 .. 2 4 32 201 142 139 Rheumatic Fever .. 15 • • .. • • 5 4 5 1 2 Meningitis 30 9 4 7 3 3 2 2 .. 8 Organic Heart Disease 660 4 .. 2 8 14 65 217 350 240 Bronchitis 471 41 16 4 6 .. 21 112 271 185 Pneumonia (all forms) 439 97 58 37 14 13 60 73 87 105 Other Diseases of Respiratory Organs 70 2 2 4 1 2 7 27 25 26 Diarrhoea and Enteritis 110 72 12 4 .. 4 5 13 29 Appendicitis and Typhlitis 13 .. .. 1 1 4 2 5 .. 12 Cirrhosis of Liver 49 .. .. • • .. .. 9 32 7 18 Alcoholism 11 ".. .." .. .. .. 7 4 .. 3 Nephritis and Bri»ht's Diseases 139 .. .. 1 4 4 22 62 46 51 Puerperal Fever 2 .. .. .. .. • • 2 •• . . 1 Other accidents and diseases of Pregnancy and Parturition 11 1 .. .. .. 1 8 1 .. 3 Congenial Debility and Malformation, including Premature Birth 286 281 5 .. .. .. .. • • .. 9 Violent Deaths, excluding Suicide 182 42 4 9 11 7 34 34 41 58 Suicide 45 .. 3 19 l6 7 8 Other Defined Diseases 921 79 *8 19 27 32 96 2l8 442 444 Diseases ill-defined or unknown .. .. .. .. • • •« •• •• 4682 710 224 199 140 158 618 ii63 1470 1665 Sob-Entries — included in above figures:— Cerebro-spinal Meningitis 12 4 .. 3 2 2 .. 1 .. 14 Poliomyelitis •• .. •• •• •• •• •• .. • • .. 329 [1912 LOCAL GOVERNMENT BOARD RETURN.—Table IV. Metropolitan Borough of Islington. Metropolitan Borough of Islington. INFANTILE MORTALITY DURING THE YEAK 1912. Nett Deaths from stated Causes at Various Ages under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under One Month. 4 Weeks and under 3 Months. 3-6 Months. 6-9 Months. 9-12 Monihs. Deaths under On/e Year All Causes Certified 190 41 2 5 24 280 133 121 81 95 710 Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. v Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 6 22 29 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 5 5 4 3 17 * Diphtheria and Croup .. .. .. .. .. 1 2 1 2 6 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. 2 4 2 7 15 Abdominal Tuberculosis .. .. .. .. .. 3 3 2 8 Other Tuberculosis Diseases .. .. .. .. .. 1 1 1 2 5 Meningitis (not Tuberculous) .. .. 1 .. 1 1 3 .. .. 5 Convulsions .. 5 1 .. 11 1 2 1 2 17 Laryngitis .. .. .. .. .. .. .. 1 .. 1 Bronchitis .. 4 2 3 9 13 6 6 7 41 Pneumonia (all forms) .. 1 .. 1 4 21 19 24 29 97 Diarrhoea .. .. .. .. .. 4 15 3 1 23 Enteritis .. 1 2 1 4 16 17 8 4 49 Gastritis .. .. 2 .. 2 1 2 1 2 8 Syphilis .. .. 2 1 3 3 2 .. .. 8 Rickets .. .. .. .. .. .. .. .. 1 1 Suffocation, overlying 6 .. 1 2 9 6 7 .. 1 23 Injury at Birth 3 .. .. .. 3 .. .. .. .. 3 Atelectasis .. 7 1 .. 1 9 1 .. .. .. 10 ( Congenital Malformations 18 3 I 3 25 4 4 .. 1 34 Premature Birth 95 13 6 7 121 6 1 .. .. 128 ^ Atrophy, Debility and Marasmus 35 9 5 5 54 35 17 10 3 119 Other Causes iy 4 2 .. 25 9 13 10 6 63 Totals igo 41 25 24 280 133 121 81 95 710 Nett Births in the year legitimate 7,878 Nett Deaths in the year of legitimate infants 653 illegitimate 333 Illegitimate infants 57 Y 3M0 1912] LONDON COUNTY COUNCIL RETURN. Borough oj Islington. PROCEEDINGS DURING 1912. PREMISES. Number of Places— Number of inspections, 1912. Number of Notices. 1912. Number of Prosecutions 1912. On Register at end of 1911. Added in 1912. Removed in 1912. On Register at end ot 1912. Milk premises .568 33 19 582 1593 208 I Cowsheds 5 ... 5 ... Nil Nil Slaughter-houses 3° ... 2 28 ... 99 99 Other offensive trade premises 6 ... ... ... ... 99 99 Ice cream premises 229 13 18 224 98 21 99 Registered houses let in lodgings .‡... ... ... ... 9037 (a)* 77 (b)* (a)f 1128 (b)†12 * (a) For overcrowding. † (&) For other conditions. J No Register now kept under new By-Laws. Total number of intimation notices served for all purposes 5724 Overcrowding, 1912. Number of dwelling rooms overcrowded 122 Number remedied 122 Number of prosecutions Nil Underground rooms— Illegal occupation dealt with during year 31 Number of rooms closed 31 Number of prosecutions Nil Insanitary houses—- Number closed under the Public Health (London) Act, 1891 1 Number closed under the Housing of the Working Classes Acts 12 Number of premises cleansed under Sec. 20 of the L.C.C. (General Powers) Act, 1904 292 331 [1912 Shelters provided under see. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 7 Revenue Acts— Number of houses for which applications were received during year 8 Number of tenements comprised therein 27 Number of tenements for which certificates were (a) granted 12 (6) refused 15 (c) deferred Nil Number of prosecutions wider By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. Nil (b) For prevention of nuisance arising from offensive matter ning out of any manufactory, etc. Nil (c) For the prevention of keeping of animals in such a manner as to be injurious to health Nil d) As to paving of yards, etc., of dwelling houses Nil (e) In connection with the removal of offensive matter, etc. Nil (f) As to cesspools and privies, removal and disposal of refuse, etc. Nil (g) For securing the cleanliness of tanks, cisterns, etc. Nil (h) With respect to water closets, earth closets, etc. 5 (t) With respect to sufficiency of water supply to water closets 1 (j) With respect to drainage, etc. (Metropolis Management Act, section 202) Nil (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) Nil Number of prosecutions under L.C.C. General Powers Act, 1907— (I) With respect to Water Supply to Tenement Houses 1 Mortuaries— Total number of bodies removed 634 Total number of infectious bodies removed 4 ■ The Metropolitan Borough of Islington. Why a Tuberculosis Dispensary is required; and what it is. A REPORT BY ALFRED EDWIN HARRIS, Medical Officer of Health. (Presented to the Public Health Committee and ordered to be printed January 80th, 1913). LONDON: Vail & Co , Printers to the Council, 170, Farringdon Road, E.C. " The Great White Plague of the North." Oliver Wendell Holmes. " Seed of Consumption, hence ! " Ben Jonson. " The application of means to ends ensures victory." Emmerson. "What the community has caused, the community as a mass alone can cure." Dr. Woods Hutchinson. " Preventable disease is the great agent for filling our Workhouses." Joseph Chamberlain. "The public health is the foundation on which rests the happiness of the people and the power of a country. The care of the public health is the first duty of a statesman." Beaconsfield. "Sanitary Instruction is even more important than Sanitary Legislation." Earl of Derby. 3 To the Chairman and Members of the Public Health Committee. Mr. Chairman, Aldermen and Councillors. WHY A TUBERCULOSIS DISPENSARY IS REQUIRED ; AND WHAT IT IS. When we speak of a Tuberculosis Dispensary we should always recollect that it is not only an institution for the cure of tuberculosis, but also the greatest and, as it has been found in various parts of the world, most necessary and useful instrument hitherto devised by the medical profession for the cure and prevention of that disease to which the name " Great White Plague of the North " has been so aptly applied. But before I fully describe what a tuberculosis dispensary is, it may be well to say briefly something about the disease, and the amount of it, with which it will be necessary to deal in Islington. At one time tuberculosis was considered to be a hereditary disease—and, therefore, unavoidable—which usually had a fatal termination. Now we know that it is not hereditary or only so in a negligible degree; that it is preventable; and that it is not necessarily fatal and is curable, especially if taken in its earlier stages. When Koch in 1882 discovered the bacillus or germ of the disease, it at once became apparent to people who studied the question that tuberculosis was in all probability communicable, and, therefore was also preventable; likewise that if its germ could be attacked in the human body it was curable. Both these theories have been most fully and clearly demonstrated, so that to-day throughout the civilised world, there is not a single medical man who does not know and believe that such is the case. The Germ and its spread.—The germ is a vegetable parasite like a rod in shape; it grows in the body, wherj it destroys certain tissues, and produces certain poisons known as toxins. These most usually attack the lungs, where the disease is known as pulmonary phthisis, or in common phraseology consumption of the lungs ; and less frequently, but nevertheless in numerous cases, the bones and joints, causing disease of the hip, knee, ankle, spine, larynx, the glands, and even the meninges of the brain. There is, I suppose, not one of us sitting around this table who has not at one time or another lost some relative or friend from one or other of these diseases, and, therefore, we must be more or less familiar with their fatal results. But I doubt very much if we have really grasped to the full extent the fact that 4 in England there die annually some 51,000 persons; in London 7,500; and even in Islington some 600 persons. These are staggering figures, representing as they do in Islington about 12"2 per cent, of the deaths from all causes. But this is not the worst feature, for each death from pulmonary phthisis represents at the very least four persons who are actually and demonstrably ill with the disease; and that they too, if some agency does not reach them speedily, will in a comparatively brief period be tabulated in the mortality returns. They can only be discovered by search, as a rule, for usually—and unfortunately—the cases do not come under medical supervision until the disease has taken so strong a hold of the victims that their cure is not certain — nay, indeed, is very doubtful—while probably for months they have been centres either in their own homes, or their friends' homes, in their workplaces, in places of popular resort, or in public houses, from which the disease has spread to others. It is, therefore, of paramount importance that such cases should be discovered at the earliest possible moment, not only for the purpose of their own cure, but for the prevention of the spread of the disease to others. Every one is not equally susceptible, for although the strong and robust may escape infection, but not always, a person whose physical condition is weak, or as we say "below par," even for a brief period, is easily infected. So, too, are those who indulge freely in alcohol. Indeed, such persons furnish a large number of the cases that end quickly. Again, persons whose vitality has been exhausted by disease, especially by pleurisy, pneumonia, measles, influenza and typhoid fever quickly succumb to the influence of the germ. Environment, too, is a potent factor in causing susceptibility, and therefore, we find the disease in dark houses and in damp houses; among persons who live, sleep or work in dismal and overcrowded rooms ; among people who work in badly lighted and badly ventilated offices or workshops, and, therefore, amidst foul air, or at trades, producing much dust; and also among people suffering privation, who are ever the first to succumb to it. Among Children.—Tuberculosis among children, who often inherit a predisposition to it, is frequent. They are often, too, exposed to danger from their parents, if either of them be tuberculous. The infection is conveyed to them by kissing, fondling, using the same food utensils, towels, bedding, and the many articles usually used in common in families. Indeed, the prevalence of the disease in families having one or both parents affected is most noticeable, and doubtless accounts for the opinion so prevalent up to very recent years that the disease was inherited. In such a family, children playing on the floor, drinking from unwashed cups, sucking those wretched 5 rubber teat?, which so often fall on the dusty floor, become infected with the germs given off in the tine spray by their suffering parents in coughing or sneezing; and so we find these children attacked with tuberculosis of the joints, the spine, when they frequently become hunchbacked, the glands, the skin, the intestines, and the lungs. Tuberculous milk, the produce of diseased cows, is also a fruitful cause of the disease among infants and young children, for, although interested persons have denied it, the fact must be admitted after the findings of the Royal Commission on Tuberculosis. The methods of the spread of the disease are many, although it may suffice, without discussing the matter too fully, to state that it may be contracted by inhalation of the germs emanating from infected persons when they spit, cough, or sneeze. It, therefore, behoves persons not to spit—especially in the streets, in public conveyances, or in places of public resort, because when the sputum dries, it may be, and is, inhaled in the form of dust—and not to cough or sneeze without the adoption of some means of preventing the spread of the spray frcm their lungs. The treatment of the disease consists essentially of two methods—the one curative, affecting the individual, and the other preventive, affecting the public. It is not necessary here to discuss the medicinal treatment, which consists so largely of building up the body-strength so as to enable the patient to resist the inroads of the disease, and in suitable cases the administration of tuberculin. But while the patient is receiving curative treatment, it is also essential, especially if he be treated at home, to see that his surroundings are of such a character as will give his medicinal treatment a chance of success ; and therefore, it is important that he should have light, air, and cleanliness in his home, and that he should have ample means of rest. His preventive treatment consists in his instruction in the precautions he should adopt to render himself inocuous to others. How he should destroy his spittle; how he should cough ; how the brushing, sweeping, and dusting of his rooms should be effected ; in fact, how he should do everything which, if the precautions were not taken, might spread the disease; for it often happens that the neglect of what seem little things to many people may be the cause of the spread of the infection, and indeed, of his own secondary infection. Then there is the purity of the home; purity as regards its light, air, and condition; for just as certainly as darkness, foulness, and dirt promote the disease, so do good light, fresh air and cleanliness tanish it. How to obtain these must be taught, for they are the great necessaries in dealing with the disease. Without them nothing that the doctor can prescribe will 6 be of avail; with them everything may be hoped for. Living under these conditions, the patient can recuperate his strength, invigorate his lungs, vitalize his blood, and obtain the very fullest benefit from that rest which is so essential in the treatment of the sufferer, so that the poor soul who hitherto gasped for his life and scarce dared to hope for an amelioration of his state, may pluck up courage and cheerfully look for an improvement in his health. Mortality and Statistics.—It is necessary now to consider what is the probable amount of tuberculosis in the borough, so that we may be in a position later on to arrive at some conclusions as to the number of cases that will have to be dealt with—for dealt with by some authority they will have to be—in the borough. But first, in order to understand this question thoroughly, we should consider what is the state of affairs in the country generally, in the County of London, as well as in your own borough ; and for this purpose I have taken the year 1910, which is the latest year for which there are full returns available, and I find that in England and Wales there were 51,317 deaths registered from tuberculous diseases, and that these represent 10.6 per cent of the total number of deaths from all causes registered during that year, which is to say that out of every nine persons who died, one died from a tuberculous disease. I find that in the County of London 7,459 persons died, representing 11.9 per cent of the deaths from all causes, which means that one death in every eight was from one of these diseases. And I find that in Islington in the same year 539 deaths were registered from tuberculous diseases, or 11.9 per cent of the deaths from all causes, which is the same as saying that one person in every eight persons who died in Islington died from one or other of them. England and Wales. County of London. Islington. Deaths from Tuberculosis. 51,317 7,459 539 Per cent of deaths from all causes. 10.6 11.9 11.9 Persons dying from tuberculous diseases 1 in 9 1 in 8 1 in 8 These are very serious figures, showing with terrible significance the ravages of the disease ; but bad as they are, far worse remains to be told ; and in dwelling on them for a short time, I propose to speak of the mortality only so far as Islington is concerned, although I may state that the Islington figures are slightly better than those for the country generally. Now what do we find in Islington? Why, this : that out of 50,275 deaths from all causes which occurred in the ten years 1901-1910, no less than six thousand one hundred and fifty four (6,154) or 12.2 per cent, died from tuberculosis. In other words one in every eight deaths was from a tuberculous disease. 7 But this by no means discloses the full seriousness ot such a debacle, because if we examine the ages at which these persons died the terrible fact is revealed that no less than 4,361 out of these 6,154 deaths were persons between the ages of fifteen and fifty-five. They were, in fact, at the wageearning period of life—that is to say, at that age when their lives are most valuable not only for family reasons, but also for commercial and national considerations. When we use figures, such as these, I wonder if we rightly appreciate their full significance. I doubt it very much, judging by my own personal experience. I will tell you why. Years ago, as I stood by a colliery pit-head after an accident, I saw body after body carried thence to the colliers' homes; and although I knew that some 300 men and boys lay dead in the colliery village, I did not grasp the full significance of these deaths. It was not brought home me. Again in 1878 (March 24th) I stood with a friend on the cliffs of the Isle of Wight one sunny Sunday in March watching a beautiful frigate with all sails set and glistening in the sun, manned with young men eagerly looking forward to a reunion with their friends that night in Portsmouth, when suddenly the sky darkened, and a fearful squall, accompanied by blinding snow and sleet, in an instant obliterated both sun and ship. And when once more the sun shone out in all its brilliancy, no ship was there, for H.M.S. " Eurydice " had gone down under those usually pleasant channel waters with more than 600 men and boys. Yet although I knew that this was so, I did not truly realize the awfulnessof that catastrophe. Again, on a pleasant Saturday afternoon (June 16th, 1883), in the borough of Sunderland, a terrible disaster befell many children in the Victoria Hall, where, owing to the rush of the little ones down a wide staircase to reach the body of the hall to obtain some prizes from a showman, as well as to the improper fastening of a door on the staircase, over two hundred little ones met their death ; and they, who were so eager to gain the hall for their prizes, only reached it at last by the aid of the friendly hands of those who had hastened to their assistance, and whose melancholy duty it became to lay them out, row after row, for the purpose of identification. Who can describe such a sight? Who realise its horror? I know it moved me, as it moved harder hearts than mine, to tears; and many, who had never shed tears before, shed them then ; it caused men to rush from the scene, unable to bear it; and it left an impression on the minds of all the men who were there which can never be effaced. 'Why was this? Many of them, medical men like myself, had often seen deaths in the hospitals and in people's homes, and well understood what 8 it meant ; but none of them had realised what an awful thing is death when seen in the aggregate. The numbers viewed in this way appalled one, and I know so far as I am concerned that their effect on me has been that whenever I speak or write of large numbers of deaths, the Victoria Hall disaster recurs to my mind, and the meaning of the record of those preventable deaths comes h me to me with full weight I want you to think of those 600 deaths from tuberculosis, which occur annually in our borough, as if the dead were actually laid out before you in a great hall; and if you do, believe me you will not only be as anxious to prevent them, as I have been for years, but also so impatient that you will hardly brook delay in coming to the timely succour of those unfortunate patients who, anxious for the future of their wives, their husbands, their children or themselves, suffer " a month's grief in a day—a year's in twelve." I have told you that in ten years (1901-1910) there died in Islington 6,154 persons from tuberculous disease, but I have not yet told you how they were apportioned amone the various forms which this disease assumes. An analysis of the mortality returns provides this information, which is as follows:— Phthisis (including tuberculosis of larynx) 4,658 Abdominal tuberculosis 383 Tuberculous meningitis 726 Generalized tuberculosis 256 Other forms of tuberculosis 131 . 6,154 9 Tuberculous Meningitis.—This disease of the brain accounted for 726 deaths, of which 564, or 77.6 per cent., occurred among children under five years of age, of whom 185 were infants under twelve months old (25.4 per cent.) and 378 (52T per cent.) from one to four years old. Abdominal Tuberculosis, which is also a disease of child life, caused in the ten years 383 deaths, of which 315, or 82.2 per cent., were those of children who had not attained to their fifth year. Generalized Tuberculosis was responsible for 256 deaths, of which 163, or 63'7 per cent., died in the first four years of their life. Other forms of Tuberculosis, such as those which attack the bones, the joints, the skin, or certain internal organs, were accredited with 131 deaths, which were fairly distributed at the several age periods of life. Proportion of Deaths at several Age Periods.— In my Annual Report for 1911 (page 116) I gave the following statement as the result of the analysis of ten years' statistics :— Tuberculosis causes 5T per cent, of the deaths from all causes 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 ,, ,, ,, 0.5 ,, ,, ,, ,, 75 ,, 85 ,, „ „ 0'0 „ „ „ „ 85 and upwards These figures are of the utmost moment, but as percentages do not appeal to every person, I will put them in another form, which may be more easily appreciated. One in every 20 infants who die from all causes die from tuberculosis. 7 children (1-5) „ „ 5 juveniles (5-15) „ ,, 2 „ 5 persons (15-25) „ „ 2 „ 5 „ (25-35) 2 ,, 7 ,, (35-45) ,, ,, 1 5 ,, (45-55) ,, ,, 1 „ 13 „ (55-65) ,, ,, 1 „ 37 „ (65-75) ,, ,, 1 „ 198 „ (75-85) ,, ,, 1 „ 1376 „ (85 and above) „ „ 10 Here we see the age-channels of these deaths—rills, rivulets, and streams, which, uniting, form a mighty liver that is brimmed to its banks with the slain of tuberculosis, and rolls on its way to the great sea of death. And the great majority are young men and young women, plucked in life's prime from the frail fingers of time, destined for Eternity, leaving behind husbands, or wives, or children, as the case may be, mostly unprovided for— because when the father is taken there is generally left a wife and children'to struggle on as best they may; and when the victim is a mother there are usually little ones cast on the tender mercies of friends, neighbours, or hired women. And what becomes of these neglected little ones ? Charitable institutions of all kinds, the workhouses, the reformatories, the gaols too often, can tell the tale. The disease itself, also, frequently overtakes them, for they cannot have lived in the same confined room, often a mere den, with a father and mother who daily sowed the seeds of consumption where they went, without in very many instances becoming themselves infected ; so that they, too, in course of time are carried away in one of those streams of death. The President of the Local Government Board has stated in the House of Commons that for every death from tuberculosis there are four cases of sickness (in my opinion this is a very mild estimate), and I can well believe it when I look on a map of the borough spotted with every case that came to my knowledge in 1912, and, recollect, these are only cases of pulmonary tuberculosis. I am certain you will agree with me that it is the most melancholy record I have put before this Committee in the course of twenty years. I ask you to examine it and study it carefully; to note where the cases are aggregated in the greatest numbers; and then I ask you to multiply the red dots by 10 so that you may form some faint appreciation of what the record of 10 years has been; and that you may obtain some idea of what the sufferings and privations—for with this disease they invariably go hand in hand—of these unfortunate people, wearied with disease and galled with their necessities, have been. They represent a sacrament in human suffering too terrible for description. Let me take a representative case. A young man in the prime of life, say 35 years of age, is attacked. He is a good workman, gets good wages. He is steady, industrious, and is married. He has three or four children, and his home is comfortable and well furnished for his position in life. He has been attacked with tuberculosis, although he does not know it. At first he merely feels a lassitude and a disinclination for work. A little later he has a cough, which gradually becomes worse; he loses a day now and again at his employment; the disease gathers force, the cough becomes more and more troublesome; he has night sweats; his strength grows less; he loses more and more time ; he begins to waste, until at last he is unable to work. He requires nutritious food he has no money. The rent has to be paid—he has no money. The 11 children have to be fed and clothed—he has no money. And then commences the disintegration of his home. Little by little the furniture goes; everything, beginning with the ornaments which mark his affection for his home, reaches the pawnshop periodically. He is compelled from time to time to move to less and less expensive rooms, until eventually you find him and his family huddled together in a mean room in a mean street, which he, in his days of health, would have scorned. And then finally, every joy and pleasure and hope fled, death lays its relentless hand on him whose heart once swelled with honest pride in his home and his family, who are now left dependent on the tender mercies ot the world, and—the rates! Is it any wonder that Sir Lauder Brunton should exclaim in the face of such a state of affairs as the preceding figures and facts disclose, —" The mortality is awful; the misery it causes its victims and their families is appalling; the actual expense, and still more the loss of productive power which it entails upon the country is enormous. And yet the whole of this evil is preventable ; it only exists in consequence of ignorance and apathy." And it is thus that a poor human being—the God-made machine is scrapped before half his working days have been completed, and civilization, by its failure to provide means whereby this disease might be warded off, has allowed it! Compare this with the care taken of a man-made machine. Is there a manufacturer, a trading company, an engineering firm who possess a machine, who would act in this way who would allow it to get rusty or useless through lack of care, attention, and forethought, so that before half its life had been completed it had to be carted to the scrap-heap? Only a fool would do so. Yet, until recently, this has been the fate of the God-made machine in all countries—and almost up to now in Islington. A higher civilization, which made its advent with the twentieth century, appeals for something nobler and better from the nations in their treatment of the tuberculous; and the nations everywhere are responding to that appeal. Tuberoulosis—A Class Disease.—If you study the map which lies on the table, you cannot fail to notice that the red spots, which indicate cases of pulmonary tuberculosis, are mostly aggregated in those districts in which the artizans and working classes dwell, while in those parts of the borough where people better circumstanced, socially and monetarily, reside, they are few and far between. This shows that the disease attacks one class of the people much more than another. The disease may, therefore, be almost designated " a class disease," although actually it is not. There is, however, no doubt that it is far more prevalent in those districts where the people are poor, and where the tenement houses are most fully occupied, for there you will find the underfed, the poorly clothed, and the debilitated of the population. 12 These are the people, therefore, who must be reached and taught the measures to adopt to prevent the spread of tuberculosis among their kith and kin, their friends, and the public. The Cost of Tuberculosis.—To prevent tuberculosis is to save money. This is a strong statement, but it is a true one. For tuberculosis means poverty; and poverty means pauper relief; and pauper relief means Poor Rates. In support of this contention I find it stated in the Minority Report of the recent Royal Commission on the Poor Laws that "the very great mortality from phthisis—a disease to which no less than one-seventh of the total cost of the Poor Law is said to be directly or indirectly ascribed—is to be attributed in no small degree to the fact that the sufferers are not encouraged to present themselves for treatment in the early stages of the disease." In the same Report it is recorded that the Superintendent of a Poor Law Infirmary told the Commission that " he had carefully examined 4,000 cases of consumption, and that of these people approximately 60 per cent, could not have come within the range of the Poor Law had they not had the disease. In short, as Mr. Joseph Chamberlain once said ' Preventable disease is the great agent for filling our Workhouses.'" If the figure of one-seventh the cost of the Poor Law be nearly correct, it is clear that in Islington, where the expenditure last year for Poor Law administration amounted to £203,810 (not inclusive of the amount paid in fees for the Notification of Infectious Diseases) the cost of pauperism through tuberculosis must have amounted to £29,115, or 3.8 pence in the £ on the rates. In a recent Report I showed that for many years this Borough had paid some £40,000 (in 1911 it was £43,534, equal to a rate of 5¾. in the £) for isolation and treatment of certain notifiable diseases (mainly scarlet fever and diphtheria) the prevention of which is far more difficult than that of tuberculosis, because in the former the agency whereby the spread of the infection is accomplished is sometimes subtle and mysterious, while in the latter it is much more obvious; that if the milk supply were protected by the Government, as it is about to be, and the tuberculous patients educated by the Sanitary Authority, the annual national holocaust by the disease would be prevented. I am entirely of this opinion still, and in support of it I would quote Sir Lauder Brunton, one of our greatest authorities, who says " if the whole people of this country would only awaken to the mischief which is being wrought by this dreadful disease, and would bestir themselves to remove it, in the course of one generation consumption woidd be as rare among us as leprosy is now .... \ and yet we allow consumption not merely to decimate the people, but to kill every seventh person. Nor are we guiltless if we say that we have only allowed 13 the massacre to go on, and have not actively helped in it. Surely it is time for us to bestir ourselves and to stop it." It is often very difficult to cure public apathy, or to awaken interest in a movement, unless some money or other advantage can be shown; and it was for this reason that I have dwelt on the probable—nay certain saving in the cost of pauperism, as time passes along, as well as the amelioration of much sickness and all the misery that sickness involves, if strong action be now taken although I know that the majority, if not all, the members of this Committee, are in sympathetic accord with the object of this Report. Indeed, during last year you had before you five reports on this great subject; and you only refrained from making a recommendation to the Council as to the provision of a tuberculosis dispensary for Islington until you knew what payments, if any, might be derived from the Government through the National Insurance Commissioners or the Insurance Committee for London. Before I finally leave this question of the cost of tuberculosis I would like to put before you some figures which were laid before the Sixth International Congress on Tuberculosis held in Washington in 1908; and although they are based on the mortality in the United States, yet they will approximate pro rata of population, and not very distantly, to the cost of tuberculosis in England. They are contained in one of the ablest papers I have seen on the subject. It was read by Mr. James W. Glover, Professor of Mathematics and Insurance in the University of Michigan, and was illustrated with a series of actuarially calculated Tables based on the vital statistics of that country, which are of very considerable interest and value, From these Tables he was able to show that the total monetary loss to the United States in 1908 was 41,944,737 dollars, and in New York City 2,322,914 dollars, or, approximately, in English money, nine millions, and half a million, pounds respectively. In referring to the figures which he obtained Mr. Glover said that " for the purpose of clearness of presentation it was decided to confine the attention to the definite group of wage earners between twenty and sixty. The results obtained on this group are comparatively free from the criticism of personal estimate. Moreover, with all the elements above mentioned omitted, the magnitude of these minimum figures should be sufficiently great to sharply call the attention of our legislative bodies and others in authority to the fact that they have a great problem confronting them. In addition to the suffering, misery, and untimely deaths due to tuberculosis, the country is constantly subjected to a tremendous financial drain. No clearer duty lies before the people of this country to-day than the conservation of these vital forces which are now so unnecessarily and cruelly being wasted. If the minimal value of the monetary loss involved in this waste of vital forces can be determined, are we not justified in Spending a large 14 fraction of this minimum amount, if it can be reasonably shown that such expenditure will result in the elimination of a corresponding proportion of the fatal terminations from tuberculosis ? " By applying these Tables to Islington I find that the annual economic loss here is approximately £33,000 per annum, which added to the cost of pauperism represents an immense sum of money. Is not the saving of this money worth striving for? There is another point that I would like to mention briefly—and everything must be brief in a short report of this character on a subject so great and so vitally interesting-—namely, the enormous number of years of life sacrificed through phthisis. This was well indicated by Dr. Hayward in his life Table (based on the mortality in England and Wales in the ten years 1891-1900), wherein he showed that if there were no phthisis at 25 years of age the mean expectation of life for males would be 39.2 years, and that at 35 30.8 years. It follows, therefore, that every male carried off by the disease at these ages loses these numbers of years of life, while his family, the community, and the State lose the money value of his earnings during these years. Writing on this subject in 1908, Dr. Newsholme in his " Prevention of Tuberculosis " showed what the abolition of phthisis among men would mean, for he says that " if we assume that the average wage of each is 20s. a week, a possible gain of over £400,000,000 might be obtained on the above lives (the working years of life before 65) or not far from £10,000,000 annually. And this makes no allowance for the loss sustained by protracted sickness, nor for the further loss from premature death of women from the same cause." Do not these figures indicate what enormous money losses are due to tuberculosis ? Tuberculosis a Disease of Urbanization.—If we compare rural with town populations we will invariably find that the disease is more prevalent among the latter than the former. This is after all what might reasonably be expected for two reasons; firstly, because the germ of the disease is destroyed by fresh air and sunlight, which countryfolk enjoy more than townspeople ; and also because urbanization means aggregation, congestion, and too often overcrowding of the population. In the towns we find the working population badly housed—and for the matter of that the same evil is to be found in the country, where, however, the open-air life to a large extent neutralizes it—living in dark rooms, amidst foul air, especially in the very poor districts, where poor food and too little of it, are the usual concomitants. These are not of themselves probably the cause of the disease, but, given its introduction among such 15 households, it is almost a certainty that it will attack the individuals constituting them, because they are in such a low state of physical health that their powers of resistance are at their minimum. It is,therefore, necessary, in any scheme for attacking the disease, that the powers of the Housing and Town Planning Act, meagre though they be in some respects, should be enforced. It was no doubt with this object in view that the National Insurance Act gave powers to the Insurance Committees to draw attention to insanitary conditions. That these powers will be used I have no doubt, because the working classes through their representatives on these Committees from the Sick Benefit and Approved Societies will be certain to make their demands heard. During the last few years I have noticed—who can have failed to notice?—that the working man has more and more insisted that his home shall be better looked after by sanitary authorities, and that owners of property shall be compelled, as you have compelled them here, to fulfil their obligations towards it. Therefore the day has come in this country for even more earnest work to be done than in the past; and already the great sanitary bodies have almost everywhere recognised that it is their duty to grapple more sternly with the great problems of life and health, to realize that the life of man is all, and that, in the words of Dr. Woods, Hutchinson, " What the community has caused, the community as a mass alone can cure." Meanwhile knowledge speaks and indicates evils which must be dealt with; and wisdom prompts responsible authorities to apply the reme dies which Parliament and the researches of our scientists point out. The minds of all thinking men have been aroused. They know that health is wealth and that mere money is not, because generally a healthy man possesses a sound mind in a sound body, and is in a position to earn money with his active brain or his strong arm, if he be given the opportunity. But money can play its part, especially in the hands of public authorities, and of great philanthropists, because it can purchase the means whereby disease, and all that disease means, can be warded off from the healthy, and is, therefore, necessary to the achievement of a great and most desirable end. Beaconsfield recognised this, and, therefore, made Public Health part of his policy as a statesman, and passed Acts of Parliament to enable these authorities to spend money for this purpose and to compel others to do so in keeping their properties in a good state, for, as he declared, " The public health is the foundation upon which rests the happiness of the people and the power of a country. The care of the public health is the first duty of a statesman." His policy was, however, only a policy of sewage and bricks and mortar. Other statesmen have since recognised, owing to the teachings of Medical Officers of Health and other sanitarians, that side by side with it must march education. Yet, although years ago the great Lord Derby declared that "Sanitary instruction is even more important than sanitary legislation," it has remained for a recent Government to 16 - give power to sanitary authorities to impart it, and still further to inculcate that cure and prevention by means of education should go hand in hand. Hence the legislation and Local Government Board Orders with respect to Sanatorium and Dispensary treatment, which empower them to provide it. What are these legal powers? And what are Tuberculosis Dispensaries, with which London Metropolitan Boroughs only deal with? Legal Powers to provide Tuberculosis Dispensaries.—The question has been raised as to the legal powers of Metropolitan Borough Councils to provide Tuberculosis Dispensaries, but I think there can be no doubt that under section 75 of the Public Health (London) Act, 1891, they can do so. The section is as follows:— "Any sanitary authority may provide for the use of the inhabitants of their district hospitals temporary or permanent, and for that purpose may (a) Themselves build such hospitals, or (b) contract for the use of any hospital or part of a hospital, or (c) enter into agreement with any person having the management of any hospital for the reception of the sick inhabitants of their district, on payment of such annual or other sum as may be agreed on." In referring to this question, the Local Government Board, in their Circular of November 16th, 1911, write as follows:— " In a disease such as tuberculosis, the prevention of infection and the treatment of the patient frequently cannot be separated. In certain cases it is no doubt desirable that the local authority should be able to offer sanatorium treatment, and for this the powers of the Public Health Act, 1875, and the Public Health (London) Act, 1891, are available. Under these powers the local authorities may either themselves provide sanatoria or may contract for the use of such institutions. The Board have also been advised that these powers also enable a local authority to provide or contract Jor the use of dispensaries or outpatient hospitals." It will be noticed that the Act does not say that sanitary authorities " must " or " shall" provide these institutions, but only " may." Every person acquainted with Acts of Parliament knows that " may." very often means " must" or " shall." However this may be in this case, there can be no doubt that a moral obligation, which I will not argue because it can hardly be disputed, rests on sanitary authorities to use their powers to their fullest extent to eradicate tuberculosis. Latterly I have noticed in Public Statutes relating to Public Health matters that when obligations are laid upon sanitary authorities the word 17 "may" is frequently employed. This has been partly explained by Mr. F. J. Willis, Assistant Secretary of the Local Government Board, who in an address at a Conference of Metropolitan Medical Officers' of Health on September 30th, 1912, said, " We have got beyond the day when it is necessary to say you shall do it. We have almost said that in connection with the National Insurance Act we ate prepared to go a long way in trusting local authorities to make adequate arrangements, and we have, therefore, hardly looked at the question as to whether there is any legal obligation." It is very plain, therefore, from these remarks that the Local Government Board hope, and expect, that sanitary authorities will provide dispensaries where they have not been already provided. Indeed, in the Circular of the Board, dated 8th December, 1912, they say that " The organisation of schemes must be taken as part of the public health administration of the area to which they relate, and the Medical Officer of Health should be the chief executive and organizing officer." I think also that it is quite clear that the Local Government Board are fully assured as to the power of sanitary authorities to establish dispensaries or contract for their use, and consequently the Council of this Borough may be satisfied that they are entitled and expected to spend public monies on them. What is a Tuberculosis Dispensary ?—Up to this point this Report has only dealt with the sickness and mortality caused by tubercular disease in order to show that there is a great and crying need for some agency which would reach those unfortunate people who have been attacked with it, as well as to inculcate the lesson that there is a great moral obligation resting on all persons who administer the public health affairs of this country to use the powers they undoubtedly possess in assisting to eradicate this " Great White Plague." Happily this obligation has been recognised nearly everywhere throughout the Kingdom, as well as in the Metropolis. In London efforts are being made everywhere to provide dispensaries, and I believe that at this moment there is hardlv a single borough which has not made some move in the matter. A few authorities have provided beds in sanatoria, but nearly all are endeavouring to establish dispensaries, leaving to the London County Council the provision of sanatoria. This is evidently what the Local Government Board expect and desire, as shown by their letter to the London County Council, dated 19th October, 1912, in which they inform them that " As the County Council are no doubt aware, the Metropolitan Borough Councils are taking steps to provide Dispensaries." This statement is borne out by the fact that a return prepared by the Medical Officer of Health of Bethnal Green shows that already fifteen boroughs are provided with dispensaries, and that six others have the provision of them under 18 consideration, while three had not replied to his request for information. It is clear, therefore, that in a very short time every borough in London will have made arrangements for the dispensary treatment of tuberculosis. All these dispensaries are not, however, supported in the same way, although all are more or less similar in their mode of administration. Indeed, this is essential, because otherwise they would not be " approved " by the Local Government Board. Some are financed by the Central Fund Committee, who have granted money in varying amounts for their support up to 75 per cent, of their annual upkeep, as well as of their cost of establishment; others are supported by the Borough Councils, subsidised by National and Insurance Funds, others are provided by the great hospitals, with the managers of which arrangements have been made; while another has been established by, and is under the control of, local medical practitioners. All of them are, however, either controlled by the Borough Councils or are in direct touch with the Public Health Departments of their Boroughs, and have the Medical Officer of Health, and in several instances representatives of the Borough Councils, on their Committees of Management. All dispensaries are curative, educational, and preventive institutions. They are based on the model of the first dispensary established in Edinburgh in 1887, by Dr. R. W. Phillip, recently knighted in recognition of his great work. They have one or more experts in tuberculosis as their Medical Officers who are called Tuberculosis Officers, and who examine patients at the dispensaries, and, if necessary, visit them. These officers work hand in hand with private practitioner^, advising and assisting them when required. The Nurses.—There are also on the staff nurses trained in tuberculosis work, who visit the patients at their homes to see that the directions given by the Tuberculosis Officers or their medical attendants are carried out, and who instruct the patients as to what they should do to prevent the spread of the disease to others, either in their homes, their work-places, or elsewhere. A nurse in her frequent visits becomes familiar with the family, who as they come to trust her more and more, make her their confidant, and then if she finds other members of the family out of sorts, or exhibiting any suspicious symptoms, she induces them to go to the dispensary or to undergo an examination by their private practitioner, so that the presence or absence of the disease may be decided. In this way thousands of unsuspected cases of tuberculosis have been discovered. The nurse will examine the house to see if she can detect anything which might retard the cure of the patient, or promote the disease in others. She advises as to the lighting and ventilation of the rooms, and notes any insanitary conditions about which she thinks the sanitary authority might reasonably be informed. If the patients be poor and without proper nourishment, she reports the matter to the Tuberculosis Officer, who communicates 19 with such charitable agencies as may exist in the locality, so that they may receive suitable support, and when such aid is forthcoming she will see that they, and not others, enjoy it. The nurses are, indeed, very important persons in this campaign, and, as a medical man declared not long since " they have shown that the medical profession, which is supposed to know at all times how much there is of every sort of sickness, and where it is located, has, in fact, very imperfect knowledge. The nurses are constantly discovering tuberculosis where its presence was not only unknown, but unsuspected. They have attacked the prevalent ignorance, and, after four years, they say that in their districts there is no longer any class which is ignorant of the infectious nature of tuberculosis." A tuberculosis dispensary nurse requires more than an ordinary nurse to be a person possessing superior education, more tact and powor of discriminating the idiosyncrasies of people, especially poor people —for it is with these she will most often come into contact—good temper, and unmindful of slights and insults. As a lady put it, " The modern instruction nurse is as different from the old-fashioned nurse as any modern scientific instrument differs from the rude one of antiquity. In olden times goodness and sympathy were considered the essentials. To-day science and efficiency, added to goodness, must constitute the woman and the nurse. Hers is the leading opportunity of giving instruction and education. Few realise the importance of her mission. In this, her newest philanthropy, she spreads the enormous truths of modern hygiene, and becomes at once its advance agent." She is the right hand of the Medical Officer of Health in the campaign against tuberculosis, for although medical men may prescribe and direct methods of living, it is she who, after all, instructs the afflicted in their own homes as to the private and public protective measures that are to be adopted. She also does more; for by her cheerfulness she raises hope of a cure in the breasts of those who may have abandoned all hope ; and thereby she raises the latent energy and resisting power of the patient, thus supplying the one thing needful to produce a satisfactory termination of the disease. The nurses are also the agents of the Medical Officer of Health to inquire into the probable origin of the disease; and hence it is doubly requisite that they shall possess a good education as well as more than ordinary intelligence. You will recollect that Art. XII. of the Order of the Local Government Board, dated 19th December, 1912, requires that "Upon the receipt of a notification under these regulations, the Medical Officer of Health, or an officer of the local authority acting under the instructions of the Medical Officer of Health, SHALL make such inquiries and take such steps as are necessary or desirable for investigating the source of infection ; for preventing 20 the spread of infection, and for removing conditions favourable to infection.'' At the present time no officers suitable for this purpose are available in Islington, and hence in order to carry out this regulation, which is not permissive, but is mandatory, it will become necessary, even if there be no dispensary established, to provide them, because it is clearly impossible that the Medical Officer of Health unaided could himself undertake such a duty in addition to the innumerable duties which recent public health legislation has imposed on him. In the circular letter which accompanied the Order of the Local Government Board it is pointed out that " either the Medical Officer of Health himself or an officer acting under his instructions is required to make such inquiries and take such steps as may be necessary or desirable for investigating the source of infection; for preventing the spread of infection, and for removing conditions favourable to infection. It is contemplated that for the purpose of carrying out the requirements of this Article a visit to the home of the patient will generally be necessary, and the Medical Officer of Health will doubtless avail himself of the co-operation of the notifying practitioner. When a case is notified, inquiries should be made to ascertain the state of health of all the members of the household. A record should be kept of the inquiries or investigations made in each case into the causes and antecedents of the disease, and of the conclusions reached by the Medical Officer of Health as to the factors which combine to produce it." From all this you will see the important part these trained nurses will play in the fight against tuberculosis. I have dwelt at length on the provision of nurses because the educational value of trained women is not as yet recognised as fully as it should be; although I am happy to think that this failure on the part of the public, who invariably look upon a new movement with suspicion, has almost passed away. There are, however, other members of the staff who must be provided, viz., a clerk, a dispenser, and a caretaker. Clerk.—A clerk will be required because the dispensary will become the central bureau to which everything relating to tuberculosis will be sent to be dealt with or recorded. Thus notifications will be inquired into by the nurses, correspondence with medical men will be sent there and replied to from there ; records required by the Local Government Board will be kept there ; the result of inquiries or investigations into the cause of the disease will be tabulated there; the results of treatment will be recorded there ; the discharges of all cases from sanatoria or removals from one district to another will be reported there, and all inquiries respecting the disease will be answered there. Clerical assistance is consequently clearly indicated, and, indeed, is essential. Dispenser.—The services of a dispenser will be required, but he may be 21 arranged for, either by appointing a part-time man, engaging one from a chemist, or by appointing a whole time officer. I think, however, that at first one who will give his services for a few hours daily will suffice. The Building.—The Departmental Committee on Tuberculosis, generally known as the Astor Committee (from their Chairman, Mr. Waldorf Astor, M.P.), say "that in most instances it will probably be found that existing buildings can readily be adapted for the purpose of a dispensary," a view in which I concur, especially as in London this is the practice which has generally obtained. They also add that it should be of easy access to the working-class population, while, as to accommodation, they think that it is generally desirable that it should consist of an office, a general waitingroom, a committee room, consulting rooms (one or more), and dressing rooms. There should also be facilities for laryngoscopical and bacteriological examination, and for the provision of drugs. Such accommodation, it seems to me, could easily be obtained in many houses in the borough. The Capital Outlay.—The capital outlay in fitting up such a building and making it suitable for the purposes of a dispensary should not, in the opinion of the Astor Committee, be much more than £250. At all events, £300 would be probably the outside amount. The Tuberculosis Officer.—The Tuberculosis Officer will naturally be the guiding spirit of the dispensary, who, in the words of the Astor Committee's Report, "should be a first class clinician, with special training in Tuberculosis," and " should be independent of control by any other medical man so far as his clinical duties are concerned ;" " he should decide as to the suitability of patients for the sanatorium: the hospital for advances cases, etc.;" " he should be in close touch with other authorities (including those responsible for Poor Law Institutions, Charity Organization Societies, and all agencies, voluntary or otherwise), which have an interest in tuberculous persons ; he would seem to be the person best qualified to advise Insurance Committees in the discharge of such duties relating to persons suffering from tuberculosis as involve medical considerations, and that when Institutional treatment is necessary, he would be able, to take or advise the right steps;" and " where treatment other than in an institution is necessary, he would be able to assist in giving it efficiently through the dispensary." It is very manifest that in order to obtain the services of such a man, whose opinion would be respected and accepted by the medical profession, a generous salary should be paid. The British Medical Association have, indeed, recommended that a salary of: at least £500 per annum should be paid, which should be the minimum salary, 22 and, therefore, this has been universally accepted by local authorities throughout the country. The salaries for nurses, I would suggest, should be £100 per annum in order to attract the very best women that can be obtained, together with amount for a uniform. Finance.- The financial burden that will have to be borne by the Council for the support of the dispensary is very small, for happily the Government will come generously to their aid. In a speech which the Chancellor of the Exchequer made to the County Councils Association he said that " so far as insured persons were concerned, it may be assumed that the authority running the scheme of institutional treatment would receive the actual expenditure on the insured." Mr. Willis, Assistant Secretaiy to the Local Government Board, in a Conference with the Metropolitan Medical Officers of Health has said (and I quote from the official report of the proceedings), " then there are the uninsured two-thirds of the population. So far as they are concerned he (the Chancellor of the Exchequer) is willing to pay half the cost if the local authorities will pay the ether half. Therefore, for a full scheme two-thirds will be paid otherwise than from the rates—a part from the Insurance Committee and a part from the grant." This means that if a dispensary cost £2,000 per annum (an outside amount) the Government and the Insurance Committee would pay £1,333 and the Borough Council £667, or one-third of a farthing on the rates. As regards the initial cost, that is, the capital cost, the same Assistant Secretary said, " we (i.e., the Local Government Board) are willing to provide four-fifths of the cost of establishing dispensaries." Therefore, if the cost be £300, the Local Government Board would pay £240, leaving only £60 to be borne by the Council. These statements have since been confirmed in an interview at my office by Dr. Chapman, one of the Medical Inspectors of the Local Government Board, who called on me in the course of his inquiry as to the establishing of tuberculosis dispensaries in the Metropolis. Hence it will be seen that only a small proportion of the cost, whether it be capital or for maintenance, will fall on the rates; and, consequently, there can be no valid reason why the Council of this, the most populous borough in the Metropolis, should hesitate to establish a dispensary at the earliest moment possible on the score of expense. In my opinion, a dispensary that is not run by the municipality would have comparatively little success, because it would lack the prestige and authority which institutions run by the public health authorities invariably 23 possess, would not he subject and sensitive to public criticism, would not possess the same ease of access to its benefits, and would savour of charity. Control.—A dispensary might be run under the sole control of the municipality, or under that of the municipality plus certain co-opted representatives from bodies interested in its work and management. The Astor Committee say with respect to this, that "the Committee are of opinion . . . . that the bodies legally responsible for the establishment and maintenance of the tuberculosis dispensary should be the Councils, but they suggest that arrangements should be made whereby, in view of payments that would be made by Insurance Committees towards the expenses incurred in connection with the dispensary in respect of the Committee's patients, the Councils might agree to be guided, in matters appertaining to the staffing and internal management of the dispensary, by the advice of a consultative committee consisting of members of the two bodies appointed by the respective parties in some agreed proportion. Voluntary bodies of an approved character specially interested in tuberculosis might suitably be given representation on this consultative committee." Nevertheless, as the sanitary authority is the bod}- primarily concerned in the administration of the public health laws of this country, it is self-evident that they must occupy the most important position in any scheme which is not only curative, but also educational and preventive. From these extracts from the Astor Report, it will be seen that the second resolution of the joint meeting of representatives of the Islington Health League, the Islington Provisional Insurance Committee, and the Islington and St. Pancras Branch of the British Medical Association is worthy of your careful consideration. It is embodied in a letter from Sir Victor Horsley, who presided at the meeting, which is as follows :— 25, Cavendish Square, W. 9th November, 1912. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, I am instructed by the Provisional Committee, composed of members of the Borough Council,* the District Insurance Committee, the Medical Profession of the Borough, the Islington Health League, and the Central Fund for the establishment of Tuberculosis Dispensaries, to request you to lay before your Public Health Committee the following resolutions passed at a * These gentlemen were present in their capacity as members of the District Insurance (Committee and the Islington Health League, and not as representatives of the Borough Council.— 24 meeting held on the 6th November, 1912; a previous meeting having been held on the 16th October, 1912. Resolution 1.—That in the opinion of this provisional committee the Borough Council should formulate a scheme for the establishment of a Tuberculosis Dispensary. Resolution 2.—That the Committee of Management of the Tuberculosis Dispensary should be constituted as follows:— The Borough Council (7 representatives). The District Insurance Committee (2 representatives). The Medical Profession of the Borough (adequate representation). The Medical Officer of Health for the Borough. Agreed unanimously. Resolution 3.—That a copy of the foregoing resolution should be forwarded to the Public Health Committee of the Borough of Islington. Agreed. Nem. con. I have the honour to remain, Yours faithfully, VICTOR HORSLEY, Late Chairman of the Provisional Committee. I have already shown that representation on the Tuberculosis Dispensary Committee from other bodies has much to recommend it, although I think it is essential that the Borough Council should have the final and controlling voice in all matters that might have to be decided by it. It is for you to say, if you recommend the Council to establish a dispensary, as I have no doubt you will, whether the proposal is acceptable or not; but in the interest of the smooth working of such an institution, I think that you ought favourably to entertain it, particularly as I have reason to believe that it would be sanctioned by the Local Government Board. Finally I would like to remind you that only one-third of the people of this borough are insured persons—and therefore more or less medically provided for—while there are nearly two-thirds, and these for the most part poor, and the most fruitful source of the spread of the disease, who are unprovided for, and by whom the benefits of a dispensary are most required. They are not paupers. They are nobody's children, and they will look to you for that medical benefit which their more fortunate brothers will possess in the future. 1 now leave this great issue in your hands—it has been before you for nearly twelve months—feeling assured that you, who, as a Committee, have charge of the weighty health interests of this great borough, will give that consideration to this subject, the most important that has come before you since the Borough Council was instituted, which it demands; and that you will not forget how much the health and happiness, the poverty and misery, and even the lives and deaths of our citizens are bound up with, and dependent upon, your decision ; and in doing so I ask that you will recollect the fundamental principle of public health work, which is that " the proper care of the sick secures the protection of the well." I am, Your faithful servant, Town Hall, Islington, N. January 15 th 1918. 25 Medical Officer of Health. 26 Showing the Deaths from All Causes and from All Forms of Tuberculosis during the ten years 1901-1910. Age at Death. Under 1 year 1 5 15 25 35 45 55 65 75 85 and over. Total. All Causes 10,450 5,666 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 Tuberculosis 57 106 26 14 14 16 9 9 3 2 .. 256 Other Forms of Tuberculosis 9 22 17 15 11 18 13 12 11 2 1 131 All Forms of Tuberculosis 537 767 287 679 1,150 1,131 927 464 177 34 1 6,154